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BRITISH 

MEDICAL JOURNAL 

THE JOETRN^L OF THE BRITISH MEDICAL ASSOCLATION 





A-ssisted 

HUGH CLEGG, MB, M R C P 


VOLUME II 1938 
JULY TO DECEMBER 


LONDON 


Published at the Office of The Bntish Medical Associalion, TanstocL Square, Vi C 1, and 
Printed bs Eire A Spottiswoode, Ltd , East Hardmg Street, E C 4 



2 Jul\-Dec 1936 


INDEX 


The Hrituu 
Medical Journal 


KEY TO DATES AND PAGES 


The following table, giving a key to the dates of issue and 
the page numbers of the British Medical Journal and 
Supplement m the second volume for 1938, may prove 
convenient to readers in search of a reference 


Senal 

Date of 

Journal 

Supplement 

No 

Issue 

Pages 

Pages 

4043 

July 2 

1 - 

52 

1 - 20 

4044 

„ 9 

53 - 

106 

21 - 40 

4045 

16 

107 - 

162 

41 - 52 

4046 

, 23 

163 - 

208 

53 - 88 

4047 

, 30 

209 - 

272 

89-116 

4048 

Aug 6 

273 - 

330 

117 - 128 

4049 

13 

331 - 

386 

129 - 140 

4050 

20 

387 - 

436 

141 - 160 

4051 

„ 27 

437 - 

480 

161 - 172 

4052 

Sept 3 

481 - 

554 

173 - 184 

4053 

, 10 

555 - 

604 

185 - 196 

4054 

, 17 

605 - 

644 

197 - 208 

4055 

„ 24 

645 - 

690 

209 - 220 

4056 

Oct 1 

691 - 

728 

221 - 232 

4057 

8 

729 - 

772 

233 - 244 

4058 

15 

773 - 

820 

245 - 256 

4059 

22 

821 - 

874 

257 - 268 

4060 

29 

875 - 

928 

269 - 288 

4061 

No\ 5 

929 - 

976 

289 - 300 

4062 

12 

977 - 

1028 

301 - 312 

4063 

19 

1029 - 

1070 

313 - 328 

4064 

26 

1071 - 

1126 

329 - 340 

4065 

Dec 3 

1127 - 

1188 

341 - 356 

4066 

10 

1189 - 

1244 

357 - 372 

4067 

17 

1245 - 

1296 

373 - 384 

406S 

24 

1297 - 

1350 

385 - 396 

4069 

31 

1351 

1402 

397 - 408 



INDEX TO YOLUME II FOE 1938 

Rem)FRS m search of a particular subject will find it u‘^ful to bear in mind that the references are m seveml cases 
distributed under tivo or more «5cparate headings — for e'^ample Brain and Cerebral Heart and Cardiac Liver and Henatic 
Renal and Kidnev Cancer and Carcinoma Child and Infant Goitre and Thvroid Subjects dealt with under vanou-^ 
mam hcndmgs m the Joupnal ha\e been set out in alphabetical order under tbeir respective headm^ — for example 
Vnnotation*! ’ Correspondence* Leadmg Articles Obituarv Revieivs etc Onginal Articles are mdicated 

br the letter (O) 


A 

Vblott Irarci Clurl'^ obiU.\n noUct ''i 

W \ S'quche of 

\MoTOtn of review of l*ooV on 1 n 

M**! Ho'ttc Marshall oUtiian no lo (f Ml 

John Jacob death of lo 

M>ortion clwinn. o procunne trnl o' ^tr AJ ox 
Itoum ^ l^idinc a-lif}--' on 

Co're'pondenco on Ij 4i“ — Log’ll 

wpomt -t>. 

and the law ^4 3 I 0 3 » 4-“ 4'^ C44 

criminal and medical -vrecn ctntlict of 

duti“% 12- 0 

dL-U'-ion on ill sal op» ntnr l.."3 

' « r « 1 j 

/ io I f^Uowin*’ 

(P \ DanKarn and rnnn WilUam I (0)— 
Correspondi-ncp on 4'’4 

tBRAHJL J John>ton \ir rud precai tior 

B odi nnd it* diff rentul di.asm*> 
iJam-^ I BratL'ord) 119 (0) 

pf'-ito vilUr-<iuia.\ 41 la-, CM 

\cadiinl d« 'tMecine El ction. ol — Tn tins t 
radical p-ofe^oa of I ItLh Ltop ri lOa — I'm*, 
fo competition pi'po t on tarrm" 01 roid 
ani Inns ennev 10*-“ 

\oadetQV 01 M'dicin* "No^^ok pr^ilert of C 4 
1 nni- Election. -*1 

\.wt>r>n PoYU- 01 MrnciNL is ifflasd 

^ifelwx of P‘^M> V — L£^t<^^\t^^^ d-mo.-vtf 
cl indnlar fever 1 10* 

of :ntr >/ — Cl it Im arl cl f* palih. 
o* _ 

Veciieat rate ivtal in ccul mines m liiv”* o 


Tad,iolher\py of C-s- 

VdaM C i>ie I < 2 ,ufli /e i/fij .»i iM / <t r 

Ce#?tn netfi-in re\ 111^ 

Tam**' Ctrophic rl imti — \lrcnihn 

trt itnient of a thni-i 1- 
tDvM A, 'Wilirid Pyelotoinv flu hin*' no 2 I 
vow-os r O IloodplUeJt l>n 
Addi-on s di»ea£o dneu jononr ern deaclopn nt 
in t^eatm nt of ISSn 
VdeUy-lm I oman dea'h tf 1 'O 
\dl r Alfred and j^cholomcal n.slicme re%i w of 
took on, S'‘4 

VdoWconn* dvo d r of o6n 
Vd >p ion of thUJren Bill 1340 
Adrenalin treatment of a,thnvi ~0O o.- o f 

1112 11 X I --0 130 

lu ancina pecto 1 41.. 

AdvertLon'’ «ci nee m x 4 _ 

Africa h alth of re^ a ch ursev 01 a contir* nt 
100'' 

Eas* nularul endemicita in 1^ o 

bouth Svphili m > 0 — Health 01 Band 

nun rs “61 — Lorrexp^denc** on 11"4 — Proceed 
m? of Medical Conmcx SO*- — ^llalnutri Ion In fcO 
— Orthopaedic erMco in llxt, 

■VV'o't Incidence, of tnbemilCKis m To’d Coa t 

0 ^ 53 — Care of lunatics in Xi" ni aoh — C-omniu ion 
on d \a.lopm nt 01 Coloniex ‘h. — V ital t uuticv 
r*' non native ofBniL pabh-hal 11 t 

VcTicultme and h alth (leading article! 1"’0^ 

C rre^pondencx. on l‘’.>x 

Air 1 au* Pkecactiosx 
C i=>* of Major S nart Blat'cmor 3v2 
Ca-iLiltiis (leading article) ~49 — ^Eaacuation 


\i 11 xiaui _4x 

defence and Col E P Hani on -9a 

pot-oma*' '^vjuf'Iac of o'* — Pro(«.c’ioa 

aruR-t 9lo 


G la respirator upplr o !□“ 

Hospital accomirodation for ca nal 1 “la 

ervicos in air rail 1 — x 

llO'pitah London aM at raid < " "i**' 

mental and lo4 

M-di-al^^rvi-e mat ml 1_ 

1 anic and di a- nn on l >_ 

Qux. jon« ID 1 irl \m nt “i > 10 0 ll** 

XM.ra*icc< of Hr J 11 Htbb If I 
I nd r'T^ound car pirks fo London 101 x 
r'«i VVar National D t n"#* 

Ailkea 1 ol>*_rt bto\en un appiinted 1 e^iu. 
Profcs o of Medicin in I ni\tr tv ot Al-erdcen 
<'13 

VLBrJ^O B Twon 3 0 ' al rran* 'a<xmla 
Albamlniirl i fi c ^ of t^-rm CM 
Alcohol injf-ction m mop rabl** m.al -man pro^th. o 
jaw and ton'ai (VViLred Har t) x**! tO) 

and mental duo d *• c4“ 

Atrwvirp Elec'ficallnjim'' "10 

J B Mslicnl evidence It m 1 C t “-b 

A1 xl G N obilcarp notice of 4 I 
AI *.r Lllice M awardM I/"! e Dim * ofl Mcdi! 
134* 

AUm n a'j d i^e ciiboVdratcs and • ^> 

All.iv F C l»on leorthcnin 1 1 

VLIXV Chtf-'d 1 jrcho'h rapp m o rmi'* dj i 
3*0 

1 Tlumbl form.- on 1-9* 

1 rank Wo’ihinztoa (and Carl L A '‘CHMiirij 

^Krufriirn of Lxo^f- nu r >n(f If'/xrr" rt 
Ezp'ri cl, tea x 0 

VU— cv ani immnnitvlaonilif tnh nailo- C-" “tc* 

tamiiK la- and all r^-ic dtatl ‘-'U (A M 

Kenneda anl D A WiUiaiiu) I'^Ot (0) 

VLLror*' Cordon A\ Ptr xiah / T* 

Irt rp /ti on rev .2:> 

Abpecia treatm nt of at 
Arabubnee fatrcVlon I m a »ia o- 
A'lEClLLF I Soidde bv tcborvl b.acilll 4 > 
Amoeb aa. catlAVono m 

Anaemu ipUtic with comp’ ic recoaerv (T 11 

Boon) 1041 (O) — Co respondent on 1 a 

ard na tro-iat/x-tinal tm t (Jan t sf v aunlim) 

S' (0>— Co rexpondtccc on -o*j 

nntritional macrocvtic in Macedonu *'14 

permeioa anti p“ djcjou principle om** 

eST rim*‘at with urin (Edouard Jeqm r ard 
t F M Ap-ej) (0 )-^o re^nl n-e on 

in i 2 l 

and jv-i chose' IIO 

tropical macrocvtic 10a2 

Vnaemn bacirolvtic o' chndho>-vi (I O Pirxotu! 

Ame the'U ba<il 244 

carbohydrate m tabolu>ra in (F P ^lacmtO'h 

and C L G Pmtt) 310 (O) 

hehum In (W stinl v Spkcs. ni Fe^uuill C 

Lawrence! 44s (O) 

review of boo^, on 12 I 

spinal _44 


’ « 

plnal blood p*es 'are af er 41 

Anaf^sth^lics arpects o' hL"torv o (A J Cix x) -.14 
1029 (O) 

basal hvp»r-tL.cep tbihtv to (B F Hill) 

ll'tD (0) 

diplomas in oaO 

electrical irmtioa ot (H W bwann! ,^A 

Anasivph- revi w of book on 40* 

Anal p ICS phanaaco tr*ical acriona 01 .»5l 
Vnal-Csia ga ard atr Apparatr 10 ^ 9“o — ^In 
nuiwuery 140- 

review 0 boox on 12t>l 

Anal-esics admin! P-a Ion o by nudwives: lo" 
Anatomy acad mic vent, clinical “u4 

tevi wo^boo*con 12o "(h “91 1-0" L- - 

termiao’crw Oo 

Avdet-ov C < Jr-ny* rf« n t7 £ «''rri»H5yi<r 
rev 200 

D H I) i ciiv f\t aTxr-ptna in efadb^'od 

''02 


VVPEE^OV D JL (and J S. Drsov) Acute lul ir 
piraly u 10*" (0>— Co’Ue«pond ncf' on 1-^1 

E W Furhi r ol>erv3tio-:5 on b*’n-^Li 

'0 ( 0 ) 

J Larcro t Gretn tooU a "4 3 

R ‘Mamm-’v cancer anl m nopau. 

T (VV P SSOPuRaV ar.1 j L PEVVlt. 

snip umidvchrvo iin^ solphanil inude onib-n 
lyLulphanibm de m tre tm nt o e-w 
3'3 (O) 

VT A S IJh and -nltore 133x 

AVDEEW c H Immcnitv m influ nz-i II ’ 
Vniruw E LolLn'^oo'i obituary no Wf or xi 

M C A ptnn p3 ouinz lu 

Aneurym ot comm ■>0 ill car*’erv(J \u*tafr H n-* 
obO 

Annina 01 cure 0 r h i or c--««*' nu. 

iiamo ‘hJ (P HaLt<»ii Dixon) cJl — L o't 
pond'-aee on 1-*1 

— — p. rttru ro 4 01 ad.enalu in 4l_ 

An-iozmphy paper and ducu aon,-4t 
An'y'Oid «tTeak_-eIa to-* d'"«''Tophica 909 
VenoxaeuE o’raphy tmpo voce 0 eO., 
Sn\ruJii,rFy rev 
Anjiiwl* cvp— iri *’0 on 10 l''o" 4jJ 

wild a car-i r 0 res^*soj' otdi-a fttr 

AnJJ-* inctn e-<ii ’>miDa at (W B P S'onteith' 
19 0 

lrn-5. tiy Tiff w ^ 0'*ol r i u <* \ot 1 t> 
5 p icaemu 6*4 

dt !/<re*. a-tick bv A ar nt 1 vo m*! id I - 

d* fo 6/<ntfe B } d CAirur c t J tnxe 

Cf xnir^^ "e volrn. 6-1 
lnnt.It of yitiiccl 11 *' lU No 1 )1 

^o 4 16 u—No J 1 *. 

A VO. W f dll'* xa'ph-n 1-mide tr itn.*nt li 
coEortboca 9l 

Annandal T1 onu. s.^'t airs ot birth o >0 1 *> 
Awir D P“vth! b rapv m 0 ■rsme di o 0 

Annotations 

Abomoa lute departta ntal fomm tt cn -.*! 
Aclaomvco radr3.he*apv 0 » 

Adve'tu.ji'^ Cl Ece in M- 
Ainoeb'a-i carbirjn<»m 
Vnaema 110 *^ cal macrocvti'* lOo- 
Vnal p 1C3 xha'^nacr'T' 1 '’’caI acuom. 01 .>xl 
Anjuia p^to'^^ rot* of adrenafiac in 41- 
Vnniaid reaks — e] r« djrtrophica 9 ^ * 

Vmnul vp^urren oa in 193“ 4o6 
Vntinen. and antibo‘’iia ch-*nucal a p'-^ta <^1 
Bacilli tub.*rcl (’ moc ratio** of in pudii 41^ 


cau,«r« ot 

Blood chan'-ts- in expoam'^ntal tub 

trardu- on equela o e4- 

Bon** nui'’ 0 ’v pc* mor* uich-r^es in " 

Bn tsf U irf Jo irrcf lOo 
t-alczU"! and — " 

Canc^ 0 ' ihraen'a'v traft compnruiie tulv ji 

sQx 

o ct-yvia: fidiQth_3pvo k » 

curs te* irn in Iabo”*aTor% l-o" 

ea Iv diauno'.a o' lo*4 

iafl.mima o"** cam n mi i tn 1 x^ 

3?racu r**-C ion f “I- 

ta- virm 131 

Cancer^ identical m id'*^ i-iltw-i- 

Carano-'i*''!'' hydrocarbon I - • 

f ereb-nl circulatuu va on? 5 <■ t-crtxr i of r 

( ho era in Pn u 1-13 

I ucuLatiou tini'» cet rr* m t 1' '’4 

Llavi “a of 2 u 

to-TU- In um -'*4 

iounc3 M. dsml r<=~-*a cn — i -y' 

f* n hiTi -* Haryev v.- Fc-’-r' lx». 

0 ^ 0 . .ron -o 

Cj-t b-tr^u- i-h-*n aro* ^ 

D ath o-y'iaert on o^cau- o *14 
D m -1- eo a a o U'* 

Diph h na imw** »a* d-auc'^ o ll^s- 


lO-l 

sC2 oio 101t> 
-» 12x3 

and t eatiTtut o 



4 Jul\-Dec, 1938 


INDEX 


Tice Brctoii 
Medical JouRN.a 


Annontfons {eo'^Unufd) 

DIrh*h''rU r ofhvhrf^ dunflon of Iramunltj 
7 2 

I)' mf rtint t^^tlncrof llul 

Domnin? rxr><.rlm''nt'il 1000 

Jini:: tril '' Cnlt«^tl Kingdom ind o,i 

I loml ‘Numb r 1 4CO 

I or-vrd lo'^nphlc rh'inc*'? duo to FmoKiDC 1S7 

rnK tf > j m a nrin^ 1'’- 

1 nt 7>0 f \ircinil Tf 

T xiinirntlor purpo f’8 of l»rs 

licInjuriM indu trhl of 27 

1 it n!i orpfinn d‘'fectivp In clilldbood 0j2 

Ic'rr cirlct irnrminizntion nciin t so 

t%phoId f'r* logic'll (Hni.no I of 1211 

lonUnbodl ^ uiUoutfl 

lund I rA-iI 'Mfdlcxl IUn#'\c»Itnt ”7 S14 

< fnr\a Hinltj nt sjT 

f onorrhof i cbf rnotln npj In 20j 

< rcnz nN® 10 

Il'im on Col r 1 nnd df'ftncc 20 , 
if<-3rf p rru H >0 of C20 

In r^'htion to blood ^npplj “s 

sfind till \niiitoni (jf 13_ 

•tndl ^ on coron*^r} occlti Ion 0 2 

Jf*m I' snnll exlilbitlon sn 

Iliitchl on I obf rt tr firnonlil to T 0 

If\?Nri( ninl "o 

Indox^^ lulf irh 

Itidti trhl b-'nltli rr ^'vrch on«* 

In tl utc li^tiur lS«v-rn^ 10)'' 

In«oinncr for iiu dirnl profi Ion >7*^ 

Jnimdlo* nnd nrfhrifls 111 
ntirrlnl '’•'I 

Ko\ to ( tirn nt 'Midlc'il Tlttr^furt 2s 
I>nl)oritor\ N'ltlornllhj Icnl Men (H\ nt 2"* 

I ir\nc( fnrlioniironchltl^ nruto 070 
J> t* ■« trin fii Ion of 1()0» 

I h(r FMr^^r^ of 1-1- 

luriitlr can of In Nk('rh 000 

I un.. j b^ loln"\ nnd colhp-^o thcr\p\ 

I \ jn| Imlt noun f ordon (c t for lloT 
Milirii now nnti Tinlnrii,! drus ooo 

tnitmaitof 70( 

■'f i M Mrn 1 1 • 
yif Ur tl Dtrfrtnr f I** o 

I r untncL \ble pnctltloncr^ 7»T 

Modlrini X irbln-. of UO 
■'fonituitl -onne ci il C-O 
^loh^lt <1\( » tnUiistrl \1 jjojson -IjO 
>111! ind nutrilii n .<> 

Mortilltj urbin trdulof 1012 
M\( lord \ trt itinuit of 77 
S( I brill* nrufo and «trt.ptococcu* 1200 
Nutrition I »ml 1070 
(b 1 In^itl* In Inf An('\ 1 »71 
Opium produrOon 1 Smlt^tllln of U4 — Con 
\( nti n < n "lk> 

0 It r In ni tnor\ of 1001 

1 ilritln^* b\ dr tor* si I 

1 \ cktnm In ilih < xf rlmr'nt PI 
1 i n H hw * r f(»rni of 11 I 
1 rib n Hr* >j \ “II *" 

I ( r I Inll 'n ind suni nm 10 U 
1 liN kiltrdnln- firr itl\i 1 2o 
1 1 Hit urowth Ik rinnn « 1 P 
n y i\ i I . r pi 
Pi utit udtl t I 

In nil binx »\fnpliunl 1 (Ij 0 
1 o’l lUMliti Inuminlntl >n n dn t PI 

j\ »t r 1 1 \tor fi « (\ 

l<l\n urif! Tl iitK inficthi P-l 
1 r » If ii fi M u r* I >IrtH < f *' » > 

1 t^ndu H J Iv in Ik il II I 
I n « HI \ (Ml rill nf”!! Ini rruifi n of ^•'0 

— t \ o I h M 1 rt icM in* in s in 


I rl 
1 r' 
1 \ 


Nrtbur 

ir • I 
If r\ 

I I 


nr HI Ilf 
r l'’V » 

I M n (.Ml HiHU* 
n r f * I 


d ith in 


I I ir V f k 
I 1 ! 

1 ! 

I ] 

1 


I ! 1 


rhl 13.1 
\ tl { r fr ni 
[ If 1. 


I >ri li I -.1 


in I Hi; 

\ k n M 
I in I 


I lur 
I'l _ 


It u 

\ -1' n M 41! 


I X (f M \ ) 


\ » 

- \ 11 
It t 4 


' % \ . 
I 1 J 

i- 1. 


Annotations (conftnw^f) 

Tniat National Radium Meeting 1S3 
Ttibcrculo Is fifalltM rates in 7o3 

ocular alle^^.^ and iminunit\ in 627 

Ulcer peptic intra\cnou3 «cditlv(. in 713 
> occmatlon Mviih tubercle bacilli succo««fiiI 1S& 

N iru f' nature of CC7 

■> itamln B, new international ‘Standard for 1093 

C in milk 45S 

E C03 

1 M\bat!sit’ llo2 

ar cmorqtncM p xchiatrlc preparations lor 137o 
l>cltmanu reaction *>S- 
>> ilklo s chronic duodenal lieu Oj.1 


Antagonistic di casca 472 
Antliropologj rea iou of book on IbO 
Antigens and antibodies clicmlcal aspects of ISC 
AntImon> rcMcw of book on 126 
\ntiphlogi«5tino note on 4S0 
Antommarchl Iranctsco (17bO-lS33) 22 
\n\ict> Infantile 300 

Mates (T \ 1 - - n 301 

prognosl (0) — 

Corrc'pondince 1014 

1003 lllo 

Aorta patholo^j of chronic % alviilar disease of 1332 
Nplona apple preparation -1 

Apoplcxj treatment of b> Infiltration of stellate 
j.ingHon Mvith no\oc.\ln (\\ Arthur "MacRex and 
iaurencol) M Stott) 1(0) — Correspondence on 
03 

Appendicitis acute drainage of pehic abset in 
(T h Coulson) 7b9— Correspondence on 017 
1014 1296 

treatment of (G Grci Turner) COl (0) — 

Discu«.slon on 2^0 

and bci\j mcitdlet 162 

Vppendix priinarj intu'^susccptlon of (John 
Corcoran) 114 d 

ArPMNO A Pernicious anaemia p >choc 
1160 

VrrLiTON A.rthur B (1\ J nmiLTOs and I C 0 
IciiMTHOFF) Surface and Itadwlogical iuatomu 
for Slr(d/'Hf3 nnd Genernl PrarrfdioncrM rc% 70(* 
VpproprUtlon Bill 32 » 

Ara4 4 0 B M (and Tdouard JjfiQxrirp) Anti 
pernicious principle some cxperiinents with 
urioo 914 (0)— Clorrcspondcnco on 1113 1220 
Vrples Lieut Col Robert Lendoo oblluarj notice 
of 477 

VPMbTkONO A Cameron Snapping jvw 1222 

— J Dexclopment of hospital sjstcin 360 
krM«^TPONa JoNi Sir Robert Tuberculosis devth 

rate In mental hospitals 84 
\rt modern for hospital 604 
VrtcrlosclcrcHk blolog> of (leading article) 1317 
\rtcry central retinal spasm of (M Dunlop 
Hamilton) 092 

— external lUic traumatic rupture (complete) of 
amputalloo rcco\cr> (II C I inker) 219 

Vrlhrltls review of hook on 572 

— rheumatoid (Wilfrid I dgccombc) S7 (0)— 
Dlscu's^Mon on 304 

— — (atroplilc) elTt<t of spoilt meom jaundiio 
on (Philip b Ilench) 39i (O) — Iniiotatlon on 411 
— Correspondence on 472 59- nin 

cold triatmcnt of %- 

orthopaedic* in (Norm in ( apt. ncr) ui (O) 

— DI*tn**lon on 04 — Corrc’pomlf nee on 
Irtidclal Ilnib-) in com,! nit li «!< f<>riniti< of k . 
(Itc<,irn!d Broomhead) 1111(0) 

— ^TCNltw of book on UHh 

\ cite* operative treitmcnt of 1 

W >t \ir r lid preciutiiMi loD 
X^'ilcroiT I) W llaomorrb i- loilowm. ton 
«llkctoinv 10“ » (O) — (orr ponloiut on 1.- 
\MIT0N bvlvii Trr itmcnt of nnirilu* mi '>71 
V plrin poi onlng 100 

rtcjvtrj after 1 ^00 ^rains of obC 

\ ocnlion Vutoraoblle Load J onk of Stotlnnd -0 

I rlt! h for \dv intcmcnt of Scieiuc Irnter 

viMon 411 — Vnnual nif'ctlng rinibrld^e 46(1 

—— Hraltti Re orts Of rod Uandbiol 72 — 

Xnnual inciting 110 

Ho pltaU Contrlbutorj scheme* \nnuil 

cnnft rcnc il'l 

for Labour I.^gl latlon R p>rt on 

N iftrdi I lu3 

\ OlMTION BPITI II MPDICvL 
\fn) work an Jeon titutionof 0^4 
Xnnual Me ting llH.rdcen 9) Vbirdien 
to-dav 1 0 

1 Ivmonth (19“4) loading irtlclcs on 

1-* — 4—1 resident saddri If — / d of 

I I rm-) h 1^0 

r >I V Hol e t\t(.a Ion of U- 
< nril In r-onev Coramittof. Dputitun to 
>lla’ tl fD to-ordlnatlon of I> f n c in_( 


\ T ivTio r^rri n Mriirn Iiimhi ksd 
Dim 10 

Z.. 1 n — \naomia an I ^.a tro inti tlnal 

t art »>" 

^ J htr I rri h — Survej o» p otitic 

criar- " i nl It* tr atir nt o 

L ^ re c"* (hr ^xr J ra^rh — Common fixd 
all"' "f* o 

b *n Tr 1 '•Ik Prt ^ — I ara i*|c fo tu* 
* uPv r » l \ op atim I, 

y ’ r J r ’i * — Jnl n r 10.“ 


AcsoCIATION BrtTI'5H AILDICAL PrOCtEPING o> 
Sections 

Exhibition of films and radiograph Sfu 
Di<ta^e<i of Chddren — Summarj 24s o-, — 

Report 560 729 920 

Medical Socmlogu — Summarv 203 
Xhdxcinc — Summarv 2iS 301 IGl — Report 
209 437 773 

iicnrologg and Psychological Medicinr — bum 
marj 241 242 306 — Report OOo 87o 12 lo 124" 
12ol 

Obstetnes and Gynaecology — Sumroirj -40 
o03 313 303— Report 331 335 337, 340 o>j 0 j4 
Ophthalmology — Summarv 313 308 — Report 
003 740 

Orthopaedics and Fractures — Summar} 242 304 
304— Report 3b7 301 1245 1247 12ol 
Oto rhino laryngology — bummarj, 247 — Riport 
167 447 OjC 

Pathology 2?acftrio7o(7»/, and linmunohijy — 
Summarj 24 j o 07 — Report 730 827 
1 harmacology Thirapcutics and Anacsth tu — 
Siimmarj 241 310— Report C9 t 1020 iloo 
Physical Medicine and Physical Ed uatinn — 
Summarv 304 30G — Report 273 337 91 

Physiolnqy and Pyiochnnistry — SumnnTv -4> 
Oil-Report 4 40 50o 

Public Ihalih and Jlygxenc — Summ »rj 30 )(ij 
—Report ool 33a 337 340 

7?gdjo7o7v — Summarj 243 30b — Report -11 
1034 1037 

^inua — Summarv 248 
6ur<jiry — Summarv 230 302 *'02 — Report bOI 
1071 1127 

lubenulosi — Summarj 247 312 — Report 2<t 
120s 

S(( al 0 bupplemenfc * 

Vssociation British Orthopaedic Annual mectln. 
1221 

of Radiologists Brodies abscess and R* 

dllTcronfnl diij,no i 119 — ElIIows passed 1344 

Canadian Medical Jlandbool on Cmicrr 13i4 

of Clinical Pathologists Summer mcctin 8S 

d 1 n I igncmcnt ]Medic.al de& IlOspItanx do 

1 aris Mtilic.a! lectures lo89 

Eir 1 astern oi Tropical Medaine Congrc« 

1323 

Ercndi Medical bequest to 434 

Glasgow Postgraduate Medical Programme 

014 

Crcnfcll 01 Croat Britain and Ireland Christ 

mas cards 92S 

Hearing Md >ranufacturcrs formation of 1320 

of Industriil Medical Olfictr** Sfcctlng 1107 

international balneologu il founded in Bud a 

pest 330 

Hospital Nteetin of United klntdom 

Council 1145 

Irish Medical Schools and Cradiiatcs Vnniial 

autumn meeting 1270 

king Edward MI Wei li ^atlonaI Memorial 

new headquarters 701 11“- 

Lausanne Rtcdical Grulnates Meeting 1241 

Jlontal Aitcr Care alms and aitnitns ot 150 

- — ^atlonnl for Prevention of Inbcrculo Is 
24th annual conference 83 

‘Vctcrlnarj Mctlic,al of Croat Britain 

Annual congress 003 

Northern Counties for Blind Vnninl report 

790 

Royal Medico P&jcholo^ical 07th annual 

meeting 143 

banitarj of Scotland Annuli congre * 

1011 

St Vndrew 8 Vrabulancc Annual meeting 147 

of Scientific Workers Teaching of medicine 

413 

of Special Hospitals Eoimdation 110— 

ricctaon of otUcers 14C 

Surgical Instrument Manufacturers Dinner 90 

XsTrx W Development of hospital s> stem 360 
V^thma adren aline trcitmcnt of 709 021 027 OOO 
1112 1178 1270 1393 

menstrual and vasomotor rhlnorrhoci (V N 

no*ea*on) 703 (O) — Correspondence on 81 
nallk and l‘'9l 

and moulds (E M Iracnkcl) 03(0) 

VSTON ( b Toxic infective jaundice - 0 
\''TOP 1 Dcount (and B Scebohm RowNTiHf) 
Itritidi AgnruUure Principles of 1 utun ! oliry 
1203 

Vsjlum Pojal Blind I dlnburgh Op ning of 
exten ion 133j 

Atclrctasl* pulmomrj c'jclopropanc and 1279 
Athlete injuries to review of book on 4 2 
XtkiN'' W R C Daylight in relation to (Innate 
ind health i>Cj (0) — Discus Ion on 311 
Vtmo plierc pollution of Survey of I04 — laniplil't 
on bOO 

XrnLSTiM Donald L (and others) I ura^iloly/y 
With 6piCial I ef r nee to Man and Dnm stimf d 
Inimals rev 1037 

Vl irviu 

X(lvl orj Connell on ^u^rltlon Repeirt » 
Change's In nborUInal bone* 1163 
National Inviiranc In (1 adlng article ) 2 400 

I oliornvchtH In 1 Ictorl i 721 
Q fever In Qu^'tnslan I 272 
Poval \a*trah Ian Coll'^ge of Ihjslclanj 12Io 
‘'■ori tj Orlilhalmnlo-’ieal formed 220 «^4 4 
Xc anda« un''n''b d «1 ('p on l'*99 


Jul\-Dec 193S 


INDEX 


The BxmsH 

^t_DtCAL JOw-^NaL 


5 


Au ttla Pcfttc c doctors and dcntl l« 4" "0 loo 
— 4. 1 tancc to medical "tndenta from 9" — 
icwi h doctoral depri\cd of permit to pnctl e 
A\M,vcHlir Frlcdrlcli All r\fv\^ r}jinr'jlx'U>j\e 

04- 

\YMArj> J I Inf ctfonsof hands and fine r« 12‘)r 
\Yrr rhillp Cvcloprop^ne and pulmonm 
atcl cti 12*0 


B 

B ten vr veil \ U <ird \ ufr Jon *501 

B'\ctcrioph.aCi r Mcvr of boo\ on 221 

tnitment Jn ontbreak of in tltntionaId\ onter\ 

(r>trid Haler’) (O) 

Raildon France Joeph obUuarv notlx of 4o 
BAlU-in ''Ir Tamc> Tralninc in p'Nchnlo-a 14 ^ — 
retirement of “ul 

Bailei J (and V rnjtLrsrcr) Xo MalnAie 
d -Itye 1 ! re\ 1314 

Bttrorr 11 la or Bnrpnra from ’^edo-mld 420 
lAtL ''trCirilne Radiolo'n In diieno I of urinara 
Inf ctnn- I-.*-. 

BtLLENrrn, Willum IJncoln and lloavard Cliarlcs 
T>i fa*f of No Tl-ror aid Ear Hefienf anf 
CM/r^irof “th cd rx\ I04f 
Bandape in p bon ur-ira 3. 3 
Ftvimjxr P K Treatm''nt of carbuncles 3-0 
BtvKS, C Dl coaira and irolcctlon of tnl'er 
ciUou contacts C4 

n Stanlea SulilianilanUdi. for menln''ococcal 

■p^rim n 
1000 

BtNTAl \ndrcw radlnlojjlcal «; uda of moai 
ments In collap^cd lune 2.'' 

Bar medical men called to lOo 1241 
BvrntnAi-Lo r latho? nic onranl m In tcmal 
l>ore marroar lOOi 

BArnrn, G 0 Vent nntcrior pollomjehtis — four 
imuUancons ca-os In chool 113* (O) 

BtnrORKA ClIfToni J Trta*ntnl bi Diti 3rd cd 
rca 623 

lUrcrorr Sir Jo ph Cram and xtt Eanrorri^rt 

TXT 1«0 

BardsarcU No«.l Bean olltuara notic*. of 1234 12*^3 
Bvrrorji J L M«'dlcal caidine* at inque t 4"j 
Bariinff \rthur Stanley obitaarr notl'c of 

— Seaitiour tancxr of bnxt 12? 
llAPtow ''ir Thonm FNCBI Chrutmaa ffift 

&D0 11''! 

BtrjcETT E C ^a-philis in '‘oulh Africa 3 0 
FAr^finLL John Finch Sitr^itnl An<ao^ / 0 / nt<ul 
eri Ncei: rea iCo- 

Ilarr Sir James oUtuary notice of 111" 

John Stoddart, obitnar> notice of S6a 

Jo«^f h *5 loteryertebral dl k fciions oa can 

of sdatlca 124“ (0) — DL*ais^lon on -42— 
Fnctur's inaolaine knee Joint CCo 
BATJetre Lada Appreciation of Dr Jane NValkcr 
1120 

— Sir James Probl m ol partlaily bbnd 1212 
Bat ooi 11 Thrombo^L of pulmonary artcra 

C_0 

Bafuk H Ps/c}\ane M/dieal^ Pfi /Sl 0 ^o^l' 2 u^ (t 
Erp&imental^ rev "4G 
Bt«tTrorJ> Sir Ilcnra Anxicta tates 301 
Ba tardy (Blood Tests) Bill lls3 — I-eadine article 
on 1210 

Ba.u Llcnt Col Pbanlndra 'Nath obUuarv notice 
of SI 4 

— L r (and S P De) Samerca In cvpcnraental 
cliemotberapN of taphylococcal Infections oC4 (0) 

BATCnrtor P C L. (and others) 2 ulphanlljl 
amlDOpaTidlnc OI A B C03) in treatment of 
gonorrhoea 114_ (0) — Correspondence on 1227 
Bate \rthur Ceoflrea obitiLarv notice of IIS- 
B\TEiiA'*t Geoffrev (and STallcr HoarAnn) 
SDxtold operations, 1304 (0) 

Bates Joah Adrenaline treatment of asthma 031 
Bateson laachan obituara notice of 
Baacr I’roducta Ltd Jubilee aolurae 10“0 
BE.trvELl^ Sore Rear Admiral C IL Orlcin of 
cancer 100— Baolntionarj theorj — Dtciwnan; 

0/ Snen/ijic Tcnnr rev 40’' — A ILP and nndcr 
cround car parks In London lOls 
Beattie, John (and others) iXirpo^balam « 
AlorpfoloyycaJ Fune*iOTial Cltmeal and Surjical 

AgpfcU rea o 0 

BeaemOTT G E Diets for DialcUs Arrany d »n 
Ifenti Form rea 1253 

Beck FepenaCook Laborcfori; AJanuaJ of Ilemato- 
toyie Teehfiie tnelu>*itij Inierpretahons rev l20r 

Stephan CarcinosenJcliv of tar-crco«otc 

mixture n ed by fi hermcn 1313 
Btd new tUtabl arith donkev mes of o 3 

— ercicc emerc ncj In London 2» 93 2 j2 42v 
4"i> o0“ 'CO 12“u 

Bepfopji S G (and F F llELLirr) Accid atal 
aaccinatlon of no-e 921 
Itecswax In nlecratlac tuberculous legions 1300 
Belt Hcmonal Fellowships for Ifedical Re^rch 
■Meeting oftnistees 2 j 0 — Election of neav Fellows 
2o0 

Btlrium Number of doctors in 46 — ''urvej of 
health crvlcc^ "oo — Mortallta In loOO 
Bell,L T Tesiboobof Falfioloyv 3rded rev "Oo 

Fairfax (and John IltrKvr ) Extra utenne 

Intra abdominal premiancy 1044 
Beits and tnusca {Ralph Coate) 1322 
Bexedict E B Peritoneoscopy "14 


BFXvrt Edward A hlalcS of d p <x-.’aa 30t/— 
Slcnlflcance of dreams ti“o 
Benvett j Co^ptratnn In health 3b3 

John n Comrllcations of cold therapv l.j- 

Ik-nncft fracture 4bl 5 *0 

Brvrin 1 H (and John MortET) Late results of 
partial castrLAtoma for peptic ulcer Cto ( 0 ) 
Iknzednnc oWraalionsonfE NV Andc^on) C0(0) 
Bfjt Charles Lneon-cious mind and medical 
practice 1^' — Psacho^amatlc lUne&a 319 
Eerm'r NVllh Im death of COl 
B riberi polamcurl is with oedema simnlatln- 
(E B Carrttt) 2a“ 

BErNsrna J Nasal inu Itls In chlldixo IC- 
BrrFY I J V Appreciation of Dr I J Balldon 
4a 

Beftoxi C Donangio s reaction m typhoid l2ol 
Beftwi Tir V 1 Cancer campaign -js — 
MuLeumof] actical radiolo'w 1303 
BesT Chari ilerbe-t (and Ncrman BurkeTtn-or) 
XiMfiy/o-i/ Tt.p^'oot in Ilum'tn Pb n Gl/yjf rea 
— — ^UcjKarln and throrabo«n 9“" (O)— L'adln-’ 
article on *> k> 

S rr of Dritufi Pel Cro*t ret 19 

— Thomas \ (and H Craaen Pnch) Ca-c of 
locked twin I 9 

Prr- Balter F Georg HI (1 3'~I32n) cr4— 
Corn; pondt-nct on “Cl — Presidents of New \ork 
A&tdcma of Jfcdi Ine 60 I — Typhoid ilary 
11 Karl ’'UdhoT 13^0 
Bfvan E'lward a I'n.v ntlon of war 140- 
I EvffUk r Sir Billlam I efu-^'e prohl m 1 - u 
Brats trip S S M o-glutlnatlrn in dn^nos’s of 
tlThoid feter and txT>hoid cam r condition ll''.> 
( 0 >— Annotation on l-U 
Bi riFT J n Dubetes in-lpldns 12*" 

Bi CFT,, J W Labo ato-y dUgno-ls of phndnUr 
Kaer HOC 

Bl G A C B Decline of brca,t feeding 13 *1 
Bile rctleae of book on Col 

Billing^ John Shaw comm moratlon of centenao of 
4 jj 8"4 

Brssrv Cecil III sal operations 1 - 3 
Blochemlitry realew of l»oo», on a39 
Blo-ccooomlc book 00 10,>1 
Bird John Wilfred obituary notice of 9-3 
BirD'-vix, S E Haemorrha-'e following ton-U! c 
tomy 1 * 

BrrjDwooD G T Ke^atltU from working with 
creosote lo 

■Dlnnmghafn Ilo^pltab Centre Poyal opening 
coremoQt 12 — Leading artlcK on 12 !^M'dlcal 
School 18"— report forl9rof MO n 1011 
Btr-xtE» C r (and J S ILtpris) Cardlazol th rapy 
In stupo 449(0) 

Bi hop P M F Ovarian the apy - 4 ,^Ln 
d-sc^nded te^tlcl 3*4 594— Fndoc Ine th rapv 
In gynaecological condition. 1103 
Bl-ACK if Blood tranifu loo In ob'fetrlcs 31,> 
BLACRcr C P Illegal ope at Ions 12*4 
Blacklock D B (and T ^^ocruwrtt) 6 t> 
Hurvxn I rrasiii't -7/ rea o“- — Aoluntary 

national r gLter of Land for war tim 1301 

ilara appointed m tuber of Poyal Coromu..tou 

luaeali^atlng «ocial and economic conditions In 
Jamaica etc 330 

BUcMnore Major Herl^ert Stna t Obituary notice 
of 10 ,^E^rHanienlary note on 
Bla ccci P Urethral strlctu e 12.>8 
Blewett P IL Sociolo'^ical aspects of dAtchet 
area 2*^3 

Blind \«vlnm and School Edinburgh 1 oyal 
Annual Nfectlu'’ 14" 

from I Irth woman acquires sight at 2 - 

(P Coll 3 ) 6 “ (O) 

C2* 


Blindorv^ adviso'y committee on 3;>6 

cans'? of *9.» 

- prevention of o94 

severe night du to vitamin \ deflciencv 

(O F FLhcr) 944 

Blomfl Id Ocor"'* WULs obituary notic of 12 - 1 

George Wills jun Admini trationof pituitary 

extract In third stage of bbour 10 J (O) — 
Correspondence on, 1— o 
Blood chan''M In experim ntal tuL rculoals -9> 

cllhiral «ilgni9cancc and estimation of vitamin 

Bjln(LlrwynN Powlandv and John F Wllkiiuon) 
b 8 (Oy— Correspoadenr^ on 10G») 1110 

dUea-es review of book on "2 

films cloning Udes fo 4^0 rao "23 

gronps and le'’i_Iatlon 3"o 4"1 

parental whole In prophylaxis 01 mca ’ .s 

(T D Cnlbirt) *0s— Correspondence on »>4 

platcl t (leading artlcl ) 1000 — C<Ir^e^pondcnc^ 

11 9 12-0 

■ • — p c urf* bl^h review of bootw on —39 

— after spinal anaestheti 44 

— renal Ttc—OF substantx SJ" 

rc«tropiC activity of (C Bctil r LI” tl and 

B P AVi'<»ner) 444 (O) 

stora" for traa-fu-lon (parlum^ntary cob) 

llSi, 

supply heart In rcbtlon to "o 

te IS In ba tardy ca^ nw Bill llaO — 

I/'admg artiri on 1-10 

transfusion "xinels of S4- 

bervicA Annual repo^ "-s 

syringes and needles combined 4 ->4 

BLXrarEXTitAL, C J CUmp tor tafo^haphy and 
plastic operations on Uda 663 


BlEXT E D Two comp^tb ifota<*^arlU ug 
baby as unusual can. of hydramnl^ 2_0 
Eo.ird Blnnin ham Jo'n 0 Pe^earcb fut L a 1 
Dl easi“ Annual report 912 

Central ilidwi-’es fo- En^Ianl -ud Wa -a 

■McAtlng 8o9 — Po=t-CArtircate trainin-' fo- mil 
wires 10a7 

Conjoint In England Inio-mation concenur^, 

400 OvO j32 

— — — — In Ireland Inn-n-ation coacemln” oO 
a 3 

in Sco land D •-t'i's -nd i>a 5 

10''’4 — Infomation conce-nin” oO- 
— — of Control {En”hnd an I Wa!-»s) Ch-n--' c 

addres- "t.9 — App oval o^ medical y-ac*’ ion rs 
under if^'otal Truatm nt Ac — Atpomt 

m nt of Commi sioufr ,^lb— Annual repo-t if- 
19o7 1005 — Co-respond ncp on H"" 

for bcotbnd (pirhiTnent.ar3 ro ) 1'’4 j 

Dublin Fever Ho,p l 41 Itr + repo-t 

of Flccation loj" annu 1 r 7-3 t _v2 — 1 j " 

repon of CTii t Medical O'ficr- 13^3 

Food Investigation P,epo t f 

ifanchistef Joint Hospitals Advi o-y Ann ul 

report 13''4 

Metropolitan Wapr OpAnm- o n *v libo-a 

ton-s — New adlress 01 AV-ter Esamloa > 

D partment 1_41 

SCO tlsh Mental Hospitals Patb''to”ical Ann - 

report CC" 

Boe Finn Ct idies in Ptolnr ■'d Pre^max^j in P i 
rev 94b 

Bo-c», sarcoidosis o (P Boll y fcco t) (0) — 

Co-respondence on <'-0 
BOFXHElsf C Child p'sycho berapy 2 j 2 
Boil alt water 01" 

Bonantie V d ath 4"f 

Eoxd C j Cc't.aia pha 's tn 1-* hi tj-y c 
polymo ph leucocyte -si (0) 

Eoxe j as Co-op<*-ation la path'* h alfh, « 

Bo.* lengthenlD” 1 — l 
' '■ • marrow post rao ten ebaD”i:s in 9 n 

tcnial patber enlc 0 ■-anl m in I0<J 

/adfographl cbao*es of chifdhjod as t-n ir 

adult Ilf 1— 

Bounty Lnest, obltnary no*i e of ‘>23 

Aicto (Chari’s FOX and Jo^n aLacIexvax) 

Tetanoa UaclUas reeov 7 d from scar ten y nrs ait 
attack, ot po-top^ratlve tetano. 10(0) 

Lo* haav H mvan biant rury of death 0 2;.-— 
Nomlxr 0 \eI''Tlnni I hjUJnft voor Gerdts 
irunde devoted to 10 9 

LOOKHALTTr •- (and J J MtT’EAY) (Ix e o Com 
pi te hypospadix- GoO 

Books and manc-crlp,? old 1 -4 — ^Sal o'doc*o*a 
coll ction 152 

Boox T H Apla-tic anaenua with eotnp^ e 
recov ry 1941 (Oi — Co— e«po*iJpnCA oa 12-o 
Boonr TA G Civil m ’’Heal o-xiaimtioa m war wbJ 
Lo"Wtje j C Pella'^ la m ntal h'wpit.il 
PoCEXE, A1 ck bumnon. 9" — Trul 0' I “a— 
Leading articles on Isa _2o— Co-re'poad ace on, 
->4 31a 3"- 4-7 4 0— Legal n wpo n 2r-— 
nieml op^’ratloua 12*3 

BotT-Ai P J Chan-re of vanaal wall 41“ 
Bowte F J T - Ch moth rapy In gono-rhoen — 
Report oa 2 (p-aminQbenzen:snlphona’nIdo) 
pyrin M A B 69i 2a'’ (0) — Anno-ation o” 294 
-Correspondence on, 3" 4-4 4*4 91 

Box Charles (A Icto-BoxxFT and John lIicLEX'-txl 
Tetanus bacillus recovered irom ear ten year 
aft«>r attack of post -op^-ative t'-tanu. 10(0) 
Botce, F H Hepatic furctloa t»-st 1-12 
BoTCOTT 2L Ho-moaf^tl -apyingyaaeco'u-y 3b4 
Bom Lltat -Col J S K- Ihepa’ucioa of p opby 


BP-AELET W H {spread of trep ococcal dis a_e 
"33 (O) 

BrunrxTXC H Dr Fegmn d^r il^rlrJo 

t'lm Encaeb :xri rev So 
Rpurr 5lrWnilarQ Bra”” Paul pul ato’ i>4 
Bra”g Paul puLator 2o4 3-0 — Parliair aji-y no 
oa 259 — Note' on 2'- 

BraraM D Protection of eczem-toc_ fa^v 102" 
BnAlD Francis O—eou-s dysfophv foil j'-ln” icterus 

gravis n onatonun 12 12'> 

Br-ATLSrOED Jam*^ F Prod* ab^ce- -rd it 
dlffertntial diamosis 119 (O) — Cou” nital d rnn 
Itl‘»3 of hands and feet 19 1 — Radio^xsphl 
chaD”e3 of childhood a in add life 122 - 
Braln Cerebral Intecrxitiou o' o^Ur moyem*a's 
(Gordon Holmes) 10 (O) — Leading a’”IcP» on, 12, 

review of books oa laO 10 " 

Ya-omoto’ control of ca co’-af nrculat'on 6*^" 

Bfaix AV Pu- ell Aertigo its aeuro '^leal 
o olo”IcaU circulatory and «ur”]cal a-pect. 

(03 — Ducn.g‘oa oa 305 — (2o’”’‘’37'Ondea'i? oa C_ 
"00 "*2 

Br-AIXE, Gin* (and o ) - ml banllrLici 

InopyriliaeOIABC'’* )intrc tm i o goa-'-^^o-a 
114- (O)— Co'Te«poad nO' on I—" 

BRJimrwirr^ Coa-vance ref/r^-cy Cifi-'u 
Enruirr into P c r of P* lu. ~}rjpj \i\ t m’lj i*y 
rev IO 2 C 

BE-AvrvELL, Cn”htoa (and E<L h A Lox ox) 
Hfcrf Dis cisr and Prt'V'xnr'i rev H< 

BR-AXPEE, j Ifeatal asn«'c,o 0 tub culn- ^ *4 
BRAXHAir Sara Gonococcal rc ninMtL 6-9 
BRax-ox WPS SA^r Pirrttrnd Son. rev (>>. 
Breast, acute ln*ectioti3 0 ' (Chart’s Donald) ®j 4 — 
(ioTespioadcnce 03 10^3 11"' 




6 July-Dec 1938 


INDEX 


TllEBMTISn 
Medical Journal 


Breast evneer of (0 Gordon 1 i>Ior) 1071 (0) — 
Dkaj Ion on 30J — C<»rrc pondence on 12"S 

infiammatora ( ^rcinonn of j'^2 

Innocent tumours of {W s-imp on Hxmllov) 

10^4 

rcllcaerind o7- 

I re 1st fccdiiu modern dccliru of (7 t Spence) 729 
(O)— I)j ciL ion on 240— (.orre pondento on «12 
HO 01 » ')fj7 ini 1002 1111 117( 1220 1202 
1 500 

suppression of b} ord m frozen ther^p^ 

(f I 1 o s \nd I ridllips) 837(0)— Note on ll-» 
Brccfh presrntation prohp t d hand and 1402 

r icufo J Jr^Ticotnd^coJ/fonefnt/ 
(•70 

Bi IDI f \\ Jtcetal reactions follouinq irrulntjon 
of cor>j\ 10 >3 

liillOLr 1 Care ami I ihubtlitatiou 7t 

Bil((s Ml in II Vbortlon ind the hM 427 
Bristol bp« cliJist sf*r\ Icis for corporation ho pital 
50 — Health «cr\lct 421 

British Hni" Hou es ltd BookUt on 7)11 \ iluos 
1'5*>0 

Heart Journal to he published b> B M \. 10a 

Journal of Dermatology jubilee of 920 llfifi 

of J hf'umaU^in first number 271 

Medical Journal eollection of for dispo al 8"4 

Museum Bill 100 

J harmaropocui pr(j)\tations lor next rdlt-ion 

(leading article) 12 (j4 

Bkitt\tn II V 1 \ci Ion of p itell i 41 — Incturc 
of carp il scaplioid 071 

Bio\ 1)L7\ II (and bir Milium (i\t\Joii>) 
Dtopli rood S9j — Correspond( nee on lOlS 
BROcr A I P3\Lholo2V of rnidicil profession ^7 

— Abortion ind the law 4S0— souil pitholo^j 
70- 1114 — Mr nid prcc.iutions 1231 

B t 1 mpyema In ehildliood 5n>— bn 

discindtd testicle 42J 
BliOCMiAM M Bronehiectasi nu 
Brodies abscess and Its dllfenntiil dii_no is 
(James 1 Bnillord) 119(0) 

Bronchiectasis points of \j(\\ of plusinan ind 
surgeon 1 5 51 

BjoomumI) Be^lnild Conueiutil deformities of 
Hs IJll (0) 

BiOTiiwoon M ( N (and Col C T liiMiui) 
(intbrcrk of boniu dasenterj 1 Oo (0) 

Brown \ndrow C irboludr^tes and aliment ir\ 
disease 0 5j 

— 1) Knthhen When to stvrt «ulphoniimd« 
treatment in Lonnrrhoci 1% 

C l/ilns bpontaneous pncumotlmrw a 

coniplicition of artifUfif ptuumothoriN I2»9 

11 C ro\lc Infective jaundice 2 53 

— —Herbert II Treatment of pneumonn IjO — 
rvplmid V (ccincs 9ns — Owuen in treitmcnf of 
sciatic i 1C90 

T A ( encral prvetitioner ind mldwiicrv Jf7 

— — Oniter I p>em » in childhood 50(» 

— U Cun>n-.him ( »r« of lunatics in NLtna 
000 

Mllllim J roliltim of mature per onalit^ -00 

—1 vebotiieripv in or^inle diae isc 70 — 
I >(holo^> It Oxford corrutloii b20— Hlaehlmer 
l»7d 

Browu-bequard Chirlc Idouird Ceiittiiatj of 43 
— Tributes to 153s 

Biiouxj Denis DhpiUTsl oi uiidt iinded testlele 
l(,s (O^— \nnotatlon on 13j — ( urrcspondcnce on 

- 9 51S J74 4-5 47 591 03u 

— 1 I Ircatim wt of praecnt i pr uvj » S3 
J rue lit ihirtui lufeetlon report on fh cases 
(Midutl i ifTncv) Ssj (O) 

fn ded with fundin ind pronto II 

(^ I ibompson) ^^4 (O) 

lhhctlon.s pront4>'il Ltoup In 4‘1 

'» uf<o levir unduluil 

Bj V \N I rink Soel il ixitboUvn 140. 

r B I rumour of mill Ire i t sp 

Bi a VNT 1 I (as^itu,rrn' 9*i( 

Bimi \ ( rabiiu Broiuhlcet i i 1> - 
1 111 b Chirks lIiUTN obitnirv notic of ( il 
Hiibo eliuntle sulphanllnnld ln(Svd^l^ 31 Uurd) 
101 

Bl CP U a t 3' Irthnti f if f ill* an I ( ntif 


re V 

( Aroni 

(' I f 1 Ut 1 Di < 

riv '91 

I lu Nti 

in hum in e ir -Oi 


iti I r 1 

( Dui 

I ito I tt rlur \ 

1 si 

Bultmii antrolo* 



1 t fL J ’ 

U D ( 

i- tut il itrr 1 1 

f ) •pbim 

*> (0> 

— (erre i 

n d n<\ « n 111*' 

/ V t*n d 

/ 

• rt 1 r il il 11 > 

h I n nr 

M< i 

f U> 

fan la 4 !— 

hr.n t / a 


I * I d r 1 

u 0_u 


1 1 u Mur* 

i h lb 

mis Mone olitiurv ruii a 

1 l I Ml V'f 

1 rl « 

11 1 1 Vp[ r < 

iatj 1 1 '*1 

H V « 

riv 1- 


lux 11 

' \ J ft if/jj nt 1 ^ r uin 

• ml 

irn 1 I 

n '' 

( b n 1* ( 1 im o’ 

•ituirv M 1 

1 e i ow 

H J > 

’'n ( xvj m 1 

-.1 

I e i 

1 1 V t hh [ in I « b d ; 

i t hv 11* s 

5 1 1 TILL 

\l 1 V 

1 N u t\| 

.f it t 

r .11 

f tr* 

I t < ' Jk I tJ\ 1 

1 » 51 ~ 

V" i 

1 <. n • 

[| 


1 i niv 

)( I I 

t 1 t ’ 5 i • 

1 1 

l * * 

\ n (1 

* H J 1 M 1 i 

1 r 1 : nt 

e» 

‘ ip .. 

M ' ■* ' 1 b 1 

!| i! il ir ' ’ 

i \ J 

» ' 




G 

{ viiLL T ^ trnej I^ntc results of surgical treatment 
m perforated peptic ulcer 403 (O) 

Cicxarean section uterine rupture foliowln" ^0 
Calcauco cavils opention for 122. / 

Calciferol high potenev (Osti hn) 947 ' 

C ilcium eiftct of on toctn .27 

mandelate in troitment of unnirv infection 

(H Droller) Co7 (O) 

f ilculn autochthonus uretbrii (T ( raham) 10s > 
talc>(lm tabli ts JOS 
Caldcfcrnim t iblcts 891 KNs 
C alender*? (nddnr/t'* 1.44 

CaIiU vr 1 "N Con-,tnit il d* lormitii s of binds ami 
feet 991 — Corre imndenee on 10t»l 
CiSfrrox r It loxic mfictivt jumdiec 25s 

I Cordon II ire conipHcition of labour 10_s 

s T (ind H I liioM«ON) bull time extn 

uterine pre^n incv 991 

CurniFLL MirjlKindl 1 Ioliton) Orv7uum</ 
Qarhnn DtoTule Jheraptt 2nd ed rev 12f'’ 

Hirri Lntonscioiis nund ind iiudicnl prae 

tice 9i — Obituarv notice of IjI 
C aaips 1 L 1 uorper il sep is 04 
Ganadt A umber sulk rmL irom merit il diseases >34 
Cancer of ahmentan tnet compiritivc sfml> of 893 

apical broneho^cnie (D Owen 1 1 Hewer and 

I H Mhlfilcf) 13«0(O) 

— ■ — Bdl 12 9 I2s9 — Conference on l-o7 — I C( 
ind 1334 — Correspondence on 139 

breast (C CordonTijIor 1071(0) — DBcn ion 

on 302 — Correspondence o i 127& 

md chronic inistitis (\\ Sunpstm 

Handle}) 115(0) — ( orrespondi nee on 471 

anil iirinar} blidder di tussion on 13-9 

ciinpalpn 2 jS 

Briti h ] mpjri Mcdicil centir} to 

Clinlc.\l Cinccr Rcseirdi Committee appointed 
207 — Ouartcrl} mcetinu oi Crand Council 2 »0 — 
Vnnual report of \ orksblrc Coiim 1) 07 • — \nnnal 
general mcctlii" 1216 

of ccrilx radiotlier ipj of 6(>9 

cure tetanus from 033 

e) 139s 

12(.7 


experimental rent nice to so* 

castrie a:ri> dlipnosisof 127- 

Government versus (leading irtiele) lOOi — 

I irllament irj note on 1184 — Soti on 1133 
and Iiercilitv 9 5 19^ 

IntUmmitor} circlnoma ofbreist *>S2 

ioo]»erible of tonutc and jav\s alcohol injection 

In (WlUred Harris) S5I (0) 

i rrad I it Ion or surger} for 18 

— lung (leadiiu artlek) 184 — (jjrrtspondonre on 
316 

— miiimur} uid imnopiuH 

— origin of 41 92 19u 

of plurjTix uid lir}nx treatment of and its 

results (Iioml <olicdu) 167 (O) — DBcus Ion on 
247 — Correspoii il mo on 2»9 

treated bv Irndlatloii (t Himlikn 

3homi«) 247 147 (0) 

Prauic pi'ri reutlons for 712 

pulmonvrv indMlicoi 411 

- — rcseireh prints for 531 
tar virus lol 

of ti tls review of l»onI on 104(» 

Meek IntornitlonaJ I iris 11(7 

Limers identical in UUntlcil twins 7>I 9I<) 

( vNpm \ I \Mm mctitatin. nu rnhrmi ( ) 
( (tunable tndtea i< five principle of 46 
Cimmb new Intrvvuiow 131a — Vib on 1102 
Cm EMI Norm in I Orthopudics In rlieumatoid 
arthritD 391 (O) — Disen ion on 304— Corre 
spondima, on 9. — \v|in nietititiiu mMul)rine 
5t > 

CvioN Norman B ( oiite rdf ildefe»riiilfi(s or liamls 
iiulleet lOi 1 

( irnon Vlviirm de ith oi 921 
( irbir one in amo* bhsl< 9» 

< irboh}dralis ind aUna nt irv di e i ( 

( irbund s treitinfntol 5.0 
( inmo nn hvdri»irt«ns I .0 1 -i 
( ireino^enicltv of tirinooti imxtun n k! bv 

II hi rin in (sti | han Bek) 151 
i inhionn 3 ^ < mcir 

I irdlizil lor diirophremi l_r7 1 >0—1 irlii 
ni»'ntarv i ot« on 1 j» 

Ihji^y jn tiipor (I '' H irrls lunl ( 1 

Blrpft) 419(0) 

( irdiolo'^v Hi irt 

i irit r iholci nf 1070 
( ir t ikin qualllKitlon lor -Us 
( M'fvLT H I N irko e Villi'* In III nuihilUi 9“j 
( irmkhi I J 1 nt ( <»1 I im *> (iurl f <irilon 
< 1 Ituirv n to ri _0 4.S 
( M > M 1 ''ul| liinll imhb ini mihuu u 

( oroii Dn I vrlditrif ml inimnil law 
ID •-I ml ind \ I 1 1 -> 

I M Ti • i 4 ml I 1> din < f I « i t f dm 1014 
1 — > I >) 

( Mvr*' \ I \ 1 I in Inriil m of i''*}di 

>an I ill'' tli — ’'•t lb sold p e'- Ion "0» 

i 1 ir "al at i »>t iti irv rotlo 
( \ II 1th! Ir 1 t f ling .49— ireventmn rf 
p T rd F " (ON— DI ni loa cn o) — 
Lea lln. 3ri*c’ oa, Sa2 
f V ax T I>ral tli \nxf 'v fates ''ijZ 


Catiicmit 1 r rh> lological approach to fit no s 
273 (0) — Di cushion on 3u0 
Catheter antrum CG5 

Cmvapus \ 1 Incomplete dc cent of testliK 
2a9 — UsCij iiid ibu es of benzedrine OCl 
Cmvston 1 C Vntimonj therapj "as 
( elluloid in tovs etc reports on 209 1007 
(el Us trail htfon of De Ibdirmn (M ( Spnctr) 
rev 2SS 

CiNTO 11 Beeswax in ulcerative tulKrculous 
lesions 1 09 (0) 

Certuna new anti mil inil drug 900 
Cervix rect \1 re ictions following irradntion of 10»7 
C/fAJfUERS T S Conqtu^t of C/iotern immen < 
Greatest Scoura 99j 
Chancre recurrent ot penl 421 
of V iginal w lii 417 

Chandllp (hinges in teeth loUowm^ pin 
throidcctom} 70 


Cj 

CiupMAN 0 D Cisgangrem OaG 
Cn vm UJi I lent Col V C Iteport on hou iiu 
conditions in Bcngil 676 
C)i iiilTeur s fractun 360 
(H(U''3E C llullographic nnalvsis 1272 
(hfisslvn burg Comm \ J- P Death from vi isp 
stilly 106 

Chemotherapv 6t< bulphoimnude ^roup 
Chemistrv rivlevv of hooks on 127 -3s 290 894 
10S7 

CiffirrriE Id (I Cottfsot and Max L^W) /< 
Duodi'num Itla^ de /iirdioftxm Clinigiii n v ‘>4 » 
Chest di case s( rial rndlOoTaph} in 1010 

dlsiasis rev ievv of book on 791 

Injurlis treatment of (A Tudor I dw irds) lom, 

radlogriphv oi (Ccorge Icsscl) 27(* (0) — 1)1 

eiisslon on -47 

Chicken pox followed 1)} pinophthilmltls lo- 
Cluld guidance conference on 1059 

he Util diploma in 5a0 

sale of for dissection 7a7 

( hlldbirth See llibour 

Childhood review of books on 8 5s 111" 

some nutritional problems of (L ( 1 \r ons) 

30a 9-9 (0) — Annot itfon on 9 
CliUdrin alone Id dark 92b 

— comparison of phvsical stand irds In two ^roups 
ofAcvrc.istIo(U < Miller) 728 

maintenance of health of (parUvuvent \T} note), 

47 

mcnfalf} dcfccHvc In 7 mcashlrc ?3 5 

ph} ical fitness In 142 

ps}chotherap} of 203 


Chin v 

\nt) epidemic work In 3 5 
Drug tralUc in 156 
I pidoinic situ vtion in 300 
Mcdldil relief for 06 148 
Opium imports lOl 
burglcil Instruments for 1)39 


Lliolcniu \mcrlca hlstor} of 99 i 

defenro a-.alnst 41b 

In Ku Ml 121 

Guoirv Col II N and ( s Opium '‘moklii- in 
India 1277 

Chorion cpithf Horn i dBcus'^lon on 36 5 
ciirlstiins cards 923 

CnuisTornrrs xir IllcLird (and T \ sintos) 

( orrcct mine of malignant tirtim milirii 
liirislte 1150(0) 

(ULliCH (i PdgvT Ischlo publi o teoeluiudnll 9| 
Cncrcinri J and A Ltd Mahral Direrton/ n 9 
1 .3 

Clrculitlon review of book on 1033 

time determination of 109| 

( Ircumclslon (Kenneth Malkir) I 
(lamp for tar orrhaph} and ph hr optritlon on 
lids 6f>5 

(lamps non slipping hjstcrecfomv <2 
< r MiK V T \spects ot hi t«irv of am* t!» tl<v 
-U 1029 (0) 

M I ( and ilranil * lilnmllwlOrv 1 J0_ 

• W J le Pros (and oth*r«) Hup ith dam t 

Morpholigical htnctional ( hmcal and Snr/i nt 
lap rt Tt\ o70 

■ M ( Cremation 147 — I uMI* In illhpolnv 

1011 

t/iFX) JJ Osmond Jrirtur/s Invohm- km* 
joint n 

( 1 in Hm d« atli of COl 

(lavicle fncturcel «lmple amlnl»tor} in Ih I *l 
treatlru 743 
fractuDsof bO 

• si.n of 223 

( bv (and C I Mfl Mi) f>u J) fi trn u f 

I T itamin and \ i<ual D luipfati >o n v “I • 
fifvnrxMX*} Jo. in Jiumnniili r!*«l r« v 
>47 

Mtvilmi ( 1 H*nr>Iran(I ol jfu ir\ noth *»f 

• John ^^h <\ r oltltnirv notlre of 1 U 

5 hnir jilinlurgh loot (nmiljin^ -ivin 4-0 
I ivi rpool 1 sv thi »f ri* l4*pjrt 3" 

• OjM n for probl ms of jnvinll* Ishivloir n ' 

Tvvisfock Coiir fs ( f trilnin- t 

( llnlo raabrnlt} ami child wclfirr (rarlhrm nt irj 
note) 157 

\e r Intemr I nnl vol J 3«* .erk* 21 



Jul\-Dec 193 S 


FNDEX 


The Britoh 
Medical JorR.s.tL 


/ 


Cii fn film tf infection followinc ibortlon 

(P \ l>\wMrn and Bn in A\511hni3> 2“^ (O) — 
t.orrc'rond nee on 4“4 
Club Old Ep'Omlin Knnuil dlnnj- 
0«kr TTi'Ctmcof S^o 

t<Ncl\rane Pl'^ir appoints to E'^ccutlve Council of 
I hnd of i renada 1_04 

— — 4^ t Orthop-aodics in rheumatofd arthriti 
— Ortho)xipdn, a«ipccts of ciatlca l-ol (0) 

Co Veroft H rKrt Mid»l a olituary notice of 
loclijoachc It I— -PevK IV of book on 40'' 

CMrine a lubit fo min- drns (1 adln^^ artulel 
tOHFN Henn ''p.vmodic torticollU _41 — bolitic-i 
24- — ^^ertlZ0 30" 

— -“Michael N w m n trnitnn toil t 1_50 
CoKKm'* \ J bulphonamidt eh moth^'rapa in 
cono rhiv-i 424 i ''0 0 I — ''nlphonimile eh mo 
th^'Fipy In 'snrsicnl mfectlon, noi — Corri-' 

pond nee on IOCk llOi 
Coll common new tr itm nt of 4^0 

prophalwi of (J B Shcrnunl ^0 — 

Corre pondcnca on lOlo 
Cole Ktcll Liur^im ftr Ma me rea 

Tufa aaanrded Ceortt "'t Kot>er m dal ''In 

CoLEBrooK Ijconard Control of puerperal f acr 
lS"n 

Cole k C Cl amne slides for blood aim. Goq 
C ohti nlceratiae dmicnl a pects (E R, Cullman) 
Idol (O) 

— ptr^onalitv tudlc^ (Frich ^ttkoav^r) 

loji (0) 

toLLFix E Lioml Triatm nt ot carcinoma In 
ph-arynx and lirj-nx and iL results 1C" (0>— 
Di cushion on _4-— Corr'^pondence on 2 j^ 

Co!l ux Ep«om 4nd Bnh h Jo imrl 2“- — 

Pension.** and choLir'liiffc' r"4 — \nnual dinner of 
Old Ep'-omian Club I- j — S t knne ncholar'hip' 
12 a 

Kidu3 Information concernimt tudv of 

m-'dican** ol2 

of rhvticians of PhlladdphU Ala-arcn-n 

Prize 112 — Premio Uvarcnpi do Puuhy Prize OjU 

^Qrth Ea tLondonPostcraduatc Infomution 

coactraia:? 5-^ 

royal \u_tralasian of Phy*lclau3 Inaucura 

tion of 1-J® 134a 

c r - V ^ , o 

Election 

In" 502 (‘ 

report of * 

of Ireland InformatioQ coacemm., 

CoLLEuE, Royal, of P^TsICu^^ or LovtioY 
AppointmeaL 3*© 1023 
Awards, 378 
Closed for cleanfn" 330 
Decrees and pass ILt S's 10-3 
Diplomas jmnted 10-3 
Election of Coxmeillora 1023 
——of officer* 37o 

of repre<entatlve3 1023 

Harreian oration 821 
Information concemms esarolnatioiL 499 
D'Ctnre* 617 669 
Lloyd Roberta lectnre 1101 
Members admitted 3"8 
Memorial to Sir Raymond Crawturd 3"3 
Pheumatic dLcases chronic, fourth annual report 
of committee on '’Oo 

Colley Poyal of Obstetricians and Gynaecoloji ts 
Election of officers 2oG— Fellows admitted 266 — 
Memb^'rs elected 260 1023 — ^Information con 
cemin" oOO— Uterine inertia 9a9 — ^Dlnn r **62 — 
PassU-ts 1023 

of Sot?: ons of Edinburgh Degrees and 

pass h-ts 321 134o — Information concemln" o02 
MS- — AdmA-^ion of Fellow 9-0— Election of 
officer* 9-6 

m Ireland Information concenun" 

aOa o21 

COLLEoE POTAL, OF S^rCEO^'' OF E'tGLAVD 
Annual meetm" of Fellow- and Member* Ilia 
Appotntm nU -6o lOoo 1-93 
Awari 26o 


0 106b 1294 
Residents 183 26© 

''9 ©00 

I0b6 

1293 


College Royal (Did.) Vetermarv Edinburgh 
Annual prize gia-ing 89 — Appointment of pnnci 
pal 2©3 

Univer itv Inionnation concerning studr of 

medicine ©13 — Heparin and thrombosis 9 " 

Cork Infonnation concerning study of 

me«licine 521 

Dublin Reprints and pamphlets IIS© 

- — Galway Iniormation concermng study ot 

medicine o 2 _ 

— Hull Appointment 111© — Award 111© 


Colless inctnrt _and chanff nr iracture (P^ A 
Fit«-imoa 3 ) »*©"• — Corre'*pondence on oOi 
Colley P A\ oman blind irom birth aenmres I'^ht 
at 2 _ \ car-. 6 " ( 0 ) 

Collin Jona* d ath of 

Collin D H Aetiology of acute rhenmatism 246 
J k Medical apparattt in lal 6 10-3 

COLLI W P r (edito ) aintraf Pa. f, trxa* ITU 
Pi‘/)re% 114" 

Colon »pi«m oi 3'^b 

Colour a I Ion method oft* tmgfor and theo et leal 
deduct loiL from ob^ rvition on colour aa ion 
(H E PoiO 440 (O) — ^Di cu- ion on 24© 

Colt i II Thimble for surgeon 1014 
CoLTtFT M D Phtumataid arthriti 304 
COLAEP Cliirl'a Ton’wmphv in \-ertIrnl po-ition 

Com tto Cirlnr» death of 12- 1» 

Committtt AdiLon on Biindn«> appomtm'-nt on 
3©b 

Int rdep-irtm ntal on Abort na 29© 

a"aiu t Malnutrition bpeci il repwrt 130 

Milk Nutrition Milk and na*ntion -o — 

rei>ort 1049 

■ Ophthalmic B nefit Approved con. titution of 

4" 

Parh im'mUrv Medical Jteetmg 100 1121 

13ti 

A oluntarv HospitaL for London Electnn of 

comnuttee and office 104 
Conceptuah m rcta w of book on 81a 
CondLU'ation water from theatre kyhght II-S 
1-44 1296 

Conf rence Child Guidance Interchmc 10©n 

on cremation ©9 

on health education 2©1 

International Red Cros Conclnding ession. 

on Phemnati DL.ea«e* Bath Effect 01 

cpKintaneous jaundice on rheumatoid (atrophic) 
arthritL 394 

m-^dical tudent training of docto- 19-_ 

of nuhtary m’dieme and pharmacy 231 

nitloaaJ on maternity and child wehare 24- 

Conccoital duease human probl ms 0 (J B £» 
Haldane) 1100 

Centre'S of Comparative Pathology Rom* 19 J9 

health Port, month <^0 

International on Luc A-surance Medicine 1939 

Part 8 * 

Ncurolo- ical Copenhagen 19''9 neo 

of Ob tetrics and Gynaecologv Rom* 

1942 S"3 

of Phriolcri ts Jubilee 419 

SocietN of burcerv Summary of papers 

publi bed '09 

of Sorgerr Account published 12^4 

on ra*dical postgraduate tudy Report 414 

of Military Medicine and Pharmacy 19 9 bl- 

9 - 

Monttssori 4-0 

for P^ychoth rapr International Medical 

369 

— “South African Medical 32ad Proceeding: SO*- 
Covcell, H C Tetanu© from cancer cure 6.>3 

CovTAD \iCtor A_ Istance to medical tud nts 

from Au«tm 9" 


mons Hou.«e) 

op*mng 01 2 ©l 
Conversion cales 131© 

Cook L C ConvuLion th rapv 144 
CooPE Robert Pleural eff a. Ion, 12-0 — norated 
gastric ulcer 122 b 

CoOPEK, Frank B (and other ) Sulfanilornid’' 
TUrapt of Baet^al Inffctiftu rev 104© 
Cooperation b*tween ophthalmolo"! t and physician 
in certain ca..e 3 of virual lo =3 (C B P Tiw) 
603(0) 

crgauized bodie* 143 

■ - jn pubhc health odmlnistratlon 367 
Cope Zachary S*ptlchatid 363— Mahgnant disease' 
of b cart- and bladder 1©30 
Copeland Boyal Samuel death ot 46 
CoPBET Robert M Prevention 01 breast infection 
10C3 

Corcor-iN John (Dubbn) Primary intua..U 3 ception 
of appendix 114© 

John (Worcester Park) obituary notice of 63 " 

Comeal tranj^ilantatlon (J W Tudor Thomas) 36© 
'40 (0) 

CORN'EP., S G Chicken pox followed bv pan 
ophthalmitis lo- 

Gorjwral puni-hment 1 tter to Home Secretary S" 
Corpus lutcnm nucrochemical revsimhea on 2’U 

Correspondence 

Abortion Cl «elah%t infection following 4"4 

and the law 193 2©4 31© 3~2 4-' 

Ab-cess penton Ular 634 
Advert! mg science m 9bS 
Air raid precautiom. 6b- 01© 06© 1016 1054 
1114 11"© 12-" 12^3 — And Underground car 
parks So London ICdS — -Evacuation of 

ca..xialtie3 1113 

Alimentarv di-ca e carbohvdrates and 63© 
Allergv and imnnnutv^"b^ ^ 

i I 

Anatomical termmology ®© 

Anatomy academic aems chnical "64 


Co rres ponden ce— (co nlxn^d) 

Angina of effort txeattneat of 1251 
Antagonis ic dLei^ea 4 - 
Antimonv th rapy 2©© 

Anxi-^tv «tate* prognO'*© o "-1 "o."* S 12 
b 1014 lObl 111© 

Apoplexy treatment of 93 

Artlmti- rh umatoid gold trea^m nt of ©" 

and jaundicf* 4"_ ©■»_ r j 

orthopaedics in 5''2 

A_ hma adren.^Lne treatment or 9_1 <■ 111 _ 

11"5 1- 9 

Au_ na a - 1 - ance to m dical tad nta fro n 9" 
B-d ejvice euicr’encv voluntan hospi*'aL> 

4-3 4"^ ©9- 
Bermett rmeture ©'^ 

Bfmdnes prevention of 0*^4 
BIx)d g'Tiupe and legulatiou 4"I 

parental who!* as inea.-Ie 3 prophvlac 1 "tr4 

lilt let 11-9 1250 

P*es ore and spinal an-esthetic 44 

Boil -^ilt water '^1" 

Bra'»" Pan! puLator 2©4 320 

Brea infection pfventim of 10f>' ll"" 

Breast f -edm" decline of 812 015 oq- iyjs 

106- IIII U-D 1223 12.^2 1310 
Bnirelli abcT* u inrectioiL pronto--!! grou > in -i"! 
Cae'-arean sec ion uterine rup ure ioIIo*nng '^3 
Cancer of breast 12“a 

campaign 2©5 

and heredity 93 10 ^ 

irradiation or snr" rv lo' ’ 3ls 

ot lunz 316 

ongm of 41 9 _ 

of pharvnx and larynx 2 j 9 

Cancer* identical in id nrical twm_ ojo 
Canri'* If tndicr active pTncipIe or 40 
Carbuncles tremn nt ot 3-0 
Ch*mothe*apy complications 0 ©01 

new 35 

Chicken pox followed by panophthalmitL. D" 

Chma medical reLef lo' 9b 14S 
Colds cure of 101© 

CoUes 3 fracture reduction of backwari di-plac!*- 
ment in ©9i 

CvclopropaDeandpuImonarvate!ect*-.i. 12" 
Diabetes and pulmonarv tuberculosis 3"3 
Diaphragm eventration of 2o<> 

Diet strict vecetanan ©9© C"9 56 
Diphth na p’opbyfaxi- »2 

treatment of 42 

Doctor* fo-eign admi—ion 01 8o7 
EcIamp'U domiribary em nrener treatm nt 0 
1336 

Bpil p-y idiopatlLc 9 j“ 

«uJphonamide fo 261 

Epith*l al celL lunctimof b 13 
Ether convulaions sb3 9-0 
Faece* accumulation 0 m r«*um 5 4 
Femur fracture of n^ca. of 6,/3 6 _ 

Fever t^boid treated with sulpharllaniid* 6 Cw 

undolant 1019 

Finger tranmatie amputation 01 b1" 

Fitness holiday colonies tor 4"© 

Food and nutrition lOla 

policv national 2 ©" 

npply m war tim* 11 *© 

Footwear comtf 22_0 

Fund Poval 3Iedical B^n-^vd at fhntmas 
gUL. SbO n-'l 
Galvanism neglect 01 b3" 

Ga© poLonin" protection again, oi© 

General paraly Is 01 in-ane treatm ntot ‘‘I* 1012 ^ 

lo- 261 3"© 
3"© 4-4 a-4 

©©I 1— , 

lavage fo* 424 

sulphanilamide treatment ot 01 — 

wh n to rtart suJphon-tnid?, treatm nt in 

90 19b 

Grenz ray the*ap\ ll"b 1 — P 
Haemo*rba’*-» loUowing tomni-Nrtomi 12-© 

oral 'make venom lor 4"© 

Hand and fingj** treatm-nt 0 infections of ^,06 
91" 11"4 

Hands and leet con-’emtal defortaiti*s of 10 1 
Ham-on E F 3 


' s b’eas 

319 4"1 

HutchLon Pobert testimonial to 19© 
Hypoulycaemia p*ofound 11"4 
Inffnenza penodiatv of 101 1 
Injection neks — Os^ of gas gangreu* 31" 
Inriuests medical evidmce at 4“© ©9o 
Jaundice catarrhal 633 °b 6 
Heratopfasty 43 2^- 
Ring Georg* in and his phwicians "54 
Labour pinntary extract m thad c 

lOt-S 

I — trial plasti" head 42- 
Lvmphangi is dlarui *ulpbanIL.mid* fa ' 


50 914 <^*"4 



8 July-Dec, 1938 


INDEX 


Correspondence (vonlinutcl/ 

re education 921 

rfieircli in Lnslind 1000 

Minn rc s di<ic,ise per oml experience 70 . 
Mcnintilh incnin(,ococcil suliilnndimide for 
317 

Menstru ition toilet new 1113 1229 12S2 
Mental after enro 1 >0 

factors in nicdlcjDo 421 

treatment scr\ ices 1177 

Mere examining bofl\ *>39 GJO 
MiIK accredited whit is it M285 

and asthma 1394 

pastouriration of 1100 

Mtnrain C in 507 7C> 

Mind uncon&eioua and medical pricticc 30 <13 

I >0 19S 2 » > 

MortiliU maternal »nd medic il education 42j 

rates 471 

^cck ph'itcr 1-78 

^curaluia facial siirsicil approach to 1278 
^nrse^ trdned orftanizition of In emergenej 752 
Occipito posterior ease 038 031 722 919 OGS 
100 J 1178 122 j 

presentation prolonged 50 1 

Oesophagus congenital atnsia of 1110 

Oil human from omentum G79 

Oleermon fractured pcnional experience 63 » 

OsUochondrltis Hchio pubic 94 148, ”17 

I'ariljais acute hiilbar 1281 

Patella excision of 11 

Pitholog) social 762 814 1012 1114 1230 1392 
l(I\is measurements of 422 
Phospbitaso test and pastuinr itlon 1109 
lituit l^^ and diibcto 1174 

" 151 1337 
1179 

dnst 1174 

Poi onnm sequel 10 of w ir k IS ID 597 
PolionuchtH can\ ilcsccnt scrum for, o83 (i‘’3, 
678 721 

tre itmont of 004 

Prognincj lU'dominil 42G 

and lojirosN 0 

Promlnal ovirdosa^oof 8G0 
Irostate cnhrted btcinach II operation for o7(i 
4 -J lOi 

1 rnst itictomj Karris G37 084 
— — sub\(sicildmt!ierm 5 2)U 423 
1 sltt ROslS 1 )l 
1 sorl i is 1 j2 

P \rliolo-.N of medical profession 07 
1 sNchi>som\tic nine s rising ineldencc of 149 107 
110 37t 17 1 50(> 

Purpun, tlirombocvtopcnic from scdoriiud 120 
4-b 

Qulns^ ami its treatment 423 
poritonsiKar abscess il 1 12 
Kiullologa practical mu eum of 1303 
Uadmm police and practice 1 idO 
lUfusec probhm l-j5» 

JUspirators nuclunicai 1*430 
Jllilmtls itropluc 4o 
JCldimrrhnci Misomotor Si'’ 

Sarcoidosis of PoecK 920 
Sears ndhermt hum moll and 14J0 
behlzophrt ni I cirdnrolfor 1 4 »0 
Schopt nhauer and sjphllls 00 
Sciatic* o\af,en m treatment of Ijoo 
bcure V adult S(f » PIS 
Sea bntlun- h\guneof 4-7 
Sept il delliction 1014 

Shm Ul acute mwllhrv i>ulp]nTul imUlc in 2G0 
bmill|K)\ ind eompulsora aicciintion 1 >\ 

4-1 I7t 

mlndi* control of sii^^otjon 1001 1180 

U- s 1 P- 
SinoJxliu ilfictsof 

u|> ‘IS 

sj))!! )l h ion 1 }Ol 
Sulplnml imid« aperhntsand SO 1 

Id <.t iptulocoee *l sKin infections 02 

Sul| lion etimk tlumothirip> In vur^lcvil infe ction 

im } no • 

suruk »1 In trununts for t him f30 

<Ud (.olumbu dkrovj r It M-Sj 
1 \imie aekl ilri in- In uoiimlH of liii-t rs fSO 
lv*tlik un<l\ '•et ruled - 9 Us o7i 4-3 l7o ''91 
C ( 

I I ( inns from t uici r cur t ^ 

Ihlmtd lor sur- s n ni7 loU 
Jenn » rej b\ In Mrtu il ition sto 
Iracti i I ill ‘ti n eif ''i ' 

liib« realm in di uno I l* 9i "e 
lilt reiile i di j n ir\ or chi t clink ’ ‘ 62li 

e-1 — -i 

■ 1 it M \ nl Unnlfi iT 1 — I 123 t 

Ik r I rfi r ite I u I trie 1— ‘ 

( rii ifitlpirnkiin frincifltln 111 l-2o 
\ir* 111 eii It inli MI '‘ml nui un 91 
it 1 ' 

% II ) auT d ts- 
\ 1 t n iture i f "-I 

Mt It d 1 1 , In n ‘*>’1 I tlintimof 10(f» 1110 

1 , u I In i lin lUI I—* 

\ » In i ir\ n iti n il ri-i t r cf lind for war time 
to d 

N\ I il - c 1 il tin nf»si^ of ‘*•1 

\S t ^ • dr* tuff ''I 
J ns e. t u In g c ral j rac I i 


Corncend * 52 27 
1188 1200 

^rr\ Lieut Col Matthew obituarj notice of 7-j 
Corjllos PohMusN death of 4J2 
Cora za See Cold common 
Cot electricall\ heitcd 182 

COTTFxor P (Mix and Ld CHf^iui if^) le 

Duodeivim Atla^ dr I ndtolojjr Cltntqiu rc\- 94a 

Cor/sov T r Dr linage of pels 1C ab cess in acute 
appendicitis 7b0 — Correspondence on 017 1014 
IJOG 

Council A-riruUural Research appointments al 

Briti h Social ID^itfic I mpirr Socuil Jfmit’nt 

3 farhool 1933-0 rc\ 104o 

Ccntnl of Kecrcatnc Ph\ leal Xnining 

Annual report 1 20 

Child ( uid tnee Awards IGl 

ChUdrens Minimum Milnutntion amon- 

school childrCTi 580 — Pamphlet on nutrition ind 
I0C.U go\ eminent 1324 

f — 1 report 1 ?3 > 

concerning 4S0 

— oo2 — ] lections 

to 037 

Heilth »nd Cleanliness Cliangc of address 

1241 

Joint Ijibcmdo 1 Demonstration of tubercle 

bacilli in sputum 41 4 — Meeting of 1172 

Council I on don Coxtntx 
Appointment 1110 

V li P in Tondon Hospital \nd ambiilamc 
verajces SOO 
Cancer Bill 13 44 

Dcnionstr Ition of mccbinleil respirators 1101 
DomicIlUrj midwiferj vr'ngcments nport on 
1487 

1 r icturc eascjs at X C C ho pit ils 117 
Hospital ser\icc3 470 — Information concerning 
542 

Ho^pltals House appointments 30 
Ment il Uospit il hi imljsts at 122a 133o 
Midwi\es Miporxi ion of 53$ 

Nursc'* trainiii- and sahr> for 674 
1 ost-radimtc Instruction in ob tetrics 1172 
Working hours of nurses *>83 

CouNcii MiPicu 111 Nnucn 
\ppointmcnt of mcinhcr 229 
Appointments to Iiidustrhl Health Hcscareli 
board 817 

Clieinieal aspects of antigens and antibodies 180 

Description of 822 

loKowslilps awarded 0»9 

Me isiirlii^ emotion 132 

Medic i{ u cs of radium 1426 

Keport of Indaistrhl Health R< carch 34oard 003 

I adlum Beaan llurapa, 1200 

inical science and 

Dysfunctional 
progesterone 110 


Cauiiell Medical Jlcscareh of Ireland Awards 141 
1 8S 

Mcrs( yside Hospital After care work of SO — 

Annii al report 587 

Middlesex Counti Hospital building scheme 

576 

Country doctor a notebook 13 »0 
CouTOh ( (indP luiMU) Irmt^di P/wrmnci( 
( himiqiif 2 \ols 2nd cd 1-OG 
COUTT'^ I f H Tuberculosis 12 
Com bsilTM K Co oiioratioii between orgaiiirod 
bodies 143 

(ow\N lohn 1 luslothorapi In m uritis IIOj 
Con Alfnd I 1 Harrhon o77 — Vpprcclatlon of 
bir James 14 irr 1118 

t IKsant JuKrcuIcHis In ruril nrea^ 83 — 

rul»cr< ulo Is In him isliirt 14 4 4 

II 1 (A /nuaf hiafykii of J ondf 2nd cd 

re a 2-J 
Cow plana 1221 

Co\Tl Ralph frii isimd belts 1322 
6! aiiPOCK \ I Dlphth'rh proph\li\i 42 — 
Small pox and enmpul ory \ aecinailon - >3 
Cial< 1 N to op ration me isesof Msinl lo s 313 
Cl \TN ( hd\s I (ind Nth \ Nusqn) 
(fiiiorr/t/aaiulIuflicIUitUh n\ 1-06 
Cra'iH W Cancer and la ridlte lOj 
CMWioiP T U (vaidJ 14 McUol< alt) Tomo 
gr»}>hy /n pulmoniry (ubtrcaifosf (0) — 

— I ItioaPLM) / }te)s 

on 1018 

(rifi W < oinnum PKit ailrru nt<* »> (0) — 

Non trauneitk iH bwaliun ol Uks 12— 

Crern dlori e 1 o (or -j 

ronf r< nee on *> * 

Inseottind 14" 

f n-o oU i an in- k<ratlth 18 
Cm* W H 1 r pir Ition and sunburn IO 04 
tliCliTON liroWM bir ^im s Doctor 1 rnxtmlrrg 
rt \ jI 

Cl k UTox MiLil! H Multiple can allon In 
P'.Mluitra tVh — 1 \rl}Olo-ie.»l factors In ph\ io 
thniN 116"- — I jehiatre t and crimlnallaw 1169 
— '•i-mbnnt ufdriini 11"0 
CMTT I 1 -t ^ (nj rnl J rratrn^it of IItrp‘^rt‘>'n^ion 
rev lU*' 

CrimiDil Ju titi Hill llijf 1_ 5 — lri>pt>^ih for 
111 ntal case 11-1 


Criminalhw p \chhtrist and llOa 
CiiTcHn\ MactiouaUI SpismodictortlcolJJ 211— 
3cntica 242 

Cl otTON W M llluumitoid arthritis and jiun 
diet 6 40 — N atiirc of V iru I s 77 „ 

I rohn disease 1009 
Croiiroii 0 death 01 7Cx 024 
Crowi II Warren Complications of gold thcraps 
44 201 

CrOMlon 1036 annual riport of Ob tctrle Sirvkt 
67) — lyphoul epidemic lOoO— ivphoid lawsuit 
tent case l-&r 

Ci Ljci\'«iMNK I W If 2 ood and i /(!/ leal 2 Uin^i 
re\ 12o 

ClinuT r D 1 arent il w holt blood in prophv I axis 
of me isles ~0o— Corn pondcnct on 70 4 
Cunen Xiionus b 70th birflid ly oi 1294 
CuiLtY A It Veute hull) ir p anl\ is I2b2 
CtfriNas L Jv loxlc iiUtctive jaundice 2 48 — 
Uses and nXiiscs of benzedrine 001— Xlinicai 
ispects of ulcerative coHtls 1 4)i ( 0 ) 

CiLilN Millais Nkdical riliet for ciuna 0(» 
CtNXAM 5[iry Decline in tire ist feeding 1112 
( urcliod Lrnest dt ath of 601 
Cline I lerre and 5rirh Jlotiiagc to 1164 — St imps 
eommeanOT vtlng l-0(» 

riitMN Desmond btitcs of dpprts Ion 306 

Cm ru T It Ihigieni riv 571 

CPI n-* ArthiirHiie 2 cxlbookof Cmecoingtj Jrdtd 

Cl MiiNO Harvey 2 utnmrv 2nfrmrcinitiiiie’i to\ 
Ibl — 5 islt to rnglaml 183 — Hon D 3 ( Oxford 
conferred on 20 *» 

Cyelopropane and pulmonary atelectasis 1^79 
CvcJotroii jD"' 1001 1217 
CviKX Ldj^ar Ireitmentof an-ina of effort 
1231 

Tames Ilhcumitle hi ulache 1307 (0) 

(ystitis acute sulpliommlde In lijO 
ty ts pelvic hydatid and obstructed labour (5lostvn 
J Imbrey) 1201 ( 0 ) 

sebaceous inheritance of 3o> 


D 

1) Am Ft A L (and Lambert Roobi s) 2nrinfai/ 
'iiirgca rev 1037 
DabrowskI Casinilr dtath of 703 
Dilt Cuthl>ert J4ra(tv obituary notlu of 1311 
— — SirJIonry J uturc of medkino bj() 

Dvnv W Allen Devdopment of hospit il svsttin 
C(»— Appouated I t C deputy MO it IIK. 
DanLUsii w Distribution of t anti r 10-3 
DvjuvMPli CMvuisnx bir Wddon irontosjl 
group in Dr uAerfii'i infeetions 171 — Appreciation 
of Altxandcr Macphall 808 
Dins W J Strict Mr.darlan diet b70 
Diner lean obituary notke of 1)5 973 
DvMpxoN L b r Hospital CO ordln itlmi 0G4 

Afaurkc Tuberculosis dip<nsanc or die*t 

dlnles ’ 6 44 

b M Kormoni thenpy oOl 

b Wliitdy \ rays and liacmoptysh 243 

Dvvirs {j JlcwiUyn Recurrent cerebral throm 
bods with recovery 121 

Ivor J Uses and abuses of benzedrine 0(t0 

SeymourW HUtldino In ])eptlc ulcer 106 

Divics Colley Hugh ol)itimry notice of 1340 
Ddh Albert A 2)>f^nicnnrrhora its Ictiohrji/ 
2 Qthologij ami Ircntmoit rev , 803 

Hillowcll (and btinliy bmltli Stivins) 

Iliitrmj Ufi I /tychnl 

I J Medic il ev 

loyil 'aartjeon 

2)r J 2i Murphy thf 
DvwnvrN Jt \ (am 
tas(s of Cf vihhit 
-79 (0) — Corrispom 
tlironic aortic v alviihr d( ( « ( 1 J - 
DdMs A C Ikimnliry iinbuhiHi In tnictlon 

Dawkin" f T 51 Aarlitions in dfccllvc 

an u thctlc do es -44 

Dvw ON ov 1 J NN J ord Addrt s at op( nlru of new 
medical sdiooT it Ibtrdcin 7o‘< — IJIfr.*! o/kti 
tions 1_“4 — Addrt loMedieo I'^iInoci ty 14-) 
Diyh-lit In n I if ion to dim itc ami h< ilth (U R f 
Atkins) 6 j (0) — Di cii Sion on 11 
Dx b 1 (itid I I Hv^t) ''yiur-v Inixptn 
mental clit moth rary of stiphylococt illnftctions 
>ri (Of 

Diafne rtvit^w of book on Oh 
Death r rtlUe ition e>f t lU e 0 / 7J4 

piinltv abolition ot (pirlliriuntiry noti) 112- 

n-itritlon premature 1 >7 

— i>tran,.i e aiesf of 1- 1 

• snddrn /\hau the in excited patli nts ">1 

DinFf J W hooping (oti-h -bO 
plCvivvluo lopo An-ioj ncuino^rajhy 30- 
DlcnM*vit M (and I DfiomiT) J / jr/''r(nr rn 
s(anM/dK 7 K rev 403 

Dt tjOWiN ''fqufU of blofvl tran fn ion bl- 
Dtgri ford-n for practltioiurs 5 jI 
lU JONe J I J 1 c 1 t anct to insulin In dlahtlas 
110- 

Pl KotK (ills Wild animals as cirri rs or 
re ervolrs of di a riO 

prKlLlt I lul hgfitf rixfr rev 403 . 

Dl I 1N( F C D 1 » II agra In na ntal hospital 9^0 


The British 
Medicai. Jolrnal 


2 430 430 C04 820 S74 97(* 1070 



JuL'i-Dcc 1938 


INDEX 


The British 
Medical Iot.Tijs.<j. 


9 


Qmn > lyrifm llUr 
''ulplnmlimUc for 


P»nnr> I (ml \ IvQirrruFi) Trtut^ 

(i f hctf\)rr: \nl 1 in I _ rc\ 

IVni 1 V (i'<.jrl diithof 4“f 
I'lFXHOI'l \01M IT M 
nf 1 _ 

I^INOWN \ 1 lUit foril 

Mirnl » 

1> nt J >1 julU'oof 10-'' 

iXnnil ncht (parluni nnn note) 1241 

Ui iM TiMiw of looV I n l-*3 

IVnll tr\ inK rnvition OMirx rnin- tul\of “iol 
I> iitj t niminl n^ltntin fx (p-irlum ntnrj 
no t.) 1 1 -- 

iKpitrtni nt 0 •' i ndtlt. nml In In rfil Pc' “irch 
iKt'ctnno to\ip L.I in Irulii trj t 
I> pro'- i >n tnlc^ of th ir dinicil m 1 nrthlo iril 
ditf rt nt itiJii (lubris T Icwi ) ''"o (0>— Di 
cu 1 n on rO 

tie Qu rxiin I rLtironicnt of lOo 
iXrnutitK chroni nrlo nriJ 004 
ULronrrr 1 (ind M Diciuimf) Llxp^rtiffen 
iinr 'f «7J‘* u \ 4ns 

dc ''cjjw initz ( csir- I dcith of 10 i 
M ''MTDT I 1 ( I 'ipi I p’Txiuction of ‘\iitO'’i.nnu3 
\acvinc for tr atm nt of pmuraonh 1140 (tl) 
r)Fx>mn ProTHir^lTP J 1 1 t'i Uttnti r\ 

10s3 

X'r rL .1 B (ami oth r ) I ETphrr*ion Pi'^ir 
I 71, vf li f-Op /n ir tU fa Ioi< J >ha\rf Pnn i 
jvif na “1 

de^C'tca Vlf m t death of 

Itfwri 1 \1 Hap<.rtmfi in pot-coaphnlific 

Barkin-son: m ll-i> 

De^ V LinKaa Dim nn -4^ ''or 
B HrrrLi.r 1 7^ /*7e ff<» / 1 f tt^rt*on 7?n.« 

It Mai littliiftcli » **■ ri\ -21 
DiaUtf^ in Ipiln p-ijyr on 1-'" 

jituitara ami (1 idin- artlcl ) lOjs — Corre 

ponlmco on 11“4 

Dialxtitv emplonmnt of (P D Laarr nee and Kate 
Madd rs) 10 -t (O) 

post mortem record of pulmorarj tnl>crcnloi 

m (5 P<«.lliou e (lojno) -IS (0) — corre 
pondfnev 3*1 

— rt>i tance to In nlin in 110- 
Dusno*i ca c> fir lOo -0 10 0 ll-o 1.44 

rtM w of book on 0 

Dliphrajm eaentritunof - t 
Dick te t tOTin nlKcrratlon on potenrr and 
ftalihta of (H Mi on Loelt and otic r ) “00 (O^ 
Dickfn X (. Xir raid preeant ion Pfo 
Dickin on John Cuthl'ert o 'orce otituirj nitieeof 
4T 

J)ICK»- H T ^pa modic tortieolli -41 — \trti'*o 
«0“ 

Dick on Charles 3 death of -C4 

Thom ntrlRTt olituirr notice of ICO 

Diet tnct ac" tarian ('*ir fjconird Hill) 41“ — 
Correspondence on 4 0 o^o C**^ '•t>4 
Di teiio reaiew of loek.« on 1 -j o-I Ul. 

Di"is,tivc tract p.tiii rean w of book on - 9 
Dnoir F Holt Cxtiftrofphxrcnxandhryiix 2d9 
Dl-itiili eite of action of lOOj 
Dillon irederick Mental tactora in mMinne 424 
— I ro^ni>i ofantKta tales tl 1014 lllj 

DrSNEE- 

1 nti h Colle 2 <. of Ob'lstricnn and l a naecoIo-.L.t 
OG- 

Kiick ton Proamc lOCo 
Ch t^a Clinical ''xicty annual l_“r 
Imtitute for Scientific Trcatmtnt of D(.llnqucncv 
12 - 

londoB School of aiedicinc for omen l 2 

ijflnjea*cr and Dntrict Nfcdico Le^I tocieta 
12 9 

Medico 3>cal ^ocietv annual 1 -o 
Old Fpomnn Club annuli 1- 
1 o\*al Dental Iloipitai of Ixin(lon,Jl“l 
at Bartholom^'w Hc^pltil Old Student^ llOs 
''Ocictv of Xpothccarl** X eoinanry llfj 

afedjcal Olhfvrs ot Health animal 1102 

bur^inl In trument Xlanuficturtr K oaition 
OUJ 

IVe^t London Xfcdico chirurgical Socleta anneal 
14C 

Me'tnun ter Hth-pi(il xredical Sclioof tudent 
1 U 

Diphtherii jrrari luctememii two fita] cas« of 
1034 

imm -dutt diacnO'i of llo- 

immunization a^ninst (loadinu article) l_o;>— 

Madt compul orr m lliin"-irv IOj Col 

in Scotland 2r9 

in I^ndOD «o e on f'f'tr Sor T r) “01 (0) 

incidence and mortahtj after Inocuhtion 3s3 

inoculation auain t 140- 

inali'mant compiratiie tc^t of natural and 
concintrited antitoxin m treatment of (B X 
I cter ^ 344 (0) 

-proplnlixu 42 — Duration of imraunitv after 

“o- 

r inf ction in (Philip Seance) 1-CO 

treatment of 42 

vitamin B in IICX 

Diploma special information concerning o49 
Dir ciiFFL, Pobert and XVilhclm Jemitntt 
Ilormoixt I i/nmt/ie wn i die He ith tnijen dtes^ 
WirLfloffc zxteinardtr rea ~o 
Di clilracr 52 lOo “ _ S-0 S"4 9“C 10_a 
Di eoTtrt new format 
Di_infectant testinsof 11 j1 


Dlaorce (sct>tlinJ) Bill -< a 
Dix X X\ Orsanoth'*rapa SC_ 

Di\on r loK I ilpat Ion of trachea ©fo 

T H (and D M Xndeilon) Xcute 1 nlbar 

p:irah is 10 “ (O) — Correspondence on l_bl 

XlQnta»me Simp! ambuUto’v mcthotl of 

tri. itin" fractur'd clavlrl "45 

H HaLtead Cure or relief of ca s, 

no'cd angina of effo t soi — c irresivmdence 

on K I 

Dal«son Leonard Cliarl's Talljot obituirj notice of 

Xfannrct {nrjJiphi Thetr Ut xn Orih'ip^it 

Trunxn/j rea 40” 

DocKir \ \\ X iccal iccumnUtlon in rectnm f 4 
Dot 1 Harold Incontlnenct from atcnmnhtion of 
fiervs,inr ctum C_4 — Correspondence on (>>.4 “-S 
Donp F C. Xdvanct's in o '^notherapa o« 1 — 
(X "s rirJiFsandP L Xoblf) Interruption of 
carla presnanev by m»'an. of orilla attiae 
o*' tro" n ( 0 >--\nnotation on o 0 

1 I (and r JLairii.) Ma lae hjdro 

n«.phrcKi and preimancy I" 

Dona- -no reaction in tsT^hoid 
Domld X B Ductoms 01 whoopin"-conch 61 " 
(0>— -Correspondence on Nb» 

Oiarl's peptic hand 3f — Xcute Iniectioiu ot 

Irea t 9^4 — Co rcspondence on icw3 11 “ 

DowlTi ON Malcolm Xlrrail frenution 1 ” 

Donoi IN T b Tills rctilou infection of bar a oaer 

cl ft pal ire 9 f_ 

Dorr Norman M Xncio.rajhv _4J — (Xnloth r ) 
H t/p^ thnlnm t Morp* fyyjrit F i« Clirticol 

and s irjital Atp^cU rea ;>“0 
Dorni^ Dan! 1 Poet il react on followin'’ Irradia 
tlonoforaiv lO^S 

DolfLa J X Kenneth Lcdtilint fever lOlo 
DOC Lass Mifion (and PoUrt L XariRXFP) 

7 ithatifltOl* (•’tneatandoun'* /t/x’J'* ITahtly / 
1 C th Chnittil t(tte*xi\nn rev o"i) 

M iihim Cliochton olitiiary notice of 204 

Dr am anilv 1 reaiew of book on 40" 

Dream sizniflcance of H"0 
DrraTP Jamc Fdncntlon of Und children 14“ 
Drink p ollcm rcai n of l>oo on 6-J 
DriNKrr Ctcil K \ct5> X.on >7 !<;o Clramttof 
yitUnnt and Do'i rt in C f>«« t Phxlid lph\a 
rea 7 ^ 

Droirr Fitahta rat's in tul'erculO'i "^1 
DroLlEP H Cilnum mandtlate and Qlpkanila 
mide in treatment of orinarj Infccthn. Oj" ( 0 ) 
Drownin'* cxp'rimcntal 1000 
Dru- tratLc Cnited Km^dom and ‘'al 
Dru'’s rcaiew of books 00 19 
Drimr CLiud 1 Colkctian of rntufh M<1» al 
Joirnal b"4 

Drunk nnes Increa e In 1 9s— <"au <.d bv methyl 
ated pinL 13 ^^ 

DrcPT U C Xppraciation of bir Pobert XVckxL 
t> r 

DrnjiN'D C XV Xlatcmltv flvlns quad "t»* 
Dcbit CHLP 1 Dcr-cA e/ mn rea 1 - 
Drpoi X Temoure developios after trauma 391 
du Boi Peymond I en' death ot IOlo 
D udgeon I^nard btanl y obitair> notice of 
Dcdli r n C bclenlum Intoxication Jaa 
1)1 FF D tr L eof tretch ras phnt ,> J 
Dcke ELDFP-SirXV Stewart Pitholoirvofsbnroma 
oCo — TeitleioL of Opl thalmol yj t ao! 1 _nd ed 
rea "46 

Dcke. Fthel PLiy fh rapy for probKra 
children -IJ ( 0 >— PIiv thcrapj anl child 
cuidancc I_bl — InftctioiL. quibr> of n urofi 
13 4 

DCNoax J 
Duvlop B 

D 'I 

cnlo-i 1 _ i" 

L Cral 2 

Duodenal il lu 
Duodenum rcaaew oi book on 94a 
Dupont John 3Iunro obitiiarj notice oi 10 b 
Dr ppt, XV H OrthoptiL cure oi exurnal quint 
of a deurcM jn aioniin of thlrta 1_4 
Ditani I B Irtientlonandoontrolofpuerperal 
psi oO t 

Dn rn Charlea II To Dnnl or n t tj Dnrk 
rea b_3 

Dr APT C Parturition with albamiDuriaardraLcd 
blood p O' arc - - 

Dv entcra in titutional u-e of Kactenopha'* jn 
Outbreak of (Daaid Haler) COa (O) 

bonne outbreak of (Cal C J Trimble and 

XV X Brotbwood) 1 » a (O) 

Djsni no rbo«.a reanew ot book on S9J 
Da pep la intestinal reaiewoi t'Vik on T*f 


Facgfp X Xu tin Crohn di ix 1009 
FaclE C H Xetioloca of acute rheumafLUi 240 
Bar nos and thrrat di e\ e reaitw of ItooXs on 
lU4b 

Fv ON H L. Fleeted Hon 3Ia ter of Iknch of 


ilerJit Dehnettey rev 2 lJ 
Xbortion and the law 644 
Xlodeni ai w on preaention of tuber 

40b 


Ecbmp'ii dotmcilurj eiuer“enca nt o 

(H J XIioTLon) 1-04 — CnrrespondeDce on 13" 
Econimic tatu and h'alth (I'^adin'’ anic' ) is“3 
Eczema of fac*. protection 10-" I0"i) 

Edf C Cattle nnnworoi in man 11 s 
Edfx T XVatt (and FardJev HollatI)) Mrr t 
of Ot rtt th e*! rev a 0 
Fo E D Xrtit^cial respirotion apparatu 2"_ 
EirrcoMBE X'llinl rheumatoid arthnti. 3-s" (O) 
— Dlcu lonrn oi}4 

F^tnt rjh Medifil Jo rrrl New editor ll®o 
Enif^xi) E P Tulerculosi di ^ o- 

clincb * ~ 

Ei nrvT> C (and bv CTEantE E5) On D-’jintt r- 
t ritiinin and Vi*inl D/npt'' re\ "4a 
Filncatnn intern and rcsi Jenrt.-» revi wufboOa.».n 
406 

EDrevnoxAL NniBFP 

Corjorotior En-li h m-al cal 400 

In h SfHlica! j04 

'^cottuh ffiel al a0_ 

Dental nr’era jol 
C en ral Xledical Conned 4^o 
Ho>pi aL chmcal m En Ian 1 o_2 
Ireland m diral remtratn’i m oD 
Dica! coverntu nt hospital e'^n'*cs ^4^ 

Meilica! currculum and (resect Ia\ n ("i 
XXalt r Lan" Ion Brown) 4si 

proctice ove -ea^ j 4 d 

chiol anlcoIIec.s. 

3Iedicine p^acho'ivucal o"! 

tropcal 0-9 

Note on 4(0 

Numbers of th p o'-'s lui 4 5 
Postiraduate tuii 
Pn on m I151I eniro 
Proie lOQ of me li in 4 4 
Public health mMical em es o34 

beraices ^ 

tniicr'‘iti's fn Cnclind and XV-I'S. 4 n. 

In Irelin 1 01 

inbcjtlind >01 

Women ID medi m<' -3 

ErwAPD X Titdo Treatment 01 injuri-s ot CL'S.: 
10^6 

( ol n Harr^ frotatectorav 6." 

Ifaroli C XmpJtation o: Pn'* 6 I — 

Comsf 3od nee on 6 o -13 
— — Pete \\ radio"Tapha of ch _4" 

Eco ruin w o: N>0(v on » 

LiNiE-ax Uarua (anl Xsel Pix TED FL of 
f fropxr 1 i/jrii/t E D intnc^i or \fr 3 S r^t^x 
or ' bl Ut7l M > 1^7 re \n d! 1 -’♦a rev "43 
Elbow joint fractures m re'U n of (> L Ifi-ss; -«u 

iDjunte to (- I Hi-s*) 1^' 

Electric lieatins pad 

Lfectncal Injun's (fenjin-’ article) ”10 

Electrotherapv re\n-=*w<. boofw or “4” 

ELX.XN Elward P Ha tero alpm-’ crapha wuh 
li relarnins in tniia nt "O'— New m n. ruaton 
trdet 1—9 — \enopu pre-marca test l_o (0) 
Elliot XValter Tul>ercnlOfW death rate — 
X I It to \i 5'v_oj- n umcal research 

departm nt ot Edm) or-b I niacrsity la 
FiiiOTT C E L«.\l ban in hnni-in e-ar -03 

T P Cinl medtcal omARtzation rn war sjp 

FuLi F Treatment of utmt-* haemo rh.i'’-^ 00 

Willii D be iree EyL of G f*j't Ij Jcly i 

rea —3 

Ellvan Philip Tab^rCTiI>Li diTs^u-ari-^ or ch-^ 
climcJ ^ b32 

Elu lie P C Pba u.al htne'=a in vounc children 
14- — Xppointed to Poval tomniL on on wore, 
men comp-'ruatun 13 - 
ErruLZTON D nm GIqcosp toJrranc* curves in 
olit-'t ca. e*- Os ■ 0(0) — D claim r S_0 
rmt-oli riai«*a of book on -0 

EirPEET M-vstam P P laic hvdatid ca t and 
obstructci^ labour 1_01 (O) 

EjrE->N 31 »j C»-n H H X Pba-iqu o^recroi 
srr 

Enntion mt.a.unn'’ 1 _ 

Fmoti in ixaiew o book an ^ 

Etnpha ema localiz dha^-^nroph tfKenn thpn’-es) 
o -* 

rmjnn with CO lein 
rmflavTU'TOt ijr Ix'a and mrl 'uud to 
Fmpjema Id clol ln.n oN ra \ti n. on t atm nt of 
(H L XVaIIicv) ^ j (O) — Di CO- unon 
E I LIT 3rar*aret N w m/’n. ruati n toil t 1_ _ 
Enc**rhahti pot \accinal (parlun. ntara not«.> 
11-0 

p >-t a~icciniAl ”b 

Lnr [rp I \ Lrxlxnn n- F jol of T irl rtv 4^^ 

Fndocn ‘ ” llul 

Fndome 

Fner^a 

FsrEL 

(Tula O -TETN and G H Newn ) Danner of 
primara al m nal tulv cu » la cn I Ir a In-" 
(0>-^ JCTtrsp >nd Dfv ua 1—4 !>. 

Enclt u XV L. Inoculation a-^mt lipb fc -na 
140- 

En t5C n Actmom co- 1160 

EPIDE?nOLO<-ttAL NoTE- 
Xnthrax 11 

C^ol PA 40 103 1 0 -0" -‘1 J-? 234 4“4 4"5 

e-Il 643 6 9 "2 0 bl« 5*0 'n.4 "4 ICr-4 

106 11-4 


10 July-Dec, 1938 


INDEX 


The Dmtish 
Medical Joursal 


rriiiEMioioGiOAL ^0Irs (continued) 

Uirlitlierh 41 103 159 207 271 328 384 434 
478 003 043 089 727 770 818 S70 924, 974 
1024 IOCS 1124 1180 1242 
rncophihtis IctlnrRic'i 1024 
rntcric IcEcr 40 103 lo9 207 434 727 924 974 
1024 1008 1180 1242 1294 1340 ’ ‘ 

MTlarh, 1349 

Mcr Ics 49 103 159 207 271 328 384 434 478 
on” 04" 089 727 770 818 870 924 974 1024 
- 1008 1124 

I’liuue, 49 103 150 727 770 818 870 924 074 
1024 1008 1124 

1 ncumonfa 49 103 loO 207 271 S28 3S4 434 
178 770 818 870 924 074 1024 1008 1124 
1180 

I’oliomjpliUs 271 328 384 434 478 003 043 
080 727 770 818 870 924 974 1024 1007 
1124 1180 1242 1294 1349 1399 
ScirlctfcEcr 49 lOJ 159 207 271 328,384 434 
478 003 043 089 727 770 818 870 924 974 
1024 1008 1124 1180 
Simll po\ 49 103 159 271 328 434 1349 
Sfntistics 089 1242, 1204 1349 
Tj-plioid fe\cr, 328 384 478 003 043, 080 770 
1123 1242 

riphus 49 103 159 207 770 
IVhooplnc couch 49 lo" 109 207 271 328 384 
434 478 003 043 089 727 770 818 870 924 
974 1024 1008 1124 
See also Supplement p 181 

rpidemiologicil worl. In Piinjnb 077 
rpidemiolc' 1 ~ 1 

48 102 
038 720 

1187, 1243 129j 1348 1401 
rpileps} Idiopathic from nnothor aspect nith 
treitmcnt of fit (Robert G Linton) 847 — Corre 
spondcncc on 907 

sulphonanndo for, 201 

rpithcllal cells function of 813 
Erjslpolr 
nnd 
(W R 
399 

rrjthcma solaro 400 

rsKKinpD, ligeo Strueturnl Vamlions of Tinman 
Trie and their Ilcreditarii ro\ 453 
TAsri T r S 1180 of shfn of fomalo breast In 
plastic surgery 1250 (0) 

rihcrconnil’lons Pith recovery (Stephen Taj lor and 
Victor Goldman) 744 — Correspondonco on, 803 
921 907 1188 

riAVB A 0 Cleaning slides for blood films COO 

Albert Edward appointed Chancery Visitor of 

Lunatics 1123 

0 A Lo\a 

Charles M f 

Oeollroj 

G S IV 

3S0 

Jfnrj Rectal reactions follow Ing Irradiation of 

elevK 1008 

i- « C i Alt » 017 


statistics 
0 C03 G42 
1009 1125 


ilphanilimlde 
treatment of 
J L Rennie) 


^ l/tnf 1 aa 


T\i 

r\er 

1 \olntlonnr> tljcor\ 880 

T*\Mvo Irene R and \Ie\ R G Handicap of 
Dcafne*^ ^c^ 94j 
1 \an\\natlon‘^ purposes of 12CS 
1 \ wnlning bodies medical 20S 
1 xerches remedial In goner'll medicine 1387 
] \ ‘Venice men Mental udfaro of ex sen Ice 
p 8 j 

1 \ c Cerebral Intcjrratlon of ocular moNcments 

(Cordon Holmes) 107 (0>— Leading article on 12S 

chinp for tarv;orrhnpb> and pl'istlc operations 

on lids t»03 

CO operation between Opljtlnlniologi‘'t and 

plii'^icKn la certain cases of il ual Io'js (C B I 
llii) COS(O) 

-a — of 27 

ndiis 8 o7 

ken pox 197 

1371 

•sp'i’sm of central retinal nrlcr> fW Dunlop 

Hamilton) 002 
lie dropper pin l.n- 


.FilTurti Theodore Infantile inxietj 300 
Family allouances (parliamentarj note) 156 
Fardel Durand death of 1389 
lardon John H obituarj notice of 1341 
F ^rxcosiBF H Complications of gold therapy 261 
Farqulnr Sir Walter 200th anniaersary of birth of 

Fat absorption dcfcctiae in childhood 9o2 
FiTJLiNEr Robert L (ai\d Marion Donon‘5S) 
Es^f'ntiah of ObsUtneal ana Gynecological Patholonu 
ivxth Clinical Correlation rc\ 570 
I iUKNEr CouBETT \\ \ Vir raid precautions 
1114 

J lyrcr Licnt Co} Frederick Durand obituary 
notice of 1343 

lrii\ A Appreciation of Dr Mm Fletcher 81o 
Fcllouship of Medicine information concerning 528 
Femur fracture of neck of personal experience 
(John C Jvicholson) 464 — Correspondence on oOO 
G3o CS2 1278 

neck of m childhood 1008 

FERrusoN lergus R Spismodlc torticoIli<5 242 — 
Sciatica 242 — \spccts of neuriti 1104 
iriiRArr ( Aicotmic acid treatment of pellagra 
887 

Feaer ghndulir laboratorj dlagno is of llOG 
oiariin 282 

paratjplioid outbreak in Isle of leu is (parlia 

mentar\ note) 40 

puerperal control of 1378 

uterine swabs In COO 

—■ — rheumatic seasonal incidence of (Arnold B 
Rowlands) !.> (O) 

on tr lining ship 260 

- — scarlet immunization aj^ainst oSO 

Obsen itions on potoncj and stabilltj 

of Dick test toxins (II Mison Lcctc and others) 
7Q0 (O) 

t> pUoid Cro>don epidemic of 10j9 — I awsuit 

test action 12SC 

recent experience in (C 11 A Snns and 

G B Fige) 714 

treated with sulphanllainldc 628 

and t3p)ioid carrier condition M a„gln 

tinationlndlagnoslsoffS S Blutnagar) 119a (0) — 
Annotation on 1211 
— — 1> phu3 carl> obsera ations on O05 

undulant In Great Britain (parliamentary 

note) 1022 

report of case, 1019 

treated Mltli prontosll (Charles 7ahra 

Neumann) 342 (O)— Correspondence on 471 
— — — See also Brucella abortus 

— jcllow And afr traffic 418 6<3Z — Inocufitlon 
of pilots against 873 

in Brazil 418 

pre«cnt situation ultb special reference to 

South America 910 
Fcaers enteric In Indian troops 1277 

— rarity of ostco periostitis In 394 

terminal disinfection nnd exclusion of con 

tacts from school 1219 
— - See also Epidemiological notes 
FlDbiAN J V Origin of cancer 92 
Fiji Central Mcdlc.ll School Sma 553 
Film on treatment of fractures 1270 
I Urns exhibited at PIj mouth 369 
FlxCKH A E Sterilization of syringe^ 272 — 
Tuberculin In diagnosis 376 
IlNPiAX G M Mouse protection test ind jclIow 
fcNcr, Oil 

G M' M Toxic InfcctKc Jaundice 233 

Finger Unusual case of bilateral digit il epfpliyscal 
deformity (Henry Poston) 991 — Correspondence 
on lOGl 

Finger print*; rc\icw of book on 1370 
of twins 330 

rin„,crs amputation of (Harold C Edw irds) 031 — 

^ « — ran Cl 

3 of OSO 

— ictures of (Daiid 
Tr(\or) 4ul 5S3 — Correspondence on uOO 

See also Ilnnd 

IIXKILSTFIV U SattgUngslranlhnini 4th cd 
rci 452 

llnlcy Harry obituary notice of 1396 
Finsbury llealtb Centre Opcnliv 912 
IISULP 0 1 Scacre nlglit blindness duo to 
xltamln A dcflcicncy 944 
Fitnc a holiday colonics for 47o 

phy 'biological approach to (L P Cathcart) 273 

(0)— Discus Ion on 366 
FiTzoinnON Gibbon Obdetrics rca o70 


1 


I uc trz nutoiL I rotation of l0-“ 10"0 
lailorl s Act 10^7 cxttn’Jlon of pro\l Ions of 709 

anmnl rcivort of Lhli f ItLp^ctor of 57o 

— ~ — h-'liting in (t ading artlW ) i-'H 

cult^ J ON il of Ihyslcians and Surgeons of 
( ivN^ou Information conc^rnin^ v>03 — Fellows 
ailmittid ‘'1*’ 1-*^* — II ctlon of oIHcyT'* 1023 
vf<xs In n Nlnm lncont!n«'nca from acvuniuhtlon of 
(HiroIIDKld) f-t — ( orrtspondcnct. on t-'t "-s 
I NtPiUXk H V r Ischlo pubic 0 tcochondritl 

n-' 

IviiMiin btltU 1 111 rp* -al « p ! 20i'-“Ol>'tctrI 
calm rv r unit JIu— I n chi ttrl>t and criminal 
Iv'c III » 

Ibtilri N Hanihtoa marroo'tlc 

irNt-r'i In MacvNl<^nu Clt 


C 1 S Dcaclopraent of hospital sy sum jou 

ilctchf’r FI MorI'*y xMtto AuatraUi 1001 1218 

Milliarn obituary notice of 81 l» 

ioetus parasitic succcssfallj remoaed by operation 
(Max CrccnbiTis) 1-1 (O) 

FoLrr J F Diagnosis of malaria 1070 
lOLLEa S J I roast fLtdin„ 249— Organotherapy 
_ 

Food analy i rca kw of book on 223 

and Drags let 8 1334 

■ DfU'’ and Cosmetic Act In U S A (1 ading 


irtlcl > 4.#*^ 

— In\c tigatlon — Irdb'x to literature of 891 


Food and nutrition (leading nrtick) '^Oj—Corre 
spondcnco on 1018 

poJicv national 139 2.>7 

supply in war time ll"o 

tinned rcMcw of book on 571 

loot common ailments (M bayle Creer) (0) 

and hand congenital dcfonnltici. oi (1 N 

Callum) 901— Corn, pondcncc on 1001 

non traumatic di location of toes 12 

rca lew of book on 994 

some ob er\ ations on shoes (Thomas yrnrlhi) 

11^9 — Correspondence on 12»0 
Footwear correct 12''0 

roPBF^ Duncan Terminal dl infection nnd ixc In 
Sion of contacts from school, 1219 
lorcecs gallbladder 403 
— —history an 1 CN Glut ion of 187 

mastoid bridge 22o 

Foreign bodies swallowed C2S 

doctors and dentists 47 79 155 26'? — Viid 

Colonial Medical Sera Icc 3S0 — Vdinlsslon of 8u7 
roufl\N Robert \nti Ntnercal measures 1% 
lOFKXtr Claude E ienlimia imd lUiid Diftorden 
rea 021 

loiMiJxi P Symptoms of cardiac standstill 132 
lORTLbT J ^aturalGolf^r T(i\ 1040 
rouFLsrFr Brown Maud E Acute poliornyemis 
o6a 

rorsxTii \V Leonard Prophylaxis of measles 2o0 
loss C L Adaanecs in organotlicrnpy 301 — 
(And P PiilLUls) Suppression of lactation by 
oral ocstroc^cn therapy 887 (0) — ^oto on 112(» 
Foster J S Cyclotron 20 

1 Stanley Fa entntion of diaphragm 2j6 

Milliam obituary notice of 1341 

Foimdln treatment of Brucella aborti«i inftdlons 
(A 1 Thompson) 8b4 (0) 

loundatlon Finney Howell Research Fellowships 
for cancer research 1042 

Rockefeller Peimv for 1037 74 — Vwards 419 

— Fellowships 419 
Fountain pen lound 430 

lox Edward LawTcnco obituary notice of 1390 
FOXTOX H V reritonillJar abscess CS4 
Iracturcs film on treatment of 1270 

pcr&onal experiences 404 590 03 » 

rcalcw of book on 222 

Fi \r\\ FL E M Moulds nnd asthma OS (0) 


IR^NCE 

Brown Sdqunnl C E tributes to 1388 
Laents postponed 1389 
Exclmnge holiday alsUs 87 
Jlonornry professorships Conferred llOs 
Institute lasteur 60th nnniNcrsarj of 720 10^3 
lectures Id Paris 3389 

Lyons medical faculty retirement of three Jiro 
fessors 44 

Medical obituary, 1309 
Roynl Malt to Hertford British Hospital 271 
Soundless rest cure In Sahara 1380 
Tilleneau Dr elected dean of Paris I acuity of 
Medicine 1027 
^jncent Prof Clovis 720 
3oyagodcNotl lOlO 


1 ranchini Giuseppe death of COl 

AUxandcr Adrenaline treatment of 
asthma 907 1170 1391 

Clement Air raid precautions 802 3283 

Ff^nkiix a Spontaneous acrslon of transverse 
presentation 928 

K J Short history of International Con 

grcsscs of P}iys)olOR,i3ts 419 
rrvNKLXN Charles \ II 1 Inal M 11 B S I ond 
2 j 5 — Abortion and the law 373 

A M Tuberculosis In rural areas 83 

Eileen Doctor Comes to I m Ston/nf lu gxnmngt 

t» the Sudan rev 1207 

G Nutritional macrocytic anaemia '‘Ij 

Sir John Appreciation of Sir David Mllkic 

oOO — Hospital administration 1011 

I oulso E 1 ITect of ocstro„cn3 on ovum COO 

Ihomas Appreciation of Sir Henry Cray 1234 

FrvzFi J Lrncst (and R TI Robbins) Manual o 
I radical Anatnvv! rev 120 
Frlitvo a Sulphonamide in acute cvstitls 1350 
1 rcke John chandelier of 433 
IrFNCii Mistair lavage for gonorrhoea 424— 
Cleaning slides for blood films 728 

b Gay (and V G Hofan) Sulphonarnldc In 

treatment of acute mastoiditis 91- (0) — 

Correction 1070 

FriUTf, Anna Lgo and Mecbanisms of Defence 
translation rev 239 

Sigmund elected Foreign Alembcr of Royal 

Society 79 

I rnst li xcdchu lnf» ttion after abor 


FriFPMVNN 

tion 474 
Fontvli G 
Sb7 

Fra T S 
- 1 M 


Mcotlnlc acid treatment of ivelbgra 


Civil medical organization in vrar lOlo 
Prevention and control of pu^rp* ra1 
sepsis Bactetlologlcai aspects 310 (0) — DIs 
cu sioa on '*03 — Leading article on 3o2 
Fciton j Struth^rs Technique of contact 
tlnrapj 12"1 , , „ ,, 

I und (ximmonwealth of New Tork FcIIowslnp* 
for 3 rjlHi subjects 801 — \in»*nded regulations 

Countess of DufTerIn s \nnual report 4^*7 

bir Ircdcrlck HolMlay I re f'ntatlon 1027 



Jul\-Dec 193 S 


INDEX 


The British 
Medicxl Journu, 


11 


Fund Klnj: Edtr\rJ s ITcbrlt'^I Tolka In nid of 700 
—Louncil inc^tlnc 12”S 

fniiRrf\l Cancer 1 c carch New addre 3 S G 

Lord Nufficl 1 for Orthopaedic b rvjccs in South 

\fr!r\ Meeting of tru^toc^ ll'^G 

'fc ropoIiLin Hospital ''Uncia> Hesult of 

coll ctJon 444 

■ National Birthday Ttxi-l Grs and air anal 

pc II 9"t^IIuman mllN for delicate habits 12"0 

Naa*3t Medical Compasalonato Meeting of 

director^ 5-0 ^ 

Poyal ^fedlaal Bi.nevoI nt Annual report "7 

—t lirl tmas appeal S44 StO llSl 
rundu< nonicnchture of dl ta^ca of Sj" 

\Ual tilnlrurof "(9 


G 

OarrNEa >Ilchacl report on fivt ca»es of BructUa 
infection " a (O) 

Caill ton Snrg Comm \lfred Thoma. obituary 
notice of loi- 

0 iTRDxrr Douclas \ Itamin C In treatment of 
whoopmu-eou''h "4- (0) 

Cale Pichard cn niyoiwitche^ SCO 
Call bladder forcep? 405 
CALlor l^n-ard New ch motherapy Sa 
Calton E M G I/Dndon emergency bed erviee 
4 C 

Calvanl m ne^l ct of 

Canchon treatment of (E Ptarec Could) 41»— 
Correspondence on S'X) 

Gangrene acute prcadinp cmphc-cmatou. 

■ of colon in Infant 
?a- lod ca^es of ^jG 

Carden Dvrrv open for benefit of liO'pItaL 4”’5 
Catuvp E Blake Idiopathic epllep^j ‘^6" 

— ~ Unsh G bcnlica 243 — Rheumatoid artiiritla 
and jaundice ^93 

Carhek George Ilerl rt granted authontr to wear 
Order of Crown of Johore 9"4 
CArjTTr E B Polvneuntia with oedema imulat 
10 " l«ril> n is’ 

CarriKin Pi Idlng H lire and I'^tters of t> 2 
Garrov Miltrld Neclect of palvani tu, C37 
Gaa ea-ualtie^ e^acuatlon and treatment of (E H 
Hall) .4a 

deftnee and Col E F Harruon 

poLon review of books on C-. 

pol oninc Sequ lae of 2^ oO" — Protection 

a^ain-t nio 


Gaii 

)0d 

CA*! 

Jes 6-3 

Ga 

late results of 


(John Mo 1 V and F H Bentley) C4a (0) 

Gauvaiv Sir Henry National fitnc' 3G0— iCarine 
Iherapentics oio — PnraarA abdominal tubercu 
lo-l 12-4 

Gebbie G N Co-operation in practice 30** 
Ceckeleb, Edwin O Fra^ures and i)i/focctiorM/or 
Prart\t\oi\fn re\ it— 

Gee Claude Alfred Heath otituar% notice of 431 
Gen^'ral in‘>dlcal erMce for nation BJil K a 
proposals (parliamcntarr note) 46 

paralv i ofimane treatment of ’ll’ 1012 1111 

Gent Snrg I leut Comm T C Treatment of 
bnccal uleer^ b-O 

Gefjiant 

Admi ion of reicgee« 1183 

Award to Irench phv iclans 1294 

Clinics in Prague reopening of 1123 

Itt-titute for study of nutrition founded 4“8 

Jewi h doctors derri\cd of permit to practice 3S6 

Medical tudent number restricted 434 

J»o of books publi-hed m lOj" 102" 

Refugee doctors and dentut- 4" "9 loa 263 

OERFArD E K Ocapito posterior cme 1063 

Maj Gen JohnJo-eph obituary notice of 1342 

Geszll, Arnold (and Helen THO'iT'OV) PrjelMlogy 
of Earlj GroirtA rev 182 
Gestation 5ee Pregnancy 
Gianelli A death oi 4 b 
Gibb John Aldington obituary notice of 971 
Gibson C r Air raid precaution. J22" 

H J Some aspects of recent work on 

bacteriology of rheumatUm, 82" ( 0 ) — ^Dlscu-aion 
on .4 d 

GiesEn J E Treatment of placenta praevia 151 
GirFAFD W L Epsom College 2"_ 

Gutopd Sanford R Ttxibool. of OpTiihalmologj 
rev 20 

CiLFiLLAN Wm P oriasis lo2 
Gilford Hastings Origin of cancer 41 
Gilt Col C A onol Fmodieilyo/ Malaria and 
Uee//iMim of Epidemic TFare "oO — Malarial 
endemicity In E Ainca 1356 
CILLE^SPII. Jc 

R B 

ClLLlES II 
J Te- 

CILL31AN s ' t of 

cluzophrenia 16 

Gilmouf John B Private patient and ome 
change-4 143 

CiNESTO\<! Etienne Blind man in religion 62" 
Ctpdlestone G R Convalescent emm in Infantile 
paralv i 5«3 C S 


Gje 1 M 5 R Schizophrenia 144 
GiAnEf-, John (tlax^er i MerfwM Jun pntdtnce 
and Torieolnj't 6 th ed rev 20 
CKnd pituitary 5^ePituitarj 
Gbneoma pathology of 3b3 
GLaiFBrooK A J (and G H Jevning ) Com 
parLoo of clinical and blood pictures in adult 
curvy "54 (O) — Annotation on "Oa — Cocre«pon 
deneo on SCo 013 

Glo- Itls suptrlKial treatment ot 6(W "-5 1023 
QiOVEP Anna P Modern decUnt of breast feedlii" 
91 d 

A loccnt J Glycosuria 1224 

Glotne b Roodhomt. Po«t mortem record of 
pulmonary tubcrculovij in diabetic* 213 (0)— 
torrtspondcnce on 3"3 

GlncO'O tolerance curves In 500 obes** ca-es (Dennis 
Embleton) 305 "30(0) 

GLtTCK Helen I (and M RacnsiOEwrrz) Treat 
ment of pellagra with nicotinic add 346 (0) — 
Leadin" article on Jal 
Gljc«>’'iria pre\*alence of 12 l 4 1337 
Gocht Hermann death of 1026 
GoiTErv V Lionel P»a eho-omatic Ulne 4"^ 
Goitre early u_e of iodine for 995 
Gold Coa-t medical efvlce(parliamentarrnote) 1346 

therapy complications of 44 1^- -61 3 o 

treatment of rh nmatoid arthritu ot," 

GoLDrEDEF Anna Te-tlng cancer cures in 
labo atory 12b~ 

ColdhaHN Pichard Die Aru^n/j rtm Op^raitc^ 
Linjnff re\ 340 

GOLDIE M m rheumatoid arthritis and jaundice 
503 

Cold>li 5 1 ictor (and Stephen Taviof) Eth r 
convukiott. with recoscry “44 -Co’Te-pondence 
on «63 9_1 

Coif Medical Medlea! Golfing Sodetr Summer 
m'^tlog 0 -— Antomn meeting 520 — ^beotti_h 
Medical Golfing Sodety m'^eting _“2 — 5tL ex 
Afedical and Dental Golfing ‘'oci ty Antumn 
meetln'’ 4'-0 

re\iew of book on 1046 

Goli_v F L Schlzoplirema 144 
Gonadyl “o 

Gonorrhoea ch moth rapy of 2b0 — Peport on 
2 { anunobeuzene ulphonamido) pyridine MLB 
603 (F J T Bowie) 2*5 (0>— Annotation on 
2^t-^orre-pondence on 3’o 424 4"4 0*^1 — 
Leading article on CCo 
lavage for 4-4 

sulpfianibmlde treatment of oi 


treated with oleron (D F WaLb) 2la (0) — 

Correction 43b 

when to start sulphonamidc treatm nt in 90 

19a 

Goodauu Frances G Organization of trained 
nurses 10 emergency "6. 

Goodbody Francis Woodcock obituary notice of 

Goodwin E St G S Evacuation and treatment of 
pas ca-ualtles 240 

Gofdon Douglas J rav 'screening stand for general 
practice 21 — Correspondence on 2o6 

George E-cape into invalidUm 911 

M H Aetiology of acute rheumatism 246 

P 0 States of depres Ion 30b — P j cholo"j 

of cripple 116" 

R 3L ilalarial endemicity In E Africa 135o 

Gofjkjv Tatiop^ Gordon Cancer 01 brea.t 10"l 
(0>— Di_ca_Ion on 30- — CorreTiondence on 12"5 
Gofer, P A Cancer and h reditv 03 
GOFHiM L AVbittm'don (and Thoma. Opj>wat) 

rev 

I — 5 


Gould Enc Pearce Adeqnacv of curriculum 1^3 — 
Treatment of tencrynovitis and ganglion 41a — 
Correspondence on oOO— Carcinoma of breast 13-9 
Gouxde'V Charles Fffradion of Ej^ including 
Elementary Pfijnolomeal Optic rc\ 6_2 
Gf^arah j Aotochthonous urethral calculn. ICka 
Gp-AHaj Lirrix, Sir E Final 3LB B S Lend lo3 
— Maternal mortality and medical education 42o — 
Tilerc examining body 55 O— Admission of foreign 
doctor* 86" 

Gram H C J death of 1293 
GF-A5GEF E Antagonutic diseases 4"2 
Grant J C Boileau VeCfiod of Anatom j Desenp 
fire and Dcdurfire rev “Ol 
GP-ASzrr E Typhoid endotoxoid Naccine SO5 
Grav Sir Henry obituarv notice of 814 1234 

L P Civil medical organization in war IOI 5 

Gratbiel, a Effect of sroo^ng on heart la" 
Opj^YLTNC Arthur Did Columbus dL cover syphflis ’ 
12So 

Greeff Pichard death of 1236 
Gfeen C a Aetiology of acute rheamati_ia, 246 
Greex ARMTTaGE, Y B Ulegai operation. 12"4 
Gpeenbetg Max Parasitic foetu- snccesJuBy 
removed by c^>eration 123 (O) 

Gpxeve, L Two fatal cases of diphtheria graNTS 
bacteriaeima 10o4 

Greenfield Lieut Jaroe- WTLon death 1116 
Greenwood Lieut -Col Arthur Powland obituarv 
notice of 92. 

Nlajor Mere examining bodv » ^ — Civil 

medical omuiizatioa in war 06 I 


Gregorv Sir Pichard dinn'=‘r to lOOo 
Grenzrava 1093 11 1 9 12-6 
Gfevelixk E Ovarian fever 2-2 
GRlv LlLTC A- Jjher Mflfiyne Soderg 
rev 1946 

Gnbben Grant Pos_ obituary notice 1341 
Gprot-ov G A Pituitary and diab^^ es H"4 
GUTTFrtH Edwaid F 5 x in Leendaj Life rev 
454 — Escape into invabdism, 912 

Evan MiHiams ob toary no ice of 100 

Griffith. Eth 1 Eo^ne obituary notice of 432 
GEnuL, IL Preservation of tuberculous matenal 
fo” cultu-e 14o 

Gedialdi Philir - 

Gpjxkxr, Poy I 
Gpoeveveld a 
hood 293 

Gpo Paul (and other*) S tlfanitumide Therapy oj 
Baderiol Infictwns rev 104o 
Geove E W Hey Fractures o' hafts o fo arm 
bone 29o — Fracture of C“Ck of femur 633 
Growth, some biochemical — pects of So" 

Gualdi Carlo d®ath of (>3" 

Guest L Haden m mb^r of CommL-ioa on deve op 
meat of Meat African Co’oul^ 9-" 

Guilford WTIliam Moore death of IS''" 

Geyn a Pugg Contact Ien.e< «69 
GrTHEiE Don Jas Physiology of vocal tn chaahra. 
11S9 (0) 

GCtt J^hur Erhl'xden dri Augt rev 1-0" 
Gemux'? E IT e» and abn_ea 01 b'*rizi»drin I 
Gynaecology endocrine therapj in 1103 

revif'w of booa. on 993 

Gvnoe^tryl products 2_o 


H 


Haematology revi w of books on I 5 I 120 
Haemoptyau value 01 radiology in eluadatim 0 
(Franklin t Mo^) 211 (0>-~Di_cu. ion on -4 
Haemorrhage following totuill ctotnv (D W 
Ahcroit) 10"9 (0>— Correspondence on 1 — a 

non malj"iiant uterine radio hxapy m (B 

Mindeyer) 10^4 {0>— DLCUs.ioa on 30a 

— treatment of (Beatrice M. MlUmo't) 

800 103" (O) 

oral nake venom fo* 4"a 

pituitarv — 1 > 

Haemo*Thoids revi-^w of boot on 1*14 
Hag n Si"nrd death of loa 
HaOXV Lo d African 6 urrti 1099 
HAiiiorici H LcsrmbflieiAr*e’iellrsdii2Jmf}r 
rev 20 

Had? a M Triphenyl ethylene tes ed cm capoa 
1043 (0) 

TTAtTHN-y J B S Some problems of hura-n con 
gemtal di_ea-e 1100 

HALDty Davl H Treatment ot plantar warts, la 
Hale Mbite, mr WUham Redts « Doctor a d 
Patient rev 349 

Haler, David U e of bacteriophage m ontb-eak of 
inrtitutional drsenterv e^'a fO) 

HaD Charlton obituarv notice of lo4 

E H Evacuation and treatm nt 01 gas 

casualties -4a 

Capt Cilb^rt Capel obituarv no*rce of ""ba 

Sorg Comm Henry Baker obituary notice or 

42a 

LI ut -Col Richard Harm obi uary noti’e of 


S Barton Mental treatment ervices ll<" 

Muufred Ci’tH medical organization in ^var 

1016 

Hallidat Jam»s L Pi-ing Incidence of puytho- 
omatic Ulna^ 11 (0) — Coire-'pondence on 140 
10“ 310 3 -b 4"5 o96 — Social patholcry 10l_ 
Hallowe'* K R CoUis PAieumatoid arthritis 304 
— HyMeU'* of ea bathing So" 42" — Man r.a 
therapeutics 909 

Haaiblex Tboha C Treatment of ca,cinoma of 
pharynx and larynx by irradiation 24" 44" (O) 
— Antrum catheter 6u3 
Haaoltox C K j B“east feeding 249 

M Dunlop Spa.ni of central re inal artery 

9Q2 

M J (A- B APFLETOX and ICC 

Tchapepoft) 5 irface and FadiologicdeAnct rrj 
for StudenU and General Praetitioncn rev “Oo 
Hand and feet congenital deformities of (E N - 
Callnm) 091 — Correspondence on 1061 

and Ungers iniections of (Norman C Lake) "l^ 

"54 “93 — Correction S"4 — Correspond nee on 

806 91" 11"4 _ 

“eptic (5ir David Milkie) 112” (O) — Dl-Cu- on 

on ob- — ^Note on, l-'^^ 

Set cUo Finders , . „ 

HAyDFiELD JONT. Ik SL (and A E Port nr) 

Es entialt of ilodem Ssr-'T^t rev 1313 
Haxdlet W Sampson Chronic ma-t ti a-d 
brea.t cancer 113 {0>— CoTcspondence on «lo 
4 - 1 — Acute app- ndimis -40 — Cancer o' b-ea. 

303 — ^Innocent tumours of brea-t lOsl 
Hax chell, H 31 (ffi^motlurapy 01 goncr'b'>»A 
3"a 4"4 

Hareord P P Blood jresruxe after pinal 
anaecth tic, 44 

Hap.dhax Angiography 241 
TTtpgv, M Y Rising incid nee of psvcho'somtic 
iHn-*' 149 


12 July-Dec, 1938 


INDEX 


The DRmsu 
Medicai. Joltvkl 


Hihkaess John (ind Palrfiv BirL) E\tn 
uterine intra abdominal prejrnancj 1044 
H\rLl\,Da\ld Allerpj and immunit% 703 
Hapman T B Medical research in Tncland 1000 
~ IS Bfsliop Pm C 5 e dropper 1207 
Harold Clnrlcs Henrj Hasler obituar> notice of 2C3 
Haurti*? G Fmra** Mcclinnical rc‘?pirators 1889 

Tboims Paiie*? obituary notice of 601 

Arthur Irofrno-^js of anxioty state; C4Q(0) 
— Corrc'ipondcnccon, 721 7Co 812 022 90G 1014 
lOm lllo 

I Ihgh Jilood Pressure re\ 289 

T S (and C B BiiMt) Cardiazol therapy in 

stupor 449 (0) 

IvcnnctJi and J dith Jhnor Meihcal Operahnn^ 

for 6/mor Jlcdwal Siv(lent$ and pcccntly Qualified 
I rarlitinncr<! rc\ 1147 

pro9fatcctom> 037 084 

llUhardC S Harri<; prostatectomy 037 

Milfrcd Alcohol injections in inopcrahlc 

mnllgnant j-ro\\ihs of jaus and tonpuo 831 (0) — 
Sciatica and its treatment 124o (())— Biscu'^sion 
on 242 — Correspondence on 1 J90 
Harrison Col T 1 and pas defence 20o 377 

I M W hen to start sulphonamidc treatment 

in ponorrhoea no 

II\rTPALi Sfanhy J Ithcumatoid arthritis and 
jaundice o93 

H^PTlFa Sir Pcrcnal Tuberculosis and creatne 
faculty 84 

nar\oian oration State and medical health (Sir 
Iduard ■Mclianbj) 821 — Lcadlh„ article on 840 
— Correspondence on 1000 

1 BfJatjon of HodpJ»]n disease and 
leukaemias U) pastne di ordcr«< 833 (0) 

H^sivn 1 K \iiac3thesla in cardne sur^or^ 310 
If^STlNOS T I’ P&ittncosis I'll 

^ 3 Ml nu re s disease and fruit diet 970 

iTa^erschnudt Jacob death of 12o0 
3I\\\i 1 liilip Pradtcal 1 Unswlo/jical Chnmdri/ 

^c^ 127 

I S Case for diapnosjs 1070 — Cattle 
rinpuorm in man 1070 

ir^UTiioisi C 0 Appreciation of Dr Huph 
Woods 99 — Appreciation of Dr IT ir\cy Caiuphcll, 
I'll — Ifolldijs »iul milk sujjply 203 

1 W Injection risks— case of pas 
pan.srom ul7 — \hdonilnal prce.nanc\ 420 — 
^c^l plaster 1278 

He sC\rn\) 1307(0) 

He leading irticlc) 1203 — 

^ 90 

- ” land Confi fence on 

-1 timati -OC — Non 


Deport 418 

Hi \7tii Mimst«\ 

Annual J7J 42t> ^ ^ ^ 

( ost of incdli il care to local autliorltics 252 

I ood and Druus A( t 1918 1''34 

Malaria therapy 790 

B( port of Clil. f Medical Oniter 9 j7 1004 

'Ircnd of urban niortahty, 1092 

Work of "2 j 

llcaltli Onice International Keport of medical 
director 418 

roiov of l»noks on 4 I 1371 

and uncmploMiiciit 1 7 3 

lUvMiA ( Launnee IrHinmtii amputation of 
finper 813— iliru c\sc of intussusception In 

adults 1 309 (O) 

ITearirip (l<f<(fl\c children nitli Deport of tom 
mittu of Inquiry, 07u— 1 irlianuntary note on 
1184 

in lovMranlmil 245 

— — ri\l( u of l>ook on 1315 
lharn Dt^lnild lohn ohlluar\ notice of 3”8 
Iltart (liict of smokin^ on 18"— Correspondence 
on 

. — p( ri usslon of ( 29 

in n tition to Kk Mood suppJ' 

— • n N (i oi hooks on 9U 114r 1 14 

— — some cardlolo^K al fill Kits (J W IlniuII and 
\ ] Jhiw) ,>})> 44- /f)> 

stmiU on(oronir\ otclu^lon 9j„ 

surplr^ (f U 

-sMiiptom tjfiirtUK taiul till 1J2 

IlHluiT- I r Dl fo\er\ and protiction of 
tulNrcuim rout i«f M -| ndltJ riph>oirJjf t -1“ 
IDUTJl lUtndhc}* tf r Ixp^i'nent lien 1 h iniui 
kil^Tie >ol I r< \ 

Hi' v!T\ 1 1 unriioii of t J ithilhl Cl 11 SI" 

Hi IM l It Is rt ( \n I »tlj r ) I iirnul ' >7'/ H itl* 

r< ?' / / r « ft y//rii :/ ID tut it a f liin/t/rP 

ri ^ lus" 

Hi 111! 1 rit it \ Die I >rt f Im r Ar it r» > 1-“ 

f IN ( m I t th r > hi! r; ft ru} tf d r 7 'ii<7 u 

^ rl ! _ N rev loi 

IN Itfravtn u tiaffv > In p* pfM uhN r “I 
m 111 u I ili-^li (\\ ''t ml V *s\kf' ind 
m iM i I lur tii\ ) t Js (Ol 
in I i nn I N » IHhio i) \tdl ntal 

l J itl 1 l f TIC' 1 ll 

r V r ( Ilf ( I ( vril \ir r li i frt f luti n 91^ 

O V i 1 '' { 1 n ul n u It r from th alr<- 

k\I »t I!" 

lu N 1 I III 1; S J T , f ^ 1 t 111 < I S juin lit. 

I ri >1 Mtf I <atr ]M ) irthrltj >1 (0> — 
At! it' t 411 — l rt-'p n ! ncs tn 4*’- 

C 1 


Hendfpcon r F Swallowed forcipn bodies C2S 
James Abbev appointed to E\ccuti\c Council 
of Island of St A incent 51 

'i.andell Aefi^ntHri « in re<tpiraUnn Modes of 

Ispht/rtafton and Met/tods of J rsusnialion rev 
790 894 

IIfnfiqijI-s j q CdiuH 8 Guuh to Social Sen ice 
666 

Hensfi G SucccNsful aaccination with dead 
tubercle bacilli 383 
Heparin 709— ^otcs on 772 1120 

^and tliromhosis (Charles. H Best) 977 (0) — 

Icadinti article on 990 

Tt « i\ 11 jQ 

677 

n) Ph/^iolofjical 

and Chnieal Clicmi^trj/ 2nd cd Tea 894 
- — JIalcolm II Nomenclature of diseases of 
fundus 8o7 

Herbalist acquitted 1342 
Heredity charts 994 

some aspects of 8<>8 

Humvn loon I rachee of Vrologu rev 400 
— — Martin death ot 470 
Hernia review of book on 707 
Hjfson 11 Treatment of buccal ulcers 820 
IlfpTzrtP ArthurF Surgical 2 athology of Ditia^e^ 

ofl^ick rev 12o 

Hespcridin (vitamin V) tablets 047 
Hlwff G lan-ton Ether convul ions 921 
— — I \clyn 1 lexthook of Ihdologu for Medical 
Sfudenit nv 747 

Ihomas r (D Ow4N and P H WmrviiR) 

~ Apical - ' — ''-'9 0) 

Hickson ding 803 

ltiar«; S ' ) — rrncturcs 

m region of elbow joint 230 
Hnoiiii \NT 1 rof 1 hannncologlcal actions of 
jaundice 5S1 

Hilt A A Fnergv and inu eiilarwork 110 > 

B r llvporsiisccptihihty to basal nnacs 

thotio 244 1199(0) 

I 1 alkner Toachin" of anaesthesin 310 

- — I Mn( Air raid precautions 1004 
— — btr leonard Strict vegetarian diet 417 — 
Corn pondenecon 480 *>9.) 079 804 — Meriianlcal 
respirators 1389 

HiMbWolTii H V Decent developments in treat 

tj « 

V I towel for midwifery 928 

I V t lapti awl Jrohhnn of 

P<!i/chotheropi/ rev aU 

Hlrd Alfred IrnestWilon obituary notice of 1^4 
Histidine in pi ptic uletr 10b 
Histolo-j revKw of book on 747 
Hon''OS 1 C Menslc*. conduct of school cpidt rule 
171 (0) — Correction 27- — Midieal 2 racltct tn 
A/ 'wlentinl Schooh rev 092 
Hod-kins d I ease and leukaemias relation of to 
’ rvtv) 833 (0) 

Lv icuntion of air raid 

Il0fMn8N 3 Con-onthI sj phfJis 4 
lloavN J J 1 thcr eonviiUioiis 1188 
lIorniN I ancelot (editor) I ohUenl Arithmeln 
Suu\po<ntnn of I opulnhon '•^tudu'i rev ffl 
Hoiutv Ovcar M Croydon cpidcinh of typhoid 
10 9 

Ilolidav camp sewage ill po al in (parli iinentary 
noti ) ll8o 

colonUs for fltnc s 47»> 

t\clian-e visits with Ircncli doctors 87 

Uolldavs and milk supple -08 
with lay Bill lob 

Hoi I \NJ» I ardlev (and 1 WaftRlniN) Manualof 
OlsUtnr^ billed rev 570 — biilphanlhmlde its 
use and abii e 908 

IIoiiiNs f T Catth rin-worm in man 1120 
IIoiMi'' ( ordon (inbril liiti-ritkm of oculir 
movtiMcntv 10” (O) — Tiadln- irtielt on 328 

J ( Aplistlc anaemia with rompUte 

ric-oviry 12-o 
Holth '•d en death of fOl 

Hoim OfliCL 1 Nporlfiicnts on animal in 10 7 4o9 

— \dditlons to 1 ol ons I f f r44 

IIOOTON I arnpst Albert tp* Men and Morons 
r«v IM) 

Hoi \N ^ ( (and S (nvlriNCii) suiphonamidc 
in treatment of acute mastoidith 9|2 (O) — 
torrcetion 10”0 

IIoi niu lord Inatnunt of trippicd children 147 

— \lKjrtlon and tlio law 19'> — ereinatinti 2 j — 

Quack lundlT inc tride -t< — IcuUn^ irtick 

on 29 « — Jlrnltk «»i<f « Jia t 4^4 — AAoim u and 
incdhm* '•0| 

Hon 'sjr Adair Neur i thenia and uuplov mont Bo 
Ilormont pn pirath n f-ojiadvlj 

th' r ipv I ookI< t on 1-14 

In kv n i* « oiogv ( 4 

In ina tlti and Irra t cancer ”19 4”I 

Hurrnon ■« di »u 1 ui on (I 

mal tl adin_artith) ‘HQ 

Mint ureiwth 13"i 

r« M w of Niok on 

N lrfv>3 1 t on 10' 

Hopni j Nuttall Amurvim of common iliac 
arte rv MO 

Hon VIL t> H III It* Ti Tied i an! F el lit n to 

2)i ri e n\ I » I 

IIorwiTT e rreatm nt of p uritns nnl 9^“ 

Ho I V ON A "s \ a e inoto rhinorrtio» a witli 
astfima a »ciitcd with ni n tniation 70 (O) — 
Corrc'tsm Krci on felo 


HosForD John bndc cended testicle 318 
Hospital Albert Dock new 900 
— -Bethlem Doval Information concerning 
studv of medicine o”” 

■ Bromptoji Ptjyorff \d 1 i 707 

Centrd Iximlon TliroU Noe and Far 

Physiologv of vocal mechanism 11S9 

Charing Cro s Information concerninu study 

of moelieine oOo 

• Chel ca for women Announcement 207 

■ contributory sUieincs 1171 

CO ordination in Fdlnhurgh 904 

fees limits of gu irantct 470 

Calashiels OjKnln^ of eaten ion 1011 

Croat Ormond Stmt for Sick Cluldrcn bMh 

annual rt port 1011 

( tftd 4th td 7 3 

I uy s Opomn- of new pitliologicil block >4 

Information concerning studv of medicine 50- — 

Prize distribution and opemn- of new sc sion n o 

Iviiik s College Information concerning study 

Of medicine 507 

London I ever Opening of new Mock 191 

Medical College Information toncenilru 

stiuly of medicine >07 — bdiorstein Memorial 

lecture 8.1 

lord ’Nfayor Trcloar Cripples Imitation to 

sj^echl demonstrations I4b 

Afadras Oplithilmlo Irhimial report 1277 

Manor Hou c Ortliopicdic Oi'enuu of c\ten 

sion 9()3 

Alandslev Dcscarch grant to 0 — Information 

concerning study olnudieint 33 

mental nccommotlatlon In Lanarksiurc 382 

olUctrs super innuation sdicine of (parlla 

mentarv note) 47 

ATiddlescN Information concermn- study of 

medicine 08 — Collected Inpers* from MMlJrai 

Stliool 120i> 

modern art for fOJ 

National for Di t iscs of Nervous Sysftm 

Queen Square Ntw wards and nseireh ilepirt 
ment opened 2 jI — I nform ition couviruUig, study 
of medieme .34 

now konernl loiitli opmln- ”9 

Prince s Ahirkaret Do e for ( rippled Clilldren 

rdinhurkh Openiiik of Nutliild Ward 147 — 
Annual imetlngof sub trll>er 347 

— Mirv s Uoyal Air 1 om Ilnlton In pee 
tlon by ITiniis I oy il lO-f 

— lurdysljurn lever lesident superintendent 
appointed 1 jss 

Qiueu ClnrlottLS Maternity Auuuil report 

075 

— Dotunda Deport 470 

—•loyal Dental (london) School of Dental 
Surury Annual prize dl trlbiitlon 7 »9 — Annual 
dinner 1171 

■ Fyo 3 \lilbltIon 27 — Meeting of cllhlcal 

loclctx, 116? 

— Iret (Tondon Sdiool of Medicine feir 

Women) Iniormillon eoiucridiu t>tudv of 
medicine >3- >24 — (Jpenlng of now ses ion ‘'04 
— Annual dinner 1-22 

Maternity Belfast Opening of new w hip 

14r — Anmi ll repe.rt bOO 

National for Blie^nmatle Diseases Bath 

Ball in aid of rrbiiildlnu fund o87 

St Bartholomews Information conee ruing 

study of ineelicme 08 — / jmrtK vol 71 1080 — 
Ohl Student dinner llOS 

St I bbv 1 p om Opening of eatenslons 

1107 

St (eorgr*8 Information conternlnk Ftuily of 

inedielne >09 

St lolm of Jerusalem Iromotlons and 

appointments 04 

bt Atirv s information concerning study of 

imdlrlni 09 

bt riionms s Information coneirnlng study 

of medicine jlO 

servlets rn operation In 12-3 

Soutliend munlilpal I oan s-metioned Ibl 

Sunday 3 uml Alitropolit in Besult of collcc 

tion 444 

Fvstem iiitnre di ichq.ine nt of ”Ci 

Univeritv ( oil' ^e Medfeal Ncliool Ceriiirai 

Intf gr it Ion of oeu! ir inov e mi nts 107 — I nfornnt Ion 
ronccrnlng stjnh of mc'dlclnf 511 — listirnt 800 
— 1 (port on rndlothfrapv 854 

Wariufeird Appointin' nt of I'hv idan uper 

Intemlcnt 0 

— West 1 nd (or Nervous 1)1 'a os Information 
conci rntri- 

Iriiulon Inforiintlem contcrnln- study 

ofmcdlem 1 

WetmlntT Inrormallon coneernlrig Judy 

of medicjn* 11 — 0|»onin„ of iif’w < ion — 

Lxpe n'iiOiro for el etmal eqeupment IJ" — 
AnmnI elinm r of fast and pre nl student 13^^ 
Wjn_ficld ilorrjs Ortiieqiae elle ^lits to 3 1“ 

1uN“ 

zones m wart uiu 109 . 

Hospitals In tol Miri^eiratfon spfrfiH t^Tvi < i< t 
b 

Centre BJrmJn Inin 1 ov il ojh nlo- e» re me ny 

1 s — 1> a'lin- nrtldi on l-> 

let Hou air'utitnenf ”0— I-iy analy Is 

at m* ntil iKHpItals I2- I 

lond'U Information c-onnrnin- dmiril o — 

— ''fre troIJfftjon — Anti air rail <3* 

m ntal tut rnilo I doatti rat In "t 



Juu Dec 193S 


INDEX 


The BRmsH 
Medical /ouxs.u. 


13 


1 mt'\r\ Imi In finin'^ (1 nlin^ 

nrti I y .4— I n rinn In-xt 'o - 

•4^*' 4‘« >- { ' — ton»initT> f r Ix^ndon 

lc»4_oi xh tn n - I 

lion numfw r I uftt x 
ffou in* wn liU n In Inncif <"■< 

(I inMiflil lm\t son ) ('♦a tlm 1) 1 ill llx 

— — nnll hoi cxhiUti'W xj 

HowAXkl Mmzoi 'll d 'ith < I 111 ■> 

- — t 10 111 niicm'nl h 1*0 (O) 

Hon vrT»i \A 'liter (ml (olriN I vtf us) 
'll toi 1 oi\mtion< 1 01 (0) 
llowiii C 'I Ilin^ lo-<p* \tiin In c-w< of 
il 111 lix-i 

Ilonu Tnni'x 1 XT' rlin ntil n pcot of trept i 
ooct-iUnf'cllm 1 Ox 
Hnl m AAilU'Vtn oUtiu ^ noticoof 4 
Hu PI** 1 Dlinm I d ith o 10_i 
Hi it ( hN ( (ml o hrix) / iw t 7/ 11 iM 

S;x.-i }} f r n-vl Ifan triljh rtr {''Vr I 
rrx lOx 

III firx < 4 Trr-itmrnti f ui> rf nJ*K>v<ltI “_x 

i tr^ll X ^l^l \ to Coinmi k n oi 1 lo fer 

tit\ cf Ao k 1 41 

\\ Kent Qumtinlit ircitm<'nt 4-1 

HviTnin l«(xl% I M T. oi Ivx^V. on \4 

1 il In tn itni nt oI n Ih nnt nr (Ct. ill C 

AA-ik 1 Ni ‘lx (O)— C irmi md nx on i » 1 i 
III \s I I rlian T nchi i* of nnmth'Xvln 10 — 
1 Th r roniul n n ' “ 

TTinux l rnlnni x^m ntrncto forjhtu tir rj 
lx_ 

Hun u fnrlnr of r f 

tnrtiir'x. of in^t md nbnpltnl r' in of 

(T I M Mum\) 1 4 
Hr^parT ( I xmsji mini r 10 s 

Hui i % iMUiumznIon n nun t difhth-'rn nnde 

DiW/l ll 7’~i 30.> » i 

Hist Vim H (ml Fne C O finrnrr^) 

1 r orit 1 y^ptio nln r livo snnic n r\uu di a 
I0x„ (Ov— <c mpon hneo o i l_*i 
ITi sTrr IXmnU ToxK mf cti\T jaundice 2 — 
VnxiiU tit*- n_ 

J x Vninthoxn in thorncic ur^'.r^ ‘'11 

Lint <il T ''t Inach II opernnon fj- 

pro'titlc <.al-ir ni nt t '‘a 

AAdnni simi iirmt or trnl labour and 

1 ctnn ot n X. li 14 (O) 

IItrpMr^,r Knt< (nnijl !l /Ti fan 0/ rrmi^n »i» 
1/ fi I J^/roni iarfir T \ m / ''nfS C t(ir/ 

r a -*l 

HrnjT feir Arthur Toml InftK'fjve jiun Iks w'l 

HtTCiiPxO'x VV r -vchoomatic iflun “« 

HlTUiisxo C A Adrcnnlme tr ati i(.nt of 
A tlinw 11X2 1_"9 — Ca fordM^noi 1*44 
HntilixoN Rol rt TMtfnonial to I“o jO— 
Op qih'’ adlfc*- to AVcxtimn t r Ho pltal Afr^ml 
school “oi 

Hvinmnuv t^ o comprcx od f»x*u n and livins 

I \ba X uou ual enu o (F 1) Blunt) 0 

Hvdroncphroi nia. t\c and pre- nam'd L Dodd 
ani r ahj 1 > r 

Hn*i m n.M ' of iKKik on Ixft 1044 I04 j 

— rural and l-ea^’ie of Nation a 

Ha-ptrt mion fe\i u 01 IkkuA on 114x 
Haprtonn In po^t-cnccpIiaUtic Parkmsjni m Il*b 
H'prlridion 4'’i ' 

Ha*T>oul'cacraia pontancen (J A Bricv and A B 

iuapT) Os" (O)— AoTTixponl nee on 11"4 
Hxpor^padia complcti m of (4 J Murray and 
^ BookhaKer) t oO 

Hvpothalamu rcaa w of iKXfk on a“0 
Ha t ria ncuroliy-ical tudv of *09 
Hy tero-xalpinpo-irapha with eh ctaimn" In-tni 
inent. Os 


I 

Iceland mcdiane in 100 year a'^o oxG 
IcteriL _Ta^i neonatoruni q> ecu dv trophs 
folIoMin* U__ Ufp 
Iramumiation a am t carkt fever »» 0 

iKConE Tax 

Alluwance for wife earning C04 
Arma {ua^ while at road -Os 
Back duty paid — allONmnce dm. 02" 

Capital pa\ in nt b\ instalment o_ 

Ca h I a 1 sN 
D'ductible expen u C44 
Deduction lor a^ 1 tant s hou e b 4 
Jxp^nditurc on appuatu and book, lot 
lap 1 . part time M O H 4^i0 

propirtinii of t“o 

■nxten ion of allowanci. lor children OaG 
Lii a. urantx rein.! educational pohc\ lOi-x 
Afoto car 01ix:>Iexcence o_ — rroic~ lonal u e of 
Itl— Fxp-n-^ 4''r G44 b"4 
Partner hip hare increa e in 8 4 
1 (1 avment cMoan 1 jft 
Sil of pencral jracfice look debt Cno 
'*tr\acx '^atnity C04 
stock of material dru^ etc. '"_s 
Ti-x deducted from annuity 1340 


Incontinence from arcumulation of faeces in rectum 
(Harold Dodd) 6-4 
Indexes hxlf'carl> 1 3 l’'x 


IspU 

V'. wlatini fw supjhin^ Medical Aid \\ AVomen 
to VAoin n « f Indii Amnnlriport It" 

IV n a| Hou iHL condition « n — ^Alodtl health 
unit * " 

Fnlcrlcf \ir« in Armf‘« I* " 
lund t Mnt -X of Duff nn 46“ 

Al-ilrta OpUthalmlt Hwpital Tri nnLal report 

Alxlical unemilaxm nt In 462 
()] im« mokin'* In l_ " 
limn in Bond a\ 4is 
I opuhtlon of I nnjal 3 j 
INJ ljal fpfdoml lo' ical Furr aa f " 

I port of I ul he Hralth ( ommi loner I-"" 
Small pox control in U''*i tlon t0‘ 1 UxO 12_s 
lulrerculvl campai n ll" 

Ki \ p o1 1 m of ■» 

A\om nAAI-Mlcals rv ice for o 2 j 

IndiLtnalh alth research o 1* 

Inlntra h aItJi in (! adinj; article) rs 
In I riat f mal iroll nicf i_ii 
infanev di r i s oi rt'i u 01 IhkiK- on 4o. 114" 
iQllrmirv Duinfrl'x and ( allowaa Ito'al Opcnin? 
oi auxiHirx hospital I01_ 

DiinWllrtal Anntnl matin f"t» 

— Cer ral at l^tal tutor Iron Inn x-., 

Itoa ll I Jinl uruli Vnnutl m ttlou 01 Lca'^'* 

of xijt mlK-r 1 4 

Vutoria tlvsou Coopratnn in hospital 

raao^r l__t 

Intlu nta immitnitx in llCa 

in titut fo lulvof In Hi lap* t lot 

I>rio.{I i(t or luta 

Irfra rtil ra\ fir n iiriti l-Or 
Is HIM JiUn xtall odium nltf pm dr' olu 
tl n f«r aistnn t lis m titin 34s 
Inhaf f mijl Id 

Injctiiarik — c-i of '-a< 'nn ’x^ne 1" 

Inrju t mxlicalcaad nc* at 4 j a'** -s 

In-tituti. JJ iti h rflCadii-fn 4nnu»I x>n_rtx 
I- I 

• C hll J P 5 cholo-n* 0| oin ofptwp mi.r' vO 
— BomIti It to CInllcius Crntre 11- 

1 rlanini II alth lone Scho at hip 49 004 

< a'diner t f Af iiejne (h oir Ofxojn'' "CO 

tor hvsun ocul ni'dleine and indu trial 

patholo J fo Lra el lol 

mcsliro leml ijO'crnment aid withheld 14-— 

Anno alt>n on 1 o 

\atlf nal of Inlu trnl P acholcrn Prtirem nt 

of D AI\«rrx 9_" — Annralrtport 1 -1 

1 a. tin hth anni\ r arc of "-h lOo 1.^-9 

VI na Anti corpm'irum XlO" 

r 'clio Anah i Cour x» trxininr o.>4 

()u 'CD ot Dutri t Nut in_ bcheirc of 

tiur Ins tun nt for L»Unl»tr h 9i4 

lalium IntorniationccQcirmn'’ 0-5 — Annual 

nport "U 

Pox of Troncal H'ciene Appo ntroenL. 4"0 

— 'Ro\a! o hnti b Arihittct Small hou e 
cshilniion x4 

tor 8ci irlfic Treatnunt of DM o<iuenrs dinner 

in aid of 1*-. 

IiLtltution Iriti ll Standanl and p» r«onal -uf la 
euuipm nt 34_ 

——'Crichton Poval Dnmfric openiD5 of addJ 
tion 01 

Liverpool Medical I Kiiral ctfn-ioo. 12-0 — 

Pathol«x.v of chronic aortic \ dvular duca..c 1^3- 
Id trum nt tol n x-4 
In u!in re»i tance to mdiaUticx iiO- 

ani Viiainin I I till 1 

In iirancc for ni'slieal prof ion 

Is rraxcr NaTiosvt Heatm 

Admin trati'c co't of lisa 
Approved ockti'x iKnetn 134" 

Arntralnn cluine — 400 

tost ot health in urance for dependant -6s 

D ntal licncBt l_4l 

D pendant and 11x4 

Incapacity 01 m urcvl workers m Scotland ll-o 
In urvncc practition ra No in FnuLind and 
Walx 10 — I o»t_ra luate eouixex for 11-" 

Aledical certificatex H_3 

«srvirc OI dependant In Scotland IIS4 

Nett Aaltnd 4oC 

Resional medical reftreneex ^x^ 

AVomen medical in pteto for imurcd perxon. lo" 

/nJernu^o»Wt/intc \er I t enc« \ol _ rev 290 — 
vol rev Z14x 

Into m cept ion in adult tliree cs’ms, (C L Heanev) 
1309 

Invaliduin C'Cap^ into on 
Iodine lorcoitr carh n cof 99a 
lodo-catf jre elixir X148 

Iraq phn lor improvement of xanitarv condition. 

1 99 

IFEL-Vsn 

Apotli-asi-icx Hall Information concermnsr aO 
Dublin lever Hospital board nr 1 report ot SM3 
Medical memberx ot «ei at amf Did 4"0 
Tern tration in oO 

Pe eanh Council Award 146 laxs 

TulwrcuIoHi in B^Ifa t l^x^ 

VLler Aledical *k>cietv ll"a 

Vital tall ticx for ‘Northern Ireland SoO 

In pattern revi wofboo«,on 4aa 
Iron Iua2« See Be^pirator 


Irwin Alaj Gen jamo* xroirav ol *xiary e ■>» 
of 1116 

s T Fractorea involving kme joint "ba 

I AAc P E Treatment 01 buccal iilcer« 

I EUs AI Infection of hand and finzer ll"» 
Italy dismi-sal of Jewi h profes o-^ 1^" 


J 

Jack_on CTiex'aher autobiocrraphy of 003 

• K Iractored olecranon pyronal exj^ 1 ne 

6I3 

Jacobi AValter death ot 4“o 

Jaft-birh fur I tnr^^rfi^niiindf nov intcmational 
journal 1193 

Jamaica Aledical rvace appointment 
JvMfx K L Volnilu of p»Ivic ml)a in vornr 
p* r ^ i L niLsmal cumplication 01 apjv ndicec: ^mv 
uO' — bnaferai mpfore of qnadno p^ tendon It/’ 

( ol & P AlaLirial end mtcilv m E Ain*'* 

!>-♦ 

Japan lopulationor and No of docto" in "Oj 
J iFMvx T Frann Condition ct our«inn -'"vicv 
5- 

Jaundice catarrlial -.al 6 oi r 

pontaneou ctfect of on rh umatcid (a^roptuo) 

artliriti (Philtf s Hcnch) 3 M (O) — innota j'^n 
on 411— Cwre-pond nee on 4 - oOl 0-9 

toxic tni imtctivL (C E takm) 4 ■■ (O) — 

Di (u on on _>s— Anno at on on o-xl— Corre 
ponl nee on C 1 
Jaw nappm- I-J*- 

JiJrrcoiTF-T A[ A Ct rineinertm 9^9 
Jimn-Os ( eotfrtv \erti 0 0" 

JFlLnr ITenrv Treatment of placenta p a vli 

Jfnmm IXnv Identical cano. m id a ica 

twin 919 

— — r H (and V J cuzebfoo'*) Compt » I't*’ 
cbnicaland UoM picturex in aoolt curve ■■ 4(0) 
— Annotation on 1.^— Co^rexpond nee oJ * j 

91x 

Jis rs JtiJiii Hrc/f in Fr '"’I'T/ic’/ rev 1140 

Edtuvi ( nJ (3 P aj ArxEV) Anfi 
p nicjoiL principi ora exp run nt with 

unnf' 9 J ((3) — CorTe-*poDlLna on ill 1 o 

Jortmv Hnroli Powt, ol iluary rotice of 4 t 
JL L, Ceo V sknnTaphv of ch t -"o (0) — 
Dlcu ion on _4" — I^rv'ention 01 tub culos*- 
ol- — ^TubsTcuI ►‘L di r^c ari“a cr eb'x.t dinito * 
"Oo — a^rul radio'Tnjhv m ch“xt di>-xi e 1010 
JEWTxBrrv Eric C o land Alan H Hot) Per 
lorated p*ptic ulcer in or-anic n rvou d* ea-s* 
XO - (0>— Aorrv'T mdencv on 1— t 
Jauv Ardx.hir D D dine 01 b et t feedm- 1 91 

JchiLon Ah'e N vill A t we 1 9- 

John tone It A\ I'rtvcntion ard cont ol 0! 
puerpt-ral pai ihclndinnit medicij-l-xal - l ’ s»e 
3al iO>— Di cu ion on -Oo— Le-din* anul on 
uo-— Trj*4».K JL J MiJnfr/ for der end 
Prartili ttm 9th ed rw a 0 
— - Sir 1 obert Jam obitnarv noticv. 01 o ♦ 

J0L\ J fettnit TuiiDjr ot 1 ladder 1 -J 
Jonf ChextcrAl Dit j*ir IrnctFcm Duijn ti.i 
and Trnimrrf rev 0 

Errext Lncon ciou mind and m“d.c2j 

practice 193 

J Trxatment ot rrurittL. am S_0 

JMtr- Cart Kenneth HorLtoa** obituary 

noti X of llsl 

A Lnirv" Tnbercnlo-i in rur-l n. xl ^4 

Jordan Lieut Col John C re'’0’v obitoa y no ice of 
s"’ 

Journal 01 duea ex 0^ m talxib m ard 01 discs ion 
Dew Cemian poblication 9 ^ 

—of Aeiirop^y \ t -ij I lounded 404 

of Pedi/Oncf Novemlxr i ue devoted to D 

Williams McKiia Aiarnott 1-.9 
r „ 1 rt* 

Jnii in 420 

JrNc 3on D 

comerreu oa u i 

JuTi prndenre medical r vi w ot TiooV. nru 2il 


K 

Kagan 9 jt 7 ,y ,i;}i LtU^rs of Ft tfjry II 
Crrnt^n rev a _ 

IvAHAS Leon Ttachin- 01 Ob'! t icx o. 

Knnavcl AUtn Buckn r D ath 01 la.^— Jnl' is-u» 
ot S ry n/ b/vec/j?/ aid Ol<~ttrfs devoted to 
4" 

Kappi Jlax deatJi o "-i 

KvYNE, C « re-’orv lai liu-oraplij of cl -4 — 
Prtventian lul rcnlo--’ ol- — Ttil.“'"CtJoi 

diTvnxarjcx c cb-x-t chnicx- t* , ... 

KJ_vTt„ H C Contrtlof mall f«o-^ m Iniia 11'-* 

Kcat roM w ci l-oc^-on o49 
KxEvii, No a L Aontrol 01 balim.! "-x 
KEITT Alexander Al rdeen to-dav l>o 

TvORt r x K Trf^atm nt of plac^-ta r a 'la 1^1 

KELLEUFF I> OvedotrA O* p OOiaial '“Fa 

Kendalu Jam'x. DreaP-' Frf It Trrth c'*’ * 
foioriGt rev C__ 

IvLVXEiiY A M (and D A VTIILIA'^ ) A lu'* 

of aram nn" and 3lf''rjrf'*<IiatheaL, (O) 

P C 8 London era r^enev N-d emce 42.x 


14 July-Dec, 1938 


INDEX 


The Burnsn 
Medical Journal 


Kennon 11 Septic hand 302 — Infections of hands 
and finLcrs 917 — Air raid precautions 9 Gj 
K enny method of treatment of interior poliomielitls 
report on 8 j 2— Leading article on 841 
K>r F I (and others) Obscnations on potency 
and 8tabiht> of Dick test toxins JOO (0) 

Keratitis from ^^orkm" iMth creo otc (G T Bird 
i\ood) 18 

Keratoplasty 43 262 

KrnrFi P V rass and haemoptjsls 244 
Kfpr DouKlas J A Cremation Act and Kecula 
tions 147 

T M jMunro Occipito posterior positions of 

xertex 240 — ^Pehic measurements 422 
Kersie\ G D Rheumatoid arthriti'^ 304 
3\.r\Nrs Geoffrej Cancer of hreast 302 — Hormone 
tlicrapj for mastitis and breast cancer 471 
Kidney double cured by ncplircctomj Go9 

renal pre«sor substance 897 

IvlLOALLES X T Acute spreading cmpliyaomatous 
gangrene 928 

Kilver 1 lomfret Injuries of nose 248 — 
Disclaimer 772 

KiND4RsrE\ Charles F Fricturcs iniohinc knee 
joint 3G4 

King Appointment of Honorary Plij&lcmns to 428 
725— Speech to Parliament 1020 — Debate on 
Address 1020 lOCC 

Charles II death of 1039 

George III (1738-1820) GG4 7G4 928 

IviRSliNFR A (and T & 0 UTin\LliL) Gmde to 
1 etcrinary Para^xlology rev 407 
Iineejo/nt /ractwres jn^ojiing 304 

Injuries to rcMcw of book on 893 

IvNianTS Trc\orn Personal experience of tetanus 
233 — Sterilizatiou of syringes 970 
Knocbfcimacbcr Mllhelra death of 155 
Kocil "Walter Bcncht ilbcr rfa? Frgebnx’x der 

OhduUion dc<i Gorxlla Bobby dcs Aoologxschen 
Gartens zu Berlin rc\ , 288 
KoiB Action of quinine in myotonia 77 
Koinbctin ■ " 894 

KON S K 

KoUMZ )d supply 78 

Koy \cs Richard rUetTothcTayn nml light Iherapy 
Ord cd , rev 747 

Kneke a Textbook of Clinical Pathology rev 70S 
KRFBb M alter Die Bechterciische kranViext 70S 
Krfis Boris La Maladxe d Armstrong Chorio 
minxngite 

KuJSirr (an der Lungen 

UibcrKulo8( 

KtIzr Paul death of 1020 , , 

Krovffid Peter C Introduction to Ophthalmology 
rev 350 

I\iC7yvSM Jurgen Hunger and ^york StaUsUeal 
S(m/jcr 794 , , , 

KOvkHj 1 INy chological mcchanlams In child 
flood 299 

Kirx/ Chester M Orthodinfcopy rev 1314 

KI/TAK S H Intrutraclical adrenaline for relief of 
asthma, 927 


L 


Dnhbf MpIion«c death of 724 
laboratories Bernhard Baron Research pamphlet 
on 52 . , , 

laboratory National PI»y«icaI lieu day, 2« — 
jSou Director 972 

— — Strangcuays Rcicarch \nnual report 13<G 


labour nilmlnl tration of pituitary extract in third 
'•tago of (Ceorgi M BloinDcld) 10S3 (0>— 


d blood pro lire 272 
cysts and (Vfo«tyn P 


1 mbrey) 1201 (0) 

■ rare compile it Jon of 102» 

safe ion , . 

trial nnnagtincnt of aiul ^election of ca«e'> 

(\Niniam Hunter) 1134 (O) 

trial and p<.h ic measurcincnt« 422 

LalKmr Olllot Intfrnatloml biippJ» ment to Orcapfi 
tion and Health publhtKd 19- 


Ti (JMFP loui-^ \MlIJarn linger prints of turn'; 

UO— Obitinry nolle* of 431 
Uicldion '^re Bua t fuallUn 
ljn.tona\lne 

1 \i>i L! 1 Mac*l<nnld Uncon«cloin mind and 
m 'dlni I ractl* I 1 0 — I rof.no^l'^ of anxkty btate^ 
“i*3 

1 \ior< II Ucn ( lini al of J sycho 

analjfit trail litfon r \ "O'* 

1 \KIN t I loxle and iiifittivt- J'vundh'e 4o7 (0) 
— 1>( cu i n on _ Annot itlon on ^si — 
l m'^ponilcnct on Cs5 o( (> — 1 n-Hndof J/'tt oiii 
s 4 1 — sidphainl imi h ‘> 0 ' — Larclnonva of I ladKr 
I 0 

1 \n»! \\\ ‘'Ir 1 atrkk I tr*/« Jh t and \ trusts 


0 *. 

I \tN 1 r 1 rl k ( ins ''h lti I>fe H\ * rg and 
ll( If t J> al B It r* \ 40'^ 

I in i '-N Ip \ Xf s.jiii {jTid* \nii 1 In illmatlc 
\ iN IM | \ 

( \K» V rinan < Inf cf( n of Kan I an I finc»*r« 
"I “ot "‘’'--t T ctl n p"! — t«>rrf>p<^inil no 

1 ‘I" ll'i—A, i n\ _nlol 9n 


Lvmbeft Dame Barrie Lax anah*sts at L C C 
mental hospitals 133o 
Lxvia M \Vhooping cough 28G 
Land aoluntary national register of for war time 
1391 

LiNDATJ Intraxenous «5cdatixe3 in peptic ulcer 713 
LiltPEF C Development of hospital system 366 
Laxodon Bpovvn Sir Walter Recent adxances In 
organotherapy 773 (O)— Discussion on 3G1 — 
^fedical curriculum and pro ent day needs 481— 
Correspondence on 589 639 921— Escape Into 
invalidism 911— IPe arc Men rev 1146 — 
Hon LL D conferred on 1276 
Lxngdon Damf*^ John PamcandAILP 1328 
Lange Johannes death of 724 
Lange Meyer j Medical ex idence at inquests 728 
Langston H H Treatment of poliomyelitis 964 
Lwkester a Medical cxidcnce at inquests 596 
L Annie Thirapeutique 1937 rex 623 
Lxforte R Pre^icrx ation of tuberculous material 

for culture 34d 

liAQ^RFliiPF A (and L Delherxi) Tratf^ 
d iileetroradiothirapie xoU 1 and 2 rex 837 
La J ifonna Medica issue dexotod to two congresses 
1398 

Lapkin Eduard Bcbaxionr of patients under 
insulin 144 

E H Disorders of adolescence 369 

L\rke\ Sanford V Facsimile of Preservation of 
Sight etc by Andreas Laurentlus Isaucd 454 
Lxroche Gux la Puherii £tiide Chnxque et 
Physiopathologxque rex 131o 
Lary ngologi t s debt to research lOOS 
Lary ngolOc,y and otology diploma In ooO 
Laryngoscope origin of C04 873 
Laryngotrachcobronclutls acute 070 
Larynx carcinoma of treated by irradiation 
(C Hamblen Thomas) 447 (O) 

treatment of carcinoma of and its results 

(Lionel ColfedKc) 167 (Oj — HlscusMoa on 247 — 
Correspondence on 2a0 

Lalpencf Geo Rheumatoid atthntib and jaundice, 
692 

Laurentlus Andreas facsimile of Preservation of 
Sight etc i-^sucd 454 

LvuriL T Shanks Sulphanllamldc In acute 
maxillary sinusitis 200 
lavastinc Laigncl prcacntation to 1356 
LamFEnce I O Cyclotron 2a 

— R D (and Kate XLxdpefs) Employ ment of 

* hypoglycaemia 1174 
27 

— * » u s/ ^ ley Sakes) Helium 

In anaesthcMa 448 (O) 

Lv xPEP U Modern decline of breast feeding 915 
LeacHnfl Articles 

Abortion therapeutic and the lau 22a 
Air raid precauHons 749 
Artcrio«c(croM 1317 
Blind man m religion C27 
Blood platelet 1090 
— “ tc»ts Bill 1210 

British 1 harmacopoeia next edition of 1264 
Cancer Government xersu 1091 
lung 184 

Codeine ns Imbit forming drug 997 

Economic «tatu» and hi alth 1373 

Electrical injurie’^ no 

Enctork'^ lighting In 131S 

lood nnd Drug Act new in U S A 4a7 

and nutrition 89j 

Conorrlioca cheinothcrapx of CCo 
Har\ clan oration 1939 MO 
Health nnd agriculture 120a 

Indu-strnl o7b 

Heparin and thrombo^l« 996 
jlonnone^ male 9t9 
Hospital xoluntarx s stem In figures 24 
Ifo^nltalx centre pioneer 120 

12Ca 

109— 


"Malaria ca. onal pcrlodlcltx In 
"Matcrnllx «erv lee for N eu Zealand 793 
Medical profe*' ion and the cnicrLcncv 710 
Midicme^ quack and ob curanti m -92 
"VlUk raw and pasteurized 1049 
Mortilltv inittrnal rate-^ 9 y 
OcclpUo posterior tri e u7" 
iathologv status of 1149 
lellagra nicotinic acid for 3 j 3 
Etlvis are peine m^a urement-* uorlh taking’ 
-91 

1 lithl I niana_Lment of 
Fitnltarv and diabetes lol*^ 

glind 137- 

riav thinpv am! child guldanct ll%/0 
I J\ mouth Hans for 1-9 — Meeting -24 
iohornMlitis anttrior treatment of 841 
I rcNldintial address I*' I 
I adiuni b am therapx 1209 
Rinat pre> or uh tanee eJ'" 

I ork» fill* r and frontkr* 74 
Sci ret clinical 1 -n 

I ui rp#*ral prexentunof 3*>- 
'•->cnl rxict Coo 
‘'tall lira of wag "9| 

TKam'^ watch on 
Trial of Vir Boura^ !*•# 

\ i ’on greate*“ 410 
\ itamin I compl-'x 6- 


Leagce OP Nations 
Anti epidemic work in China 33 
Conference on rural planning nnd hvglone lOjO 
Drug traffic and United Kingdom 9ol 
Health Organization "Meeting of subcommittee 
33 — Treatment of malaria -27 — Radlotherapx 
of carcinoma of cerx9X 669— Report on ass( tanee 
to^Chma 843 — Codeine as habit forming drug 
997 

Hygiene rural 78 

Opium production Limitation of, 414— Conxen 
tion on 713 

Survey of health services of Belgium 709 
Lexk W N Catarrlnl Jaundice CSS — Air raid 
precautions 1234 

Leathapt Pcrcival W Biological s,j.nincance of 
tonsils and adenoids nnd other external lymphoid 
masses 835 (0) 

Lerxpd Ledoux T ray diagnosis of gastric cancer 
1272 

Lfbfxu F (and G CotTTTOi®) Traili de Pharmacte 
Chimiqtte 2xol3 2nd cd 1200 
Le Comite P M cm C A^intfpnit 7 and R M 
Thovla*') Btologi/ of Arteno^cterosis 1317 
liccturc Blair Bell Memorial Uterine Inertia 959 

Dawson Williams Memorial 30 j 929 

Guthrie IlOo 

Kettle Memorial 1000 1102 — I^cadlng artick 

on 1149 

Lloyd Roberts Problems of human conctnital 

disease 1100 

Macalistcr This mortal coll 8o 

Norman Kerr Jdemorial 847 

Rede CCS 

Schorstcin Memorial Haemolytic anaemias of 

childhood (L G Parsons) S51 
Scraon 1003 

Silxnnus Thomp on Memorial 12“2 

A ictor Horsley Memorial 34 — Cerebral Integra 

tion of ocular moxcnicnts 107 — Lt idini, article 
on 22S 

W E Dixon Memorial Re Istancc to experi 

mental cancer 807 

W lUmm Slitchell Banks Afcmorlnl 9^1 

Lectures CliadwIcK 1 ubllc Iro^nmine "02 — 
Congested populations 902 — Control of pucriH.rnl 
fever 1378 

Harvey JnNcwAork publication of 33K 

Hony man Gillespie 809 

LibiNCHAM L A i angrene of colon In Infant 9-7 
Ljf Niaurice New Intravenous cannula 1402 
ItFLS Rol^rt (and others) 2 sulphanllylamino 
pyrid " of gonorrhoea 

1142 

Leftf Ijstrvations on 

potency nnd stabllitv of Dick tist toxins 700 (O) 
LiIanu W R Brdi»A J enodieals of Medieine 
rev 747 

Li ItEMiNO Sir Kaye Difficulties In co operation 
CS — \ppreriation of Sir Robert Tohnstone 071 
Leg congLUltai deformities of (Rc,.lnnld Broom 
head) 1311 (0) 

Ll ITCH J Nell Dlsclnlincr IOC 
lUTNtR / A Grenz rax tlierapy 1170 
Lrv!li.rrE A Suicide by lul)erc)D haellll 4 
LFNhOPr J Carotid sinus reflex 3 j 0 
Lenses contact 360 
3 cprosy effect of pregnancy on 39 
Lett llu^h elected Ire Ident of Royal Collete of 
Surgeons of England 183 
Ixjttsom England of 819 
Leucocytes transfusion of 1092 
Leukaemia review of book on b-l 
Lcukaenija'' and Hodgkins d I case rrlvtlon of to 
gastric disorders (F Harvey) 8^3(0) 

I/ixerhulmc Research Itllow ships and C rants 313 
433 

Levitt W AI Treatment of uterine haemorriiage 
309 

Levx IIcrlKJTt fcareoldo is of Rocck 020 
LtvTT Afax (1 Com NOT nnd Id Cnfiiinit) 

1 e Duodinum Mins de I adiologxf CUnxpte rtv 
945 

Levy S Di clalmcr 1023 

LFWIn Louis Drugf their Cse and ibuse (ransu 
tion rev 792 

Lltt/s Aubrev 7 States ot dfprrxsJon tbeJr 
clinical and actIolOni<*al differentiation fe7»» (0) — 
Di CTL ion on OG 

E 0 Ccnctlcal problems In mental defickney 

14j 

Ivor Di claimer 874 

Ilcut Col btanlcy Lverard obituary notlct of 

1230 . , 

AA P (and r Huntlj AVOODCOCK) Canned 

} oods and Canning Indudn/ rev »»71 
I^wiss Jfedical and scientific Library Catalogue 
part 1 1371 

Llvcis I ANixr E Trend of urban mortality, 109- 
Librarj Surgeon General s founder of 455 
Light In relation to climate and health (AA J G 
Atkins) 50^(0) 

Liilie Geoffrf 
Lillinfston « 

Lindsay Cohr 
and public 

IiNG if C Two fatal casi'S of diphtheria pravi 

bact/‘riaemia 1034 

/ iyvell j W (and AA A I T/IOM ox) Sorn^ 
ca dlolo'-lcal falbci*^ 442 (0) 

I ixniN PolK^t O Idiopathic epikpsy from another 
a.p-'ct with treatm''nt of ft b ^orrespord ncr 
on 9* ‘ 



Juu Dec I 93<! 


INDEX 


Tre BvnsH 
Medicvl 


15 


Iip cVft of 1>C2 

liter •vt I nl\ir^U\ CoU'-sr tirj llo'j itnl '>CK) 

H ut Col \ L J ^rr cclatlin cf Dr Hi ttr 

Di’l'^mlih Sir 

''pncvr IrcplijUctJc Inoailatlon isnin t 

rn..nnionin 11*4 

Little Cixrcc WhllP U olltuarN no lex of *^*l 
iDrr «tjrv».r% anl 1212 

IjNxrpcxl \tjrinlrrpo toflortll xlth \utho Itv 
4C9 

Ltoir J H \ Unnun C In mlltv 

O Trextm nt if rLa<xntx p ie\li 1^1 

- \\ L \ ra> xntl liAcmoptx'^'^ -4 

Local education aulli"' ill'' and lU'Jlcal ln«pi.ct!on 

pon’Tiircnt licxpUal «^r\icT Information 

tx^ncirnln-' 

LcKhmni Neal Leo obltuara notlex. of l_la 
LocKiurT L 1 National tltnc< 2Gb — Co^dic a 
tion tt-Ater from theatre kail lit 12^i 
Locklxart Munnr rx J P "'Hao loundatJon 1 ctnre 
pul hh 'll Cjx 

l/jrrrr Maanee Jt\t i nr ef Cnrtncf Ifiwn 
faire nv Kt 2 

LoiLiJt, Alfred \ Hormon therapv |n raxstitii 
an I brex-t cancxr *110 
Lcvvip Cmo death of 10-b 

LorTr\ r E Thromboevtopi nlc purpnra from 
cxlo m d 320 — 1 aucntcral nhole Hood as mca-Ica 
r I pbxhetic *f4 

l>Oi IX D ( Decline in I rii t feedln'* 1111 
IXIM'ON 

Diphtljfrja ImninniratloD in no*e on 701 
Fm r" ncx KaI rMcx 03 I'C 59“ 

"to 12*0 

U capitals and air raM Ci-* S09 

— ~ treit coliectlcn 5a* 

lledical 1 ahilntion ^59 

il O II fi- I xrt of -a — Pepo I of 94a 

Notification of m a 1" and xchoopinc-conch 2ol 

Nur me inquire \ku-s of London hospltaL 4C9 

Cud rpround cxr a^d CUP 101a 

lniTe*«it\of ^ecLnlveritT 

^cluntaT> HopitaD Committee elections 104 

Lom on Idith \ (and Crichton BiuiDmi) 
7/cftr* Divert, e rnrf Pre-rnn/ie*/ rev 114G 
liOii nnuGF, J a Quick al''^ w^armn^ 1-44 
LorriE» F M ^lala^la^ endcmieitx In La-t Airica 
l^NO 

Lorr 1 J ’McNtUl \ente appendlciti 2C0 
loxecroTe Frederick Thomas Alexander olitoan 
notice of “-4 

LowE^BEPG Harrv en Core of /n/infi end 
Chldrtn rev 1147 

LotrrsrELD Margaret PLiv therapy 299— 
Di'orders of eonvale cence Son — piar tberapx and 
child guidance 12al 

Lotvi \ Wilbur C Appreciation 01 Dr Hodson 

49 

Loz-iNO A P Habitual xomitiQS "CO 
LrCE\ H C Combined blood tran-Iu ion yriages 
and needle 4^4 
Luser Altred death of 6a“ 

Lunacx and mental deficiencv Hepo^t of Board of 
Control 1000 — Correspondence on 11"* 

Lunatics criminal ci.rtiflcatlon of 2b3 
ns peC -Oa 

I un^ apical hroncho'^emc carcinoma (I) Oxreo 
T F Hener and P K Whitaker) 1300 (0) 

cancer of (leadioq articD) IM— Correspondence 

on olG 

collapsed re^piratorv moxementa in 2-o 

cvclopropant and pulmonarj atelecta^l 1279 

disease imcsti^tion in South Wiles 1184 

phr-iology and collapse therapx 8^ 

tuberculous cavities in and artifiaal pneamo- 

thorav treatment (Lawrence 1 obxrts and W 
I acel) 1.99 (O) 

Lvmphxdeiiomx Gordon test for lloS 
Lvmphancitx fllxnal ulpliamlarmde for nig 
Lymi hogranuloma inguinale See Poradenitu. 
xenerea 

Lyttle, j D Acute nephritu and streptoccoei^ 
l_t>G 


M 


Watkins 

LSI 

MacAbnirr Litut Cen W P Wudom of old 
le'irniD'’ 

Micxi.LA\ Brace J 5Aip Stir^fon * J7n/i<flool 
rex JoO 13*1 

Marj Parmt^^ of future 143 

Mc\t LAND Stuart larico'cvem. lls^ 

Met LEAF! G F I op tlaHon To Daft Qiiesiton 
rex 1_09 

McCowan P K Schizophrenia 144 
McCracKEN I F Medical apparatU- in 1810 129G 
McCrLLOcu E Cooperation m cases of vi ual lots 

MciipncH H J Medical man power in xrar "62 
McDimel, M B Affair of 1013 prmtinc of 
Joliannes Rumclm 3 Cc/optAm 433 
McDonach j F P HeFirtn 1120 — Blood 

platpk-t 11*9 


^IiCPONVLD \ D Spinal •ina's.th 'SIX 244 
—— Duncan 1 numx ial unx til’d siyi 

Ittcr CooDntnn In pnbli h iltli ijo 

M 's D xtloi m nt ho-pitxl r-tem 36o 

MePot ML 1 B land J H Afiwtofd) Toma- 
in^iphx In pnlmonirx tubcrculoi _ (O) — 
Co fopon I nee on *5ot « 

— — AMUnm olituxrv notice of 12 2 1293 
Macedonia nutritional •' » 

McFllICott r L M 
In cnnorrlicy x 4.4 
u nnl abu e 905 

McFtPhFN < cor^c D F I chio pubic ty-teo 
chonlrltl 31“ 

ALiCFxinFN Norman EmL of con'V'tion 05. — 
Sxchl patliol ZT l-oO 

MacFall J L Whitley obituary notice of 816 
SlcFirLtN A M Incidence of patho enic «taphv 
loctccl In no>e^ ^O) 

McFifli^d Brxan Optratlon for caJcaneocaxiu 

12.2 

McFetTIPCf F M Hepatic function te'* 1212 
AIcCAFFni J (arJ other ) Ob-crvations on 
potency and ttxbilitv of Dick te«t toxin "00 (0) 
M t OMOLT C C M Dtthneofb ea^t fcedin'’ 10*2 
McCowtS J I Nxtlonal food i-oUcy* .9* — Food 
nnd nutrition 101a — Health and agriculture 133* 
Sixer rrcon, a '' M Co-operation between 
orcanlzed bodi'' 143 — Health of t U,i:ow 110a 
AIcOrEiOF H t F -lor »n r«ccrc/ 

Dir a. rev l.ol 

''LtCCFFt Or T N Oc'trillol benzoate treatment 
of ml xaslmtl *" — Dv functional uterine 

llAydicc treated with prcr-e'ttrone 116(0) 
McGnrE c S n ttlxcne to bei. tine and ant 
bite^ 49 

Maciiafdy P Treatment ot nterinc ha mor 

rhaci 309 

McIlfoy Louise Puerptral epl 304 
Macikto n P I (and t L t Pratt) Carbo- 
hvdrate metxbolbm In anaesthesia C9o(0) 
NtAcK.ix Chari's A Patholo- ica! changes in 
Au-txailan aboricioa] bonc' 1163 
MacKez, Ceorge M. T r<j and Padt im tn Trer 
rn^nt of Dt vsofSltn 3rd ed rcx 2.1 
MacKeith A (andD N PaFfTiT) smcideaikr 
treatment as xoluotaty pati nt 4al 
Nlackonni LnuCalxo death of 601 

*' r of gonococcal 


19" 

' ' • e D w scorr) 

Treatment of apoplexv bv Infiltration of tellate 
ganclion with novocain 1 ( 0 >— Correspondence 
on 93 

SlacKDvTO H James M Hospital ccKiperation 1011 
— Health and ceneral p’-actUioner llOa 
■MaCKtvoop John '*l 2 niflcance of dreams 11*1 
MacLaciiLaN John T PTolon^ed occipito posterior 
pre><otatian 

Maclag'^nn Thomas John (IsSi^inoS) 499 
ilCLacoffLC? C K New merntroation toilet 12-9 
MacLiY David T Abortion and the law 2^0 
McLean E K Sea-ickne- as po'^^fble aetiological 
factor in volvulus ot small uite«tm<» 12oO ^ 
MaclEa> Sir Ewen Puerperal ep'ia, 394 
MacLe5Yax John (Victor Bowey and Charl^ 
Box) Tttanm bacillus recovered from car ten 
X ears after attack 01 po-t -operative tetanu- 10 ( 0 ) 
Macleod Douclas H Lndocrine tb^rapr in 
gvnaecolo^cal condition. 110 - 
MacIIaHOX Pyan Treatment of malaria Cal 
McJIillan Kenneth bet of non-'lippmg by^erec 
tomv clamp* C-A 

McMrrJiAY T P Fractures of haft and snbcapital 
rccion of humern 134 

MiCNiGHTEb jQ_tice Lnchangmq Common Law 
13.0 

3klACNALTT Sir Arthur Apprecution 01 Dr L S T 
Burrell ~o6— Mmirtry 01 Health repo-t Oo" 1004 
— Board of Education report 13^3 
McNeil, Charles Decline of breast feediu" S63 
Macphail Alexander obituary notice of bOO s6b 

Sir Andrew obituarv notice of “-3 

J M Tuberculotsi. and po-t partum haemor 

rhage 10 0 

McShine Arthur Hutton appointed member of 
Legi latlve Council of Colonv ox Tnnidad and 
Tobaco 9*4 

McAea Jarufts Anthonv obituarv notice of 1*4 
Maddep. Kate (and B D Lawfence) Employ 
m^’nt of diabetics 10"6 (O) 

MAEGU-irrH B r (and R L Vollcm) Bacteno 
Matic effects of ulphonamidt P oIa.epta.me and 
M A B 693 (tea 

>Iagxer William TejctlooiofBa^vuxloJoipi rex ISl 
SlAGNiEE, 21 F Bednction of backward dirplace- 
ment m ( oUes tracture a9l 
MAXMAbD D Pexcaa.ioD of heart 6.9 

Donald T reatm/^ of C/iwieof ood lalfordor^ 

Data rev .2 l 

MiiZELi. G (and B L DodDs) 21a. ixe hydro 
nephrosL and pregnanev l" 

Mal^n availabilitv of new drugs med in 35o 

control in tropical Airtca fc02 

diagnosD of 10 0 

in La.t Africa 133o 

in Ln<»l3nd 13a- 

new anti malxrial drug (certuna) ooO 

parasite malignant tertian co rect name 

01 (''ir Pickard Chrutoph r and j A s,nton) 
1130 (O) _ 


JIalana in p egnancy review of book on Co. 

ea.Qnal p nodicity in (Dading arti e) "o • 

tre 3 tm<*nt of 2 -* oOo t-si — Ci’-C'T 

dence on 9 i- 

unit, in BritLh colonic’s (parliam(»nt-r^ no 4" 

2 IALOP. 1 S p (and 0 her«) i Eij'’iTCivm F t 
b>/i, // Po»f Of^rdoire de la Voie EHi^x-e P-in/n 
jv'f rex "1 

2liiK 2I]chaeI Alopecia, al 
2IAX10F1 Frank Bnxr FalF^VyDei^ Ted’\ 
rev iQso 

2[alnntritiQn local inqnirr into 12*9 
Maloen. Ceor"o« death o 601 
Malvoz Em'S!! death 0 1119 
Manclicster Annual report of chool rc<^ical o'See 
116 

ManipnlatHa of diiBmJt joint (Ceo ''ePe^lan.) I.tO 

in «mTgprv (Georg*» Perkins) 1-14— AToTir^pon 

dence on 1 oj 

2Iaw Ida Contact lenses 69 
ALivznio A Imm^Nfiate diagncw^ 0 dipbth i_ 
Uo 2 

2rAFOT!iEF Edward 31 ntal equ lae oi h-^d 
Injun's 80 — Phv ical ba.! 01 alcoholic m ctal 
disorder® 84“ 

2lAFCtr M bnlphanilam de m taphvlocootal 
skin Infections 92 

■'larine th rapeutics dLcurion on 909 
3Iarin®®co Georges obituarv notice o 100 
MaeDteovitch P 21 a B 69 m coao’^hoea I — " 
Mtp.LTN Thomas aom ob-^rvatiou. on ho^ 11^9 
— CoTespocdence on 1—0 
A tiRu, D M Air rail precantion. 10o4 
2lAFRArE J P f h^rti r / of lrrjjr<n» end Ar i 
todie 1 b 

Mamage revi w of book on !-*>. 

2LmPi W A Treatm''nt 0 p uritua am *20 
M«p_ nrx J piclnord Lonfrol 01 ®mall pox in 
India 1 s 

MtpgTT Leonard L Becttf ard Vnfn^pWmert 15*3 
3Li.F-.HAXL, C Jennin'* Chronic Di# a. i of 

Aldov\en Diajnf le ^ rev 13b9 

C K Active p mcipl 01 Cennaii xrdiea 40 

JF BnhAVo-uf rev S®. 

3Lu'm Demck J Endometnoma 0 -pp^ndix, 
644 

2Iargaret Anxi tv tate« 202 

2Uril5tz A Adult curvy 9 js 
if Arj Hermaiia Kun s Barjll ic^ d'T Ol'Tenhn.l 
tird' rex lal 

3Iasoy oeo-ce Thoracic urserv at Newca.tl<» b44 
21 a ef,, a a Condea-a ion water from th^’at*® 
kvbiht 1-44 

2U EY A Prexentioa -nd control 0 pufrpxral 
epsi admin-tiatixe asp>*rt. 31" (O) — Di 
CQa,.ion on 303 — Leading articl on SoJ — 
Correspondence on 4*1 

211 sOBFJO E PemicioL- anaemia and p^ydioes 
116L 

2Iastiti chrome (Cecil Powntrec) 1002 
— ■. — and b^ea.t cancer (W samp-on Hand) v' 
113 103— Co’Tesnondence on. 319 4-1 
Martcil operations (Walter Howarth and Geoffrev 
Bateman) 1304 (0) 

2 Lx^oiditL aente sutphonamide in treatment ot 
(A C Horan and b Cay French) “ 4 . (0) — 
Correction 10"0 

Matenutx and child wehare Conference on 14_— • 
Iniormatun concerning medical oficxr* aSa 

flvinc quad (E Farquhar Mtirrav) 6a4 (O) 

— Di cu..ion on 313— Corre'pondenct, on 3"" "to 

rvice for New Zealand (leadin" article) " 2 

21atrimonial Cau.rt> Act 3ledical «upenntend nt 
and 1184 — Care and treatment nnd lo 4 
Mavor O H appomted to advi.orv committee on 
Cinetaato"raph Act 10-" 

Maxwell Ernest Jame® obituarx notice of 43- 

Tames Introd etton to Dis a ^ of Cfef* rxv 

"91 

J Pres on Puerperal eps. 304 — Chonon 

epithelioma 3 l 3 — ^Sterilitx 3b4 
llAYEF GEO W Early diagnosis ot chizoplirenia 
9 b(0) 

llavors medical election of 10o7 
2 Iayp Julius Uardharh dn A.r*ef He rev 13"iJ 
2LB B & Lend hnal lo3 -aa 
MeaJes Conduct of chool epidenuc (F G Hob-jn) 
1"1 ( 0 >— Correct on -"2 

parental whole blood m prophvlaxis 0 (T D 

Cnlbert) "Oa— Co’gcspondence on "64 

me 01 placental extract in epidemic of (T N 

Pan h) 60 (0>— Co’re'pondence on 2a^ 

xiru. mo 

Medal Darwm awarded 10-" 

Dxxw awarded 10_" 

Alan King:lev axrarded 13sb 

Trudeau awarded 434 

2IedicaI appamtus in 1*16 l_9o 

cernneates (parliamentarr note) 1123 

cum ntnm and present-dar needs (sir Wal e- 

Langdon Brown) 4 si — Co— e-pondence on a ' 
639 o_i 

traimng of doc or I®!. 

Direeionr 1X9 lo3 1-1 j — TT ncopimnnioted 

addfs. es S30 

Exhibit on London s^o 

Hi 'o^j Cal^rA^r of 9_3 

In nrance A'*encv Agent ap-xunted 20" — Air 

raid insurance announcement ".9 

Life to cea.e pnbLcation "o9 

man p 3 wer in war "o_ 

tr n of Vlctonan e’w 1164 

mi_ o-’anes info’mation concemln" 1:^9 


18 


THE BRITISH MEDICAL JOURNAL 


Jun 9, 19'S 



eTHlCAV-P^ 


NORMACOL A purely vegetable 

Product for the 
treatment of 
Constipation 

A British made •' NORGINE" Product 


HAY FEVER & SUMMER COLDS 

Quick relief may be obtained by the direct administration 
of ' Endrine ’ to the nares 

‘ Endrine,’ by virtue of its content of natural ephedrlne, 
exerts prompt control which is maintained for several 
hours 

For small children or where the membrane is hyper- 
sensitive use ‘Endrine’ Mild (Green label) 

ENDRINE’ 



iXAS^L COMPOUND 


Rcgd 


JOHN WYETH & BROTHER LTD , 25. OLDHILL PLACE. LONDON, N 16 







ffT' '-•- “W 









BengersFood when prepared is a damfy food 
cream in which the tough curd of cov a milk 
has been broken dov/n so *hat it can no 
longer form ind gestible dots Because it 
IS so easy of aasimilation Bengers Food 
y IS almost uri/eraally prescribed by the 
A Medical Profession fo er^eeb'ed cioes- 
^ \ tion and for extreme conditions its 
iv\ prescription is almost ^tardcrd 
Bengers Food is so delicious 
^4^'/ /l eaten with enjoyment by 

tj/' those who find milk or di’uted 

milk unpalatable 

^ /I ° Vi " f '* i''d u V jSI 

poit free on r ouert 


BHNGERS FOOD, LTD, Holmes Chapel, CHESHIRE, Eng 

MtT TOPS c 41 If du L. e SttstT t>0 Oj - g * CrrTw ^10 Po- » 

Bsng r s Foa^ n mt J «x oi x te through j *-9 'd by CFes- xt. e 


tc 'Vs 

\ \'5oe3s*fi^e*V-*^\ , V ^ n Art rt. * 









20 


THE BRITISH MEDICAL JOURNAL 


BAUAAOL TOiLET SOAP 

A pure super-fatted soap introduced to the 
public more than half a century ago 
Recommended by the medical profession 

BAUMOL BATH SOAP 




3-a" 


fj' 



Particulars 


application 


A super-fatted hard soap specially milled and " 
perfumed for use in the bath 

BAUMOL MEDICATED SOAPS 

A full range of medicated soaps Invaluable 
in dermatological practice 


DUMCAg^, FLOCKHART & CO. 


EDINBURGH 

104-108, HOLYROOD' ROAD, 8 


and LONDON. 

155, FARRINGDON ROAD, E.C.1 


0X0 LIMITED 


“ HORMONOXOID ” 

TABLETS 

\ reliable preparation for tKc stimulation of the 
rndocnne Glands 

Corrects menstrual irrcgularilics 

E\lensi\c]^ prescribed for re 3 uvenation md 
premnlure senility 

“PITOXYLIN” 

A protein free e\tnct of the Pituitary Posterior 
Lobe Ehminitcs nil risk of protein shock 
In 0 c c nnd I c c ampoules 

VITAMINS “A” & “D” 

CAPSULES 

Each capsule contains 
7 000 International Units of Vitamin A 
900 D 


“LIVEROID” 

Bnnd 

PREPARATION OF JLJVER 

A concentrated preparation of the mtunl 
uncoagulatcd juice of fresh Iner in combination 
with nerve forming substances 

Highlj recommended for the treatment of Annemn 
in all Its forms Pleasant to lake 

“ERYTHOID” 

An active and efficient stomach tissue prcpafTtion 
In boxes of 10 vials Each vial contains J5 gram- 
of desiccated material 

“OXOID” LIVER EXTRACT 

FOR INJECTION 

The potcnc> of this extract is guaranteed Each 
batch clinicallj tested In 2 c c ampoules 


Oxo Cubes and Bottles — Hospital Oxo — Beef Essence — Meat Juice 

0X0 LIMITED 

THAMES HOUSE, QUEEN STREET PLACE, LONDON, EC4 



JuL-k 9 193S 


THE BRITISH MEDICAL JOURNAL 



BAXTER’S INTRAVENOUS SOLUTIONS 

IN 

“VACOLITERS” 

AND 

BAXTER’S BLOOD TRANSFUSION APPARATUS 

WE INVITE YOU TO AN EXHIBITION 
OF THE ABOVE APPARATUS ON OUR 

STAND (No. 40) 

AT THE BMA MEETING AT PLYMOUTH 

JULY 18th to 22nd 

John Bell & Croyden 
WIGMORE street, 

LONDON, W.1 


Da\ and AisJt Sci\ice 


Tel IVELbcck 5555 





22 


THE BRITISH MEDICAL JOURNAL 


JUL’I 9 1918 



OLD AND NEW FRIENDS WILL BE 
WELCOMED AT 

STAND NO. 14 

BRITISH MEDICAL ASSOCIATION EXHIBITION 
DRILL HALL, PLYMOUTH 

JULY I8tb to 22nd, 1938 

// unable io aiiend, n)nle for Free samples, quoting B M J , to 

WWI. GAYMER & SON LTD. ATTLEBOROUGH, NORFOLK 

In Allergic Cases and for 
Cosmetic-sensitive Patients 

you wjll find it helpful to be able to presciibe 



Tins comprehensive range of toilet prepaiations has been prepared under Medical 
guidance and supervision for prescription in Allergic cases It does not contain 
orris root, or any other of the many ingredients capable of provoking Allergic 
Symptoms The “ Queen ” range can safely be prescribed in place of suspect pre- 
parations to anv lady patient, their excellent quality affording little excuse for 
backsliding or ignoring instructions 

The ‘ Queen ” series includes Face Powder, Day Cream, Liquid Powder, Nigli* 
Cream, Sunburn Lotion, Seaside Cream, Bath Powder, Levigated Talcum 
Nurserj Powder, Complexion Milk, Liquid Medicated Skin Cream, Skin Sonp. 
Special Skin F ood, Thealncal Cold Cream, Astringent Lotion, Muscle Oil 

Orders mav be placed through vour Chemist, or direct from 

BOUTALLS LIMITED 

150, SOUTHAMPTON ROW, LONDON, W.C.1 


JUL\ 9 193S 


THE BRITISH MEDICAL JOURNAL 


In the - ti eatment of acute infections 

The intramuscular injection of Manganese But> rate B D H is 
% indicated in the treatment of such acute infections as the 
% comphcations of gonorrhoea caused by secondary' coccogemc 
V m micro-orgamsms Its chief value in routine chnical 
practice, however, lies in its power to fortify the host 
OSfc against staphydococcic and streptococcic mfecnons , it 
adrmmstered, therefore, m the treatment of furun- 
culosis, carbuncles, erysipelas (including the form 
\ following vaccmauon), bods, whitlows and ulcers 


k 


•- ' ’ 




-MANGANESE BUTYRATE BDH 

Sample on reouest 


THE BRITISH DRUG HOUSES LTD LONDON Nr 

Telephone ClerkenweU 3030 Telegrams Tetradome Tele\ London 


GERMICIDAL EFFICIENCY mamtamed 
in the piesence of organic matter. 


In the conduct of labour ‘ Dettol ’ possesses marked supenonty 
over carbobc and cresihc antiseptics ‘Dettol* has a Rideal 
Walker co-efficient of 3 0 , yet ‘ Dettol ’ can be used at really 
effectii e strengths — mthout discomfort, danger or stainmg 
‘ Dettol ’ maintams high bactericidal efficiency m the presence 
of blood and other orgamc matter ‘ Dettol is a clean, clear 

a 3 .1 SeU ly Ot-misrs m Icrtia I/-, 

non poisonous tluid — wvth a ,,3 5.orj-6crjm i.ry^ n.« /=■ 

CK/f/ii-Imr Th^e ’ 

distmctl'v pleasant smell „o:ent^ v- c-, re-jti 




DETTOL 


r THE MODERN 


ANTISEPTIC 


KfCKlTT ^NO iONS I TO ( P K K R M A C E L T I C ^ L DEPT» HCLL LO DOS 40 BEDFORD SQUARE VP C t 


'W\\SW\WW\SWVWl'iVS"' '' 


24 


THE BRITISH MEDICAL JOURNAL 


Jnn 9 19^8 



Vish our s^anil llic UlllTlSIl 
MEDICAL ASSOCIATION 
EXHIBITION. PLYMOETII. 
JULY ^o 




I 


(Ka\lene Brand of Colloidal 
Kaolin ) 

KAYLENE-OL 

(Kaalene Brand of Colloidal 
Kaolin \MtIi highh viscous liquid 
paraflin ) 

MACSORBEiVT 

(The oiiginil and standaid hi and 
‘of Santhetic Hadratcd M iq- 
nesium Tiisilicale) 


Saiiiphs and hitiainu obtainahh fioiit tin. \oh ntaniifactni ii ^ — 

KAYLENE, LTD , Sole Distributors ADSORBENTS, LTD, WATERLOO RD , LONDON, NW2 

t tlcflionc GLddt/oi:c 1071 / 2/3 1 digrams kn\loidol, Gold, I niidoii 


MAWMAWMAWM/*WMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAV\'riAWMAWMAWMAWMAWMAWMAWM«VVMAVVMAV ’ 
M AWMAWMAWMAWMAWMAWM AWM AWMAWM AWMAWMA A/MAWMAWMAWMAWMAWMAWMAWMA WM AWMAWM AWMAWMAWMAWf lAVVf lAl / 
MAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAWMAW^JAW^IAWMAV/MAWflAW 


THROMBIN-COAGULANT-MAW DRESSINGS 
HAVE PROVED THEIR EFFICIENCY / 

In the short time they have been on the market, Maw s 
T C M Dressings have achieved remarkable success 
Members of the profession who have used them have 
been impressed by the rapidity with which coagulation 
Is achieved and numerous instances are recorded of 
severe haemorrhage being checked almost instantly 
T C M Dressings are treated with Thrombin-Coagulant- 
Maw, a preparation of natural Thrombin which acceler- 
ates blood coagulation and causes clotting within 
5-15 seconds They are supplied sterile, in sealed drums, ready for immediate use, and the series consists-of spcail 
int Squares suitable for most purposes Special T C M Dressings can be supplied when required 
hey cost only a trifle more than ordinary Pressings and are well worth the extra charge Wc ask you to give 
them a fair trial, for we are confident that you will be satisfied with the results 

A Product of the Maw Laboratories 



VISIT OUR STAND AT THE PLYMOUTH EXHIBITION 


Fu// details and^^^ '-al 


S MAW, SON & SONS LT 


HAWr WM AWr lAWn,^WMAVVM ' WM^ V ,/t AWMA\ /’-'A' 
NAWriAWMAV nA\ >MAWMA\Vi'AWnA\/MAV't' 

MAWM AWf 1 AWMAW f lAV/MAWMAVVMA Wt lAV/f 1 f, v 


TALL 


information on request 

>ERSGATE ST., 


LONDON, EC1 


j^HAMPTON 


V/ V 


At ffi ' /ri ':u '* f 


/JA » 



9 193S 


THE BRITISH MEDICAL JOLRNAL 



BY APPOINTMENT 

SUGAR-FREE GINGER ALE . . . . 
SUGAR-EREE TONIC WATER. . . 
SUGAR-FREE SPARKLING LIME 

Apprized by the Institute of Hyziere and tie Diabetic Assoaatwr 

These beverages ha\e been anahsed bv the Institute of H\giene and 
found “free from sugar and metallic contammants ” The anal\ses 
shonn ha\e been accepted b\ the Medical Addison Council of The 
Diabetic Association and recommended for diabetic and obese subjects 


ANALYSIS SHOWED THE FOLLOWISG RESLLTS 


Sclz.t.ppes Sugar-Free Ordinary Dry 
Dry Ginger Ale Ginger Ale 
Carbohjdrates absent 62% 

Protein absent absent 

Fat absent absent 


ScJrzeppes Sugar-Free Ordinary 

Tone ir*af£r Tome IFarer 
Carboh\ drates absent 9 

Protein absent ab-^en 

Fat absent absent 


Sch^ **^5 Sugar-Fr Ordtr ar\ 
SpOTpUng Lir Spjrklt g Lw 

Carbohydrates ab>enf iiS^ 

Protein absent absent 

Fat absent absent 


FOR FREE SAMPLES STRIFE TO MESSRS SCHWEPPES LTD , i COVXWGHT PL\CE, LONTION W 2 







The advantages of T.C.P. in the 
/oca/ treatment of 





A powerful antiseptic, T C?P prevents 
the spread of infection. 

+ + + + 

It relieves congesnon and infiltration 
+ + + + 

T CJ? allays pain and imtation by its 
combined antisepnc — analgesic acuon 
+ + + + 

In mild ca<=es, T CJ* mav be painted 
on and allowed to dr\ It is mMSiblc 
and obviaLCS the need for bandaging 

Ij— r*!:.-* c-^ d ~l 

TC^ t^ssr c fsr'SJ' tt — 

BRITISH ALKALOIDS LTD 

D_shwood Pojse London E CJ. 


26 


THE' BRITISH MEDICAL JOURNAL 


JuVi 9, lOis 




LOCOL 

QcAlx^\Aal ‘HAjdn/Docjud& of .Atumuaiu/m. 

For Gastric or Duodenal Ulcer 

TN view of the increasing adoption of intensive alkaline medi- 
*■ cation for gastric and duodenal ulceration, the selection 
of a suitable antacid agent is a matter of considerable im 
portance to the general practitioner 

Alocol allows of antacid therapy in a particularly cirectne, safe and 
reliible form, and replaces with adiantigc miMurcs composed of sodium 
bicarbonate, magnesia, bismuth, etc It docs not determine anv unpleasant 
secondary reactions, even when taken in strong doses and over a long 
period of time 

The powerful antacid effect of “Alocol” is more mechanical than chemical 
in nature It icts by adsorbing excess of hydrochloric acid, thus facilitating 
its elimination It promptly relieves pain and being non absorbable is free 
from toxic sequelae 

Contpltie chemical history of Alocol with com lacing clinical reports and supply lor Mol 
sent free to physicians on retjnest 

A WANDER, Ltd , Manufacturing Chemists, 

J84, Queen’s Gale, London, SW 7 

II orKs KING S LANGLES HI RTrOUDSHlUr 


M’8’ 



ALASIL 


Better Salicylate Therapy 


W HATEVER be the season of the 
sear there is a sside sphere of 
iitihts for Alasil, the improved 
form of s dies late medication 


Alasil IS a sen definite advance on 
ordimrs compounds of saheshe or 
acetsl s ilicslic acid both in therapeutic 
efficicncs and in freedom from the risk 
of unpleasant gastro intestinal sequelae 
This high tolcrabilits is due to the fact 
that Alasil is composed of calcium 
■'ceivl sahcslitc — the least irritating of 
the saheshte compounds — and Alocol 
(Colloidal Hsdroxide of Miiminium) a 
posscrfiil gastric seditisc and int icid 


A careful senes of experimental tests 
has shown that Alasil is more com 
pletcis absorbed than ordinary salicylate 
compounds and that it is practically free 
from the risk of liberating free salic>hc 
icid in the stomach 

Wide clinic il experience anticipitcd 
these findings b> demonstrating tint 
Alasil can be pushed or prolonged 
to a much gre iter extent thin ordtnirv 
s dies late compounds ind that it cm he 
given with sifctv to children adults the 
aged and patients with finds bal meed 
digestive capacities An analgesic anti 
psretic and sed disc of established s due 



-1 s)/p/>/\ /or iliiiiciil Inn! muIi /nil ilcsiriplne 
htirtiUiri urn /rce t>»i riqmsi 

\ W W DI U, 1 tfl , MamifactiirinK Ch« mists, 

18-1, Queen s Gate, London, S W 7 

rtiloru I I/nd 11 tirl s KING S I ANGLLY , HER fS 





Juu 9 1938 


THE BRITISH MEDICAL JOLRN\L 


THE 


AT THE EXHIBITION OF 
BRITISH MEDICAL ASSOCIATION 


TAMPAX 

Adaptation of the medical 
tampon to menstrual hygiene 


Alenibers of tlie mcdicil prote>5ion will it 
once ippreciate the significince ot the new 
method of sinitin protection which being 
di'plived It the Exhibition of the British 
Jledicil Assocntion 

The principle of Timpax l^ thif of the 
\agiml tampon, which even doctor Lnows 
to be safe ind efficicious for absorbing ceni 
cil discharges it the site Di'peii'ing with 
sinitin towels Timpax spares the patient 
much local discomfort and minimises risk 
ot infection 

T ampax is made of long fibred surgical 
cottonwool which has been sterilised and 
highli compressed Each tampon his in 
lb orption cipiciti of 1 — \{ ounces It is 
indi\ idualli scaled within its own patented 


applicator which enables e\en u er to 
insert it m the proper po ition w ithout 
contact with the hand The tampon 
IS eisiK remoied b\ ni'ans ot a cord 
sewn through the cotton b\ 'n exclusive 
stitching process whch makes disintegrition 
impossible The tampon being contained 
within the tagini awa\ trom contact with 
the urethra contamination trom this source 
IS minimised There is complete elimination 
of labial irntition Odour is almo t cntireh 
prevented as the menstrual fluid dots not 
come into contact with the air 

Tampax miv confidentlv be recimmended 
6v phvsiciaos to their women patients the 
onlv exceptions b-ing tho e m rtqirnt ca 's 
ot intact hvmen with orifice too snT’Il tor 
in ertion 


Tampax IS displaxed at Stand No 43 of the Exhibition of the 
BMA, VI here a qualified attendant mil explain the method ot 
construction of the tampon and the principle of the applicator 
Samples and all further information mat be obtained at the 
Stand, 01 on request to Tampax Ltd , lo, Bolton Street, London, i 




Reffd Trade l/zir'* 




28 


THE BRITISH MEDICAL JOURNAL 


Juu 9, 1938 



n^ew 


ted 






TUBERCULIN PATCH TEST 

(VOLLMER) 



jQederle 

T he notable progress made tn recent years in the 
control of tuberculosis has been due in large 
measure to earlier diagnosis and improved methods of 
diagnosis 

Among the significant advances in tuberculin testing 
is Vollmer’s development of the tuhemilm patch test 
This test, winch has been shown by climcal trial to be 
at least as reliable as tlie Pirquet test, possesses the 
important advantage of insuring co-operation of the 
patients, especially in the cases of children 

The patch is applied for 48 hours and read 24 hours 
later By eliminating pain, elaborate preparation in 
the sterilisation of instruments, etc trauma to the skin 
and other inconveniences attending the use of instru- 
ments, the performance of the test avoids cxating 
nervous patients 

The method is ideally suited to the testing of large 
groups It IS simple, safe and time-saving A focal 
or general constitutional reaction has not been known 
to follow the application of the test It is 
available for immediate use at a moment's 
notice 

“TuiiCRCUUN PAaCH flST 
(Voiemer) Lcdeile'’ is avail- 
able in the following 
packages — 

Single tests 1/3 
10 tests 10/3 

100 tests 42/- 

A PRODUCl or Til E 

LADORA JOUIES 
Inc Ntw Vouk 

Distributed in England by 


The Old Medical School LEEDS 

Jtlegroms end Coblej * A%cbtlc Ucedl Teltphcnc 20005 (3 tlnej) 

2S2 Regent Street LONDON W I 

cnif Cobles Recent IB84 Loodon 

for Eire 

WILCOX JOZGAU &. CO (9 Temple Bar Dublin 



JULI 9 I93S 


THE BRITISH MEDICAL JOURNAL 



Liver Extracts 

of 

High Potency 


NEO-HEPATE} 

(Parenteral) 

Intravenous and Intramuscular 
Clinically tested 

HEPATEX 

(Oral) 

Palatable and efficiently fractionated 
Contains the full therapeutical efficiency 
of 16 times its weight of fresh liver 
The most active liver extract 


The Evans Biological Institute 


Evans Sons Lescher & Wetili Ltd 


Ln'ERPOOL and LONDON 







THE BRIIISH MEDICAL JOURNAL 


Ji'H 9 IQL'; 



^ - mtf.. A 


' ' 2 ''' ^3 




A vnjor if^trotK ) 

frivrrjs m 
('i'ir WtQthemcr) 
a l.i'fij n ) } 




THE DANGER 
OF INFECTION 


It IS not onl}’ in the operaung theatre that the value 
of anuscpuc protection is to-daj recognised iMcn 
and women in everj day hfe are learning the import- 
ance of gcmi-frec cleanhness More careful attention 
to hjgiene is resulting in better standards of health 

Of course, it is not possible in c\ err daj h) gicne for 
ordinarj people to take such elaborate precautions 
against infection as those taken bj the surgeon before 
an operation Net crtheless, protectit e measures against 
the daiK risks of infection are obtioush needed, and 
u is generalh accepted that the simplest and probably 
the most cfiectisc protection is thatgi\cnb\ washing 
e\posed parts of the faoda, such as the hands and 
ficc rcguhrh wath a rchablc annsepue soap 





Wiight’s Coal Tai Soap has enjoyed the confidence 
of the medical profession for health protection for 
over 70 years It has substantial antisepnc and anu- 
pruiitic qualities, and is made from thi? costliest 
materials obtainable It is the only soap in the world 
to contain ‘ liquor carbonis detergens ’ (Wright’s), the 
aaluable skin therapeutic recommended bj leading 
dermatologists An ins csugation by the Institute of 
Industrial Psychology reseals that more doctors 
themsches use Vv right’s than any other brand of 
toilet soap You arc safe in recommending \\ right’s 
to jour patients— and in using it m jourowai practice 


WRIGHT'S 
(OAL TAR SOAP 

The Safe Soap 

ltri,It Ii\>un-_ Ln ir\ ltd 44 ^0 S 1/ -r/Srrr;/ 




Juw 9 19 S 


THE BRITISH MEDICAL JOURNAL 


'I 


For the 

EARLY PREVENTION 

of 

VITAMIN & MINERAL DEHCIENCY 

IN INFANTS 


It IS now a ttideli recognized fact that infants 
need \ egetable food as eark as possible m order 
to balance and augment the usual milk diet 
The difficulty, hitherto inseparable from tege- 
table in any form, has been the intestinal dis- 
turbance — notably diarrhcea — of w hich inabihtt 
to digest the tough fibrous tissue surrounding 
the food cells is the primary cause 
By' the Libby process of Homogenication this 
fibrous co\ ermg is broken up into fine particles 
which protide non-imtant bulk and smooth, 
easy elimmation The' nutriment is of course 


at the same time released so that it comes into 
direct contact with the digestive enrvmes 
There are suv seientihcalK fo'mulated com- 
hmations of Cereds \ egetsbles and Fruit in 
Libby s Homogenized Foods w hieh can be pre- 
scribed in an\ case where \ itamin and mineral 
dcficiencv is indicated and have been given 
successfullv to infants as v oung as 1 2 to 8 w eeks 
A partial analvsis of one combination se'' 
out in the table below, shows how the de 
ficiencies m any one v egetable are compensated 
for bv the values in the others 


Partial Analvsis of a Group of Vegetables 



Protein 

Fat 

Per Cent 

Carbo 

h-'drates 

Calcium 

Phos 
phorus 
Mg per 
100 zms 

Iron 

Vitamin 

\ itemin 
B 

\ itamin 
C 

\ ifimm 

G 

SPINACH 

2 1 

03 

32 

67 

68 

2 5 

— 

V 

— 

— 

CARROTS 

1 1 

04 

93 

56 

46 

06 

--T 

— 

— 

— 

PEAS 

36 

02 

98 

23 

127 

20 

— 

— 

— 

— 



ircr'CT'AOt C - PPDPA.1 — FRUIT” SOUP 


Samples together wath clinical data and labo-atory renorts w dl be gladl supplied upon 
request to Messrs Libby, McNeill &. Libbv Ltd, 15, Lime Street, London, EC3 


Lll I 


















THE BRITISH MEDICAL JOURNAL 


Jtm 9 19 if! 


THE 

MEDICAL CASE FOR 
A WHOLE WHEAT 
CRISPBREAD 




W Hli.AT has always been Man’s fiist chojce among the ceieals, whcnevei 
climatic conditions did not prevent his getting it ^'Ihat lemains tiiic of all 
bieadj either white or wholemeal, either soft or biscuit~cnsp And Vita-Wfcat, 
the wheaten ciispbread with the WHOLE of the wheat left m it, has advantages 
which entitle it to a vei y high place among the staple foods of the woi Id 


ITS^CALOUiriC VALUE 

Bread is t/ic 'energy component' and Vita- Went, 
since It toinaim, onl) 3 per cent ot water, Ins t 
fuel \iluc near]} twice that oi ordinary bread- 
according to T//e PiactitWHd Its caloric laluc is 
2,1 32 per Jb 

Lteh section of such .1 crisp bread — each ‘'lice,' so 
to spcik — has a calorie t line ot 37 That is to s-ij 
that in meeting whit is probably the greatest 
requirement of a national staple food Vita-Wcat 
is ahiiOit twice as cffcctnc as the softer kinds of 
wheaten bread 

STARCH AND DIGESTION 

V crisp bread, ob\ioiis]\, ealls for a more thorougli 
chewing than a soft ‘eriimb’ bread and =alwatipn 
is therefore more he iltliily promoted The starches 
and eellulose in ^ iti cat arc also ‘comerted’ 
into 1 more digestible form bi the special processc-, 
whieh go to make a good crispbrcad— ju t as toast 
and crust haie become greath more digestible 
th in bread in its quite uneoiivcrtcd’ starchy form 
\N hile <;// the wheat berre b u ed the bran and 
tibre are tfiorougliK di-integritcd 
I he result 1 , therefore that the weight which 
s\uiiuiwes of uneoneerted sfirch places on the 


digcslion is ilmost cntireh elimmitcd tvlicrc 
Vita V cat has been prescribed 

VITA-WEAT AND ITS ADVANTAGES 

In addition to these great advantages of superior 
■'fucl-yaluc and digestibility Viti-Wcat retains the 
'protectwc' elements of the w heat-berry which arc 
Irequcntl) rejected in the ‘refining’ of yhite flours 
Proteins, yitaniins and minerals in winch bread is 
noriinlly deficient irc present ind the ‘balance’ of 
this crispbrcad as a food is tlierefore increased 
I he use of V na-V'eat can be shoavaa to be cspcci illy 
elcsirable in cases of mild inenm, Iiabiluy to 
infection, lack of appetite, poor digestion, diabetes, 
obesiiy and 'is a food of ‘protective’ value to the 
teeth 

y/ /tu/c bookht has hit/i f>tpru<l Jot thi medical 
ptoftsston IttiiHs sumtr austnss the midtcal case Jot 
a -i foie '( heal ct tsp/ju ad and it 'i til gladls he si nt 
pose-Jtti 10 a)\ docioi on application to Peck hean 
O Co , I td , Kcitons Road, London, SI 16 

THE BRITISH 

WHOLE WHEAT CRISPBRCAD 



BRAND DRESSING IS useful as a surgical dressing 

It IS antiseptic m the bactenostatic sense, without harsh or caustic qualities It has 
a tonic action on the capillaries Its use obviates the need for constant redressing 
of a wound Its application and removal are not painful It is an aid to leucocj- 
tosis and, therefore, a real adjmani to the natural healing process 

Made in England 

THE DENVER CHEMICAL MFG CO, 12, Carlisle Rd, London, NW 9 





34 


the BRITISH MEDICAL JOURNAL 


JuL\ 9 1918 


/gaNStes 

GROWTH FACTOR 

OF THE ' 

ANTERIOR LOBE OF THE PITUITARY GLAND. 


Clinically the growth hormone is indicated 
in cases of stunted growth' or dwarfism 
occurring before the closure of the Epiphyses 

The preparation of "Glanoid'' Growth Factor 
IS practically free from gonadotropic hormones 
and IS. especially suitable for children 

Standardised physiologically, the assayed 
potency of the "Glanoid" Growth Factor is 
100 growth units per cc 

"GLANOID" growth’ FACTOR IS SUPPLIED 
IN 5cc RUBBER CAPPED VIALS. 



Write for literature to - 


THE 


II 

h 


flrmnur i.a]inrainriBS 

"flRMOliR HOUSE* ST MRRTINS LE GRRND- LONDON -E C 1 
Telephone National 2424 Telegrams Armosala Cent London 


4 


'BENZEDRIN 

BRAND 

TABLETS 

- ^ ^-Phenylisopropylamine (Isomyn) Sulphafe i 

1 

! 

I 

Prolonged MedicsfionD 

Beta-Phenylisopropjlamine Sulphate has been the subject of e\tensi\e clinical 
and pharmacologiCcJ investigation Since 1930 more than eighty published 
articles have described its action and uses 

The effects of continuous large doses of Benzedrine Brand Tablets ^vere 
recently reported in the Nexv Eng Jour Med (217 696 1937) The author 
concludes 

“ My expenence supports the experience of others that 
benzedrine sulfate, when used in the proper manner, has no 
apparent permiuient deletenous action All ill-effects noted 
thus far have been largely of minor character and only tem- 
porary There is no evidence of habit formabon ” 



The drug has shown special promise in the following conditions — 

NARCOLEPSY 

POST-ENCEPHALiTIC PARKINSONISM 
ASTHENIC AND DEPRESSIVE STATES 
GASTRO-INTESTINAL SPASM 

A sample and the latest literature will be sent to any interested phjsician 


Dislribulcd bv 

MENLEY 6. JAMES LTD . 64, HATTON GARDEN, LONDON, E C I , 

for Smith, Kline & French Laboratories, owners of the Registered Trade ftark, Benzedrine 


THE BRITISH MEDICAL JOURNAL 


JUL\ 9 IQLS 


^f) 


INDICATIONS FOR 'SANATOGEN’ 


No 4 


General Debility 

" 91% subnormal " 

found the Pioneer Health Centie at Peckham. 

The phj^sicians responsible for the celebrated Pioneer Health Centie at 
Peckham recently examined 1530 individuals, composing 500 families 
Of these, 8 per cent weie under medical treatment for recognised disease , 
but of the remainder only 9 per' cent were perfectly healthy , whilst 1270 
persons weie found to “ have something the matter, and to be doing 
'nothing about it” — most of them believing themselves to be well This 
widespread subnormality would seem to be attributable to urbanisation 
and industrialism on the one hand, and to faulty nutrition on the other 
Experience has shown that the body’s disease-resisting capacity is greatly 
increased by the regular use of ‘ Sanatogen ’ — a carbohydrate-fiee product 
of 95 per cent pure milk casein, with 5 per cent sodium glycero- 
phosphate ‘Sanatogen’ is easily digested and quickly absorbed It strikingly 
promotes healthy nervous functiomng and the harmonious interplay of the 
endocrine glands 


Sanatogen 


4 1/ > 

i If itti f in «»»/ Stiili in O^icrro/’/rj/*/ iff 
SiH I till cftniis /uc *3 io ion 


DOSAGE lot cl ildftn -nJ a lults 
tv.o ttasp^ t^nsful thttc tunes or 

an. )r iin., to virciimstan I if inMn s 
^ icaspoontul a Mt 1 to en h h<ut*t nt\! 


T r I - \N t HI ? N tl T { If If f 
iiltl llr Ifrf I I 

t ( J '> I » K r I I 

\ < I \ V H>> \N r * I I ■ 

< I N \ in') \N m I II \ f I '' 


Cl tinea} ^a tuples and Iiteiatme aiailahlc ou teque^i to 

GENATOSAN LTD., LOUGHBOROUGH, LEICESTERSHIRE. 







Jt.L\ 9 193*5 


THE BRITISH MEDICAL JOURNAL 



Supreme in 
quality and 
reliability 


u2^ 

s-s 



li, OMit 


ISSULIS 


uvrrs 


_ 

^ o 


1 

ts ae 


* w i - 


;firLAMfCC3 


rpn 


ELLCOM 

INSULI 


Made v/ith pure crystalline insulin A triumpr oi 
many years oi patient research 


^ t 


20 Units per cc See phials 16 tO Uni^ per lv 

c c 10 c c 2;10 30 c c 


P'1 1 : 


2 10 
D 6 


‘WELLCOME 

PROTAMINE 

INSULIN (with ZINC) 

Suspension 

Injected as an alternative to or m association vrith 
unmodified, insulin to prolong the blood-sugar lov'^ering 
action Quantity may be so adjusted 
as to maintain the patient on a single 
daily dose 

4C Uni s p® c-c 



5 c c Dhtal 2 4 
46 


if PurtvNS 


c c 10 c c 
c c See, 


80 ccScc, 46 

£tt>f Pri es to if /of Pr f s ^ 



Burroughs Wellcome & Co 


London 

A^arrs, tor cor, ,u .coco s Sj; ^^ H lLL B U E C I 

rb,l,o, OoUcncs lO HENRIETTA PEACE CAVENDISH SOJARE W1 

A tso t ij Ht^u set 

Nf>% York MON'^Rfe-L Sidney Cape To 

H joc-j I ■ — I ' ■ ■ ■■ ■ " 


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3on Ba- 


SHaaC GM.A 


OS — I»£S 
corrKicHV 



38 


THE BRITISH MEDICAL JOURNAL 


Jun 9 I9iSv 


by members of the 


’""iinninwv 


Medical Profession 


Read \\hat a doctoi sa)s — 

“ I n1a^ sa^ that I frcqucnth recommend ‘ T> phoo ’ ten to 
patients i>ho cannot take the common \anetics nithout the 
production of dxspepsia ” MRCS,LRCP 

V, The fiboNc is one o( mini hnnrfrcds 

of testimonnis rct-cised 

Medical men and women, throughout the country, are recommending 
our pure “ Ty phoo ’ tea as indicated by the daily despatch of 
hundreds of samples which doctors direct us to send to their patients. 


IS so .mild that it does 
not cause indigestion 



Furthei 

you save by using “ Ty phoo for being 
’ leaf-edge ” it “ goes just half as far again ’ 
astringent tea 

Write to 

Sumner’s Ty*phoo Tea Ltd., Birmingham, 5. 


so rich in 
as coarse 





(This offer applies onb to the Bntish Isles 


for a FREE sample 

WeTcgret that \ic cannot send ‘T> phoo tea abroad) 


»!#/////> 


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an outstanding fault 

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(B A1 J , 16 O f , 1937, p 753) 

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BRITISH MEDICAL JOURNAL 

LO^DO^ SATURDAIi JLLl 9 1938 


A SURVEY OF PROSTATIC ENLARGEMENT AND 
ITS TREATMENT* 

BY 

KEi>i\ETH WALKER, F R C S 

Gentto Unnan Siirqeon Roxal Northern and St Pants Hospitals London 


The » 2 ct that I propose to gi\e a general sur\ey of 
prostatic enlargement and note an> advances that have 
been made in our understanding of it and in our methods 
of treating it, is an indication that I have reached that 
time of life at which a man is prone to look back into 
the past and to contrast what he thought once with what 
he thinks now And m spite of the big gaps that still 
remain in our knowledge and of the imperfections of our 
treatment this survej will give cause for satisfaction 
The last ten jears have witnessed a great activitj not 
onlj in our surger> but also in our knowledge of the 
aetiolog> of prostatic enlargement We have made 
definite progress and unless I am mistaken are on the 
threshold of still greater advances 

Some sixteen jears ago I had the honour of delivering 
a Hunterian lecture before the Rojal College of Surgeons 
on The Nature and Causes of Old Age Enlargement of 
the Prostate When I came to assess the result of mj 
two jears work on this subject it amounted to little more 
than an assertion that everv theorv that had so far been 
advanced to explain the nature and causes of prostatic 
enlargement was inadequate We were not onlj in 
Ignorance of its aetiologj we did not even know what 
It vas The onlv positive statement in mj lecture was 
the following which 1 give verbatim 

The close dependence of the prostate on ihe ductless 
glands dunng its penod of development affords sufficient 
ground for considenng carefullv the possibiliiv that enlarge- 
ment mav be associated with some change in the endocrine 
svstem The menopause in the female is generallv accom 
panted bv a temporarv loss of endocrine balance and it is 
not improbable that a similar state of affairs mav arise dunng 
the period of •sexual decline in the male The condition 

of the endocnne glands in cases of prostatic enlargement 
offers a fruitful field for research 

This at the time was a new point of view Up till 
then enlargement of the prostate had been considered 
to be an inflammatorj lesion (Ciechanowskv and 
Rothschild 1903) an adenoma (Cohnheim Rindfieisch 
and Velpeau) or a form of degeneration associated vvuh 
arteriosclerosis (Launois ISSa) Mv suggestion that it 
might be the result of a disturbance of the endocnne 
balance was a blind shot that modern research has sho vai 
to have been verv near the mark I did not know at 

A paper read lo the Glou-eelcr hire Bran-h of lb" Bntish 
Mcdieat As-a?cialioa 

1 


the time that Paul (1910) of Live pool had twelve jears 
previous! j been struck bv the resemblance between the 
enlarged prostate and mvolutionarv cjstic mastitis and 
had suggested that enlargement vvas an involutionarj 
lesion similar to that of the female breast at the time ot 
the menopause 

It IS difficult to sav what particular subsequent research 
vvas responsible for establishing bejond doubt the 
endocrine factor in enlargement but if emphasis is lo 
be placed on the work of anv one researcher it would 
have to be on that of Lacassagne m 1933 \Miile 
experimenting on the carcinogenetic powers of various 
sterols Lacassagne found that if oestrone was administered 
over long periods to mice it produced an overgrowth ot 
the dorsal prostatic lobes This interesting discovers was 
confirmed independentlv bv de Jongh (1933) bv Burrow, 
and Kennawaj (1934) and bv other workers 

Care must be exercised in appiving these results lo the 
problems of human enlargement The dorsal pros'atic 
lobe of a mouse is a specialized gland secreting a semen 
coagulant There is no true homologue of this in man 
Zuckerman and Groome (1937) nave however shown 
that prostatic enlargement can be produced in dogs bv 
injections of oestrone and that the histologv of this arti 
ficiallv produced enlargement is similar to that which 
often occurs sponlaneouslv in this animal Parkes and 
Zuckerman (193a) have also studied the his ologv of the 
oestrone stimulated prostates of monkevs and found that 
thej undergo a fibro muscular overgrownh and a 
stratification of the uterus masculinus 

These experiments suggest that enlargement of the 
prostate in man maj also be due to Ihe action of an 
excess of oestrogenic substance It has of course long 
been Inown that Ihe male bodv forms oestrogenic as well 
as male hormones and that both of these substances could 
be extracted from the te<tis It is therefore not illogical 
to suppose that an upset in the normal balance b,twe,n 
these two antagonistic principles mav be the cause of 
prostatic enlargement But so tar no direct confirmation 
of this theorv has been obtained from anv quantitative 
estimate of the hormones formed bv sufTe-ers from 
prostatic enlargi.ment Hamilton and his co-workers (1936) 
failed to extract anv oestrogenic substance from seven 
enlarged prostates and Lower (1933) sated that Ihe con 
centration of male hormone in the blood of proslaiics was 
even higher than normal Buehler (1933) has however 

4044 


V 


54 JuL\ 9, 193S PROSTATIC ENLARGEMENT AND ITS TREATMENT 


asserted that this is only true of the blood of the vounger 
prostatics, and does not apply to older patients ' Direct 
evidence is therefore still lacking that artificially produced 
prostatic enlargement in animals is a true analogue of the 
condition found in man, and we shall have to wait for 
further evidence before we can feel fully satisfied that we 
have really found the key to the riddle Our uncertainty 
need not, however, prevent us from attempting in the light 
of these animal experiments, treatment along hormonic 
lines This subject will now be considered 

Hormonic Treatment of the Enlarged Prostate 

The fact that the testicle lorms both male and lemalc 
hormones supplies a rationale for the old treatment of 
prostatic enlargement by means of castration No modern 
surgeon would care to rev ive this practice, even although 
-ji} many cases n appears to have achie\ed its object — 
namely, the shrinkage of the prostate He prefers rither 
to aim at restoring the normal balance between the two 
principles by injecting male hormone De Jongh has 
shown expeiimentally that male hormone does possess the 
power to inhibit the action of oestrone on the prostate, 
and Parkes and Zuckerman (1935) have confirmed his 
findings tn the case ot monkeys Incidentallv it would 
appear that progestin is capable of exerting the same 
antagonistic action as male hormone, thus supplying 
another example of interchangeabilitj of hormone in the 
two sexes 

There is plenty ot experimental support, therefore for 
the attempt to deal with human enlargement means 
of endocrine therapy either directly by injection of male 
hormone or else indirectly bv the use of gonadotropic 
substances Until recently these attempts have been handi- 
capped bv the difficulty of injecting enough hormone to 
produce an effect, but with improvements in methods of 
extraction and of manufacture this diftctiltv is being over- 
come The Ciba Companv have now prepared ampoules 
containing 50 mg of testosterone propionate in sterile od 
A large supply of this has been put at the disposal of the 
Medical Research Council, and some half-dozen ot us 
are testing it out on carefulh investigated cases ot prostatic 
enlargement W’hat will be the outcome of this trial 
remains to be seen It must be remembered that second 
only in importance to the actual hormone preparation 
given is the method of giving U 

Important work, which may hive a bearing on future 
lines ot treatment, is at present being done bv Parkes 
Zondek and others on the rate ot absorption of hormone 
liter injection The ideal to be aimed at is to ensure a 
slow continuous absorption ot small amounts over a long 
period 1 result that has been obtained in animals bv 
injecting compressed tablets of hormone into the muscle 
It IS possible therefore that new methods of administra- 
tion will in the future play a part in the hormonic treat- 
ment of prostatic enlargement 

The Steinach Operation 

k Bilateral vasectomy was used as long ago as 1S90 by 
P cniiancler ot Lpsali in the treatment of prostatic en! irgc- 
mient is a substitute tor castration Interest in this oper-’- 
tion w IS n.viv(.d bv the writings of Stem ich in 1918 
ind It his sini-e been used cxtensivclv as a trcitnicnt 
of borh premature senilitv and prostatic enhrgcment on 
the '■ssumption thit it increased the output ot male 
hormone in the testicle The original Stein'>ch operation 
ot he iture ot the vas not hiving given sitislictorv results 
Nieh ins in 1”2T svibstiiuted for it ligature ot the cffcrcni 


Tilt 

Medicai. 

ducts ot the testicle It is diflicult to see why a iieattirc 
in this situation should prove more effective than a hgaiute 
placgd higher up on the vis It is even uncertain that a 
cutting off of the external secretion of the testicle is neees 
sanly followed by an increased output of hormone 
Nevertheless Niehans and other operators hue chimed 
manv successes for this simple form of treatment 

The proof of the pudding lies in the eating, the value 
of Niehans s operation can only be assessed bv the results 
that are obtained from it The ingenious endocrinological 
arguments put forward by Niehans as a justification of his 
operation carry with them little conviction, for m the 
present state of endocrinology it is possible to bolster up 
almost any thesis by choosing those observations tint 
happen to support it and rejecting those that arc opposed 
to It We vvoiild be wise, iherLfore, to judge tin- Nidi ms 
operation by the results that follow it rather than bv tht 
endocrinological arguments that support it What, thm, 
are the clinical results of the ligature operation that goes 
under the name of Stomach IP Niehans himsclt gius 
no actual statistics, but makes only the following general 
statement 

Since 1927 1 have operitcd on about siv hundred prostatit 
patients m mv olmic at Chiens and in the hospitals at \e\e\ 
and Montreuv, and mv experience for ten years empowers 
me lo assert that Steinach s ligature 11 is paiticularly suiiaMt 
for the soft adenoma of the prostate so often cncoiinicrcd 
and eqiiallv suitable for mvomaia whilst its influence is less 
apparent or n// on small hard fibromata In fact, llic 

great mijoriiv of hundreds of patients with adenoma ol flu 
prostate who have undergone Steinach ligature II see ihcir 
bladder troubles graduallv disappear often indeed very qiiicUi 
Thev pass urine more casilj and in greater quantities, con'c 
quentiv less often Slrangurv ceases and the bladder is com 
pletelv emptied The prostate decreases in size’ 

Niehans s statements have found little favour either in 
Europe or in America, and few urologists of repute have 
even given his methods a trial Personally I feel that, 
however incredulous one may be abour any form ol 
treatment, n should not be condemned oflh ind without 
anv attempt having been made lo assess its value I hau- 
therefore during the last two years cirried out Nichvnss 
ligature operation on a number of patients who h ivc come 
to me vvith the express wish that I should do so Out ot 
some thirty patients within my range of observation, three 
onh w’oiild appear to have benefited from their operation 
and to have maintained their improvement Three or 
four others have asserted that they were slightly belter 
and the remainder have cither expressed doubt whether 
anv change had occurred or else have been sure that it 
had not 

The onlv statistics bearing on the subject of the 
Steinach 11 operation that I can find arc those published 
bv Elliot-Smith (1936) He performed the operation on 
twentv patients, most of whom were admitted to hospital 
as enaergenev cases with acute retention Three died md 
seventeen left hospital with four ounces or less of rtsidua' 
urine It was noticeable that several patients with coai 
plcte retention passed urine on the same day as the opera 
tion This males it likely ih it the improvement was u’l 
to a reflex action on the sphincter mechanism at '' - 
neck ot the bladder It is inconceivable that in so ‘hi 'I 
•' time any change could have been effected through it 
influence of hormones 

The Surgerv of Frost itic Olistruction 

It is unnccess irj in this paper to describe at lencib 
worl of Bellficld and riillcr in America and ot ^ 
nd Frejer m this counirv in laying (he found iticns o 



JULI 9 193S PROSTATIC ENLARGEMENT AND ITS TREATMENT 


prostatic surger\ Here \se are not concerned with 
foundations but with the building that is being erected 
on those foundations What form is it now taking’ 
Where base we failed m our building and where hate we 
succeeded ' 

In the British Medical Journal of Julj 20 1901 Frejer 
first ad\ocated and described the technique of suprapubic 
enucleation of the prostate It was a crude and blind pro- 
ceeding guided onlj b> the sense of touch and entailing 
the insertion of a finger m the rectum After enucleation 
no attempt was made to deal with haemorrhage b> the 
usual method of ligature or suture reliance being placed 
on the haemostatic processes of the bod> to bring bleed 
mg to an end Drainage was provided for bj means of 
a large tube inserted not in the most dependent but in the 
highest part of the field of operation Although the results 
were as a rule evcellent no conscientious surgeon could 
feel entireh satisfied with the operation described b> 
Frever since it violated almost everj surgical principle 
Obviouslj It could only be regarded as a stepping-stone to 
a more finished operation 

We will now consider the efforts that have been made 
to get nd of the shortcomings of the Frejer technique and 
irv to estimate what success if anv has attended them 

The Perineal Operation 

In this countrj these efforts have been mamlj directed 
to a more finished toilet of the prostatic bed and to the 
adoption of better methods of arresting post operative 
haemorrhage We have hitherto never departed verj far 
from the original technique nor abandoned for long the 
suprapubic approach to the prostate In America the 
suprapubic route has been seriouslj challenged bj the 
perineal operation elaborated bv Proust, and strongly 
advocated by H H Young of Baltimore There are 
manv points m ns favour, notably the better drainage 
provided bj a wound in the perineum and for a time the 
protagonists of the suprapubic and of the perineal routes 
seemed evenly matched Of late years however, the pro 
tagonists of the suprapubic operation have steadilj gained 
ground and it is now chieflv through the influence of 
H H \ oung and of those trained in his clinic that perineal 
prostatectomy still remains the routine operation for the 
reliet of prostatic obstruction in certain American chnics 
In this countrj it has never gained anj hold A few of us 
have af one time or another been attracted bj the advan 
tages of the perineal operation and have provided our- 
selves with the necessary equipment for carrving it out but 
at the end of a year or two this equipment has usually 
found Its way into our surgical lumber rooms 

Suprapubic Prostatectomy 

The first serious effort to eliminate the more obvious 
shortcomings of the Frever operation was made by the 
late Sir I Thomson Walker in 192S By means of a 
lafgcr suprapubic incision, introducing a suitable retractor 
and placing the patient in the exaggerated Trendelenburg 
position after the prostate had been enucleated the field 
of operation could be inspected torn shreds of tissue cut 
away so as to reduce subsequent infection and bleeding 
points ligatured Haemostasis was completed bv the inser- 
tion of a continuous suture along the posterior segment 
ot the bladder outlet The originator of this open opera 
tion hoped by these means to reduce post operative 
haemorrhage and sepsis to a minimum and to banish 
enlirelv that occasional sequel to operation post- 
prostatectomy obstruction 


Tttt B,mm 

V*^t-JL. Je ,s,t 


Ten years have elapsed since Thomson Walker intro 
duced his open operation and experience has shown th-t 
It affords no certain guarantee against the occurrence o, 
anv of the accidents that its originator hoped to prevent 
Severe haemorrhage sepsis and post prostatectomv 
obstruction have all occurred after an open operation 
Their incidence mav be less frequent but none of ih-ve 
accidents has been entirelv eliminated and manv of Us 
have come to the conclusion that the extra half hour 
required for the open operation is not justified by the 
benefits It confers WTiere speed is necessarv the o'd 
Frever operation still remains preferable A glance at th. 
last annual surgical report of St Peter s Hospital in which 
the results of the various operations performed there 
during the vear are admtrablv set out serves to confirm 
this view There it will be seen that the highest mortaliiv 
rate is that which follows the performance of the Thomson 
Walker operation Undoubledlv its originator was right 
in attempting to eliminate the defects of the Frever opera 
tion but unfortunatelv his efforts to do so have not met 
with the success that he hoped for 

The Harris Technique 

To a worker m Australia — namelv the late S H Harris 
(1933 1935) of Melbourne— -must be accredited the next 
serious effort to gel nd of the glaring detects ot the Frever 
technique Dissatisfied with the half measures of Thomson 
Walker he aimed by means of carelullv placed sutures to 
arrest haemorrhage so complelelv that the bladder could 
be closed bv primary suture 1 oung s boomerang needle 
a clever invention that had been originally devised to aid 
in the difficult task of closing fistulae left by the perineal 
operation provided him with the instrument necessarv to 
his purpose With the boomerang needle it was possible 
to take a big bite of the tissues round the prostatic cavitv 
to underpin all bleeding points and to reconstitute the neck 
of the bladder The suture on which Harris placed most 
emphasis was a median postenor suture so inserted as to 
carry a longue of mucous membrane and muscle deep 
down into the prostatic cavity This trigonization 
suture as he termed it served to re form the floor of the 
urethra Lateral stitches were then inserted m such a 
manner as to draw together the walls of the cavity and to 
help to obliterate it Drainage was provided for by an 
indwelling urethral catheter anchored in position bv means 
of a stitch passed through its eye and brought out through 
the abdominal vvall Tbe bladder was then closed by 
primarv suture Harris claimed excellent results from his 
operation and published a remarkably low mortality rate 
That uglv trio of the Frever operation — haemorrhage 
sepsis and post prostatectomv obstruction — ^had apparemlv 
been conquered and the author of the new operation 
waited confidently for his colleagues blessing on the m-w 
technique 

The urological world was slow to take note of his 
writings In opening a discussion on prostatectomjf at ihe 
Centenarv Meeting of the B M A held in London in Julv 
1932 Mr Swift Jolv commenied unfavourablv on the 
Harris operation He expressed the opinion that atlempls 
lo perform plastic opcations on ihe prostatic caviiv 
resulted onlv in an increase of sepsis Other speal e s 
were inclined to agree with him Hams was bitterlv dis 
appointed 

Soon afterwards the tide began to turn Clifford 
Morson and Ogier ISard gave his method a trial and later 
published good results from the new technique Oth-r 
British urologists followed suit, and at the annual meeting 


56 July 9, 193S 


PROSTATIC ENLARGEMENT AND ITS TREATMENT 


of the Urological Section of the Royal Society of Medicine 
a complete reversal of opinion was iound to have taken 
place It was the majority of speakers who now upheld 
the Harris operation, the minority who opposed it But 
It was very noticeable that everyone who, was using the 
new operation had considerablymodified Harris s technique, 
one having eliminated the ^posterior tngonization suture, 
another the postero-lateral, and a third the antero-Ialeral 
Moreover, only a few had dared to follow Harris s lead in 
carrying out primary closure of the bladder as a routine 
measure Usually a small suprapubic drainage-tube was 
inserted and retained during the first few days of con- 
valescence 

Present Position of the Harris Operation 

Operations are subject to the same laws as those that 
control other human inventions , at first a new operation 
meets with a certain resistance, and then if it has any 
merit it is acclaimed as a great advance that will supei*- 
sede all other methods Finally it reaches the period of 
equilibrium or of decline it eithei takes a permanent 
place in the repertoire of the surgeon or else sinks into 
oblivion This I believe will be the history of the Harris 
technique, but at the present moment I am not prepared 
to say what the final stage will be I am sure, however, 
that in the exact form in which Harris planned it his 
operation will not survive, for it suffers from a great 
defect, a defect from which the Freyer operation is 
altogether free In inserting some of the sutures the 
boomerang needle passes well outside the limits of the 
urinary tract, and is therefore capable of carrying with it 
infection — if infection there be — into the cellular tissues 
of the pelvis That this is not merely a theoretical 
objection but a very real danger is shown by the 
fact that practically every operator who has used 
(he Harris technique at all extensively has met with 
cases of pelvic cellulitis It can of course be urged 
that pelvic cellulitis may occur after every type of 
prostatectomy, but the consensus of opinion favours (he 
view that it is more frequent after the employment of the 
Harris technique This is a very serious objection, and 
H irris s insistence on the necessity for the careful pre- 
operative treatment of infection does not remoxc it 
However carefully we prepare our patients we cannot 
gu irantee that we have rendered the bladder aseptic 

A second shortcoming of the operation is that while the 
lateral sutures certainly dimmish bleeding thev do not 
obliterate (he prostatic caxity All that they do is to draw 
the bladder together oxer the hole left by the prostate, 
unless, of course, the boomerang needle is inserted so wide 
th It It goes xvell outside the prostatic capsule Such a big 
excursion of the needle not only increases the risk of 
pclxic ct-llulitis but also when the stitches are tied, turns 
in i great part of the base of the bladder and causes a 
marked deformity of that xiscus Although Hams him- 
self showed no hesitation in inserting these xxidely pi iced 
sutures 1 cannot feel that so gross a deformity of the 
hi idder IS desirable 

Beetuse of these xxeik points in the Harris operation 
some ot those who had prexiouslv adopted it haxe gixcn 
11 up while exthers haxe so greatlx modified the method 
thu It ean no longer be called a Harris operation My 
own position is that I still emplox a modified Harris 
technique but onlx in those fax Durable cases in which 
I im fullx satisfied that the pitient is able to support a 
longer opention When a two stage operation is advis- 
able or when 1 feel inx doubt about the patient s capacity 


TiirllRiTmi 
MjniCAL Jninvi 

to xvithstand a more formidable procedure, I luxe Itllen 
back again on an operation that in its essentials resembLs 
the old detective method of Frejer For me the tech 
nique of Hams, xvhich at one time I hailed as a grcit 
advance in prostatic surgery, appears to be a method ol 
definite but of limited utility 1 look upon it as a portent 
of things to come rather than as a method that his 
already arrived It indicates the lines along xvhich wc 
must continue to xvork — a direction and not a goal 

On the Continent and across the Atlantic the Hirris 
method has met with no favour Eftorts to advance m 
prostatic surgery have in the United States taken another 
direction, more pai ticularly the development of pcrtirelhi il 
methods of treatment This important branch of pros! itie 
surgery xvill now be discussed 

Perurethral Operations on the Prostate 

Ag<iin It xvill be unnecessary to deal with the foiinih 
tion of perurethral surgery laid by Bottini, CixciV, 
Young, Caulk, and Luys, for we are mainly concerned 
with modern developments Alter the usual period of 
lesistance this method of dealing with prostatic obstruction 
received widespread recognition rather siiddenlv lij 
some enthusiasts it was even proclainicd to be a method 
that within a decade would entirely icpiacc all others 
Prostatectomy would then ictain merely a historic intcrevt 
This has only prox'ed to be approximately true in the 
case of the Mayo Clinic, at which about 98 per cent ot 
prostates are now being dealt with by perurethral methods 
Elsewhere it has been felt, first, that resection is not i 
universal substitute for piostateclomy but a valuable alter 
native to be used in certiin cases and, sccondlv thu it 
IS not a minor proceeding immune from all dangers At 
a very eaily stage after the spretd of perurethral methods 
disturbing reports of deaths from haemorrhage and sepsis 
destroyed the illusion that the resectoscopc was an inslni 
ment that could be used by all and sundry with light 
hearted enthusiasm Even to the experienced urologist a 
perurethral resection often proves to be a difficult opera 
lion In the hands of the inexpert the rcsectoscope v m 
be an instrument that is more deadly than the knife 
Years of practice arc necessary in order to become master 
of it 

As in the case of prostatectomy, the chief dangers of 
perurethral resection have prox'cd to be haemorrhage and 
sepsis , and it has been to eliminate these, and at the same 
time to increase the facility with xvhich prostatic tissue 
IS remox'ed, that our efforts hax'c in the main been directed 
All techniques that entailed the leaving behind of a large 
area of coagulated tissue have now been abandoned on 
account of the sepsis that they encouraged Of the man) 
instruments that have been devised two have now definitely 
gained the ascend mey , these ire the McCarthy rcw'-io 
tome and the Thompson punch In this country wc prefer 
a modification of the former instrument, not necessarily 
because it is the better weapon, but because we find the 
direct-vision ocular system of the Thompson punch mure 
difficult to use From the point of view of sepsis 
however, the Thompson punch, which employs i c(’< 
knife for cutting and only uses a coagulating current for 
stopping haemorrhage, is probibly the better inslrumeni 

On the whole it may be said that in this coinu 
urologisis have reached an igrecmcnt not only as to tt' 
best method of carrying out pcrurclhr il resection '■ 
also as to the indications for doing so Onlv ' 
America do we find discrepancies of opinion so w/d'- 
to result in the pcrurclhr it method being u‘ed or 



Jlu 9 193S 


PROSTATIC ENL^RGE•tENT AND ITS TREATMENT 


Tft'BtrrsH 
Mto kl Jy 1LN E 


cvceptionallj at one clinic and as a routine procedure in 
another Here we regard it as a treatment that is suited 
to certain prostates and to certain circumstances 
Perurethral resection is no longer on its trial but has 
established for itself a definite place in the surgerj of the 
prostate 

Conclusions 

Having survejed the work that has been carried out b\ 
innumerable researchers m the laborator> and in the 
operating theatre during the last twentj jears 1 feel 
that we have no reason to be dissatisfied vvith the 
results We have made definite progress both in our 
understanding of the aetiologv of enlargement and in our 
methods of dealing with it The investigations of the 
biologist and of the biochemist are now leading us m a 
direction which mav well mean that within a few vears 
we shall be able to prevent its occurrence and possibl) 
cure the condition once it has arisen In the meantine 
close co operation between the clinicians and the designers 
ot instruments has provided us with a valuable alternative 
method of surgical intervention in the shape of perurethral 
resection Finallv it mav be said that even if the efforts 
of prostatectomists to nd the original Frever operation of 
ns shortcomings have not so far met with success there 
IS no reason to disbelieve that m the end this also will be 
achiev ed 

Biblioorvphv 

Buvhkr F (1933) Z exp Med 86 650 
Burrows H and Kennavvav tv M (1934) Amer ] Cancer 20 
4S ' 

Caulk J R (1934) Snrg G\nec Obsiei 58 341 
Ciechanowvkv S (1903) Anatonncat Research on Prostauc fixper 
tropfn 

Elhol Smith A (19 6) Proc ro\ Soc Med 29 825 
Frever P (t90tl Bnnsh Medical Jonrnat 2 125 
Hamilton S B Demmg C L and Allen E (1936) Proc Soc 
exp Biol Ml 34 193 
Harris S H (19ja) Brit J Snrg 21 434 

(1935) Austral Aen Zeal J Snrg 4 226 

de Jongh S E (1933) dcta brei Txeerl Plustol 3 112 

(1935) Arch till Pharm Ther 50 3vS 

Lacassagne A (1933) C R Soc Biol Pans 113 ^>6 
Launois P E (1SS5) These de Pans 
Lower V\ E (1933) Apt, Engl J Med 208 37v 
Niehans P (1936) Lancet 1936 1 307 

(1937) Presse iiud 45 ISvS 

Ptrkes A S and Zuckerman S (19j5) Lancet 1 925 
Piul FT (1910) Ibid 2 294 
Swifl 3oIv J (1932) Bnnsh Medical Journal 2 192 
Thomson Walker j (19j0) Lancet 1 116a 

(19 6) Genito-L nnarx Snrgerx London 

Walker Kenneth (1922) British Medical Joiiri al 1 297 
Zuckerman S (19a6) Proc rox Soc Med 29 1557 
and Groomc J R (1937) J Paih Baci 44 113 


The fourth annual meeting of French radio eleclrologists 
will be held m the phvsics theatre of the Pans Faeoln of 
Medicine from October 5 to g Professor Johot-Cune will 
deliver an opening address on the biological applications of 
the neutrons and the artificial radio elemenis including the 
therapeutical hvpotheses concerned Professor Didier will 
speak on the radiological methods of examinaiion of sections 
of organisms Professor Baudoum and Dr Fischgold vvill 
present a communication on the bio-electrical phenomena of 
the nervous svstem and their possible applications m practice 
Dr Gaston Daniel of Marseilles will discuss radiotherapv as 
an antidote to inflammation Lectures on vanous aspects 
of biophvsiologv will be given bv Professors Lamarqtic Soula 
Marques and Sirohl rv Djoumo \ isits wall be paid to 
in mules and hospitals and there vviU be enlertammcntv and 
evsursions Full intormation mav be obtained from Dr 
Delherm 1 Rue Las Cases Pans 7e 


A^AE^\IIA A^D THE G4.STRO- 
IMESTINAL TRACT* 

BY 

JANET M A AUGHAN D M , M R C P 

Senior Assistant tr Chrici.1 Prihologx Briiisl Pcstsrrdiiaie 
Medical School 

It IS recognized to dav that the commonest came ol 
anaemia is a lack of one or othe' of the e<- enlia! haemo 
poietic principles The known h_emopoietu, pnncip ^ 
are (1) iron (2) the P A substance in live effective m 
Addisonian pernicious anaemia I'l vitemm C Mim le 
quantities of other minerals such eopper eODah and 
manganese mav be required tor norma! h^emopoies s 
but are usuallj present m sufficient ouan tie even in 
poor diets since onlv evtremelv small amcen s a e needed 
Thvroxine is often included but its effec' is piobab'v 
an indirect one (Bomford 1936) The bedv is dependent 
for ns supplies of these haemopoietic p'lrteipies upon 
the food ingested and subsequentlv digested end ebsorbed 
in the intestinal canal I is therefore not surprising that 
there is a close relationship beiveen en-em - and dis 
turbances of gasiro intestinal function sinee abnormalit es 
in food intake digestion and absorption mus' result m a 
dcficiencv of these principles It is es'enlial m (real n,, 
a patient with a deficiencv anaemia to recognize not onlv 
the t>pe of anaemia — that is whether it is due to lack of 
iron hver or vitamin C — but also lo determine bow ihe 
deficiencv is brought about so that an atlcmpi mav be 
made to correct the disordered mechanism It must also 
be remembered that an adequate supplv of haemopoic ic 
principles mav be converted into an inadequate supplv 
if the demands are increased Thus iron-deficiencv 
anaemias are eMremelv rare in men unless there is some 
source of chronic haemorrhage On the o her hand iron 
deficiencv anaemias are common m women oi the working 
classes because the iron content of the diet is not 
sufficient to make good the continuous iron dram of 
norma! mensiruation (Davidson ard Fullerton 193S) 

For purposes of discussion the disturbances of gavtro 
intestinal function that mav convert an adequate into an 
inadequate diet so causing whai Castle has called a 
conditioned deficienc) mav be grouped as tollows (1) 
haemorrhage (2) deficiencv of gastric digestion (3) 
deficiencv of intestinal absorption (4) production ot tovic 
substances So far as is known such factors influence 
onlv the utilization of iron and the P A principle There 
IS no evidence that intestinal abnormalities affect the 
utilization of vitamin C 

Haemonhage 

The commonest sources of gastro intestinal haemorrhage 
are bleeding gastric and duodenal ulcers and haemorrhoids 
The latter especiallv in men are an important cause of 
severe iron-deficienc anaemia ft should alwavs b. 
remembered that m tropical countnes bleeding fro n 
hookworm infestation associated with a poor diet is a 
possible cause of hvpochromic anaemia An anal>sis of 
the stools for occult blood is an essentia! invesligation 
uj all cases of anaemia of unknovvn aetiologv 

Deficiencv of Gastnc Digestion 

Deficiencv of gastric digestion mav be due to fa) 
organic lesions (b) diminished secretion of hjdrochlo ic 
acid (t) diminished secretion of the intrinsic facto of 
Castle 

• A paper read to Ihe Eveter D vision of rht B iiivh Medical 
AssOsaUoi 03 March 10 I9j5 



58 July 9, 1938 


ANAEMIA \ND G ^STRO-INTESTIN AL TRACT 


(a) ORGANIC LESIONS 

Within the term organic lesions” are included new 
growths of the stomach and complete or partial gastric 
resection Such lesions cause anaemia in part by 
diminishing gastric secretion and in pait bv altering 
intestinal function They respond well, so far as the 
blood picture is concerned, to treatment with iron and 
liver extract 

ib) DIMINISHED SECRETION OF mOROCHLORIC ACID 

There is a high incidence of achlorhvdria associated 
with all types of anaemia It is invariably present in 
Addisonian pernicious anaemia, and is often found in 
iron deficiency anaemia of women and infants and m 
anaemia associated with hookworm infestation, sepsis, and 
nephritis It was thought at one time to play such an 
important part in the aetiology of the iron deficiency 
anaemias that the type occurring in women was called by 
some workers, “ achlorhydric anaemia ’ The evidence 
available to-day suggests that inability to secrete acid 
favours the development of iron deficiencv, especiallv when 
the diet is defective, but that iron deficiency often occurs 
when the acid secretion is excellent Barer and Fowler 
(1937) have recently made elaborate iron-balance observa- 
tions on people with and without achlorhvdria They 
found that people with achlorhydria retain less iron on an 
ordinary diet than those without achlorhvdria Medicinal 
doses of hydrochloric acid do not increase retention It 
must be remembered, however, that such acid is quickly 
neutralized by the stomach contents If food is gi\en 
buffered to an acid pH (Mettier and Minot,_ 1931) iron 
IS more readilv absorbed than if it is given buffered to 
an alkaline pH Barer and Fowler (1937) found that 
when large quantities of iron are given the amount 
retained was unaffected bv the gastric acidity, being the 
same approximately m people with normal acid secretion 
and in those with achlorhydria These observations 
suggest, therefore, that m practice the use of hvdrochloric 
acid will not help the absorption of iron either from the 
ordinary diet or from medicinal supplies It is, however, 
impracticable and also unnecessary to give a diet 
buffered to an acid point, since medicinal iron 
administered in large amounts appears to be nell absorbed 

As a result of their observations Barer and Fowler 
suggest that in iron deficiencv anaemias there may be a 
1 ick of some as yet unidentified substance in the gastric 
secretion Evidence on this point is at present conflicting 
md unsatisfactory 

(c) DIMINISnrD SECRETION or THE INTRINSIC FACTOR OF 
CASTLE ’ , 

Addisonian pernicious anaemia is dependent upon a 
deficiency of such a substance, called by Castle “ the 
intrinsic factor’ In a senes of classical experiments 
Cistle showed that if beef-steak was fed to patients with 
pernicious anaemia the blood picture vtas unaffected If 
normil gastric juice was fed the blood picture was still 
un affected, but if beef-steak predigested with normal 
gastric juice was given the blood picture became normal 
Prtdigestion with gastric juice from patients with pemi- 
eioiis anaemia, or with hvdrochloric acid and pepsin alone, 

* was ineffective He concluded, therefore, that the 
fundimenial abnormalitv in pernicious anaemia was an 
in ibiliiv on the part of the stomach to secrete some 
principle essential for the digestion of certain foodstuffs 
ind the consequent elaboration of the active liver prin- 
ciple It IS probiblc that inabilitv to secrete the intrinsic 
f 'Ctor IS not •'bsolute — that is that some patients arc able 
to excrete small quantities and that the amount may 


Titc pRinMi 

AuDICAL JOkKNU. 

varv from time to time (Goldhamer 1936) This would 
account for the occurrence of spontaneous remissions 
before the davs of liver therapy Goldhamer (19^(,I 
goes so far as to suggest that there is a constant 
relation between the blood level and the volume of 
gistric secretion The cause of this inabilitv to secrete 
the intrinsic factor remains^ obscure Gaslroscopic 
examination of the stomach shows atrophic gastritis 
affecting the fundus and cardiac portions in pernicious 
anaemia and to some extent in iron-deficiency anaemias 
Histological examination of the stomach in pernicious 
anaemia shows atrophv both of mucosa and of musslc 
coats (Magnus and Unglev, 1938), affecting the liindus md 
cardiac portions only Since all experimental evidence 
(Meulengracht, 1935) suggests that the intrinsic factor is 
secreted by the pvlonc glands and Brunners glands, this 
anatomical abnormalitv is at present difficult to interpat 
There is no evidence that after treatment the power to 
secrete the intrinsic factor ever returns to normal, though 
It may improve slightly Goldhamer (1937), who Ins 
estimated the quantity of gastric juice before and afler 
liver treatment, has obtained only an insignificant 
increase The average gastnc-juice volume in normal 
subjecis he found was 150 c cm per hour , in pernicious 
anaemia patients it was 20 c cm m relapse and 46 c cm 
in remission It is therefore essential to continue trcii 
ment with liver extract indefinitelv in true Addisonim 
pernicious anaemia 

Anaemias associated with gastric dysfunction arc 
usually simple — Ihat is, chore is lack of the PA fucior 
alone or of iron alone Theiapv takes the form therefore 
of either liver" extract or iron This is true particiilarlv of 
iron deficiencv In practice it is sometimes found lint 
patients with Addisonian pernicious anaemia have also 
some degree of iron deficiencv The red cell count 
reaches a level of 4 000,000 per c mm or slightly higher 
w'hen hv'er extract is given in adequate doses, but even 
with increased dosage it will not rise further Trcitment 
with large doses of iron in addition to liver extract how 
ever will often result in satisfactory hacmatologicil 
improvement Realization of this is important, since it 
IS absolutely essential, if subacute combined degcnenlion 
IS not to develop or grow worse when already presenl 
that a red cell count of 5 000,000 per c mm and i 
haemoglobin of 100 per cent should be maintained in 
all patients with Addisonian pernicious anaemia 


Deficiency of Intestinal Absorption 


It IS known that in many patients hypcrchrome 
anaemia responds better to liver extract given h) 
parenteral injection than to liver extract given by mou h 
while anaemia is often found m association vvilh v irioiit 
disturbances of intestinal function It is concluded, ihcrc 
fore, that failure to absorb haemopoictic principles mi) 
play a part in the development of anaemias 
following abnormalities of intestinal function are though! 
to hinder absorption (a) changes in the pH of ihs 
intestinal contents, (h) increased moiility , (c) abnormili 
ties of muscle tone , (^/) abnormalities of inlesiirj! 
mucosa 


(a) CHVNcrs IN r/I 

Gastric secretion of hydrochloric acid, so far as '« 
known at present, regulates the pH of the inlcstin^ 
contents Evidence showing ihal smill doses of 
arc bellcr absorbed from an icid medium and thal imf^ 
food IS given in a buffered medium it is impossible lo i '■ 
the pH of ihe inteslinal conlcnls his bef: alrc-c 
discussed 



Jcu 9 I93& 


ANAEMIA AND GASTRO-XnteSTINAL TRACT 


A. J-tf HN.4 




(M INCREASED \IOTlLm 

Increased motihts of the intestinal contents is a more 
frequent cause of anaemia than is generallj recognced 
Following gastric operations such as gasiro enlerostomt 
gastrojejimostomt or partial resection anaemia often 
deselops Mans studies have been made as to the cause 
of this anaemia but onlv one abnormalitv has been 

demonstrated to occur at all constanlh Hartfall 

(1934) found in a large series of such cases that on 
screening a barium meal appeared to fall through the 
small intestine — that is there was greatlv increased 
motilitj Little time is available therefore for absorp 

tion of essential principles when the> occur in normal 

amounts If given in large quantities they are apparently 
absorbed more easilv The mechanism of this increased 
absorption in the presence of large amounts is not clear 
Such increased moiilitv is probablv a factor also in the 
production of the anaemia of sprue and the anaemias 
associated with severe diarrhoea of any type 

(c) ABNORVIALITIES OF MLSCLE TONE 

In the case of sprue abnormalities of muscle tone and 
movement have been demonstrated during a relapse and 
have been shown to be absent during remissions tMackie 
Miller and Rhoads 193a) No increased motility was 
demonstrated, but in a series of seventeen cases the 
following changes were almost invariablv present 

(0 Great variation m contour and size of the lumen (ii) 
segmentation of the column of barium (ni) pocketing of 
barium liv) mucosal changes shown bv a distorted mucosal 
pattern Studies by barium enema frequentlv demonstrated a 
dilated and somewhat redundant colon Fol'ovving treatment, 
considerable if not complete improvement was noted Since 
manv patients with sprue respond better to liver extracts when 
given bv injection than when given by mouth it is thought 
that some failure of intestinal absorption must be present 
probablv dependent at least m part on these demonstrable 
changes in muscle function 

(<0 ABNORVIALITIES OF THE MLCOSA 

Anaemia is common in all forms of colitis Here 
probablv mucosal as well as muscular abnormalities plav 
their part in hindering absorption of essential foodstuffs 

In idiopathic sleatorrhoea there is failure to absorb 
manv essential substances from the inlestinal canal not 
only baemopoietic principles The cause of such failure 
remains obscure Other iniestinal abnormalities such as 
multiple resection multiple adhesions stenosis of the 
canal or fistula formation may all result m anaemia 
presumablv through interference with intestinal absorption 
through one or other of 'he abnormalities discussed 

It has been suggested that lack of ascorbic acid mav 
result in a failure of intestinal absorption especiallv of 
iron It IS known that apart from glutathione ascorbic 
acid IS the most powerful reducing agent present in the 
body (Hopkins and Morgan 1936) The mucosa of the 
small inlesiine is unusually rich in ascorbic acid and 
since iron is absorbed in the terrous form it has been 
thought that a deficiencv of this powerful reducing ageni 
in the intestinal canal might result in a failure to absorb 
sufficient quantities of iron (Macfarlane 19^6) This 
view however at present lacks anv direct experimental 
support 

The changes in inlestinal function already discussed 
might be expecled to affect the absorption of manv sub 
stances simultaneouslv rather than to exert a selective 
aciion This is often found lo be ihe case A mixed 


type of anaemia is common m anaemias of intes' a_I 
origin — [hat is the'e is a deficiencv of bo h iron and 'h* 
PA principle The recognition ot such a deal ^n^e-* - 
mav sometimes vli eel attention to the mies inj c„n-! 
when a lesion there has not been suspec ed S'ai"-d 
blood films in such cases show the small pa'e se'ls sot 
taming little haemoglobin which are charactenstic of iron 
deficiencv anaemias together with the large w^M 
coloured cells full ot haemoglobin which are charaeie'iVis 
of P A deficiencv anaemia Such ca es require fe-t 
ment with both iron and liver Their revOgm ion 
therefore important UTien such a pu.iure is e^n m 
stained film an intestinal abnormaliiy should at b, 
suspected A special examinjlioa houM be mad^ n 
all patients with a known gastro intostma' le iot o d' 
cover if this dual deficiencv is pre-eni Ii m-v otaur 
With onlv a mild degree of anaemia but adm nistraiion ot 
hoih liver and iron m such cases will result m remarkib'e 
clinical improvement Such treatment has to bt con 
tmued indefinitelv since it can onlv replace a di.hsii.nsv 
and does nol affect the disturbed mechanism 

Production of Toxic Substances 

Recent experimental work has shown that the pro 
duction of toxic substances m the intestine avsosiatsd w ih 
a deficiencv of certain food substances in the diet mav 
cause anaemia possiblv of a haemolvtic type It mav bs 
necessan in the future to think m terms ot conduioned 
loxicities as well as ot conditioned deficiencies Rhoads 
(1937) found that when he fed indol to dogs on a 
normal diet the dogs remained welt bus when he ted 
indo! to dogs on a deficient diet a severe anaemia 
rapidly developed This was cured bv liver extract and 
Its onset prevented bv the addition of liver to the diet 
Indol IS a substance which mav be present m the normal 
intestine and under some circumstances mav Owcur n 
large amounts These observations are loo recent to 
enable us to do more than note them Thev serve 
however, to emphasize the extraordman importance ot 
an adequate diet m maintaining normal health and are 
a vet further indication of ihe close relationship of normal 
gastro intestinal function to normal haemopoiesis 

REFEIIES.tS 

Barer A P and Fovvler \\ \I (19 TJ drr/i inirrn \ted 59 
"S' 

Bomford R (I9sSl Pt* sonal cornTnuitcaijon 
Davidson L S P and Fultenon H W (19 Si Edinb mej 1 
45 1 103 I9r 

Goldbamer S M |19 61 Amrr 1 med Sci 191 ..05 

tl9t7) Ibid 193 31 

Hartfall S J (IR341 Cu s Hoip Rep 84 

Hopkins F G and Morgan El 19 61 Biucfem I 30 14^6 

Macfananc W D (19j6i Ibid 30 1473 

Mackic T T Miiie’' D K ard Rboads C P 119^^1 An er J 
trop Med 15 s7i 

ktagnus H A ..nd C C I19V3) Lancet 1 ..30 

Meiuer S R and Minoi G R <19311 4 ner 3 med Set ISl 

3S 

MeuFngrachl E fI9 x) Proc rot Son Med 28 
Rhoads C P Il9s7l Proc Soc exp Birtl N y 36 6S_ 


Cremation as the mo t hvgienic mean*^ for di^po^l of the 
v.as advocated bv Dr N\ G Cl-rk dcpjiv medical 
officer of health for Edinbursh at th- joint confererve of the 
National A.^^ociation of Ccmclcn. ard Crenatonum Super 
intendenl^ and the Federation of Crenatton Authont C'i m 
Great Bniain held n Edinburgh last wcei D' Dougl-s 
Kerr nedical referee to the Edinbyk-h Corporaiton <iajd that 
cremation was advanong *vo rapidh becom ng *0 w»de\prcad 
and such exten ive practical experience of the working of the 
pre>enl Act had acutm ufated that fresh /ecrdation could N* 
foreseen in the near future 



60 July 9, 1938 


FURTHER OBSERVATIONS ON BENZEDRINE 


FURTHER OBSERVATIONS ON 
BENZEDRINE 

E W ANDERSON, M D , M R C P , D.P U. 

The interest in benzedrine, particularly m its use in 
psychiatry, would seem to justify yet another contribution 
to the literature The following is an account of a study 
of the effects of benzedrine, over a period of fourteen 
months or go, on a group of patients at the Cassel Hos- 
pital who were suffering chiefly from the minor forms of 
mental disorder 

Thirty-three patients in all were given benzedrine orally 
in doses ranging from 5 to 45 mg In addition, eight 
normal subjects were given the drug Among the patients 
twenty-one were male and twelve female The diagnostic 
grouping was as follows twenty-eight depresstves, two 


Tut Bmtpu 

'ftOtCAL Joi RNVU 

stituents has been observed either at the time or months 
later (Schube, Raskin, and Campbell 1937) altlioiich 
before this Mverson, Loman, and Damcshck (1936) hail 
reported dramatic changes, including a poh c\ thaenn i m 
some cases, as well as a striking leucoc\tosis It would 
appear that still further work on this problem is rcquiad 
m view of these obseraations So tar as its iist. m 
psychiatry is concerned there is fairlv general agreement 
as to its effects , the change of mood in the direction of 
elation, removal of inhibition fatigue and so forth call 
for no further mention, but before discussing the psvcho 
logical effects m greater detail the present results will be 
considered 

The Present Imestigation 

The patients have been giouped in three categoras 
(1) those showing no change mentally or phvsicallj after 
taking benzedrine (Table A) , (2) those who appeared to 
benefit by it, including those cases in which the benelienl 


Table A 


No 

Sex and Asc 

Diagnosis 

Maximum Dose 

Duntion 

Unfavourable Phvsjcal 
Svniptoms 

PvvchologicTl Svmpionis 

1 1 

M 

aged 49 

Recurrent depression Kthird) with 
paranoid features and much 
retardation 

30 mg j 

! 

One month 

! 

None 

No change During perud 
of severe retard uion ro 
change 

2 

F 

aged 34 ' 

Schizophrenia (catatonic stupor) 

20 mg 

One occasion 

None 

No chinge 


M 

aged 44 

Depression \Mih hypochondriasis 

1 10 mg 

One day 

No change 

No change 

■ 

M 

aged 49 

Depression (agitated self accu 
saiory) n 

20 mg 

' Two days 

' No change 

' No chingc 

5 

F 

aged 56 

Depression (retarded) 

20 mg 

One day 

No cnect 

No effect 


“ anxiety states,” three schizophrenics, and one organic 
(manic-depressive with disseminated sclerosis) 

At the beginning of this study the pressor effect of the 
drug was studied as well as its central effects, and careful 
observations of the blood pressure and the mental state 
were made throughout the day The blood pressure was 
taken each morning at 9 o clock, in the lying and stand- 
'ing positions, the third reading being taken m each case 
The drug was then given, the variations in dosage being 
concealed from the patient by using tablets of a neutral 
substance (calcium lactate) as well, so that the same 
number of tablets was gnen each time The normal 
variations ot the blood pressure in the individual were also 
determined These observations presented nothing new, 
and w’lll not be discussed further After a time, there- 
fore, we ceased to study the blood pressure alterations and 
devoted our interest entirelv to the psychological changes, 
and it IS these which form the mam topic of this paper 
After Davidoff and Reifenstein s (1937) excellent paper 
and a recent leading article on benzedrine in the British 
Medical Jointwl (1937) it is unnecessary to review the 
literature at length The two main effects of this sym- 
pathomimetic drug— the pressor and the central action— 
<re now familiar Its use in narcolepsy (Prinzmetal and 
Bloombera 1935 , Ulrich, Trapp, and Vidgoff, 1936), post- 
<^ncephahuc Parkinsonism (Solomon, Mitchell, and Prinz- 
'”‘^‘11 I937J intestinal spasm and hence Us employment 
'P gastro mtcbiinal radiologv (Nherson and Rityo, 1936), 
i9 yasoconstrictor in rhinology (Scarano and others, 
19 ai 'pyLus elTcct on gastric juices (Myerson, Rinkel, 
and Dam<.sh(.K no\y require no further mention 

A mori. rn.em non psjchialric use is in orthostatic hypo- 
tension (korns and Randall 1937) in which fayourable 
results hayc been ob^tryed it seems, hoyyeyer, inferior to 
cphcdrinc in the treitment of this condition Although 
cont lining a benzene ring no effect on the blood con- 


psychological effect outweighed anv unpleasant pin sic il 
sensations yvhich may haye occurred (Table B) , and (3) 
those in xvhom it yvas necessary or desirable to disconliniit 
the drug because of untoyvard effects or because it provul 
of no value (Table C) In an earlier paper I described 
with Dr Scott some tinfayourable cardioyasciilar com 
plications, the most notable of yvhich yvas a transient heirt 
block These experiences made us for a time exceed 
ingly cautious m dosage , but yve noiv bclicyc this case 
to haye been exception il and ih view of increased cxpcri 
ence yvith benzedrine, together yvith the fact that others— 
for example, Prinzmetal and Bloomberg (1935) — hne now 
given the drug continuously for long periods, in some of 
their cases for oser a year, without mishap we lia\e not 
hesitated to give larger doses Ncyerthelcss I considtr 
there is still need for caution in its idmmistration and 
more detailed investigation of its cardiological effects m 
particular I agree yvith Davidoff and Reifenstein (1937) 
that It IS best giyen under superyision in a hospital So 
far, despite the comparatiycly large amount of work 
yvhich has been done, the drug is still in the experimental 
stage 

Of the total number of patients to xxhom the drug was 
gixen, in fifteen or just under one half, it yvas found 
necessary or desirable to discontinue the drug In too 
others the drug appeared to be of no yaluc and was dis 
continued essentially for this reason Some undesirably 
sjmptoms also occurred in these patients, but thc> were 
not seyerc enough in themselyes to haye justified dision 
tinuance of the drug had there betn a concomiiant 
psychological effect of any yaluc One patient a nim 
(CIO), yyas the ‘ organic case menlioned ibose th: 
other, a yyoman, yvas a case of inxicty slate (C ID wit 
numerous phobias, who h id been depressed for a da '' 
two and for yvhom it yyas thought the drug mignt hue 
a beneficial effect in tiding her oscr this crisis In eleven 

























JUL\ 9 1938 


FURTHER OBSERVATIONS ON BENZEDRINE 


Tr B T ■?» 
-D Cau J ■> tnk 


SI 


Tvble B 


No 

ScT and 
Age 

Diagnosis 

^taTlmum 

Dose 

Duration 

Lnfa«?urab'e Pbvs -a! 

S inp OTIS 

P vebo »C 3 tS\rn to^v 

1 

Fema-i. 

I 

I 

F 

aged 27 

Depression with ob 
sessional and hvs 
icn-^l features 

10 me 
Dsualdise 
20nTg 

Twice o r 
l h r 1 c c 
w cekl V 
for on- 
vear 

I 

Felt shs.kv TmJins sc“va i 
tton ovc h»ad nd bod 

Ta h>cardta Tin^itn 
sensation later cot worvt 
and she felt her heart 
neari) choked her An 
orexia. Pains over 1-^ 
Stcarcled feeing and 
palpiiati n 

Fc! 1 vclv — tan mal ie-1 
in aqaic feclnj, Fe- 

lichtrtess nd b ar- Se~<c 

o remote'eN T '^e veered 
p_s r'ore qu k! Fe- 

cornd "cc -rd 
s iDusnevs tj-' p- ^uhr ^ 

After sr*a ■•r u >es m keu t. 
crease IT d'*^rs nauea n » t 
larger doses f'*e,s urawt u r a 
$e f more absorbed ard r„n 5 

! 

1 

1 

1 

i 


M 

aged 46 

Depression wth ob 
sessional features 
(Phases of se'-erc 
agitation) 

30 mg 

Twi^ 

Shakiness «n legs D’n 

mouth Fcehn** of film 
on longo- noticed two 
hours after ing~s nn of 
drt-g Later tongu- felt 
dried up 

More composed Tread '* an 
air Lieht ^ead-d Af erz 

tnn of ti’T*- expene'"e — r 
felt he w_s I m u 

sent Felt for h st t me bis I 

nesa was real! I'l cs Aiier 
10 me fe t av it he had bad al 
cohol fcu* wnh di'Tcrer'c ih t 
bead was clear Later fell 

drows but OR qu-^iio-'tn thi 
was shown to be mo e a fee ing 
of absolute control O-^ 

sional p’eocuuration over b-ad 
tier ard bo veji dimirished fn 
crea.»ed talkat c'^e^ Lik-^ and 
dislikes for jNso-e t ensibcd 

0**Y be ^ 

Da I'j c w 4 w~*V. * 

i e — - p 

D ui e •* T al 

rjj A jj 

3 

M 

aced 33 

Schurophrenia (Ear 
tier acute attacl. 
uith haUuutnosts 

1 and paranoid fea 
[ turcs— nov. disap- 
! pea red) 

20 mg 

Regular for i 
one 
month 

N-*n** 

1 

More {vned un phvsi all 

Drvw M re e-ergj 

[ D-h ov a'u' N cT-t “ 
pv b tr svi^-'t -14 r T 
could be attributed t u ■> 

4 

M 

aged ^0 

Inv-olutional depres 
Sion with promi 
nent hjpochondrt 
asi5 

45 mg 

S \iy two 
djv5 

Severe pam n occipital re j 
S' >T (prob-bly ot san- 
ruture a similar sensa 
lion assos-iated wri h dl 
ness) Tach carwa ard 
consciousn'*ss of hear > 
a-nton whrh he irter 
preted e$ a good sign as 
against form'^r unaware 
n*ss. wl lah h felt ndi 
cated trccble with h^art 

Queer fecUrgs in scalp mou ti^d , 
favou'abl bv drug Nlo e i 

cheerful Fee! r it was c" 
ratural — nvi h rr^lf After : 

10 ard 25 verv elated a~d : 

tall _tive 

I Effcc* -nab Al-riwe-i> 

' tw ua thu *' c -c* *■ 
dru wean B a«, 

a be- nu a a 4 

wi b I F 1 m- t P'S 
si’' bemn wur^ a^j n 
wh “h wi b u dfu n uU 
probe’ll be I'^’v vi’' 

5 

F 

aged 41 

Depressive p jeho 
path with penodic 
severer depression 
with suicidal ide^ 
he3v> spinl dnn 
ker taken to over 
come inhibition 

30 mg 

Frequent 
ocnasiors 
ovTf per 
lOd of two 

month 

H-av> fading in cpigas 
fnum Con>aousn<5s of 
heart $ action 

Felt noar ceLted less depres>eu 
More inclireJ to talk to peop 
Less ererg) tban with laahoi 
Did no regard druj, a> s.i e®^ 
live Fell drug eaab ed h-*r to ^0 
through wav more easu Trw ] 

ward erd ol treatr-ert with | 
drug felt note depressed iha*! 1 
u ual when efeci pavsed oT— 1 
1 usual consntuiion_l miens bca 
non 0 ^ mvod th s 
mo-e probabi* 

On tf tvbnie tb dn. had 

ftni 1 e®‘e“t 

6 

aged 49 ; 

D-prcssion with hv 
pochondn3$i» (lirst 
attack) 

10 mg 

Three isrv- : 
fared oc 
casions, 
then con 
tinuousl> 
some 
months 

later for 1 
twelve i 
d3>s 

In ensified feeling of pres 
sure in head wh n drug i 
(fir t Civurse) given h-*n 

second cours given some 
nonihs lai r thi sjtnp- 
fom was not tnad-* wors^ 

Talked more rnore avru’an’^ 
Spiftts nsen fOO per cent 
Felt a little drunk D-pression 
m en»i*ved hve hours after on 
dos- 

0’'thcwh’v’ badab^r li 
eff*-* 


\! 

aged 2S 

Re-urrcni depression : 
with promt-eni ; 
antietv with pho 
bias, etc 

10 mv. 

Three c>cc 2 
sions 

Palpitation and sweating 1 
Tremjloosness 1 

Felt drows> and beav> beaded 
Alteration of itrre perception it 
direction ot nonatai — t e re 
certi pa i events seer*'^ r'O’^ 
vivid 

Doub ful wh ib-r bcrebcial 
eff-n 

S 

Nt 

aged St 

Recurrent depression 
with obsessional 
features 

30 mg 

Five weeks i 
(ihirtj 
bvedavs) 

None 

Ab oIj el> nght as ram ©’•e 
might sav too ngh a'J n\ 

tfcrub e fell avva Af cr five 

davs on IS r^s lh 00 a>t drug 
losing ef’xt Dose incrr^sed to 
30 and this has be-n s eadil> 

effective si'nx 

Attion vanab e in p^eb-. 
spnere but alntfist en rely 
fa oj ab e effect Dura 
ton o'* penx. bc’wecn 
dos a''J ps ch e**’“ct — 
va-ned 

9 

\t 

aged 49 

I>cpTessive (first at 
tack) with obses 
ijoaal colounng — 
ee irubilit to 
make decisions 

10 mg 

On ISO ated : 
oocostons 
during 
ore 

month j 

Nore 

More chee'fj Not so le-rse 

Mont talka oe con‘iv.c''t. ard 
ho'vcful Fe t he cou d deal with 
bis prob C'^ bett r 

\d*rn vrai no^dmpe n 
iTu-d w th d-^n - ard 
p ow evv X e^aical in 

^rove-n** t 

10 

aecd 49 

Recurrent depres 
Sion (second) s^lf 
reproach feeling 
of inadeqoaev 

20 mg 

Two occa 1 
st ns 

Slight heada'^'^ and giddt 
ness 

Drows ness ard hea^revt Se--*ntu 

c.ea~ tn eves. M “c 

confd'^t and self rcha~ 

Gi "■ u 1 pc-i d if 

„-d 

S.N n « i. a —d — .jch 

11 

Nt 

aged 49 

Recurrent depres 
sion (second) 

emotional i-sta 
bihtv inabi! tv to 
concentrate 
earlv organic 

iSutTered ta m 

asthma) 

m 

Isolated Oc 
casions .1 
first Re 
gularl> 
lor f n 
m^''t al 
so after 
diScharg- 

Felt w bblv Asthmatr 
ivrv'Moms irrp a ed and 
brra htnv, c*s-T S. r— 
b^omr** if vts*o*» Ci’nS 
ached SI 4 ,ht heaJa h- 

I Fd a I til-" *- Raihe" f" > 

[ cSc"lul After 30 r’s^fc* -■'c'' 
evb a a or M re i ka ve 

Fej~'d‘a;f -non Af^rj nor 
li*n* penx-t on see-r-d jq 

go fas 'D Co**'^ rat im 

proved 

Bw ^ *t e"’£ci a*t r d s 

c‘'a c* tSi ) 

E^en of 44 “'* d>vag* 
va t'J 

























































62 July 9 , 1938 


FURTHER OBSERVATIONS ON BENZEDRINE 


Tilt n>tiTisii 

'(ttJlCAt lOtKVM 


Table C 


No 

Sex 

1 and Age 

Diagnosis 

Maximum 

Dose 

Duralion 

Unfavourable Phvsical 
Svmpioms 

Psvchatogical Svinptoms 

j 

1 Remarks 

I 

M 

nged 51 

Chronic depression 
N\ilh depersomliz 
ation 

20 njg 

Three times i 

Shght headaches and dizzi 
ness Anorexia 

Head slichtlv clearer Fell more 
tired and was unable to concen 
tratc so well 


2 

M 

aged 35 

Dcpressiic xuih hjs 
lerjcal features 

to mt 

Four occa 
sions 

Dizziness 1 cgs felt hea »3 

Dazed More depressed j 


3 

F 

aged 29 1 

1 

Ansicty slate 

(palpitation acid 
d>spcpsn some 
phobias etc > 

10 mg 

One occa 
Sion 

Oirzmess Later palpiia 
non headache and 

nausea Increased la 

bilii> of blood pressure 
and some cvtrasj sto’es 

No change m mood 


^ 1 

! 

i 

] 

F 1 

nged 35 ' 

j 

Mild manic depres 

SINC 

20 mg 

On isoiated 
occasions 
during 
one 
month 

Sev ere headache Pam from 
chest upwards and in 
eluding all face Inter 
mittent spells of giddiness 
eniirclv due to drug as 
she had reported this be 
fore) Thc> ceased imme 
diately after drug to re 
appear at miervals 

Less tense Bod> fell more 

comfortable Ntmd worked 

ver> acttvel> and poor sleep 

Dubious value 'o dtveon 
tinned 

5 ' 

! 

M 1 
Tged 29 j 

1 

Depression \\ ith self- 

reproach Feeling 
of inferiorii\ etc 

10 mg 

One occa 
Sion 

Headache Tremulousness 

Felt frantic More self rc 

proachful two and a half hours ' 
later felt calmer then one 
and a,, half hours Inter still 
shak> and complained of 
headache Some diarrhoea 

No beneficial efTcct 

1 

M 1 
iged 35 ' 

Depressive ps>cho 
path obsessional 
nnd paranoid Tea 
lures 

to mg 

Seienl 150 
fated oc 
casions 

Head throbbing Giddiness 

• 

Made held a bit more clear I 
think 1 feel more gives me a 
little more brightness More 

self confidence After two or 
three doses asked that U should 
not be given him again as it ' 
made him (cel unnatural and 
excited 

Left hospital as he refined to 
continue treatment with 
drug 

7 1 

1 

1 

1 

1 

1 

" M 
aged 29 

Recurrent depression 
niih obsessioml 
feiiures 

30 mg daifi 

Twentv two 
da>s 

1 

Complained ofheavv sensa 
tion m epigastrium 
Marked hU m u eight 
(physical examination re 
veaied no reason) Anor 
cxia mote marked ' 

1 

Indecision less nfter drug Felt he 
could concentrate belter more 
energv Rram more active 

Pleasant thoughts Davs passed 
more tju)ckl> than befort. To 
wards the end of period cfTccl 
seemed to wear oil and svmp 
toms became rclativcl> more 
prommcni for which patient 
blamed the drug Fatigue 

Discontinued chefiv omne 
to loss of weigh! whah II 
w IS felt mitht be due to 
the dru^ 

S 

1 

aged 49 

Involutioml depres 
Sion with paranoid 
features 

30 mg 

One occa 
Sion 

Trans cm fcan block 

Calmer Lived more in the present 
Did not think so much about his 
trouble j 

Reported m earlier irtalc 

9 1 

1 

F 

aged 47 

Depression «ith h's 
icncal features 

20 ntg 

One occa 
Sion 

Tachvcardn Vision blurred 
and felt shakv Numb 
feeling down the arms 

Felt brighter 


10 

M 

^gcd 46 

Manic depressive 
with disseminated 
sclerosis 

40 mg 1 

1 

Continued 
for one 
month 

1 Feeling of constriction in 

1 neck Unsteadiness ol 

i cait Dizziness and 

nausea 

1 No change m mood Fell if anj 

1 thing a bit mori, lethargic and 

1 unreal 

1 

i 

It 

r 

1 nged 46 

AOMCi) Slate pho 
bias cic 

IS mg 

Four times 

Skin drv and hot Hot and 
light m head 

' Brain worked all night and raced 

1 from topic to topic No chance 

I m mood 

i Given during a brief r^ti d 
i of depression lasting two 
[ da>sorvo 

12 

r 

'\gcd 52 

tnvolmroml depres 
Sion vMth hvsien 
cal features 

20 mg 

One occa 
Sion 

Severe svmpaihciic rcic 
lion Fami Nearlv co) 
lapsed CNtras> stoics 

1 No cbani-c 

Case reported m cadi^r 
article 

13 

M 

nged 29 

Manic depressive 
with dcpcisonali 
zaiion 

20 me 

1 Two dajs 

1 

1 


1 Dazed imsieadv and headache 

Increased aclivui 

14 

F 

1 aged 56 

1 

Manic depressive 
Hvpochondriasis 
Pun in head and 
face 

20 nit, 

1 

1 Two dajs 

1 


Giddv and drunk 

No clTccl 

i 

J*: 

1 r 

ated 3S 

Manic depressive 
Hvpocbondnasis 

i 20 mg 

Four da's 

Palpitatjon and nausea 

Talked with greater cave 


16 

M 

aged 24 

Schi/ophrcma Dc 
pressed icnvc h> 
ptYchondrucal 

20 me 

One dav 

Pam in chc t 

No change except cvatveraiion of 
hvpochondriasis 


17 

f 

iped 24 

Depression (retarded) 

20 mg 

Two dav s 

Dizca 

Some davs later said inner evcite 
meni had been present 



if thi. patients (one-third) a btnchciTl eflect could be 
cl iimi.d in soi'.c cases with resersations In two of them 
the benefit \as somewhu dubious one (8 7) was t nnn 
of 28 with mild depression and depersonalization with 
some phobias and an\iel' feilures prlpilation, sweating 
and tremulousness which were increased as might hwc 
been expected This is in iccord with Guttmann and 
Sul mis (!9i7) ohs,r\ uions of the effect of the drug 
in \n\iel\ conditions The other (B 3) was a schizo- 


phrenic in whom there was a slight clinical improtenunt 
which seemed doubtftillj due to the drug NcicrihcKw 
he thought it “ toned him up 

Phssical Sctnpfoms 

Of the elesen patients who appeued to benefit from tf: 
drug onl\ three had no phvsicil semploms— th it w ta- 
drug ippeared to exert us effect in the sphere 

alone Of these three, one had 30 mg d ul) for a men' , 
















































































Ji,L\ 9 !938 


FURTHER observations ON BENZEDRINE r, 

Ai ^ '• 


T^ble D — \ormat Controls 



Sex and Ace 

; Maximum 
r Do5e 

Duration 

Unfavourable Phjsical Svmptoms 

Ps •ncaJ 

1 

M aged 35 

20 mg 

! Once 

Palf'iiation Pams m kfi and m kft 

S^-Joress m vvalians Svt^atmg mc'eased 

of fatigue 

, . ...... i 

Thtckmg q a-d eav'cr An S t- -c*- i 

rr-rs a! Lets r*$er\e Fe* ito. ^ •»- -be 

Tir— se-T~*d i-x ra s m e q r k S.-r-tv. 

a««Ux.e tow'X’ds va. -e the n ~ieca>es 

ruT>x*d FeeJi’' ^ 

eve’Tf s k.ak,o"i, SeSf-de- evut n rc-jccw bu- 
1 enc) ro o erva ua Fe-i r t be 

QG enamel Fee in-' ftc^s nt 

an hot-r -f laki-o dn. 

2 

F aged 46 

20 mg j 

Once 

Feh changes ui sensation in fing-r ups and iruswles 
of pvk Gjddtress. Tend no to walk to lefL 
Dift uh to keep a straight lire B’umng of 
VIS on Got tirrf of holding teacup tt n 

effort to eat 

S ighJv ap"reV*ssiv- Mo-t a r A is ' hj’'- e 
tb-n usual 

3 

F aged 35 

20 mg 

Once 

Seme swimm ress on I'lng <Johtj Tingling 
scn>3tian tn legs Breathlessness and duavTcss. 
Anorexia later sorre dmress of 

vision motncntar> some abdominal discotnfoct. 
Dn mouth Decreased m-ciontion 

Elation Increased out'‘Lt 1" 

cr-^rg> r-etttal and ph \ il 

ligi 

M ag*d 46 

20 mg 

One da> 

Fullness in head Nat-sca. Tirrdrcss Feehng of 
nausea day after test Increased frequ-ecy of 
mictuntion 

Full of beans More onnx. -n i lai e 

and er^r^etic Tur* paiuni^ m re qa»i.U> Less 
reserve 

mil 

M aged 34 

20 mg j 

Three daj’S 

Pam m chest 

Increasvd a-tivt > 

6 

aged 35 

20 mg 

One daj 

Pam in chest 

Increased a'livnv che-^futnes anv. r m cd 
uii.auveness 

- 

F aged 23 

20 rng 

Txnce I 

isonc 1 

Sooe 

S 

F aced 19 

jO mg 

One month 1 

Som-' anorexia 

Non* 


the second 10 mg on isolated occasions during a similar 
psnod and the third the schizophrenic alreadj men 
tioned 10 mg dailj for a month In the other eight U 
was considered that the favourable central effect out 
weighed anv physical phenomena which may have 
appeared though these m several casea were quite un 
pleasant In five cases no mental or physical change was 
noted Two of these (A 1 and 5) were depressives with 
much retardation Here the result was in accordance 
with what Outtmann and Sargant have found in this type 
of case Another was a case of catatonic stupor (A 2) 
AU the controls except- one had physical sensations some 
of them unpleasant 

The principal symptoms vvere headaches giddiness and 
cardiovascular symptoms — for example tachvcardia pains 
in chest extrasystoles and the case of heart block already 
reported elsewhere Two patients complained of a heavy 
feeling in the epigastrium possibly due lo an increase in 
gastric acidity Four complained of blurred xision m 
eluding two of the normals five complained of anorexia 
including three normals — one of the patients (C7) showing 
this symptom had complained of anorexia before but it 
became definitely worse while the drug was gixen This 
patient was also the only one of the series to show a 
notable loss of weight (oxer a stone) which might haxe 
been secondary to the anorexia but may also have been 
an effect of the drug Davidoff and Reifenstein found a 
loss of weight m most of their subjects Physical exam 
imtion in this case failed to reveal anv cause for it 
These results are all the more noiewonhy vxhen the 
relalivelv small dosage used in most cases is taken into 
account^ One normal subject (D 4) had decreased fre 
qucncv of micturilion the other (D 5) also normal 
increased frequenev One patient (B2) complained of a 
sensation he described as a film on his tongue One 
patient reported diarrhoea (C 4) 

Psvchical Effects 

So far as the effect of the drug on different psvchialric 
conditions goes the best results were obtained vxith the 
dcprussivcs It seems impossiblv to predict what patients 
will benefit by the drug It seems as if the drug vvere 


perhaps of greatest value m the terminal stages ot a 
depression — that is when clinical improvement has already 
appeared This was true of several of our cases ind 
IS again m agreement with what Sargant and Guttmann 
had found These authors are diffident ot giving the drug 
to patients vvith promineni hvpochondriasis but m some 
of the patients of this senes the hvpochondriacal svmp 
toms were beneficiallv modified however lemporartlv and 
It seemed m one case the only form ot therapv Inown 
likeh to prove of much value It enabled this patient 
(B4) to face a medical board and perhaps even to launch 
him again on his duties In another case (B ei a depres 
sive psvehopath vxho had been accustomed to tale large 
quantifies of alcohol to overcome her inhibition ahd 
enable her to do her work it was hoped to replace 
alcohol bv benzedrine This was unsuccessful In this 
contest it mav be mentioned that N\ ilbur MacLean and 
Allen (1937) found it gave marked relief to the craving m 
chronic alcoholics acting as a suppfemenian stimulant 
over a period of months A subjective alteration of time 
experience was noted in a number of cases (Table B) 
One or two of the patients complained that the drug made 
them feel unnatural and one of these (C 61 implored me 
to give him no more of the drug although he admitted 
the beneficial psvehic effect He finallv left the hospital 
in order to escape the treatment One or two others 
allhough admitting benefit were unwilling or reluctant to 
have anv more — an odd and probablv unique situation m 
therapeutics Others again — as might be expected depres 
sixes — while admitting benefit pointed out that it was 
after all a drug and thev did not wish to be dependent on 
this an altitude preciseh similar to that adopted by mans 
such patients towards the necessarx scdaiives to p ocurc 
sleep 

With regard lo sleep the re ulls were very v^nabL 
Several on the larger doses eO to -.0 mg a dav slept well 
even when the drug was given at midJaV Moreover the 
sleeplessness vehen it occurred was usuailv not a painful 
or unpleasant experience In general the effect observed 
on sleep was similar to that found bv other workers and 
needs no further comment Four patients feh drowsv 
or dopy after the drug and two felt fatigued In one 






































FURTHER OBSERVATIONS ON BENZEDRINE 


64 July 9, 1938 


or two c ises there was an increase in the depression when 
the effect ot the drug was wearing off, and it is important 
to bear in mind that Davidoff and Reifenstein mention 
a case of manic-depressive illness in which the patient 
impulsively attempted suicide One of our patients (the 
alcoholic depressive) became very much more depressed, 
and the question of suicide was uppermost in our minds 
for some days, and in another (C 5) the depression was 
considerably intensified This might, of course, just as 
well have been a usual constitutional intensification in the 
first case, but it appeared to be a definite effect of the 
drug in the second 

Comment 

It must be admitted that, so far at least as these results 
are concerned, it is difficult to claim any great therapeutic 
value from benzedrine Nevertheless, if its use relieves 
the depressed patient even transiently and gives him a 
few hours’ respite, the drug has a place in psychiatry 
To claim more than this from it at the moment, however, 
is impossible, and there are many limitations to its useful- 
ness, not the least ot which is the variability of its action 
A small minority of cases seem to benefit definitely from 
benzedrine, and its greatest usefulness perhaps is m those 
cases of depression in which a clinical improvement has 
already set in Here it may be helpful in giving the 
patient a temporarily increased insight, which has been 
of use psychotherapeutically Apart from this, the drug 
IS of doubtful value as an aid to psychotherapy It was 
difficult to resist the impression in one or two cases that 
the speed of convalescence from a depression was in- 
creased, but this IS difficult, if not impossible, to establish 
objectively Indeed it is almost impossible in many cases 
to separate the changes of the normal process of recovery 
from the effect of the drug, which makes any pro- 
nouncement of Its value in such cases very dubious For 
those patients who have clinically improved but who for 
economic or other reasons are unable to stay in hospital 
and must return to work, benzedrine is sometimes of help 
in* enabling them to face their day s work The drug 
should, however, be controlled by frequent examination 
of the patient afterwards For those depressed patients 
who may at any time get worse, and perhaps contem- 
plate suicide, suitable doses of benzedrine mav enable 
one to keep them in a hospital or even in evervdav life 
without extra supervision Here, again, they should not 
be given a bottle of tablets and allowed to go their 
way 

SVith regard to dosage, 10 to 40 mg in ordinary cases 
should be enough, and a divided dosage — sav, 15 mg at 
9 am and a further 15 mg at H 30 am — is to be 
recommended , and certainly, unless the patient is under 
full in-patient supervision, this dosage should never be 
exceeded The drug is admittedh still in its experimental 
stage but enough work has now been done to make it 
doubtful how far, if at all, it is likelv to be of greater 
value in psvchiatrv than n is at present The contra- 
indicitions arc now being established, but from mv ex- 
perience It would appear to be unwise to give benzedrine 
.o anv siibjLCi with cardiovascular disease in anj form, 

, or to those with prominent anxietv svmptoms The initial 
dose should not exceed 10 mg and the optimum dose 
should he determined carefulh I agree with Davidoff 
and Reitensiein that it should be used cautiousK in 
certain depresMvex because of the possibihtv of intcnsi- 
iving the depression wnh consequent suicidal risk This 
risk has not been sufficicntlv stressed 


MtDiCAL JOlXVAt 


Suniman 

Thirty-three patients suffering from difiercnl forms of 
mental disorder and eight normal subjects were given 
benzedrine orally in doses of from 5 to 45 mg In sixteen 
the drug had to be discontinued because of iinjowml 
effects, mental or physical, and in two more because no 
beneficial effect was produced In eleven (one-third) ihc 
drug appeared to be helpful In five no effect, mvniil 
or physical, was produced Dosage, contraindications, 
and the general value of benzedrine in psychiatrj ire 
discussed 

I should like to thank mj colleague Dr W C M Scolt 
for having furnished me with liis observations on several 
patients in this scries and some of the controls, and also for 
much Valuable help in the preparation of this paper 

1 vvould like also to thank Messrs Mentcy and James, the 
distributors, lor supplying me with a generous suppK ot Ihv 
drug with which to tiny on this work 

References 

Anderson, E W, and Scolt, VV C M (19^6) Lniicct 2, 1461 
British Medical Journal (1937), 2, 625 
Davidoff, E , and Rcifcnslcin, E C (1937) J liner iiieil 
108 1770 

Gullmtnn, E , and Sargant, \V (1937) Brilnli Medical Joiinml, 
1, 1013 

Korns, H M, and Randall W L (1937) rimer Ilciirt J, 
13, 1, 114 

Myerson, A , Loman, J , and Dameshek, \V (1936) Amcr I 
tiled Sci , 102,' 560 

Rinkcl, M , and Dameshek, \V (19361 Nru Cnef J Med 

215, 1005 

and Rilvo, M (1936) J Aimr mid Ass 107, 24 

Prinzmetal, M, and Bloomberg, W (1935) J Aniei iiied Ash 
105, 2051 

Scarano, J A (I93«) Med Rec 140 602 
Schubc, P G , Raskin, N , and Campbell, E (1937) Ncn Oisl 
J Med 216, 922 

Solomon, P , Mitchell, R S , and Prinznicl il, M (1937) / Ainer 
med Ass 108, 1765 

Ulrich, H, Trapp, C E , and VidgolT, B (1936) Ann micm 
Med . 9, 1213 

Wilbur, D L , MacLcan, A R , and Allen, E V (1937) I’toc 
Mayo Clin 12, 97 


The following medical promotions m and appomimcnls to 
the Venerable Order of the Hospital of St John of Jerusalem 
are announced m the London GnziUt of June 24 As 
Knights Major A W Anderson, M B , Major W 0 Tvans, 
MBE, LRCS , as Commanders D \V A Bull, MD. 
C Armstrong MB, as Officers L L Westrope M D • 
H Riddell, MB, E H Knowles, LRCPandSCd, H 
Banks F R C S , A P Marlin, M B , J Vaillancouft, M B . 
Lieutenant Colonel F A Voung M D , Major General P S 
Mills, CIE, W T Thomson MRCS, C A Vcrco, MB. 
W G Shellshear, MB, Colonel J L Hamilton, MC. TD. 
M D , K S Maurice Smith, MRCS, Lieutenant Colonel 
C L Dunn, CJE, J K Milligan MRCS, A T Mckay, 
MD,E Levvys Lloyd, MRCS, Hon P P Debono. MB. 
FRCS Professor J Ellul, MD, E L D Parry, MB . 
Associate Officers Colonel D H Rai, M C as Serving 
Brothers F M Longson, M B , E Ringrosc, M D , J R 'B' 
M B , G Fisk 5f D (since deceased) G H EdgccomK, 
MB, L A Williams, MD WOT Sinclair, MB J ' 
Scales, MRCS J C P Bavlev, L M S S A , J B Mcka/, 
M B, F C Cozens, M B W W A Kelly, Nf B A I Crai. 
MD T D Dclprit MB A F Janes MB, H C l 
Donovan MB J McK Woods MB,C S Rcnwicl 
F L Firkin MB P D Braddon FRCS. av 5 c vi t 
Slater Frances C B McKav MB 



Jdl\ 9 193S 


PLACENTAL EXTRACT IN MEASLES 


THE USE OF PLACENTAL EXTRACT IN 
AN EPIDEfflC OF MEASLES 

BY 

T X PARISH, M 4 , M D , 

Metlical Officer to Benenden School 

This IS an account of an epidemic of measles in a 
girls school in which placental e\tract was used as a 
prophylactic 

The girls sary in age from 13 to 17 years There had 
been no such epidemic in the school for nine years and 
at the beginning of the Easter term 193S of the 205 
girls under ms care eighty nine had not had measles 
On January IS a few hours after the return to school 
one child was found to be in the incubation stage of 
measles She came by the school tram and school 
bus so that contacts were widely spread throughout the 
school Prophslactrc measures were discussed and in 
new of the difficulty of obtaining convalescent serum 
It was decided to use placental extract in an attempt 
to modify the subsequent attacks and to lower the com- 
plication rate Moeller (1937) maintains that this 
extract is as effi 
cacious as convales- 
cent serum and of 
greater prophylactic 
value than adult 
serum Parents were 
circularized and 
forty -seven asked 
that their children 
should be given the 
injection some of 
them requesting that 
this should be done 
at once WTien the 
time of injection 
was left to our dis- 
cretion the injection 
was given as soon 
as a case occurred in 
either the girl s house 
or form All were 

given between January 27 and February 16 
ended on Apnl 3 

Dose and Reactions 

The extract used was Lederle s immune globulin and 
It was given in one intramuscular injection of 4 ccm 
into the buttock There were no immediate reactions 
but after a few hours stiffness and some pain at the site 
of injection were usual The sjiflness persisted for about 
two days One child had a temperature for twelve hours 
but m no case was there constitutional disturbance of any 
seventy nor did any delayed reactions occur 

Course of the Epidemic 

The case incidence throughout the term after the 
initial infecting case (which is not included in these 
Statistics) IS given m Figs I and 2 Fig 1 shows the 
da\ of onset of rash m the unmodified cases and Fig 2 
the dav of onset m the modified cases 

Taking into consideration the larger number of cases 
m which the prophv lactic injection had been given it 
does not appear that the extract had any effect in 
delaving the onset of the attack 


B\ the end of the term seventv five of the e ch \ " -e 
susceptibles had developed measles as wJl a, fve o. 
the 116 said to have had measles previouslv o*^ whom , vo 
had also received a prophvlaciic injection The dis - 
bution of cases in the modified and unmodified -rojp, e> 
shown in Table I 


Tvble I — Incidence of Mecsles 



Pr*%TOus Nleas 

1 (116 Cases! 

1 Sjs;— S 

( 5 Cases 


Modeled 1 
(2C^) 

1 1 

(ll-t Cases) ' 

1 M 'x-Ji d 
' (-rSC-SM) 

ei) 

MeJis’es developed 

2 

3 

4_ 

’3 

No measles 

0 

ni 

3 

M 


It IS obvious that the extract had no effect whatsoever 
in preventing the attack of measles On the contrarv 
the above figures show that among the susceptible cases 
measles developed in 93 per cent of those who had been 
given the modifying injection and m onlv 75 per cent 
of those who had not The two children who had 
previouslv had measles and who had also been injected 

both developed 
measles 

The epidemic was 
of moderate seventy 
although there vas a 
most remarkable 
freedom from serious 
complications Tern 
peratures of over 
103 were present m 
66 per cent of the 
total cases The 
onlv complication 
of anv seventv was 
one case of sup- 
purative otitis media 

Effect of Extract 
on Attack 

The effects of the 
prophv lactic injec 
tioBs were much more noticeable in the first half of the 
term It is not possible to convey a clinical impression 
bv statistics but the impression received by all observers 
was that those cases in which the attack developed within 
three to four weeks of the injection suffered far less con 
stitutional disturbance A few of these shoved a slight 
rash of small discrete papules with no tendenev to 
coalesce but on the whole little difference was observed m 
the rashes of the modified and unmodified cases 
The most noticeable feature of the recently modified caves 
was that although the temperature was high and a wtll 
developed rash was present the patient remained sjr 
prisingly cheerful and undisturbed and did not p-escnt 
the tvpical woebegone facies and pros'ration 

The cases were classified (Table ID as thev occurred 
as mild moderate or severe this classification being 
based on the deg-ee of constitutional disturbance This 
IS necessarily a somewhat arbitrarv classification for the 
degree of distu-bance did not appear to have anv 
relation to the tempera ure or nature of the rash 
The effect of die extract in reduemg the seventv of Ine 
attack is most no iceab'e m those cases in which it had 
been given within three weeks of onset of rash 



rBsi-RY 

1 ’ si 5t 1 S'lHi.ECKlSbl.l-t?! IPo -S-ti/S I . j-3 o 7 5 “I Itjrb^-bfcli' r37 ” 



4-U, 

‘ 1 • , ! Ill 1 J 1 1 1 1 . 1 t , 1 , 1 1 ' , 1 . i , 


I ; 

4 j - 

' i i ' ' • * 1 ' 1 . n ! — 




t ■ ■ ^ ; *-» t , It ! . 1 1 


ini 

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! : t i i 1 Mi — i r — ^ ' 1 — r 


t 1 

1 I 

. 1 1 i ■ ■ . ' . . 1 “!■ i , ! 1 ■ ' ; • ' 

. — 

Ini 

1 1 1 

> 1 « 1 ll > 1 


LM 

1 ' 

1 1 ‘ 1 » 1 ■ ■ 1 i . . 1 1 1 

¥ 

a 

1 • 

±fcx 

lllnn 


Fio I — Unmodified cases (’6) 


fB5 -Ry 1 A CP 

1 ’3456789MlCli^soIi3-?'d2i3 BiTOl » 

5fc7 5“SnC'inbcf7rr>i'h m 

1 1 1 M 1 f It* T 

» iTTT Tf — m — 

— ; — 1 1 1 ■ 1 ' ' 

S Li-l-I 1 ! » 

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^ 1 ‘ * 



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i 1 I ' 1 1 

a. 'rr ' 





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3: .1 mm 




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a 1 i ^ i i . 

1 MB 1 Bi 




FiG 2, — Modified cases (+,y 
The term 




20 


THE BRITISH MEDICAL JOURNAL 


July 2 I93S 



a century of association 


There are abundant grounds for the belief that 
DINNEFORD*S continues to enjoy the approval 
and pationage of the Medical Profession as surely 
as when — over a century ago — it was originally 
prepared at the request of the most prominent 
practitioners of the day 


PIMMEFOMP’S 



PROTAMINE INSULIN 

(witli Zinc) SUSPENSION ..BOOTS 

The fall jn blood sugar after injection of Prota- 
mine Insulin (with Zine) Suspension is 
gradual, and the Insulin carbolu drate metabolism 
repioduees closely the continuous secretion 
of Insulin as it takes place in the normal person 


RELATIVE HYPOGiyCAEMIC EFFECT OF 

PEOTMINE MSUIIIV 

(miH ZINC) SUSPENSION B00IS»J INSULIN 



WNili sin ill doses (uiidci 30 iiinis) ilic ii«k ol 
h^po^hcaciniT is less t!i in >ulh liisuliii iikI 
Piolaniinc Insulin (uilh Ziiu ) Suspension es' 
pirlieiilarl^ \ ilii iIjIl foi use m ^eneril pruiirc 
Siipplitd in ruLbci c ippcd \ijiN m ilic follou/iip, 
s|rt n,-!lis 


LO untt'i p4 r or 
5 I 
10 c 

tmits Jit r or 

5 < 


BLOOD SUGAR CURVES 


o 

o 

s 

5 KO 

XZ 

eC 

5 wo 

s/Y 

o 0 

^ INSULIN 

15 »0 tS 

XINC f^OTAMlNl 

40 _ 


T 





I 








V 
















> 

« Ji 

BRFAKfASI 

12 

{. 12 6 

pin w"' ®'S 

EAt BKEANWI 

f . 

6 12 

jin> O'* 

J ... 


lit if fl tutz ir cur ct frnm a mnn ogril ^5 %«irj the 
ichit In ttUn thv ncroml I rotnmtnr 

Jntnlm (irjf/i Z nr) Sn«^ r»Mi n — 7lo I T/tr </i t tt$ the 
fame «?rt bdtf t ertmt puf {S c JJnt i J JJ!” t 5t t) 


31 il 

(200 


2^1 

Tiill ilel II'- ol llio liLalincnl of 

Ouilu Jcs 

Mil 

( 100 imii»J - 

- 

t/fi 

MeiJiIiis iiii/i Pronsniiic In-iilin 
>uspen'‘ion ire ,^ivcii in our liooKIel 

ill /lIU ) 

1 I op\ 

M l1 

( 100 iimlv) 

• 

1 0 

of ^vlmli will h< spill on rc(|ucs| 

III (III 




^imm 




-J-3 - • 


" .-:jd 


13 39<-jNf-D 




JuL\ 2 10 <! 


THE BRITISH MEDICAL JOURNAL 


21 



at then laboratories in \^ elw \ n Garden Cit\ Hei ts ‘ Bencr\ a ’ 

IS issued in oral tablets each containing 1 mg aneuiin ecjual 
to oQO int \ itainin B, units, 1 c c amj oules each containing 2 
mg and ‘ Benerva ’-Forte ampoules, each containing 10 mg 

‘BENER VA’ 


Oral Tablet** nnd Ampoule** 

Roche Proclucls Ltd, 47 , Ro^ea Ttoad London, iS 13 and Vt ehwu Garden Cit\ Herts 




ASIHMA 

BRONCH^SailSN 

mhalahon Therapy wi*h the Inhaler 

arresfs Asthma aHadcs Obviales Ong Bottles conf 12 5c.c:. 

Dr R &Dr O WEIL, CHEMICAL WORRs 

SOLE DISTRIBUTING AGENT IN GREAT BRITAIN , , . lU ■! 

FRAHClS RIDDELL LT0„ Aictelf House, Warwick St, Regent St, London, W T 







i the BRITISH MEDICA L JOURNAL 

The Original and Standard Brand of Synthetic 
Hydrated Magnesium Trisilicate — 


Juu 2 193S 








The safe and effective ANTACID for the treatment of CHRONIC 
PEPTIC ULCER, HYPERCHLORHYDRIC DYSPEPSIA and ACID 
FERMENTATION 


MAGSORlIKif; 


® ACIDITY — Complete 
Control 

e NEUTRALISATION 
—Sustained 


0 No Toxic Alkalosis 

^Correct Physico- 
chemical Constitution 


*•«>«<»> „ 




, . *-y,' 




REDUCED PRICES — Magsorbent Powder 
2oz 1/6, 5oz 3/-, 16 oz 8/9, 3 lbs 23/- 
Tablets— 65 for 2/4 , 250 for 7/9, 600 for 15/- 

SAMPLES ON REQUEST 


Manufaclwed onl\) 

KAYLENE, -LTd", WATERLOO RD , N W 2 

Sole Dislnbulors ADSORBENTS LTD 


Id 1^4 I T d value . in reduction 

!▼! Jfi\ 1% !▼! lid of puerperal death rate 


PARTICULARS OF GROUP 

NUMBER OF WOMEN IN 
GROUP 

PUERPERAL DEATH RATE 
FROM SEPSIS 
(per 1 000 tola! births) 

Cases receiving special 
food 

10 384 

0 09 

Cases not receiving 
special food 

18,854 

2 91 


The food given consisted of a certain milk preparation and 
Marmitc The Marmite was rich in the vitamin B complex 
which was a neuro muscular stimulant ’ 

Another point was that Marmite had a very important haemo 
poietic action which was not understood and was probably not 
associated with any of the vitamin B constituents at present 
recognized *’ (Drit Med Joum Jan 22nd I9tS p 19! ) 

, , , for VITAMIN B COMPLEX 

For sampte and / 

literature apply to — 

THE MARMITE FOOD EXTRACT CO LTD, Walsingham House, Seething Lane, London, EC3 

In Ufi 1-01 6d 2-oz lOd 4-02 la 6d B-oz 2s 6d 16-cz 4s 6d Special quotations for Marmite packed for u e In hcspiu!? clima welfare r-ctr^s etc- 
avt 7 



JUL\ 2 I93S 


THE BRITISH MEDICAL JOURNAL 


t 


MANDECAL 

(Compound Cslaum Viand Jjte B DJI ) 

/;; Pyehm of Pregnaiicy 



J E\penence m climcal practice has nou established 
1 ( uy be\ond doubt that bj the use of Mandecal the 

nausea which is often set up bt mandelic acid 
preparations is almost entirelj eliminated 

B -^m ^ Mandecal, therefore, is ideal for admmistration 
, J in pjehns of pregnanes 

Rl Further, in Mandecal the immiscibihty of calcium 
mandelate has been osercome, and a pleasant, 
HS^ palatable suspension is easil} formed b\ stimng 
the ponder m nater As tnth preparations of 
,/ ammomum mandelate, the collateral admimstra- 
non of ammomum chlonde is rarelv necessars 

Sample and hterature on request 

BRITISH DRUG HOUSES LTD LONDON N i 







AS A RESTORATIVE FOOD 

‘ PANOPEPTON ’ presents, in a 
form ready for absorption, the entire 
nutritious substance of beef and wheat 
It IS a complete solution of all the 
nutrient, savoury, and stimulant nitro- 
genous and inorganic constituents of 
these typical foods 

Supplied in ]2-oz bottles 


FOR THE PREPARATION OF 
PEPTONISED MILK AND OTHER 
PREDIGESTED FOOD for the SICK 
Peptonised Milk prepared 3\ith 
‘ Zymine Peptonising Tubes is a 
perfectly digest ble and absorbable 
food Its use precludes all accumu- 
lation of unassimilable matter in the 
intestinal tract 

Supplied in boxes 
containing 6 and 12 lubes 


Onsjinated and Manufactured b> — 

FAIRCHILD BROS & FOSTER (Inc > AEH IORA nM/6^ notion, l induct London Ed 

Agents — 

BURROUGHS WELLCOME & CO, lo\do\ siosEt and cape tou \ 


the BRITISH MEDICAL JOURNAL 


July 2, 1938 


The respective merits of 

DETOXICATED 


TOXIC VACCINES 


The obMous 'ld^?nf'lgc of DetoMcitcd Viccincs 
js (lint Inige doses cnn be ndniimstcrcd VJthout 
cnusing serious renclions This is of grcnt \nlue 
in the trentment of cases ^\helc nnj gncn bac(crinl 
disense is nlrendy esHblishcd In such c-iscs 
(o\ic \nccincs nre npt onl^ to necr-wnte the 
symptoms \\herens modcrnte doses of the nppro 
piinte detoMcnted \iccine cnn be gi\cn sifclj 
\M(hout further nggrnvntion of the disease 

Wc hn\e always upheld the superiority of 
defo-^icafed ^acclnes, but some authorities prefer 
the toxic \arietics because thc^ bclie\e that it is 
important to obtain moie or less marked reactions 
in ordci to produce a salisf'tctor^ immunity 


The toxic \accines ha\e the advantage of 
cheipness T)ie detoxicated vaccines arc more 
expensive, for the obvious reason that the dosage 
IS nearly one hundred times greater so (hat much 
larger quantities of bacteria are used in (heir 
preparation 

We supply both the detoxicated and the toxic 
varicfaes of vaccines in order to cater for the two 
dilTcrent schools of thought in this matter A 
booklet, giving details of our full range of 
Detoxicated and Ordinary Vaccines, will gladly 
be supplied on request 


GEKATOSAN LTD., 

VACCINE DEPARTMENT 

LOUGHBOROUGH, LEICESTERSHHIE 









Jr. 


A V 

1 


RADIOSTOLEUM 

(Standardised Vitamins A and D) 

In Pi egnancy 

_,-5:^^!^5|iMRadiostoleum is administered during the 
*^Jast few months of pregnancy m order 
^ m a to build up the mother’s resistance 
^ ma against mfecuon at the birth and 
to counteract any deficiency of 
the calcifying Vitamin D , 
furthermore, Radiostoleum 
provider an abundance 










5%,. of the essential 
Vitamins A and D 
j to meet the needs 
of the developing 
foetus 

Sample on request 


THE BRITISH DRUG HOUSES LTD LONDON 




JuL\ 2 193S 


THE BRtTISH MEDICAL JOURNAL 


23 




Cofron Elixir (\bbolt) supplies MlioK 
Li\ er Extract, Iron and Copper m deli 
nite Standardised proportions It is 
indicated for the treatment of mild 
anaemias and for use in man^ non- 
specific conditions m -which there is a 
decreased red coll count or a lowered 
haemoglobm percentage The product 
IS particularly smtahle for general use 
as an iron tome, or to hasten restora- 
tion of normal red cell ^alues following 
illness that has resulted in anaimia 
• Each flmd ounce of Cofron Elixir 
represents Fresh Lner 40 gms (iJa 


oz ) Iron 66mgnis (Igr) (tliecipina 
lent of 6 grs of iron and ammomum 
citrate BP) and Copper 2 66 mgms 
(1/25 gr) • The hr er extract contains 
the factor or factors necessarv for the 
maturation of red hlood corpuscles 
and in addition supphes appreciable 
amounts of Mtamins B, and B whicli 


COFRON CAPSULES 

For Serere Secondary Ane^ntos 
Supply alfoui twice as much Iwer ex- 
iracLas Cofron £hxir m proportion 
lo their copper and iron content In 
bodies of oO and 100 capsules 


supplement the patient s daiB intake 
of thc^c factors and thus conlnhule to 
improied appetite • Iron is essential 
m the svnthesis of hmmoglobin wlule 
much chnical cndince indicates that 
copper aids m the full utflisation of iron 
b\ the bod% • Cofron Elmr is supplied 
through pharmacies m I2-oz and 80-oz 
bottles Desc^ptl^e htcralure and a 
free sample -will be sent upon requfet 
ABBOTT LABORATORIES 


(Er\GLA^Di LlalTEn 
adsworth Road I’crnal. Aljddlcaw 

MOVTRE-VI. «rPNrT 70BANXFSB PC BOW*''*’ 
"sT-wiCPK mcco MEXirnrrxr 


COFRON’ ELIXIR 







w >? 


THE BRITISH MEDICAL JOURNAL 


JUL> 2 I93!n 


EVANS’ 

ANTITOXINS 

Diphtheria Antitoxins - - Concentrate! 


- Concentrated ' 

It800 2|200 units per cc 

. Super-Concentrated 

3,000 (or more) units per cc. 


Streptococcus Antitoxins Er/sipelas 

Puerperal 
^ Scarlatina 

I 

Tetanus Antitoxins - - - Prophylactic 

Curative 


Evans’ Biological Institute 

IS ideally situated in rural Cheshire overlooking the Mersey 
The horses needed for the production and standardisation of Sera are 
housed tn the welt designed airy buildings shown above which are 
adjacent to the Laboratories 


.Evans Lescher & Webb Ltd, 

LIVERPOOL and LONDON 


JuL'i 2 I93S THE BRITISH MEDICAL JOURNAL 



ANAH/€MIN B.D.H. 


In the Treatment of Pernicious Ancemia 

Clinical evidence in support of the value of consists of a monthly injection of 2 c c 

Anahtemin in perniaous anasnua continues A recent chmcal report^ confirmatorj' of the 

to accumulate 5 physiaans find that an imaal foregoing, states that' the patient uas 
injection of 2 c c of Anahaemin followed by bedndden, face hke parchment and ver^ 
I cc every 14 days constitutes efFecti\e weak He rapidlj gamed weight, enjojs 
treatment, whilst maintenance treatment normal health now on 2 c c monthlt 

Sample on request 

THE BRITISH DRUG HOUSES LTD LONDON N i 



2S 


THE BRITISH MEDICAL JOURNAL 


Jun 2 I9^S 


INDICATIONS FOR 'SANATOGEN' 

Disease -emaciation 


“EVERY medical practitioner knows how difficult it is to nourish a patient 
suffering from disease-emaciation Do we not all recognise the fact that the - 
starving tissues are fed, not by the lood swallowed by the patient, but by 
the amount of nutrient matter absorbed by the gastric and intestinal mucous 
membrane ^ If we could ensure the absorption of nutriment into the blood, the 
problem of nutrition in disease would be reduced to a matter of mere chemistiv 
and mechanical feeding Judging from clinical results, ‘Sanatogen’ appears 
in many cases to possess some power of read)' absorbability, rvrthout rvhich the 
iichest foodstuff represents simply so much foreign matter in the stomach and 
intestines owm experience of ‘Sanatogen’ is that it stays the diairhcea 

— ten or twelve motions a day are thereby reduced to one or two , it stops vomit- 
ing, and It improves general conditions and causes the patient to put on flesh ” 

"NUTRITION IN WASTING DISEASES Or*CHILDRCN AND ADULTS” - 

— (Mdhca! Preis anil Circular) 

“THIS condition, which results from imperfect digestive or absoiptive power, or 
which may follow stomatitis, pyloric stenosis, deformity of the tongue or palate, 
tuberculosis or syphilis, is most frequently associated with improper feeding Fats in 
such cases ate not well tolerated, but the contrary is true w ith respect to proteids 
The use of ‘ Sanatogen’, in these cases, proved so satisfactory that we Irave been 
encouraged to try it in other cases of infantile atrophy, and hare had almost equally 
pleasing results in a number of patients suffering from this condition It is quite 
apparent that ‘ Sanatogen ’ has considerable power in influencing nutrition ” 

■ INFANTILE ATROPHY ” 
(Praclilwnrr) 


I HAVE before me the records of forty cases fed with ‘ Samtogen’ They show, what 
was oba lous to my selt and the nurses when watching the cases, that these patients 
Viasted less during the acute stage, and picked up more rapidly during the convalescent 
Stage, than patients vv ho did not have ‘ Sanatogen’ This fact, indeed, was soon 
recognised by the vv'ard sister, without my havang in any way drawn her attention to it 
, . lam firmly convinced that it is a most v aluable food for the tv phoid patient ” 

“THE TRI ATMENT OF T\ PHOID FEVER” 

{Medical 7 lines) 


Sanatogen 


A Irinii of t /» iin inil indium ( hceropi ? phate 


DOSAGE For children and adulfi tno 
teaspoonsful three times duly or accordinju 
to circumstances For in 
fsnisj tcaspoonful added -r 
to each bottle feed 4^-^ 


So/if in all f/amts/s 
pin to 



III'' 


^ 1 
t 


Clinical samples and hteiatme available on request to 

GENATOSAN LTD., LOUGHBOROUGH. 



Tl woM P^NSTOIIKN « 'ftrfc of 

\ r to in Ltd an! j ti tc t» ir f nu It nl I 
I m and Civ «*r ph 1 1 at*' 

K OIN^TOMXS rn lu t mi I It 
l h NATOS XS 1 1 1 Lo U>croi 1 L^icf t r I ir 


JuL-i 2 1938 


'THE BRITISH MEDICAE JOURNAL 


29 


Eli Lilly and Company Limited 

Pharmaceutical and 'Bwlo^ical Produces 



^ SODIUM AMYTAL' 

Sad im Oso amyl Sibyl SarbiUirale 

The anxietj and apprehension iMth 
which patients once anticipated hospi- 
talization ha\e largely become things of 
the past due to the efforts of hospital 
personnel to make the stay as pleasant as 
possible It has been learned that many 
disturbing recollections can be a\oided 
when 'Sodium Amjtal' has been the 
hypnotic and sedative of choice It con- 
tnbutes to the rest and relaxation \vhich 
are so essential to proper convalescence. 


Prompt Jlttaition Qweii to Projessioml Jitcjuines 


2 3 AND 4 DEAN STREET LONDON AN 1 


tqint iv rnlam for 

ELI LILLY AND COMPANY, INDIANAPOLIS, USA 



30 


The BRITISH MEDICAL JOURNAL, 


JOLV 2, 193S 


CRUNCHY FOODS AND 
THE TEETH 



N 

Cnsp,^ fibious foods are generally considered to perfoim a useful 
function in scouring die teeth, thus keeping them free from sticky 
food particles, which are apt to ferment and cause decay. The 
plentiful saliva, which haid, diy foods produce, is also of value 
in cleaning the mouth 


Fuithcimoie the vigoibus mastication that haid foods demand is 
geneially held to assist the giowth and coiiect development of 
the jaws. 


For these leasons many piactitioners lecommend 'that the noimal 
diet should include a piopoition of hard, dry foods. They find 
that Ryvita eaten d.uly has a beneficial eftect upon the teeth, 
especially those of children Fiee samples of Ryvita for 
distnbution to patients will gladly be supplied on rec^uest 


THE RYVITA COMPANY L I M I T Jl D 
96-98 S O U T H rV A R K ST LONDON S E i 
B a k e 1 I e i in B 11 m t n gh n m 



uu 


Juu 2 193S 


THE BRITISH MEDICAL JOURNAL 


31 



Simplify the Technique of Infant Feeding by using 

Allenburys Progressive System 

ALLENBURYS SYSTEM EMBODIES THE FOLLOWING 
ADVANCES IN ‘THE SCIENCE OF INFANT FEEDING 

(1) Humanised Casein lactalbumen ratio 

(2) Intimate incorporation of Dextnn-Maltose, the benign starch-free mixture of non fermenting 

carbohvdntes 

(3) Homogemsed Cream in reconstituted Milk Foods 

(4) Prophylaxis of Scuit} Everv tin of Allenbuixs Foods bears and has borne in the past explicit 

instructions for daily administration of \itamm C 

(5) Prophylaxis of Rickets Calcium Phosphorus ratio adjusted 560 units of yilamin D per quart 

reconstituted Independent biological assay of antirachitic potency 
{6) Prophylaxis of Anamia The reconstituted foods contain 4 parts per million of axailable iron 

Allenbiirjs System prondes eyery knot™ Nutritional Requirement of the Infant 
It enables the physician to replace unreliable home-made milk mixtures yvith readily prepared infant 
foods which eliminate the risk of enteral infection, and proyide easily digested, scientifically balanced 
meals for babies at eyerv stage in their development 

ALLENBURYS Humanised MILK FOOD No 1 (Entirely Free fmm starch) 

The best first artificial food because it resembles breast milk closeh m composition and m the ease 

\Mth which It IS digested 

Composition when reconstituted by dilution (1 6) with water as instructed on tins 
Fai Casein Lactalbumen Lactose Dextnn Maltose Ca as P as Fe parts Vitamin D per fi oz 
31' L 0 7 /^ 7 3 3 3 CaO PO per miJlion not less than 14 units 

I 09 0 16/ 4 

This food IS intended for use from birth to 3 months or for longer penod:> in 
dyspeptic infants who tolerate it readilv 

ALLENBURYS Humanised MILK FOOD No 2 (Enhreh Free from Starch) 

Milk Food No 2 IS prepared in exactly the same way as No 1 and retains Us general features It is 
intended for use during the second trimester when digestion is established and it contains a higher 
proporhon of milk protein and correspondingly less carbohv drate The mineral content is adequate in 
respect of calcium, phosphorus and iron and each fluid ounce of reconstituted food contains not less 

than 14 international units of vitamin D 


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32 


THE BRITISH' MEDICAL JOURNAL 


JUL\ 2, 1938 





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rHE BRITISH MEDICAL JOURNAL 


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IREATMENT OF APOPLEXY BY LNFILTRATION OF THE 
STELLATE GANGLION WITH NOVOCALN 

BY 

\RTHLR MACKEl, MB,ChB,FRFPS,FRCSEd 

Assistant to the Regius Professor of Siirgcrs Unixerstn of Glas"Oxi Dispensars Siirgioi to tin’ T! esitri 

Infirmarx of Otasgoxx 

L\URA>CE D W SCOTT, MB.ChB.FRFPS 

■ixsisiant to the Regius Professor of Methane Unixersnx of Glosgoix Dispensarx Phxsictan to tl e U i i n 

Infirniarx of Glasgoxx 


A paper bj Leriche and Fontaine (1936) suggests the 
use in cases of apople\> of a method of treatment wh eh 
mas be dramatic in its immediate effects It consists 
essenttallj tn the temporars anaesthesia of the stellate 
ganglion b> means of nosocain These authors submit 
that in an\ case of apoplew the sascular lesion be it 
haemorrhage or softening acts as an irritant on the sur- 
rounding sessels and produces a halo of imtatise 
vasospasm If this be true then vasospasm b> rendering 
anovaemic an area of cerebral tissue around the organic 
lesion mav pla> an important part in determining the 
scope of the initial svmptoms and if persistent mav 
contribute to the ultimate neuronic degeneration Leriche 
alid Fontaine claim that vasospasm can "Be abolished b> 
interrupting the sympathetic outflow to the head bv 
infiltration of the stellate ganglion with novocain and 
suggest that such treatment, bv sparing neurons that 
would otherwise perish may in certain cases save life 
and also aid manj patients to make the most complete 
recoverj 

Their argument in favour of this treatment is supported 
by the results obtained m two patients who developed 
hemiplegia during convalescence following gynaecological 
operations The first case was that of a woman aged 59 
who developed right hemiplegia with coma eight days 
after the performance of hvsterectomv for uterine fibroids 
She was in extremis and 10 ccm of 1 per cent novocain 
was injected into the region of the left stellate ganglion 
There was immediate improvement and in fifteen minutes 
she was so far recovered that she was able to reply to 
questions with a few words Her improvement was main 
tamed The second case was less dramatic for the patient 
though aphasic was not comatose Within fifteen minutes 
of the injection of novocain she could articulate with 
difficulty The injection was repeated next dav and in 
three days the signs of hemiplegia cleared completely 
In view of these results further investigation of the 
method seemed to be desirable and therefore during the 
past few months all patients with apoplexy admitted to 
the wards of Professor J W McNee have been treated 
by infiltration of the stellate ganglion with novocain 


Method 

The injection is made into the neighbourhood ot th^ 
stellate ganglion on the side of the lesion — that is the 
non paralvsed side The ganglion is not easilv accessible 
King at the inner end of the first intercostal space between 
the heads ot the first and second nbs above and fallow 
the bodv of the first thoracic vertebra mediallv and the 
pleura in front It is reached bv means ot a Icng needle 
of the tvpe used for tapping the spinal theca passed in 
a downward and medial direction under the neck of the 
first nb The landmark of the neck of each rib is roughiv 
a point 4 cm lateral to the tip of the spinous process of 
the vertebra above The needle mounted on a svringe is 
theretore inserted 4 cm lateral to the tip of the spine 
of the ve-tebra prominens and driven steadilv on until 
at a depth of about 4 cm it impinges on the transvers- 
process of the first dorsal vertebra which must if ncces 
sarv be sought and found The needle is then withdrawn 
slightly and made to pass in a downward and medial 
direction under the transverse process and the neck of 
the first nb until its progress is arrested bv the bodv of 
the first dorsal vertebra This occurs at a depth of 7 to 
8 cm and the needle point must no'w he m close proximitv 
to the stellate ganglion between the heads ot the first and 
second ribs The needle is withdrawn slightlv and gentle 
suction exercised bv means of the svringe If no blood 
IS obtained it is sate to proceed with the novocain injection 
and 20 to 30 ccm of a 1 per cent solution mav be 
introduced without apprehension The objeciivc is to 
infiltrate the ganglion and the surrounding tissues if this 
IS achieved Horners svndrome develops wiihin a few 
minutes This consists of enophthalmos narro v ng of the 
palpebral fissure contraction of the pupil and abs.nce 
of sweating on the side of the injection 

Rationale of the Method 

It has come to be realized in recent years that the results 
of vascular occlusion do not depend entirely upon the 
mechanical obstruction to the circulation A whole lung 
mav be removed at operation or the pulmonary pedicle 

4043 



2 July 1 , 1938 


TucDrihsh 
Medical Journal 


INFILTRATION OF STELLATE 

ligated, with trivial upset of the circulation, while a 
pulmonary embolism obstructing a much smaller pro- 
portion of the pulmonary circulation may result in sudden 
death When embolism occurs in the mam vessel of a 
limb there is widespread spasm of the collateral vessels, 
which jnay be relieved by antispasmodics such as 
papaverine (de Takats, 1936 , McKechnie and Allen, 1936), 
passive vascular exercises (Herrmann and Reid, 1934), 
spinal anaesthesia, sympathetic ganglionectomy, etc The 
importance of vasospasm in determining the extent of 
ultimate degeneration has been demonstrated experi- 
mentally by Chase (1934) in mesenteric air-embolism 
Lenche and Strieker (1933) go even further and legard 
an area of dvomc arterial occlusion as a source of vaso- 
spastic stimuli, ti eating such cases by excision of the 
thrombosed portion of the artery, with immediate benefit 
to the circulation of the limb The therapeutic procedure 
which we describe is an extension of these principles to 
the blood vessels of the brain These blood vessels derive 
a rich sympathetic nerve supply from the plexuses sur- 
rounding the internal carotid and vertebral arteries Pre- 
sumably these nerves are vasomotor, and under stimulation 
are capable of setting up a condition of cerebral ischaemia 
The brain however, differs from the tissues of the limbs 
in its lability , oxygen deprivation is tolerated for only 
a short time It is to be expected, therefoie, in cases of 
cerebral vascular accident that good lesults will be 
obtained from vasodilator therapy ohlv if it be instituted 
very soon after the onset of the illness The anatomical 
and physiological facts and the preceding analogies pro- 
vide a pi toil grounds for expectation of improvement in 
cases of cerebral vascular occlusion, but the clinical course 
of our first case seems to justify the hypothesis that even 
m cerebral haemorrhage there is a considerable amount 
of vasospasm in the surrounding brain, and that this may 
be removed by sympathetic anaesthesia 

Case Records 

Case 1 — A man aged 26 suddenly became unconscious on 
the day of admission On examination presxstolic and svstolic 
mitral murmurs >\ere noted The face arm, and leg on the 
left side were paralysed, he was deeph comatose and could 
not be roused Two hours after the onset tO c.cm of 1 per 
cent noaocain was injected into the region of the right stellate 
ganglion, and within two minutes he regained consciousness, 
and was able to recognize his relatnes and gi\e accurate 
details of his previous illnesses Horners ssndrome appeared 
but there was no change in the parahsis The improsement 
was maintained for some hours when he gradually became 
stuporous and relapsed to a let el of consciousness little above 
that on admission Another injection of 30 c cm was given 
eight hours after the onset and this was followed bv a Horner 
syndrome and improvement similar to that previouslv noted 
This improvement was maintained for the next five davs but 
on the sixth dav it was evident that he was much weaker 
phvsicallj, although still conscious On the seventh dav he 
again lost consciousness and a further injection of 30 c cm 
produced a Horner svndrome but no other changes death 
occurring within four hours Post mortem examination showed 
a hvpertrophied heart which was the seat ot subacute 
bacterial endocarditis A large haemorrhage measuring six 
inches in diameter was present m the right cerebral hemisphere, 
apparentiv arising from a ruptured mvcotic aneurvsm A. 
recent embolus was present at the termination of the left 
internal carotid arterv, extending a short distance into the 
middle cerebral arterv 

fuse 2 — On the dav of admission the patient, a man aged 
48 suddenlv became unconscious On examination there was 
weakness of the face and arm on the right side but no obvious 
parahsis of the right leg the right plantar response was 
extensor in tv pc He was unconscious but could be roused 


GANGLION IN APOPLEXY 


with difficulty The heart was not enlarged, and the blood 
pressure was 110/70 mm Hg Two hours after the onset 
30 cem of I per cent novocain was iniected with no imme- 
diate change in the clinical condition and Horners svndrome 
did not develop Within an hour he regained consciousness 
and within two hours was able to converse freelv On the 
following dav it was noted that there was no longer any 
parahsis, the right plantar response being indefinite in type 
Five davs from the onset he became stuporous, and the weak- 
ness of the right arm returned, 30 cem was again injected, 
with no improvement in the condition despite production of a 
Horner svndrome Following this he graduallv improved, 
and was dismissed one month later with the right plantar 
response extensor in tvpe but with no other evidence of 
neurological damage 

Case 3, — On the day before admission the patient, a man 
aged 53, suddenly developed a paralysis of the right arm and 
leg and at the same time became aphasic There was paralysis 
of the face, arm, and leg on the right side, and the right 
plantar response was extensor in tvpe He was deeply 
unconscious The heart was not enlarged and the blood 
pressure was lOO/iQ mm Hg Thirty cem of 1 per cent 
novocain was injected thirty-six hours after the onset, with 
reproduction of Horner s syndrome but no other immediate 
change in the clinical condition Twelve hours later he was 
much less' drowsy, but the paralysis was unaltered and the 
aphasia was pronounced Imnrovement m this case was slow, 
and the patient was dismissed six weeks later with paresis of the 
right leg and a slight degree of aphasia 

Case 4 — ^This patient, a man aged 60, was admitted com 
plaining of severe headache and'^vomiting The heart was 
enlarged and the arteries thickened and tortuous the blood 
pressure was 250/150 mm Hg Thirty six hours after admis 
Sion he suddenly became unconscious The right arm and 
leg were flaccid and the plantar responses were extensor 
Thirty c cm of 1 per cent novocain was injected half an hour 
after the onset of coma without the shghtest change in the 
chntcal condition He died thirty minutes later Post mortem 
examination showed a greatly hvpertrophied heart A large 
haemorrhage was present m 'the left internal capsule and 
lateral ventricle, and a smaller one in the pons There was 
extensive destruction of the left lenticular and caudate nuclei 

Case 5 — A man aged 57 had on two previous occasions been 
under treatment in the Western Infirmary for aortic mcom 
petence , the Wassermann reaction was positive at tnese times 
Some hours before admission he suddenly became unconscious 
There was paralysis of the right arm and leg , the right plantar 
response was extensor in type The blood pressure was 
224/68 mm Hg and systolic and diastolic murmurs were 
present over the aortic area Four hours after the onset 
40 cem of 1 per cent novocain was injected Immediately 
afterwards Horners syndrome developed and-he was able to 
move the light arm at the elbow slightly and the right leg 
at the hip quite strongly He regained consciousness to some 
extent and was able to say a few words with difficulty This 
improvement was maintained during the next twelve hours, 
after which time his condition gradually deteriorated and 
eighteen hours after the onset he was again completely 

paralysed in the right arm and leg Thirty cem was again 

injected, and following the injection Horners syndrome 
developed and there was a return of muscle power to the 
paralysed limhs He was dismissed five weeks later still 
aphasic and with a severe residual hemiplegia 
Case 6 — A woman aged 55 suddenly became unconscious 
on the dav of admission On examination she was deeply 
comatose and could not be roused , there was a flaceid 
paralysis of the right arm and leg, with an extensor pi intar 
response on that side The head and eves were rotated to the 
left The heart was enlarged to percussion and the blood 

pressure was 240/130 mm Hg Two hours after the onset 

30 cem of 1 per cent novocain was injected Horners 
svndrome developed and the head and eyes were no longer 
rotated to the left Two hours later she was much less 
comatose and made efforts to speak, but aphasia was ilmost 
complete She retained this degree of mental improvement to 


juL\ 2 ms 


INFILTRATION OF STELLATE GANGLION JN APOPLEXY 


the da\ of her death which occurred se\en da^s after admis- 
‘ion from h\postalic pneumonia the parahsis remaining 
unchinged Permi^ision for n post mortem examination was 
ret used 

Case 7 — On the das he was admitted to hospital a man 
'iged M began to ha\e conMilsions which lasted until his 
admission He was deepU comatose and the face arm and 
leg on the nghi side were panhsed The heart was not 
enlarged and the blood pressure was 160^68 mm Hg Four 
hours after the onset 30 cem of 1 per cent no\ocam was 
injected with no immediate impro\emeni Homer s s\ ndromc 
did not de\elop One hour later he regained consaousness 
and made efforts to speak his vocabuhiw being defectue 
Eighteen hours later another injection of 20 cem was gi\en 
this being followed b\ the de%elopment of Homers sandrome 
" Immediateh thereafter he was able to mo\e his right arm 
quite strongh and to feed himself One hour later there was 
some return of muscle power in the right leg This improve 
ment was maintained and he was dismissed four weeks later 
With some aphasia weakness of the right leg but with full 
function of the right arm 

Case S — On the daa of admission the patient a woman 
aged 64 suddenly became unconscious On examination she 
was comatose and could not be roused There was parahsis 
of the face arm and leg on the left side The plantar 
responses were extensor The heart was enlarged to per 
cussion and the blood pressure w’as 225/125 mm Hg Four 
teen hours after the onset 30 cem of I per cent novocain 
-ft as injected with the production of Homers svndrome 
Within a few minutes of the injection she began to speak but 
there was no change m the parahsis This improvement 
lasted a few hours onh and eighteen hours after the injection 
she was again deeph comatose and the head and e>es were 
strongh rotated to the right Thirtv cem was again injected 
with reproduction of a Homer svndrome a similar immediate 
improvement in the mental condition and disappearance of 
the deviation of the head and eves This improvement lasted 
some eighteen hours when she again became comatose with 
rotation of the head and eves to thb nght A further injec 
tion of 20 cem was made with a slight immediate improve 
ment m the mental condition the production of Horner s 
svndrome and abolition of the rotation of the head and ev-es 
This lasted onh a few hours and she gradualh became weaker 
dving five davs after admission Permission for a post mortem 
examination was refused 

Case 9 — One hour before admission a man aged 44 suddenh 
became unconscious On examination there w-as a flaccid 
parahsis of the left arm and leg the plantar response being 
indefinite on that side Twentv cem of 1 per cent novocain 
was injected one and a half hours after the onset but Homers 
svndrome did not develop No immediate change occurred 
in the clinical condition but thirtv minutes later there was a 
return of some muscle power in the left arm and he could be 
roused Following this he improved slighth and one and a 
half hours later could move the left arm weakh and made 
efforts to speak Thirtv cem of 1 per cent novocain was 
as,ain injected three hours after the onset, and wath the 
completion of the injection he became deeph evanosed and 
respiration ceased Artificial respiration was commenced 
and maintained for thirtv minutes when he began to breathe 
naluralh Two hours later he was greath improved and 
could move the left arm quite strongh there was some move- 
ment at the left hip and knee and he was talking freelv 
This improvement was maintained for some hours but there 
after he gradualh became weaker and died fourteen hours 
afier admission Post mortem evamination showed a bvper- 
trophied left ventncle with vegetations on the mitral vahe sug 
gestive of healed bacterial endocarditis Emboli were found 
in the right internal carotid arterv and also m the nght svhian 
arterv A large red softening was present in the area of the 
left lenticular nucleus there was evidence of old infarction 
in the iMand of Rcil on the left side and also in the left 
laieril cerebellar lobe 

Cnve 10 — A man aged 67 collapsed on the dav of admisMOti 
On examination the heart was found to be enlarged and 


Tm Bf-mst 9 
VlmiCAl. Jo TCVAt 


there ttas paralvMS of the face arm aid leg on the left side 
The head and ejes were deMaled to the nght the pUn'-'r 
response was extensor Twenl> cem of I per cent no\o"ain 
was injected in'o the region of the nght stellate gangiron w o 
hours after the onset, the injection being followed bt Horm-rs 
sxndrome No chance was noted in the clinical condition 
Six hours after the onset another injection of 20 cem w„s 
made resulting in the production of Horners sxndrome bu 
xxtih no other effect Foilowang this he became progressixcl 
weaker and died suddenlx on the sixth dax Post mortem 
examination shoxxed a large haemorrhage present m the ric.ht 
cerehral hemisphere that appeared to haxe been there fc 
some daxs Apparenllx the haemorrhage had ruptured into 
the lateral xentricle on the sixth dax and the xentricular 
sxstem was filled with blood 

Results 

Since some cases of apoplexx improxe sponlaneoush 
during the hours immcdiatelv folloxxing the catastrophe 
the results of an\ forin of active treatment must be 
rexiexxed cnticalh If hoxxexer marked improxemeni 
occurs nit/iin a /eii ininiiles of the carrying out ot a 
therapeutic procedure there can be less doubt of the 
existence of a causal connexion For the purposes of 
the present inxestigalion the injection is regarded as being 
without effect unless a change was produced in the clinical 
picture xvithin a few minutes of the injection of noxocam 

Infiltration of the region of the stellate ganglion xxas 
practised on nineteen occasions m nine of these improxe 
ment in the clinical condition was produced within a fev 
minutes of the completion of the injection Onl> in Case I 
was the immediate tmproxement dramatic and m this 
patient the result was so remarkable that b> comparison 
subsequent results seemed rather disappointing Life was 
certainh prolonged and the patient was brought from 
deep coma to a state of clear consciousness m which 
had It been necessarx he might have made a will On 
occasion this might be of medico legal importance 
Death occurred sexen davs after the onset of the apoplexv 
from a subsequent massive embolism of the middle cere 
bral arier> on the opposite side 

In the other cases m which there was immediate im 
provement the effects were much less striking Some 
showed diminution of the depth of unconsciousness and 
more readj response to questions and phjsical stimuli 
Others revealed some return of muscle power m the 
paraijsed limbs In all of these rune successful injections 
introduction of novocain was followed b> the development 
of a Horner svndrome indicating that the stellate ganglion 
had been anaesthetized and that the injection had been 
correctlj placed 

On ten occasions the injection of novocain produced no 
immediate improvement, after five of these injections 
however Horners s>ndrome did not develop anff pre 
sumablj therefore the absence of improvement mav bv 
attributed to the fact that the s>mpathetic oulflow was 
not blocked in these cases Some proof of the irulh of 
such an explanation was obtained in Case / This patient 
received two injections of novocain the first was given 
four hours after the onset of the apoplexv but was appar- 
entlv incorrecth placed as a Homer sjndrome did not 
develop and no improvement was noted in the clinical 
condition The second injection giv>.n twentv two hours 
after the onset, produced Horners svndrome and was 
followed b> immediate return of muscle power in the 
hitherto paraljsed arm 

On five occasions there was no immediate improvement 
after the novocain injection in spite of the p'oduction 
of a Homer s>ndrome In one of these the injection 



4 July 2 1938 INFILTRATION OF STELLATE GANGLION IN APOPLEXY 


The British 

Medical JoLRVAL 


was made seven days, and m another five days, after the 
onset of the apoplexy, when it was most unlikeJv that 
benefit would accrue from relaxation of xasospasm Two 
injections were given in a case of massive cerebral haemor- 
rhage which eventually riipliired into the lateral ventricle 
and was of such seventy that no improvement could 
reasonably be expected from any form of treatment In 
the remaining case the failure of the injection to produce 
improvement cannot be explained at the present time 
These findings are summarized in the table 


' Case 
No 

1 Injection 

1 Mn 

^ Suspected 
( Variety 

1 Inier\al 1 
1 since ! 

1 

Immediate Kcsult 

Hornet s 
Svndromc 

! 


l of Apoplew 

1 Apoplexy 1 




ri 

i 

Cerebral 

1 1 

1 2 hours 

Recoxery of con 


I 

j ! 

1 

haemorrhage 

1 

sciousncss from 
deep coma 


i ■] 

1 2 


8 ! 

Reco\ery of con J 

^cs 





1 

setousness . 



1 

13 


7 da\s 

No improxemeni | 

Yes 


t J 

n 

1 Cerebnl 

2 hours 

i 

No 




thrombosis 




1 



[ 3 dajs 

[ 1 

1 f* tf 1 

Xes 

3 


1 


36 hours 


Yes 

4 


1 

, Cerebral 

1 

* hour 

j 

No 




1 hnemorrhage 






ri 

' Cerebnl 

! 4 hours 

Jietum of muscle 

Tes 




ihromboMs 


pONser to arm and j 
leg slight^ 


5 

- 



! 

recoNcry of con | 
«iC»ousness 






IS , 

Return of muscle 

Xes 






power in arm and 
let , 


6 


1 

Cerebnl 

2 „ 

Head and eics no 

"its 




haemorrhage 

longer rotated to , 
side 1 


1 



Cerebnl 1 

4 „ 

No improxemcnt j 

No 

7 , 



thrombosis 





(2 


22 

Return of muscle 

^CS 






power to arm 



1 

rt 

Cerebnl 

14 „ j 

Recovery of con 

Xes 


1 


haemorrhage 

setousness 




2 

32 „ ^ 

Rcco\cr> of con 

■^es 

S 

i 



sciousncss head 



1 


j 

1 

and ejes no 
longer rotated to 
side 




,3 


50 ^ 

Slight recoNcrv of 

Yes 

! 





consciousness 




fl 

Cerebral 

u , 

No improvement 

No 

9 

i 

l2 ' 

embolism | 

3 , ' 

Collapse respira 

No 



1 

1 

1 

too fTilorc 




ft 

Cerebral i 

2 „ 

No miprocmcnl 

^es 

10 

■ 

u 

haemorrhage i 

! 

8 , 

- 

Yes 


It IS necessary to point out that the procedure described 
is not always devoid of danger Case 9 received a first 
injection of 20 c cm of 1 per cent novocain in the region 
of the right stellate ganglion without noticeable effect 
A second injection some hours later was followed by 
immediate respiratory failure, and artificial respiration had 
to be carried, out for thirty minutes before breathing was 
rc-established A possible explanation of this accident 
IS that some ot the noxocam was injected intravenously, 
despite the effort always made to ensure that a vein had 
not been entered A similar case is mentioned by 
Cyriax (1937) as occurring at the clinic of Leriche Our 
patient died twelve hours later and was found to have 
had a large cerebral softening, yet the suspicion persists 
that in this instance death may have been accelerated bv 
treatment Furthermore, it is not alwavs possible to 
differentiate cases ot cerebral haemorrhage from cases of 
cerebral xascular occlusion and it might be supposed that 
the production of cerebral xasodilatation in the former 
xvould carrv with it the risk of increased haemorrhage, 
and so xvould be dangerous We hax'e been fortunate 


in encountering no untoward effects suggestive of this 
complication even in cases which seemed hkcly to be 
suffering from cerebral haemorrhage, 

Summarj and Conclusions 

Infiltration of the region of the stellate ganglion''xvas 
carried out on nineteen occasions m cases of apoplexy , 
a definite clinical improvement followed nine of these 
injections Only in one case — the youngest of the series — 
was the improvement dramatic, and in this instance the 
immediate beneficiaL effect of the treatment cannot be 
doubled In the other cases the degree of improvement 
'vas relatively slight In one instance the injection was 
followed bv respiratory failure apparently produced by 
the solution being accidentally introduced into a vein 

The results obtained do not justify the adoption of 
anaesthesia of the stellate ganglion as a routine method of 
treatment in apoplexy, but further study is necessary before 
the method is rejected as of negligible value In the small 
series of cases studied it was impossible to control such 
important variables as the age of the patient, the duration 
of the illness, and the nature of the causal lesion, but it is 
believed that the following tentative conclusions are 
justified 

1 The use ot the method m cases of severe cerebnl 
haemorrhage in patients of middle age and older will 
serve only to bring it into disrepute 

2 Cases of cerebral thrombosis may show some im- 
provement of their clinical condition following anaes 
thesia of the stellate ganglion , the degree of such improve- 
ment will be partly dependent on how much arterial 
sclerosis is present 

3 The ideal case would seem to be one of cerebral 
embolism, especially m the young 

4 It IS important that in all cases the treatment should 
be given as soon after the onset of the apoplexy as 
possible, and probably only a negligible degree of im- 
provement can be expected if the illness has lasted longer 
than twenty-four hours before treatment is commenced 

Our thanks arc due to Professor McNee for permission to 
treat patients m his wards One of us (L D W S) was m 
receipt of a grant from the Rankin Medical Research Fund 

RErERENCES 

Chase, \V H (1934) Siirg G}nec ObsUI 59, S69 
Cjnax, J H (1937) Bridsh Medical Journal 2, 1199 
dc Takats, G (1936) J Amer iiicd Ass 106, 1003 
Herrmann, LG, and Rcid, M R (1934) Aim Sarg 100, 750 
Lerichc, R , and Fontaine R (1936) Rci Chir Pans 55 755 

and Strieker, P (1933) L Artcncclomie dans Ics arlirncs 

obhuranlcs, Pans (quoted by Young, A (1936), dixn-mc 

jiongres dc la Societd Internationale dc Chirurgic, 2, 406 ) 
McKcchmc, R E , and Allen, E V (1936) Sarg Gynec Obsicl 
63, 231 


E Hoffmann (^nicr J Svph Goii March, 1938) confirms 
the doctrine of without a svphilitic mother no svphiiitic 
child ’ He points out the importance of a search for spiro 
chaeles in women suspected of infection especiallv in the 
cervix, and of blood and cerebrospinal fluid Wisscrminn and 
Kahn examinations after the fourth month He considers that 
the germ cells and foetus up to the fourth month are never 
affected, and points out the value of (1) a note of the placental 
size (2) search for spirochaeies in blood from the umbilical 
vein and (3) v rav examination to reveal osteochondritis in 
infants In treatment he stresses the good tolerance of mother 
and child to the arsenobenzene group 



JoL'i 2 193S 


COMMON FOOT AILMENTS 


Ti _ Bxri « 
NUd cu. 3o •"VVi 


C03\IM0N FOOT AILMENTS* 

BY 

W SAYLE CREEK, M Ch Orth , F R C S 

(From the Orthopaetltc Sen ice Salford Royal Hospital) 

Abnormalities and'deformities of the feet causing pain 
and disability are so exceedingh common that the diffi 
cult\ IS to choose conditions which can be described and 
discussed with profit within a reasonable space 1 am 
told that the aserage medical practitioner is ignorant of 
them because there is no literature in which he can read 
about them This is not strictU true though one must 
admit that the textbooLs dismiss the subject with verx few 
words and that onh the specialist is likeh to read the 
journals or bu\ the books in which full descriptions are 
gixen It IS in the hope that help can be gixen that 1 ha\e 
dared to produce this resume 

The medical profession is privileged to see the private 
life of the public to enjov confidences not given to anv 
other and is at times burdened with the responsibilitv of 
making or marring a life The orthopaedic surgeons 
responsibilitv is verv often to restore an injured workman 
to tull earning capacitv or to relieve the foot troubles of 
those whose life is to sav the least made a burden because 
of pain 

This problem of pain so frequentiv glossed over or 
forgotten is a verv real one and because there is a wide 
spread belief among the- public that surgeons are ’oo 
fond of the knife there is a great deal of hesitation in 
seeking aid Too often after assuring the patient that 
some simple form of non surgical treatment will give 
relief one hears the sigh. I vvish I had known that twenty 
vears ago' For twentv vears afraid to seek help' 
What this aid could have amounted to is revealed bv a 
consideration of some common foot ailments and their 
treatment without recourse to surgerv 
No better idea of the prevalence and ratio of some of 
these conditions can be obtained than bv analysing me 
figures for the orthopaedic clinics of two foot hospitals 
In these two institutions everv patient who requires advice 
or treatment tor conditions that are not simple or straight 
forward chiropodv is referred to the orthopaedic surgeon 
for advice In two vears these cases amounted to 1000 
In the following table the figures in the column Cases 
refer to the number of times such a condition has been 
seen As the patient may have more than one eondition 
the number of cases does not correspond to the 
number of patients In fact the average is 1 35 lesions 
or condiuons per patient 


Table Shoinag Analysis of I 004 Patients seen from April 
1936 to March J93S 



[ Cases 

/ 

Ntetatarsal arch abnormaJttr-s (flattenin'* pain 
etc ) 

254 

24 j Found m 327 

J or 33/ of 

HaMu^ \algus comp ex (see belou for dexenp 
tion) 

203 

20 ; th-* patients 

Flat foot (a quiredonlj) 

J94 

20 

Hallux ngidus 

103 

10 

Hammer to„ 

40 

4 

Unusual $v.\-cre or persisieot corns and logrow 
tng toe nails etc 


— 


These figures convev some idea of the extraordinary 
number of patients seeking relief from chiropodists for 
foot complaints which have alwavs been regarded as 
orthopaedic conditions There is a reason for this Later 
m the paper palliative methods of treatment are described 
and the reasons why thev arc used are given laider the 
heading Contraindications to Operation as well as in 

Thi paper w an expansion and adaptation of a tecliue itln> 
Iralcd b\ sketches and a cine film given to Ihe Lancashire and 
Clieshire Branch of the B.XI A at Salford Roval Ho pilai on 
rthniarv 19Vs 


the paragraphs dealing with the methods All the 
measures described are commonlv used bv chiropodists to 
a far greater extent than bv surgeons (unless the ortho 
paedic department is fortunate enough to have a chiro 
podist attached) so that the nervous patients fearing 
surgery yet craving relief have gone to those from whonl 
non surgical treatment could be obtained 

The Hallux 3algus Complex 

Bv far the most common of the afflictions that beset the 
feet of the twentieth centurv Briton is an abnormalitv 
of the metatarsal region Excluding the figures for meta 
tarsal arch defects which include all cases in which the 
metatarsal arch is flattened irrespective of svmptoma 
tologv the most common ailment is the hallux val_us 
complex Although much has been written m recent vears 
of the operative treatment of this condition little has been 
said regarding the manv factors of which it is an aggrega 
tion and which suggest the name hallux valgus complex 

Examination of some 300 cases has shown that the 
various parts of the foot a-e affected approximatelv in 
the following order of frequenev and include the follow 
mg conditions (Fig I) 

(1) Flattening of the metatarsal arch with spreading of ihe 
metatarsals and the formation of 

(2) callosities on the plantar aspect 

(3) valgus deformilv and inward rotation of the hallux 

(4) formation of a bunion over an evosiosis on the inner 
side of the first metatarsal 

(5) The second toe lies either under or over or is pushed 
laterallv bv Ihe hallux If the former it is generallv a hammer 
toe and has a painful corn on the dor um of the proximal 
interphalangeal joint 

16 ) The outer three toes are usuallv crowded together the 
fifth tucked under the fourth the fourth under the third and 
the third under the second In other cases they are clawed 
and more or less ngid The wor e the metatarsal arch 
reversal — that is the arch reversed from a concavuv down 
wards to a convexitv — the more likelv will there be clawing 
ot the toes 

(7) Dislocation of the second meiaiarso phalangeal joint is 
surpnsinglv common when looked for In mv experience not 
less than 8 per cent are so affected Sometimes the disloca 
tion IS of the third metatarso phalangeal joint and I have 
seen it affecting the fourth while two joints mav be concerned 

^8) A genuine flattening of the longitudinal arch with both 
foot and calf svmptoms mav be found 

(91 Corn formation on the dorsum of the fifth toe and at 
the ups of the second and third toes is frequent 

(10) Affections of the nail of the great toe are common 
Pressure of Ihe second toe on the nail sulcus causes in 
growing toe nail Interference with the nail bed gives rise 
to onvchogrvphosis onvchalrophia and the like 

(11) Swelling of the foot from oedema not due to general 
conditions is occasionallv met with 

Anv or all ot Jiese conditions mav be bilateral or 
unilateral This picture is not an exaggeration in any 
wav It 15 not supposing that the patient complains of 
pam in several sues In fact even single factor of ihe 
deformitx mav give rise to pain or tenderness I sav tender 
ness because so often it is pressure when walking wh ch 
causes the pam while at rest there is comparali c 
comfort 

Possible Modes of Production 

One could argue about the cause of all these troubles 
for vears without being able to give conclusive support to 
am contention A few facts clear the ground a Iilllc 
Mv figures show that the number of males affecled is 
onlv one to everv fifteen women It is usual to find on 
inquirv that the males whose leet are reallv deformed have 
suffered from a general or local infective disease su.h 
as rheumatic fev'er gencmlized arthritis gonor-ho.a o 
frost bite Clinical examination shows that me at.'s_l 
flattening and spread and callosity formation a'c mo 
common that slight hallux valgus and a small exo o, v 


6 July 2 1938 


- COMMON FOOT AILMENTS 


Thc Bwnsn 
Medical Jolrnal 


come ne\t, and that the whole gamut of dcformtties ts 
present only in the fully developed condition 

Theie is one other factor to consider, and this in my 
opinion IS the key to the whole piobiem Women wear 
high-heeled ” shoes which slope down from the heel to 
the base of the toes (Fig 2a) This, as can be demon- 
strated by radiogtaphs, means that the metatarsals are 
more oi less vertical and that the body weight is thrown 
forward on to the metataisal arch This throwing or 
sliding forward at each step causes (1) rubbing of the 
plantar skin on the sole of the shoe at point x m Fig 2a, 
and almost certainly accounts for the thickened skm , 
(2) distorts the transverse or metatarsal aich , (3) ciowds 
the toes into the front of the shoe , (4) dorsiflexes the 
toes at the metatarso-phalangeal joints and leads to 
secondary contracture of the long and short extensor 


Wl 



Fig 1 — ^Tncing of a radiognph of Inllux \algus complex 
^ t'ce text) 

muscles, with stretching of the small foot muscles, the 
interossei, and lumbricals 

If the heel part of the shoe were horizontal instead of 
sloping (Fig 2b) the sliding might be reduced, though it 
can never be abolished with heels higher than about one 
inch Added to the heel height and slope we have the 
fact that there is insufficient heel and instep grip m most 
shoes and none at alt m court shoes — that is, shoes with 
no fastening across the instep A stfap across the instep 
IS effective onlv with moderate or low heels With high 
heels It presses too hard and causes pain The inefficient 
grip of the mid- and hind-foot necessitates the toes being 
used m a manner that Nature never intended, in order 
to present the shoe lading oft This upsets the normal 
muscle balance and is the cause of the flexion contractures 
at the mterphalangeal joints — the gripping eflect necessary 

The effect of sloping and high heels is therefore to 
change the posture of the foot, to pitch the body weight 
on to the metatarsal heads and the transverse arch, and 
to cause spreading of the arch Inevitably the toes are 
dorsiflexed at the metatarso-phalangeal joints, and in 
order to grip the shoe become flexed at the mterphalangeal 
loinis (Fig 3) 

To accownt for the lateral deviation — the valgus de- 
formity — ot the hallux is perfectly simple, though there 
arc two chief schools of thought The first says that 
short tight hose and/or shoes are the deforming factor 


This hypothesis takes no notice of heel height It can 
not be gainsaid that since our maidens start wearing 
pointed shoes at a very tender age this is a not tin 
reasonable theory It is undoubtedly the explanation for 
the crowding together and overlapping of the outer toes 
But I cannot help remembering the cases one sees in 
males, where pointed shoes have not been worn and 
where there is the other factor — generalized infection 
Anyone-who has seen a pair of feet swollen and distorted 
With gonorrhoea or acute rheumatic fever must be struck 
by the fact that all the tissues are oedematous and 
softened The effect on the small muscles and the liga- 
ments IS only too easy to visualize And we know, too, 
how these feet become deformed, almost as we watch 
them, even though the patient is wearing no shoes 




Fig ‘i — Tncing of i ladiograph of a foot in a shoe, showing 
that pointed shoes picvent the great toe being kept straight and 
tint the point of the shoe is lateral to the mid line of the foot 

Whereas before the attack they were reasonably or per- 
fectly shaped, by the time it is over, some very ft-vv 
weeks lalei, there is spreading of the metatarsal arch, 
hallux valgus, and clawed toes as severe as one can ever 
see 

By analogy I have been forced to believe that m women 
the wearing of high heels and the abnormal posture ot 
the feet cause vascular and mechanical disturbances which, 
by affecting the small muscles and ligaments, allow the 
metatarsals to spread or “ fan out ’ This spreading 
separates the attachments of the adductor transversus and 
the adductor obliqiius hallucis The outer attachments arc to 
bone, and are therefore “ fixed ” The inner attachments 
are X'lrtually to the base of the phalanx of the great toe, 
and as the phalanx is connected to the foot by a joint 
any pull on the bone will move the joint and move the 
toe into the known valgus position An argument sup 
potting this IS that as the muscles are attached to the 
plantar aspect of the phalanges one would expect them 
to cause rotation around the long axis of the toe as well 
as lateral deviation We would expect the relation to be 
so that the toe is twisted inwards till the nail looks towards 
the opposite foot The rotation is found (Fig 4) 

Briefly, then, it can be asserted that the hallux vilgiis 
complex IS caused by (1) an “ infective ” process affccUng 
the feet, or (2) the wearing of unsuitable shoes The 


JUL^ 2 I93S 


CO'r^ION FOOT AILMENTS 


The Outoh 

'ItD C.VL. Jo TLSM 


former cause is less common 
one m males 


but IS the more frequent 


That the salgus deformit> is assisted b> narrow-pointed 
shoes cannot be doubted The point of a serj large pro- 
portion of feminine shoes is outside (lateral to) the centre 
line of the second metatarsal and toe and it is impossible 
to fit a foot with a normallj positioned great toe into 
these shoes All these points are easih demonstrated bs 
radiographs Tracings ot radiographs are much more 
easilj understood therefore some are presented here 
instead of the original films (Fig 5) 

The explanation 
of the dislocated 
metatarso phalangeal 
joint(s) is eas> It is 
caused bx the pull of 
the light extensor ten 
dons on toes which 
are kept dorsiflexed 
because of the high 
heels The proof is 
simple and depends 
on clinical facts 
anatomical and opera- 
tise dissection and 
experimental stimula- 
tion of muscles at 
operation 

Surgical Treatment 

The surgical treat 
ment of hallux \algus 
deformitx has been 
argued and discussed 
for at least two 
generations In one 
group of operations 
an attempt is made to 
correct the fanning 
of the metatarsals as 
well as to correct the 
great toe So far as 
I know these opera 
lions have not gamed 
an\ wide popularitv 
because although the\ 
look well on paper 
their execution is not 
easj nor is their effect 
that which might be 
hoped for 

The popular opera 
lions take the form 
of rftaking a false 
joint for the great toe 
b\ excision of (1) the 
base of the phalanx 
or (2) the head of the 
metatarsal I will refer 
jou to some corre- 
spondence in ihe 
Journal (1935 1 -1-16 
504) for opinions on 

the relative merits of these operations After months 
of facts and figures no side won The truth is that m 
many cases anj reasonable operation will cure the valgus 
deformitj of the hallux but as Sir Robert Jones pointed 
out man> vears ago there is small satisfaction for patient 
or surgeon if the more shapelv foot is still painful and 
he emphasized what most of us know that the foot (as 
a whole) must be considered as a whole In so manv cases 
the patient complains of pam onlv at Ihe base of the 
second toe The enthusiastic surgeon who corrects the 
deformed great toe and neglects the cause of pa n in the 
Second toe has performed a good operation but has not 



nccessanij performed one to cure the complaint \ h ch 
made the patient consult him 

It the patient s complaint is referab'e to Ihe second toe 
and there is a dislocation here one must ei her excise 
Ihe base of the pnalanv of the second toe or tenotomize 
Ihe extensor tendons If the pam is due to compression 
of the second toe between the first and third toes ind 
there are no other complaints it mav be wiser to ampui e 
the toe It has been argued that this will allow ihe 
great toe to deform further I dcubt it But it d'.s 
allow the vain ladv to go on wearing poinied sho-s — 

no small psvchological 
point 

The trouble "ruv 
be the pain, ul e i n 
on the hamme loe 
There mav b- eorns 
on o her toes Th -se 
corns mav be di e *o 
the tight extensor ten 
dons which p'ess the 
toes up agains the 
shoe In such cas^s 
tenoiomv ot n ex 
tensor tendons must 
oe performed or the 
tendons mav be trans 
planted to the m-U 
tarsals in order to 
aid re tormation ot 
the metatarsal arch 
One can go on almoSi 
for ever describ ng 
the manv ihii gs 
which mav need do 
ing and one or more 
of which will have to 
be done in m'>nv 
cases but as ibis is 
a matter to' the sur 
geon I will not take 
up anv further spai— 
here 


Fig 2a — High heekd shoe showing sloping heel 
Fig 2b — Sinclar shoe with level heel 

Fig 4 — Showing roiaiion of hsllux in a case of valgus deformilv 
Fig 6 — Metatar^ dome or pad 

Fig 7 — Metalarsal rocker bar showing range of movement permitl'd vwibout 
movemeni of great toe 

Fig 8 — Prot-aive bunion pad 
Fig 9a — Dorsal toe pron 
Fig 9b — Single dorsal toe padding 
Fig to — Example of mstrui-iions sent 


Contraindications to 
Operation 

Uhat of those who 
refuse operation or 
on whom operaiion 
cannot be performed'’ 
The former are a vers 
large group The 
medical contraindica- 
tions to operation are 
exceedmglv few If 
It were necessarv to 
use a general or 
spinal anaestheiic one 
might hesitate to sug- 
gest ope-ating on a 
fadv ot 70 whose 
cardiovascular svsitm 
was poor But if she 
IS suffering constant pam as a result of a fool con 
dition which can be relieved one has to ask oneseK 
whether it is not true that relief ot the pain would 
imp'ove her general condition Seeing that it is 

perfecllv easv To perform almos anv operation under 

local anaesthesia Ihe operative risk nseil is negiigifaE 
1 refuse however as a resell of experience to 'ansp ant 
tendons under local anaesthesia ll is noi v - lo op 'i - 
on a case where there has b^en recen rh^umvl ^ f-ver 
or gonorrho.a because of be r sk of Irgh ing up |h. 
inflammation Severe cases of dub-ie' ar e lo - ere s 
or other vascular disturbarces and advanced ncphriiis O' 


Co a shoemvker m case of flat foot 




8 July 2, 1938 


COMMON FOOT AILMENTS 


Tctt. Briush 
Medical Journal 


cardiac disease or varicose veins with oedema of the feet 
make one pause, because a poor circulation in the foot 
always implies the risk of sepsis or poor healing of the 
wound , but each case must be considered on its merits 
The final contraindication is when the patient refuses to 
wear reasonable footwear after the operation the 
- corrected foot will not fit pointed shoes, and if the foot 
is forced into them soon after operation the deformity 
will recur 

A much more important group of~patients includes 
those who cannot afford the time for operation and after- 
treatment I warn all my patients that they must expect 
to be away from work for not less than six weeks In 
some cases nearly three months is required It is not 
that the patient is laid up for long — most patients can 
start walking in three weeks — but when we remember that 
the feet do more work and support moie weight than 
any other part of the body it is not surprising that in 
the elderly it takes two months to restore them to their 
original agility and power There is always this consoling 
fact when deciding whether the time can be afforded 
that whereas before the treatment the patient was a cripple, 
afterwards he or she will rediscover the joy of painless 
movement 

Palliatne Treatment 

But to those for whom operation is an impossibility 
we can offer palliative measures that are worth while 
They may involve a little trouble and some attention to 
details, but those of us who have prescribed them know 
how grateful the patients are for the jelief of the pant 
These measuies apply to all foot conditions not only 
hallux valgus complex They can be divided into 

(1) Alterations to shoes or the prescription of special types 

(2) The fitting of protective pads 

(3) The application of corrective strapping 

(4) Attention to corns, callosities, etc ' ^ 

(5) Physiotherapy— that is, heat in various forms, massage, 

exercises ^ 

The whole of this issue of the Jounial could be filled 
on these subjects alone, so 1 will confine the account to 
examples of what can be done and the reasons behind the 
suggested treatment 


ALTERATIONS TO SHOES 

I have seen a number of cases of hallux valgus complex 
where the patient s whole life was overshadowed by her 
foot troubles Shoes were ordered from ordinary shoe- 
makers— not surgical shoemakers We sent a draft w 
outline of the toot togeihei with naeasurements taken 
with an oidinarv domestic tape-measure, and asked tor 
modified stiaight-inner-sided shoes with one-inch heels, 
plenty of toe room, etc These shoemakers supply good- 
looking comfortable shoes in a short time and at a 
reasonable price In some cases my patients, who decided 
to have these shoes until such a date as they could take 
time off for the operation, were so relieved by wearing 
them that the operation never was performed 

Simpler measures include the fitting of a rubber meta- 
laisal dome into the shoe (Fig 6) This is a most 
useful little sujiport It distributes the weight of the fore- 
foot and the callosities and pain due to localized pressiiie 
m this region are greatly lelieved An alternative suppor 
of great value is made b\ cutting and shaping 7/J6-incti 
semi-coniprcbsed idhesivc felt, which adheres to the lOO 
In the case of hallux rigidus where there is pain 
because the metatarso phalangeal joint cannot be moved 
or ii/icn It IS moved, the fitting of a metatarsal rtKker 
bar makes it possible to wilk without any movement uEre 
I have patients whose radiographs showed very marked 
osteo arthritis, but who have been freed from all pain by 
this fitting which costs Is 6d Fig 7 illustrates the 
principle well 

1 ROaXCTIVE PADS 

Bunions corns cillosities, and all tender areas can often 
be relieved by the fitting of a well-shaped pad 1 knew 


of these measures as a medical student, but it was a 
chiropodist who taught me the secret of success I used 
the same material as he did — adhesive felt But whereas 
I only cut out what I thought was a good shape he 
carefully makes his pad to shape -fiom a metal template 
and then skives or bevels it so that it fits without any 
abrupt edges (Fig 8) Similar kinds of pads can be used 
for the toes The type illustrated in Fig 9a fitted on 
to the dorsum of clawed toes and overlying the metatarso 
phalangeal joints, with a smaller one underneath the toes, 
will provide an extraordinary degree of comfort The 
smaller type (Fig 9b) on one toe — for example, hammer- 
toe — will protect and relieve painful corns It will be 
obvious that the limit to the use and design of pads is 
that of the ingenuity and skill of the doctor or chiropodist 
The important point is to skive or bevel the edges To 
make and apply them consumes more time and patience 
than the busy surgeon or doctor may possess And one 
must express the opinion that here is a case where we 
might very profitably utilize the skill and time of the 
chiropodist, who spends his life working with such 
material 

corrective STRAPriNG 

The uses of this^ method of treatment are somewhat 
limited, but of value in the young No other treatment 
IS required for deformed toes in early childhood In 
hallux valgus one can sometimes prevent pressure of the 
great toe against the second by employing it, but unless 
the patient has a particularly good pair of shoes the 
benefit of the strapping is lost 


CORNS AND CALLOSITIES 

Callosities form most commonly under the heads of the 
metatarsals in metatarsal arch flattening and in hallux 
valgus usually under the second, third, and fourth meta- 
tarsals , in pes cavus most commonly under the first and 
fifth They can be exquisitely tender Protection by 
adhesive strapping or a metatarsal dome alone is of a little 
value The best treatment is to remove the thickened 
skin A special form of scalpel^a spade scalpel— which 
cuts at the end of a broad blade is a very easy instni 
ment to use and is a favourite of the chiiopodist After 
removal some means of preventing rapid j-eturn must 
be devised The metatarsal dome or pad such as that 
described is one measure A special insole shaped and 
hollowed IS even better, and for this a good surgical shoe- 
maker s aid must be sought Ideally one should order 
shoes made on a last which has been built up to match 
a plaster cast of the foot This ensures— provided the 
surgeon insists on it— that the inner surface of the sole 
IS shaped to the foot the exact opposite of trying to make 
the foot fit the shoe 

There are two common ways of treating corns C)nc 
is to prescribe a corn paint or plaster These contain for 
the most part salicylic acid They do help but so often 
do infection of the corn and inflammation of the foot 
follow then misuse that I have no hesitation in con- 
demning them Far better to let the chiropodist use 
his skill in enucleating the corn ‘ lOot and all ’ Conis, 
like callosities are due to intermittent pressure of the 
shoes When the shoes aie unsuitable permanent cure is 
ensured by seeing that coriectly shaped shoes are obtained 


IAIN CORNS AND TLVT FECT 

Aside from the discomfort itself, corns, cillosities, and 
other causes ot pain play a much more important part 
in the production of foot disabilities than is commonly 
realized Most of us have experienced this at some time 
or other when, on a long walk or march, we developed 
a painful blister or rubbed toe or simply made a hole 
in our socks We soon became conscious that besides 
the pain there was a tired aching feeling in the foo “ 
the calf This ache is the symptom of muscle Ia"e‘'c 
Why should muscle fatigue arise because of a pain/ 
Previously vve walked with no trace of it 

The muscles of the legs have a postural tone or sup 
porting action, which is under reflex control Agonist 




JuL'i 2 I93S 


co\ri\roN FOOT ailments 


TfiE B msa 
Medical 


9 


and antagonist groups of muscles influence each other and 
in conjunction with stimuli from skin and joints a perfect 
ba'ance of power is maintained Sherrington and others 
ha\e shown how easih this reflex balance could be 
affected how the tone of one group of muscles could 
be altered b\ stimuli of man> tjpes and from man) sues 
and organs In particular pain could inhibit the tone 
If for instance the action of one muscle causes pain from 
pressure against a nail m the shoe a blister or a corn 
then the tone of that muscle is reflexU inhibited and its 
power reduced This upsets the delicate balance and if 
we persist in trxing to walk the muscles protest b\ aching 
and tiring While there is no agreement as to whether 
the human foot should or should not possess an arch 
or whether the muscles of the leg are the pnncipal 
supports of the arch common experience teaches us that 
the first sxmptoms of flat foot are ttredness of the legs 
and achmg m the calf Furthermore treatment directed 
to the relief and cure of muscle strain relieves the 
condition For this reason one believes that the muscles 
are of supreme importance 

In the treatment of mobile flat feet and of muscle 
fatigue m the legs it is manifestl) important first to make 
sure that there is no painful com present So often there 
IS such a cause After treating this, or if there is no 
such painful element in the case the following measures 
are needed First the overstrained muscles must be 
relaxed^ and rested bv providing a mechanical support 
Wedge the inner side of the heel The heel must be low 
enough and wide enough to allow of it If high heels 
are wedged the stabilitv of the whole foot is impaired 
and the condition made worse Depending on the width 
of the heel the wedge should be from three sixteenths 
to one third of an inch The inner side of the heel should 
be elongated bv about three quarters of an inch to pro- 
vide extra support under the astragalus and scaphoid 
(Fig 10) In ver) severe cases rest m bed for a few 
da)s ma) be required To restore the tone and power of 
the muscles massage exercise and electrical stimulation 
must be ordered After a few treatments the patient ma) 
be permitted to continue to exercise at home without 
supervision 

PHV SIOrUEBVPV 

It IS not possible to sa) verv much here on this subject 
but ,it must be mentioned Radiant heat or infra red 
ravs relieve pain help to loosen rigid joints and assist 
recover) after operation Massage influences the circula 
non and increases the blood sUpplv so improving local 
metabolism and aiding in the removal of fluids The 
mechanical effect of massage and vvrenchings also removes 
fluid breaks dow n adhesions and restores mobilitv Exer- 
cises restore mobilit) to joints and increase the tone and 
power of muscles 

In minor foot conditions there is unlimited scope for 
the use of ill these measures but I will not enter into 
details now except to sav that manv of us are apt to 
neglect them in the after-treatment of feet which have 
been operated on There is not the slightest doubt m 
my mind that the) are almost essential in the elderlv 
and in those cases where no operation is performed they 
p'av a most important part 

Shoes 

The correspondence columns of the Journal have shown 
how little agreement there is on the question of what 
constitutes a good shoe I hold definite views on the 
subject That thev are of value can be demonstrated to 
anv vho care to examine and question the patients for 
whom I have ordered what 1 consider correct footwear 
It IS verv simple (I) the shoe must gnp the heel firmly 
(2) there must be a bar or other tie which fits over and 
grips the instep (3) the fore part (vamp) must confoiin 
to and be a little more anatomicall) correct than the 
fooi and must allow enough room for the toes to move 
about (4) the heels ot the shoes worn out of doors 
or at work or plav (and m the case of indoor occupation 


those worn during the dav) must not be higher than one 
to one and a half inches So simple )et so difficult to 
obtain though in the last three )ears or so there has 
been a marked improvement in the models made b) good 
shoe manufacturers 

A Problem 

There are two theoretical objections to the palliative 
measures I have described The first is that thev are 
palliative onl) But as we have seen thev frequentlv do 
restore the patient to comfort The other is that so 
much of them is tedious to carrv out and requires reeula- 
repetition We have the trained masseur or massnisc 
to give ph)siotherapv but in the past there has been no 
one to see to the paddings strappings corn cuttings etc 
It ma) be for this reason that the) have been neglected 
The specialist cannot expect his private patients to p^) 
his fees for regular visits He has no time m a busv 
orthopaedic clinic The general practitioner is far too 
busv and m anv case has no wish to acquire a reputation 
as a corn-cutter 

There are specialists in this branch of auxiliar) medical 
work — the chiropodists The public discovered them 
man) years ago and are going to them in ever increas ng 
numbers for such treatment as I have mentioned There 
were 45 000 attendances at two of Manchester s toot 
hospitals last )ear Ver) few medical men and fewer 
hospitals have lelt it wise to enlist their aid We at 
Salford Ro)al Hospital have had the benefit ot a chiro 
podists help for over a )ear and we appreciate to the 
full just vvhat he can do I would like to make a plea 
for some definite liaison beiween properlv trained and 
approved chiropodists and the medical protession There 
IS so much that thev can do They are doing it in their 
own private practices and clinics One wonders whether 
we are not missing an opportunit) to render even beiier 
service to our patients bv failing to utilize their skill in 
our hospitals and our own private practices 

Since the above was vvntlen a report has appeared from 
Universitv College Hospital advocating the appointment of a 
chiropodist to all diabetic clinics Thev state that since the) 
appointed a chiropodist the incidence of gancrene among 
diabetics has fallen bv 50 per cent One wonde s whether 
there is not a medico legal aspect to be considered The 
hospital which does not appoint a chiropodist mav be tmilt) 
of negligence in not providing expert treatment to the best 
of Us abihtv as laid down bv several High Court judges 


G C Higoumenakis (Ana Derm S\ph Paris December 
1937) points out that in 1927 he recorded" the case of a 
patient with congenital svphilis who had a swelling on the 
inner third of the right clavicle and he showed at the same 
Ume a radiograph of the clavicles of another patient suffering 
from these two conditions After investigating a large number 
of unselected dermatological cases and reviewing the literature 


in the subject the author has become convinced that this 
ign IS as important as anv in the rJiagnosis of congenital 
vphihs and that its frequenev is as great as that of the 
letter known stigmata of the disease It does not occur in 
hose who are healths or in persons suffenne from acquired 
ivphilis He stresses the selection bv the spirochacle of con 
lective and Ivmphatic tissues the presence of “ 
lentre of ossification at the inner end of the clavicle an i e 
nembranous ong.n of the clav icle He 

actor in the production of ihis swelling is Ihe ^ 

mtation of the sternal end of ihe clavicle at Ihe terno- 
ilavacular joint as it is the clavicle vvhich ' 

icromion from slidinc towards the mid line when the arm 
s beme used Allbouch Ihe condition no t common v aliccts 
he inner third of the ri.ht clav isle he has ihirleen case o' 
leople who are left handed or who use the I'fl h-nd i 
treat deal who have developed a swelling of the inner vnJ 
if the left clavicle \ rav cxamiration and the p-tho'o. -d 
inding indicate that the condition is essentnlh a formilion 
if new bone and not a perio titis 



10 July 2, 1938 


BACILLI FROM SCAR TEN YEARS AFTER TETANUS 


The Briti h 
Mecicai JoLrsa 


TETANUS BACILLUS RECOVERED FROM 
THE SCAR TEN YEARS AFTER AN 
ATTACK OF POST-OPERATIVE 
^ TETANUS 

BY 

VICTOR BONNEY, M S,B Sc, ERCS, TRACS. 
CHARLES BOX, M D., F R C P , F R C.S 

AND 

JOHN MacLENNAN, M B , Ch.B. 

(Fioiti t)ie Depai liiieiils oj Obstetrics and GMiaecotogy and 
'of Pntholog\ of the British Postgraduate Medical 
School Haninici smith Hospital London) 

In 1-928 a young unman led woman aged 31 was admitted 
into the Royal Masonic Hospital under one ol us (V B ) 
with a large mass of uterine fibroids reaching to the 
umbilicus He performed myomectomy, enucleating 
fifty-three tumours from the uterus and then reconstructing 
It The suture materfal used was composed of strands 
of catgut and very fine silk interwoven Fifteen days 
after the operation the patient complained of not being 
able to open her mouth, difficulty in swallowing, rheu- 
matic pains, and stiffness of the posterior cervical muscles, 
and m a short time all the typical features of tetanus 
presented themselves 

She was placed under the care of C B , who carried 
out intensive seium treatment Cistern puncture was pei- 
formed three times, 20,000 units of anti-tetanic serum 
being injected on each occasion, and, m addition, the 
patient was given a total of 26 000 units by two intra- 
thecal injections and a total of 9,000 units by two intra- 
muscular injections Morphine, heioin, chloral, and 
bromide of potassium were also administered As the 
result of this treatment and after a period of great 
anxiety, the spasms diminished and she eventually com- 
pletely recovered The abdominal wound healed by first 
intention, and the condition of the uterus did not appear 
at any time to be unsatisfactory The discharge from the 
uterus and the unused remainder of the suture material 
employed at the operation were examined for Cl tetaiu, 
but it was not found, and therefore the diagnosis of 
tetanus rested on the clinical picture, which was unmis- 
takable 

Early in 1938 the patient, now aged 41 and still un- 
married, came to see V B because for the last year she 
had noticed her abdomen enlarging He found a large 
mass of new fibroids and advised subtotal hysterectomy 
The possibility that the spores of Cl ieiam might still 
exist in the uterus or the abdominal scar occurred to him, 
and he communicated with C B on the matter The 
latter strongly advised a prophylactic dose of anti-tetanic 
serum after the patient had been protected against anaphy- 
laxis by desensitizing her 

She was admitted to Hammersmjth Hospital, where, 
after the precautions mentioned had been carried out, 
V B opened the abdomen through the old scar and 
performed subtotal hysterectomy, at the termination of 
which he excised with scissors, in two strips, the whole 
thickness of the abdominal scar tissue After the opera- 
tion two further prophylactic injections of anti tetanic 
serum were given The patient made an uninterrupted 
recover}' except for a certain amount of joint and muscle 
pain, which was judged to be the result of the serum 


' - Bacteriological Findings 

The specimen submitted to the bacteriologist (J Mad ) 
consisted of a portion of the uterine wall and two strips 
of scar tissue, including the skin and the whole thickness 
of the abdominal wall 

These were finely minced up by means of sterile scissors, 
inoculated into a series of tubes of cooked meat medium 
and of glucose blood broth, and incubated anaerobically 
for forty eight hours at 37° C At the end of this period 
there w'as some slight growth of a coccus in one tube 
onlv, but after a further two days incubation all six 
cultures made from the operation scar gave considerable 
growth of typical slender bacilli with round terminal 
spores in one of the tubes these were apparently in pure 
culture, in four there was in addition Staph albiis and 
in one Staph albiis and Cl spoiogeiies The cocci were 
destroyed by heat and the drumstick bacilli readily isolated 
by the method of Fildes (1925) Apart from some scanty 
growth of Staph albiis in two of the tubes the cultures 
made from the uterine wall remained sterile after one 
month s anaerobic incubation, and were then discarded 

The SIX cultures obtained from the scar tissues were 
examined and compared in considerable detail, ai 3 ,d were 
found to be quite indistinguishable It was assumed, 
therelore, that one stiain alone was involved This was 
in all respects a perfectly typical tetanus bacillus In view 
of this It would be unnecessary^ to detail the morpho 
logical and cultural investigations Toxigenicity was 
tested for in a series of mice Intramuscular inoculation 
of 0 25 c cm of a twenty-four-hour broth culture produced 
spasm and death in from twenty-four to forty-eight hours , 
previous injection of a similar amount .of anti tetanic 
serum invariably gave complete protection 

By agglutination tests with sera prepared against the 
nine types of Cl teiani the organism proved to belong 
to Tulloch s Type 111 , incidentally it was one of the coin- 
paiatixely uncommon Type III strains which do not agglu- 
tinate spontaneously in saline suspension Apart from the 
Tvpe VI strains (which are non-motile) this difiercnti ition 
of Cl tetani into various serological groups depends very 
largely if not entirely, on the flagellar antigens The 
heat stable ‘ O ” agglutinins of Cl Ictani have recently 
been studied by Gunnison (1937) Healed suspensions 
of our strain weie tested out against ‘O antisera of 
the nine types The results are in complete agreement 
with those obtained by Gunnison with hei Type 111 stiams 
— that is. It possessed the “ O ’ antigen common to all 
nine tvpes, but not the additional heat-stable component 
found in toxigenic strains of Types II, IV, V, and IX 
To sum up after presumably ten years in the spore form 
this strain of Cl tetani showed no difference from other 
representative strains in its morphology, cultural 
characters, toxigenicity or antigenic composition 

In view of the long time that the organism had remained 
in the tissues it was thought of interest to investigilc 
whether any antibody response had been evoked m the 
patient Unfortunately she had received several hundred 
units of anti-tetanic serum before the bacilli had been 
identified so that any investigations from tint standpoint 
were impossible However, it has been suggested that 
m tetanus an actual anti bacterial immunity may be 
developed, and in support of this Ten Brocck and Bauer 
(1923) and Condrea (1937) have demonstrated naturally 
occurring agglutinins in man and certain animals The 
patient s scrum was tested for ihe presence of ‘ H and 
O ” agglutinins against the original strain and against 



JUL\ 2 1938 


BACILLI FROM SC/^R TEN YEARS AFTER TETANLS 


The rwnsH 

>f£Z> CAi 


n 


representatives of all nine serological t\pes with com 
pleteh negative results In addition her serum was tested 
against a suspension of the original strain which had been 
a'lowed to spore verv freelj but no reaction could be 
detected either bj agglutination or bj complement fixa- 
tion technique 

Discussion 

Comparative!) carlj in the studv of the bacteriologj 
of retanus it was realized that the spores of the bacillus 
had verj great powers of resistance Thus von Eiselsberg 
(I88S) reported that a splinter of wood which had caused 
tetanus in a bo> was capable of infecting rabbits two 
)ears later and Henrijean (1891) recorded similar results 
after an interval of eleven years As regards survival 
Within the animal body opinion was much more guarded 
It IS true that Vaillard and Rouget (1892) Tarozzi (1906) 
and others had shown experimeniallv that spores might 
he dormant in the tissues for several months vet this 
Was generallv looked upon as quite exceptional and it 
was not until the war and after that a number of cases 
of tetanus were recorded in which the primary infection 
had occurred months or even vears previously 

The longest latent period about which there can be little 
doubt IS in the case reported bv Ernst (1931) in which 
tetanus developed fourteen years after the original war 
injury but intervals of seven years (Brunzel 1929) and 
four and a half vears (Kaposi 1917) are also on record 
None of these cases however are comparable with our 
case for in all of them the symptoms of tetanus developed 
first and then a possible source of previous infection was 
sought For instance in Ernst s case a wad had remamed 
embedded in the tissues of the hand for fourteen vears 
but without any svmptoms The patient then accidentallv 
crushed his hand but without breaking the skin and 
developed tetanus the spores of the organism presumablv 
having lain dormant in the wad 

In post-operative catgut tetanus examination of the 
remainder of the ligature material used and of the dis 
charge from the operation area has often failed to show 
Cl telani and it has been suggested that the condition is 
not true tetanus but in the case we now publish the 
findings show that it cerlainlv was Thev also show how 
important' it is even after the lapse of mans vears to 
take anti tetanic precautions when operating on a patient 
who has previously had tetanus 

AVe are indebted to Sir Frederick Menzies Chief Medical 
Officer London Countv Council for permission to pubhsh the 
record of the case from Hammersmith Hospital 

References 

Brunzel (1929) Quoted b> A Buzello Der It ttnditarrkranipf betm 
MenscUen 

Condrea P ei a] (1937) C R Soc Biol Paris 125 76S 

Eiselsberg A von ()8S8) It leii kltn It sclir 1 2 2 2S9 27-t 2S9 

Ernst V\ (1931) Arch Hig 106 235 

Elides P (1925) Bm J e\p Path 6 62 

Gunnison J B (1937) J Immunol 32 63 

Hennjean F (1891) Ann Soc nud chir Liege 30 367 

Kaposi H (1917) flien klin B schr 30 237 

Tarozzi G (1906) Zbl Bakt Abt I OriE„ 40 aOs 4'! 

Ten BroecL C and Bauer J H (i921) J exp Med 37 479 

Tulloch W J (1917) J R^MC 29 631 

A'aiUard L and Roucet J (1892) Ann Inst Pasieiir 6 vss 


Dr \y u Lien Teh for thirty vears in the health and medical 
services of the Chinese Government and for fifteen vears 
editor of the Sotionnl Mediiol Journal now the Chit ese 
bfedteal Journal has recenllv retired to his home in Penanc- 
He was founder of the Chinese National Xfedical Association 
m 1914 


THE RISENG LNCroE>CE OE PSICHO- 
SO’yiATIC ILLNESS 

By 

JASreS L HALLIDAl, AI D , D P H 

Restondl Medical O^icer Department of Health for 
Scodand 

TTie increase in incapacitating siwkness ib mainttnanwC 
at a high Ie\ef and the grovMh of chronic mvafid sti 
among insured persons ha\e puzzled raan\ commenia ors 
both la-N and medical Recent inquines b\ the Region-l 
Medical Staff ot the Department of Health for Scodand 
ha\e sho%\n that the mass ot chronic incap2CH\ m hat 
counir\ mav be regarded as genuine** (McKinl^v i9'7) 
In a previous srudv (1935) of the incidence ot psvcho 
neurotic illness I wToie It is mteresiing to speculate 
how tar the rise in the rate of incapacit\ among insured 
persons during the last ten \ears has been due to an 
increased prevalence ot psvchoneurotic disabiliiv Th^ 
present paper — an anaivsis of morbiditv statistics — shows 
that in the light ot modern knowledge the onh po 'b'e 
interpretation ot the maintenance ot the present high 
Sickness rates is an increase m psvchoneurotic and 
psvchosomat/c illness 

\oie on the Term Ps'\cl osomatic lllress — wo d> 
psvchoneurotic illness suggest inter aha the absence ot 
‘Structural change Recent researches, howeve- have «.howti 
that emotional reaction mav bring about change^ not onlv in 
function but abo in structure iDunbar 19 •’) A more appro 
priate tern for disorders of this nature — whether (to u e 
medical jargon) thev are “ ca es of functional di^ea e or 
cases of organic di ease — is psvcho omai c illress Thi> 
term is cumbrous but useful It connotes both an aetiolocv 
and a mechanism As regards aetiologv it indicates that the 
extemal agents which provoked the reaction of illress w*rc 
of a speaal kind being neither phvsical nor chemical nor 
micro organic but ps\choIogicaI — as tor example the loss 
of a beloved object As regards mechani m it indicates that 
the external agent is encountered bv the individual not 
directlv bv the outer or inner surfaces of the bodv suv.h -s 
the skin or mucoL membranes but mdirecih vi^ th-* sp'»'nal 
senses and the integrating mechanism of the dienceph-’on 
autonomic nervous svsiem and endoenne gUnds Tht tnad 
Is sometimes called the p-^vcho-neuro endoenre svstem o the 
bodih mechanism of emotion B\ its means p vcho^o-ical 
factors mav affect an individual profoundlv bnncing about 
change in chemistn rhvihm secretion and even slru^tu-e 
m one or mo e parts of the bodv In other words fcodth dis 
turbance*. mav be the secondanes of preceding disturbin-'Cs 
in the integrating psvcho neuro-endoenne s stem which m 
turn was set into a turmoil when the individual encountered 
events which to him repre'*ented dcpnvation frustration 
upset strain or difficultv 

Knowledge of Psvchosomatic Disorders of Statistical 
^ Relercn'e 

I THE LVBELS 

The presence of psvchosomatic illness in a communit) 
IS not revealed directlv in its morfaidit> statistics but lies 
concealed under a number of labels which with the 
exception of such terms as neurasthenia nervous debilit> 
and neurosis have a reference to localized or mechanistic 
faults onlv A knowledge ot the considerable latent 
content of psvchoneurotic and psjchosomatic illness in 
certain common diagnostic labels ** has novv become 
available as a result of recent researches Some of these 
which are relevant are indicated bt.Iow but the reader 
IS referred to the onginal papers for an adequa e 
presentation of the problem 

Gostrins Rheutra nm Ar aern u Oehili Hck-ri 
— Of un^elewlcd inM^red patie^u sufferinc fren p cbo 

neurotic illness imairU anxietv the cd C 2 u ' 

of in«:^pacil\ in app-ovimateh or-' half (1“0) w-as o-e o 
other ot those labcK The proportion of p, cho-ex o , 
iline>s for each lab-I vsas as foPo v gastn i "0 p^ ccr’ 



12 July 2, 1938 


RISING INCIDENCE OF PSYCHOSOMATIC ILLNESS 


The Hritish 
Medical Journ\l 


rheumatism, 40 per cent , anacmn, 40 per cent debilitv 
60 per cent , heart disease, 14 per cent (Halliday, 1935) 

(/)) Peptic Ulcet — OE 205 unselecled patients with peptic 
ulcer (both gastric and duodenal), in 84 per cent the symp- 
toms of ulcer first emerged at a time of emotional reaetion 
in response to psychological factors associated chiefly with 
occiipaiipn finance and family health The mechanism in 
volved was considered to be the psycho-neuro cndociine 
system The authors concluded that the crux of treatment 
was to free (he patient from his anxiety, and if this could 
be achieved they believed that the patients dyspepsia would 
tiouble him no more (Davies and Wilson 1937) 

(c) Chi owe Rhcuiiiatisiii — Among insured persons the 
various teims which indicate “non arthritic iheumitism" fre- 
quently cover anxiety states or hvsteria with or without the 
presence of ' rheumatoid’ swellings of joints (Halliday, 1937, 
1938) The need for considering psychological factors for an 
understanding of aetiology and as a guide to scientific treat- 
ment of clinically defined rheumatoid arthritis and osteo 
arthritis has been demonstiated by American observers, such 
as Jelhffe and White (1935, 1936), Nissen (1936), and Booth 
(1937) 

(d) Chronic Bionchitis — “It is little known to practitioners 
that there exist purely psychogenic forms of bronchitis ’’ 
(Stekel, 1923) This author summarizes many examples No 
systematic investigation of the relation of psychological factors 
to the primary onset and recurrences of chrome bronchitis 
appears to have been made Among insured persons 1 have 
noted that male patients with chronic bronchitis who arc 
enmeshed m a ‘ pension situation ” for this disability arc often 
better understood when regarded as examples of anxiety 
hysteria with secretory neurosis of the bronchi I have also 
noted that persons may work for years in a dusty atmosphere 
but only become ill|\vith bronchitis on encountering psycho 
logical factors and reacting with emotion This also applies 
to many persons whose occupation in no way involves fumes, 
gas or dust Another interesting point is the not uncommon 
alternation of bronchitis and rheumatism in the same patient 
— that is to. say, when the bronchitis is troublesome the 
rheumatism is quiescent , when the rheumatism is trouble- 
some the bronchitis is quiescent A similar alternation ot 
peptic ulcer and rheumatism is not uncommon A number 
of authors — for example, McDovvall (1934) — have noted 
how patients with chronic bronchitis may be cured by psycho- 
therapy, qnd in my own limited therapeutic experience 1 have 
seen some interesting impiovemcnts after the patient has 
‘coughed It up' or ‘got it oil his chest" The application 
of the psychological approach to chronic bronchitis is a Virgin 
field for research There is evidence however, that recurring 
or chronic bronchitis is sometimes a localized manifestation 
of psychosomatic disorder, but in what proportion of the 
patients thus labelled wc do not yet know 

This seclion is not intended in any way to suggest that 
“ every person with rheumatism, bronchitis, gastritis, etc , 
IS a case of psychoneurosis ” Its purpose is to indicate 
that a proportion of patients whose illness is certified 
to be “ cavised ” by certain common labels of disease arc 
suffering from disorders which are psychosomatic m origin 
and nature ,.This applies not only to labels which arc 
often used in a vague sense — for example, anaemia — 
but also to labels correctly applied — peptic ulcer, 
bronchitis, fibrositis, etc r 

2 THE AGE INCIDENCI 

Statistics of age and sex incidence arc few and in- 
complete, but all available evidence points to_ the age 
incidence of primary onset of the symptoms being highest 
m the younger age groups or m early middle life The 
lollowmg ex imples may be quoted 

In my inquiry of 1935 the incidence of psychoncurotic dis- 
abihtv among the patients examined was the same for each 
sex As regards age, the incidence (for the combined sexes) 
vv IS highest in the xoungest age groups Thus the incidence 
in the age groups 16-34 was 33 per cent , in the age group 
3S'S4 42 per cent but in the age group 55-65 it xvas only 
14 per cent 

Bruce Pearson (1938) in an analysis of 950 linscicctcd out- 
patients at a general hospital found that the incidence of 
psvchoncurotic illness among the patients examined xvas 
highest in fcmiles As regards age (for the sexes combined) 
tile incidence in the igc group under 29 was 22 per cent in 
the age group 30 49 19 per cent and in the age group over 
50 onlv 5 5 per cent 


In their senes of 205 patients with peptic ulcer D ivies and 
Wilson (1937) found that the age distribution of onset for the 
sexes combined was as follows under 35 vears, 60 per cent 
35-55 vcirs, 33 per cent over 55 years, 7 per cent ' 

In a senes (unpublished) of 134 consccuttvc referred insured 
persons certified to be incapacit iled because of terms indiea 
five of rheumatism, the age incidence ot psychosomatic rheum 
alism m the age group under 35 was 45 8 per cent in the 
age group under 55, 41 8 per cent , and in the age group over 
55 only' 14 3 per cent 

In a senes of 450 piticnts with rheumatoid arthritis Glover 
(1928) compiled a table which shows lint for males the age 
distribution of onset is highest m the group 30-40 years, and 
foi the females m the gioup 20-30 years 

It is perhaps of inteiest to note that these age distributions 
<are comparable to those found for the onset of asthnii in 
adults (Brav 1934) and for nystigmus in miners (M R (2 
licpoit, 1922) 

3 DURATION IS III LATION TO RECOGNITION AND TRTATMCNT 

If the need for supplementing the ordinary cxaininn- 
lion of the teaching schools with an investigation into 
psychological factors is not understood, the range of 
clinical observations is loo narrow and adequate remedial 
measures appropriate to each individual cannot be taken 
In such circumstances the doctor ins rcgird only for the 
“ secondaries,” and treatment is confined to stanclardized 
mechanistic and local interference However, m so far 
as this action ignores primary causes it may be incficclivc 
in preventing rcctiiicncc and in cutting short incapacity 
Further, because of the features of innocence md 
increased suggestibility which are present in all paticn s 
with psychosomatic disoider, routine continuation ot 
mechanistic treatment may succeed m fixing the symptoms 
for life (Examples of such procedures arc percniml 
alkaline powders for peptic ulcer, course upon course 
of physiotherapy for rheumatism, or successive nasal 
operations for bronchitis ) The risk of fixation is m 
cieascd whenever treatment becomes very intensive, very 
elaborate, or very impersonal, and todiy, when cvci 
growing facilities arc available for mechanistic diagnosis 
and therapy, there is a danger, if relevant considerations 
are omitted, of inducing “ fixation invalidism ” on a scale 
hitherto unknown 

The Indices of an Upward Trend in Psyeliosomatic Iliac s 

From the information surveyed in the previous section 
it would be reasonable to infer an upward trend in 
psychosomatic illness (relative to illness with ictiology 
dependent on other environmental factors) if, over t 
period of years, morbidity statistics showed changes in 
three respects, namely 

1 An increase m the average duration of “jncipa 
cities ” 

N^otc — Increasing ficililics for intensive mcchinistic treat 
ment provide only one of the ni my factors winch may 
contribute to the prolongation of sickness 

2 An increase in the certificated causes known to 
cov'er psychosomatic illness 

3 These increases would be most marked in the 
younger age groups 

The Application to Morbidity Statistics 

Note — Statistics ot morbidity arc not common In Scot 
land, since 1930 the Department of Health his issued Anniid 
Reports on Incapacitating Sickness in the Insured Popnlition 
These statistics deal mainly with the incapacit iting lilncs'cs 
which begin and end within each annual pciiod under review 
A valuable survev of these statistics w.is recently made by 
Mckinliy (1937), who, from the standpoint of a sf ilislician, 
sums them up as follows 

The major problems, from the point of numbers ‘CLni 
to be at least six (1) droplet infections (int hming 
mfiucnzi) , (2) accidents md sepsis of the skin (3) rlicum 
itism especially m its chronic forms (4) gistric upsets 
of sarious kinds (5) chronic respiratory m o’f'' 
(bronchitis) , and (6) those ill defined si ties of ill hcalin 



JULI 2 193S 


RISING INCIDENCE OF PSYCHOSOMATIC ILLNE^SS TmTsim.u 13 

Mioical Jo ■*s»t 


which constitute the bulk of cases labelled debilit> neur 
asthenia DAH and lachscardia and perhaps in less 
degree anaemia 

He adds'^ that the disergence of these illnesses from those 
found in statistics of mortalitj is verv striking 

1 INCRESSING ASERSGE DURATION OF INCAPACITT 

The most significant feature of sickness among insured 
persons has been its rise o\er the past twentj jears For 
example in England and Wales the rate of sickness during 
the Jears 1921 to 1926 rose bj nearlj 50 per cent and 
that of disablement bj nearlj 80 per cent These have since 
continued at a high level Turning to the more detailed 
data available for Scotland since 1930 we find (Report 
No 6 1937) that, although there has been no definite 
increase in the incidence of ‘ incapacities (onlj 2 3 
per cent), there has been a verj definite increase in their 
aierage duration (about II per cent) Moreover 
during these jears the number of ‘ chronic patients 
(that IS those who were on the sick list continuouslj 
throughout the annual period) increased bj one third 
Indeed of the nineteen million dajs of incapacitj m 
1935-6 more than half (eleven million dajs) is attributable 
to a sickness of a j'ear or more duration 

2 THE RISE MOST MARRED IN CERTIFICATED CAUSES WHICH 
COVET PSVCHOSOVIATTC REACTION 

The table illustrates the growth of chronic incapaci- 
tating sickness between the annual periods 1931-2 and 


Table shonme Chrome Incapacin in Scotland (1931-2 to 
1933-6) 


A 

B 

C 

D 


Percentage Increase 
(1931-2 to 1935-6) 

Regiiter 

Order of 

• 

of Patients at 


(1936) 

Ab olulc 

Ceaihcated Cause 

Various Ace Groups 

Percentage 

Rise 






Constitu 

(1931-6) 






tion 



AIT Ages 

16-34 

35-54 

SS-Ss 



Pepiic ulcer 

130-140 

126 

I6S 

92 

1 9 

7 

Gastn((5. 

110-120 

121 

139 

65 

1 9 

a 

Nervous defcibty 

90-100 

154 

96 

53 

ZO 

9 

Bronchnts 

70-80 

166 

136 

31 

79 

4 

Anaemia 


90 

79 

59 

IJ 

13 

Rheumatism 

50-60 

85 

90 

31 

12.6 

I 

Cardiac debility 


95 

112 

54 

1 4 

13 

Diseases of the circu 


78 

ss 

35 

II 4 

2 

tion 







Other diseases of the 


76 

78 

35 

39 

6 

respiratory sjsiem 
Neurasthenia 

30-40 

74 

46 

12 

3 5 

10 

Injuries 


51 

37 

28 

34 

ft 

Insanity 

20-30 

60 

31 

I 

21 2 

3 

Tuberculosis 


42 

IS 

2 

n 2 

5 

Cerebral haemorrhage 


84 

61 

5 

24 

14 






86 0 



So/r — In 1930 cefi3/n dewili about insured persons m Scotland who became 
ill and unfit for work, began to be colJccted and anal>sed (See Reports on 
Incapacnating Sickness m the lasured Population of Scotland 1931-7 ) A 
special register was de%oted to those persons who had been on the sick Ii t 
continuously for more than twelve months. The table is comptl d from this 
Chronic Register and is adapted from data provided in Report No 6. 
pages 39 to 52 Column A shows the fourteen certificated causes of 
incapacit> which provided the greatest incrcave*in the number of patients 
between 1931 and 1936 Column B shows the percentage nsc in respect of 
each cause at various age groups Column C shows the percentae.® constitution 
of the Chrome Register m J936 and indn-ates that those fourteen causes 
provided 86 per cent of the total register Column D indicates the order of 
absolute increase in th- number of persons allotted to each of the cenificaied 
cau^ fir example against rheumati m which provided the highest increase 
— nameli 1 500 persons — is pla-ed th* number 1 »h reas against cer brat 
haemorrhage which provided an increase of onl> I'O persons ts paced the 
number 14 

1935-6 In Column A are shown the principal certificated 
causes of chronic illness arranged in order of relative 
increase Those specified account for S6 per cent of 


(he patients on the chronic register Bv placing a tick 
opposite the terms which cover psvchosomalic illness we 
find nine of the fourteen certificated causes specified m 
Column A to be our old friends 

5 THE RISE IS THE VOLNGER AGE CTOLPS 

Column B shows the percentage increase in the certifi 
cated causes at various age groups The highest rate of 
increase for all ages is shown bj peptic ulcer and 
gastritis Next in order of rate of increase are nervous 
debihtj bronchitis anaemia rheumatism and cardiac 
debilitj If we underline the age group which shows the 
maximum rise in each certificated cause we find in age 
group 16-34 the highest nse was in respect of ner-ous 
debilitv bronchitis anaemia, and neurasthenia v hereas 
for age group 35-54 the highest rise was in respect of 
peptic ulcer gastritis rheumatism cardiac dcbililj and 
diseases of the circulation In no instance was the par 
centage increase greatest in the oldest age group Tlie 
finding that the increase in such illnesses as rheumatism 
and bronchitis is not in the older age group will surprise 
onlv those who have not appreciated the influence ot 
Psvchological factors as a cause of illness 

Aole — Chronic illness is still relativelv more frequent in 
(he old than in the vounc and the tendenev towards .n 
increasing proportion of older people in the population would 
tend other things being equal towards an increa e in chronii. 
sickness but within the ages under consideration this factor 
offers at best onlv a small part of the explaralion 
(McKinlav I9 j7) 

The fable contains manv other points of interest For 
example one fifth of all chronic illness is due to insanilv 
and the rise in this during the last five jears is most 
marked m the joungest age group Again rheumatism 
(see Column D) shows the greatest absolute increase in 
the number of patients Also the rise of cerebral 
haemorrhage in the jounger age groups is an interesting 
phenomenon 

Findings from the Anaivsis 

On analjsis of chronic sickness returns during recent 
jears vve find the three indices which m combination 
reveal an upward trend m psvchosomalic illness — namelv 
(1) increasing duration of incapacitj f2) increase in the 
labels known to cover a significant proportion of psvcho 
somatic illness and f3) the jounger age groups most 
affected It is therefore reasonable to conclude that 
Psjchosomatic illness is becoming more prevalent and 
that the maintenance of the high rales of morbiditv at 
present existing in the communitj can onlj so be under 
stood No other interpretation covers all the I nov n 
facts 

Aoie — It IS misleading and even erroneous to regard 
illnesses of this nature as “nervous diseases It is more 
appropriate to desenbe them when v e are thinking 
or speaking in terms of mechanism as diseases of ihe 
psvcho neuro endoenne svsiem" Certain writers however 
would describe them as illnesses of the spirit or sicknesses of 
the soul In ans case to state that nervous diseases are 
increasing misses the whole point of the phenomenon 

Discussion 

(a) A high level of incapacitating sickness dependent 
on psAchoneurotic and psAchosomatic disorders is not 
incompatible with concomitant happenings such as a 
falling death rale increasing height and weight of school 
children and t(ie abevance of major epidemics These 
occurrences— the usualls accepted indices of improsenient 
in the public health— have been achieved bv .ction 
directed mainlj towards the noxious phvsical chemical 
and micro organic factors of environment Ps cho 
somatic illness on the other hand maj be rega'ded s 
a response to noxious psjchological factors of c- irm 
ment The potenev and practical implications of ib'-s. 
however have hitherto received little svscma'ic -t -Ti n 
in so far as thev affect the health oi the commumi s 
a whole and as a result psvchosomalic illn-ss progre-ss s 


14 July 2, 1938 


RISING INCIDENCE OF PSYCHOSOMATIC ILLNESS 


TiicURtTisn 
Medical Jours a 


Without check and even with unwitting encouragement 
A discussion of the “causes” of a high incidence of 
psychosomatic illness does not, however, enter into the 
scope of this paper, the aim of which is to point out the 
phenomenon and to indicate that it is a matter which 
concerns all medical men 

(b) A few remarks may be devoted to the problem of 
preventing incapacity once this type of reaction has 
occurred To avoid confusion, it may be said at once 
that only a minority of these patients require specialist 
psychotherapeutic treatment The great majority can 
be handled, as they are to-day, by the practitioner — but 
with a difference The first requirement is the recog- 
nition that there is a problem The second is an altera- 
tion in thought — an appreciation that illness is a reaction 
to environment in all its aspects, ‘including the psycho- 
logical In other words, curative medicine can no longer 
be contented as at present with the academic question, 
“ What has the patient got‘> ” — because the answers to 
this question — no matter how accurate and detailed — 
may in isolation be irrelevant as a proper guide to 
scientific and effective action A guidance which is often 
more valid and pertinent may be obtained by posing 
the natural questions of biology — for example, ‘ Why did 
he take ill when he did? ” , “ What is he behaving like 
this for”? ” To know what a patient has met, or feels 
he may meet, is often of more practical value than to 
know what a patient has got The third requirement is 
an alteration m action — namely, the inclusion in practice 
of what may be called the modern supplement to medical, 
examination, especially when the patient first consults 
the doctor In the absence of this, much incapacity 
preventable at the beginning becomes prolonged and 
permanent I have noted that practitioners .who examine 
their patients m this more adequate way do not tend 
to produce invalids in their practice, whereas those who 
are unaware of it, or who neglect it, tend to induce or 
even create incapacity This observation, which refers 
to civilian practice, may be collated with the observations 
of others which refer to service practice during the great 
war For example, “ At all times the most important single 
influence determining the ratio of war neurosis was that of 
the regimental medical officer ” (Mapother, 1936) And 
again, “Correct handling of patients in the early stage -is 
likely to make all the difference between rapid recovery 
and chronic invalidism The first link in the chain is the 
unit medical officer He alone has the power to supply 
relevant information concerning the causes of breakdown 
in each case He should have sufficient psychological 
knowledge to make an early diagnosis ” (Burton, 1936) 

(t) Certain of my medical friends have suggested that 
if this interpretation of the facts be true, it is a grave 
reflection on the medical profession Actually, however, 
there is no reflection, and morals are not concerned 
Neither is there any criticism Historical observation has 
shown that the slow percolation of a new scientific out- 
look is a natural and predictable hapjjemng Instead of 
studying the data and the inferences made from them 
with attention and clear-headed thinking, people respond 
with emotion, the reactions being characterized on the one 
hand by intense enthusiasm and on the other hand by 
indifference (the * blind spot ”) or even open resentment 
When we react emotionally we exhibit the feature of 
inereased suggestibility Thus, if we become emotionally 
excited about any theory, our perception and judgment 
become distorted — we see what we want to see and infer 
what we want to infer On the other hand if we resent 
the introduction of a new technique into medicine (as 
our grandfathers resented the bacteriological and some 
doctors of to-da\ resent the psychological), our emotional 
state prevents us from seeing what we do not want to see 
and inferring what we do not want to infer 

‘ The influence of emotion on reasoning is consider- 
able when the question is one affecting either the interests 
of an indnidtial or some theory deeply rooted m his 
prejudices Darwin recounts that one of his geological 


friends tried to assure him, against all evidence, that a 
certain fossil was not found in a given locality, for other- 
wise his argument (the geologist’s) on the geology of the 
neighbourhood would be wrong , four of his voluniis 
would go for nothing This incident made a great im- 
pression on Darwins mind It showed him that the 
pursuit of truth demanded qualities of courage and will, 
1912 )** than those of the intellect ” (Quoted from Lynch’ 

However, the reluctance of the profession to adopt a 
psychological outlook cannot be dissociated from the 
growth of unorthodox cults which continue to flourish 
and impress in fields where orthodox medicine often fails 
Moreover, within the medical profession itself, lack of 
instruction in how to think about illness in an adequate 
way IS responsible for many “ good men going wrong ” 
when, discouraged by their failure to get permanent results 
by standardized mechanistic methods, they begin to adopt 
freakish methods of treatment which have no real 
scientific foundation It is true that they may obtain 
“ results,” but to the detached observer their successes 
are very obviously a function of their personality on the 
one hand or of the magical aspects of their treatment on 
the other 

id) Lastly, it is interesting to speculate whether, 
ceteris panbiis, a still further extension of mechanistic 
forms of treatment provided to all comers in the absence 
of a “ threshold ” examination whieh includes the modern 
supplement will result in a still further inerease in the 
dination of invalidism Time and the yard stick of 
morbidity statistics will show As McKinlay neatly puts 
it “ The efficiency of a service must ultimately be judged 
by the standard of health of the people rather than by the 
nature and amount of the facilities available for its 
preservation ” 

Conclusions • 

1 An analysis of Scottish morbidity statistics m the 
light of modern knowledge reveals a rising incidence of 
psychoneurotic and psychosomatic illness 

2 The extent and significance of this phenomenon arc 
not yet generally realized, but it has definite bearings on 
(he public health as well as on the future of medicine — in 
outlook, training, research, treatment, and prevention 

For assistance m the presentation of this study I am 
indebted to my colleague Dr P L McKinlay, Medical 
Statistician to the Department of Health for Scotland 

Refercnces 

Booth, G C (1937) } iien meiit Dts 85, 637 

Bray, G \V (1934) Recent Ad\anccs in Allergy 2nd cd , p 193, 
J and A Churchill, London 
Burton, H L (1936) Proc roy Soc Mul 29, 865 
Davies D T, and Wilson, A T M (1937) Lancet 2 1353 
Dunbar H F (193S) Emotion anil Bodily Clinngis, Columbia 
University Press New York 

Glover, J A (1928) Ministry of Health Report on Chronic 
Arthritis No 52, p 17 London 

Halliday, J L (1935) British Medical Joiirnal (Siipitlcmciit), 1, 
8S, 99 

(1937) Biitish Medical Journal 1, 213, 264 

(1938) Proc roy Soc Med 31, No 1, 167 

JcllilTc, S E, and White, W A (1935) Diseases of the Ncnoiis 
System 6th cd , p 245, Philadelphia 

(1936) Amu J Psycliial 92, 1051 

Lynch, A IJ (1912) Psychology 1, p 363, Stephen, Swift ind 
Co , London 

McDovvall, R J S (1934) Scienct of Signs and Symptoms 3rd 
cd , p 250, Heinemann London 
McKinlay P L (1937) J roy san Inst 58 374 
Mapother E (1936) Proc ro\ Soc Med 29, 8S8 
Medical Research Council Report of the Miners Nystagmus Com 
mittcc (1922) No 6S, 1, S2 London 
Nissen, H A (1936) New Eng J Med 214, 576 
Pearson, R S Bruce (1938) Lancet 1, 4S1 
Report on Incapacitaiing Sickness in Scotland, No 6 (1937), 
Edinburgh 

Stekef, W' (1923) Comhttons of Ncnoiis Anue/y ami thar 
Trcaimuit p 56 Kegan Paul London 



JLrL\ I ^lyjcS 


SEASONAL INCIDENCE OF RHEUMATIC FEVER 


Th£ B*miH 
\f£D C<1. Jo 




SEASONAL INCIDENCE OF RHEUMATIC 
FEVER IN THIS COUNTRY 

BY 

ARNOLD B ROWLA.NDS, M B , Ch B 

The stud> of the seasonal fluctuations of infectious diseases 
in this countrj reseals the evistence of two characteristic 
t}pes 

1 The Solstice Type — This t>pe dominated bj the 
prevailing temperature includes certain respiratorj and 
alinientarv infections which we associate respectivelj with 
the winter and summer solstices 

2 The Equinox Type — Measles and whooping cough 
usuallj show a conspicuous increase at the vernal equinox 
while the autumnal equinox is associated with an increase 
of throat infections diphtheria scarlet fever and rheum 
atlc fever 

Though this classification has severe limitations it has 
the merit of simphcitj Further — and this is the reason 
for iis presence here — it emphasizes a contrast between the 
conditions prevailing at the two equinoxes It is much 
easier to appreciate the nature of this contrast than to 
slate directlj what is the characteristic feature of the 
autumnal equinox First in respect to negative evidence 
there is no significant difference between the temperature 
and the relative humiditj at the two equinoxes What, 
then IS the nature of this contrast’ 

Djnamic Change 

The answer to this little riddle is to be found in 
dvnamics rather than statics The seasonal variation of 
temperature is determined b> the obliquitv of the ecliptic 
which effects a periodic variation of the angle of elevation 
of the suns ra>s At an> one place this angle is of 
course equal at both equinoxes However during the 
weeks in immediate relation to the equmoxes the angle 
js changing ver>^ quicklv Thus the angle increases 
rapidlj in the spring and decreases in like manner 
in the autumn It is this rapiditj of change in opposite 
directions vvhich supplies the fundamental difference 
between the equinoxes We have not onlj a contrast but 
a significant reciprocal relationship between the two 
periods of the jear when climatic accelerations and 
decelerations are at their height 

The Rate of Change of Temperature 

Graphs 1 and 2 illustrate our point Graph 1 portrajs 
the average seasonal variation of temperature at Green 
vvich Graph 2 deduced from the former represents the 
rate of change of temperature and shows clearlv the 
contrast between the equinoxes Despite man> secondarv 
climatic factors' the changes of temperature are still 
dominated bv the theoretical solar climate The most 
important deviation from our standpoint is the lag in the 
earths response to changes in the suns elevation Thus 
ihe most rapid changes of temperature are post 
equinoctial phenomena 

Rate of Change of Relative Humiditv 

\\ e are aware of an approximate inverse relation 
beiut.en the changes of temperature and ^elall^c humiditv 
til ihrs counirj (Graphs I and 3) can therefore 

anticipate a close inverse association between their respec 
tive acceleration^ (see Graphs 2 and 4) Let us summarize 


Graphs sho^^ing the Seasor al Incidence of Rheumatic Fe\‘^r 
and Its Association n/z/i CUmatic Factors 



GR-aphs I-** — Seasonal Incidence of Rheumaiic Fever 


Graphs 1 and ^ illustrate respect vel> the seasonal vana 
(ions of temperature and relative hunudiiv at Greenvsith 
Graphs 2 and 4 deduced from Graphs t and ^ sho’* th* 
ratei> of change of temperature and relative humiditv at Green 
wich Graphs 2 and 4 are merelv an etpre^sion of the ^teep 
ness of the more familiar Graph> 1 and “t 
Graph ^ illustrates the beavonal madeOwe of rhcumati 
fever in London 

these vieus m the simplest possible form reletant to our 
subject We ma\ sa\ that in London September and 
October are characterized bv a deceleration of temperature 
and an acceleration of relative humidity 


Seasonal Incidence of Rheumatic revor 


Graph 5 is based on the onset of svmptoms in nearl> 
I 500 first attacks of rheumatic fever (St Bartholomt-w 
Hospital IS82-I904) This graph shows a striking re 
semblance to the preceding graphs (2 and 4) Siudv of 
these graphs suggests a promise of close correlations This 
promise is realized 


Rate of change of 
Temperature 

Rate of change of 
Relative Humiditv 


^ and 
^ and 


onal variation of \ _ 
Rh umaiic Fc\e'-J 

Seavona’ vanation of\ 
Rheufiutf* Fevc 


-0 S6 
~0 S> 


(In the te\l I have refrained from including the maihc 
matical probable error as this mav lead to a falst. idea 
of accuraev The rate of change of lemperaiure fo' each 
month has been derived graphicallv from the rate of 
change between individual months This leads to an error 
in draughtsmanship Thus the total error is p-objbl in 
the neighbourhood of — 10 per cent ) 

There can be no doubt that in this counirv the c a 
significant correlation between the <;.asona! variations of 
rheumatic fever and the rates of change of icmp^ aa c 
and relative humiditv fs there anv c_us«ii c ’'Lh lon hip 
between these cUmaUc acceLrauonb ani the on -t of 
rheumatic fever‘d 




16 July 2, 193S 


SEASONAL INCIDENCE OF RHEUMATIC FEVER 


TiicBRmsn 
AlEDIC^L JoURKAt 


Chnnte and Rlieumatic Fe>cr 

In this country there are two well-established associa- 
tions between climate and the incidence of rheumatic 
fever 

1 Sir Arthur Newsholme (1935) has clearlv demon- 
strated that the incidence of rheumatic fever is highest in 
/lot dry years 

2 Damp cold has been implicated by numerous workers 
(Poynton and Schlesinger, 1937) 

At first glance these associations appeal to be mulu dly 
antagonistic Fortunately this paradox is apparent lather 
than real It will be appreciated that the maximum 
seasonal incidence ot rheumatic fever does not occur in 
the hottest and driest months , neither does it occur in the 
damp cold of winter It is to be found between the two, 
when the hot dry conditions of summer are changing most 
rapidly to the damp cold of winter 

If we regard hot dry and cold damp conditions as two 
extremes, then the rate of change between the two will 
be accentuated by an increase ot one or both of these 
factors It would therefore appear that, while hor dry 
conditions predispose to the onset of rheumatic fever, it* 
IS the rate of change to damp cold which acts as the 
precipitating climatic factor 


Clinical Memoranda , 


Treatment of Schizophrenia 

Since Sakcl (1935) introduced his method for the treatment 
of schizophrenia by the induction of hvpoglicaemic 
‘ shocks ’ a wave of optimism has spread among psychia- 
trists of almost every country in the world, and insulin 
therapy m its different sphere is rivalling in popularity 
the malarial treatment of general paralysis 
The Vienna technique has been practised at the Hatton 
Mental Hospital since June, 1937, and fifty nine cases of 
schizophrenia have completed a course of treatment com- 
prising fifty or more shocks, unless cuie was established 
with a smaller number In order to get the results of 
treatment in their proper perspective we have inquired 
closely into the results obtained in cases of schizophrenia 
during the years 1931 to 1935 inclusive, with TAB 
vaccine with somnifaine prolonged narcosis, and finally 
with no special treatment beyond ordinary nursing care 
and the psychotherapy ot friendly interest We have 
collected the after-histories of these schizophrenics up to 
the present, but here we are only concerned with the 
results achieved during their first year after admission 


Conclusion 

In view of the presence of significant correlations and 
a happy reconciliation with current ideas on climate, I 
submit that one of the factors controlling the seasonal 
incidence of rheumatic fever in this country is the 
reciprocal acceleration of temperature and relative 
humidity 

I wish to express my indebtedness to Professor P C Cloike 
of Birmingham, without whose inspiration and kindlv encour- 
agement this investigation would not have been undertaken 

Referexces 

Church, W S (1906) Allbutt and Rollebton s Siitcm oj ^Icdicntc, 
2, 594 

Nc-Wsholme, Sir Arthur (I'lSS) Fifl) J ears in Piibln. Health 
London 

Pojnton, F J and Schlesinger B (1937) Rcctnt 4tl\anccs in 
the Study of Rheumatism London 


At the annual general meeting of the Society for Relief of 
Widow's and Orphans of Medical Men, with Mr V Warren 
Low, president, in the chair, the report for 1937 and the 
financial statement were presented and adopted During 1937 
sixty-one widows and seven orphans were in receipt of grants 
and the total amount distributed was £4,702 Owing to the 
increase of the number of widows in receipt of grants there 
were not sufficient funds available to make them the usual 
Christmas present, but each orphan received a present of £5 
The receipts for the vear amounted to £5 390, including 
£367 18s lid from subscriptions and donations The total 
membership of the societv is 285 which is a verj small 
proportion of the medical men eligible for membership 
Relief IS only granted to necessitous widows and orphans of 
deceased members Membership is open to anv registered 
medical man who at the time of his election is residing 
within a twentv mile radius of Charing Cross Each widow 
receives a grant of between £60 and £75 per annum, and 
the orphans £50 per annum Anv wadovv with an income 
of £125 or under is eligible to receive a grant The directors 
arc anxious to bring the great advantages of membership of 
the socieiv to the notice of medical men The invested 
c'’pita! which amounts to over £140 000, mav not be used as 
income, onlv the interest is available for this purpose This 
vear the societj celebrates the one mindrcd and fiflielh 
anmversarv of its foundation Full particulars mav be obtained 
from the secreiarv at the office of the societv, 11, Chandos 
Stre^, '^Cavendish Square, W1 


Tnb/e shonnig hiinicdiate Results in Treatment of 
Schizophrenia 



No 

of 

Cases 

Ctscs 

Discharged 

Aver 

ate 

Slay 

m 

Hos 

pital 

A>cr 

age 

Age 

Rchpses 
in One 
Year 

Final 

/ 

/ 

No 


Sjmptoms 0-t year 

- 





- 


Treatment— 




Mills 

Years 



Insulin 

18 

18 

100 0 

4 5 

22 8 

2 

S3 8 

TA B 

49 

40 

81 6 

73 

23 7 

3 

769 

Somnifamc 

6 

3 

SOO 

47 

25 2 

1 

33 3 

None 

26 

22 

84 6 

88 

23 7 

2 

76 9 

Sjmploms J-I jear 








T/tTlmcnt — 








Insulm 

12 

9 

75 0 

5 3 

21 9 

0 

75 0 

TAB 

16 

13 

81 2 

99* 

23 6 

3 

62 5 

None 1 

9 

6 

66 7 

85 

24 6 


66 7 

S>mptoms 1~2 >cars 








Trcilmcnt — 








Insulm 

10 

5 

50 0 

4 5 

24 2 

1 

40 0 

TAB 

22 

12 

1 54 5 

I 89 

23 9 

6 

27 3 

None 

9 

6 

66 7 

8 1 

24 2 

'0 

66 7 

Sj mptoms ON cr 2 > ca rs 








Treatment — 








Insulin 

10 

3 

30 0 

30 

25 1 

0 

30 0 

TAB 

17 

6 

35 3 

150 

25 8 

I 

29 4 

None 

4 

3 

75 0 

40 

25 0 

I 

50 0 

Second Attacks 








Treatment— 








Insulm 

9 

4 

44 4 

35 

25 I 

0 

44 4 

TAB 

16 

7 

43 7 

73 

24 7 

3 

2‘:0 

Somnifamc 

6 

4 

66 7 

72 

23 0 

2 

33 3 

None 

32 

15 

46 9 

57 

255 

7 

25 0 


• Excluding one case in hospilal for 45 jears If tins case is included [he 
average stay m hospnal becomes 13 1 months OC all cases in this lahlc the 
immediate discliargc^ Tre for m?uhn 66 I / for TAD yaccinc CS for no 
treatment ^5 and for somnifamc narcosis 3/, 



JuL\ 2 J9^S 


CLINICAL MEMORANDA 


Although the berieb li small it has the ad\antage that 
almost e\er\ patient was well known to one of us 
(D N P ) and the diagnostic criteria are therefore essen 
tiallv the same in each group The effects obserted are 
summarized in the table 

It will be seen that the superioritj of insulin is onij 
slight when the percentage of discharges is considered and 
careful studj of these cases has convinced us that this is 
a genuine comparison James (I93S) has pointed out 
the great reduction m the period of residence m hospital 
and this is the chief advantage of insulin for the period 
in hospital is roughlj halved and clinically it is striking 
to see the rapid improvement which often takes place 
and which is apt to generate an exaggerated idea of the 
value of this form of therapy In everv group of insulin 
results in the table the hospital period is short and as a 
general rule it can be stated that if treatment is going to 
be successful this will soon be apparent 

With TAB vaccine as it has been used here no patient s 
life has been in danger but one insulin patient died and 
several have Jiad close calls This is an important feature 
when one is deciding whether the results of insulin therapy 
justifv the difficulties it incurs The results of T A B 
treatment would appear from the table to be worse than 
those obtained without special treatment but this is 
largely explained bv the frequent use of T A B when 
progress vyas delayed and we believe that this treatment 
was in most cases a mere incident of no great importance 

SUMVIARY 

Our conclusions about insulin therapv at present are 

1 The period m hospital is roughly halved 

2 There is a slight superioritv in the percentage of cures 
when compared with other methods 

3 These advantages justify its continued use 

S W Gillvian MRCS LRCP 

Asbistanl Medical Officer 
D N PvRnTT MD MR CP DPM 

Medical Supenntendent 

Coventry and Wanvickshire Mental Hospital 

References 

James G V\ B Freudenberg R and Cannon A T (19 S) 
Proc ro\ Sac Med 31 57S 

Sake! M (193S) Aei/e Behandhinssmethode der Schi^ophrente 
Vienna 

Massive Hj dronephrosis and Pregnancj 

The following case is considered worth reporting 
because of its rarity 

C\SE HISTOR\ 

A pnmipara aged 23 was seen on September 17 1937 
as an abnormal case at Dulwich LCC Hospital on account 
of the great discrepuncv between the apparent size of the 
uterus and the duration ol amenorrhoea Her last menstrual 
period began on March 17 1Q37 and twent\ six weeks later 
the abdominal swelling had extended up to the diaphragm 
and rendered the abdominal wtiII tense Otherwise the case 
was obstetncalU normal The pelvis was commodious the 
Wassermann reaction was negative and there were no signs 
of toxaemia The patient had felt foetal movements lor 
-SIX weeks onl\ No foetal parts could be felt and the foetal 
heart was not heard 

A radiograph was taken and the report read One foetus 
of about Iweniv eight v eel s l\ing m the richt hac fossa 
the head being uppermost presum ibh a case of hvdramnios 

The. patient was admitted for paracentesis abdominis in 
the hope that the nresence of urea m the fluid ivould confirm 
the radiological diagnosis and exclude the alternative one of 
ovarTan evst Urea was present but in a concentration of 
0 75 per cent which could not be regarded as indicative 


THEBsmni I" 
Med ca^ 


of hvdramnios for it is about double the concenlratioa or 
urea in normal liquor amnn Moreover the abdominal ira s 
presented a firmer con istencv m the nght iliac foi^ than 
elsewhere The patient was m excellent h^lth and anxiOL 
to have a child The distension was o enomous 
premature labour was considered inevitable A.5 the diacno 
of hvdramnios was doubtful the decision \%as made i & 
full explanation to the patient to explore the abdomen 
were almost certain that the case was not one hvdramic 
but at the same time could not under land whv a evst sho->lu 
contain so high a concentration of urea The true diagno i 
never occurred to us 

0PER.VT10N 

The abdomen was opened under general an-e the o 
September 30 1937 A ten e evst was found reuchin« rrom 
the diaphragm down to the pelvic fioo' The ute'-U'v v as 
identified m the nght iliac fo sa with the (.v t overKing it 
above and in front The intact tumour v .is qu te ur 
manageable so it was tapped and iwenlv five pints c'-^-r 
greenish fluid withdrawn The evst wall then Lv fold upon 
fold m the abdomen like a collap ed balloon O’-eti I 
examination of the e folds showed that the transve-^e jpJ 
descending parts of the colon were do elv applied to that 
portion of the evst wall which had occupied the nght de 
of the abdomen It was then realized that the evst waN a 
colossal left hv dronephrosis Pentoneum to the left ot tl e 
colon was stnpped up and the whole wall separated bv blurt 
dissection in the space corresponding with the pen enal ta ^la 
This led to isolation of the renal pedicle the ves els of which 
were small Thev and the ureter were ligated and divided 
separateh and the evst vvall removed No cau e of the 
hx dronephrosis could be seen in the region of the ren-'I 
pedicle The nght kidne> was felt to be large' than normal 

An enormous dead space occupvmc the left side o*" the 
abdomen and pelvis was covered with pentoneum as vvell as 
possible and the colon replaced A. large drainage tube was 
placed down to this area The uterus now occupied its 
normal position and corresponded in size to cvesi ot 
twenty eight weeks The emplving and removal of the cvsi 
caused considerable collapse of the patient but she began to 
recover as soon as the abdomen was closed 

Dunng the following week 2 units of proluton we-e gi c** 
dailv and o minims of adrenaline eight hourlv with a viev 
to preventing premature labour 

The onlv complications which took place wee a sti ch 
abscess at the top of the wound pus from which grew 
Staph\lococcus aureus and a severe B colt infection of the 
remaining kidnev The wound was well healed in three 
weeks but the unnarv infection remained till deliverv in 
spite of everv vanetv of medical treatment 

DELIVXRX 

Labour started with rupture of the membranes on 
December 29 19^7 thmeen weeks after operation Except 
for a first stage lasting ihirtv two and a half hours the confine 
ment was normal The second stage lasted two hours and 
fiflv minutes A live male child weighing 6 lb 9 oz vvas 
delivered without rupture of the penneum. The puerpc'iurv 
was normal and on the fourteenth dav the unne was s cnle 
Mother and child left hospital m good condition on the 
eichteenth dav after deliverv the babv then weighink, 
/lb 12 oz. • 

The case was remarkable for the size ot the tumour 
which possibh represents a record for hxdronephros s tor 
the quiescence of the uterus after an operation o the 
first magnitude and for the courage of the moffie' The 
onlv comparable case we have found m the li.eralure is 
that of Dr Heinz Kuslner of Leipzig' Here the evst 
weighed 20 German pounds (17k pints) and was removed 
intact Miscarriage at five months tooe place the next 
dav _ 

R L. Dodos M Ch„ F R C.S_ M C O G 

G Mvizels M B. Ch B MCOG 

‘ \fsc/ir Ceburish G\’raK 1931 89 179 



18 July 2, 3938 


CLINICAL MEMORANDA 


■* TutBiknisii 
Medical Journal 


Treatment of Plantar Warts 

There is no doubt that during recent years plantar warts 
have become much commoner There is a consensus 
of opinion on this point among those concerned in their 
treatment, whether general practitioners, dermatologists, 
or chiropodists During the recent discussion on the 
subject in these columns, little attention appears to have 
been paid to the pathology of these troublesome little 
tumours As regards this it has “been established beyond 
all doubt that they are infective in origin, which accounts 
for the fact that they^are very often multiple, but they 
are extremely superficial in nature, never penetrating 
deeper than the epidermis Sometimes a large one may 
be as much as a quarter of an inch thick, but even then 
it always lies as it were in a cup, of which the base is 
the dermis while the" sides are formed by the epidermis 
with a greatly thickened horny layer The thickening 
of the horny layer is no doubt a compensatory reaction 
m order to take the pressure from the wart itself, which 
IS usually extremely sensitive, and transfer it to a healthy 
skin This thickened collar is exactly analogous to the 
corn plasters, with a hole cut m the middle, commonly 
used for the relief of corns The leading principle in 
the treatment of plantar warts is to effect a separation 
of the base of the wart from the underlying dermis In 
the case of small warts this may often be done by the 
employment of some keratolytic agent, salicylic acid, 
which softens the horny layer, being the best On the 
heel and the ball of the foot the horny layer is very 
thick, and after treatment for some days with a salicylic 
ointment or plaster it will often peel off m an almost 
unbroken sheet, carrying away with it small warts— for 
example, those which are not of greater diameter than 
two or three millimetres , but in the case of the larger 
specimens, which may be as much as a centimetre m 
diameter, macerating treatment alone is ineffective For 
them some form of surgery is usually required, but 
excision by means of a scalpel, followed by the insertion 
of sutures, should neser be practised It is unnecessary, 
and often leads to the formation of a painful scar 

Surgical Technique 

People sometimes talk about the “roots ’ of warts, 
but there are really no such things Even the largest 
of them, if extracted entire, will be found to have a 
smooth pearly white basal surface which lies in a capsule 
formed by the surrounding skin As a rule it is riot very 
difficult to find the line of demarcation between the wart 
and Its capsule and to curette it out with the aid of a 
sharp spoon Whether this little operation should be 
done under local or general anaesthesia depends sery 
much upon whether the patient is a child or an adult 
Usually, general anaesthesia is best for children and a 
local anaesthetic for adults The base of the wart is 
often tightly attached to the dermis, so that there is a 
chance that the line of demarcation may be missed and 
the adherent dermis be removed with it, thus making a 
wound right through to the subcutaneous tissue such as 
IS likely to lead to the formation of a painful scar It 
is desirable, therefore, before curettage to adopt some 
means of loosening the wart m its bed There are two 
good methods of doing this first, by the administration 
of a dose ot v ravs , secondlv, bv the application of a 
pencil of carbon dioxide snow If asiilable, the adminis- 
tration of V ra>s IS to be preferred It is, indeed, quite 
possible to kill plantar uarts and cause their dis- 
appearance by the use of x ri>s alone but for this 
purpose a ser> hea\> dose is required m he case of 


large and thick wa-'ts, and there is some degree of im- 
certainlv as to exactly how much is necessary in each 
case As a measure preliminary to curetting a 
dose equivalent to two Sabouraiid- pastilles may be 
satelv gix'en, provided of course that the surrounding 
skin IS carefully screened This dose is at all events 
sufficient to cause a certain amount of shrinkage of 
the wart, and after a few days it is much easier to 
curette, as it is no longer so tightly adherent to its bed 
The administration of x: rays has also the advantage 
that It at once diminishes tenderness on pressure, which 
IS iisiidlly the chief symptom complained of by the 
patient The application of the carbon dioxide pencil 
is also useful because it causes a certain amount of 
effusion between the wart and its bed thus facilitating 
'removal, but it has the disadvantage that it is painful 
in Itself and has no analgesic effect subsequently Many 
cases, probably amounting to some hundreds m all, have 
been treated on these lines with unfailing success I 
do not remember ever to have seen a recurrence 

H Haldin Dax'IS, 

London, W MD FRCP 


Keratitis from Working with Creosote 

These two cases are of clinical interest from an ophlhalmo- 
logical point of view and also useful as drawing attention 
to the danger to^ employees of working With creosote 
Both cases arose in gardeners who were creosoting a fence 
in different localities Neither of them was conscious of 
a splash of creosote getting into the eye but rather thought 
fumes got into their eyes, and they suffered later from 
irxitation and consulted their own doctors after work In 
leality small droplets must have gained access to the eyes 


Case I 


H H aged 67, was creosoting a fence on January 28, 1938 
He thought some fumes of creosote got into his left eye He 
hTd uneasiness Tnd ^blinking but no great pain He was 
treated by his doctor till February 10, when he came to me 
sax mg the sight of the left eye was blurred On examina- 
tion there xvere three small grey maculae below the pupil, but 
also numerous small grey spots on the cornea and a hazy super- 
ficial keratitis a condition due, 1 thought, to numerous small 
dioplets of creosote mxpingcing on the cornea The condition 
under treatment has settled down but there will be permanent 


impairment of xision 

Case 11 

\ G , aged 49, consulted me on May 13 with a history of 
creosote fumes getting into his left eye about two 
prexiouslv, since xvhen his xision has been hazy He Uio 
not haxe much pain, but he xvent to his doctor, who treated 
him But the haziness remained On examination on eac 
side of the pupil there xvas a small grey macular 
txxo bigger globules of creosote must haxe landed, but there 
XX ere also numerous small grey specks and a superficial hazy 
keratitis xxhere minute droplets of creosote must h'"'® 

The condition had apparently settled down but Ictl h. y 
X ision 


In both cases the history xvas the same Both patients 
complained of irritation of eyes after working wUh 
creosote, neither complained of great pain, such as one 
xvould expect m such damage to the cornea, and the 
clinical appearances xvere the same— both were gardeners 
In both the impairment of vision wiU be permanent 
Creosoting of posts and fences is a common occupation 
both for amateur gardeners and their employees, 
publication of these two cases may lead to scneral prac - 
tioners giving a xvarmng to any of their patients 

work in gardens / xfi-v nr 

G T Birdwood M D , B v, , 

Xlnv 19 jS War Memornl Hospital, Deal 



JUL\ 2 193S 


REVIEWS 


Reviews 


THE BRITISH RED CROSS 

The Ston of ihe British Red Cross S H Best 

Foreword bj The Hon Sir Arthur Stanlej GBE (Pp 
27i 1 1 illustrations including a frontispiece 8s 6d 

net) London Toronto Melbourne and Ssdnes 
Cassell and Compans 1938 

The British Red Cross is a subject on which not a great 
deal has been written and indeed its discontinuous historj 
— for It IS only in war that it becomes reallj significant — 
IS not easy to relate Mr S H Best in The Story of the 
Brtitsh Red Cross which has appeared opportunely 
during the 16th International Red Cross Conference tells 
a plain untarnished tale and Sir Arthur Stanley who 
contributes a foreword is equally matter-of-fact but e\en 
these sober details of organization pulse now and then 
with adtenture It is strange that no Red Cross organi- 
zation was built up in this country following the Crimean 
War for Florence Nightingale embodied if anybodt e\er 
did the Red Cross spirit It was the Franco Prussian War 
of IS70 which led to the foundation of the National 
SocieU for the Aid of the SicL and Wounded m War 
which was the precursor of the British Red Cross Societs 
An organization was swiftly improvised and British Red 
Cross surgeons were operating amidst the bullets at 
Sedan But it was not until 1S97 just before the Boer 
War that the organization of Red Cross work in this 
country took a decisive step forward when representatives 
of the National Aid Society the St John Ambulance 
Association and the Arms Nursing Reserve met m 
conference with a view to finding out how best they could 
co operate with the Army Medical Service and vvith one 
another As a result the permanent Central Red Cross 
Committee came into existence and almost immediately 
had Its baptism of fire on the South African battlefields 
Later it was felt that the principle of unification might 
be extended and the present British Red Cross Society 
came into existence in 1905 with Queen Alexandra as its 
president — essentially a woman s work said the Queen 
in her inaugural speech But when the European War 
broke' out the Society was still a small organization 
occupying two rooms in Victoria Street and living on a 
negligible income Its expansion was on a similar scale 
to that of the British Army itself To take the financial 
measure alone by the end of the war it had raised 
£24 000 000 

Nearly half the present book is taken up with the story 
of the Society in the war of 1914-18 This again is not 
easy to relate for Red Cross work had no well defined 
limits merging sometimes almost imperceptibly jnto the 
work of the Royal Army Medical Corps At first much 
confusion was caused by the fact that the Army Council 
in which the control of the Red Cross emblem is vested 
had granted authority for Us use to the Ambulance Asso- 
ciation of the Order of St John so that there were two 
bodies engaged m the same work sending personnel and 
material to the armies at the front The situation was 
remedied by the formation of a Joint War Committee con 
sisting of representatives of both bodies In the early 
days of the war the Red Cross offered an obvious channel 
for patriotic and compassionate service To Sir Frederick 
Treves it fell to interview the doctors who wished to 
serve and 400 were engaged at £1 a day vvith quarters 
and rations Many of them served in France some in 
Serbia and elsewhere Some were in units of which the 


THEBtirm 19 

CXL JOL^NCe. 


Society had sent out thirteen and the joint organization 
a further six before the end of 1914 Vivid memories of 
those davs are recalled by these chapters — the establish 
ment of the auxiharv hospitals the organization ol the 
VADs (who were a matter of jest at firsL but earned 
the tribute from Sir Arthur Sloggelt D G M S that ihsv 
were one of the greatest factors of thr medical o^ganizn 
tion of the war ) and the purchase of the S*ar and 
Garter Home The Red Cross emblem was the brightest 
thing that many a war-weary eve saw m four vea's 
Here is a tvpical example of service which perhaps would 
not be accounted much of an achievement to dav bu 
twentv vears ago made a shining record 

A telegram was received at Boulogne he„dquarters 
requesting a suppiv of pituitary extract urgenllv needed bv 
a casualtv clearing station A suppiv of this extract was 

received at noon on the following dav and was immedutetv 
dispatched bv motor cvclist who delivered it at tbe casu-liv 
clearing station the same evening 

But that IS only one of scores of quotable instances 
A bare dozen pages are allotted to the post war activi les 
of the Red Cross but these include such vvorl as the 
blood transfusion service the clinic for rheumatism in 
London and the training of personnel for the A R P 

ACTIONS ANT) USES OF DRUGS 

The Essentials of Materia Medica Pharniacoloes and 

Therapeutics By R H Micks M D F RC P 1 Second 

edition IPp s78 12s 6d ) London J and A Churchill 

1938 

The appearance of a second edition of Professor Micks s 
textbook confirms the opinion we expressed when the first 
edition appeared three years ago that it was of excep- 
tional merit and would prove popular The outstanding 
feature is the clearness with which the author states the 
really important actions and uses of drugs At the same 
time he has little respect for age in relation to therapeutic 
traditions and when he believes a drug to be useless s ales 
this opinion without superfluous qualifications This 
simple method of approach results m a textbook which is 
both interesting and east to read 

The material has been thoroughiv revised An account 
IS given of the numerous important new drugs that have 
^appeared dunng the last three vears A separate chapter 
IS devoted to prontosil and sulphonamide and it is 
interesting to note that as much space (seven pages) is 
given to these drugs as to the treatment of cough 
Emetics on the other hand are dealt with in a single page 
while volatile oils occupy four pages which end with the 
remark that the presence in pharmacopoeias of most of 
these substances is a relic of the past rather than a 
testimony to their therapeutic importance These examples 
suffice to shovv the striking difference between the textbook 
under rev levv and those which follow more classical 
traditions Professor Micks s treatment of the subject is 
of course the one which really accords with up to-date 
clinical practice It would indeed seem that though 
pharmacology is onu of the youngest of the medical 
sciences yet it already has acquired classical Iradilions 
which are lending to lag behind currtnl practice Pro 
fessor Micks s textbook undoubtedly hcljw to w ird olf 
this threatened senescence since its very oriiivsions tniplin 
size the faci lhai most of the points iroiiml wbieli eomio 
versy centred during Ihe nineltcnili tenliiry ire to d lyr 
of minor importance 

We congratulate the author on the care he h 1 I d cn, 
not merely to incorporate an account of nee/ dni- in me 
new edition but to rewrite v hole eti iptcrs <0 iIm' it - 
relative importance of new ind of tild riie'l or) 1 ifi i a 
true persjicctivc 



20 July 2 1938 


REVIEWS 


The pRiTmt 
NtEDicxt Journal 


AN AMERICAN HANDBOOK ON EYE 
DISEASE 

A nxtbook of Oplithnlinoloni By Sanford R Gifford 
MA MD,FACS (Pp 496 249 figures , 10 coiourcd 
plates coloured frontispiece ISs net) Philadelphia 
and London W B Saunders Compahs 1938 

Dr Sanford R Gifford, professor ot ophthalmology in 
the North-Western University Medical School, Chicago, 
has written a handbook on the diseases of the eve for the 
use of medical students and general practitioners The 
book follows the usual lines of such works There is a 
good account of the evamination of the superficies of the 
eye, then of ophthalmology and the functional reactions 
of the eye There follow chapters on refractive errors, the 
diseases ot the several parts of the c\es, and a chapter 
on the eye m general disease There is an appendiv giving 
the appraisal of loss of visual efficiency according to the 
standard method approred by the House of Delegates of 
the American Medical Association m 1925 The text is- 
well and clearly written , it is a safe guide to the student 
and to the general practitioner The type and paper aic 
good , but the illustrations ot which there arc many, arc 
disappointing Dr Gifford has used photography far too 
much There are many fundus pictures done by photo- 
graphy which are clerer m themselves but winch m our - 
opinion are quite useless its an aid to the student Such 
pictures m their hick of distinction are in sharp contrast 
to the several colour prints prepaied from drawings made 
by the artists of Theodore Hamblin of London There 
are few photographs of eye conditions which can equal the 
careful limning of the intelligent artist 

PERIPHERAL EMBOLECTO^IY 

Les Embolic^ AUcruths (its hfemhrex By H Haimovici 
Preface by R Lenche and J Fiolle (Pp 336 55 fr) 

Pans Masson et Cie 1937 

In this welcome monograph Dr Haimovici reviews the 
whole subject of the occlusion of the limb arteries Based 
on the personal experiences of the author as well as a 
bibliography of several hundred references, which is by 
no means the least valuable part of the book, the field 
covered includes sections on history, aetiology, symptom- 
atology, diagnosis, prognosis, pathology, and treatment 
It IS introduced by a short preface by Professors 
Rend Lenche and J Fiolle, who, m drawing attention 
to its importance, state that hitherto the subject has 
been dealt with in only a random way, and that tips Ms 
the first contribution to analyse the subject and deal with 
It as a whole The pathological aspect, however is given 
most pi eminence, and the whole of the twcntv-four illus- 
trations, with the exception of the first few which are 
concerned with experimental work, are photomicrographs 
from Sites of lasculir occlusion and depict emboli or 
the vessels containing them This is our chief criticism of 
this excellent monograph , we should bate welcomed some 
illustrations of the clinical aspects — for example, common 
sues ot lodgment of emboh and ot the lanous methods 
used in their treatment bj surgerv Verv appropriately 
the work ot Swedish surgeons is referred to, but we should 
hue liked to ha\e seen Professor Einar Ke\ s important 
personal contributions and those of his associates given 
c\cn more prominence Jor it i^ to the Swedish school that 
we ha\c been accustomed to look for some time now for 
guidance in the treatment of cases of arterial embolism 
British readers might think that undue importance is given 
to artencclomx since manj ha\c faded to confirm the 
striking results claimed lor this procedure, so popular m 


parts of the Continent Other explanations may he given 
for some of the results ascribed to synipaihclic denerva- 
tion by artencctomy, since success has also followed 
embolectomy with ligature of the mam vessels Making 
due allowance for such considerations, however, there Ts 
much to recommend tins work to those interested m 
vascular surgery 

A SIEDICO-LEGAL CLASSIC 

Glaisiirs Medical Jiiiispnidcncc mid Toxicohs't Bv 
John Glaister M D , D Sc Sixth edition (Pp 747 , 107 
ilkistrations, 8 plates, 3 of which are in colour 25s net, 
postage 7d) Edinburgh E and S Livingstone 193$ 

In preparing the sixth edition of (his famous book Pro 
lessor Glaister decided that considerable changes were 
inevitable It was originally written for the student, and 
he found that it contained too much minor detail and 
interpolation in small type for modern tastes He lias 
therefore opened up the whole format by using 1 irgcr tvpc 
and has improved the style of the index Considerable 
portions of the book have been -lecast in ordei to include 
new matter Dermal prints and palmar prints are litatcd 
m some detail, and the section on putrefaction now con- 
tains some useful data on the identification of maggots, 
for vaarious species have Iife-cv'clcs of various lengths 
The Ruxton case giv'es the editor an opportunity to 
enlarge the original section on the identification of dis 
membered remains He also includes the latest intorma 
lion on blood grouping the use of filtered ultra-violet 
light, (he Pharmacy and Poisons Act, 1933, and war 
gases He has a large toxicological section, with two 
fine colouied plates of various poisonous licrnes and 
seeds As might be expected, Dr Glaister treats ade- 
quately one of the subjects he has made pecuharlv Ins 
own the identification of libres and hairs The civil 
aspect of medical jurisprudence is dealt with in a some- 
what perfunctory wav, but the section on the Generil 
Medical Council informs the practitioner of most of the 
pitfalls of the medical code of conduct A valuable 
feature is the close attention pud to Scots law, which in 
its medical aspects as m others, differs widely from the 
law of Eng] md The v.ihie of this work, already great, 
has been considerably increased by its learned md 
experienced editor 


Notes on Books 

Very opportunely since the Glasgow Exhibition will 
doubtless ittvvct more than the usuil number of visitois 
to Scotland this v'car, the Automobile Association has 
issued the Road Book of Scotland thus completing the 
trilogy of A A roadbooks covering Great Britain and 
IieliTnd The 400 pages which this book contuns ire 
packed with useful intormation, and, what is more, this 
mass of matcriil is so arranged that whatever the rcider 
wants to know — from the best of several possible routes 
to the size of the golf course at, say, Wick or (for the 
Englishman) the correct pronunciation of Gaelic names 
th it information is to be found with a minimum of effort 
There arc more than 250 spcci illy surveyed, detailed 
Itineraries which arc cross referred to a gazetteer of more 
than bOO cities, towns vilhgcs, and lochs Day drives 
from vvventy-nme centres, chosen to cover the countr) as 
a whole, are described, and there is also a descriptive 
article with regional sketch maps on ‘Tovinng m Scot 
land Sections of the book arc devoted to moimtamctr- 
inc angling and shooting and niisccllancous mfornialion 
IS 'to be found on steamship communicattows femes iinl 
highland clans and lowland families Finally there arc 



Juu 2 1038 NOTES ON BOOKS Thx Bvra*' 1 

^'_D '•jLt. Jo 


excellent road maps in full colour on a scale ot tweUe 

miles to the inch Altogether a volume which no serious Preparations and Appliances 

motorist in Scotland can afford to be without Its price 

to members of the A A is 8s 6d ' - — — • - — 


It IS an act of piety on the part of Dr Louis Sauve — 
himself a hero_\vorshipper — to save Le Docteiir Recanner 
{I774-IS52) from the oblivion into which he was fast 
sinking Recamier in his dav was a great figure in 
French medicine as a phvsician surgeon and gynae 
cologist He was among the first to remove the uterine 
cervix bv means of the ligature he invented a new form 
of speculum and he taught that cancer was at first a 
local condition which could be cured bv earlv operation 
He came of old French stock His father was notarv 
royal and mayor of Rochetort his godfather was Brillat 
Savarin the gourmet vvho wrote the Ph\siologie du Gout 
Recamier himself entered the Armv of the Republic when 
the Terror was still at work He was present at the 
siege of Lvons m 1793 and then passed into the Navv 
to fight the English in the Ca Ira Eventuallv he became 
phvsician to the Hotel Dieu in Pans then surgeon to 
the charitv tor the profession was not then so strictly 
separated and he ended his life as Professor ot Medicine 
in the Royal College of France His friends were 
numerous and included most of those vvho are familiar 
to us by their classical writings This little book (Pans 
Edition Spes 20 frs ) is interesting^to the general as well 
as to the professional reader It gives a first hand 
account of the state ot affairs in France at the end ot 
the eighteenth centurv when Recamier s pav was , three 
hundred livres a month paid in assignats worth tvventv 
sous a hundred m cash The father s income had been 
attached so the son had to live on his pav Dr Sauve 
reproduces a portrait ot Recamier in middle age 

Sciennfd Contribatwas in Honor of Joseph Hersey 
Pratt on Ins Sir/> fifth Birthda\ is published at 7 dollars 
bv the Lancaster Press Incorporated of Lancaster Penn 
syhania A hundred and thirteen colleagues former 
pupils and friends of Dr J H Pratt of Boston, under 
the leadership of Dr Richard C Cabot pav this tribute 
to one vvho has done such notable service to the sick 
poor in such an effective and warm hearted manner Dr 
Cabot writes enthusiasticallv of Joe Pratt the pupil 
of Osier and Welch at the Johns Hopkins who thus 
inspired has been able to prove that scientific fervor 
and delight can be maintained at white heat in the cool 
climate of Boston for fortv vears More than thtrtv 
years ago he instituted his class method of helping 
tuberculous poor patients to get well in Boston and 
obtained as good results as those at Saranac Lake and 
other first class sanatoria another psv chological but 
similar method of helping the sick poor the thought 
control class has also been strikinglv successful Most 
of the articles here brought together have already 
appeared in the Annals of Internal Medicine and cover a 
wide field For example Sir Arthur Hurst writes on 

alcoholic gastritis 1833 and 1937 and Dr G C 
Shattuck a v^ell known Boston name desenbes the 

incidence type and probable cause of anemia in the 
highlands of Guatemala It is interesting to hear that 
a hundred bedded Joseph H Pratt Diagnostic Hospital is 
to be constructed in honour of this famous phvsician 

The first volume of the first series of the Aeu Inter 
national Clinics (Philadelphia Montreal New York J B 
Lippmcott Co 4 vols yOs ) appears under the editorship 
of Dr George Morris Piersol professor of medicine 
at the Graduate School of Medicine Lniversitv of Penn 
svivania and differs externally from the old senes bv 
appearing in a blue binding vvnh a green label The 
volume contains seventeen original articles eight clinical 
lectures on a great vanelv of subjects and a review of 
recent contributions to the subject of biliary stasis and 
decompression 


XRATi SCREEMAG ST4AD FOR GEAERVL 
PRACTICE 

Dr Dolguvs Gordon (Richnond) writes 

Radiology is not vet practised as generally as it is abroad 
and in the dental profession but with the introduc loa ol 
shock free apparatus it appears ' keh that the next d»cade 
will show a considerable increase of general p-acti'ior—N 
with installations However even a shock free ell p oiec ed 
T rav tube is not as safe as it sounds if used for sereenirc 
chests I mvselt suffered from a sudden attack ot alop-scia 
within a few weeks of installing an t rav appa plus A ^cn 
plete cure was effected bv constructing the screening rd 
here illustrated 



The stand has the great merit that vvnen not in u e it 
occupies practically no space at all owing to the empiovr^cni 
of a chair to keep it vertical ard of wheel to pemit of e v 
movement A la inch bv 12 inch Levx Wet screen with 
10 mm lead glass slides m grooves in the t\o upnchl 
members and is capable ot adjustment as is a small p„nel 
of wood and lead v hich lies below it in ihe grooves The 
vertical members are drilled and a brass roJ passing through 
them retains both screen and panel Wheel are fitted at ihe 
bottom of the vertical members and stnns of wood fix them 
to the back of the chair so that the chair legs nrevent the 
stand being moved when in use but a sli_hl ult enables il 
to be wheeled about easilv Protection is complied bv 
lead apron fixed lo the ve-tical members from Ihe level o'' 
the too of the back of the chair down to v i bin a few inches 
of the floor and laterally bv four hinged flaps of lead a"d 
wood as seen in the illustrations The two unper serve ihc 
double purpose of proiecting the obsener from x ravs and 
nhen shin of prolecling the screen irom sunlight The lov ir 
flap fold back on double hinges when not in use The ranee 
of adjustment available suffices for all chests and a suiiabk 
stool or box for the patient lo stand on permits screenine of 
the abdomen Omilting the cost of ihc Lew West screen nd 
of the chair the whole appuralus was coesirucled for le s 
than £2 

APPLE DICTARA 

Aplona (Me srs Coates and Cooperl i a pcrn.r di- 
preparation made from apnies It com ns I „ c ' 
tannins cellulo e ana pecline Clnicai repo ts I*- i 

IS valuable in the -ealment of diarrhoea bo >- n cr '3 
and adult 



22 July 2, 1938 


NOVA ET VETERA 


Tilt: BRnisu 
Medical Journal 


Nova et Vetera 


ST HELENA- AND ITS HISTORY 

In St Helena 1502-I93S Dr Philip Gosse has produced 
not only an important historical work but also a vivid 
and interesting narrative of the island s chequered story * 
To the great majority St Helena is known solely as the 
place of Napoleon s second captivity and previous writers 
have devoted themselves almost entirely to the last days 
of the illustrious exile Dr Gosse, however, has wisely 
refrained from allowing any undue concentration upon 
this over-written period to upset the careful chronological 
balance of his book This is to be commended, for both 
the lomantic earlv history of the island and the reasoned 
and sympathetic survey of the deplorable conditions exist- 
ing at the present day are more worthy of the readers 
attention 

An uninhabited island, St Helena was first discovered 
by the Portuguese admiral, da Nova, m 1502, and for 
eighty-six vears, realizing Us great importance as a calling 
station for their homeward-bound aigosies from the East, 
the Portuguese succeeded in keeping the discovery to them- 
selves Then the English and Dutch came upon the scene, 
and there followed a period of sea-fights and assaults, of 
which Dr Gosse with his wide knowledge of the old sea- 
rovers, is well fitted to write Turbulent too, was the 
internal history of the island, disturbed by frequent 
mutinies, and marred by the cruel treatment of the black 
slaves who had been imported under the auspices of the 
East India Company, to furnish labour for the plantations 
and farms The East India Company, nevertheless was 
lavish in its expenditure upon this vital link m us sea 
communications and the transference of administration to 
the Crown in 1833 dealt a sad blow to the islands pros- 
perity The opening of the Suez Canal and the gradual 
disappearance of sailing ships sounded the knell of St 
Helena s former glories and the island is to day im- 
poverished and neglected 

Dr Gosse has supplemented his text with nine most 
interesting appendices, one of which contains a complete 
list of Governors from 1657 to the present day Among 
these IS Dr W I J Arnold, colonial surgeon who was 
acting Governor in 1911 and in 1924 So beloved was 
Dr Arnold by the communitv, to which he devoted the 
best years of life, that a monument was erected to his 
memory, bearing the inscription, “ The best friend St 
Helena ever had This book, written with scrupulous 
accuracy and at the same time with sympathy and humour, 
miy deservedly be regarded as the standard work on 
St Helcm The illustrations are numerous and well 
chosen 


FRANCESCO ANTOMMARCHI, 1789-1838 

Of all the petty men who wilked under the huge legs ot 
the Colossus Napoleon one of the strangest and least 
attractne was his compatriot Dr Francesco Antommarchi, 
the centenarj of whose death occurs this year Sir Arthur 
Keith has called him the Maholio of ihe drama of St 
Helena Born at Morsiglia, m Corsica, he studied medicine 
at Pisa and Florence and in 1812 became prosector to Paolo 
Mascagni (died 1815), whose beautiful illustrations for an 
anatomic itlas were entrusted to him for publication 
These he began issuing in 1S19 { Prodromo della grande 
anitomia ) "but his methods were so questionable that 
Mascagni s lamili soon chose other editors 

Mnien Napoleons Irish phxsician Barry O'Meara was 
sent home on Julj, 25 ISIS, Antommarchi, at the request 
of the Emper or s mother and of her brother. Cardinal 

'St Helena Bv Philip Gosve iPp 448, 33 figures 

ISs net) London Cabell and_Co I9’S 


Joseph Fesch, went to St Helena in 1819 He was then 
but 30 years old Though a skilled anatomist and patho 
logist he was an inexperienced and incompetent jihysi- 
cian — excitable, unbalanced, vain, pretentious, and greedv 
Towards the sufferings of his patient he was scarcely 
sympathetic, believing them to be simulated for political 
ends Napoleon s dread of having inherited cancer from 
his father, who died at the age of 39, Antommarchi tried 
to quiet by asserting that cancer was not inheritable The 
patient frequently tried (o get rid of his doctor, saying 
‘ I would give him my horse to dissect, but I would not 
(rust him with the cure of mv own foot ’ Though he 
performed the post-mortem examination, Antommarchi 
refused to sign the official report He is suspected by Sir 
ArihurKelthofhavingabstracted theportions of Napoleon s 
intestine which are preserved in the Museum of the 
Royal College of Surgeons (Bntish Medical Journal, 1913, 
1, 53-59) 

A Spurious Attribution 

Antommarchi s name is illegitimately linked with the 
so called Antommarchi death-mask of Napoleon, which 
was really the work of Dr Francis Burton, surgeon to 
the 66th Regiment of Foot, the face pari of the mould 
having been stolen by the Corsican In 1825 Antommarchi 
published his worthless and mendacious book Denuerr 
Moments de Napoleon in which he gave a fabricated 
account of how he had moulded the mask Very proii- 
dcntially for his rival, Burton died of pulmonarv apoplexy 
in 1828, when Antommarchi decided that the time was 
now ripe for reproducing the mask and placing casts 
upon the market for sale On luly 15 1833, he issued 
a prospectus and invited subscriptions Though the mask 
was exquisitely beautiful — m its youthfulness it recalled 
the First Consul rather than the Emperor--with_its re 
ceding and narrowing forehead and commonplace skull, 
It was so unlike his conventional head that the response 
was most disappointing In disgust Antommarchi retired 
to Cuba and died at Santiago at the age of 49 His fraud 
was publicly exposed at Dublin in 1835 by Robert lames 
Graves (of Graves s disease fame), a cousin of Burton, 
some of whose papers he had inherited, and Burtons 
daim was' resurrected m 1900 by Lord Rosebery In his 
book, Napoleon The Last Phase The story of the 
death-mask was told convincingly with the aid of original 
documents by G L de St M Watson m 1915 Though 
Heine calls him an evangelist of the worldly saviour 
Antommarchi seems to have had scant regard for historical 
accuracy and truth It was he who invented the theatrical 
tale — repeated to this day — that when Napoleon lay dying 
a violent tempest was raging over the island, tearing up 
every tree which the exiled Emperor had cherished 

W R B 


While a medical student at the Unncrsilv of Gottingen 
Arthur Schopenhauer who was born 150 >eirs ago con 
traded svphilis, which was treated with huge doses of mcrcurv 
so popular at that time The accomp inving wretchedness of 
salniiion, depression, and internal pain were responsible for 
his lifelong sjphilophobia and out of his hatred of women— 
under sized, short legged, long haired creatures whose sole 
purpose in the world was to spread sjphilis — grew his 
philosophy of pessimism In commemoration of this anni 
versary Danzig his native city, has recently issued a set of 
three stamps bearing his likeness 


Sir Walter Farquhar, Bt , MD, who was born in Scotland 
200 vears ago, served as army surgeon under Lord Howe 
commander in chief of the British Arnij in the American 
Revolution, .and was present at the siege of Bcllcislc in 1761 
On his return to England he started practice as an apothccarv, 
was created baronet in 1796 and shortl> afterwards became 
phjsician m ordinary to the Prince of Wales He died on 
March 30, 1819 



JUL\ 2 1938 


N'\TIONAL INSURANCE IN AUSTRALIA 


M o»c*i JcrTLNAt 


2 ^ 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDAY JULY 2 1938 


NATIONAL INSURANCE IN AUSTRALIA 

In the Journal of June II last (p 1279) the pro- 
visions of the Bill for National Insurance and 
Pensions in Australia were described The Bill 
had then received its second reading in the Federal 
House of Representatives Its subsequent course 
has not been altogether a smooth one Within 
the House the Labour Party put up a dogged 
opposition mainly on the ground that any such 
scheme should be non-contnbutory while on the 
other hand certain of the Government s own 
followers especially a section of the Country Party, 
pressed for tanous extensions of its proposals 
so that some farmers and employers with small 
incomes as well as the dependants of insured 
persons should be prOiided for Outside Parha 
ment the friendly societies feanng that the Bill 
might affect adversely their present position 
expressed their dissatisfaction and the general 
body of the medical profession attacked a number 
of Its proposals in no uncertain way It was only 
by the firmness of the Pnme Minister and by the 
application of the ‘ guillotine that the third 
reading was secured by a small majority Even 
so Mr Lyons had to promise to appoint a Royal 
Commission to consider the capitation fee for 
medical practitioners gixnng service and the inclu 
Sion of the dependants of certain classes of insured 
persons and to consider the establishment of a 
' voluntary scheme for small employers with a 
rebate of the contnbutions on behalf of their 
employees The Bill w’ent to the Senate on June 
21 and it is understood that it has now been passed 
without substantial alteration 

The conduct of the negotiations between the 
Australian Government and the Federal Council 
of the British Medical Association on behalf of 
the medical profession in the Commonwealth has 
not been satisfactory' No doubt both the Govern- 
ment and the Federal Council were in a difficult 
position The former understandably but vve 
think unwisely did not wish to make anv public 
disclosure even of its mam proposals until the Bill 
was introduced into Parliament The latter was 
thus placed in the position of negotiators who were 


unable to assure themselves of the reaction of the 
general body of those whom thev represented to 
important points which thev were prohibited from 
disclosing dunng a vital penod 

Observations on the position especiallv as 
regards details made under the handicaps of 
distance and of time must necessanlv be guarded 
It IS possible that there are factors as tc which fuU 
information has not been forthcoming but cnu 
cisms made as the result of actual expenence mav 
be helpful There is no doubt that a considerab’e 
number of members of the medical protession in 
Australia regard anv scheme of national health 
insurance as unnecessary and as likelv to be 
injurious to professional work and traditions 
Such an attitude comparable to that taken up bv 
many in Great Britain a quarter of a centurv ago 
IS mainly due to misunderstanding as to the nature 
and effects of such a scheme in actual v orking 
These have proved to be not unsatisfactory in this 
country and there is no reason to suppose that 
in Australia if regard is had to that twenty five 
years experience and to its application to condi 
tions in some respects different a similar scheme 
will be a social measure other than beneficial alike 
to the profession and to insured persons Further 
if uniformly administered throughout the Common 
wealth it would seem to offer the best means of 
relieving the profession and the people of Queens 
land and of Tasmania from the worst effects of the 
attitude of the Governments of those States to the 
medical profession In any case the Australian 
Government is redeeming promises definitely made 
dunng an election from which it emerged with 
success 

The chief differences between the Government 
and the medical profession now appear to be with 
regard to the capitation fee and mileage and to ihe 
content of the service It would seem that in the 
original negotiations tlie decisions arrived 3' ’ 
were that the capitation fee for a general practi- 
tioner service excluding treatment in respect a 
confinement and treatment of an insured person 
who becomes entitled to the benefits of anv Com 
monwealth or State Workers Compensation Act 
or Seamen’s Compensation Act and excluding 
major operations and inhalant anaestheUcs be 
eleven shlllinss and that mileage be pavable 
at the rate of two shillings a mile one wav bevond 
three miles with an increased rate for areas of 
special difficulty The present demands the 
profession are that the capitation fc,. shall bw 
fourteen shillings with a 25 per cent increase for 
country areas that mileage shill be 2s 6 j a 
mile bevond two miles sixpence ol inis to be 
payable bv the patient that there should be an 



24 JuL\ 2, 1938 


NATIONAL INSURANCE IN AUSTRALIA 


The British 
Medical Jolrn^.l 


extra 2s 6d fee payable by the patient for calls 
between 8 pm -and Sam, that, m addition to 
the administration of general anaesthetics, the 
following should be excluded from the service — 
attendance for acute alcoholism and acute 
venereal disease, attendance for miscarriages and 
abortions and premature births, and attendance for 
“ the more difficult and complicated fiactures and 
dislocations ” 

A capitation fee of eleven shillings, having regard 
to differences of exchange, cost of living and other 
conditions of practice, must be regarded as 
entirely inadequate A case put forward to the 
-Commission now promised by the Government 
should certainly be successful m securing a- sub- 
stantial increase upon this It must be remembered 
that when the lower amount was decided upon 
medical attendance on workmen’s compensation 
cases was to be excluded from the service 
Experience here shows that it would be both un- 
desirable and very difficult to exclude this, but 
that the amount of such attendance is considerable , 
and the Commonwealth Government should surely 
recognize that, if it is not now to be excluded, 
this m itself constitutes a reason for a higher fee 
Experience tends to show also that it would be 
unwise and inconvenient to exclude acute alcoholic 
and acute venereal cases from the contract, and the 
same applies to miscarriages and abortions, though 
perhaps less emphatically , but of course the work 
entailed by these tioublesome cases should be 
reflected in the capitation fee With regard to 
major fractures and dislocations, it may be that 
they are excluded as requiring, except for emer- 
gency treatment, specialist skill On the other 
hand there is much to be said, in the conditions of 
Australia, for a higher mileage fee and for a modest 
fee for night calls, some portion of which, m both 
cases should be a liability on the patient It may 
be suggested however, that the practitioner should 
be paid these fees not by the patient but from the 
insurance fund, that fund obtaining payments into 
the fund by the insured person 

Proper pressure on the Government on these 
points with regard to capitation fee, mileage, and 
night calls, with the presentation of a well-prepared 
case to the proposed Royal Commission, is called 
for, and it is to be hoped that the profession m 
. Australia will be umted m presenting reasonable 
demands upon such points as these The principle 
upon which the whole matter should be based is 
that the profession should offer not an unduly 
restricted sersice but a full and efficient service, 
and that the Government m return for this should 
guarantee such remuneration as will encourage and 
suitably reward good work and great responsibility 


THE VOLUNTARY SYSTEM IN FIGURES 

The voluntary hospitals are a long time dying 
It might-be argued that they are no longer voluntary 
in the sense of the words which are still to be seen 
over the entrances of many of them — “ Supported 
by voluntary contributions ” — ^for voluntary gifts in 
the shape of subscriptions, donations, congrega- 
tional offertories, even including workmen’s contri- 
butions, Hospital Saturday funds, and contributory 
schemes, amount in all to much less than half the 
income available for maintenance But as Mr 
RHP Oide, editor of The Hospitals Yeai-Book,^ 
points out in a foreword to the new edition, the 
reference' to voluntary contributions has largely 
obscured the picture The really important 
characteristics of the voluntary system are not the 
sources of income but th? absence of statutory 
control and of the desire to make any profit out of 
the treatment of the sick 
With that definition in mind it is worth while 
examining some of the massive statistics presented 
m the yearbook They relate to 1 936, the last year 
for which complete figures are available During 
that year 1,378,050 patients were treated m the 
wards of the voluntary hospitals of Great Britain 
and Ireland, and 6,216,497 fn their out-patient 
departments These figures show increases over 
the previous year of 52,614 in-patients amd 272,544 
out-patients The growth of the out-patient 
department catches the eye everywhere m the pro- 
cession of statistics In the London hospitals alone 
the number of new out-patients in the year was 
just upon two millions, an increase of 80,000 on 
the year before At the twelve London hospitals 
associated with medical schools the new out- 
patients numbered well over three quarters of a 
million- At two of them (the London and St 
Thomas’s) the number m each case was over 
100,000 At this rate the out-patient clinics will 
vie with the cinema as the place of resort for the 
British people The same story is repeated at the 
special hospitals At the four large ophthalmic 
hospitals m London, for example the new out- 
patients numbered 72,000 The cost of out- 
patients IS rathei difficult to assess, and the dis- 
parity of some of the figures m the analyses suggests 
that diffeient methods are taken by different hos 
pitals At the Birmingham Geneial Hospital for 
example, the remarkable figure of- 6s 8d is 
returned as the cost per out-patient attendance, 
but in general at the provincial leaching hospitals 
the figure works out at something over one shilling, 
and at the London teaching hospitals it averages 
just over two shillings 

'The Hospitals y ear Book I93S (Ccnlnl Biirciu of Ilospinl 
Inforimtion, 12, Gros\cnor Crescent SWl) 



JUL\ 2 193S 


THE VOLUNTARY SYSTENt IN' FIGURES 


T*r»- BRmsH 
MrirtCAt 


An interesUng section of the report this jear 
deals with hospital nurses In the London hos- 
pitals associated with medical schools the number 
of beds per member of nursing staff \aries from 
2 46 at St Mar)' s to 1 34 at Guy’s and at similar 
hospitals elsewhere in the country from 3 OS at 
Aberdeen Ro)al Infirmary to 1 97 at Adden- 
brooke’s Hospital, Cambndge Ver)' few hospitals 
whatever their size, have more than four beds per 
member of nursing staff The average for the 
800 hospitals furnishing complete particulars on 
this point IS 2 36 m the case of the general hospitals 
and 2 84 in tlie case of the special the special in 
eluding such places as the spa hospitals where 
the number of beds per nurse may be from ten to 
fifteen On a summary of information from a 
number of large provincial hospitals the number of 
hours’ duty per week for the day staff (excluding 
times taken for meals) is about fift)-fi\e and for 
the night staff very generally over si\t\ Tvpical 
salaries for matrons of large proiincial hospitals 
are £400 for ward sisters £90-£150 for staff nurses 
£60-£S0 and for fourth year probationers £40 
The financial position of the \oluntar)' hospitals 
in 1936 ma) be summarized by saying that the) 
recened £17 680 000 and spent £17 167 000 
Returning prosperity to the nation brought the 
hospitals a w'elcome increase in voluntary gifts 
the total of which w'as £6 071 000 a gain of not far 
short of £300 000 on the year The only diminu 
tion W'as m Scotland But the cost of running 
hospitals IS generally rising reflecting the rising 
price level and the fear of a deficit is ever present 
rn the minds of hospital managers An inde- 
pendent Mew of the whole situation was put 
forward the other da) by Professor Ernest Barker 
who holds the chair of political science at Cam- 
bridge m an address to the British Hospitals 
Association on ‘ The State and the Voluntar) 
Hospitals ’ - The deficits of the hospitals said 
Professor Barker were in no sense the result of 
bad management Hospitals had developed into 
organized co-operative concerns and their problem 
now was how to meet their deficits The method 
of setting wards aside for pa) mg patients might 
vitally affect the V'ery essence of the voluntaiy' 
hospital and turn it into a quasi-commercial 
nursing home The onl) solution now is the way 
which adds State charity to the resources and 
achievements of private charitv When the com 
munit) gives as vvell as private persons, it makes 
a fairer and more equitable world In answer to 
the question how aid should be given bv the State 
Professor Barker put forward the analogs of 
universities Tlie Universit y Grants Commiltee 

’ Times Ma> 27 IS'S 


receives an annual Parliamentary grant of some 
£2 000 000 and distributes this among the univer 
sities attaching no specific conditions A 
Hospital Grants Committee might receiv e an annual 
Parliamentary grant and probabl) a svstem of 
regional hospital councils acting on behalf of the 
committee in the same wa) as the central federal 
authority of the Univ'ersity of London acts on 
behalf of the Univ'ersitv Grants Committee might 
be a further necessity ’ He claimed that this ide i 
was m tune with the general English wav of do<ng 
things So far from defeating self help or 
drying up the spnngs of pnvate charitv it v as 
likely to stimulate and increase them The 
grants made by the State to universities have not 
diminished the pnvate support and the pnvate 
endow'ment of universities The plan is an 
economic one and a good and valid alternative 
to the other and far more costl) method to which 
we might otherwise be driven — the method bv 
which the State owing to the failure of unassisted 
voluntar) effort to face the gigantic task of mam 
taming v'oluntary hospitals would be forced to 
take them over and to run them at a far greater 
cost 


THE CYCLOTRON 

Scientific progress depends no less upon the production 
of new research tools than upon new wavs of thinking 
and the cvclotron in this respect bids fair to rank witli 
the V rav tube ihe microscope and the magnet Iis 
inventor Professor E O Lawrence wished to produce 
high speed ions of sufficient energv to penetrate and 
disrupt atomic nuclei Ions can be accelerated bv the 
application of an electromotive force and a vanetv of 
apparatuses have been made — -for example the impulse 
generator or the high voltage r-rav tub,. — in which 
about a million volts can be applied to the ion source 
Difficulties of insulation at present stand in the wav 
of further development of such apparatus and Lawrence 
therefore thought of repeatediv aeceleraung the ions 
bv Ihe successive applications of a voltage of the rela 
tivelv low order of about 40 000 volts An ion can be 
made to traverse a circular path bv the application of 
a magnetic field at nghl angles to the plane of the 
circle and the angular velocitv of such a moving ion 
li constant If now the linear velocitv of the ion is 
increased bv the application of a voltage in Ihe plane 
of the circle the ion will travel in a larger circle and 
bv repeated accelerations its path becomes an ever 
widening fiat spiral In the cvclotron the ions fonned 
near the centre point between two semicircular hollow 
electrodes spiral around from within one electrode o 
within the Oiher under the combined influence of a 
high frequence oscillating field between the clectrof.s 
and a magnetic field perpendicular to the p!„ne o'' t’ 
electrodes The frequence of the oseillations and tn. 
strength of the magnetic field are so adjus'ed iha' th. 



26 July 2, 1938 


THE CYCLOTRON 


The British 
Medical Jolrs^l 


ions remain in resonance with the oscillator, and after 
perhaps a hundred revolutions the spiral has opened 
up to the limit permitted by the size of the accelerating 
electrodes, and the ions are drawn off their track by 
about 40,000 volts applied to a deflecting electrode 
They then strike a beryllium target with an energy 
tipproaching six million volts, or they may pass through 
a very thin platinum window into the air The ions 
used are as a rule those of heavy hydrogen (deuterons) , 
the cyclotron m steady operation gives 7 micro-amperes 
of 5-million-volt deuterons, and the neutron emission 
from a beryllium target bombarded by this deuteron 
beam is equivalent to that which might be produced 
by something over 50 kg of radium m a beryllium 
mixture There are two cyclotrons at present in course 
of construction m this country (for Cambridge and 
Liverpool), and one is also in process of installation 
at McGill University The latter has been made the 
occasion by J S Foster for a paper^ showing the con- 
tacts of the cyclotron with \-ray and radium therapy 
The cyclotron makes available a variety of high-speed 
particles which are not emitted by radio active sub- 
stances found m nature — protons, deuterons, neutrons 
— as well as producing particles which also occur 
naturally (for example, alpha particles) in considerably 
greater number than from a radium source of average 
size Such high-speed particles may be used directly 
for therapeutic purposes (a beginning has already been 
made with electrons and neutrons), or they may be 
used to produce artificially ladio active substances 
In a day’s bombaidment of sodium metal with deuterons 
an amount of radio-sodium having a gamma-ray activity 
equivalent to 200 mg of radium is produced , the end- 
product of radio-sodium is magnesium, and there aie 
a number of aitificial radio active elements which 
similarly lead to harmless end-products It is there- 
fore possible to inject such radio active elements into 
the blood stream, and J C Hamilton and R S Stone- 
have already administered ladio-sodium intravenously 
m the treatment of leukaemia Lawrence has himself 
obtained good results up to date in a case of myeloid 
leukaemia treated by radio-phosphorus When in- 
jected into the body phosphorus is to a large extent 
selectively absorbed into bony tissue it is clear, then, 
that radio-phosphorus will be brought into close 
proximity to the proliferating elements of bone marrow, 
and Its use in the treatment of leukaemia should 
supersede that of radio-sodium There are now more 
radio-active nuclei known than stable ones, so that 
the selective absorption of different elements by different 
tissues opens up wide therapeutic possibilities As 
Piofessor John Beattie pointed out in his first Arris 
and Gale Lecture last week, the discovery of such a 
selective clement for cancer tissue would place a power- 
ful therapeutic agent in our hands The introduction 
of radio active compounds into an organism also makes 
manifest the movement and disposal of the element 
concerned, so that the use of radio active indica- 
tors IS likely to prove of great value in biochemical 
research 

' Citnml neil /Isj J 10V8 38 222 

* 1937, 28 178 


MILK AND NUTRITION 

The first report of the Milk Nutrition Committee, which 
was published some months ago, dealt with the results of 
experiments carried out on rats at the National Institute 
for Research m Dairying at Reading and at the Rowett 
Institute, Aberdeen Careful comparisons were made 
between raw and holder-pasteurized milk, and the con- 
clusion was drawn that the total nutritive value of milk 
foi rats was not significantly diminished by this type 
ot heat treatment The second volume,' now published 
by the committee, records a senes of observations on 
the, effects of adding milk to the dietary of school 
children The observations were carried out on an 
extensive scale m five different areas — Luton, Wolver- 
hampton, Burton-on-Trent, Renfrewshire, and Hudders- 
field In each area the children were divided into four 
groups Group 1 received biscuit with a caloric value 
ot 52 , Group 2 received onc-third of a pint of pasteur- 
ized milk , Group 3, two-thirds of a pint of pasteurized 
milk , and Group 4, two thirds of a pint of raw milk 
In any one area the raw and pasteurized milk came 
from the same source of supply The total number 
of children, who were between 5 and 14 years of age 
amounted to 2,000 m each group The experiment 
was conducted ovci a complete school year Assess 
ment of the state of nutiition was made by physical 
measurements, clinical examination, and certain func- 
tional tests, the children being' examined at three 
monthly intervals The data have not yet been 
completely analysed, and the present report refers 
mainly to the increases m height and weight of 6 099 
children who attended school regularly and were present 
at all four medical examinations The 'general results 
showed that children on a milk supplement increased 
both in height and weight to a greater extent than 
children in the control group on the biscuit supplement, 
and that the children given two-thirds of a pint of milk 
icacted moie favourably than those given only one 
third of a pint The absolute differences however, 
between the average increment of height and weight 
ol the groups given milk and the control group on biscuit 
were very small Comparing, for example, the extreme 
groups — namely, those on biscuit and those on two 
thirds of a pint of milk — they did not amount to more 
than 0 I inch in height during the year or to moic 
than two-thirds of a pound to one pound in weight 
The reasons for this are not known with certainty, but 
it is thought that the total quantity of milk given as 
a supplement was too small to produce any considerable 
increase m growth It may be noted, too, that no 
control was exercised ovci the dietary of the children 
in their homes, and there is some reason to suspect 
that children receiving biscuit in school may have 
received extra milk at home and that children receiving 
milk in school may have had their home ration of 
milk reduced Particular interest attaches to the be- 
haviour of the children on two-thirds of a pint of raw 
and those on two thirds of a pint of pasteurized milk 

> i\filk mil! ^'iilrition Pin II 1 he LfTecIs of DiLtnrv Supp’c 
ments of pTbteunzed ind Rtw Mdk on the Giov.ih nnd IlcTiin ot 
Sehool Children NTtioml In^ititute for Rcscuch m Dur>jni 
Shcnfild Rending Price Is 9d , post free 



Tnr BRtnsn ■^7 
lir caL JotrsiL “ 

In the different age sex and place groups the reaction also the testing of clinical thermometers to the number 
of the children \aried but taking all groups together of some 1 400 dailj One of the pieces of work which 
no significant differences in either height or weight attracted most attention has been done for the Meieoro 
increase could be shown between the children on raw logical Office and tales the form of a short wave ridio 
and those on pasteurized milk It is pointed out that trinsmitter which is sent up in a small balloon The 
the absolute increases were so small that a real differ- changes of pressure and temperature which it encounters 
ence in the nutritional \alue of raw and pasteurized m the upper atmosphere arc indicated bv changes of 

milk mav possiblv have been obscured No definite frequenev in its continuous transmission and these 

evidence however was obtained to suggest the occur- indications arc received and measured on the ground 
rence of this possibihtv The findings in fact arc Not onlv so but a parachute is attached to the 
similar to those which have emerged from a number apparatus so that when the flight is ended bv the 
of evpenments m recent vears on both rats and calves bursting of the balloon the transmitter is retrieved 
ana add further support to the conclusion that holder gcnerallv undamaged Heights up to nine miks have 
pasteunzation has no significant effect on the nutritional been reached with good reception throughout It has 

value of cow s milk for the human subject alvvavs been a matter for surprise that mcteorologv does 

not seem to advance to the same extent as other phvsic il 
sciences As it is we are still at the merev of the 


JoLV 2 I9^S 


MILK AND NUTRlIION 


VJEIV-DAl AT THE N P L 

What is know n as the annual inspection of the National 
Phvsical Laboratory occurred on June 28 when 
visitors were received bv Sir William Bragg President 
of the Roval Societv and by his son Dr W L Bragg 
vvho is director of the Laboratoiy The reception took 
place in the immense hall which houses the million 
volt electrical plant The journalists present before 
being taken on a Press tour of the many buildings in 
which the work of the Laboratorj is earned out were 
handed two documents one prepared for the popular 
press and the other for t)ie technical As the one 
prepared for the popular press contained such terms 
as audio frequenc) modulations iron-cored induc- 
tances and ‘ rotating coil direction finders the ter 
minology of the one prepared for the technical press 
maj be left to the imagination The fact is that such 
highly specialized work as is done at Teddington can 
never be popularlv described It uses and depends 
'upon a language which is foreign not onl> to the man 
in the street but also to workers in scientific fields other 
than phjsics Science can never reallj come down and 
explain itself in simple gospel those who would learn 
its language must first learn its grammar At the same 
time there was a great deal on view which in its 
applications if not m its process was of general interest 
The Laboratorj is at present caro>ng out manv investi 
gations on noise in particular the noise of aircraft and 
of tube trams It has also put up a special double 
vv died building to determine the causes and the nature 
of the noise made bv motor-c)cIes with a view to 
Its anaivsis and reduction Another interesting exhibit 
concerned tooth structure Knowledge is 'still accumu- 
lating about the structure of both diseased and sound 
teeth Photomicrographv radiography and crvstal 
amlvsis are all pressed into this service The exhibits 
showed how the enamel perhaps a millimetre in thick- 
ness has an outer lajer which is more highiv calcified 
than the remainder with less calcified regions at the 
inner and outer boundaries of the dentine The orienta- 
tion of the constituent crvstals which are accessible 
onl> to xriv anaivsis was demonstrated The testing 
Of radium at the Laboratoiy was asalwavs of interest. 


weather and vve cannot even forecast its changes with 
absolute accuraev Perhaps the meteorological balloon 
with the shortwave radio transmitter will usher in t 
new era but for the time being a cautionarv note ha 
to be put in the programme that the demonstration 
of the balloons must be subject to weather conditions 


THE PREVENTION OF INDLSTRIVL 
EliE INJURIES 

An exhibition designed to call attention to the need 
and possibihtv of prevention of industrial eve injuries 
was recentlv arranged at the Rojal E>e Hospital in 
Southwark Part of the exhibition was staged onlv for 
a dav or two but another part is intended to be per 
mnnent and to form at the hospital a museum of pro 
tective devices and graphic instruction The need for 
caution IS brought home bv posters and admirable 
photographic enlargements the different kinds of 
goggles used m grinding riveting welding and other 
occupations also the anti glare and anti dust goggles 
used bv air pilots are shown and finallv the safciv 
measures adopted in well known factones gasworks 
and transport undertakings are presented The pur- 
pose IS to bnng home to the public espeaallv the 
industrial worker the nsl of eve injury which manv 
operations entail and the simplicitv of the means of 
protection— such as goggles or safetv screens — which 
mav be emploved An admirable film bv Kodak Ltd 
has been papared with the same object in view and 
was shown at the opening of the exhibition Jt was 
made in the wards of the hospital and in adjacent 
factories It represents a workman who is supposed to 
have sustained an eve injurv through the neglect of a 
simple precaution and who is taken to the Rojal Eve 
Hospital exammed bv the surgqpn and has a spliiittr 
removed from his eve bv a gnnt magnet Mr J 
Mmion of the hospital staff to whom much vt this 
enterprise is due before showing the fitni it h xed o 
Ihe thousands of prcvi.ntabL aCCiiLni- ivt v v^ t- , 
large economic loss and the fact if 'f f* ‘ f ' 
partial or complete blindness rcsultevl > v -vsv ' 

Act he su wall assist the c''''np ' " s ^ 



28 July 2, 1938 


KEY TO CURRENT LITERATURE 


Tiic Dumsii 
Med cal Iolksal 


and other protective appliances, but only a long and 
continuous campaign of education of workmen will 
bring about a leal diminution of these injuries Another 
task to which the hosjfital is setting itself is the re- 
education of the workman who has lost an eye A 
re-ediication clinic is to be established, so that the 
workman can be taught to adjust himself to his new 
visual perceptions and to estimate distances and heights 
and depths The Earl of Athlone opened the exhibi- 
tion, and in asking him to perform the ceremony Mr 
L V Cargill, chairman of the hospital, said that the 
number of industrial eye accidents to which the hospital 
had to attend reached 7,700 in 1937 Accordingly an 
Industrial Eye Injuries Committee had been set up, 
and one of its first efforts was this exhibition, which 
was intended to bring home to employers and work- 
people in the area of the hospital in South London the 
usefulness of safety devices The staff of the hospital 
are to be congratulated on the active steps they have 
taken Eye hospitals in other localities might follow 
the example set 


LONDON EMERGENCY BED SERVICE 

The object of the Voluntary Hospitals Emergency Bed 
Service, as fully explained in two recent issues of this 
Joumal,^ IS to facilitate the admission to voluntary hos- 
pitals of emergency and acute cases to the mutual advan- 
tage of the patient, the doctor, and the hospital Nearly 
every voluntary hospital within eleven miles of St Paul’s 
Cathedral is co-operating When a medical man has 
an emergency or acute case which he wishes admitted 
to a voluntary hospital he should ring this service (tele- 
phone, Metropolitan 8781) He will then be asked to 
give his name and telephone number, the patient’s name, 
age, and sex, and the diagnosis If he then states to 
which hospital he wishes the patient admitted the 
operatoi will tell him whether there is a bed vacant, 
and if there is will book it for him If there is not he 
will be asked to state his next preference, and so on 
until his requirement is met By this means the practi- 
tioner can ascertain whether there is a free bed at any 
oi all of the hospitals which he may think suitable for 
his patient with the least possible delay In the case 
ot certain hospitals which have undertaken to bear the 
cost of the ambulance it will be possible for the service 
to book an ambulance for him and it is hoped to 
extend this arrangement to cover all hospitals in due 
course The service started on June 21, and is open 
c\ery dav from Sam to 10 p m , Sundays and holidays 
included There is no charge since the cost is being 
met by King Edward’s Hospital Fund for London 
Emphasis should be laid on the point that the service 
!•, intended to deal with acute and emergency cases only, 
and that hospitals must preserve the right to refuse 
to retain m tiieir wards any case admitted thereto under 
this scheme which docs not require immediate medical 
or surgical treatment The office is at 10 Old Jewry, 
E C 2 and the secretary is Mr R E Peers 

British Mir^Uiil Jountnl June 4 p 1221, June 18, p 1325 


KEY TO CURRENT MEDICAL LITERATURE 

The end of the first volume ot the Bntish Medical 
Journal for this year saw the last of the old Epitome, 
which has been a familiar feature to readers for a good 
many years There was no doubt that the Epiiomc 
was widely read and also no doubt that during recent 
years it was read with a certain sense of disappoint- 
ment , it had not fulfilled the bright promise of its 
early youth The growing volume of medical journals 
and the increase of specialism and specialties made 
it impossible to do justice to these m the limited space 
of four, 01 occasionally six, pages of the Journal Nor 
was it possible to do justice to those subjects classified 
m the Epitome The mould in which it was cast was 
too small and did not allow' for expansion In the new 
“ Key to Current Literature,” which appears for the 
first time tins week, we have tried to obviate some of 
these difficulties and to make our weekly survey of 
medical journalism more comprehensive, and so, wc 
hope, more valuable to both tlie specialist and the 
general reader The periodicals received are arranged 
in two groups — general and special — and under the title 
of each appears a list of the oiiginal articles m it, a 
translation being given when they are m a foreign 
language Below the list of titles appear brief abstracts 
of certain selected articles These abstracts arc short 
and factual, and. their purpose is to guide the reader 
to the original article itself They are not intended 
to provide hints and tips for practice, nor to serve as 
a happy hunting ground for the writer ot a short paper 
who wishes to appear learned by adding to it a long 
list of references to ai tides he has not read and is never 
likely to read The new Key is, in fact, meant to be 
a Key, and as such w'lil, we believe, be of value to a 
wide circle of readers 


A general meeting of Fellows ot the Royal Society 
ot Medicine w'lll be held at 1 , Wimpole Street, W , on 
Tuesday, July 19, at 5 30 p m , when the Jenner Medal 
of the Society will be presented to Sir Arthur 
Ncwsholme, K C B , M D 


On the afternoon of Tuesday, Julv 19, Queen Mary 
Will open the new surgical wards and research depart- 
ment of the National Hospital for Diseases of the 
Nervous System, Queen Squaie, London 


The Corporntion of the City of London Ins appointed 
Dr Montagu Travers Morgan as medical officer of Iicallh 
for the Port of London Dr Morgan graduated in 
medicine at the University of Lnerpool m 1912, and is 
at present a medical officer under Ibe Ministry of Hcalih, 
being associated particularly wiih port health administra- 
tion ships sanitation, and the welfare of merchant seamen 
He was formerly county medical officer for Pembroke ind 
county tuberculosis officer for Hertfordshire 



JuL-i 2 1938 


INJURIES IN REGION OF SHOULDER-JOINT 


Ti E S rtrr 
CM. JiS'TlsU. 


'0 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

This IS one of a senes of articles contributed bi inutatioi 


LVJURIES IN THE REGION OF THE 
SHOULDER-JOINT 

I. C4PSULE AND TENDON INJURIES 

BY 

R WATSON-JONES, ill Ch Orth , F R C S 

Shoulder injuries other than fractures and dislocations are 
often misunderstood and indifferentls treated because 
neither the functional importance nor the sulnerabiliti 
of the supraspinatus tendon is recognized The majoriti 
of the painful shoulders of domestic hfe are due to minor 
injury of this tendon and complete rupture though rarely 
diagnosed is a common and disabling industrial accident 
The tendon of the supraspinatus with that of the sub- 
scapularis and of the infraspinatus on either side forms 
a thicL continuous fibrous sheet fused with the underlvmg 
capsule of the shoulder-joint and separated from the 
deltoid and the acromion process by the subdeltoid bursa 
With even abduction movemen't of the shoulder, particu 
larlj through the range of 60 to 120 degrees there is 
impingement and friction of the supraspinatus tendon 
against the acromion process (Figs la lb Ic) It is to 


Supraspinatus Tendinitis 

The svmptoms are often attnbuted to a mino'- st am 
and the patient complains of pain on the outer aspect o' 
the shoulder and over the deltoid insertion It doe> no 
radiate to the elbow and forearm as in brachial n-urii s 
due to cervical osteo arthritis There is tendemC'S on 
pressure accurateU localized to one spot— the great 
tuberositv of the humerus where the sup^aspinatu t-ndcn 
IS inserted Movement is not limited m an> oreciicn but 
there i> an acutelv painful arc ot abduction be'neen 
60 and 120 degrees — the range during which the tender 
area impinges against the margin of the acromion Move 
meni of the limb bv the side is painless Uhen the painful 
arc IS passed the tender region lies protected beneath tnc 
acromion and not in contact wath it and movement is 
again entirelj painless As the arm is brought dov n to 
the Side there is once more sharp pain from 120 to 
60 degrees of abduction Radiographic csamination 'no s 
no abnormalitv 

Dramatic results mav be secured bv injecting ^ to 
10 ccm of 2 per cent novocain into the painful area 
The skin is anaesthetized and the point of the needle is 
introduced into the tendon and capsule Pain is at once 



minimize this friction that the subdeltoid bursa lies 
between the two , structures As vears go on especiall} 
in the case of labouring men accustomed to strenuous 
shoulder exercise the protection of the bursa becomes 
inadequate and the constantlj repeated trauma gives rise 
to degenerative changes in the tendon and capsule The 
fibres undergo wearing and attrition — siipraspinaliis 
tendimns This degenerative process occurring in a 
relativelj avascular tissue mav lead to a calcareous deposit 
— siipraspinaliis calcification The worn and necrotic 
fibres become unusually susceptible to mjurv a simple 
fall or a sudden muscular effort may cause incomplete 
or complete rupture of the siipraspinaliis tendon In the 
more severe cases the tendinous and capsular degeneration 
extends to the bicipital groove and accounts for spon 
taneoiis rupture of the biceps tendon Years of latent 
tendinitis possibly associated vvith a distant toxic focus 
may be lighted up bv a simple strain to culminate in an 
attack of periarthritis with periarticular adhtswn 
formation 


relieved and for the first time the patient is willing to 
move his arm freelv and without caution in all direciions 
He must be warned however that within five or six hours 
as the analgesia passes off pain will recur and mav be 
intensified Morphine mav be necessary The exacerba- 
tion generallv subsides within a few davs and m many 
cases the symptoms are permanentlv relieved Presumably 
the infiltration of the tissues is followed bv an irritative 
reaction causing swelling which tcmporanlj increases the 
effect ot impingement against the acromion and hyper- 
aemia bv which ihe degenerati.d avascular tendon is sub 
sequent/v re^ascuJsnzed ff the symptoms are incom 
pletelv relieved bv the injection diathe-m. and radiant 
heat are of value in encoumging the neccssarv reva'cular 
izalion 

Calcification of the Sup-asjjinatus 

The svmptoms and cl meal signs of sup ,.5p n_it.s clc f 
cation are identical with tho'e of tend ni tv vnhoj* c„lc7 
fication and ihe conditions are to b. di' mguisheJ radio 



30 July 2, 1938 


The DR.rTi«jT 
Medicxl Jolknai 


INJURIES IN REGION OF SHOULDER-JOINT 


graphically The deposit of amorphous calcium carbonate 
and phosphate is of the consistency of tooth-paste and lies 
wholly enclosed within the tendon fibres Its volume ‘so 
increases the degree of impingement against the acromion 
that abduction movement beyond 60 degrees may be far 
too painful to be attempted With large deposits the 
patient- sits and stands with the -arm hanging from the 
shoulder, to increase as far as possible the space between 
the humerus and the acromion , the support of a sling 
may be intolerable 

Whereas simple supraspinatus tendinitis is very common, 
tendinitis with calcification is rarely seen The source of 
the calcareous deposit is the impairment of blood supply 
from preceding tendinitis But the calcareous mass at 
once produces a secondary irritative hyperaemia in the 
adjacent tissues, which may not only cause spontaneous 
absorption of the calcium but also cure the underlying 
tendinitis Small deposits should therefore be treated 
conservatively by diathermy, radiant heat, and massage 
The limb should not be supported m an abduction frame, 
because abduction is the most painful position of the joint 
Active exercises are encouraged as soon as possible 

Large deposits should be removed IhrouglT'a two-inch 
incision The mass is usually too inspissated for removal 
by aspiration The deltoid is split, the subdeltoid bursa is 
incised, and a greyish-yellow mass is seen enclosed within 
the tendinous and capsular fibres The fibres are divided 
m their long axis and the granular paste is evacuated tvilh 
a small spoon There is immediate and complete relief 
from the pam, and full active exercises can be practised 
at once 

' Complete Rupture of the Supraspinatus 

Although there is no doubt that the earlier degenera- 
tive changes of supraspinatus tendinitis predispose to 
rupture of the fibres, complete rupture of the supra- 
spinatus tendon usually follows a definite injury — a fall 
or a severe muscle strain — ^in middle-aged hard-working 
men Occasionally it occurs as a complication of disloca- 



Tio 1— Active abduction bj> the deltoid is only possible it 
the head of the humerus is lixed by the supraspinatus If this 
tendon IS rnpturi-d iieak abduction to 60 degrees by scapular 
movement is all that is possible 

tion of the shoulder or fracture of the upper end of the 
humerus There should be no difficulty in establishing 
the diagnosis, for active movement of the shoulder is 
seriousiv restricted The diagnostic sign is a greater limita- 
tion of active than of passive abduction in the presence 
of a normally contracting deltoid 

The humerus cannot be abducted by the deltoid alone, 
houever powerful it may be, the supraspinatus is an 
essential svnergist Like the workmans mate who stands 
on the boUom rung of a ladder to prevent sliding while 
it IS elevated to (he vertical position, the supraspinatus 
must anchor the head of the humerus to the glenoid to 
provide a fulcrum from which leverage can be obtained by 
ihe deltoid (Fig 21 If the supraspinatus is inactive 
strong contraction of ihe deltoid pushes the head of the 


humerus up towards the acromion and holds it there while 
the scapula rotates Weak abduction to about 60 degrees 
IS possible through scapular movement, but there is no true 
gleno-humeral abduction The more the patient struggles 
to elevate the limb the more he shrugs his shoulder 
Since the deltoid is felt strongly contracting the loss of 
active abduction cannot be due to circumflex palsy, and 
since passive movement of Ihe shoulder by the examiner is 
normal, or at least is possible through a further 30 or 40 
degrees, the limitation cannot be due to” adhesion forma- 
tion or arthritis The wmee of pain at 90 or 100 degrees 
abduction as the limb is raised or lowered passively and 
the tenderness on pressure over the insertion of the supra 
spmatus clinch the diagnosis 
As with any other tendon rupture, if the torn fibres arc 
approximated and immobilized with unfailing constancy 
satisfactory repair will usually take place Operative 
treatment is not as inevitable as many recent writers 
suggest ' The arm is immobilized in 90 degrees abduction 
and 60 degrees external rotation in a frame applied very 
carefully so that the arm cannot ever be lowered below 
the right angle At least ten or a dozen wide bandages 
must be used to fix the frame to the trunk and to prevent 
It sliding down The position is maintained rigorously 



Fig 3 — Complete nipUirc of supnspimlus tendon and the 
capsule The articular cartilage of the humerus and the biccps 
tendon arc visible through the rent 

for at least eight to ten weeks and until the arm can be 
raised actively and held 20 or 30 degrees above the right 
angle Throughout this time active exercises arc prac- 
tised for the-fingers and wrist- and elbow-joinis 
Conservative treatment cannot be really successful 
unless it IS instituted promptly within a few days of the 
rupture If there has been delay m establishing the diag- 
nosis, or if there is doubt whether the frame treatment 
wifi be earned out with absolute efficiency, operation is 
to be preferred Fairly satisfactory results arc possible 
even many months after injury Through an anterior 
split deltoid incision the triangular-shaped rent in the 
tendinous expansion and capsule is exposed, with the 
articular surface of the head of the humerus msidIc 
through It (Fig 3) The apex of the triangle is the 



JULI 2, I93S INJURIES IN REGION OF SITOULDER-JOINT 


retracted supnspmatus tendon the base is the great 
tuberosity from which it has been avulsed The humerus 
IS moderatel} abducted to approximate the torn fibres and 
^eseral mattress sutures of No 6 chromic gut are 
emplojed A ‘ bone needle should be used and the 
stitches passed through the tuberositj itself, so that cutting 
out from the short distal fibres is asoided An abduction 
frame is worn to prevent earlv strain on the sutures and 
IS retained for several weeks, until the patient can easily 
lift the arm and hold it 20 or 30 degrees above the right 
angle If in addition to the tendinous rupture there is 
adhesion formation limiting the terminal degrees of 
abduction, this movement must be regained b> the 
'patients own active exercises, repeated many times during 
the day 

Incomplete Rupture of Supraspmatus 

Between the case of simple supraspmatus tendinitis and 
that of complete rupture of the tendon there is a whole 
range of cases of varying degree of incomplete rupture of 
the tendon fibres These are the cases which may present 
difficulty in diagnosis and treatment Although common 
they are more often overlooked than diagnosed and there 
IS no doubt that the victims suffering has frequently been 
increased by an unjust charge of malingering Evidence 
of incomplete rupture may be found during routine 
necropsies in no less than 30 per cent of all cadavers 
Radiographic examination is negative and the clinical 
features are all important 

There is pain over the shoulder, often referred along the 
circumflex nerve to the region of the insertion of the 
deltoid this is increased by active use Tenderness is 
localized to the insertion of the tendon at the great 
tuberosity Active abduction is probablv possible through 
a normal range but there is the characteristic catch of 
pain at 90 or 100 degrees as the torn fibres pass the 
acromion The movement cannot be sustained against 
resistance As the rupture becomes more complete active 
abduction becomes increasingly difficult It may onlv be 
possible to abduct the humerus if it is first fid/} externally 
rotated There is a characteristic reversal of scapulo- 
humeral rhythm Vi'hereas normally the first halt of 
abduction movement is mainly a movement of the 
humerus on the scapula and the movement of the scapula 
on the chest-wall is most pronounced during the second 
half of the range in the case of incomplete rupture of the 
supraspmatus the movement is initiated by rotation of the 
scapula and humero scapular movement is most pro- 
nounced m the second half of the range 

Conservative measures should usually be given a tnal 
The shoulder is immobilized in abduction and external 
rotation The frame is retained and no single downward 
movement of the limb is permitted until full power of 
abducUon is restored and the painful catch at 90 or 
100 degrees abduction is relieved This mav necessitate 
fixation for only three or four weeks or in more severe 
cases for several months If there is no sign of real 
improvement after six or eight weeks the tendon should 
be exposed and repaired 

If at operation there is no evidence of rupture of the 
supraspmatus the humerus should be fully rotated inwards 
and outwards so that the whole of the front outer aspect 
of the capsule and of the subdeltoid bursa is explored 
Occasionallv thickened hvperaemic fringes are found 
within the bursa which have accounted for creaking on 
shoulder movement and because thcv are nipped between 
the head of the humerus and the acromion for all of the 
symiptoms and signs of incomplete rupture of the supra 


'Lit CA- JOVK k- 


spmatus tendon Although subdeltoid bursitis has be^- 
a common diagnosis in past vears it is actu-’llv ext errelv 
rare The svmploms are relieved fav excision ot t>-- 
thickened fringes and bursal wall followed bv regu ^r 
aciive exercises and phv siotherapv \erv excep lorail 
It IS found that there is neither rupture of the tendon nor 
calcification of the tendon nor subdeltoid bursuis The 
symptoms have been due to resistant supmspinatus tendi" 
itis without rupture The tendon should be Iightiv 
scarified to assist in the revascularization necessan lo' tn. 
relief of simproms after operation phvsiotherapj and 
electrotherapy are employed . 

Penarllintis of the Shoulder 

The symptoms arise spontaneouslv o' alter a triv al 
twist or strain Pam is diffuse and tenderness is not con- 
fined to the tuberosity or region ot the supraspmatus 
Movements of the shoulder are guarded bv muscle spasm 
but there is no complete limitauon of all 'capulo hume al 
movement such as occurs in tuberculous arthritis It is 
particularly abduction and external rotation which a c 
limited internal rotatton and forward and b^cl ward 
flexion are free The limitation of movement bv truscL 
guard rapidly passes to limitation bv adhesion forma ion 
varvmg from a few localized hands to diffuse generalized 
adhesion of the whole of the capsule — the frozen 
shoulder 

In the earlv acute stage the worst treatment is mampu 
lation under anaesthesia or frequent passive and forcible 
stretching bv a masseuse Forcible treatment tears the 
alreadv inflamed tissues and increases the sero fibrinous 
exudauon It the range is actuallv measured and recorded 
It IS found alwavs to have been reduced bv <uch measures 
On the other hand the patient must be urged to practise 
active exercises Massage phvsiolherapy and hvdm- 
therapy mav help the patient to persevere despite dis 
comfort but the one essential treatment is active exe cis. 
performed for a few minutes hourly througnout the d->v 
The resistance of gravitv mav be avoided bv practising 
exercises in recumbenev and m the stooping position 

Penarttcular kdhesion Formation 

The adhesions mav follow periarthritis or a simple strain 
or contusion of the shoulder or thev mav arise msidiouslv 
when a fracture of the elbow forearm or wrist is treated 
with the whole limb in a sling Abduction and exiernal 
rotation movements are limited It is the limitation of 
external rotation which is of significance The normal 
shoulder cannot be abducted bevond the nghl angle if 
the humerus is held internally rotated and until externa! 
rotation movement is regained abduction cannot be re 
gained The range of rotation is tesied with the elbow 
to the side and the forearm and hand pointing forwards 
Normallv it is possible to rotate the limb out through 
almost 90 degrees so that the torearm and hand now 
point sidewavs If this is completely limited jl is a waste 
of time lo practise abduction exercises The palient 
should stand with bis back lo a wall with his cibo vs 
touching It and turn the forearms further and further out 
until the hands reach ihe wall He must trv o reach ihe 
back of his neck and »ilh ihe fingers clasp-d move Ihe 
elbows back into the position of true atdiic ion /'v 
external rotation improves he reaches ove' lop e f v 
head to the oppo itc car He nav then p act se era i -c 
up a wall wi h his fingertip man ing the Lvt' re c -d 
and Irving to atiain a higher level everv da 

The exercues arc repealed len minuics heu 1 ” i-*" 

out the dav There musi be encouraceme"! s'--- 



32 JuL\ 2 1938 


RED CROSS CONFERENCE 


TueBrituu 
Medica-U Journal 


tion, but no passive stretching no sudden jerking or 
forcible movements, and no hanging by the affected arm 
from overhead beams or bars Manipulation under anaes- 
thesia should not be used except as the last line of treat- 
ment, to be applied only when actual measurements show 
that movement is no longei increasing If a manipulation 
IS unfortunately inevitable, it must be performed as gently 
as possible and not more than one group of adhesions 
must be broken at a time If too much is done the 
reaction is so severe that the movement cannot be retained, 
and the joint may become stiller Many shoulders, tem- 
porarily stiff after dislocations and minor injuries, have 
been made permanently stiff by injudicious manipulations, 
performed too early, repeated too often, and followed by 
passive and forcible stretching 


THE RED CROSS CONFERENCE 

CONCLUDING SESSIONS 

After the opening proceedings recorded in the last issue 
(p 1381) the International Red Cross Conference divided 
Itself into four Commissions, which met at the British 
Medical Association House for sessions lasting for three 
days At the ensuing plenary session, which was held at 
St James s Palace on June 24, reports from the Com- 
missions were piesented 

The first Commission of which Miss Norah Hill (Indian 
Red Cross) was rapporteur, brought forward a series of 
resolutions dealing with organization, all o£ which were 
passed unanimously by the Conference with one exception 
— namely, a resolution asking that the needs of the two 
international bodies, the International Red Cross Com- 
mittee and the League of Red Cross Societies, should be 
studied with a view to suggesting the best procedure for 
raising the funds necessary to meet as far as possible the 
needs of both bodies The German Red Cross asked mat 
Its abstention might be recorded for reasons presumably 
given in private to the Commission Another resolution 
which was only cairied by a majority in the Commis^on 
but unanimously in the Confeience declared that no Red 
Cross delegation, section or committee should be estab- 
lished in foreign territory without the consent of the 
central committee of the national society of the country 
concerned, and that such consent should only be asked for 
m exceptional circumstances, for purposes definitely deter- 
mined in advance, and for a limited period 


Zones of Immunitj 

After two hours discussion on the form of a resolution 
it was agreed unanimously, on the motion of Mr Norman 
Daxis to appeal in the name of humanity to the comp^ t 
authorities in all countries to prevent or so 
from the air as to safeguard the lives of helpless women 
and children and aged civilians and to urge those autho- 
rities in all areas where civilian lives are liable to be 
endangered by anv militaiy operations to arrange for the 
e\'\cuation oC women and children into zones oi immunuy 
under Red Cross protection This was the unanimous 
icsolution of the fitty-four National Red Cross Societies 
assembled at the Conference, and was endorsed by the 
Conference also unanimouslv at the plenary session 
The second Commission which was entrusted vvith legal 
considerations, and was reported upon by M Gorge 
(Switzerland! also brought forward a resolution on me 
subject of the ere uion of hospital towns and areas Alter 
thanking the committee of the International Congresses 
of Military Medicine and Pharmacy for the assistance it 
hid given the Commission considered that in any case the 
creilion of hospital towns or areas could not in anv way 
vveiken the protection resulting from the rules of inter- 
national law as a whole and urged the convocation m 


the neai future of a commission of military and legal 
experts with a view to establishing a draft on the subject 
for the consideration of a diplomatic conference In the 
meanwhile it hoped that the Governments would consider 
as need arose the possibility of concluding mutual agree- 
ments providing for hospital towns and areas This was 
agreed to unanimously by the mam conference Another 
resolution pointed to the satisfactory results obtained 
during a recent conflict by the creation of an area of 
immunity for the civil population, and requested the 
International Committee to bring these satisfactory results 
to the attention of the Governments concerned at all 
times when such action might seem expedient Ollier 
resolutions related to the protection of women and children 
against the suftenng resulting from aimed conflicts, and' 
the role and activity of the Red Cross in civil war 


First-aid- Posts on Highways 

One resolution of the third Commission, reported on by 
Di de Carvalho (Brazilian Red Cross) urged that every 
effort be made to develop collaboration with automobile 
clubs and other national and international organizations 
with a view to providing highways and, more especially, 
the international trunlr roads with standardized types of 
first-aid posts, the position of which may be shown by 
standardized road signs It also recommended to the 
secretariat of the League of Red Cross Societies that the 
development of first-aid services on highways on a 
standardized plan should continue to be encouraged and 
the scope of its activities in the prevention of accidents 
be widened, in the first place by teaching the rules of the 
road and first aid to children through the junior Red Cross 
This Commission also noted the great progress made m 
the use of aviation to bring relief m cases of disaster to 
establish communication with isolated populations, to 
bung supplies of food and medicine to further the trnns 
port of doctors, nurses, and relief personnel and to 
evacuate the sick and wounded ' It asked that the national 
societies should attempt to organize courses of training m 
aerial transport, and that the use of aviation for relict 
purposes be encouraged 

The fourth Commission the work of which was reported 
by Miss Mabel Boardman (American Red Cross), dealt 
principally with the educational work of the Red Cross 
One of its resolutions congratulated the American Red 
Cross 6n the splendid organization of its voluntary aids, 
and recommended that all Red Cross Societies should 
extend their activity in this field both as a particularly 
beneficial means of action and as a means of spreading 
the Red Cross spirit throughout the community 


Iflie Next International Conference 

It was decided that the next International Conference 
should be held at Stockholm in 1942 The following were 
elected a committee to act in the interval between inter- 
national conferences 

Sir Arthur Stanlev (British Red Cross Society) 
General A Hulikrantz (Swedish Red Cross) 

Senator G de Michelis (Italian Red Cross) 

Chao Phva Bijavanati (Siamese Red Cross) 

Dr Pedro T Vignau (Argentine Red Cross) 

A large number of complimentary speeches were made 
by members of the Siamese, Polish, Japanese, Chilian 
French and Egyptian delegations among otlicrs, sPf J 

thanks were accorded to the British Red Cross Society 
actinc as host A representative of Nationalist Spam con 
grltufated the chairmL (Sir Arthur Stanley) on the m inner 
m which he had kept the Conference away from poh icai 
questions Senator de M.chehs (Italian Cross) n adv 
a tone statement on Italian law which, he said, pr 
?o! Th® “on or sntcly zone, fo, mod,c»l STVicc, »nd 
sheller for the civil populalion nlso 
to be dealt vvith according to international rcgul 
men m the case of a country which had not honoured the 
international Convention 



JuL\ 2 ms 


ANTI EPIDEMIC WORK IN CHINA 


Tk»- E rMri 

Ci-. JOVTfVil. 


In the course of the v%eek a reception was gnen b\ 
HM Gorernment at Lancaster House another b\ the 
Lord Ma\or at the Guilohall and an afternoon parts at 
Buckingham Palace The closing e\ent was a thanksgising 
service at St Pauls, when the Archbishop of Canterburj 
ga\e the address HRH the Princess Rojal Com- 
mandant in-Chief British Red Cross Societs was present 
svith parties of VA D members representing etert countv 
branch in England and Wales and Scotland The Red 
Cross Colour was escorted b\ a represeniatise companv 
of commandants and was laid on the altar dunng the 
sertice and attensaros taken to the Chapel of St Michael 
and St George The Lord Mas or rnd Sheriffs also 
attended the serrice In the course of his sermon the 
Archbishop said that if he were to choose a motto for 
the Red Cross mosement not onI> to describe but to 
inspire its work it would be the injunction of the apostle 
Honour all men It stood for the honour of humaniiv 


ANTI-EPIDEmC WORK IN CffiNA 

The Council of the League of Nations some \ears ago 
concluded an agreement with the Chinese Government 
by which the League technical organizations (health, 
traosit -and communications economic and fwanciai) 
couM be used to help forward ns policies of national 
reconstruction Political and administrative responsibility 
of course rested with the Chinese Government m the vast 
enierpnse of trying to reconstruct one quarter of humamtv 
and modernize a 4 000-\ ear-old cmlization But under 
the plan of technical co operation Chinese civil servants, 
engineers doctors educationists and technicians have been 
able to gam experience and pursue studies abroad useful 
for their work Side bv side with this the League has 
put at the disposal of the Chinese Government the 
services of foreign experts either for consultation m 
regard to" some particular piece of reconstructive work 
or for a period of vears, to give technical advice for the 
framing and application of some long range policv such 
as road bu Idmg modernizing silk cultivation, organizing 
agricultural co operation, and establishing the nucleus of a 
public health service 

Effect of AVar 

With the beginning of the Japanese invasion the Chinese 
Governments national effort was switched over to putting' and 
maintaining China on a war footing From (he outset of the 
military operations one of the most pressing problems was the 
care of refugeei* and the danger of epidemics The National 
Health Ministrv and the Central Field Health Station at 
Nanking were wrecked bv 'iir bombing at the beginning of 
the war China s «canty resources m medical personnel and 
equipment v\ere strained to the utmost bv the needs of the 
Army At the same time the invasion of large areas of China 
“and the devastation of numerous aties and villages set up great 
movements of population Immense numbers of refugees 
destitute and fleeing for their Iive^ became an urgent and 
grave problem for the Chinese Government, and even for 
neighbounng temlories not least from the point of view of 
public healib 

In September last the Chinese Government drew the atten- 
tion of the Council of the League to this situation and to the 
resulting danger of widespread epidemics It requested that 
the plan of technical co-operation between China and the 
League should be adapted to this situation bv concentrating 
pnmanlv upon co-operation with the National Government 
and the provincial administration^ in the prevcniion and 
control of epidemics and ;he general relief of the civilian 
population and refugees The Assemblv voted 2 000 000 Swiss 
francs for technical co operation wuh the Chinese Governrr'*nt 
in carrvmgTjut an anti epidemic campaign Acting on mstruc 
tions from the Council a special subcommittee of the Health 
Committee met in October to frame a plan of action 


The Health Committee s Pbn 

At this meeting the Chine e repre eniative Dr Hco 
tsai said that the Chinese Government ccnPning its rcqc" ^ 
vvjthm the financial and technical limits of the A 
resolution asked the Health Organization to make a pcvj^I 
ePbrl m five areas prefemblv m the provircei. of i 
Hupei kiangsu kiangsi and kwang Tung He a ked tn-t 
anil epidemic units should be sent to the e '>reas v iihout d'’! ^ 
Each unit should consist ot a foreign epidemic commi s o*" ' 
a toreiga hactenologist a foreign anitarv engineer an i a'z 
tion hospital with a foreign doctor a car two ambulance*: ard 
ten light lorries The^e units would operate under the o ders 
of the Chinese auihonties Dr Hoo emphasized the Lr^eri 
need for rapid action As a result of the war hundred u 
thousands of refugees were streaming inland The di-irt ^ 
and the danger of widespread epidemics vvere great Xledical 
Mocks were running low Available -supplies from *.11 ourecs 
Would last barelv three monlh« All available health per^^onn-l 
had been mobilized, but there was a shortage of expenerced 
<urgeons 

The subcommittee had before it a survev oi the epidcniv. 
situation the probable effects ot miluarv operations and the 
movements of refugees with special reference to the danger ct 
Widespread epidemics of plague tvphus '^majl pox enter e 
fever and other infectious disea e«« The plan .-dopted vva«; 
based on prcMous evper/enre adapted to ^un the ^peti^l ton 
dition« In Mew of. the financial and technical hmiiwi ens 
imposed bv the As'emblv and Council resolution il vv*is 
decided that the work mu«t be limned as reprds geographical 
area and methodc though not stricih limited to one region 
The Chinese auihonties ihem<elve> would a<«ume re^ponnbil tv 
for the work being earned out 

The technical plan had as its one object the remforeentnt 
of the collaboration alreadv evi tine in view ot the excep 
lional circumstances ot the hour m other word to cdvi c 
and support the competent Chinese technical «erMce< Thw 
subcommittee decided to constiime three mobile rrcdical units 
and lo assign an area of action to each The c units m 
addition to their own re<ource would draw upon a ten rul 
supplv of 'anitary and medical material TTiis enabled t*'cn 
to secure additional supplies for organizing on the spot iht 
means for the isolation and observation of the sick In inis 
wav it was believed a general organizaTlon could be ^et up 
that would be elastic and mobile in action and around which 
the Chinese health auihonties could m agreement with the 
units concentrate their own medical and health 'enice« s 
well as any units that might be <ent from abroad (Red Cro«« 
etc ) The whole organization could then work on the ba^i"; of 
1 considered plan adapted to the area and to current necec 
sitie«: and concern Jl«elf not onlv with preventive mea<ufe^ 
but also with combating epidemics that had alreadv started 

The League Epidemic Commission 

The three medical units — the first under Dr Xfoo cr (Swi‘0 
the «:econd under Dr R C Robertson (Bnti h) and the third 
under Dr (In^pecteur Genera!) La«nei (French) — am cd in 
Hong kong earlv in Januarv The Epidemic Commu ion 
consists of the three Commissioner^ together with i repre 
senlaUve of the Chinese Government ard Dr Borcic (A ugo 
slavia) the League of Nations Technical Advicer on public 
health queMions to the Chinese Government 

Subsequentiv the epidemic po ilion in China wa^ di«cu«<ed 
The future location of the League units was dended upon 
and the laboratorv and other medical facihuc'- alreadv ews mg 
m the areas covered transport budgetarv cueNtion and details 
of the liaison to be cMabli h-d with the Chinese Government 
were alt considered No 1 Lnii went b roll through fLnlo 
lo Sian Fu capital of Sben i No 2 Lnil to Ch-ni: b- capi’-I 

of Hunan and No " Lnit to N^rrinc cap: al of k va-'c » "d 

to Canton Eirlv m Februan. all three unit h d rca 
their station established hcadquartc s ^nd wc e c^c •' d m 
making ofiicial contac s In each tb" i ' 

Chine e medical 4ind auvj! ar v as m o po ’ 

local health administration ard ui I'-c -me ti~'c cj 



34 July 2, 1938 


OPENING OF NEW PATHOLOGICAL BLOCK AT GUY S 


' TncBRiTisif 
MCDICAL JOURV41 


close touch with the Centnl Government through a special 
Chinese liaison officer In this collaboration e\er^ effort has 
been made to meet present emergencies and also to strengthen 
and where necessary establish permanent health work particu- 
larlj m rural districts It is hoped that the present League 
assistance to China will not simplv be of a temporary nature 
but will serse to continue the medical assistance given prioi to 
hostilities and thus be a permanent contribution to China s 
welfare , t 

An account of what has been attempted and done in certain 
areas b> the emergency health services appeared in the Biilisli 
Medical Jountal of June 4 (p 1222) 


GUY’S HOSPITAL 

OPENING OF NEW PATHOLOGICAL BLOCK 

The new Pathological Building of the Medical School of 
Guy s Hospital was opened on June 23 by the Earl of 
Athlone, Chancellor of the University of London It is 
a handsome building of eight floors, housing in addition 
to pathology, the departments of bacteriology, clinical 
chemistry, pharmacology and physics To bring about 
these impiovements the School has expended the very large 
sum of over £85 000 Of this sum it has provided £35,000 
out of its own income , £30,000 has been boi rowed on easy 
terms from a friend of the hospital, and £10 000 has been 
made available by the munificence ol the University 
^ The Chancellor was received by the Vice-Chancellor, 
Sir Robert Pickard, Viscount Goschen, president of the 
hospital. Viscount Nuffield treasurer, and Mr T J Evans, 
dean Certain of the goveinors and medical staff were 
piesented, and a procession was formed to the physiological 
lecture theatre, where the formal proceedings took place 
After Lord Nuffield had welcomed the Chancellor, the 
Dean gave an address in the course of which he said that 
the School felt that by coming to open this latest extension 
Loid Athlone was giving his commendation to its attempt 
to met ease the teaching and research strength of the great 
unnersity of which he was the head 

A Teaching Hospitals Giea^ Effort 

The teaching hospitals of London (the Dean continued) 
had giown out of small beginnings, within houses built 
for the care and cuie of a neighbouring population, but 
they had become the training ground for tli€ medical 
service of a whole nation To day the small hospital 
founded by Thomas Guy in 1725 had sons in every corner 
of the Empiie Unhappily now the very existence of 
teaching hospitals was in imminent dangei It was one 
of the queerest anomalies of British civilization that the 
training of the most important and devoted of its public 
services should be hampered at every stage by being com- 
mitted to an existence of perpetual mendicancy Guys 
had accomplished an effort not only to bring to higher 
efficiency the mechanism for training physicians and 
suigeons, but also to provide more modern and abundant 
tacihties for skilled, researchers into the cause, control, 
and cure of disease When, in 1923, the present superin- 
tendent of the hospital welcomed the then Prince of Wales 
at an opening ceremon> he stated that the occasion marked 
the completion of a scheme of rebuilding of the medical 
school In the preceding twenty-five years the School had 
spent £100 000 on rebuilding Now, after another fourteen 
years it had again grown dissatisfied and had made a 
V iliant effort to provide itself with an institute of pathology 
as spacious and up to date as any in the kingdom 

Advantages of Concentration 

The Chancellor of the University began by recalling the 
fimoiis names of Bright Hodgkin Wilks and others 
founders of the great tradition in scientific medicine which 
the hospital so worthily maintained The University 
viewed with great satisfaction even effort made by its 
constituent schools to provide themselves with buildings 


adequate to the needs of students and teachers It was 
specially proud of the strength and size of its faculty of 
medicine Its schools tiained nearly half the medicrl 
students of Great Britain He congratulated Guys on 
concentrating all the departments of the school on one 
site thereby obtaining that close co operation between 
departments which was necessary for the best work He 
was also glad to' learn that special accommodation had 
been provided for the Guy s Hospital Research Fellow and 
for the Clinical Research Unit of the Medical Research 
Council The establishment of such research units was the 
sign of a new age in the scientific study of human disease 
The University recognized with appreciation that the new 
building had been financed mainly from the ordinal y funds 
of the school without public appeal, though with some 
assistance from the Court of the University He hoped 
that the example of famous benefactors of the past would 
be followed in the future , 

School and Hospital 

The medical school and the hospital (Loid Athlone con 
tinned) were inseparably wedded A medical school with 
out a hospital was useless and impotent The association 
of a school with a hospital at once placed the hospital in 
a higher category Not only did it then attract teachers 
of the highest standing but the presence of a body of 
students ensured that the teachers, stimulated by'constant 
criticism and observation, gave of their best to both the 
science and the art of medicine The reputation of the 
hospital depended on its school and the reputation of the 
school depended on the financial stability and efficiency 
of the hospital For the full fruition of the partnership 
It was therefore essential that both hospital and school 
should be efficient, progressive, and equipped to the highest 
standaids The charitable public perhaps did not always 
quite appreciate the exceptional claims of the teaching 
hospitals Their vvoik went fat beyond the mere local 
treatment of patients They were the training grounds of 
the medical profession, the homes of research, and the 
pioneers in benefactions not only to their own patients 
but to humanity at large 

The Chancellor then declaied the new building open 
The chairman of the School council Mr W M Mollison 
in proposing a vole of thanks, said that for the last six 
years Lord Athlone had been Cliancellor of the University 
and he was convinced that no university had a more active 
and hard-working head He dev'oted a great deal of his 
time and energies to the interests of the University and was 
familiar with the medical schools 


VICTOR HORSLEY MEMORIAL LECTURE 

The Victor Horsley Memorial Fund, which was raised 
m 1920 to commemorate the services of Sir Victor Horsley 
to Science and the Empire, is devoted to the giving 
of a lecture triennially in London entitled the “Victor 
Horsley Memorial Lecture ’ By invitation of the Truslees 
(the Presidents for the time being of the Royal Society, 
the Royal College of Surgeons of England, and the British 
Medical Association, the senior physician of the National 
Hospital for the Paralysed and Epileptic, Queen Square, 
the senior surgeon of University College Hospital, and 
Mr Stanley G Robinson, son in-Jaw of Sir Victor 
Horsley) the sixth lecture will be delivered by Dr Gordon 
Holmes, CMG, CBE, FRS, FRCP, Physiciin,, 
National Hospital for Nervous Diseases and Charing 
Cross Hospital, in the Lecture Theatre of University 
College Hospital Medical School, Gower Street, WC 
on Tuesday, July 12, at 5 pm The title of the lecture 
is “The Cerebral Integration of the Ocular Movements 
and the chair will be taken by Sir Cutbbert Wallace B1 
KCMG, CB, DSc, DCL, President of the Royal 
College of Surgeons Admission to the lecture is free on 
presentation of a visiting card and tea will be sened 
in the Library of the Medical School at 4 30 pm 



Juu 2, I93S 


INDIA. 


Tks 


INTERNATIONAL SOCIETY OF SLRGERT 

RcMSeri Plans for Congress 

For some reason \shich has not jet been explained the 
German authorities hare cancelled the congress which had 
been fixed to take place in Vienna from September 19 to 22 
and was announced in the Journal of June 4 (p 1219) 

In order that the material prepared for the discussions 
which had already been arranged mar not be rrasled and 
to dinvinish disappointment the executire are making plans to 
hold a congress in Brussels on the same dates Particulars will 
be circulated to members as soon as possible Trarel 
arrangements rnll be made br Messrs Thos Cook and Sons 


Local News 


INDIA 

Tuberculosis A Kcr Problem of India 

A lecture under the auspices of the Orer seas League 
and the East India Association was giren at Orer Seas 
House, London on June 21 bj Major General Sir John 
Megarv, President India Office Medical Board and 
Medical Adriser to the Secretary of State The chair 
rvas taken bv the Marchioness of Linlithgow Vice-Reme 
01 India Sir John Megaw rvhose subject was Tuber- 
culosis in India,’ said that nobodr could tell, eren 
approvtmatelj rvhat rras the death rate from tuberculosis 
in India as a whole or describe the geographical d'str 
bution of the disease, or sar to rrhat extent it rras 
increasing In the cities and large tors ns the deaths from 
tuberculosis rvere recorded in Carvnpore the latest figure 
rras 4 600 per million ot population or much the same 
as it rvas in England one hundred rears ago in Calcutta 
it rvas 2 500 and in Bombay 2,000 These rates probabU 
erred greatly on the side of optimism since manr deaths 
from tuberculosis were returned under the headings ot 
ferers or other respiratory diseases The death 
rate from tuberculosis among girls and young women 
rvho bred in purdah in the large centres of population rras 
appalling being sereral times higher than that of males 
of the same age group 

IXCREASINO INCIDENCE OF TEBERCCLOSIS 

Medical men m India, Sir John Megaw continued 
rvere almost unanimous m declaring that the disease rras 
increasing rapidh, and rv-is extending^ to rural areas 
formerly free from infection also that rrhen the disease 
spread to new localities it assumed a more rirulent form 
than m places preriously affected A few rears ago 
he had attempted to make a rough and reads survey of 
the number ot cases of tuberculosis and other diseases 
m the rural areas of India His method rras to issue a 
questionarr to a large number of doctors m charge of 
dispensaries m typical agricultural Milages An estimate 
based on their replies suggested that there we'e U to 2 
million cases m India though not even a moderate degree 
of accuracy was claimed for this estimate An examina 
tion had also been made of the statistics published ererr 
year on the health of prisoners From these it appeared 
that m 1935 the admission rate for tuberculosis of the 
lung m prisons was 5 per mille as compared with '5 
forty rears ago Not much encouragement was to be 
derived from this slight reduction for over ihe same period 
the general health of prisoners had impro'ed in a 
striking manner as shown br the fall in the total death 
rale to between one half and one third of what it was in 
IS9s During Ihe same period of fortr years the number 
of cases ot tiiberculosis of the lung in Indian soldiers fell 
from 2 3 per miUe to 1 9 this small reducuon again 


contrasting sharply with a fa'l m the death ra'e frem a'i 
diseases in Indian troons trom 11 6 to 2 15 and r m a. 
fall tn the mterculosis case rate ot Bntiifa soidiyTs n 
India during the same period from 4 g to 1 per mine 

rtErSUSEs FOR PREVENTION 

The spread ot infection m India uou'd onh b p r 
rented hr a process ot educational persuasion Tr-- 
people must be taught ho droplet and alim"n,,. r 
tections were conveyed and how they cou'd be ar,. urj 
It rras important not to lar unace tmpha'iv on r. 
horrific aspects of the disease There rras much o b- 
said for directing propaganda against all nit,, a ur 
diseases of the resp ratorr and alimentary sy Iem^ 
than against tuberculosis alone Suitable arn-mTi^ da rn 
in a verandah or open lean to could be p o o a 
patient at trifling cost at anr rale m ural „ ras _nd a 
member of the patient s family could be rained to ioos 
after him From ten to twenty patients sould be treated 
m their own homes for the cost of a single p_tient in 
a modem sana.orium The fi'st essen lal m p-ereno o 
measures was to hare a sound plan mis demanded h- 
CO operation of men with practical knowledge o m ' 
.ure industry economics hrgiene educat on and abort 
all, of men with a sympathetic understand n^ ot he 
psychology of the Indian peasant The'e wt t t" 
touraging signs that those responsible tor the wtltatt t 
India realized the nature and graritr oi the p'ob em ..nj 
the responsibility of the Goremment tor m tiatmg aLtion 
On Ihe subject of medical relief Sir John \Iegaw aadtd 
that m India there were rerr special reasons for supply 
medical aid to the victims of the disease the chief b 
that before anr prerentire acuon touid ha i i hope o 
success the good will of ibt people must b. enli ltd br me 
cure of disease Tuberculosis was a lev p oblem o* 
India and its solution rrou'o mean tar mt e than tne 
conquest of one terrible maladr He peti„llr prais.d 
the efforts made br Ladr Linlithgow tor tht rtUit o' 
sufietmg 

Population of the Pumab 

The continuing increase m the population ot th. Pen ab 
IS giving rise to tonsiderable cisquiet -eritus etint" t 
and pubic health prcbieirs rrill hart to be rat.d e'esi 
the birth rate soon begins to fall In his -nniial report 
for 1936 Lieutenant-Colnnel C M Nicol Direcmr o' 
Public Health states that for the last five '^rs there h„s 
been an average re<.rlr increase in population ot 419 27 n 
a figure which is almost certain'r an under-esumaic of ,h 
actual position since in i9..6 the figure was S'- 
representing a natural increase per 1 oJb ct popnlaticn o, 
21 t 6 calculated on the estimated population tor 19 is 
this rate of increase is much higher than Ihe comesnord 
mg rate for anr other Province in India While ih^ binli 
rate per 1 000 is 44 the highest or record the correspond 
ina death rate IS 22 the lowest figure ret recorded It car 
nol be determined ret whether this state of ih ngs is a rra, cr 
for congratulation or for alarm or how the future w )1 
develop since the factors which make for increase in the 
population are not constant and the estimates ot foed 
production probably are too low ii is e’ear howe er that 
careful consideral on of the whole position is new urgent!, 
necessary AA'heat nee and maize are the staple fooii- 
sluffs m the Punjab ard all the crops hare increased 
vast new areas are feeing brought under cuitirciion 
thanks to the extension of irrigation Lnfc tunatcl 
horrerer these already txidence ot phxs cal detertora- 
tion of ihe nsing ceneralion in the Pro incc as sho rn b 
the examinations ot school child'en ana of recrui s fer 
the Army Of the total deaths in the Punjab i" 1926 
s097 per cent cccu'rea in infants under 1 rea- 17 1 in 
ch'ld'en aged between 1 and a and 5 44 m ch 'd en b; w^en 
the Tges of N ard 10 — that is lO sar s3 'V pt' cen' o*’ ''t 
total deaths m the Prorirce occurred n p.'se-s u-der 
10 vears The mfanule monaUtr nte for the rear urder 
rerierr rras ]sS44, slightly higher than the liCa c fc 


36 July 2, 1938 


F-NGLAND AND WALES 


The British 

NfEDlCAL JoURSAL 


1935, but well below the average for the last ten years 
Colonel Nicol remarks that it might be argued that there 
cannot be a great deaL wrong with a community which can 
show in comparison with past years a record low death 
rate and high birth rate, a larger annual increase in popu- 
lation than has ever been known previously, and a reduc 
tion in the incidence of plague sufficient to suggest that 
the disease is dying out Yet it still remains true that the 
odds against any individual born ever reaching the adult 
state are high, and the damage done b'y non-fatal illness 
to the youth of the Province is painfully clear though 
in these respects there has been an obvious improvement 
during the last few years 


ENGLAND AND WALES 

Specialist Services for Bristol Corporation Hospitals 

At a meeting of the Bristol City Council on June 14 a 
scheme was approved whereby teams of specialists in 
medicine and surgerv will be available for the hospitals 
under the control of the Health Committee The scheme 
IS based upon the fact that Southmead Hospital a corpora- 
tion institution, IS now carrying out work of a standard 
equal to that of the voluntary hospitals, and it is desired 
to ensure for it the necessary specialist services As » 
result of discussions with the Professor of Clinical Medi- 
cine and the Professor of Surgery of the University of 
Bristol (who will be , responsible respectively for the 
medical and the surgical services under the new arrange 
ments) and the committees of the Bristol Royal Infirmary 
and the General Hospital, the corporation for a hxed 
yearly payment will be able to call upon ‘he services of 
the t4ms The specialist medical service will be provided 
by three visiting physicians or teams of physicians, who 
will have entire charge of the medical cases, and so far 
as the surgical woik is concerned theie will be four teams, 
each consisting of two surgeons The whole of the 
specialist 5 tafi: will meet regulaily to discuss the progress 
of developntent at Southmead, and any recommendations 
from these meetings will be forwarded by the medica 
superintendent (the convener) to the medical officer of 
health for submission to the Health Committee Nothing 
in the scheme is to interfere with the internal administra- 
tion of Southmead or any of the hospitals of the corpora- 
tion this remains the medical superintendent s responsi- 
bility No hard-and-fast lines are to be liid down with 
legard to cases admitted to the voluntary or the coipora- 
lion hospitals In general, as at present the acute cases 
and emergencies will be admitted to the Royal Infiimary 
and the General Hospital, while cases requiring more 
prolonged treatment will go to Southmead from the firsl 

but no patient is to be kept waiting ^ IxnmsSs 

at any of these three institutions, and if a patient expresses 
a strong wish to enter any particular institution this is to 

Tun m.o Tta payment 'S “he 

subject to annual review, has been fixed £900 for the 
medical services and £900 for the surgical These payments 
will meet all the medical and surgical specialist services 
which the corporation may require with the exception 
of attendance in court in connexion with workmen s com- 
pensation or other litigation It has also been agreed that 
a physician or team of physicians and a surgeon ^ 
^ of surgeons shill attend at Southmead each day and that 
c ich team shall attend at least twice a vveek After sotne 
experience of the arrangements U will be necessary to 
'\npoml house-ph\sicians and house surgeons but at present 
the number and cost of such appointments cannot be 
stated As this is an enlargement of the specialist services 
of the covpotaVion it does not affect physicians or surgeons 
v^i ,5 existing contracts except the consultant physician 
\'^,\Ticart cases and the consultant surgeon at Southmead 
both of whom will be included in the teams of specialists 
Before the proposals were adopted by the citv council the 
re'mirk was made by a member that much remained to be 


done before Southmead Hospital became what it ought 
to be, and that there was a grea't shortage of hospital beds 
in Bristol 


Institute of Child Psychology 

The new premises of the Children s Centre, the Institute 
of Child Psychology, at 6, Pembridge Villas, Wll were 
opened on June 23 by the Marchioness ot Cansbrookc 
who expressed herself as being delighted with the building 
and equipment and took special interest in the play 
therapy rooms particularly in those rooms wheic children 
could play with water and messy materials to their hearts 
content Professor _Winifred Cullis chairman of the 
Management Committee pleaded lor financial support for 
the work, which she had watched with interest for several 
years and of which she fully approved Mr Kenneth 
Lindsay Parliamentary Secretary to the Boaid of 
Education said that official education was coming to 
recognize and be interested in the fact that there were 
different kind’s of children for whom special provision 
must be made He instanced the special categories 
already provided for, and looked forward to the moment 
when provision could be made for nervous and neurotic 
children to receive such help as they needed He heartily 
endorsed the work of the Institute of Child Psychology 
Dr Margaret Lowenteld m giving the histoiy of the 
Institute, laid stress on that aspect of its design which 
emphasized the importance of having a childrens centre 
to which mothers could bring all the children they were 
troubled about and where a differential diagnosis could 
be cal ried out by experts Educationists who came to 
know the methods of treatment and the results were 
almost unanimous in their approval The varying 
activities of the Institute and its relationship to other 
agencies were touched upon by Dr Ethel Dukes who 
also spoke of the environmental influences activating the 
many difficulties from which the children suffered Dr 
Hazel Chodak Gregory, vice chairman, proposed i vote 
of thanks to the Marchioness of Carisbrooke for Jicr 
kindly interest in the work of the Institute Altogether 
about 300 people inspected piemises during the peiiod 
that the committee the directors, and the staff wen. " At 
Home to those who -had been invited to the opening 
ceremony ' 

Research Grant to Maudslcv Hospital 

The Rockefeller Foundation of New York has offered 
a grant of £25,000 during a period ol five years from 
July I towards the support ot psychiatric rcscirch it 
Maudsley Hospital subject to a condition that the mioimt 
ol grant dining any one year shall not exceed £5000 
This grant follows another from the same source of £J000 
in 1935 The offer has been accepted, and an expression 
of the London County Council s appreciation of the 
generous gift has been sent to the donors The manner in 
which the giant shall be spent is under consideration 


House Appointments at London Countj Hospitals 

A regulation of the London County Council prescribes 
that the period of engagement of house-physici ms mo 
house surgeons in the hospitals service shall be limited to 
SIX months but provided that not more than twelve montiis 
are spent at one hospital the engagement may be cxtenocd 
for further periods of six months up to two years when 
employment ceases unless promotion has been secured it is 
proposed to vary this condition to provide that a home 
physician or house surgeon maybe employed at one hospitai 
for not exceeding two years on the understanding that tic 
shall not be employed on work of the same type for more 
than twelve months It is considered (hat such variation 
would conform in spirit with the principle that medical 
practitioners at the outset of their career should not he 
employed tor more than limited periods in any one typ- ot 
work and the limitations should be based on dudes rat 
than on change of hospital ^ 



Illy 2 I93S 


OESTRADIOL BENZOATE FOR SENILE VAGINITIS 


Tl _ 


Reports of Societies Correspondence 


OESTRADIOL BENZOATE TREATMENT OF 
SENILE AAGINITIS 

At a meeting of the Edinburgh Obstetrical Societv on 
May II with the president Professor Jwies HEroRv m 
the chair Dr T N MacGregor read a paper on 
oestradiol benzoate theraps m senile \aginitis 

Dr MacGregor s communication recorded a clinical 
and photographic studj of fifteen cases of senile saginitis 
which was described as an inflammator> condition of the 
^aglna charactensticallv associated with post menopausal 
life All the patients had had a normal or artificial 
menopause the siTnptoms complained of in order of 
frequencv were sulval irritation and \aginal discomfort 
vaginal bleeding dssuria leucorrhoeal discharge and 
dvspareunia The diagnosis was based on examination 
of the suha and xagina directh and bj the speculum 
the characteristic features were renness round the xagmal 
miroitus areas of petechial haemorrhage scattered oxer 
the vagina, and narrowing of the vaginal vault Uterine 
carcinoma was excluded bj curettage when there was a 
historv of bleeding 

Results of Treatment 

As a result of therapj eight patients were completelv 
cured and had remained svmptom free for periods 
varjing from fourteen to twent> one months Seven were 
relieved m that ihev were almost svmptom free but there 
was shU evidence of some inflammation of these one 
was a diabetic and two had an associated leuhoplakic 
condition of the vulva The rationale of oestradiol 
benzoate therapv m senile vaginitis was the restoration of 
the atrophic vaginal epithelium to that condition which 
existed during the period of reproductive life The recon- 
stitution of the vaginal epithelium bv the oestrogens not 
onl> increased ihe vascularitj of the tissue and thus 
promoted healing but the increase in the cellular 
structure subjacent to the denuded areas caused shedding 
of the infected tissue Oestrogenic therapv also stimulated 
the production and deposition in the vaginal epithelium 
of nutritive substances necessarv for a normal vaginal 
flora which once re established proved inimical to the 
invading organisms Cessation of therapv was followed 
after a time interval bv a reversion of the vaginal 
epithelium to the atrophic condition which normall> 
existed after the menopause The mam form of treat- 
ment given was the intramuscular injection of oestradiol 
benzoate supplemented m two cases bj vitamin A The 
- dosage varied from 5 mg bi-weeklv to 10 mg dail> 
according to the severitj of the condition and the response 
obtained Intramuscular injection was the most successful 
mode ot administration Oestradiol in the form of 
suppositories though conceivablv a practical vvaj of 
treating this condition had proved disappointing probablj 
on account of the atrophic state ot the vagina which 
would have militated against the absorption of the 
oestrogens This form of treatment might however 
constitute a useful adjunct to therap) after the vaginal 
epithelium had been rejuvenated bv intramuscular 
administration ot the oestradiol benzoate 


The eighth International Congre^ for the Studv of ^cc^dcnts 
and Occupational Diseases will be held at Frankfort from 
September 26 to 20 under Ihe presidencv of Profes or 
Marteneck Professor Magnus will be chairman of the Sccnoa 
for the Studv of Accidenls and Professor Koebch of the 
Section for Occupalional Diseases Further ir^orr-alion can 
he obtained from Ministerialrat Dr Bauer Unlcr den Linden 
1' Berlin 8 


Treatment of Pneumonia 

Sir — Nfav I be permitted to make some commcri 
the valuable leading ,.rticle in the loiiri al Oi June 2' ip 
1371) I have made some investigations mm the ae lea 
ot 2fp-aminobenzenesulphonamido) pvrid ne kno vn s.ao 'i 
as T693 and from these experiments I have come o b 
conclusion that chemotherapv and immuno he -pv 
pneumococcal iiifeciions_ are not competitive ba eo- p 
mentarv I have found that T693 is ircapab'e c ih ng 
an> pneumococci m human blood from which the lei-c- 
evtes have been removed everj pneumecoccus impL- ea 
will grow out but there is a certain retardation o gro v b 
If however the human blood has its tull cotiplement o 
leucocvtes then the presence ot T69s in a concen'rai cn 
which ought to be easilv attained in the bedv compte 
arrests the growth The T69v can retard the grow h Oi the 
cocci but the natural defences have to do the kiMin^ 

I have also found that human blood logtiher wim 
T693 and immune serum can deal with a much 'arg r 
infection than the same blood containing eii/ier T69j > r 
immune serum This being so the more immure tb 
patient is the belter will be the killing of ihe pneunii 
cocci and the ultimate result vvdl depend on whether ih. 
patient has sufficient resistance to deal vith the pneir'e 
cocci even after ihe> have been in contact vith the 
drug 

For these reasons I suggest that the advent ot T69, h^s 
made the problem of anti pneumococcal serum ot even 
greater imponance In the past serum therapy in pneu 
monia has suffered from the fact that it has ne er been 
possible to make a serum ot potenev sufficient to ensu e 
With certamt, that it would be able to combat a pnein c 
coccal infection, but it would appear that with a eorr 
bination of T693 and serum the latter is likelv to b. 
effective even when the potenev ot the serum is relativeiv 
low It IS not difficult to make serums tor all the tvpes 
of pneumococci if one does not aim at verv high poicnev 
The tv ping of the pneumococcus is not nowadavs a matte 
of great difficultv nor is it beyond the powers ot th- 
younger generation of practitioners to make intravenous 
injections True it is much easier to prescribe tablets to 
be taken three or four times a dav but from the results 
I have obtained m the laboralorv it seems clear ihat if the 
best IS to be done for the patient then he should be 
immunized as well as treated by the drug 

Hitherto I have onlv talked of serum as a means ot 
immunization but we must not forget that it is possiMe 
to immunize patients activelv bv means of vaccines It 
has been shown that m animals which have received 
pneumococcal vaccine protective antibodies can be den c”- 
slrated wuhin three davs and ihe same thing has bc.r 
demonstraied in patients suffering from p-ieumcnia Th s 
means that the serum of these immunized an maK 
patients has the power of protecting other an mals ac-m 
otherwise lethal doses of pneumococci and for ihis tc 
to be positive ihere must be a verv considerab . deg'ee o 
immunitv p-esent Ifor the amount of serum in rodec-d 1 s 
to be diluied m the animals b'ood) It is reason bie o 
assume therefore that well within thsec davs the p ' -n 
who has rceeived vaccine vvi'I have re'pnnded v th -n 
increase ot immunitv and such inc'c-s, ma we ! 
sufficient to turn the scale when it is aided b a d i_ 
like T693 


38 July 2 1938 


CORRESPONDENCE 


The nMtiSK 
Medical Journal 


My 'object in writing this letter is to try to prevent 
physicians discarding immunological methods entirely in 
favour of chemotherapy when theoretically it should be 
bO much better to combine the two Pneumonia is a 
>"rious disease, and should be treated by all methods which 
have the effect of increasing the immunity of the patient 
or which are detrimental to the pneumococcus Hitherto 
attention has chiefly been given to increasing the patient s 
immunity , now, howevei, it seems as if a chemical has 
been found which is in some way detrimental to the 
pneumococcus Let us not discard the oldei methods but 
supplement them with the new if we are to obtain the best 
results in the treatment of our patients, which, after all, 
i: our only aim and object — I am, etc , 

Inoculation Department, St Maiy s ALEXANDER FLEMING 
Hospital, London, June 27 


The New Chemotherapy 

Sir — T he objection to the use of sulphur-containing 
apeiients for patients taking sulphanilamide has been 
stressed recently in the columns of the Jotiiital (June 4, 
p J236 , June 25, p 1392), the reason for the objection 
being the danger of causing or aggravating the cyanosis 
due to sulphaemoglobinaemia As the mode of action 
of the new group of drugs is still so largely a mattei of 
conjecture, it may well be that this fear of sulphaemo- 
globinaemia is quite misplaced, to say nothing of the 
chemical difficulty involved in understanding how so 
stable a substance as, for instance magnesium sulphate 
can be i educed in the body 

Sulphur taken by mouth will diffuse widely, as its 
'' excretion through the kidneys, lungs, and skin indicates 
This property, incidentally, is taken advantage of in some 
old-fashioned treatments, such as the rectal injection of 
hydrogen sulphide (or phthisis or the eating ol onions 
foi acne vulgaris Does the sulphur in the new com- 
pounds dissociate easily in the body'' The frequent 
occurrence of sulphaemoglobinaemia suggests that it 
does, penetrating widely, for it must be remembered that 
this condition occurs when there is no other possible 
source of sulphur tn diet or drugs Spectroscopic 
examination of the blood points to us being a common 
occurrence Perhaps it is an invariable one to some 

degree, if a sufficient dose is taken and the drug is to be 
of ser\icc so that it is the price that must be paid foi 
effective action It is difficult to understand why so 
much anxiety has been caused by it Marked cyanosis 
in patients subsequently making a good recovery must 
have been seen by all using the new drugs extensively 
Another toxic sequel has been noted, however, which 
occasionally leads to a fatal result and is ot great 
theoretical interest — acute agranuloc> tic anaemia 

U IS sometimes said that a few years ago the search for 
a drug with a selective lethal action was regarded by 
many as a search for a chimera yet such drugs were 
known and used Benzene (5 to 10 minims) is an official 
preparation It wvs used in the ireiiment of leukaemia 
and the precaution of counting the while blood cells 
freqiiLntly was taken as its selectise poisonous effect on 
these cells was sometimes \er\ rapid Recentlj eten 
more spccihc effects hi\e come to light in a long series 
of cises ot igranulocvtic anaemia following ihe use of 
amidopyrine i derivative of benzene In these cases 
the vction IS principally on the polymorphonuclear 
Icucocvtes It IS interesting in this connexion to consider 
the lormulac of the new igcnts There are manv of 
them but so fir is I know they arc all benzene deriva- 


tives with a sulplnir'containing group the best known 
of couise being p aminobenzenesulphonamide Are we 
perhaps dealing with a series of which benzene, amido 
pyrine, and sulphanilamide are members and of which the 
last, by virtue of its easily dissociated and diffusible 
sulphur IS so modified that it has a specific lethal action 
on some pathogenic organisms which, after all, can in 
some respects be compared with the relatively inde 
pendently existing white blood cells > It is worth pointing 
out that there is much to suggest that the discovery was 
an accidental one in the course of a laborious investiga- 
tion of azo dyes There has been little official informa 
tion respecting this matter published in this country It 
would not be the fiisl time that chance has smiled on the 
Farbenindustne, and, of course, this would not affect the 
practical importance of what came to light, but it would 
certainly help to limit the field of inquiry as to hovv these 
diugs work — I am, etc , 

London, S W 1, June 27 Edvvard Gallop 


Treatment of Placenta Praevia 


Sir — The paper on the tieatment of placenta praevia 
by Drs O Lloyd and J E Giesen (/oiiinat, June 11 
p 1258) would seem at first sight to show that in hospital 
practice it is possible to plug the vagina m placenta 
praevia without greatly increasing the risk of sepsis for 
m their series the morbidity rate was increased by some 
thing less than 1 per cent , though the number of cases 
treated fay plugging was more than doubled Probably, 
hovvevei, few who read the aiticle will be convinced that 
the fall in moitality was due to the plugging It seems 
much more likely that it is due to the increased use of 
blood tiansfusion seeing that in the second senes the 
number of transfusions was thirty-seven, as compared 
with only ten in the first series 
Do the writers reallv believe that packing the vagina 
controls haemorrhage from placenta praevia if the mem- 
branes are unruptured'? One might expect it to do so 
if the lower uterine segment could be firmly compressed 
against some unyielding object — usually the foetal head 
Whatever may be the possibility of doing this if the 
membranes are ruptured, it is obviously not possible if the 
foetus IS still floating freely in fluid "The condition of 
the patient was, as a rule, adversely affected by a com 
bination of haemorrhage and shock lesiilttng jioin ihi 
operation of pliiggiiig (my italics) May it not be that 
arrest of the haemorrhage was brought about, not by the 
plugging at all, but by the shock resulting from it^ In 
any case, leaving a pack in the vagina for twenty-four 
hours or more before performing Caesarean section seems 
to be inviting trouble sooner or later It will be noticed 
for example, that of the sixty-five cises plugged in senes A 
the number of morbid cases was twenty-two (33 per cent ) 
Furthermore, of the twenty-two morbid cases in this 
senes no fewer than twenty (91 per cent ) h id been 
plugged Of the 121 cases that were treated without 
plugging only two were morbid (1 6 per cent ), and in 
one of these pyrexia was due to a urinary infection 

If the use of blood transfusion in placenta praevia 
needed any advocacy to day this paper, so cxcclicnilj' 
and clcarlv presented, might furnish strong evidence of 
Its value Few, however, will find in it any encourage 
ment to perpetuate the use of the vaginal pack whith 
most obstetricians nowadajs believe to be a septic and 
therefore dangerous appliance — I am etc , ^ 


London, W Cl Jin" 20 


F J Browne 



JuL-i 2 19:!> 


CORRESPONDENCE 


The Unconscious iMind and Medical Practice 

Sir — The arlicle b> Dr Ernest Jones on the unconscious 
mind and medical practice in the Journal of June 2s fp 
1354) states the case for a wider application ot ps\cho 
therapj with an incisi\e luciditx and a lack of polemic 
which IS as refreshing as it is rare among writers on that 
specialtj The first reason he gises for the neglect ot this 
all-important side of the healing an is much the most 
serious I refer to the difficult> experienced b\ the 
general practitioner in obtaining ant form of guidance in 
the technique of this form of therapt It the parturient 
woman is in difficulties if the bab\ suffers from a phimosis 
or if It later contracts diphtheria and the practitioner 
needs adtice as to the best war ot dealing with an\ of 
these problems he can find at once in his librarj lull 
simple and detailed guidance as to the method which he 
ought to adopt Certainlj he will find that the experts 
differ as to which treatment is the best in anj giren case 
but at all erents the technique will be described with such 
meticulous care that he can at least trj out the method of 
his choice Mr examples are of serious conditions rrhich 
though iher might be better treated b> a specialist can 
be and often are, successfulK dealt with bj the general 
practitioner 

Now let us take two not uncommon and ceriainlr 
equallr serious functional conditions impotence in the 
husband immediateJj after marriage and functional 
aphonn in a woman whose bring depends on her abilitr 
to use her roice Neither of these is rare and the first is 
serious enough to lead to suicide I hare read a ferv text- 
books and manr articles in the journals on psrchotherapr 
but m none of these hare I found the instructions rrhich 
would enable me to set about the treatment of the irvo 
cases mentioned Surelr some form of technical guidance 
capable of being follorred b\ eren the dense un 
conscious ridden mind of the general practitioner can be 
derised If the rrhole bodj ot familr practitioners hare to 
wait till ther can undergo a period of discipleship m order 
to learn this art then progress is bound to be rerr slow 
indeed Is there not still hanging about this specialtr 
just a remnant of the dark draperies of the occult rrhich is 
repellent to that hard core of common sense rvhich has so 
often sared our profession from the pitfalls of immature'’ 
doctrines m the past’ Something in the nature ot a 
inife mecum of psjchotherapr for beginners is rrhat one 
would like to see We cannot hope to emulate ihe work 
of the maestros in the art but the fumblings of our 
prentice hand might produce results rrhich rrould inspire 
us to greater effort and attract attention to and gire us a 
respect for that all porrerful but murkr basis of our 
conduct the unconscious — I am etc 

Malrern Link June 27 G M'suGH ScOTT 

Sequelae of ^^'ar Gas Poisoning 

Sir — In reference to some correspondence that has 
appeared in the Journal in connexion rriih mortahlj rales 
among ex soldiers particularly those suffering from 
sequelae to war gas poisoning and the letter rrhich 
appeared m your issue of April 9 last (p SI3) orer Ihe 
signature of Dr W N Abboll I raised this matter br 
question in the House of Commons some rreeks ago and 
rour readers mar perhaps be interested in a further letter 
which I hart received from Mr H Ramsboiham Minister 
of Pensions who has giren authority tor its publication 

It IS undent from the hrgu correspondence I hare 
received on this matter that there arc ren manr cases ot 


Th£ EmS'C “vj 
Xlro CAU Jc 

serious disabilitv arising from war gas poisoning wb c" 
hare nerer received anr pension from rhe Stale ,.rd 
similarlv manv deaths have been accelerated from h 
same cause which have never come under the no ice o* he 
Ministrr 

It seems to be the particular penaltv of gas poire- rg 
to show us effects at a much later stage and this has b—n 
a real hardship to manv an ex service man in that he cci d 
not have made an application for pension at a stage wh a 
It could be substantiated br aceurate medical cerliht,. ion 
— 1 am etc 

Hou e of Commons June 2 Henrv Morris Jones 

The letter of the Minister of Pensions to Sir H-r 
Moms Jones dated June 1' is as follows 

I hare read the items in the Brmsh \fedual Ji un I 
issues of the 1st Januarx and 9th April wnich promp'ed 
roursupplementarr question on I6lh Mar and I am glad o 
Ihe opporlunitr it affords me of correcting ihe erroneci r 
impression which might be formed (as indeed in ro r 
own case it would appear to hare been) from the st,.tis w 
m question 

It IS true that I said on the Moiion for the Chrrirw 
adjournment that Ihe mortalitr rate among penrione r 
compared with the cird population rras p>r eeni abwr 
the civilian population of Ihe same age in this coun'r 
whereas in the Dniled States the excess was 71 per eeni 
and in South Africa 77 per cent But thes- mornliiv 
figures referred ot course to deaths among all disabiliiv 
pensioners from all causes and not etclusneh to caser o/ 
nar gas poisoning or respirator\ diseases Incidennll 
I mav sav that the excess death rate for di abilitr pen 
Stoners orer the average for the population is diminishing 
For the rear ending 31st March the excess was not mo e 
than 38 per cent 

I note the statement orer the signature W N Abbott in 
the April issue of the Journal but this mereh reiter^ier 
the above statistics as I gave them and goes on to sar It 
has been observed in New Zealand that the morialiiv 
statistics for respiralorr diseases are jO per eent bwe 
normal in similar groups of ex soldiers \khat this means 
IS not clear I can onir sar firsilr that we hare r ' 
stalls ics of the mortalitr rale of ex service men as distm- 
from pensioners — indeed I know of no countrr that h- 
and secondlv that the percentage proportion of death 
from respiralorr diseases (including tuberculosis) to deatns 
from all causes among the general male popubiion 
between the ages ot 32 and 60 in this counirv is rougblv 
25 to 30 per cent in other words the morialilv from 
this group of diseases is a-high one 

Pregnancy end Leprosy 

Sir — I have read with considerable interest the arieL 
on The Interaction of Pregnanev and Associated Dir^,.s_ 
bv Professor R 3\ Johnstone I April 9) In ihis cen 
nexion vour leaders mav be interested in the relationship 
between pregnanev and l-prosv The leper hospital h» e 
under mv charge has over two thousand patients of varv- 
ing nationalities Some 'ix hundred of the e are fema!c< 
and there is on an average about one birth per momh 

In the interaction of pregnanev and asrociaied paiho 
logical conditions leprosv must be I imagine one of ne 
lew major rr^lemic diseases where such ac ion is to a” 
one sided Leprosv does noi havu the slightes dice on 
Ihe course ot pregnanev pregnanev has a marled dTe^t 
on leprosy A slow but progress vc spread of the d 
IS usual first noticeable in the later months ot p-egnarr 
and going on long afle' delivers A pregnant wo-i-n 
with mild svmpioms of leprosv mav and offen di cs 
become an advanced textbook case in a vear s lir-^ 
The pnmarv factor is I think mineral deplciitn -s n 
mv last tweniv cases a richer did with increased c^'c i ~i 



COR R ESPONDENCE 


Trtc Dritisii 
Medical Joursel 


40 July 2 1938 


inlake appears to check the tendency to leprosy aggra- 
vation 

Metabolic disturbances of various kinds frequently 
precipitate an acute febrile dissemination of leprosy (lepra 
fever) In over seven years experience I have never seen 
the strain of pregnancy or partuiition cause lepra fever, 
ailhoiigh I have seen very severe attacks after disturb- 
ances of a very much lesser nature — dietary indiscietions 
or a few days constipation, for instance The leprosy 
aggravation caused by pregnancy is insidious and chronic 
In these cases which I see both parents are, of course 
lepers Routine examinations of placenta, cord, and baby 
are constantly negative foi Mycobacterium lepiac and the 
child, if removed from the mother at or shortly after birth, 
lemains free from leprosy — I am, etc, 

Selangor, F M S GORDON A Ryrie 

The Active Principle of Cannabis Indica 

Sir — I am indebted to you for drawing my attention 
to two papers about Cannabis inciica which have appeared 
since my retirement from active work I have now read 
both of them Neither paper, I venture to submit, 
supports your contention (Joittnal, June 4, p 1233) 
R S Cahn s paper (J cbim Soc 1933 p 1400) is the 
fourth of a senes and is an interesting study of a not 
yet complete synthesis of a substance he terms cannabmol 
It IS not, however, the same substance as that which was 
first isolated by Wood, Spivey, and Easterfield (J client 
Soi 1896, 69, 539) Cahn s substance is stable, is 
devoid of pharmacological activity, and has the empyric 
foimula C ,H jO Wood Spivey and Easterfield s sub- 
stance was relatively unstable, was powerfully active 
phaimacologically and had the empiric formula C,sH ,0 
I showed that passing oxygen through the warmed sub 
stance changed it and destroyed its pharmacological action 
(y Antei med Ass 1898 31 882) 

The note of Bergel, Todd, and Work (C/umisln and 
Indasiiy 1938, 67, 86) appears to be a search for some- 
thing active without much success Their pharmaco- 
logical expel iments were made on rabbits by intravenous 
medication Rabbits arc but slightly susceptible to 
Cannabis indica and do not show characteristic symptoms 
and the intravenous administration of an insoluble (in 
water) resinous substance probably as a relativclv crude 
emulsion is not in my opinion an admissible piocedure 
in pharmacological research I will try to justify my 
statement that the active piinciple of Cannabis indica 

was isolated, but perhaps not in its purest form, over 
forty years ago by Wood, Spivey, and Easterfield 

Thej worked with charas the resinous exudation of 
Indian hemp and the most powerful of cannabis products 
Their first consignment consisted of man) hundredweights of 
the finest char s I have seen The qu ilitv of the initial 
product IS of importance as later research showed The\ 
isolated a terpene 0 “i per cent) a sesqui terpenc (2 per cent) 

1 cr)stvllinc paraffin (0 15 per cent) and a so called red oil 
(51 5 per cent) which was onl\ such at high temperatures 
An indistillable pitch and sandv residue were left behind 
The products were passed on to me for pharmacologic d 
investigation The resin ( red oil ) was powerfullv active 
ILimcu 1897 1 23*5) Later consignments of charas were 
of inferior qualil) Thev vielded less red oil meantime 
termed cannabmol because it contained an alcoholic 
hvdrowl which again was less active pharmacologicallv than 
tliL rtsin first examined 

^bou^ this time 1 had to devote mvsclf to other lines of 
rtscirch and the close association of chemist and pharma- 
cologist ceased The chemists continued Iheir work and 
separtied from the nevver samples a higher homologiic which 
vv Is pharmacologicallv inactive but to which thev unfor 


tunatelv gave the name of pure cannabmol It will noi he 
further considered in this note 

At the beginning of 1898 1 was invited to the Annual 
Meeting of the American Medical Association held ih June 
of that year Upfortunatel) I was unable to go 1 was 
asked to send a communication to be, read As the research 
work in hand was alreadv earmarked 1 wrote up the work 
done on Cauttalns indica and sent it 1 believe the paper 
still remains the most comprehensive account of the phanna 
cologv of this drug The addenda which 1 was allowed to 
make summarized 144 animal experiments — thirl) three on 
mvself Curiously, Sigmund Frinkel writing five >ears Infer 
sa)s' Animal experiments with hashish are in hterahirc 
extraordinanlv few His own experiments are much less 
numerous but he figures a somewhat characteristic attitude 
often assumed by dogs which 1 had previoush describdd as 

h>enoid Rabbits he savs are conipletelv refractor) 

Since these experiments at Cambridge 1 have made a 
large number of chemical and pharmacological experiments 
with Cannabis iiultca Hemp products have been obtained 
fiom various parts, chiefly India and an active cannabmol 
has been prepared from all of them No further ptiblica 
tion has been made because apart from experiments directed 
to standardizing the drug no sufficient advance was felt to 
have been made on the Cambridge experiments All that 
need be said now is that the various cannahinols prepared 
from these various crude products had not quantitativeh the 
same intoxicating power And 1 mav add as of some slight 
importance that I sealed hermetically in a test tube some of the 
verv active pioduct isolated at Cambridge and kept it for 
about iwenl) )ears without apparent change or loss of 
actnitv 

Since the cannabinols prepared bv mvself from different 
samples of Caiwabts indica showed some variation in pharma 
cological action can this substance be regarded as the active 
principle of the drug> 1 think it can and in a simple vva\ 
and as brief!) as possible I will try to jiislit) this opinion 
Let iis^eturn to the active red oil isolated from the first batch 
of charas and let it be conceded that a constant boiling 
point IS generally an indication of tolerable puritv unless In 
chance we have a mixture of two or more substances with 
boiling points closel) similar The red oil distilled over 
in a moderate vacuum (20 mm Hg) constantly at 265' to 
270' C It contains a hydroxyl group and can be converted 
into acel>l cannabmol and the aceiv) cannabmol can be 
de aceiv lized and cannabmol reformed But the new product 
possesses little if anv pharmacological action What has 
happened'’ Has something disappeared during the irans 
lormation'’ If it had it would be a verv remarkable sub 
stance such is at present unknown to pharmacology and 
I think I may add organic chemistrv On the other hind 
a slight rearrangement of intramolecular structure is i 
common occurrence of less severe leactions , but on the 
nature of such change I shall not speculate Nfr Calm I 
gather prepares his cannvbinol bv the method of acclalizi 
tion and de acetahzation Although not pharmacologicalh 
active It IS properl) allied to the active principle and its 
complete svnthesis ma) throw some light on possible group 
migrations and lead to the desired haven But it is no cas) 
task especiallv as it is difficult to gauge accuratelv the 
activitv of different products The best wav to standardize 
cannabis preparation^ is to take them oneself Even then 
until one becomes expert the percentage error is consider 
able 1 merclv wish to state the fact without recommending 
the procedure 

One point more and one that mav be particularlv dis 
lurbing The resin in the examples tried did not show tlic 
increased pharmacological effect over the crude drug which it 
should base done if U were the sole active principle The 
charas containing 32 5 per cent of resm was somewhat more 
than half as powerful as the resin itself Although owinc 
to the presence of terpenes the crude drug mav he slight!) 
more readil) absorbed than the purer resm the cause of the 
difference is more probablv due to some degree of oxidation 
occurring during the fractional distillation Oxidation is 
slow at ordinarv temperatures but rapid at high temperature. 
It is probable that oxidative changes begin immcdntclv aficr 



CORRESPONDENCE 


JuL\ 2 1938 


TiicBfrmn^ Jj 
JoiTLVtl. 


h*ir'e^tjng ^nd products \’.hich reach this countr'. have under 
gone change due to ^^rMng age and someijmes to unsuitable 
storage Other changes too of an intramolecular kind 
possihlv occur producing an inactne or less actise product 
uhich could not be separated from the real aettse principle 
b\ frictional distillation Variations m actiMts of different 
cannabinols might thus be explained 

An unstable resin with the properties possessed b\ 
an actixe cannabinol explains all the pharmacologx of 
Cannnbis indica If the actixe principle is not such a 
resm it is difficult to conceit e what kind of substance it 
can be Few aclixe principles xxould surxixe the heat 
xxhich an actixe cannabinol bears with impunilx — I am, 
"etc 

Tunbridge Weils June 9 C R MxRSHXLL. 


Excision of the Patella 

Sir — Mr G O Tippett states (Joiintal June 11 
p 1284} that m kneeling xxhich is probablv the most 
simple common trauma the patella takes no pan 
This assertion is incorrect In kneeling xxith the knees 
flexed to 90 degrees xxhich is the usual position the 
patella takes the majontj of the xxeight Mr Tippett 
can easilx proxe this for himself proxided his patellae 
haxe not been excised bx flexing his knees to 90 degrees 
outlining the skin oxer the knee cap xxiih ink and then 
kneeling on a piece of paper — I am, etc 
Norx'ach June 21 - HA Brittxix 


“ Quinsx-PeritonsiKar Abscess” 

Sir — T ts an ill wind that blows nobod> good and 
xxhile the phxsictan max think the fates hard xxhen, like 
Job — a perfect and an upright man one that fearelh 
God and eschew eth exil — he suffers from ailments that, 
franklx, he wou'd prefer to see in his patients rather 
than m himself, set he has th/s great advantage that 
as a patient he max learn more of a disease ils sxmptoms 
and Its irealmeni, than he xvould as a mere onlooker 
Part of this meditation is due to the fact that, xxhen 
scarlet fexer attacked me while house surgeon xxnh the 
late Sir Hector Cameron mx transference to Belxedere 
Fexer Hospital and mj six xxeeks residence there taught 
me more of fexers than a// the books in iu\ librarx 
But the second and more important reflection leads me 
as a sufferer for half a life time from acute recurrent 
quinsx to disagree formallx xxith almost all the sug- 
gestions in the article bj Mr R Scott Stexenson in the 
Journal of Jnne IS (p 1323} on Quinsx and Retro- 
pharxngeal Abscess 

For about thirlj jears from 1SS7 — the first attack of 
xxhich I haxe a clear recollection — to 1917, xxhen 1 had 
m> tonsils remoxed bx the late Dr Cue of Fans I suffered 
exerx jear or two from an acute abscess tonsillar or 
pe-itonsillar Your author sais that m such cases pus 
forms about the third or fourth daj of the illness xxhich 
lasis from fixe to fourteen dajs but should nexer be 

allow -d to run its course 'J tranklx disagree xxhen be 

goes on to state that it does good to open a quinsx 
carlx rather than late exen if onlx blood and not pus 
fioxx-s from the incision But I tultx agree that opening 
the abscess is not alxxaxs as easx as (t max sound Not 
onii Ts It not easx but it is often impossible and exerx 
attempt is made at the cost of extremeix acute pain to 

the xiciim It is not uncommon he adds to fad 

to open the abscess exen after scxcral attempts As the 
x\ retched patient can xxith dilficiili^ open his mouth a 


quarter of an inch and is hxpersensiUxe this is no' to 
be wondered at Exen xxith the efficient 7s 6d batter in 
the forehead obxiatmg the use of a torch in the uns e-u 
hands of an assisiani and the benzo-cocaine lozencc or 
the 10 per cent cocaine sprax the author admits" n t 

no local anaesthetic has much effect m qumsx Ii 
the abscess fills again alter a second incision the luthir 
concludes that it xxill be well^to consider xxheihe b 
tonsil should not be remoxed 

Voiis axez commis une gros<e imprudence ajs h. 
emphatic remark I heard Professor Tillaux, ihirix xej 
ago make to an assistant who remoxed a tonsil m a 
state of acute inflammation and suppuration — a les on I 
nexer forgot Mx personal experience as a pat en "i. 
in no xxax as a throat expert is that quinsies shou'd 
be opened till pus has defimielx formed ihat 'ess h , m 
IS done bx x aiting than bx earlx interxenuon that 10 p r 
cent cocaine is a dangerous sprat and that tonsils shoo’d 
onlv be remoxed when all inflammation has subsided — 
1 am etc 

Cannes Jure JO A A WvRDE M D 


The Origin of Cancer 

Sir — In jour leader in the Journal of June IS (p la!"' 
the opening statement that the idea has long been aban 
doned that the cause of cancer will be discovered i‘ 
taken at its face xalue seems calculated to act as a 
knock out bloxx to some of those engaged in cancer 
research Although most laboratorj work on this subject 
IS noxv done for the ax owed purpose ot adding a fex 
more facts to the colossal heap alreadj accumulated there 
are among these researchers manj who are sustained in 
their efforts bx the hope that thex max one dax chanut 
to stumble upon a clue which leads the wax out of the 
intricate maze that now represents the cancer problem 
To these latter and still more to those who enter upon 
this research xxnh the definite object ot finding a can 
an authontatixe statement that cancer has no cause and 
that thex are condemned to wander round and round m 
nexer ending if benign circJes or segments of circles as 
thex are noxv doing but xxnhout the incitement of hope 
must be anx thing but an encouragement 
Sureix the aboxe mentioned statement does not repre 
sent the opinion of oncologists m general’ There are 
in fact manj clinicians and pathologists xxorking at this 
subject xxho haxe reason to think differenllx Max I talc 
the Iibertx of doing mx best to present (his other side ot 
the case 

M> object IS to show that not onlx will the causes 
of cancer be found but. that ibex haxe alrcadx been 
found and are noxx being sorted out and inxeslicalt-d 
Writing as an adxccale for the optimists I put mx case 
in the lorm of propositions as folloxxs 
Cancer is not one disease but a xast group of diseases 
Cancers are primarilx of internal origin as comrasied 
xxith the bacienal diseases xxhich are primarily of external 
origin Cancers xarx in kind x'llh ifn. nature or spetics 
of tissue or ot animal so ihai cancer of one species ot 
tissue differs from that of another species and cancer ol 
one* species ot animal irom that of anoJier species As 
xxnh the bacterial diseases the causes m general are l vr- 
fold (ul predisposing and (b) actixa mg 
(a) The predispo me Or fcahtalne c-t. es ha 'cn Fc l s c 
ot dexelopment and h me c-i dece-er-tiow tefo c it 
An one the c can es i hccdi x The stole of p e-d' — 
non o produced w the corneetm- hns retween the '■s r* ’ 
tissue and the cancer and is co~i~or! 1 ro '* o i' - p c 
CaH'-ef 



42 July 2 1938 


CORRESPOND£NCE 


The Bretish 
XT dDtCAL Jours VL 


(6) The activating causes are agents — chemical or ph>sical — 
which act impuJsivelj' upon the degenerate, dedifferentiated 
embryonoid cells of pre cancers and cause them to multiply, 
much as agents of a similar nature activate the eggs of sea 
uichins or other lowly organisms and cause them to multiply 
But whereas in the former the cells activated are progressive 
in the latter they are regressive and therefore incapable 
of producing other than degenerate parasitic organisms In 
both cases the activating causes are selective or specific and 
vary with the species of animal or the species of tissue upon 
which they act 

Let us now choose some one organ as an example, pie- 
ferably the female breast that being to the clinician what 
the mouse is to the experimentalist Owing to disuse or 
inadequate use m suckling, and/or to heredity, the breast 
may degenerate before its noimal t me Its dediffer- 
entiated embryonoid cells, instead of quickly passing on 
to the final stage — that of molecular degeneration — as they 
should do, are stimulated an'^ kept alive by hormones 
fiom the ovary, an organ which has not shared m the 
piemature degeneration of its satellite oigan They pro- 
liferate to some extent, and are those “ pre cancer cells ” 
which fill the ducts and follicles in the fibiocystic pre- 
degeneration known as Schimmelbusch s disease If left ' 
alone these pre-cancer cells continue their course and dis- 
integrate But should they be stimulated by some adequate 
and suitable stimulus, such as that of a streptococcal 
toxin, of radium, of some mechanical injury, or, above 
all — m the breast — of the luteal hormone, then they may 
stait off on that process of endless multiplication which is 
cancer 

This represents the cause of cancer in its simplest form 
There are, of course, variants such as when cancer is 
caused by t rays, when the same agent first bungs on a 
state of premature degeneration and then activates the 
predegenerate cells 

It is with much diffidence that I have ventuied to com- 
ment in this way on a statement which I recognize as that 
of an authority And as I am conscious of having pre 
sented my case rather awkwardly, perhaps I may be per- 
mitted to" make it clearer by using a precedent It was 
not very long ago that it might with truth be said of 
tuberculosis that it was attributed to such a multitude of 
causes that of only one thing could we be sure, and that 
was that its true eause had not been discovered 'But now 
we all agree that the cause of tuberculosis is known and 
that it is twofold — a bacillus which is the actual cause, 
and a group of causes, all of which can be lumped 
together as the predisposing cause It is these two — the 
seed and the soil — which together constitute the cause of 
tuberculosis My claim is that we now know enough 
about cancer (and cancers) to be able to say that we 
know Its causes in the same way that we know the causes 
of the microbial diseases m general and of tuberculosis in 
particular With cancer as with the diseases of extrinsic 
origin we have passed from the stage in which the true 
cause IS lost in a multiplicity of causes to that in which 
the causes are well defined and can be linked together 
as one 

Now the question arises Which of these views is 
correct — the one which denies that the cause of cancer 
will ever be discovered, because a malignant neoplasm is 
the result int of a number of factors or the one which 
states that the cause of cancer is already known and that 
It IS duplicate or divisible into two factors'^ — I am, etc, 

■" Railing June 18 HASTINGS GtLFORD 

Perhaps the word the should have been put 
\\ve» quotation marks and not th'* words ‘cause of 

cancer "-Ed 


Diphtheria Prophylaxis 

Sir — During 1937 four cases of small-pox were noti- 
fied in England and Wales with no deaths {Jownal 
June 4, p 1243), whereas during only one week of this 
year 1,110 cases of diphtheria were notified with twenty- 
six deaths, an inciease incidentally of 260 and six, re- 
spectively, on the corresponding week of the previous 
year {ibid p 1244) There can be little reasonable 
doubt that the remarkable position in lespect of small-pox 
is due largely to compulsory vaccination , unless a con- 
scientious objectoi the father is not allowed to disfigure 
his child with small-pox, but he may with impunity 
expose him to the grave risk of diphtheria 

About 90 per cent of children between the ages of 
6 months and 5 years are said to be Schick-positive 
Among 3,000 such children in a London borough who 
vveie immunized against diphtheria two or three years 
ago not a single case of the disease has since been ic 
ported In view ot what has been achieved in sm ill pox 
surely it is not too much to ask that all children in this 
countiy should be immunized The bogy of diphtheria 
looms larger in the public mind even than that of small , 
pox at the present time 

It is Well known that Schick-positive nuises, doctors 
and medical students, whose professional duties take 
them into contact with sick children, aie very liable to 
contract diphtheria, and this is recognized and guaidcd 
against in most hospitals — and should be in all hospitals 
It seems incredible that there are still hospitals m this 
country where immunization in such cases is not insisted 
upon, even where successive residents have taken the 
disease 

Dr W Hilton Parry s communication m the Joiifiinl 
of June 11 (p 1264) raises interesting possibilities m the 
treatment of early cases with severe toxaemia It would, 
be valuable to hear from him whether sulphanilamide 
given to such cases before removal to hospital may be 
expected to be beneficial, and whether in fact the whole 
course in these patients in whom a streptococcal toxaemia 
IS piesumed is influenced by the drug — I am, etc 

London June 22 A L CRADDOCL 

' Treatment of Diphtheria 

Sir — I am much interested to see Dr W Hilton Parry s 
note on the treatment of diphtheria in the Jour/ial of 
June 1 1 (p 1264) It forestalls to some extent a three year 
investigation of my ovvn 

For some time 1 have found that cases admitted as 
diphtheria required a great deal of investigation as to the 
causation and that swab diagnosis was liable to grave 
errors It is as well to query all cases of over 17 years 
of age, even with a positive swab, and many under that 
age Mixed infections such as Vincents angina and 
streptococcal throats with or without the presence of 
diphtheria bacilli arc quite common , very frequently the 
diphtheria bacilli ^re avirulent , if treatment is earned out 
with antitoxin alone the results are often disastrous 
Fortunately grave cases may be diagnosed clinically and 
treatment accorded It is my practice here to use anti 
streptococcal serum or prontosil and, if necessary some 
arsenical preparation for such cases, with anti diphtheritic 
serum if required 

The cases admitted to hospital as diphtheria, with or 
without a positive swab have shown that the diagnosis 
must be revised in about two cases out of three 1 think 
the time has come for ‘ observation thro its requiring 
hospital treatment to be admitted freely to the infectious 



JuL-i 2 193S 


CORRESPONDENCE 


diseases hospital and to be diagnosed there In Sunder- 
land \se do admit such cases, and thev require hospital 
treatment more in man> instances than diphtheria I 
often wonder hots mans cases with a negatise swab are 
left at home unnotified that would ha\e benefited bj 
quick remosal to hospital and a dose of anti-streptococcal 
serum During the past tear or two more than half the 
cases that hate been admitted to the Sunderland Infectious 
Diseases Hospital as diphtheria hate actuallj been strepto- 
coccal throats or Vincent s angina and required treatment 
for these conditions The swab seems useless to diag- 
nose such cases, smears are more helpful but in the 
former blood culture appears the only useful procedure, 
if obtained early enough 

I hope shorth to publish an article on the differential 
diagnosis of acute throat conditions based on the cases 
admitted under mv care during the last ten years As it 
IS swab diagnosis leads to an entirely fallacious number 
of notifications of diphtheria suggesting a much greater 
prevalence of diphtheria in many districts than actually 
exists, and this would be prevented by adding a new 

indefinite throat condition to the notification list 
Mans cases are notified as diphtheria merelv because 
the clinical condition suggests the need for hospital treat- 
ment since there are no beds for acute throat conditions 
other than diphtheria Many practitioners have told me 
that a notification of diphtheria is the easiest way to 
get a bad throat into hospital — I am etc , 

E Thorp 

Sunderland June 17 Deputj htedical Officer of Health 

Kerafoplastj 

Sir — M r T H S Tizzard records in the Journal of 
June 18 (p 1303) an excellent result in a case in which 
corneal grafting, was done by a conjunctival flap An 
examination of the photographs of this case suggests that 
the comeal scar was dense and localized to the centre of 
the cornea the nm of the pupil is seen The operation 
of comeal grafting is hazardous and entails a high degree 
of risk , it is a moot point whether in these cases of 
localized opacity an optical iridectomy is not the belter 
operation to perform from the patients point of view I 
have alvvavs advocated that a corneal graft should not 
be carried out unless the vision of the affected eye was 
reduced to perception of light and the cornea was 
generally opaque Furthermore a graft may remain 
comparatively clear for a year and then suddenly become 
opaque — am etc , 

London, W I June 22 B W Rv Croft F R C S 

Atrophic Rhinitis 

Sir — 1 much appreciate the courtesy of Mr E D D 
Davis s reply Uaiirnal June IS p 1341) to my letter 
(June 4 p 1236) Mav I add that I also appreciate his 
scepticism as to sinusitis being an essential factor in 
atrophic rhinitis It is onlv after an experience of 170 
cases over more than thirtv \ears that I have come to 
this conclusion , treatment accordingly- has bv its success 
confirmed mv belief The Mew that atrophic rhinitis is 
the end stage of a hvperplastic — that is mflammatorv 
process is proved bv the historv of the cases and bv their 
histologv How a neglected nasal suppuration beginning 
m childhood and lasting for wars could miss the ethmoid 
has ncvi-r been explained 

The mflammatorv proce-s beginning m the mucous 
membrane and allowed to become chronic antcls ine 
bone, just as it docs m chronic suppurative oiitis media 


TnrBivrnss 4^; 
MtOSCAL JCrt. VSAL 


beginning in 'childhood The laller disease and not 
otosclerosis is the aural analogue of atrophic rhmuis 
Its history histology and treatment are similar Tf - 
mastoid process and antrum in ,he one case the novi. 
and maxillary antrum in the other tend to remain -ni,.'! 
Thrice I have seen the mastoid antrum obliterated and 
in one bov the maxillary antrum was almost oblitcraicd 
Leucocvtic infiltration is succeeded bv fibrosis and hen 
sclerosis the microscope shows this m both disea ex 
The fibrosis bv constricting the vascular supplv to the 
mucopertchondrium of both surfaces of thin bones h.c 
the turbinates and ethmoid cells, hinders development 
and causes sclerosis and atrophv Nature somcnmes 

cures the condition bv a gradual atrophv ot he 
ethmoid honeycomb but this takes many vears „-d 
then the atrophv is extreme it is the rmnologisi s 
job to anticipate this and to deal with the cthmoidil 
focus which keeps the process going and so to prevent 
further atrophv of the turbinatej The sphenoid also 
often needs drainage the antrum less often Lnhfv 
the ethmoid the antrum has a rich blood supply other 
than on its nasal wall and the walls thicken even when 
It contains' no pus Like Mr Davis 1 have often pune 
lured the antrum vviib negative result but this does not 
negate sinusitis of the ethmoid or sphenoid LsualK 
there is an offending cell high uD and far back in ihe 
ethmoid apt to be missed and often leading to the 
sphenoid Usuallv also the clearing out of the ethmoidal 
cells with due attention to neighbouring cavities when 
necessarv will stop ihe crusting Lack ot vuamms is a 
predisposing factor in these children wan dirtv noses 
and for successful treatment must be met Possiblv a 
defective supplv of magnesium salts may also be a factor 
these salts are esicnlial for ciliary function — I am etc 

Glasgow June 2t JaMES ADW! 


Tuberculin in Diagnosis 


Sir — The evidence for my belief that the subcutaneous 
test IS selective may be stated quite shortly A patient 
with tubercle bacilli in the sputum is obsioush sufferini, 
from pulmonarv tuberculosis When treating such caves 
with tuberculin mv first dose in treatment is OfXXXXtOI 
cem BE Whv'> Because patients with active disease 
mav give a febrile reaction even to a dose as small as 
this In Chapter VI of The Tuberculin Handbook 1 have 
set out a senes of 106 cases in which Ihe diagnostic value 
of the subcutaneous tuberculin test vvas compared wilh 
the radiographic evidence The cases were those of sus 
pected pulmonarv tuberculosis without tubercle bacilli 
m the sputum It Dr J R Forbes will refer to that 
work he will I am sure agree that the radiographic 
evidence vvas in favour of Ihe subcutaneous test being 
selecliv e — I am etc 

London VV 8 June 24 HvIXIDVI SutHERI-VSd 


Sir — I have proved bevond doubt and have cenatnh 
onvinced the leading ophlhalmologisis at the Roval yVest 
ninster Opbihafmic Hospital — notably '•H Charles 
.eonard Gimblett Sir Richard Cruise Mr T L lylc 
ind Mr E Wolff— hat tuberculin is ihe cvscnliil Ley to 
he diagnosis and is also the onlv safe and cerium 1 cy to 
(tc successful trvaiment of tuberculous diseases of the c <. 
.iihm range of vision and even in other organs intl pjr s 
f the bedv although wc cannot observe directly „nil 

ontro! With our eves the phenomcra of hcalmf Ur J (> 

■orbes Will find mv book Tulurcabn w Ibi Hmn ,nl 
rcaimtm of Tnhcnulous prob.bly .Mbf d t of i) 
loval Society of Medicine md tetliUliU ul It I ,t. „ 



44 July 2, 1938 


CORRESPONDENCE 


Tire Bunisii 

McOICAL JOLRVIl 


the Royal College of Physicians This and my last booh 
Tubeicuhn < its Vindication by TtUmique (J and A 
Churchill) will disclose the truth Clear pi oof can also be 
seen any Monday afternoon at my Tuberculin Clinic 36, 
Nottingham Place— I am, etc, 

loadon, W 1, June 25 W Camac JWlLUNSON 


Complications of Gold Therapy 

Sir — Referring to the letter of Dr John B Bennett in 
the Journal of June 25 (p 1392} describing a case of gold 

dermatitis, ' we are constantly treating considerable 
numbers of patients at the Charterhouse Clinic with injec- 
tions of gold with most satisfactory results, and in some 
cases quite dramatic improvement In our senes we ha\e 
never had any to\ic reaction of any kind whatever, noi 
has any single patient ever developed a dermatitis We 
aie convinced fheretore that these complications are 
entirely unnecessary, and are simply due to the method of 
administration, and more particularly to the amount of 
gold given 

Gold IS most valuable when interposed in a course of 
vaccine treatment where hyperergy develops The gold is 
given m minimum doses at as long an interval as possible, 
depending on the tendency of the symptoms which are 
allayed by the gold to recur The usual period is a fort- 
night, but three weeks or even a month may elapse during 
which period the symptoms are relieved It is true^ that 
attei the first injection there may be an exacerbation of the 
iheumatic pains, and if this is found to occur on the next 
occasion the amount of gold injected is one-tenth of the 
initial dose In. lare cases even one hundredth of the 
dose IS required before relief is obtained The kind of 
gold salt used does not appear to make very much differ- 
ence — I am, etc, 

London W 1, Jane 27 H Warren CrOWE 


Blood Pressure after Spinal Anaesthetic 

Sia-^Mr D L Lewis and Dr E G M Palsei {Joinnal 
June 4, p 1202) state that falls in the systolic and diastolic 
blood pressures aftei a spinal anaesthetic aie regular and 
begin 2 6 and 2 2 minutes after administration ceasing 
after 13 and 12} minutes for the systolic and diastolic 
pressures respectively They say the recovery is to the 
extent of 7} to lOi per cent of the initial values and 
occupies eight minutes 

Looking back at records taken during the past year of 
blood-pressure curv'es following spinal analgesia alone, 
I find a great variation in the times of onset and recovery 
In all cases the anaesthetic is the same but some exhibit 
only a slight fall and others go on falling for fiftv minutes 
This divergence of results is interesting because it points 
to the fact that spinal analgesia alone is not adequate 
to protect the patient from shock-producing stimuli except 
in the case of very low blocks am, etc 

R P Harbord 

June 24 Denionslriior in Anaeslliclic;, 

Unncrsily ofj Liverpool 


Three professors of the L'ons medical facult> have recentlj 
retired — namelv Drs CoUel (oio rhino larv ngologv) Cluzel 
(biological phvsics radiologv and phjsiothenip}) and Gajet 
(urological chemistrv) A new chair has been founded at the 
fveuhv for mfccuous diseases and ils first occupant is Dr 
JO'.eph Chaiier hitherto professor of medical ptipology 


Obituary 


JOHN V W RUTHERFORD, MB, CM 
Consulting Surgeon Newcastle on Tjnc Infirraarv 
The death took place on June 21 of Colonel J V W 
Rutherford in his eighty-second year John Victor 
Walton Rutherford was educated at Bedfoid School, sub 
sequently proceeding to the Royal High School, Edin 
burgh, and later to Edinburgh University, where he gradu 
ated MB CM He Was for some lime honoraryisurgcon 
to the Newcastle Royal Victoria Infirmary Before and 
during the war he held the position of Assistant Direcioi 
of Medical Services of the 50lh Division and was men 
tioned m dispatches for his services in France Afici 
returning from France he became D M S at Callerick 
Camp , from 1918 to 1922 he was Honorary Colonel 
of the R A M C (Northumbrian Division) On his retire 
ment from the Newcastle Infirmary he went to reside 
in the South of France, but leturned to Newcastle last 
September He had been in indifferent health for the last 
two years Colonel Rutherford was a keen sportsman and 
one of the stalwarts of Rugby football and did notable 
service in the Northern Football Club and the North- 
umberland Rugby Union Of a kindly nature, he was 
most popular With all with whom he came in contact, and 
his death will be regretted by his many friends m the 
Newcastle-upon-Tyne district He is siiivived by his wife 
and one son His first wife was the daughter of the lalv. 
Sir Walter Scott , she died in 1922 

Piofessor G Grey Turner writes 
With his brother, the late Dr Vickerman Rutherford, 
John Victoi Walton Rutherford started in general practice 
m Newcastle-on-Tyne to carry on the work of their father 
who was not only a successful practitioner, but a vcij 
well known educationist It was, m fact, as a result of 
the efforts of John Rutherford senior that the College 
which still flourishes under his name was founded 
The subject of this note was educated in Edinburgh 
where he was well known as a Rugby player He was 
always attracted to surgery, and when the opportumti. 
arose at the Newcastle Infirmary he sought election In 
1897 he became assistant surgeon and for some years was 
associated tn that capacity with Professor Rutherford 
Monson In 1906 he was appointed to the full stiff with 
charge of wards and continued m that office until 1917, 
when he retired on reaching the age limit and was made an 
honorary consulting surgeon John Rutherford had a 
great knowledge of human nature and was very shrewd 
and sometimes made striking diagnoses by some process 
ot intuition He was always considerate to his patients 
and was popular with his colleagues Rutherford hid 
good hands and was a very nice operator but was not 
attracted to the routine of hospital work or of teaching 
bu* he did encourage the junior members of his firm md 
gave them many opportunities and was always interested 
m their exploits I was associated with him il the 
Newcastle-on-Tyne Infirmary during the whole of m> 
hospital service as registrar and as assistant surgeon 
and am grateful for the encouragement which I 
received Comparative affluence at that time enabled 
Rutherford to enjoy those country pursuits at which ht 
was an adept and also allowed him ,timc to tile 
a very active interest in the old volunteers and in ihc 
Territorial Army At the outbreak of the (ate w.ir he was 
A D M S for the Northumbrian Division of the Territorial 
Army and served in France m that capacity 



2 1938 


OBITUARY 


‘Colonel John, as he T;\as al«a\s known, was 
immensely atlachcd lo his own homeland and to the 
Newcastle on-T\ne Infirman, and when his health began 
to f■'Il^ery senousli during the last jear or two he returned 
to Newcastle where he died He was buried in Benwell 
Churchtard not far from his old home on June 21 
the funeral being attended bv some of his old residents 

F J BAILDON MB CM 
Professor R J A Berrj writes 

During the now sleadilj accumulating burden of rears 
in which It has been m> weeklj task to open the British 
Medicai Journal and at least to glance through its pages 
I hare from time to time been saddened by learning ot 
the unexpected death of some old friend or former col- 
league That the issue of June 25 should hare aec.dent 
allr opened at the ren page recording the tolallr un 
expected death of a life long jnd greatlj honoured friend. 
Dr F J Baildon rvas as melancholy a coincidence as 
It rras an extrdordinarilr grterous shock No man could 
hare known Francis Baildon as long and as mtimatelr 
as I did rrithout realizing his lor able nature his high 
ideals, his sincenlr and loraltr as a friend his scrupulous 
obserrance of the highest and best traditions of the pro 
fession he lored so rrell and his abounding and abiding 
derotion to his and mr Alma Mater — the Unirersitr of 
Edinburgh 

Most men if ther are honest at least rvith themselres 
rroiild readil> admit their indebtedness m life to some 
apparenllr tnrial arcumstance Baildon was a rerr earir 
and lasting influence in mj life He it was rvho adrised 
me to abandon commerce for medicine who assured some 
slrangeh doubting relatires of mr abilitr to pass the then 
br no means difficult professional examinations rrhich 
barred the aspirant s entrance to medicine and rrho finallj 
sent me to his own unirersitr It rras therefore rrith a 
special and peculiar pleasure that onl> a ferv months 
ago 1 accepted his inr nation to attend tinder his presi 
dencj the dinner of the Manchester Edinburgh Unirersitr 
Club and to propose under his kindir dictatorship the 
toast of Alma Mater — his and mine 

Such rrere m> first and last recollections of Francis 
Baildon His friendship meant much to me Nerer did 
rve meet in London, whaterer the business without a 
dinner at his club on the sweet shadj side of Pall Mall 
^nd here did Baildon rereal his richlj cultured mind his 
extensile knowledge of life lore letters and art and 
rarelr was a mans after dinner talk more rrorth the 
listening to To him then a man to whom I owe more 
than to an> other of his time and generation of those 
better things rrhich alone make life the better rvorth bring 
do 1 par this last personal and affectionate tribute 

WILLIAM HUDSON MD DPH 

Dr William Hudson died at the age of 54 at his home 
in Bedlinglon Northumberland on June 19 He had 
been m failing health for orer trro rears but had con 
tinned to serre his patients up to rrithin trro months of 
his untiraelr death He rras born at Bedlmgton and 
receired his earir education at Morpeth Grammar School 
His medical training rras at Durham Umrersitj College 
of Medicine and he there proceeded to the degrees 
of M B B S Subsequentlr he obtained his M D and 
DPH at the same school He conducted a large nanel 
and prirate practice in his name torrm and also held 
the offices of medical officer of health Poor Larr medical 
officer and public raccinator Dr Hudson rras a most 
energetic and conscientious practitioner and rras held in 
xer> high esteem br colleagues patients and friends He 
rras generous in disposition and had n great capacitv for 


Tt!^ D JTI- 1 


making and retaining friendships He rr,.s in great 
mand at all social functions in his neighbourhood 
his quick tongue and readr wn made him exc^piion^il 
popular He had been a member of the B'lti h Xled ^ 1 
Association since 1915 and had been chairman o it" 
Birth Dirision He is surrired br his rrife and two sons 
one ot rrhom has alreadr embarked on a medical tarter 

Dr Wilbur C Lorrrr (honorarj secretarr ot the B' ih 
Dirision) sends the follorring appreciation Br D 
Hudsons untimelr death Birth Dirision and the Bsimn 
Medical Association hare lost a most influential and 
actire member He rras nerer absent from anr mating 
of the Association in the district except on urgent burin 
He could be relied upon to conlrifauie lo the rxlut oi a 
scientific meeting br pointed questions or br informa on 
or criticism of a practical and pertinent nature At a 
medico political meeting his adnee was of that broad 
minded nature which enhanced the practitiomr s status 
in the neighbourhood as an indiridual and „s a member 
of the communttr rrhile at the social gatherings he n is 
able to relax and enjor a song or slorr to the full Dr 
Hudson rras chairman of the Birth Dirision on i\ro 
occasions in recent rears and until failing health com 
pelled him to relax was a raent,ber of the Execume 
Committee He rras also a member of the Conlraci 
Practice Committee of the North of England Branch 
He rras a most energetic rrorker and was reported to 
hare a store of odd jobs on hand on which he could 
draw if routine demands became slack As a practitioner 
Dr Hudson was cool detached and accurate m his 
obserrations as befits a scientific mind shrewd and quick 
in his deductions which gare him the reputation of being 

good at diagnosis and as a result efficient and helpful 
in treatment And m addition whererer one met him 
rrhetner at the bedside of a patient in general discussion 
or in public serriee one had the impression that the 
central object in all this concentration and ener^r w is 
an indiridual patient who required treatment as a hiim-n 
being rather than as the medium of some intere ting 
disease Herein laj Dr Hudson s success as a general 
practitioner and as a public administrator and abore all 
as an indiridual himself 

We regret to record the death of Dr Leonskd Chskles 
Txlbot Dobson lalterlr of Bournemouth and formcrlr 
of Holland Park Arenue London rrhere he practised for 
some jears rriih his sen Dr Eric Dobson rrho died in 
Februarr 1937 Leonard Dobson rras born m London 
in 1S64 and receired his education at Cranleigh School 
and St Bartholomew s Hospital In ISSa he obtained Ihe 
diplomas MRCS and LSA and m the following jear 
the LRCP rrhen he graduated M B Lend winning 
Ihe gold medal and first-class honours in obstetrics ard 
proceeding \f D in ISSS He had been a member of the 
British Medical Association for fiftr one rears One of 
his earliest jtosts was that of senior cl meal assistant in 
the Throat Department at ihe W'est London Hospital 
he rras also e'eclrical assistant at St Barlholomcrr s 
Hospital from 1905 to 1910 and phrsician in charge of ihc 
eicctrotherapeutic department of the Freemasons Horpiut 
His connexion with the West London Hospital rras 
especialij close for a long time and he rras an cx p esrdcnt 
of the 'Vest London Medico-Chirurgical Sccieir He con 
iributed to ns journal articles on the injection of clhcr 
into Ihe abdominal car nr after operations on sep ic cases 
the use of radium in the trea ment of lupus err hem trs i 
nnd the practical treatment of rheumatoid arthritis He 
rras i dtsoted Freemason and trarclled f-equen'ir { - 
Boumemoutn to attend meetings ol the C-re-’ti h Led 
of rrhich hie his son later he rras fo- n term " ki H 
death IS mourned b> a large circle of fricrds ard co’ -- 



46 July 2, 1938 


MEDICAL NOTES IN PARLIAMENT 


The Brittsii 
Medical Journal 


Dr Royal Samuel Copeland the only physician 
serving in the United States Senate, died at Washington 
on June 17, aged 69 A graduate m medicine of the 
University of Michigan he had been Director of the 
Flovver Hospital and Health ' Commissioner for New 
York City'' 

The following well-known foreign medical men ha\e 
recently died Dr Albert Peters emeritus professoi of 
ophthalmology at Rostock University, aged 76 , and Dr 
Frederic Moutsset honorary physician to the Lyons 
hospitals corresponding member of the Academic de 
Medecine and officer of the Legion of Honour 


Medical Notes in Parliament 


The Royal Assent was given on June 23 to the Preven- 
tion and Treatment of' Blindness (Scotland) Act, the 
Infanticide Act, and the Housing (Rural Workers) 
Amendment Act 

In the House of Lords on June 28 the Criminal Pro- 
cedure (Scotland) Bill, which has passed the House of 
Commons, was read a second time 
The House of Commons this week completed the 
Committee stage of the Finance Bill 
The Tuberculosis (Attested Herds) Scheme, 1938 was 
laid^on the Table of the House on June 27, as was also 
the Annual Report on Alkali etc , Works 
On June 28, m the House of Commons on the motion 
of Earl Wmterton a return was ordered of licences 
granted under the Act of Parliament for experiments 
performed in 1937 and the registered places at which such 
experiments might be performed 

In view of the volume and importance of the work 
connected with air raid precautions, Mr Geoffrey Lloyd, 
Parliamentary Under-Secretary of Slate for the Home 
Department, will devote practically the whole of his time 
to assisting the Home Secretaiy in the conduct of (his 
branch of Heme Office business Earl Wmterton, 

Chancellor of the Duchy of Lancaster, will help the Home 
Secretary with his other work 

Assessing Nutrition in School Children 

During the debate on the Education Estimates on lone 20 
Mr Kenneth Lindsai said there had been criticism of the 
clinical method recommended b.\ the Board of Education for 
the assessment of the nutrition of school children There were 
ndmiUedh inconsistencies between the returns for similar aieas 
showing that different standards had been adopted bv school 
medical officers Thev would all like to ffnd some index 
which would accurateh measure malnutrition It was not casv 
when dealing with 5 000000 children to arrive at i proper 
method of assessment unless thci proposed to give school 
meals to all on a contributorj basis and if thev did that thc> 
would hive to be prepared for the appropriate expenditure 
• He w is sure no one would desire such an index more than 
the Advisorv Commillec on Nutrition vet the> stated that the 
Boards own method which was being used at the moment 
was the most promising Various alternatives had been sug 
gcsicd which he as a lav man had examined and which experts 
hid lone igo worked out but thev all had serious limitations 
Tht-v did not applv the test which the Board required and the 
Board therefore was bound to conclude that the clinical 
hod based on the opinion of an experienced phvsician 
s the best it present open to them He did not sax thev 
ould not discover a belter but at present it was the best 
iv 111 ible and if ipphcd with sLiIl and most of all with iinder- 
stindmg It discovered the great ma;ont\ of children whose 
nuiriiion w ts dcftsiivc The returns for 1937 showed an 
insreasL in the pertentage of children with excellent nutrition 
ind a slight fall from 0 7 per cent to 0 6 per cent m the per 


cenlage with bad nutrition^ Deficiencies in diet still existed 
but there were other causes of subnormal nutniion such as 
heredtlx want of sleep had environment and the effects of 
illness or infectious disease The past >ear had shown an 
increase from 248 to 264 in the number of local education 
authorities which provided free meals or milk for necessitous 
undernourished children 

Parat)phojd Outbreak in the Isle of Lewis 

On June 21 Mr Wedderburn replying to Mr M Mac- 
Millan said (hat an official report had been received b) the 
Department of Health for Scotland regarding the ouibreak 
of paratyphoid fever at Aignish, Isle of Lewis The invcsti 
gallon bv the countj medical authorities suggested that there 
was no common source of infection such as milk or water hut 
indicated the possibilit) of the outbreak having arisen from 
the consumption bv one of the patients of shell fish on the 
seashore The Department of Health were advised bv the 
counti medical officer on Maj 18 that there had been no fresh 
cases for three weeks and that the outbreak might he regarded 
as over 

Mr MacMillan asked whether in view iif the fact that 
about two months after (he outbreak of the epidemic appar 
entiv no investigation had been undertaken and no report 
made the Under-Secretarj' would explain at vvhat time the 
inxestigation was actuallx made 

Mr Wedderburn The Department received from the 
medical officer on April 27 a report on the outbreak of 
paratxphoid The first case was brought to the notice of the 
assistant medical officer of health for Stornowax on April 16 
and according to the latest report there had been no further 
cases since April 27 ^ 

Legislation on GoternmenVs Milk Policj 

Dt Elliot announced with regret on June 22 that it was 
impossible for legislation to be introduced and considered this 
session which would give effect to the Governments pro 
posals on milk policv The Government hoped to introduce 
such legislation next session and as an interim measure would 
ask Parliament before the Summer Recess to extend the chief 
provisions of the Milk Acts until September 30 1939 An 
extension of Section 11 of the 1934 Act would enable 
Exchequer contributions to be made towards the cost of 
schemes for cheap milk for school children and for expectant 
and nursing mothers and children under school age To 
facilitate development of these schemes the Government would 
ask Parliament lo provide £250000 in addition to the 
£500 000 hitherto made available annuallj 
The Milk (Extension and Amendment) Bill was presented 
in the House of Commons b> Mr W S Morrison supported 
bv Dr Elliot on June 24, and was read a first time Its 
purpose IS to extend certain temporary provisions of the Milk 
Acts 1934 to 1937 to release milk marketing boards and the 
Government of Northern Ireland from certain obligations 
under those Acts and for purposes connected with the matters 
aforesaid 

B M A ’s National Medical Service Proposals 

Mr Walter Green inquired on June 23 whether the 
Minister of Health had considered the report recently puh 
hshed bv the British Medical Association oiiihmng a scheme 
for a national health service, and whether he intended to take 
anv action in the matter Dr Elliot said he was not vet 
in a position to indicate the attitude of the Government m the 
matter 

Maintenance of Child Health 
The Esumiles for the iNfmisVrv of Lvhour were discussed 
m the House of Commons on June 24 

Mr L S Amlrv said the Stale should consider at mv rUe 
the minimum conditions of health for children The Stall, 
contributed to the maintenance of a workers children when 
he was dead Should it make some allowance for Uw 
sustenance of those children while he was alue if bis wag-s 



Jui,\ 2, 193S 


MEDICAL NOTES IN PARLIAMENT 


were inadequate to <iustam them’’ The present fiat rate wagea 
siitem meant that the coming of each additional child was 
a hardship to the rest of the famiK and to itself \ sune\ 
of milk consumption in working-class households showed that 
the consumption per head fell m the larger families just 
where the need of it was greatevt The medical officer of a 
large industnal concern wrote that working class parents could 
have onlv one or two children if the\ were to afford an 
acequate diet for them That was a major national catastrophe 
All but the most improvident elements in the communitj 
were vielding to the inducement to restrict their families 
Dr Hvden Guest said the Minister of Labour should call 
for a report on the phvsical condition of all families on un- 
emplovment assistance A medical report on its condition 
should be rendered at least once a quarter 'O long as a family 
was receiving unemplovment assistance If the Mmister 
received these reports he could not resist the argument for 
increasing the allowances to an amount adequate to give those 
children proper food Dr Guest suggested that Parhament 
should abandon the effort to find the elusive standard of mal- 
nutrition and should sav that if a child did not come up to 
a reasonable standard of health and nutrition it should be 
treated as undemounshed As an old consultant medical 
officer of the London Countj Council he assured the House 
that this would be an easier wav technicallv The Minister 
should consider a scheme to provide cheap milk in the home 
In Ulster bv administrative measures the price of milk bad 
been reduced bv about one-half compared with the price m 
this countrv WTiv not have a five v ears plan to improve the 
nutrition of the children m this countrv '> 

Mr Ervest Brows said he desired to saj a good deal 
about familv allowances and the relation of human need to the 
wage structure but would do so on another occasion 
A motion to reduce the Ministrv of Labour vote was 
rejected b> 200 to 97 

Refugee German and Austrian Doctors 

On June 25 Mr Parxcr asked the Home Secreiarv whether 
refugees from German) and Austria were allowed to practise 
as doctors or dentists in this countrv it suitably qualified 
and whether the Government m dealing with this question, 
consulted the principal professional organizations concerned 
Mr Leovd said that permission had been given in a limited 
number of cases to refugee doctors and dentists from Germans 
to practise their profession after admission to the British 
Medical and Denial JJegislerr The question of admitting a 
further number of refugee doctors and dentists from Austna 
was under consideration Before reaching a deasion the 
Home Secretarv proposed to consult representatives of the 
medical and dental professions m this countrv 

Constitution of Ophthalmic Benefit Committee 

On June 28 Major Mvcnwivra asked the Minister of 
Health vvhv the Ophthalmic Benefit Approved Committee 
which was a statutorv committee did not give their names 
to bona fide persons who had to appear before them or had 
to have dealings with them and if he would state the names 
of the Committee Mr Bernvvs said that the Minister was 
not aware that the Ophthalmic Benefit Approved Committee 
had declined or would decline to give the names of the 
members to anv persons w ith w horn the) had official relations 
The Committee consisted of fourteen representatives of 
approved societies and an equal number of opticians with 
Sir Robert Aoung MP as chairman There were also two 
official observers with no voting power one from the Mimsir) 
of Health and one from the Department of Health for 
Scotland 

Detention of Mental Defectiies 

In the House of Lords on June 27 the Tvrl or Mis-sirp 
moved the second reading of the Mental Dtficicm-v Bill which 
has passed the House of Commons He cvplaincd that the 
Bill aojusted a posiiion of serious difiicultv vvhich had arisen 
from a recent judgment of the Court of \ppcal in sonncvion 
With the Mental Defivienc) Acts The Bond of Control 


Tk Eirriri 47 
vim CSX ro- xsiL 


which had to revaevv the position of ’ OPO palicnls cash 
quarter had been advised that thev could have a few d„vs 
after the end of each quarter in which to make an o-dcr 
continuing the period of detention if thev thought fi The 
Court of AppeaL however expressed the opinion that Ibere 
was clearlv a slip m the drafting of the Mental Deficiercv 
Act of 1913 which ought to be put right bv legislation \s 
the law now stood there were thousands of per ors of ib s 
kind against whom orders had been made in complete good 
faith after taking counsel s opinion and exercising eien s»rc 
and at the moment these orders were invalid It was impos 
sible as the law now stood for the Board of Control at 
quarter davs to examine 6 000 documents and m addition 
look into certificates and reports to see if thev were ju tit ed 
in continuing the orders The Bill declared that the ordt. s 
vvhich had been made were valid and that an order m de 
under the Act of 1913 might he continued bv an order made 
bv the Board of Control within one month after the dale 
on which but for the Bill the order would be limited to 
cvpire Probably the whole of the month would not be 
needed but it reallv was not in the interests of the defiacnis 
that the Board should not have time to con ider the mitter 
before making the necessary order 

The Bill was read a second time 

Sleeping Sicki ess Free TreaSmeni in Seiessnons Cases — 
On June 21 Mr Pvrker asked the Mmister of Heal h 
whether m view of the difficulties and financial burden ir 
curred bv anv familv m vvhich there was a case of sleeping 
sickness he would consider the provision of free treatment ard 
care for persons suffenng from this disease Mr Berms s 
said no serious difficultv had been evpenenced in ecuring 
suitable accommodation for persons suffenng from this dis 
ease and where the accommodation was provided hv a local 
authontv the authoniv had power to remit any charges if 
they were satisfied that the financial circumstances of the 
patient justified this course 

Malaria Liiiis in British Colonies — Mr Mslcoevi 
MscDosvld slated on June 22 that m the southern Lnited 
States fulltime malaria units consisting of a phvsician an 
engineer and an entomologist were now added to the si-f v 
of State health departments and that similar steps had lor 
some sears past been taken in most British colonies 

Cleanliness 0/ Milk Containers and Churns — Answering Sir 
Joseph Leech on June 23 Dr Elliot said the Milk ard 
Dames Order 1926 required everv vessel used for containing 
milk 10 be kept at all times in a state of thorough cleanliness 
and m particular to be vv^hed after use and cleansed md 
scalded with boihng water or steam before it was used again 
Dr Elliot further said that the Milk and Dames Order 1926 
placed a dutv on the dealer to clean e chums thoroughlv 
before returning them to the producer and on the prodi ccr 
to cleanse and scald with boiling water or steam all ves els 
used bv him for containing milk Failure to cam out tbesc 
duties was an offence punishable bv fine He was rot 
satisfied that an attempt at closer definition would assist in 
the administration of the law 

Superannuation Scheme of ^fenlal Hospital Olficers — 
Captain Ellistox asked on June 23 vvhciher as under ihc 
Asvium Officers Superannuation Act 1909 an officer dis 
missed for mi-conducl might at the discretion of the visiimj 
committee be entitled to a refund of coniributions whrii-is 
no refund could be sanctioned in the case of an oDiccr who 
volunlanlv resumed 11 was propo ed to corrccl such irn'milv 
bv amending Icgishtion Dr Fi I lOT m leplv s ml Ihc suj n 
annuMion scheme apphc-iblc 10 isiliim olh cm v m vciv 
liberal the bencfiK being hqh md llic imitiilnilions pud tv 
them low As al present idvoed tic s.i\ no ic <n 10 (lo 
pose Ihc siicic led imcndnicnl 

Comimttic an \itrtine lenne — lhc enr : 'let <- 
with the nil inr service is still cm red m ll - t 
evidence and Dr I Ihol c mnot ly i 1 '•n 1 
position to issue a repo I 



48 JuL\ 2, 1938 


EPIDEMIOLOGY SECTION 


The BRnmi 
Medicai. Jouksvl 


INFECTIOUS DISEASES AND VITAL STATISTICS 


We print below a summary of Infectious Diseases and Vital Statistics in the British Isles during the week ended June 18, 1918 

Figures of Principal Notifiable Diseases for the week and those for the corresponding week last year, for (a) England and Wiles 
(London included) (b) London (administrative county) (c) Scotland (d) Eire (e) Northern Ireland ' Median values for the 
last 9 years for (a) and (b) 

F/gioes of Births and Deaths, and of Deaths ucoided iindei each infections disease ate foi (a) The 126 great towns (124 m 1917) 
in England and Wales (including London) (b) London (administrative county) (c) The 16 principal towns in Scotland (d) The H 
principal towns in Eire (e) The 10 principal towns (9 in 1937) in Northern Ireland 

A dash — denotes no cases a blank space denotes disease not notifiable or no return available 


Disease 

1938 

1937 (Corresponding Week) 

1929 37 (McdianValut 
Corresponding Weeks) 


m 

m 

m 

Ce) 


1181 

m 



1 (a) 

(b) 

Cerebrospinal fever > 

Deaths 

22 

2 

2 

12 

2 

2 

■ 


> s 

) 1C 

> 1 

K 

■ 

imu 


Diphtheria 

Deaths 

SS9 

29 

115 

167 

4 

' 57 

16 

I 1,02 

35 


■ 

) s: 

5 - 

> 17 

' 877 

164 

Dysentery 

Deaths 

37 

14 



pA..- 

H 

) i 

> 1( 

) 

— 



Encephalitis lethargica, acute 

Deaths 

3 

1 

— 


— 

4 



1 

J 

n 

1 



Enteric (tvphoid and paratyphoid) fever 

Deaths 



1 

3 

3 

24 

1 

2 

13 

1 


■ 

30 


Erysipelas 

Deaths 

■ 

■ 

58 

6 

2 


2 

52 

I 



~\ 

Infective enteritis or diarrhoea under 2 years 
Deaths 

48 

20 

16 

7 

1 

41 

10 

14 

3 

2 



Measles 

Deaths 


5 

258 

4 

1 

1 

11 

i 

126 

1 

2 

1 



Ophthalmia neonatorum 

Deaths 


3 

31 


■ 

139 

i 

34 

■ 

2 

“ 


Pneumonia, influenzal § 

Deaths (from Influenza) 

787 

21 

49 

2 

2 

1 

1 

I 

18 

1 

574 

7 

42 

1 

5 

1 

1 

3 

1 

796 

52 

Pneumonia, primary 

Deaths 


12 

205 

17 

8 

II 

■ 

12 

144 

Sh 

10 



Polio encephalitis, acute 

Deaths 

1 

— 



■ 

1 

s 

■ 



1 


Poliomyelitis, acute 

Deaths 

— 

— 

1 


■ 

12 

1 

■ 


— 



Puerperal fever 

Deaths 

2t 

2 

It 

2 

2 

39 

5 

n 

9 

— 

— 



Puerperal pyrexia 

Deaths 

174. 

16 

19 

i 

2 

125 

22 

i 

18 


1 



Relapsing fever 

Deaths 

— 

— 


■ 

— 

i 

— 

— 


— 



Scarlet fever 

Deaths 

1 746 

5 

156 

383 


77 

2 

1,549 

138 

356 

1 

109 

2 

44 

1,551 

247 

Small-pox 

Deaths 

i 

i 

■ 

— 

— 

— 

5 

a 

— 

— 



Typhus fever 
^ De iths 

■ 

■ 

■ 

— 

— 

— 

■ 

1 

— 

— 



Whooping cough 

Deaths 

15 

3 

119 

I 

1 

34 

1 

13 

3 

180 

4 

1 

6 

1 



Deaths (0-1 year) 

Inf int mortality rate (per 1,000 live births) 

310 

51 

59 

48 

80 

24 

15 

304 

50 

45 

37 

63 

22 

19 



De uhs (excluding stillbirths) 

Annual death rate (per 1 000 persons h\ ing) 

4,172 
10 3 

736 

94 

560 
11 4 

181 

122 

134 

119 

5 768 
93 

724 

9 1 

549 

11 2 

176 

120 

126 
12 1 



Live births 

Annual rate per I 000 persons living 

7 685 
189 

1,393 
17 7 

974 
19 8 

393 
26 5 

246 
21 8 

7 165 
177 

1 336 
16 8 

979 
20 0 

425 
29 0 

252 
24 I 



Stillbirths 

Rate per 1 000 total births (including stillborn) 

297 

37 

55 

38 




310 

41 

46 

33 





- 


• 1 m Belfast Death from puerperal sepsis , ^ , . , s« i. i i „ 

t After October 1 1937 puerperal feser was made noiiiiable onlj in ilic Includes primarj form in figures of England and wales London 

adTumsiraUNC couni> cf London (administrative couniv) aaJ Northern Ireland 



































































































































Jm.\ 2, 1938 


EPIDEMIOLOGY SECTION 


The 

MtU ext J'-CTSVL 


.9 


EProEmOLOGICAL NOTES* 

Enteric Fever 

During the week under review there were 15 notifications of 
enteric fever m England and Wales compared with '0 in the 
previous week of these 5 (2) were in London — 2 m Battersea 
and 1 each m Chelsea Kensington and Woolwich In Scotland 
there was 1 case of paratvphoid fever m Greenock 

Diphtheria and Scarlet Fever 

In England and Wales notifications ot diphtheria tell in the 
week under review from 912 to 8S9 but in London there was 
an jncrease of 2 — 1 13 to 115 Notifications of diphthena ro^e 
slighth in Scotland and in Eire there was a considerable 
increase in Northern Ireland however an appreciable drop 
Was noted Deaths in the 126 Great Towns of England and 
Wales rose from 23 to 29 while in London thev fell from 
4 (o 3 Of the 29 deaths from diphthena recorded in the 
126 Great Towns 3 (1) occurred m South Shields and 2 each 
in Liverpool (13 and Derbv (0) There were 4 deaths from 
diphthena in the 16 pnnctpal towns of Scotland dunng the 
weel — 3 (0) m Glasgow and 1 (0) in Paislev There was a 
'light rise m the notifications of 'carlet fever in England and 
W'ales during the week under leviev — 1 746 compared with 
1 743 — and in London where 156 cases were recorded as 
against 149 in the previous week In England and W'ales the 
figures were m excess of the median value for the last nine 
tears but m London lbe> were considerabh less In the Great 
Towns of England and W’ales 5 deaths from scarlet fever were 
recorded compared with 4 in the previous week there were 
- no deaths irom scarlet fever during the week m London 
NoUfications m Scotland fell from 420 to 383 with no deaths 
while in Eire and Northern Ireland thev rose from 74 to 76 and 
66 to 77 rcspectivclv in Northern Ireland there were 2 deaths 
_'-both in Belfast 

Pnmars and Influenzal Pneumonia 

Notifications of primarv and influenza! pneumonia m Eng 
land and Wales fell from 801 to 787 during the week under 
review and m London from 63 to 49 both these figures were 
Well below the median values for the last nine vears for England 
and W'ales and for London Fewer deaths from influenza were 
reported in England and Wales and London during the week 
a'so m Scotland where thev fell from 2 to 1 In the West 
Riding (Yorks) 88 (121) cases were notified of which 27 (34) 
were m Sheffield 21 (38) in the Administrative Countv 13 |19) 
in Leeds 7 (10) in Bradford In W'arw ickshire 48 (49) ca es 
were notified of which 29 (38) were in Birmingham Of the 
167 (120) cases reported in Lancashire 42 each occurred m 
Liverpool (27) and Manchester (19) There were 21 deaths 
from influenza m the 126 Great Towns of England and W'ales 
during the week of these 3 (4) were in Manchester and 2 each 
m London (6) Liverpool (I) Birmingham (2) and West Brom- 
vvich (!) In Scotland 205 cases of pnmarv pneumonia were 
notified compared with 210 m the previous week there were 
only 2 cases of influenzal pneumonia — as against 1 1 in the 
previous vseck — and 1 death which occurred m Glasgow In 
Eire there were 17 cases of oneumoma and 8 deaths 6 <103 ot 
which occurred in Dublin There vvere 11 (15) deaths from 
I pneumonia in the ten pnncipai tovvns of Northern Ireland 
during the week — 10 (11) in Belfast and 1 (2) in Londondem 


hospitals on Fridav June 17 was 971 compared with 1 IPS ca 
June 10 On the same dav there were order treair-c' m 
the LCC fever hospitals 984 (' 014) cases of dip''ths'i- “"6 
fSOO) cases of scarlet feve" 2^6 (268) ca'es ot vvhoopin^-sca^h 
Notifications for the week ended June IS in the eleven "" o 
politan borouchs in which mea les is notifiable were 326 1 -s' 
distnbuted as follov s Battersea IS (39i Bermonc ev ' I'l 
Finsburv 27 12-1 Fulham 30 (61) Greenwich 107 (6"i H„r - 
stead 17 I2I> Lambeth 40 l32) St Pancras 2, Shorcoii a 
6 (113 Southwark 12 (121 Steprev 13 (263 In Sco’iard -'5 
cases ot measles were notified compared with 09 in irc 
previous week the figures for Glasgow were '0 i76l L-r rs 
Countv 4S I67> Falkirk 41 (353 Dundee -0 I 6) Kukc idv v 
(21) Edinburgh 16 (29) During ihe week there v e c - 1- 
deaths from measles m the 16 principal to' ns ot SsP nj 
of these I each occurred m Glasgow ill Dundee i|i ki > 
caldv (0) Hamilton (0) In Eire there was I dcuih from rs^v' s 
m Drogheda and m Northern Ireland there vv„s 1 death (m 

Belfast) 

In England and Wales there were Ij 'I!' deaths from 
whooping cough during the week of which j lOl occurred n 
London In Scotland 119 ca«es of w hoop nu cough vcc 
notified comnared with 56 in Ihe previous week v hi'e ihc e 
was 1 death — in Glasgow In Northern Ireland - il“) c- cs 
of whooping cough were recorded vviih 1 death-— in Belf-si 

CTioIcra 

During the weel ended June IS 66 ca C' ot cholera were 
reported at Shanghai and 2 cases with I death at Hong Kong 
In the same week m Burma S cases with 8 deaths vere notif eJ 
in Calcutta 7^ ca es with '2 deaths in Bombav iPtesidenc ' 
20 cases with 9 deaths in Delhi 10 cases wuh deaths So 
far there have been 17 a 0 deaths m the cholera epidemic m 
the Lniied Provinces 01 India and 5 000 cases reported 
During the week under review 28 cases wuh 12 deaths were 
notified m Cawnpore in the same week in the Punjab the e 
vvere DO cases vvuh 96 deaths m Sind 37 ca es v tlh IS dea hs 
and in the Central Provinces 1 2s9 cases vsnh 6-9 deaths 
In French Indo China dunng the same wee' 225 ca e of 
cholera vvere reported in Annam 519 case inter r la es 
m Hanoi 

Plague 

Dunng Ihe week ended June 18 in Burma “ ca es of plague 
with 7 deaths vvere reported m Bnlish India dunng the ame 
week 3 cases wuh 5 deaths were notified in Bombav (Pre 1 
denev) and 2 cases wuh 1 death in Madras iPresidencv) In 
Shanghai 66 cases were reported dunng the week under reviev 
compared wuh 84 m the previous week and in Hong Kong 
2 cases with ! death 

Sroall-pox 

Dunng the week ended June IS there were 2 cases of smill 
pox with 8 deaths in Hong Kong In (he same wee) in Biirm I 
26 cases vsuh 5 deaths were reported in Calcutta 45 u uis 
with 40 deaths m Bombav (Presidency) 179 cases will' ''' 
dealhs in Madras (Presidencv) 29 cases vsuh 3 sleiths '' 
Central Provinces 45 cases wuh 1 1 dealhs in Siild " 5 ‘ , '' ' ' 
a deaths In the same week m French Indov 
of small pox were reported in Tonkjng and ! v ’ ® 

and Hanot Dunng the week endcsl 'i“ s v s 

small pox vvere notified m the U \ 


Measles and Wlioopmg-coagh 

In the 126 Great Towais there were 14 dealhs from measles 
compared vvath 12 in the previous week of the'e 5 (0) were 
in London 3 (2) in Leeds 2 (1) m Burv and 1 each in 
Tottenham (2) Portsmouth (0) Kingston upon Hull (0) I iser 
pool (0) During the weekT 680 ca cs were reported from the 
LCC elemenlan schools compared wath 660 in the prev 100s 
vseek The average dailv admissions to the LCC fever hos 
pUals were 24 compared with 33 m the previous week and 
the number of ca es of measles under treatment m these 

' Except vice oihenv e mentioned ftcurcs m patenlhe'Cs refer 
to the week p-eceding the one under renew 


Dunng the neck erdcx’ ' 
were reported m Cm-x ' *' 
85 cases vvere rsps x' '' 
Mo"occo 170 v-'w' 
tnbuled as fv s' ^ ^ ^ ^ 

34 cases C' 5s ^ 

death Ci i>, ^ 

Durm^ s s ^ 

vver— •s'* " ^ 

s s 

j-x- -Z ' 


fVts'SsV 

s ' o s cases c£ 

V V stia in tre — 
V vice-s ennea — 
s were notifissi. — 

sises 10 o — 

death. -- 
■th T.- 


: — n 
. ed z 



UNIVERSITIES AND COLLEGES 


TnrBurrtsH 
MtDicAi. Jours M, 


\ 

50 Juu 2, 1938 


in Algeiia 105 (55) cases were reported, mainlv distributed as 
follows Algiers (department) 29 cases Constantine (depart 
nient) 57 cases and Southern Territories 7 cases In the week 
ended June 4 m Yugoslavia there were 8 cases of tjphus with 
1 death In the USA during the week ended )Vla> 21 
28 cases were reported Georgia 14 Texas 5 3 each in 
Alabama and Florida, 1 each'in Connecticut Tennessee and 
Mississippi 


Universities and Colleges 


UNIVERSITY OF OXFORD 

The Professor of Anatomj has recommended that the Welsh 
Memorial Prize, 1938 for the best set of drawings illustratixe 
of human anatomy be awarded to J L Boldero (Oriel) The 
drawings submitted bv Q J G Hobson (New College) deserxe 
commendation 

At a Congregation held on June 23 the following medical 
degrees were conferred 

DM — D A Robertson, F Bicknell 
B M — R G Blackledge, S R Gloyne, F G Ethiraj 

In Conxocation on June 21 a decree was passed accepting 
■' a bequest of £2 500 under the will of the late Miss Annie 
Harrison Symonds, daughter of a distinguished Oxford surgeon 
for the foundation of a Horatio Svmonds Studentship in 
Suigerj ” Mr H P Symonds died in 1923 aged 72 

UNIVERSITY OF CAMBRIDGE 

Dr R A McCance University Reader in Medicine, has been 
elected to a Fellowship at Sidney Sussex College 
The following candidates have been approx ed at the exam 
mations indicated 

Third MB — Part I (Singen Miduifer} and Guiiiicologi) 
H St C C Addis, H W Adeney, R S Alexander J T H 
Butt, D L Caldwell, P L Candler, RIG Coupland ARP 
Ellis, J Evans, D Foskett G A Fouler, D Garcds, W Goulstone 
S G Hamilton, J P Henry C H HosKyn, R D S Jack G B 
Leyton, A G McPherson, JAR Miles P L Mollison N E 

Monteuuis M E Moore, AWN Oatway, J S Pratt L M 

Reid D L Ridout, C J Rooke C C Shaw, I F Smith E \V 

Somerville, T L Stoatc N Vere Hodge J D Wade D O 
Walker W W Wiggins Davies, J M Wilkin, B J O Wmfield 
M C Woodhoiise, B M Wright, A Young J D Youngluisband 
IVomen E F Graham Kerr, I T Hinde, M Lloyd, V L 

Lutwychc Pait II (Piinciples and Piactice oj Plnsic Palliolog\ 

and Pliarniacolog\) H W Adeney, E W O Adkins, R S 
Alexander, C H Bartlett A H Baynes K G Bergin J R 

Bignali, R D D Birdwood A W Bone R 1 C Bradford 

R W W Broxvn, P L Candler, D M Carding R D Caton 
A G H Clay M J Clow E Cromn A J Daly TAW 

Edxvaids W B Exans D Foskett, A C F Green J E Hardwiek 
Smith R D Hearn, J S Heller, J P Henry L R Holt G N 
Hunt T G S James R M Johnstone P A Knilt Jones 

J Laughlm, R B Leech G B Leyton G M Little A G 

McPherson A G Marshall A H Masina, T K Maurice, JAR 
Miles sW A M Miller P L Moltison WED Moore, J Murray, 
R O Murriy A P Norman, G Oppenlieimer, W E Owens 
R Piper, JOB Platts, J S Pratt B H Price J S Prichard, 
S R Reynolds E L N Rhodes (Pathology and Pharmacology 
only) J H B Round J Smith P M Smythc H Stott A M 

Thomas A J Walton J M Wedderspoon H F Whallcy, 

C F H Wiessncr W W Wiggins Daxies M M Wilson R R 
Wilson, B J O Wmfield, J W Wood, P J Wormald G M 
Wright D E li arrow M D Young J Budkin 

UNIVERSITY OF LONDON 

At a meeting of the Senate held on June 22 Dr A M H 
Gray xxas appointed Deputy Vice Chancellor for 1938~9 
J D Boxd MD M Sc Belf was appointed to the Univer- 
sity Chair of Anatomy tenable at the London Hospital Medical 
College as from the beginning of next session 
The degree of D Sc m Anatomx was conferred on Thomas 
Nicol MDGlas FRCSEd professor of anatomx and 
dean of the Medical Faciillx at King s College 

UNIVERSITY OF WALES 
NVulsh Nxtionxl School of Medicine 
The following candidates for the degrees of M B Ch B 
hast passed in the subjects indicated 
OnsiLnucs xsd Gxsvfcolocx — J M Bowen (with distinctiony 
Marx yV Bowen Mirjoru. E Bright G R Di\ic> D B E 


w Jarman Elizabeth G Jenkins H V 

Jones G W D Lewis O O Lewis M Lewis Mair LlewcKn 

Llai^ M I’^rry J L Reis 

Bex an Alice Dax ies Miriam E Daxies D G Evans D G 
PnTlu" t^i ^ ^ Millard Mary D Owen Lyndi B 

WiUiams^^ ^ ^ Rees Emily K. Willnms (with dtslmclion) Wnry 

Pathology and Bacteriology — Beryl Badbam (with distinction) 
Doreen M E Cranch C Davies Joan B Davies, G C D Evans 
.E'lms, R G Gntruhs. Helen C Hodges D D Howell 
r, J J V Jones Anne N M Llewhclin H L 

Lloyd, R M Marshall Brenda M Mead D G Morns R F 
Packer, Mary C Powell H V Roberts, D C Taylor C Thomas 
C E Thomas Margaret R Wade 


UNIVERSITY OF GLASGOW - 
The honorary' degree of LL D was conferred on Dr Matthew 
John Stewart, professor of pathology in the Universitv ot 
Leeds on Commemoration Day (June 22) 

QUEEN S UNIVERSITY BELFAST 
At the summer graduation to be held on July 8 Sir Robert 
Johnstone Professor of Gynaecology in the Universitv and 
President of the British Medical Association is to receive the 
degree of LL D lion causa 

The following candidates have been approyid at the 
examination? indicated 

MD — fli Thesis J R Armstiong S L W Ervkinc *J W 
McFettcrs B\ Esainmnlion ’Muriel J L Frazer, L Herbert 
E J Sankcral/i 

MB, BCh bad— GF Adams H W C Bailie W S 
Braiduood J Biownc J Bunting JOY Cole, S D Corry, 
J I Cunningham W M Davidson D McL Deeny S Dobbin 
J Elliott Jane M Fullerton S Gibson W G Gibson J Gilmore 
J R Gialnni H G Greeves A G Hawthorn Rosetta Hill 
SAC Hunter S T Irwin W James W R Johnston J A 
Lavvicnce J Lazarus A T Linton J McCabe J K McCibe 
H A McCaflrev S H McCaughey, Florence M McClellind 
L McCrory, E McF McKee A Maclaine, J McMnstcr V J 
McVeigh L F McWilliams fR Magill J Mahood J A 
Mark Agnes J A Maybin R P Maybin C W Mcarns 3 
McI Megaw R A Moorehead W M Morgan, J H O Connell 
J R Roulston H C Rutherford J P Savage W F Smyth 
Vcia M Sterling J Tayloi tW Tovvaisley, F G C Walker H H 
W’cir, R I Wilson R J Wright 

’With high commendation jWitli second class honours 


The Services 


MEDICAL UNIT, VLOTC 

The annual training of the Medical Unit of the Universitv of 
London Olftcers Training Corps vvill take place from July 16 
to lulx 30 at Shorncliffe Camp This unit contains 400 
medical students drawn from all the teaching hospitals in 
London It is from these medical students undergoing train 
mg at present that the junior medical ofRcers would be 
drawn in the event of mobilization The officer commanding 
the Medical Unit U L O T C is Colonel C Hope Carlton 
On Saturday JtiK 23, Major General the Earl of Athlone 
KG Chancellor of the Unncrsitv, will inspect the con 
tingent on parade and H R H Princess Alice, Countess of 
Athlone xvill present the challenge cups at the conclusion of 
the display 


M R Giro (Arch Derm Syph Chicago, February, 1938) 
reports the effect in cases of pemphigus of oral administration 
of sulphanilamide, which was tried in view of the presence 
of a streptococcus jn mans such cases Two cases arc 
reported one that of a Jew also suffering from an acute 
attack of diabetes who improved after the administration 
of 5 grains four limes a dav the other that of a Jewess who 
had suffered from pemphigus for one year and improved after 
one weeks treatment with' 10 grams of sulphamhmidc fo! 
lowed b\ 15 grains of sodium bicarbonate six times a day 
in association with the application of 5 per cent tannic act 
jellv locally 



Juu 2 1938 


MEDICAL NEWS 


Tk£ 

CJU. 


<! 


Medical News 


Letters, Notes, and Ans^’^ers 


Mr Aleck W Bourne obstetnc surgeon to St Marv s 
Hospital and consulting obj.tetrjc surgeon to Queen Charlottes 
Hospital has been summoned b\ the police on a charge of 
unlawfulh using an instrument with intent to procure a mis- 
carriage The operation \vas performed at $t"Mar\ s Hospital 
Mr Bourne s defence is being undemken b\ the London and 
Counties Medical Protection Societv A report \\ill appear 
in our ne^t icsue 

The new isolation block which has been added to the London 
Fe\er Hospital Liverpool Road Islington will be opened b\ 
H R H the Duke of Kent on Julv 14 

Professor Chevalier Jackson of the Universitj of PennsvI- 
vania with the collaboration of other lecturers will hold a 
theoretical and practical course in broncho oesophago'^copv 
at the Hopital Necker in P?ri^ from August 23 to September 
1 The fee is 3 000 francs Further information can be 
obtained from Dr Jean 2ha Hopital Necker rue de Sevres 
Pans 

At the meeting of the Societv for the Studv of Inebneiv to 
be held in the rooms of the Medical Societv of London II 
Chandos Street Cavendish. Square W on Tue dav Juh 12 
at 4 p m Dr J D RoBe^ton vnB read a paper on 
Fore! and his Campaign Against Alcoholism 

The Committee of the Pnvv Council for the Organization 
and Development of Agncultural Re earch has nppoin ed the 
Earl of Radnor 'ind Sir Joseph Barcroft to be members of 
the Agncuifural Re earch Council with effect from Julv I 
when Lord Richard Cavendish and Sir Fredenck Gowland 
Hopkins retire from membership 

The Minister of Health and the Secretan of State for Scot- 
land have apcointed a Departmental Committee to consider 
whether the Rag Hock Acts and the regulations made under 
them are adequate to secure proper cleanliness of rag flock 
used for the manufacture of uphohterv bedding etc and 
whether all or anv of the provisions applicable to rag flock 
should be applied to other materials used in the manufacture 
of household furniture Lord Merthvr is chairman of the 
committee and the other members inLlude Dr S Clark 
and Dr G - H Pearce All communications should be 
addressed to the secretarv ot the committee Afr N Hutchm 
son Mmistrv of Health V.'lwtehaU SW 1 
The jubilee of the introduction of aniirabic vaccination 
into Rumania was celebrated m Bucarest on Mav 6 at the 
msiilule named after Professor Victor Babes who was the 
pioneer in this respect and abo the founder of the oldest 
medical societv in Rumania there follov\ed a conference on 
hvdrophobia A jubilee volume will be issued containing 
the speeches and lecturci deli\ered on this occasion The 
pnmarv objective of the scientific part of the proceedings was 
to illuminate a problem which is vetennarv as v\eU as of 
human interest Homage was rendered m this connexion also 
to Professors Mannesco and Levaditi Excursions v\ere made 
to the Danube delta and the Carpathians 

The king has appointed Dr James Abbev Hender«on to be 
a Member of the Executive Coun'‘il of the ^Island of 
St Vincent 

Professor Ferdinand Sauerbruch has succeeded Professor 
Erich Lexer as editor of AVi/e Deutsche Chirurinc and has 
been elected an honorarv member of the Gernan Surgical 
Societv 

Professor R Alexandri his been elected president and Pro- 
fessor C Frugom \ ice president of the Rovil Academv of 
Medicine of Rome 

Dr Chev-assu profes or of sure cal palholocv in the Pans 
Facultv and Dr Pevion Kous of the Rockefeller Institute of 
New Vork have rccentlv been elected rrcnihers of the 
Academic de Medecine 


AH communicationi in regard to editonal busi^'C^s N; 

addrcNscd to The EDITOR Bpitish Medc^l Joi.o»^i- BM \ 
Holse Tk\istoc}- S<?lir£ RCI 
ORIGINAL ARTICLES and LETTERS ferwarded for i 

are underiiood to be offered to the Brim/ \fed -c/ Jo i „ i.- 
unless the contrarv be stated CorTe>ro'*d‘*n.5 wj i ” - 

to be taken of their commun cations should ^utheit ca t ihc~i 
w tb their nam*s no necess^nh for pjb’ica^jon 
Authors desinng REPRINTS of ihetr ^rtic’es publ hed n ’ 
Brius/x \fedfcal Journal must communicate vnth the Se 
B MA House Ta%i towk Square V\ C 1 on rec**ip - o ^ 
Authors overseas should ndrcaie on ^ISS repnrt? .. c 
required as proofs are not sent ab oad 
All communicaoons with reference to AD\ ERTlSEklENTS he d 
be addres ^ to the Adverti ement Man>-cer O d rs ter cep-N 
of the Journal and conmunicattors wrh rctercrce to u-' 
ttons Should be addressed to the S-^n. -rv BMA Hi.uc 
TaMstock Square \\ C 1 

TTie TeI-Ephove Nevibee of the Bru h Xtediccl A ect-uen a-<i 
the Bnitsh Medtccl Jounzul is ELSTON 2111 
The Tei^graphic Addresces are 
EDITOR OF THE BRITISH \fEDJC-iL JOLR^AL <iri 
R esteem London 

SECRETARY Med/fecra H esteem Lordou 
The address of the BMA Sl .0 li h OTce 7 Dnirn *'eu I 
Gardens Edinburgh (telegrair^ Assoeiute E linb 
phone 2-* 61 Edmburchl and of the Office ot the Insh f 
State Medical Lnion Tl MA ^rd BMAi 1^ ki'dare S rea 
Dublin ftelegram^ Ba^'/Jus Dnb'in tel'’phcre Dublin) 


QUERIES \ND \NS\NERS 

Recurrent Ulcers 

Borderer nsks for suggestions for the treaimem oi a tur! 
aced 20 who has suffered from mucous ulcers irtcrmi teniK 
(or the pas tour vears At fir t there were onl o ca onal 
buccal ulcers Now the ulcers ^ppe^r spa modicallv ard 
mav be buccal anal or vaginal The senriwim rcatiicn 
ib negative the girl has had all her teeth e\i t.cied and 
examination bv a phvsician and bv an oio rhino l^r n-olosn t 
has proved negative Treatment bv means of diet'* r uth 
V ashes tomes” and sulphan I^mide ha** had no eflcci Pht, 
patient is a domestic servant m a good hou ehold and ap ir 
from this trouble en,ovs perfect health 


Alopecia 


D Michael Malk fjohannesburt.) ' ntes In repiv to 
R J C (Joitrtial Mav P p 10^41 I had an identical 
ca<e ot alopecia v hich responded with dramatic ';uccc'*s 
to treatment wiih I gram thvroid tablets three limes a dav 
and 


p 


Cn.uc cod li>e 
L?^ r carb 
■V-tclioe 


t d -"h"' 


To b« n-bbtfd j lo lie ves-r da i 


1 mat add (hat all the usual retredies had teen tried un 
successfuiis O'er a p-eiod of 'c eral 'ears Aficr cicht 
months of Inis ireatneni m' patient has to 'I'lt hts hair- 
dresser t"ice a month 


Operative Treatment of -Vsciles 
Dr D P O Bries (Rockhampton Queensland) "ntes in repiv 
to Perple\ed (Feb i-arv 12 p 3~tl) "bo inquired about 
the operative treatment of ascites In the ^ledicai Journal 
of -tusiralia ov November 26 IV-. (P 3^-) ) pnWt ^bd - 
description of an omentoFC-vv diferent from previous omenio 
pe-vies This operation un’ike omer remains efticicni for 
life and leaves no bands round which bowel m eM_^s ranju- 
iaie 1 be article de ertbes one case treated in )9I-. a man 
aced 0 It was one of Ihrombos s of the inferior vcn_ cava 
and previous to operation I.ppnc ' as required c e rrec 
weeks After -oreralion Huid disappeared Irom the ^'■vv"'n 

and no more relumed Tbc pat eni was seen m nv i" 

afterwards He had no a'-dominai troub c< I 
sccondarv veins arc to be een ..t the b^ck ^rd l" i 
sices of the abdomen as well *.s on ib^ ccs rc.tf 
down to the ankles Tbc c ve ns row can- on tt-e c-n _ 
non instead of the inferior 'era cava 


2- JULV X 1938 KEY TO CURRENT MEDICAL LITERATURE 


Tne Dntnsii 
^^CD{CAt. JoUKNXt 


Medizinisclie Klmik 

Bcrhn vol 34 April 22, IWg 

Imporuncc of Chronic Injury G Mitgnus 
Recurrent Fncturcs of ftic Corpus — E Schneider 
^Anicsthcsia in War Surcerv — R Shicb 
Treatment of Lupus Vulgiris with Scinfications — Kranlt 
Earty Diagnosis of Urgent Abdominal Affeetjons in Children —A Loeschke 
•Appendicitis m Childhood — A Obernicdc mayr 

Aetiology und Surgical Treatment of Inflammatory Ucctat Stenosi —H 
WUdegans- 

Anti bacterid Properties of Animd andx^Human Secretions (Cutanenua Masai 
Bronchial Oral and Mammary) and ot Vegetable Excretions tHono 
tie ) — H DoW 

Possibiliiies and Limiimons of Internal Antiseptics — r H Hormg 
Disinfection of the Titld of Operation with Scpso tincture — J W Wirtz 
Bone rraciurc through Strain —VV Baetzner 
Present Problems of Collapse Thcrapj \V ftcK 

Appindnim — Between 1928 and 1917 1 794 children were 
sent to the hospittl with the diagnosis of appendicitis In 
708 cases the diagnosis could not be confirmed on further 
observation Of the 1,086 cases operated on only 1 per cent 
showed normal appendices In 350 cases there was a diffuse 
piuulent appendicular peritonitis, and m 104 cases a localized 
purulent peritonitis 


investigation Tonsiilectom> was responsible for a snialkr 
proportion of cases than is generalh realized and compared 
favourabh with other postoperative conditions and with 
pneumonia Nearlv all the post tonsillectomy lung abscesses 
were m adults 


Nordisk MedicinsK Tidskrift 

Slockholni vol 15 April 21 I95S 

'AsensK m Sursscry 'cspccijllj from tliv nactvciOloRicil Poini of %u.w — 
O Hiriminn 

0«amitati%c Chcmicil Di.tcrminatton of Cmotmoids 'md Vinmm A in Scrum — 
H WillMtcdi and T k With 

Asepsis — During ''the last decade there has been onh a 
slight decrease in the comparatively frequent pvogenic infec 
tions of aseptic wounds and it would seem that infection 
from the hands of the surgeon the skin of the patient msiru 
ments sutures, and dressing materials is of relatively little 
significance The chief danger is droplet infection from the 
persons engaged in the operation The masks ordinariU used 
are of limited value The frequenev of catgut infections is 
overestimated 


Medizimsclie Welt 

Berlin vol VL Aon! 2i 

Feeding by ihe Jciunal Sound m Gistnc Disc iscs — H Curschminn 
Modern Views on "H lemopbUva —A Fonio (CoiicUtsion ) 

AivC ind Opcruiivc Risk vn Svirgicnl Conditions — F Hollcnb'ich 
PjJonc Ulcer and Ab cncc from Work — R Ducsberg 
Value of Nocturnd Insulin Injections— f Bertram 
Tlicr'inv of Chrome Amocbnsis— -R Boss 


Munchener Mcdizmischc Woclicnschrift 

Munich ^ol 85 April 22 1938 
Orcanotropi'im — Hnecniorn 

Spent incous Cure Intern'll Treatment tnd Indications for Surgicil Inter 
\eniion in Lung Abseci* — K Vosschultc 'tnd E Schinrzhoff 
Empyem't cmiscd by Fusiform Dtctcrn — P O SUssmann and H Dicker 
Estimation of the Scro rctciions for Gonorrhoea — M Jenisch and W Ztindcl 
Common Cold and Diseases produced by Cold — A Weber 
•I ensth of Pregnancy and its Esiim'tuon — K J Ansclmino and L Spciikamp 

^Picgnancy — No fewer than 15 000 cases were examined bv 
Anselmmo and Speilkamp The arithmetic mean of the length 
of pregnancy in these cases was 283 days Termination of 
pregnancy should be estimated as three months backwards 
plus ten days forward from the first day of the last period 
The length of the menstrual cvcle should be borne m mind 
In cvcles of 21 to 28 days pregnancy is shortened by seven 
davs, in those of 28 to 35 diys by an average of four davs 

Nature 

London vo) 141 April 23 I93S 

A Ra> Studv ot rhymonucicic Acid — “W T Aslbury and F O Bell 
Bioloeic'i! Synthksis. of Ammo -rcids from Atmospheric Nitrostn — A I 
\ irtincn md T L nne 

Mo t Prob-iblc Location ot the Genes m the Chromoncm^t't — D KostofT 
Prikuc St.ro FL'iclions for Cancer — F Bcrgh O M Kcnriqucs "ind J 
Sthousboe 

^urplp^nf^u Social Kclation of Science 

New Engl tnd Journal of Medicine 

Bo'ton wl 2IS April 21 I91S 
• \ciiolouy of Lung Abscess — L M Fuedman 

Lum. rkbscess and us Relation to Surgery of the Upper Respiratory TrvCt — 
H Morrison 

Ctncral rriciinont.r and Thor'xcic Surgeti — E Burnett 
Cl f' tlicaiion tnd Trcraimt.m of Arthrui::» — D S O Connor 

/-irnv. Absitss — Ftecefrmn amhses 276 cases of Uinf> abscess 
occurring ai the Boston Cils Hospital from 1926 to 193*' 
Medical conditions uerc rcspon''ibIe for 196 trauma for four 
tnd post operatise conditions for sesents six Thus the i,cncral 
impression that post operatise eomphcUions arc the pre- 
domin tting factors in actio!oL.\ is not borne out bs thts 
52 b 


Pohclinico 

Rome \o! 45 April IS 193S (Sez Prat) 

Hidrothcrupcutic Truitmcnt of Btltar) Calculu** — S Pismi 

LocaI Att'iLsthc la in ihc Surgery of the Uterus md Adnesa — U Bonoh 

Ctst of Ptrci s Discisc TrcTikd sMih Cdcuim 'ind Vilamms — A Tcrranf 

s 

Presse ModicaJc 

Pins \ol 45 April 23 1918 

EspcnmcntiJ Study of Piin — Rent LcrRhc 

Hallucinations in Ihiicnis with Ampunted Lwb*‘ — Ji.Tti Lhcrmhc and Z'oninur 
Susie 

Double Fact piece for the Administration ot Oxygen —L Daulrcbande and 
Edm Dumoiilin 

Schtveizerische Mcdizmischc Wochenschrift * 

Basic vol G8 April 2t 1938 

•Boeck s Distasu of the Lungs m Brother and Sister — M Dressier < 

Frtquutcs Form and Position of ihu Tcirs m Dctachmcms of (In. Rktina at 

Zdnth Eye Hosnml from 1928 to I93f — G Mt>ur 
Parts Phyed by Thyroid and Patathvroid m th^. Produciion of Artcnoscltro h-, 
— H Handovsky 

SimphlicJiioft of the Countins of Blood CotpiwcJcs by ihu Recording Counter 
and Metz s CouniinR Chamber —A Jordi 

' Boicks Disease — Bocck s disc'isc li t mmc prcfcnble to 
Boeck s s^rcold, in that several orgins are often ifTected 
There may be rarefaction m the small bones of the fool or 
hand better known in the later stage is lupus pernio pul 
monary changes delected by v ray v but not by ortho ir\ 
phvsical examination ocuhr changes splenomegaly <urcr 
ficial enlargement of the hmph glands etc The radiographic 
findings (suggesting at first hilar gland tuberculosis) arc illtis 
trated m a brother and vjster diagnosed as suffering from 
Boeck s disease general symptoms and auscullitory signs were 
absent and the skin was normal Possible relations of sicli 
cases with benign Ivmphogranulomatosis (of Sclnumann) with 
chronic or healed miliary tubercle and with tiveo parotid 
fever are discussed In similar cases withoiii cutaneous 
sarcoid the diagnosis appears to have rested largely on histo 
logical demonstration in excised hmph glands or mlnnisil 
nodules of epithelioid cell foci without necrosis or caseation 
and With fevv or no giml cells Tuberculosis is considertd i 
probable acliological factor 

Science 

NiwStjrV vol 87 Vpiil 2’ I'lU 

Ncu I (s-aluy for Trypanosoma Cniri CIiik , m C iltatron — S F VVo>i 
pjoeenc Virus in ihc Ral — W H VVoalom aiKl 1 VVarrin 
Inliibiiory FIToci of Oridirctl Adicnilinc — X Li sal. 

Molecular VV'ciRhts ot VniihoOlcs — I X K,abil ami K O Prj-rsco 
Xiaunin L — VV Nalihara r InuIsM and S Uvimi 



Juti 2 19'!S 


KEY TO CURRENT MEDICAL LITERATURE 


Ti E Eumsii 
Met? Cal 


South African Aledical Journal 

Carciown \ol 12 Apnl ^ lO’S 
HiMon of ^^c<JICInc — P \N Laidicr 

TcwD-planntnp Rchou^mp and Slum-clearance — G H Gunn 

Control m Dairies — K J Milne 

Milk and the Public Health — F N\ P CIuTcr 

SironR>lo diaAis m Natal — H S Osburn 

Plapuc — J H Har\c> Pine and E Gn set 

Infection of the Gall bladder b> ScJiistosama haernctob um — H B Stem 
Mjelcmatosis with Nisccral Meta t.^cs m a Natnc of Soutbern Rhooc^ta — 
V Carlisle 

Nen Chemotherapeutic Agent in Gcnorrhcca — C K O Mallcj 

Uhron in GonorHioea — Uliron is a prontosil dernatixe— 
4 benzol suIpho-dimethNlaraide This is a preliminan report 
of Its ii<e in txxentx two cases of gonorrhoea The general 
imprecision of the author is that uliron has a decidedlx faxour- 
able influence m the majontx of cases some failures were 
noted No serious signs of intoMcation were seen even in 
patients who receixed oxer 20 grammes the maximum given 
in anv case was 32 grammes 


Ugesknft for Laeger 

Ct'jcnhagen \oI 100 Vpnl -1 19^8 

Bctaxin in the Pol>ncuntis due to Pregnan > and Other CtiKes — H Je< cn 
Colds in Children and Xdulis ETperiences with ^ac^ne Ircatmcnt — 
V Frm MOIler 

K Ca<o cf Lcriosrdocis Canicolans Clcsel> Related to Wcils Dicae — 
• E Brammcr C Borg Petersen and A Schcel Thom en 
Diagncstii. Gl nd Puncture — \ N>fcldt 


Colds — The author who is^ police surgeon calcula e« ih^t 
about txvo thirds of his police consultations are to deal v il 
colds Of iheir sequelae Though he still beltevcb that rest 
in a warm bed is the best cure he has found that p^e erlixc 
treatment with an autogenous or standard xaccine is l^trl 
effective to judge bv his expenence with about 600 patient'- 

Wiener Klinische ochenschrift 

Vienna \oI 51 April 19X8 

Trcatrncm of Thrcmbcpcniu Purpura with Sir^phron — H Pc-v.*!** I-t 
C rgen'> of Intcrferen c foMowing Injuries cf the Sku 1 — R Mat, iir 
Vfodem Views on the Clotting cf Blood ard St>T 3 t)CS — F $^*“0 c 
VfarccniJher?ry in the Course of Pclicimjclitis — A Cc_rai 
Rea on for the Di appcaran'c of Delusions ip Paralyin Trc~ cx> w b r- — 
V V ujio 

Physical -nd Bath Therapy in D turbar cs of l*‘e Ptr cbcral At — 
A MUdek 

Anau cuttalory Tuber-ulosts and the Diagnxis of Ar u Csii — 

J Sorgo 


A\iener Medizinische ochcnschrift 

V icnn- sol £8 Apnl lO s 

Conscrsamc Treatment of Hspe^trophy of the Prost tc — R Lteb r 
Treaimert cf Tub'rcu’osis of the B’ dder — K Huitcr 
Cp latts in Children — E VV c<sefj 

Indications for Opcraine Treatment of Sen Ic Catarat— I t he 
Intrasaginal Llim moIc Light -rd Heat ray Thcraps — H kannlcr 

Prostatic H\pcriroph\ — Dailv injections of n to 20 fCo 1> 
units of testicular hormone lor thirlv davs and repeiition .ifler 
an interval of some weeXs are recommended 


SPECIAL JOURNALS 


Ada Medica ScandinaMca 

Stockholm xol S4 Fetruarr 19X8 

Porphyrin Mciaboli m in Bloid Formation and Destruction —C D dc Lan co 
and VV Grotepan 

Investigai-on of the V Jue of the Landi Te<t of Capillars Pcrmcabrl ty — I Bmg 
Complete Blood Vnalys.s of Hep-nmzed Blood — O W dander 
tlndcniii. Occurrence of Scarlet Feser and D phtheria — L A cher 
Elccirocatdiognm in Pcncatditis (Part 111— M Wimcrnitz and R Langendorf 
Esuicncc o Nersc Centres in ihC Infundibulum wbivh Regu axe the Fur non 
of the ThjTO d Gland — M Cahare and T Cabanc 
Rupture of the A cendmg Aorta in Two Cases cf Ancury-^ma Dissccan — 
E Hul in and B E VVdhnder 
Mctachrcma la and Ctmpl meni — P Hedeniu^ 

Incscrsiblc Allergic Reactions ssith Non-Bacierial Antigen — M (Th Ehrstroem 

lrrc\crsiblc Allert^ic Reactions — Changes in glomerulo 
nephritis penartentis nodosa and rheumatic arthritis are 
tvpes of allergic manifeMaiions in which bactenal products 
form the antigen 2xIore recenth non bacterial antigens such 
as pollen have been shown to cause similar conditions Two 
ca^cs of foodstuff allergv are reported one developing joint 
lung and kidnev svmptoms with a raided temperature after 
'ihock and the other one with fruit allergv and a clinical 
picture re‘iembling that of diffuse glomerulo nephritis 


Acta Paedjatnea 

Uppsala >ol 20 M-rch j1 19 8 

EpkIcituv of Acute Lymphocytic Mcrin-iiis — J H Magnu- on 
Diabetic Children on Free Diet — K BojJcn 

Rectirrcn'e of Mono-artaular or Bone Infection follow ng T Tho d after Socr-I 
\car> — A Can III 

New pT»i blitics in the Trcatmcrt of Cardiac Comrh^r ons f H D r- 

thena — G Gold^chcidcr 

S me Avrorbh. Acid Saturation Tests on Infants — I Launn 
Acu og and Sgnin-ancc cf Noaumal Teeth Gnr<Jj*c--R 
Ob<c'>atc-'s on Cingental Tuberculisii — B Hamnc ard N GcHcr cd: 

Aot/iirmff Tttth Gn/iffmc— Goldmann argues that although 
adenoids arc frequently met with in children who grind ihcir 


teeth at night thev are not the onlv cau«e Infection of the 
sinuses through the ear tonsils or lower air pas ege^ reqinrc-s 
investigation in all ca«es 

CongemiaJ Tuberculosis — Hamne md GellcrMcot de crihc 
in full a case of a premature child which died two monihs 
With a tvpical pnmarv intestinal tuberculosis It was rexer 
in contact with its mother who died of phthisis two davs after 
partuntion inira utenne infection was the onh po’^’^iblc 
source 


American Journal of Hvgiene 

B-him«.re m. 1 27 M rcb 19XS 


Studies of Strorgslodes II — Homogom- ard Hctcrogo*" c Pr fer\ f the 
Stng*c Homo oni'^Ily Derued S aiit P-ira c — George L Gr h m 
Infection with Tr chomoras foftui m Hei ers — Ju im Arurc s aru Fred W 
Millet 

Suncy of IntcsDcal Protozoa and EiTe~t cf ■V'Jar'r e on C c da arJ O he 
Inte<‘tiRaI Pretoroa of Man — V cr n ca vrm h-n Ge rgc C 

Mcdiary 

In »dcn c xnd Dt-inbuLcn of Axon lurrb tco dfs T cftocfrha.ui ir cl ^ 
/fyiT*er£ifer i na/ia Enlercb us e m cularis ard Hy ncrc rp r d r la 
in Sc eniy Couni es m North Carol na — \ F Kd er VV S Lc::thcr 
-nd J C ktOT 

Firtors influenwing the Dctclopnent ard Viab ly o' the Fact of 
hrpa Ica — Geo g W Lut emoser 
C~trie as Res rtoir Hosts of Sch stoson a ya on cum t 

Ktarz VV u , - c , 

Infeaion of an Abnormal Host (Gun«r-e) w h J- nr 
Sheldon and C T O to , . , , ^ rT-v 
Funfccr Notes on tltn E rnrmc Ir'cs. n ( IN t. I 
\ N McK.rth> ard VV C Sweet 

Test of a Th-cm o( l> Orts - i f P -f r‘'Vr--K W C-cr 

bS r tcrts n Hxkw rm ^ J XV lanu Srtx 

F f«cnr*er at S C ~ a hrpw ti n 

Crt. ge VV Lut rm "cr 

Cu nt - c Fjf t.um cc.ti'r-eT um [.j],,/ |llc l 

Ir rv^ -d Egx and Ra*-** t ^ „ tilu n u , 

c Tran- •X c’f .'‘n Af „ "N 

ars! P cci hemtr um'i 


, cs I a-- H 


»»*« 'X 
Cenft t 


Tfsns -1 I— mun r> »o f ^ 1 
Monlitr '>o 
J All'll 


man 

^ rnOE of ' 
Henry Bee c 


4 JUL\ 2, 1938 


The Dritish 
\fEOiCAL Journal 


KEY TO CURRENT MEDICAL LITERATURE* 


'Purihcr Studies on Intestinal Emplijscmn oi Svonc — D P EscKth ^md 
H C Bi ester 

Complete Revised Technique of Actinic Sunshine Analssis with MOdincntions 
for rtccitnE Wetthcr and Near Meridian Exposures —Tred O Tonnes 
and Paul P Somers 

Sir tin of Ftasmodmm reheUttn from Doves and PiEcons [nfscuse to Cmities 
^ and the Common Fowl — G Robert Coatnes- 
Studs-'of the Therapeutics' and Prophylaxis of Malaria by Synthetic Drugs as 
Compared with Quinine — Malaria Commission of the League of Nations 
Health Organization 

Cuhcoidcs of Siam with Descriptions oI New Species— O U Caiisev 
InHiience of Young Red Cells on Infections of Ptasiiwtiiiini cathfmetmm in 
Birds ^Robert Kegner and Redctnal Hewitt 
Development of Dratitnculits meilinen^is Larvae in Cvclops — V N Moorihy 
Forced Calcification with Parathormone in Experimental Trichina (Trichimrila 
_l spirahs) Infections Th v Brand G F Otto and EseWn Abrams 
SusccptibiUtv of Young Red Cells to the Mcrozoites of Avian Plasmodia — 
R Hegner and Lvdia Eskridge 

Altlaisone and Hiiwnii Iiitcslinaf Piotozoa — Aidarsone is 
a new penta valent arsenical — 3-amino 4 hNdrox\-phen\l 
arsonic acid It is tolerated by rats dogs, and rabbits, and 
was tried out in thirty cases of intestinal infections amongst 
1 Oyt inmates of a training school Given in capsules it was 
effective in eliminating from 33 per cent to 100 per cent of 
different (named) protozoal infections m man 

Helinmths in Noitft Caiohna — ^This is an elaborate 
analysis of the results of examining 37 346 specimens of 
faeces, of which 9 5 per cent contained eggs of Ascaiis 
Iambi icoulcs with lessei pioportions of other helminths 
The incidence of infestation was three times heavier in negtoes 
(22 5 per cent ) than in whites (7 0 per cent ) 

Bacteiiophage — ^Two rival theories concerning the nature 
of bacteriophage are (1) that it is a living virus which invades 
the bacterial cell and (2) that it is a non living substance 
derived from bacterial metabolism The result of experi- 
ments on house flies does not support the theorv that bacterio- 
ph fge IS produced bj the interaction of host and bacteria 

InUs/tnal Ei)ipJi}Scwa oj Smne — A gaseous dislension of 
the lymphatics of the itltestinal wall and mesenterv of the 
pig IS produced bj a diet deficient in the vitamin B complex , 
■iO per cent skim milk powder in the mixed ration prexents 
the occurrence of this condition 20 per cent is ineffective 


American Journal of Patliologj 

Bosion >ol 14 Marcli 193^ 

•NtMklioblaMomT The Islei of the Pancreas —G I LaidUw 
DcvclopmtniU Defects M the Toramcn Ovale— 0 M Paiitn 
effect oi SypMis on LociJ Tuberculous Lesions m R ibbits — 3 D Aronson 
Tod D R Mcrinze 

Spontaneous C'ttdiova'vCiifit Disease in the Kai f Lesions of the Heart 
S L Wilunsi nnd t E Sproul 

Sponnneous CtrdtovascuJar Dlsca^c in the Rat H Lesions of the VTvculnr 
System — S L NVilens and S S Sproul 
Tmosmtssion of ChlorokukTcmiT of Mice — 3 W HtII and T J Knockc 
DiMribution of MaiLrnJ folloninp IniraccrcbraJ Inoculation into fifaemuj rfuint 
Monkeys and us Possib/c Influence upon the Res«/fs of f^cutrahzat/on 
' Tests m Experimental Pohornycmis— M SchnlTcr Tnd R S Muckcnfiiss 
Modjficinon of Masson Tnebromc Technique (or Routine Libortiory Purpo cs 
— J Goldner 

Useful Methods for Routine ExTmmuion of Bnin Tumours —N C loot 

N( udiob/as/omn —This paper is a histological description 
of nine islet cell pancreatic tumours successfully removed for 
the relief of hvpoglvcaemia Since the onlv existing specific 
name for these tumours is cumbersome the author proposes 
the term nesidioblastoma from the Greek njiriiiioi — an 
islet 


zVnnals of Otology, Rhinologv and Larvngologv 

St Loliiv vol 47 Xlirvh Ills 

Sufv; ur vru a m ihc Petrous r>ramid — J R Lmd ay 
\V tJib >1 iPe Rasilar Membrane m Man — t G Weser 
D up Infeuions of ihc Ncuk — H R Orton 

M ni re Di ct c is an Indicator of Di turban es in Ihc Water Mctabukirt 
CApilIiry f unvuon and Rck1> Condition — S H Mvcind and D 
DcdcrdtnR 

lefiph ral LnUinffY of the Cowhicar Serve — W P Ci vth 

Inr r t tc fcx m an CxtH-rtmentat xnJ Citn -"ti StanJpnnt — W Huwh oa 

52 D 


Liicnl Sinus Thrombosis Study of Eighty CK^ht Cases with Ten of \cnouv 
Thrombosis found at 12 500 Conwutivc Necropsies — C W Id h 
Management and Trcafncm of Otogenic Mcninpujs — S J Kopcizkv 
♦Review of 303 Cases of Cholesttatoma — h M Hotmc.s 
Peob/ems in Durposis nnd Treatment of HypcrplTstic Smusms -vnd Mkrex — 
E R rauiknet i 

Masker for Bones-onduciion Tests — ^3 nH Hulka 
ExDcrimi.nis on the Conduction of Sound in the Ear — H G Kobrnk 
Ciinicai Availability of the Ostium MaxiHare — \\ C RoscnbcfRcr 
Contour Reconstruction after External Frontal Sinus Operation — G B 
O Connor 

OtomveoMs Remarks on its Prevalence Sympiomatolosy md Truiimtm — 
W D Gill 

Comparative Amiomy of the Tontuc — G McGregor 

Is the HcirinR Aid the Prohlcm^of the Otoloeist or the Layman*’— M S 
Ersner 

Blood Cell Response to Sulphandamide Therapy — J A Bigler 
New Operation for the Correction of External Dcvniions of the Lower End 
of the Nose — J A T imcnn 

Roentgenogram as an Aid m the Diagnosis of Surgicil Mastoiditis Com 
pamon of Operative and Roentgen Findings m One Hundred Ciscs of 
Mastoiditis — D H Bromivell and I J Hauser 
Inner Ear Deafness from Tetanus Antitoxin Injection — P B MacCready 
Cerebrospinal Rhinorrhoea with Autopsy Report • — 3 3 Shea 
Tuberculosis of the Petrous Pyramid — L Kicinfeld and G '1 Smith 

Basilai Memhianc — Previous studies of the width of the 
basilar membrane had shown a progressive increase in the 
width from the base to the apex of the cochlea Helmholl? v 
resonance theory is based on this assumption V/ever Ins 
reinvestigated this point m serial sections' of tvventj five 
human cochleae He finds that the increase in width from 
base to apex shows wide variations The maximum vvidili 
IS not at the apex but ibout a half turn before the apical 
end after which there is a rapid decrease in width The 
maximum vvidth measurements were 498 micra, the mimmiiin 
80_ micra 

Cholesteatoma — Jn a series of 303 cases of cholcsicitoma 
Holmes found onlv one case which was definitely proved to 
be a piiman cholesteatoma Primary cholesteatoma is 
probably of congenital origin secondary cholesteatoma is t 
complication of chronic middle ear suppuration and is 
formed by an ingrowth of epuhehum from the deeper part 
of the meatus Some otologists believe that cholesteatoma 
IS primarv in many cases of chronic middle ear suppuration 
especially if the ear discharge has lasted a comparatively short 
time — that is not long enough to develop by an ingrowtfi of 
epithelium Or the perforation may be in such a position 
that ingrowth of epithelium is unlikely The author favoiirv 
the view that primary cholesteatoma is present much more 
frequently than is generallv believed 

Arbcitcn aus dein Rcichsgcsundheitsamtc 

BclUlv 'Ol 71 Fcbnnry 1938 

Knov.R<U.c xnJ Skill of Midwncs from a Sntrsiicil A'pccl— Rcsiilis of 
American Midwikrs Exxminations 

Gmdex to Uic Nciv Annual Sutixlies ot the Midwifery Scriicc in the Gcrmin 
Empire 

Suicide and AtiemDicd Suicide iir Buleirn — Toma Stcfanoll 
Sini ticxl Methods ns Aids m FormulnimK Qucsiionarics for Capibi'iiy Testm* 
Explinitipn of ihc New Qiicsimmry ol the Annual Hcalih Rcporl Pul B 
(Sociil HjRiencl nccordinn ro the Rciiwop of 1936 — Ktirl rnhUn 

Statistical Siimmniie'i 

fa) Statistical Problems of Influenzi and Pneumonia 
(/)) The Seasonal Epidemiological Position of influenn 
Moiialilv in the German Large Towns at the End of the 
Year 1936 

(c) Incidence of Influenza and Pneumonia amonkvt 
Persons in the National Health Insurance Scheme at the 
End of 1936 

fcf) Morlalitv of Primary Pneumonia in Various Child 
Age Groups ^ 

fe) Sex Proportion in Births after the Great War—w i 
Russell 

(/) Development of Sports Standards in Switzerland 
(x) Frequenev of Breast feeding in the District of Holbacl 
(Denmark) 

Ih) Stillbirth Erequency according to Age of Mother 
(Denmark) 

Ol Suicide and zVttemptcd Suicide in Poland 



Jua 2 I93S 


KEY TO CURRENT MEDICAL LITERATURE 


Tnt Fjms« 
^Ut‘ cui. JooNa 




The Sijnificincc of (he Percencjges in Mial Sta(i$(ii.s 
(Denmark) 

Basle Problem of Populabon Balance in Age Groups 
Slatistics of Frequencs and Penod of Breast feeding in 
infant Welfare with Guides to the Reph to the Questions on 
the Frequencs in the Annual Health Reports — Kurt Pohten 
Genetic and Co ordinatise Relationships m Population 
Statistics On Calculating Mortalits and Marital Figures 
Problem of Assessing Fataliti in Chronic Diseases —Kurt 
Pohlen 

Child birth and Maternal Mortalits in the New Midwifen 
Statistics for the German Empire (Results from the N|id 
wnes Da\ books for the "Vear 19^6) 

Organization of Combined Clinical Anatomical Mortalits 
Statistics in the German Empire 
On the Frequencs of Ssphilis and Ssphilitic Sequelae as 
found Chnicallv and Pathologicalls 
Danish Mortalits Statistics 

Stillbirths and Earls Death Cases in the New Midssifers 
Statistics for the German Empire (Results from the Mid 
wises Dasbooks for the 'Vear 1936) 


Archis fur Dermatologie und Ssphilis 

Berlin sol 176 Acnl -0 19 S 

Paihcrgcmctnv Researches on ibc Skin > Groef s ^^clho<l m Coflorrtioca — - 
C Montaf 

Hciofrenesib of Sjnn^oma — J ejKJ?bcrficr 

ResuJJ' of Abortive Two'Stace Treairaenr of R Brantfi ard A 

Blow 

•Bv«eos Df^easc aod Keratoma Senile — U L L Ofo/ E L J Meunar 
C Posima and I R PraLken 

Rare injuries of the Skin b> Mustard Gas m Ph'Mcuns and Nur<c* — T 
pjcmmfer 

The Frequeno of He*p« Zoster — S Lans 
•Flsdroa Vaccintfortnji— J W endlberser and A Klein 

Method of ClearN Demon tratmg Lanserhans Cells tn ibc Horn o 
Eptdcrmis and m the Foo of the Games pie aod Cat — F Schaaf 
Cutvifrous Sytrotoms m Mjioedema and Grisfts Dcea e — H S«.hucrma.rn 
Deep Blaslonwcosis of ihc Skio — G Gchnns 

Cultunms Together with a Single Vftcroscopieal Examination la Deteetjors of 
Gocorrhoea m the Female — C Er cr and J Schnitz 
Human Infection hi Foot and Mouth Di^a^c— \\ Richter 
•amital and Pathological Features of For Fo dice D ca^e—S Taptxioer 
Ar^cnicaJ Poisoning of the Slun as an OrupatJonal D scasc m Morkm m 
\ ine\-ards —A Matras 

Disease and Ker'alon a Senile — Histological in\exli 
gallon m four cases of Bo^'ens disease showed in two an 
infiUrau\e growih in the deep direction which was absent in 
nine cases of %ernicae seniles and five of keratomata It is 
concluded that Bowens disease is carcinomatous from the 
beginning (carcinosis cutis multiformis verrucosa in Carols 
lerminologv) Daners teaching concerning dvskeratoses in 
general is cnticalU reviewed and the term considered in 
applicable to Bowens disease Paget s disease or molUiscum 
contagiosum although appropriate for Daner s dj ease — 
psorospermosis folliculans 

B\droa Vccamforryns — The parts p^aved m pathocene^.is bv 
photosensitivitv porph\nnuna and impaired hepatic mcia 
bolism are discussed \ case is desenbed m which treatment 
b> insulin and deMrose as well as liver extract was successful 
From the urine uroporphvnn was isolated as the methvi ester 
Vesicles could not be induced b\ experimental irradiations 
but subcutaneous injection of the patient s urme induced 
protosensibihtv in white mice 

Fox Ford\cc disease — Tappeiner reviews the conception ot 
Schiefferdecker and others of the xpoenne glands as 
atavistic organs (allied to the scent organs of lower mammaN 
and Jike them showing some variation with sexual develop 
ments and cvelex) represented m the human xubjevt m the 
axilla nipple prepuce and labia minora and perhap> m the 
lips cvehdv and audiiorv canals Three cases ot Fox 
Fordvee disease m females are described in one the nipples 
and m one the labia majora were affected and m all a 
menstrual vanalion was noted Deep r rav iherapv js 
advocated 


\rchn fur Ophlhalmologie 
Ecr in VC 135 FcbT.3r> lO S 

t* cf Mbrtth: vtn Gr’C e — R Grcef 

HcrcU tan Cbo t.K.'wrcti'uJ Di ea e — Vf Svh-crb_ b 
Fhcrortcna of Coo-jr Xtsor Xfte j'sasei- — I K ai 
loTcsiiiratioa. ca ib Lea B ood ard Ag o-s o'’ P is ttu " G c — 
T Swsaki 

Foil cular Naevvs in ihc Lp'xr Ltd m a ef Tab* o^c s>. j _ 

t*»hcT acd J W crdJbe get 

CclJoiJcKcb-nj cal Ob'cnat ons ct ibc Difcrcts ParL> tf the E c »v ‘i rc 
Reference to rhe Dark and Lu-bt a-aptev. pe .. — \ S ftu 
Xamtions in the Hisfo-vbcn -al Rea<r ritn cl D cre^t P.. ft Iw — 
X Susiu and S Sopu 

Act on of \ itsTim C on W b c Extra t f C-u-ra tt jx Lc*' cv ~P .w c 
F u-xh r Ccrirbutorx to ih Hsstofeo of tb S rv c Gu - J *' — 

E Sa Inann 

Fonsi o' rftc Health) and ch D sealed E c— A Fa 
MechantcaJ Funaioral StmetL es o the E c — W K V t 
Faiho ojjcal ard Tberapeutic Actioxs ' Pe—'tr ms r j R 

EiC — H vVaensT 

HerediJan Chorotdo retun I Distust — The hier i re on 
choroidoraemia is reviewed and attention drawr to i\\o ex 
of this ivpe m a familv studied over fou i.enc aliens in 
which other members were affected with a* div imiLr \e ton c 
the pepper and salt t\pe The que tion vvheI^'* t*"? c 
appearances arc different stages or the wme ffe v n or 

di<iint.t entities is discussed The ex ditrihiion s 

that they are different entitle 


Archives des Maladies de 1 Appared Digestif ct des 
Maladies de la \utntion 

y^rn 2 J XJ-r h )s- s 

Diets Pct-r m Fats a-d Rich ir C-f** hi*- tes n the Trc ' D-betc — 

M Uth: 

f.atnMa tnfe t n i Liver D ox-*— *'f Gaeft er 
itLd.«s cf Ibc 'fctabcN-n of V itam t C R’rt f A««.Lrr A d C ntr r 
the F tint L nne — M Vaithci 

ChoIedcKhocJvti — DucdenC'tran' he ed-Nhi- Feeunr— V J B r *~m. pv! 
SC VeJa o 

Diabetic Dieii a — A diet rivn m tarbohMlraie- ^nd root 
m fa(s m general did not impro'e the condition of ocil-eiu. 
patienti On ihe contran it aucmenied the i.hi .0 uria md 
rai ed the hiperghcaemia Thus the findings of Force ^ro 
Adlesberg could noi be confirmed 


Beilragc zur Klinik der Tubcrkulosc 

Berlin vcl 91 'f rcb I 19 

Aic’ect Vis >n Tube cuWis ci ibe HiLr Clard — R VV Mj c* 

Congen ul Heart Dtvc-.s< ard Bi atcral P'‘eL"tCThc’^x ~H H cv^ti— 

Per istcnt and Rcourrest Ft-rm 1 Srontar js ppcur-ciho as ~L K krr t 
T tnc Faac*" «x 7i,hcrcul'~.is — T Zivanov 

Mcroc>te-L>7np^ocTTc Ratio m TutercuK i wih S'nxuI Rcfcrer c t x 
Value ir CemranKT «Tth the S-h Seed r *'urc -v t c B J 
Sedirt rtaticn R-te — Ruth Von;<Kb 

Exccnrtcotal Ccnintuuon to ih<. God Tb-rapv c TuNi It Tt-'* 

I J* le^vC of Gold Th rarv on i •* 0''<c'’ n Cc^tc” cf the Serm^ ir 
Aci-n^l — J Leitrcr 

Ca<e of La e Prtaijry Tube"t. cu< fnecTtn — A VVe^ Ha-^ r 

Coii"i.i ital Hicrt Discus-, aid Pncnmntlwrrr — In spue of 
cfefinKe clinicallt and elecrrocardiographicalh demon^irshle 
weakness of ihe right hean bilateral pneumoihcrax irc^ln-ent 
for phthisis ssas successfulls carried out 


Brain 

Iccov.3 is! El '! r 15 S 

tcTOseU Srsntjs's US s S > r -ns- sco - ' 'tc" rr E (-s' 
c p n> rts- 

S-osart . lljr-.-ts- c'.. Ss^Kc, cs . Fc^ I fC ^ 

Jp rv Arrc—a •‘d < -v i X" C - f 

C.uvn —J C Rh-ha s-- - 

V -ra D >■ 1 - P— s » ■! C-- - tt -.-s S'C- 

V J ' s.-o 

Th- Ve- — 4u d '* M --L A xa-s." 

O'^t n of t»*e Fa n t e P'c' -■'c r' i'-- Ce I 

At f U Dev t 1 t} J r O n —T H B 



KEY TO CURRENT MEDICAL LITER \TURE 


6 July 2» 193S 


*V ^^cula^ Lesions m Ihc Bnin Stem nnti Occipital Lobe occurrmfi in Associa 
tion with Bnin Tumours— M T Moore and K Stern 
•Observations on the Pathways transmiitinst the Sensation oi Taste —M G 
Scluvaria and O Weddell 

Case of Primary Generalized Amyloid Disease with Iniolvcmcnt of the Nerves — 
S dc Navasquez and H A Treble 

Noinial Dnks in Chiasmal Lesions — A study has been 
made of the site of turnours producing' chiasmal lesions in 
relation to the occurrence of primary optic atrophy In 
SIX cases m which the optic disks were normal the optic 
nerves ran straight from the optic foramen to the chiasma 
Five of these tumours were retro chiasmal and only one was 
pre chiasmal It 'a concluded that pallor of the optic disks 
is produced by displacement or stretching of the optic nerves 
and this is more likely' to result from a pre chiasmal than a 
retro chiasmal lesion 

Vascular Lesions am! Biain Tiiinoitis — Fourteen cases of 
vascular lesions of the occipital lobe and brain stem occurnng 
m association with distinct space occupying lesions are 
described clinically and pathologicallv In five ischaemic oi 
haemorrhagic infarction was found m the occipital lobe and 
m ten cases brain stem haemorrhage and in one case brain- 
stem softening The brain stem haemorrhages weie from 
the arteries and histologically resembled the haemorrhages 
in arterial hypertension, they are considered to ha\e a 
similar origin Arterial congestion in the basilar i^rterv causes 
a predisposition to haemorrhages which are finally brought 
about bv a reflex rise in the svstemic blood pressure 

Fathnais for Taste — As a result of the study of lesions of 
the trigeminal facial, chorda tympant and superficial 
petrosal nerves following trigeminal neuralgia and ear opeia- 
tions the authors conclude that m certain induiduals taste 
sensation from the anterior pact of the tongue is conducted 
to the facial neive via the distal part of the chorda tympani, 
the optic ganglion, and the great superficial petrosal nerves 


British Journal of Urology , 

London \o\ 10 March 

♦Malienain Disctsc oC (he Testicle with Special Reference to Neoplisnii of the 
, Undciccndccl Organ —G Cordon T'ljlor md A S fiU 
Current Urin'nr> Stone m Central Enropt ^ Otos'^mTnn 

T«o Cnscs of Hydnud Disease nt the Sue of the Prostate— N K B KimKU 
Rcmnrfvablc Accident with t Filiform Guide — K H Wnikins 

Maligiuint Testicles —This well illustrated article based on 
a hundred cases, classifies testicular growths as teratomata 
(average age 28) and seminomata (average age 40) Clinical 
varieties are the insidious relentless type, the hurricane 
tvpc the acute tvpe simulating orchitis, the stow latent-period 
tipe and that in v hich metaslascs dominate the picture 
causing pulmomrv or gastrointestinal symptoms pain in the 
back glandular enlargement in neck, axilla, etc The 
Aschheim-Zondek reaction helps to distinguish neoplasms from 
other testicular swellings, to determine the response to radia- 
tion therapy and to detect early recurrences (the urinary 
prolan increasing) Fergusons quantitative modification of 
the test seems necessary, since one thfrd of his cases secreted 
less than 2 000 units per litre an amount which the quali- 
tative test IS not delicate enough to detect The article further 
deals with diagnosis malignant disease of the retained 
icslicte and the results of Us treatment malignancy super- 
vcninc after orchidopew or abdominal replacement 
malignant diseise of the epididymis prognosis (much worse 
with teratomata than vviih semmomaial and treatment 
orchideciomv and prophylactic radiotherapy being preferred 
to the radical operation Of twenty-four cases so treated 
37 S per cent are ah\e after four years (tO per cent m the 
asc of seminomata) 

Cancer 

Brussels sol 13 I9'6 7 

LitHvytvicnaia and LitKsc^tTscs (Lipobtasiomata and LtpoManto A Con 
tnbu 1 n to the Stuly of Deep L»po arwomita — N Gov. fma?htieh 
I NanJerlinden and H De ru>»sc-.)r 


Tut. Rmtuu 

MttytCKL JOLK'iKl 


•Internal Secretion and Hcrcdtti i? r ic/ors in (he Onetn of Cmccr— L Locb 
Influtncc of } rotan Intosiciimn on (lie CvidiiiQn and Prnpcrticv of nlooJ 
Scrum —R Rediny 

Summmion ol EnJovunous Laciorv m Cancer Palicnn— F SincL and L 
sprinscr 

Etpcnmcnnl Production of Malijtnani Tumours of ihc Liver in vyiiiic Kai, 
bv t> amidoazoioliiol — S 7vlbcrszik 

LipocMomata—The term is applied to deeply siUiatcd 
Uposarcomata which are characterized by a tendency lo 
recurrence and yyhich, though less benign than subcutaneous 
lipomata are not rapidlv fatal like other sarcomata The 
clinical and pathological features are fully described on the 
basis of four persona! cases md a review of the literature 
to which 119 references are given 

Hoi moms ami Hciedtts — While containing no new ficts 
this paper provides a good summary of Loebs views on the 
causation of cancer 


Journal of Infections Diseases 

Chicaco Vol 62 March April 1958 

Attenuation aod Town I rodticlioit of Ihc Diphlllcrn Jlicilluv V I Ultnrillraliun 
ol Toyin produced in Pcptonc-cinlisaic Mediums —AoRusttis W'vdvuorth 
Mary VV Wheeler unJ Laura Mendez 
•Ltnkaic ot Phase induced Characters in E nplw — Jcanciie D TawnA 
lane £ Snow 

Variation in the Haemolrtie Streptococci — M H Dawson G L tlobb> 
and Miinrp Olmstead 

•Comparison of Eactenunt ncerophorum from Ulcer iiiyc Colitis In Man with 
Strains isolated (tom Animals — G M Dack L 11 Dtassvedt Rohett 
Johnson and N B McCulloch i 

Studies of Anaerobic Streptococci from Pulmonary Abscesses — Ch-rles W'ei s 
and Dora G Mercado 

Hacmoiitic Sttcmoeocct of Hitman Tacccs — T R Smith and J M Slietman ‘ 
♦Hacmobfic Streptococci of SUIk — J M Sltcrman and C T Niven 
Studies on Bacterial Nutrition The Possible Role of Inoryanic Sails and ol 
Alterations in the Culiurc Medium in providiny Growili pronioune 
Lltecis — Sicvvart A Koser R D TinVtlc A Dorfman and relit 
Saunders 

Studies on Bacterial Nutrition A Comparative Studs of the Growth ”promotine 
Properties ot Various Substances — Stewart A Koser B. D Tinkle 
A Dotfmart Mars V Gordon and Teliv Saunders , 

Attempt to Assay the EnteroloMC. Subsyawee produced by Siaphyleicocet b) 
Parenteral Ituection ot Monkevs and Kittens — Ellen Divion G M 
Dack and \V E Cary ’ 

Linkage of Phage induced Chat octets tii C i\phi — Tht 
three environmentilly induced characters — namely phage- 
resistance haemolytic power, and magghuvivybylyty — svre 
apparently independent variables in E tsplii cultures with no 
suggestion ' of physiological immunochemical or geneiic 
linkage If the phage resistant variant is considered as a 
phage immune bacillus this may have a bearing on current 
theories of heterophile intigens 

B iieciaphontm — This is w study undertaken to determine 
whether one or two species of bacteria are associated with 
necrosis of the mucous membrane in chronic ulcerative colitis 
Nineteen strains were isolated No clear-cut method for 
separating B fumhihfoiiiie and B iiecrophoriun was div 
covered The authors recommend the retention of the latter 
name 

Haitiiohtic Stieptococci in Milk — Of 245 samples of pas 
teiirized milk 8 5 per cent showed haemolytic streptococci 
the common tvpes being Sii diirans and Str zsinogcnes Of 
sixty eight samples of raw milk eighteen showed streptococci 
the prevailing types being Str iiwsiitidis and the anmial 
pj ogenes 


Journal of Tropical Medicine and Hygiene 

London vol dl April I 1938 

AdvamukCi in the U c ot I’Kvmi niher thjn Scrum for Certain Immunol vocil 
rrocedutts wiih Special Reference to its Uve in Tevrv for SyvMo — 
K L Burden „ , 

On 3 New Species o' the Cenuj Vfierovporum \t<cr<ripmim jtilliami UrncO'V 
1917 N S I vvith Special Convider„tion of the Phenomenon of Di >«» 
trorr m rmiei Impertccii —Tiber Bcncdck , ^ ^ r 

Un-uvee still Attempt, at cutmc Schotovomiaviv by Oral Tablet, I 
CaHslon 



JoL\ 2, 1938 


KEY lO CURRENT MEDICAL LITERATURE 


Titt Etmr 
'fimcAi. J(?cTNu. 


Medical Clinics of North Amenca 

Philadctrbra \ol 22 March 1Q36 
Symposium cn AUcrsy 

AUcrn as a Facrot m General Medicine — R L Haden 
]n\cstigaiion of the Paiieni with Allerg) — C R K Johnston 
Allergy as a Factor m Oto-lary neology — M L Dceion 
Ocobr Manifestations of AlIcrBj — \ D Ruedemann 
MIergy as a Factor in Disturbances of the Ga_iro-tntcstinal Tract — E N 
Collins ..nd C P Pntchett 

Allergic Bronthiiis — H Scott Van Ordstrand and V C Emstene 
Allergy as a Factor in Headache — C L Hansock and F J McGuri 
Atopic Dermatiti — E W Netherton 

Bfon hiaj Asthma Cair'cs and Trcsiimcnt — R S KnowJton 
Hay Fescr — C R K Johnston 
Contact Dermatitis — G H Cunis 

Diagnos s of Dyspepsia of Extra ga iro-intestinal Origin — C L Hansctk 
Ch onto Dyspepsja Common Carnes and Approach to Treatment — £ V 
Collins 

\ Ray Examtnauon of the Colon — I C Root 
Recent Chemotherapeutic Ads-ances in Treatment of infections of the Erinary 
Traa — C C Higgins and F C Schlumberger 
Diagnosis and Treatment of Penphcral Vascular Disease — S Tucker 
CVnical Signifimncc of Prccordial Pam — A C Emstene 

Diagnosis and Treatment ot Cerebral Vascular Accidents m Attencsclciosis — ~ 
R H McDonJd 

Indications for the Use of Iodine in the Treaimcnt of Hypenbyroidism — 
G Crile jun 

^fedicaJ Treatment of Flaccid Paralysis — W J Zeirer 
Diagnosis and Treatment of Hypo-ownanism — E P ^^cCuIIagh 
Treaimcnt of Sciatica — I I Kendnefc 
Some Observations on Toxic Psychoses — J Tucker 

Alleri.% — ^In the senes of articles comprising this sjm 
posium the phenomenon of allergs m medicine m general is 
considered After indicating the importance of this phenome- 
non the investigation of an allergic case is outlined and then 
the mamfestations of allerg> m oto lanngblog} and ophthal- 
mologv Gastro intestinal disturbances bronchitis headache 
atopic dermatitis asthma ha> fever and contact dermatitis 
are dealt with bj recognized authorities The details of treat- 
ment are precise and lucid 

Radiolog'. of the Colon — An account with illustrations 
of the more common abnormalities encountered in the 
examination of the colon bv t ra^s The technique and value 
ot the double contrast r rav are described Bv injecting 
air after evacuation of the banum enema the coating of 
banum which remains adherent to the ulcerated mucosa is 
rendered apparent and the diagnosis of the causalive lesion 
made possible before the ulceration has progressed to produce 
a hlbng defect in the wall of the colon 


Public Health Reports 

\\i hmgton >oI 53 April 2- J9J8 

Fwutncj of Surgical Procedures among 9 000 Famihes fcajed on fvaj;oi>-»KJe 
Periodic Canva'ses 192S-3 1 — Selwy n D CoHins 
Maictnal Monabw Rates by States 1926-36 and Deaths and Death Rates 
from all Puerperal Causes 193--6 

Public Health Service Publications — I k: of publfcations issued during the 
penod July to December 1937 

SroJisticat \fii/ter VV ecUy list of deaths including data of claims etc from 
insurance companies prevalence of certain communicable di eases in the 
Untied States Foreign and Insular 

Frequency of Surgical Procedures — Records ot all surgical 
operations — minor and major — uere obtained from S 758 
white families in J30 localities in eighteen Slates for a penod 
of twelve consecutive months and the results v\erc classified 
The general rate worked out at 65 per 1 000 somewhat 
higher for females than for males and hichest in the ace 
penods 5-9 vears and 30-34 vears TonsiUectomv constituted 
nearlv one third of all operations followed bv fracture^: 
appendicectomv and removal of benign tumours in that 
order The irequencv increased with the income level and 
was higher in cities than in rural districts Of all operations 
61 per cent were done in hospital the rest m the office or 
clinic or at home The durilion of invaliditv is discu ^ed 
at length 


Re^ue de la TubcrcuIo«e 

Paris vcl 4 Ma fc P 

‘Thora op.. Appearances (Cormbt-jon to the Sit'^v of t^c F i'- re 
of Pleurisies asscoateu «.uh Preu-netberax) — D Mjchctti 
Sktapram and the Theraco^cop Pinurc in a C-se A1 cr- t S 
Pneamo hcrax — A Brork und 

R diologicaj Ccrtrol on Adr-'S on to Several I—rg Cc— n tics— A F <.c 
mann ..nd A Albert. 

Fall in the Tubcrculc^ts Vfortality — D K Rykels 

Retarding Action of the Eth I Esters ard o Certain SafLrai*!. Ft) A u 
and Pwni’-ularly of Ethyl Palcntucc or O'z Evcfjic- cf Etpen-'- _ 
Tubercufos s —L Nbgrc A Berthclot -nd J Brc-cv 
Selcciive Rcf..x_ticn by a Thomcopla ly folowtn? Peuc*cpv E- - ' 

Marking-oul o* the Adb-s on by T-itv*tn'* the Z're ft P.. --t i 
Insertion — R Vfonod ard Lclon- 

Coninbutton to Study of G'ave Ftrrrs of Tutercu «>'•< Tb or ~ 

Fau! Rihout Renusorrs— E Benu d B K.rcr< a-d M i 
Technique of Extrapleural Pncunotho-’x — E H utc cl 1 c - D t 
Foyer 

Is Irtr-bron bul fn,cct n of Lipiodol AI»a>T With ut D re r — L K r 
Lobar Dislocation in rhe Course of Thcfareufu. Pr-ur-nh r^t — F B^car r 
P Braun and A Vfeycr 

Thoracoscop\ — The author maintains that edhe lonv h-ve 
a traumatic action on the visceral and parietal pleura Thi 
causes various degrees of pleural imtaiion and f.-vourv ihe 
evicnsion of pulmonan. foci and the development o a i i^cr 
culous pleurisv Thoracoscopv shows that m most c.. ev the 
pleunsv first develops at the level of the adhesion* Th- c 
should therefore be sectioned within the first few week> of th 
induction of the pneumothorax Delav mav mean that the 
operation will have to be carried out in a pleural cavitv ih..l 

15 no longer healthv 

Radiological Control — ^The results are given of rouimc 
radiological examination of the chest of those seeking admis 
Sion in France to an important State railwav to the prefeciu e 
of police and to the civil service In the first group 2f ?27 
persons were examined and 1 2 per cent rejected Of 
2 066 candidates for the prefecture 0 9 per cent were rc;ected 
but this group consisted of men who had alreadv been polite 
men who had all done militarv service and who had all been 
examined prev louslv bv the phvsician to the prefecture Of 
the 1 891 candidates seeking admission to the vivil service 

16 per cent were rejected The authors anaKse iheir 
findings in detail and discuss the problems that present ihen 
selves in deciding when to reject a candidate on the basis ot 
the radiological appearance of the chest 

Rjvista di Patologia Nerrosa e Mertale 

Ftcrerce vol SJ January Ftbroary J 9 ^s 

Coitnbuiion to the Know edec of Exrenmcntal ReFcx Er* cm i''J cs. t* 
Lomjrouv Stcnuii — E Fuicb tncni 

Two Ca cs cf Corcbral Cy^ucercovj diagno^cO Our/r— Life — C Cana—’’) a d 
A Vobile 

U e of the Ceninfugc in the Carmn»-out of the CoMoid l Benaoi^e Rcacti'n 
— R Bozn 

Syndrome of Acute Antenor Poficwrtye/rttx in VfedaUao S>phJ-v — E Ferga 
Type of Hcredit-ry Tremor — Macrob pti-us Multip-ru' — G Prtov 
Ob'cnaticns co a New Method for the Study cf the Va_-ular Nctecrk n 
the Nervous Svyien in Norrul and Patho o caJ S.3tcs — C F xic 
Vfeninsiomata cf the Antenor Cranul Fovsa and their CtTcvrondcrwc v'-nh 
the Medan Line A Corjibaiicn to the Siud as to hom far the 
Determination cf the Sdc of the Lesion is of Preci'c D-xr ■rttK V-Io' — 
P OttoncJIo 

Cerebral C\sticcrcosis — The authors describe two ci es in 
which the diagnosis vvas made dunng life b\ the di coverv 
of a marked eosinophilia in the cerehro^vma) fluid Thc> 
insist that if a diagnosis is to be made vsUh anv confidence 
the proportion of granular eosinophils should not be less 
than 1 per cent The value of this finding i* treat bji is 
perhaps somewhat le sened bv the fact that on rare owi.*.sions 
cerebral cv sticcrcosis mav be met with without chances m 
the fiuid while verv cxccplionalK eosinophilia rrav be ro ed 
in the cerebrospinal fluid in cases o*" cerebral s phdjt 

4mcnor Fossa Menmciomcic — These tumours are of 
special importance smee ihcv lie outside the cc*“ehral ii* ues 
everting their effects bv p^’cssurc and being e* ent ill 
amenable to surgical treatment The occurrer c i ‘^iL cral 

52 o 



-8 JUL>, 2, 1938 


KEY TO CURRENT MEDICAL LITERATURE 


TiieButimi 

Mt.lCAL JOlKNa 


malignant olfactory meningioma which cltnicallv appeared 
to be situated in the left half of the anterior cranial fossa 
gives the author an opportunity to discuss some aspects of the 
diagnostic problem He stresses the importance of 'tiemor 
of alterations in the fundus, of the radiographic findings and 
aboie all, the most careful study of the encephalograms In 
tfre case of the menmgiomata of the anteiior fossa it may be 
Vers difficult to determine whether the tumour is strictly 
unilateral or implanted on the middle line this should be 
borne in mind in determining the surgical approach 


Strahlenttierapic / 

Berlin 3ol 61 April 19jS 

Impcriancc of Spectroscoptc Amlysis jn )T)d ~ 

W Ocrl ich and W Oethch 

Biophysical txplaniiion oi ihe Auiorv of Liftht — B H'ljt.yssWi 
Acuon of the Visible and Infri red Lishl on the SKm — -G MievcliLr^ 

Clinical Experience with Cirbonarc LiJ,ht Hofmann 
yrtaimcni of No*» Tuberculous Skin Affection wilh ConcentrTted Carbon ifc 
Lifiht — S LoinhoU .r r 

Heat CTy Emission of SeverM Thcraocuiic He'll Cmiucrs — U MoriKofcr 
C trbon and Impregnated carbon arc 1 ighis — M Hansen 
Etythema produced by Sun and Sky Rndniion ■ — K Butincr 
♦Li^ht and Esophvhctic Tunction of the Skin with Parbcuhr Reference to 
the Uciiculo endothchunn — A M Mcmmcshtimcrv 
Ncu Botanical Intcstigations on the Relation baween the Mulabditv of the 
Gene and Qumiuy And Qunhiy df Short wave RAdiailon Nocihnne 
Wasc length of the UltrAMoIet Liahl capable of Producing Mutations* Expen 
menix on Dfosophiia wclnnoso^t^r -^A Rcusb 
Hereditary Transmission of Affcciiony produced by Light — K Hoede 
rarmuton of Light scnsitlzinR Substances by ^flcfO oreanisms —A x 
Mnltmckrodt Hnupt , , „ , . 

Imeuigwons into the Scns.t.v.ly ot ilw Skm lo UUts Molct >« 

Two PTiicnts suffaine from Xeroderma Pigmentosum —i J 
rurlhct Acimo-bioloRical InNcsUfsation of Huichisons Siimmct Vtuuno 
} Scbaiiminn ind T Lindbolm 

Pornlury and Patholoeical Symptomi produced by Porpbyrms (Porphyrmo 
palbvi— H Th Schraw 

«;iTv\ct«rL of Several Natural Sensitizing Dies— A ireibs ^ . 

Use of lluorcsccnCR Spcsitoscom tot Clinical Dcictminai.on of Porpliyrma- 
r Bandow , ' 

Death ilirOush Exposure to Lishi— E „ Hoelncr 

Sun and Sky Radi ition considered asa Climatic raciora —O Hociptr 

Nuv Mcihods ot Calsulation and Determination of Eaponirts lo Light for 
~ Biodimatic Purposes— 'V Schmidt 
Dosage ot Chnaatic Remedies— H tflcidcrer 
Importance ot the Micro-climalc tor CUmalic Dosage — K Blitlncr 
m"r A"mospbbr.e Layers as Light Filters and Light Emiitcrs-r NV V ^ 
Chtz 

Csopinhictic Skw rmic/.mi-Histaminelil.e 
produced in the skin under fhe influence of light and they 
produce a vasodilatation either directly or through the inter- 
mediniv of the nervous system , the papillary and subpapillary 
vessels are mainly affected In the presence of foreign sob 
stances in the skin there is a more rapid appearance of micro 
plnces and macrophages which attack the foreign bodies and 
digest them the disintegration products are carried awav and 
eliminated In the irradiated animals the elimination is 
more rapid than m control animals the process m man does 
not differ from that in animals 


Virchows Archiv fur Pathologische Anatomic unii 
Physiologic und fur Klinisclie Merfixin 
Bctlin vol 301 March s 1 S 5 S 


tncompkw Dorxo wnltal Dupliewcin ot ihc Spin it Cord ~VV ®slmsiderlin« 
Nov Snmdie Ccrpiivek conmmmg an Acid rtsivnm in Human Lvmnlmic 

ROiiion<’t'H«Tcn Vii^Tiif'and ihe Reiiculo-endoihel.al S»Mem-U Udtila 

ChwgeTm'’.he''-nfrm^Cland m Ca«. ot A B C and O AM.amlnowc - 

Rpk of V^i^mar Malformaiioni, in Ihe RaihoRcneaii. of Inicinal Haimor 

rhikic Pach>tncninRUi5 — P Hevimann 

c.uea of Sncllini. of CotlaRcnoui Fibres during Hyperergic Innjmmalion 
(\rihuxs Phtnomenrn) — ^f Uerntr -r « 

Dukaenjt Sicno^w Problem of Situs Inversus Partults in Man — C Tondury 
and H Wisstcr ^ ^ . 

Pis, ros m the Tcvhniquc of Imcauwation of Medicinal Prcp3ra!ion> by 
Soccirum Anil>ai — N% Gctlach W Rolb'ascn and R Intomi 
Can vf ot the Prostate— E P Ga>nor 

I theft a lwLni> «. cn-sJu Period of Moriakiy ('Thai i K there a 
I eltuon hiP berwexu Moriabn amJ the Acnviiy of the Sun >— S Bchk 

52 H 


HsncrpliMa of the rhimus m Endoennt Disiurbinccs — U W mser 
Two riinhkr Cascj* of Cirdnc itums A Contribution to Smutr >* 

PhyfORcncbc Ihtorj (I) rnnsposirton of the Aorta with PutnuMntv 
Stcttosfs (2) Transposition of ihw LarivC Aricnts with DkssUtpmuni 
of An Appari.nl Third Ventricle — \\ Ootrr 
Ptoportiun Studies m Dwarfs I ChondtodysuopUia — H GilnJlitr 
Nirco>J^ and Allergic hypcrcrpic Irinarnmaiion 11 —W rickholT 
Ccmrcj* of Origin ind Tornis of Development of Ihrombosis of tbv. Is. — 

R Ncum^utn 

Congenital Hranchicctasis —S Chodkowska 

Pttscncc of Sptcoch vclcs m Organs afict Death \t\ C vses ot To.tLk.u.oub 1 uindii.t. 

* — K Essbach 

Relation of the SkuW to the Btsm undut Normd vnd PuUoUvgicil Cun 
dmons — J Erdhum 

I 

Zcitschrift fur Hals-, Nasen- und OiircnliDilktinilc 

Berlin vol 44 April 10 193Si 

•What should Car Nose and Throat Spctnhsis Know of SpLcch »nd \ojcc- 
Therapy — ^f Nadoicczny 

1 oial Ihcuipy — In a lengthy article which occupies tin. 
whole of this issue Nadolcctnv surveys the entire field of 
vocal therapy under various headings development of tlii. 
voice and speech mutation disturbances of the voice it 
pubeily voice defects found in public speakcis vnd singcts 
laying particular emphasis on the psychoneurotic element m 
aetiology , the speech of deaf-mutes ind scvcicly dcifcticd 
persons Nadoleczny dcsciibes a method of testing the hear 
ing in very small children— a feat usually considcietl impo> 
sible This is done by means of a musical box and ont 
approaches the chtid who is occupied with his tovs from the 
back ind notes when he turns round lo listen lo the Him. 
Special chapters aie devoted to stuttering and speech defects 
such as sigmaiism and nasal speech The article serves as in 
introduction to a discussion on these subjects at the annual 
meeting of Ihc German Laryngological Society in )une IDIR 


Zcttsclvnft fur Ouhopadte und ihrc Grcnzgcbictc 

BtiUa xol 67 March 18 1918 


Functional Swuctiitc and Fimcuoml Accommodvimn ot Gliding Tcndnio — 
C PlocU , _ 

Jiwcsiigaiiom of Icrmancnt Rcsiilis of Non orenuve lUdiiciion of cmi 
genual Dolocvtion of ilit Hin — H Otcklcr md J Nfciircr 
•Early Dhsnocis and Catly arcarrocnv cst So called Congcninl Dislnciiion nt 
Ihc Hin— U Kickclhasn 

•Trcalmcni ot Flexion Coniticmrc \Mih SiiViUixWioo ot ihc Knee joint 
E Splra 

Para articular Graft Arihrodcux m Tiihctciiloxfs of Ihc AnUc loint —I Mciircr 


Tieatmtnt o/ Conytmta] Dirlotnlion of tin Htp Ll'e 
German literature dealing with this question is discussed at 
gieat length and earlv treatment is advised The fact tint 
congenital dislocation occurs with much greater frequency m 
certain German districts than in others is attributed to raciil 
factors Changes in the superior nm of the acetabulum irt 
taken as evidence of a favourable progress after reduction 
Apposition of bone in that region can occur m the first fen 
months after reduction and can be shown ndiologically nic 
lesults of early treatment and possible complications ire 
discussed 


rfevioii Conti flctiirc ruirt' SiiMii\atwn of the Knee It i( 
suggested that division of the cruciate ligaments m u 
correction of this deformity In one case of " 

luxation the cruciate ligaments were found to be m'ened 
at operation after division of Ihc ligaments the snbliiv ihon 
....... i.i pacilv hi" corrected 


Zcitschrift fur UroJogic 

LnntiR 'O' 32 1W8 Hcfl < 

up,d E'aruuiion of Ihc Bladder .n Chrorue Ur.uarj, Rc.cn.lon and ,i. 

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ol Pyctograpby —E Lichtcnaucr 
i% Sepbro;>cxy ObsolcVc'’— I Licbicnaucr 

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JULI 2 193S 


THE BRITISH MEDICAL JOURNAL 


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ARCHIVES OF 
DISEASE IN CHILDHOOD 

JUNE 1938 

CO^TE^TS 

Intracranial Haemorrhage in the Nen-bom B\ W S Craig, M D , F R C P Ed 
■^htamm C Excretion in Children, iiifh Particular Reference to Rheumatic 
Feier Bt J D Keith, M D , and Erelrn M Hickmans, Ph D , M Sc. 
Otitis Media and Mastoiditis in Infano Bt Grace McConke\ MB B Ch , 
B A O , D C H , and Edward C Ross Couper, MB Ch B , F R F P S 
Radfologt m the Diagnosis of Hypertrophic Pylonc Stenosis B\ Lcomid 
Findlay, DSc, MD, FRCP 

The Blood Phosphorus m Egyptian Infants By I A Sabri, M R C P 
D T M and H , and M A Abboud, M R C P , D C H 
Osteopetrosis Bj A M Nussey, M D , M R C P 
The Cooley Syndrome w an English Child By E G L 
B S , M R C P 

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THE BRITISH MEDICAL JOURNAL 


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OUY anrt REPAIR ALL 
>1AKES el Typewriters 
Duplicators and Calcti 
lating Machines 

II riif ior Parnatti lit 2 

(f I hone— lit Jl orri 3703 

DUY A BldOU EOn 
15 a Month 


THE 

Iht b t I irtal U \\ ntci 
1 « tuple «. in 1 nr IIuip. 
C i e £14 14s 
14 CH AHCEnV LANE (Holborn End) V/ C 2 


OesRs Tables and Chair 



A GENTLEMAN ALWAYS LOOKS WELL 
DRESSED IN SAVILE ROW CLOTHES 
NEW LICin 0\CRC0\TS 
tot see DRESS SrORlSSUlTS 
ct<. b\ alt eminent lailorv \tz 
S».hoJte Le*lc\ L Robert Kdeour 
oun PRICES 0 to S Cns 
Alir arum < n rrrm 

nrGr\T co 

-nd flxr Pi Mjrt icr i” 
r\ \\ pL^aJitlv Cjrt.uN 
U ttSexiCafvM "i Cl F 
L \nU S DM 1 t "I I I I (xm 



•X- RAY 


CHISWICK HOUSE, 
PINNER, MIDDLESEX 

Telephone F^N^CB 234 


POWER ROAD, CHISWICK 

TELEPHONE CHISWICK 4006 


A Privitc Hospitil for the Treitmenl 
nnd Cire of Menlil 2 nd Ncrioiis Illnesses 
in both sexes 

A modern country house 12 mdcs from 
M.irble Arch in beiulifiil secluded grounds 
Fees from 10 gumexspcrwccL mcUisi\e 
Cases under Certificate Voluntary and 
Temporarj patients received for treatment 
Doughs Macauh> M D , D P M 


HOUR AMY BAY AKY MIGHT 

ANYWHERE 


XAME l»l.ATES 

in BRONZE oi BRASS 

I '■linuttes and Sketches sent free 

fl K. LEWIS & Co Lttl 

tfii/irof and SetenUfir StnUimcrs, 
13(5 Gower Si, London WC 1 


Al^I E "bV-V-V-i.--*.--"-*.---.! 


IN BRONZE 
ENAMEL 
OR BRASS 

Phone 

Clciktnv'cH 2441 


Free Skclth 
and Booklet 
vt 1 1 1 be sent 
on receipt of 
tlctnil- 


5 J 4 Herd, ao Clerltcn>.rll Rit I C t 

V*b'b"bVb»,J-b-b"b---b''bPE/\TES 


NAME PLATESf 3 ef;s"e:t 

mm^ REDUCED PRICES 

bind -/or lit JJt t0 ibo triiifil Uni fr 

F OSBORNE & Co 1 Ltd tcI Eustt)n<J824 

117 Gow€r Street, London, W C“! 


NAME PLATES 

StainIcAA Steel BnAs or Chromium 
yXclual MaKcrs ^ueV Dcliteti Low Price 

The B HITE BRO> ZE Co ‘‘'r/torllos''' 


NAMEPLATES 


Send lor llUntraieit Orochurr and Price Lul 

f b hall SCO 


THE GRANGE, 

nenr KOTHEBIIAIH. 

A HOUSE Hcenied for the Tcccptlon ot a 
imned number of Ladies suITcrintr from Nenous 
and Menial dtforders Doth certified and \oiun 
iar> patjcnts received Approved for temporarj 
laiicnts Th‘s is a larcc country house with 
b'-auitful grounds and park five mitei from 
iS fhetd TcI No 40030 Ecclcsficld R« Phyi 
f J8t*T t Moiap LRCI MRCS Station 
C SAP'’- Lane U N E Jlly 


HALLIFORD HOUSE, UPPER HALL! 
rORD SHCPPERTON ruabiuued in imi 


This handsome secluded residence standlnj: In i 
park of 3(x nct«. suuatcd 16 miles from London it 
hccnkcd for the rctcpuon of a limited number ol 
Patients of the tipper nnd middle classes suiTcnnn 
front nervous And menial an'cciions 
Vohmnry or ccriificd ciscs received Term’* 
modente Patients ire under ibe constim pcfsomi 
care of the Ucsldcm Mcdicil Supcrmicndcni 
Dr R A Stewirt from whom full piriictihrs c^n 
be obtained Tel Sunbviry on Thimcs 70 


ASHWOOD HOUSE, 

KING SWIN FORD, STAFFORDSUmn 

An old established PRfVAtC ffOMC for (he eifc 
and rrcTimcnt of Lidies ind Gentlemen mentaUy 
iITlicicd Probitloniry cises nnd non cettificd 
paticms nrc received ns well ns those rcRUbrly 
ceriUicd 

The home IS bcnulifiilly sihinted in its own 
grounds of 40 ncrcs 

Tull pirticulars ns to reception terms etc tmv 
be obiiincd from the Resident Medical OITiccr 


“LCCLESFIELD,” Snp’clmrst, Kent 

(Removed from Ashiord Middlesex ) 


PRlVAfn HOME for the CARE and CURT ol 
ALCOHOMC PATICNTS (Lidies) Large mm 
sfon bCTurl/Rlly sitontcO In IDO urcs oi ptA 
hnd Lxtcnsivc views Home farm R C Chard 
Undet the managcmcni ol the Sisters of the Good 
Shcpheid Apply Rev Mother Tel 
Siaplchursi 61 


SPRINGFIELD HOUSE, 

> car BEDFORD (’Phone 8417 ) 

I i»p Mentn! PIsordinra vlil> Or vdiliout OrtlGe*t«* 

Resident Physichn CCDRfC W BOWER 
Ordinary Tcriimj Five Culnr'is I»«r week 
(Includms Separate Bedrooms vvhciw suliabie I 
Interviews in London by Appotnimcn 


WYE HOUSE, BUXTON 

Tot the treatment oi Ladles nnd Genefemen 
mcntalli aRlictcd Voluntary Boarders received 
&;»uaicd I 200 It above sea level facing S H 
*>crcs of grounds — For terms apply to the Resident 
Mcdital SuD W \V Horton M D Nat Tel (JO 


Till moil IIOU^^F 
CHuntii i-TJiFTroN biiHorsuinv 

A private Home for the care of and ircatmcni 
o! *1 limited number of Ladies mentally ifnicteJ 
VoUmiary and Temporary Pauems received under 
the new Mental Trcaimcm Act I9J0 
Medical Superintendent Dr IfcCcrNToor: 


rin or iomioa Mf vtil ' ffO‘.r/TAL 

OinTFOIlD KFNT 

d cs and Gentlemen recoved tor treatt*’ rt 
dcr ccrrtficarcs and without eerhficafJon x' 
'icf VOLOVTARY or TEMIORARY PATILM*' 
a weekly fee of TWO GUINEAS and upwardi 











JuL'i 2 193& 


THE BRITISH MEDICAL JOURNAL 


I 


tyKeford abbey, 

NEMTORT PAGVELL BUCKS 
rt'NCTIONVI NFJl>OLs DISORDER** MEDICAL 
AND CON> VLE.CFNT CASF-S 


ST. 


ANDREW’S HOSPITAL 

FOR MENTAL DISORDERS 


The Home IS a Mjn ion of Ht>ioncaI Jnicresi 
sundins in 1^ acres of garden and grctinds 
and IS "suuaied 14 miles from Nonhameton 
and 12 miles from Bedford on the mam London 
lo Nonhampton Road firt> miles from Lond n 
Both sexes arc accommodated Psscho- hcra 
Ptuo Treatment i u cd exten !ac 1> m suitable 
ca ca Radian: Heat. \ raj and Ultra \ lolei 

Light Diaihcrmj and foam Baths Billiard 

Tennt etc 

ApPl> Dr D C M DOLGLAS-MORRIS 
Tclephon Ncuport Pigncll 1..1 


HILL END HOSPITAL AND CLINIC 

FOR THE PRFMTVriON \ND TREATMFNT 
OF MENTAL AND NERAOl*! DI'^ORDER** 
m le J om hendonj 

Ladies suflcnng from all form o! MENTAL 
ILLNESS are recetted for treatment on modern 
lines as \oluntar> Temporary or Ctnified 
Pn\atc Patients at the Hill End Hosp tal 
Convalescent or mild cases can be treated in 
a delightful country mansion ttith exten i\c 
grounds Lnawn as 

HIGHFTELB HAIX. 
situate about a mile away from the Ho«pital 
FEES TWO TO THREE GU1NE.AS PER WEEK 
For tunher particulars apply to the Medical 
Supt W J r KiMBtR 1_R C P D P Af 

ST A3LBA^S HERTS 


NORTHAMPTON 


FOR THE UPPER VSR SHDBUE CLASSES ONL\ 


Prevdem The Most Hos the ^LARQLESS OF EXETER CMC ^ D C 


\ted fJl Sup^ mtendeti Tho us Tostnt 'ID MRCP DPH DPM 


This Refctstered Hopital n itaated n 1_0 a..rcs ot parL and p ca u c gr ari. \ c u r 

who are st.frcnng from m ipient rieTTUl dr order or *i h to p cve^t rc^Tcnt ri cA t i“"'_ 
trouble tenporary rat,ents and cerLied patjen.s of buth »cx''s ..re rcvcivcd f r Lcatr'c ^ C« c 
clinical biochemical bacten |«JgtcaI and pathcln-ical cxamiratioK Private room « *i -w.-t r ''o 
male or female in the Hopttal o. m cn-* of the cjmerous vflLs n the gTNcrK,s ot die « r -xiA bra- b *s 
can be provided 


WANTAGE HObSE 

This b a Receptoa Hospital m dCL. hed grooru with a separate cnaanuc to pat c- s can 

be admitted It is cduipned with ad the arparatis for the ino<t modern treat.— t o* M-tu’ aru 
Nervous Disorders U contair» spcaal departmerts for hydf'^herapy by anxis r~e*bOL i--. ud 
Turkish and Rq sun batbs th prolonged jmm-rs on bah Vihy D uebe S^c ._h O xbe E-cttica! 
bath PJonbicres treatment etc There & an v)perati'*- Theatre a D-rj? Scr-ery ar X-ray r'*'r' a- 
Ultra N lofet Apparatus -and a O parnrert f r Duthermy ~rd Hi h Frequer*? treaunen It a o c a 
Laboratories for bOLhemical tactenolo— cal and paiholcgcal research. 


MOULTON PARK 


BARNWOOD HOUSE 

GLOUCESTER 

A REGISTERED HOSPITAL for the CARE and 
TREATMENT OF LADIES and GENTLEMEN 
uffering from NERAOUS and MENTAL DIS- 
ORDERS Within two miles of the GW Rail 
way and L 'I AS Railway Stations at 

Gloucester Ihe Hospital b easily accessible by 
rail from London and all paa of the Lruted 
Kingdora It is beautifully situated at the foot 
of the Coiswold Hills ard 'tand m ns own 
grounds of over 300 acres \oluntary Patients 
of both sexes are also rcce* cd for treatment 
Special accommodation for Lady Noluntao Panents 
IS ilso provided at the MANOR HOUSE which has 
Its own private grounds and i entirely separate 
from the Mam Hospital For particulars ..s to terms 
etc apply to O W T H FLEMING M R CS 
L R C P DPM Medical Supt 
Telephone No 6 07 Bamwood 


STRETTON HOUSE, 

Church Stretton Shropshire 
\ PRINATE HOME for the treaimeat of 
Gentjemen suflcnn„ from Mental ard Nervous 
(lino including the allied disorders of 
Alcohoh'm and the Drug Habit All lyTCs of 
carl) Menfil and Nervous ca es arc received 
without c ruhcalcs as Aoluntary Patients unde 
the provT ton of ih Mental Treatment Act 
fotO Braang hill country See \ff(f cal 
Di cctorj p — Apply to ih^ Medi-al Super 

inicn\.ent Phone 10 PO Chur h Stretton 


Two miles from the Main H'^^ptul th c arc exeml b^a^^.h estafcl«bme-ts a-d vii-js v u-i M i- a 
part, and farm of 6*0 acres Milk r*cat fruit ard vegetables are supplied to tbe Hctrial frem iN: fa— ’ 
gardens and orchards of MouItoA Park 0>.-upatJon Th-m-y is a feature of I’-x bra-ch a-d ca 
arc given every facility for ounipyinc them chei m Lrmng garden rg and fruit grew 


BRyNA-NTUADD HALL 

The easide hou e of S Andrew s Hmpi.al is beautifu fy si'u-ied m a pari of 3t0 a res L~jp j ffcv*'ji' 
amidd the finest cncry in North Wales On the Ncnh Wes — e cf the Esu-te a r* e c <a 

foon the boundary Patients nay viat thi. Brar-h for a shOT sea. de ch-r rr f I r peri x.s 

The Hcr>pttai has it own pnvate b-tbmg bouM? cn th- se3_hore There ts irout-f b s* n pa k 

At all the branUtev of the Hes— ul ih-re are cn<.ket ground football and b-ckey gr l la«n 
tennis courts fgra s ard hard courts) croquet grounds go f courses and bowling c s Lau es a 

gentlemen have ihcir own gardens and facilities are provided for hard -raf^s su^h as car-er ry c 

For terms -nJ funhei r-fticul-'^ apply to the Medical Supenrterd..rt (Telerbe c No * a-vl J* 
Northampton) who can be seen m Loruon by -ppouitmerL 


COURT HALL, KENTON, near EXETER, 

for the treatment of ei^ht Ladies xoluntan temporarv or certified patients 
Large gfardens and on*n dairj 

CLIFFDEN TEIGN MOUTH for earlv and convalescent ca^e' A well appomied 
house with spacious balconies and extensive views of the South Devon cca t 
Sub tropical garden^ ovvn dairv in 2:) acres Private road to beach 

Telephones 

„ ^ BERTHA M MULES MD BS Starcro<s 59 

Resident Phvsicians ANNE S MULES MRCS.,LRCP Teignmoulh 


THE COPPICE, NOTTINGHAM 


FENSTANTON, 

CHRISTCHUKCH KOVD 
Streatham Hill S M .2 


A Pn ate Home for the Care and Treatment 
I 3 limiieJ num^r of Ladio with VJertaJ and 
Nervous Disorders Certilied Voluntary and 
Temronry Paiienu received Large Man i n 
with I- a'TC' of ground (See Medical 
Dtrecto y p _al-) Apply Resident Physi lan 
Telephone Tul c Hill “I’'l 


BAILBROOK HOUSE, 
BATH 

For u(T rers from Nervou and vicntal Dis- 
orders with or without certificates 

The h Use I glonouslj situated m wooded 
ground ot 20 acres with magnifi ent views ot 
Ih City and thi. Vvon Valley (S'c Medt cl 
Dir I ry page ..-2_ ) 

For terms apply A GurunMvvt M \ DM 
B Ch DPM RcMdtnt Physjcian 

Td pliine Bathes-ton sls9 


HOSPITAL FOR 3tEXTAL DISEASES 

This Institution is exclusivelv for the reception of a limited number ot Pnvatc Patient 
of both sexes of the Upper and Middle Clashes at moderate rates of pavrreni It i 
bcautifullv situated in its own grounds on an eminence a i^hort distance from Nottin- 
ham and from its sincularlv heallhv position and comfortable arrangerrents ifford* 
everv facilitv for the' relief and cure of those menlallv afilicied Oi.cup,.tiona! 
Therapv \oluntarv and Temporarv Patients received 

Tel e^Il* Fc lerrvt eic «*» r r tf-e Mei^ciJ Sj err er^ r 


HA YDOCK lodge 


Telet 


NEWTON - LE-AVILLOM S 

Street Ashtor-sn Makcrfi d 


LANCASHIRF 

Fh re A b I ' n V - kiT ’ 


ft 


LTPFP AND 


F r the rc-crtiO'i ard of PRIV \TE PATIENTS of bcdi ciev f l 

MIDDLE CLASSES <uTcn-c fr "t r-cr rd r-rv - r-^J7c4d -v 

unJ r Cent icaic P..f - x . c da ^ i“ w k 

Seated n ratV -nd g-jund o -OO »cres Se. ..--o-rd by U _ 

r iiert are e- wu's-'-o to --c-snv E n > f 'r -x. xr n-ca r 

ictrv rrovPeOUi. Cm— . arc i MEDICAL SLPEPINTENOEXT 


HEIGH4M HALL, NOR\MCH 

\ PRIVATE MENTAL HOME iiuatcd in II 
ic ol veil wooded ground For L-uJcs and 
Gentlemen ufl nng from Ncrvci> or Men vl 
Dincsv Voluntary Patient Tenp •ary Pat ent 
anu Pa ictw<i urde Ccnb~atc arc -dmiited fer 
ire-tmert Fes frirv •• guineas a week upward 
aevordmv i r'qutrement A few -caru cs exi 
lor Lad es and Gcntlem n at redo ed fee* cn the 
iccomra ndaii n of the Puicnt own Ph -.n 
Applv tc Dr J A Svtvit Telepbooc 0 NcrwKh 
Telegram Small Norwi h 


NORTHUMBERLAND HOUSE, 

GREEN I.VNES FINSCLrV PARK N 4 

. PRI\ ATE HOSPITXLforlhetreatnentof rr- rtaUndrenOL il’rt cvCi" 
iiuaied and ca« of ’Cce« f'om a!i Si% .ere' of cro.-d i-- -v 

in bun, Park Volunlan and Tempo-an P tienn re ci cd u *-o .e 
Uuupational Thcrapx Pnchoiherap^ ard olbc '"odf'7’ , 

rr/- ST'VroRD HILL Tr rr - " SL EilH 'S' ' L' N1>< 

i^r>alcsieI•I He— c KEARSNC1 COL P ) UO\ ER Per 1 —tr n— -i r — i 







About the Harrogate CURE 


Harrogate specialises m the Treatment of— Disorders of 
, Lucr— congesuon cirrhosis, laundice, cholecystitis, 
cholcUthtasis, and tropical liver Also in Diseases of the 
psoriasis the coccal infections of the skin 
etc The -* P D - Arthritis Fibrosms 

Neuritis, (i ' ' Colitis, Functional 

Disorders i ‘ , » ) orders of Women, 

Comalescence from acute illness 

A wide range of Sulphur and Iron waters is available 
for dealing with the large group of disorders amenable 
to Spa treatment Prescribed drls for Spa patients 
can be obtained at hotels and boarding houses without 
extra charge Complimentary and reduced price 
facilities for the Cure Accommodation and Amuse 


ments ore asailabte for Members of the Medical 
Profession «.ui».ui 

Full d tails of Harrogate for Cure and Hobday will be 
wnt tree upon application to Spa Man ger. Information 
Bureau, Harrogate, i (State if a medical cnquir>) 

HARROGATE 

“IT’S QUICKER BY RAIL” 

Cheap monthly return tickets to Harrottate from all stations 
Any tram any day 



PECKHAM HOUSE, 112, Peckham Road, London, S.E. 15. 

Telegrams “ Alle\ lated, London ” Telephones Kodnej 2641-3642 

■"The ibove House is for the care and treatment of persons suflenng from mental diseases and nervous disoiders Certified 
voluntary and tempoiary patients are received Separate houses for treatment and accommodation of special cases adjoin 
the Institution Occupational therapj phvsical drill and olhci forms of modern treatment There is a seaside branch, kcarsnc> 
Court near Dover, to which patients may be sent for treatment or on holiday Motor drives are arranged when required 
"Tennis courts Entertainments dances and indoor amusements held throughout the year Terms from £3 3s per week 
Illustrated piospectus and further particulars can be obtained from the Medical Siipenniendent 


Tuc r-rmrip ^ nursing home for surgical, 

IliELLllllL AND MATERNITY CASES 

«lfl Fees jo gns to iS gns per ijo Stoic Registered Nurses 

20 Uevonsilire Flace sseektWmge— UgnsJ aRcsidcnt Medieal Officers 

8 Operating Theatres (for etnergenocs) 

Londons W»1 Pauents only received -under the supervision of their own 

' Medical Pracuuoner 

Tel WelbecL 4444 (20 hnes, SMSrS’MiSuon 


MEDICAL 







The MUNDESLEY SANATORIUM 


The central building makes 
the Mundesley Sanatorium 
the best equipped building 
in England for the cure ot 
Tuberculosis All the bed 
rooms have hot and cold 
I tinning water electric light 
and wireless headphones The 
public rooms iic spicioiis 
and comfortable 


Resident P/ivsicmiis ’ 

S VERB PEARSOH, 

M D (Canfab ), M R C P (Lond ) 

E C WYNN E-EDWARDS, 

M B (Cantab ), F R C S (Edin ), 
GEORGE H DAY 
M D (Cantab ) 

Tor all Infornnlion appl> 

1 he Secretary 

THE SANATORIUM MUNDESLEY 
NORFOLK 

Telephone Mnndesles 94 and 95 
, (2 lines) 

TEUMS FROM 71 GUINEAS WEEKLY 


The buildings face S S W 
and are sheltered from the 
sea by a pine clad ridge 
The 'sunshine record and dr) 
air complete a perfect site 
The medical equipment is ot 
the latest kind, and there is 
a daj and night nursing 
staff 


THE CORNISH RIVIERA SANATORIUM 

ROSEmLl>, PENZANCE 

For the treatment of patients suffering from tuberculosis 

The Sanatorium stands in its own grounds of 13 acres of garden, lawn, and woodland and is well sheltered from winds 
The clim lie is mild in winter cool in summer Artificial pneumothorax and other modern forms of treatment arc a 
Dav ind night nursing staff Electric light Wireless in all rooms 

Medical Siipt Francis Chow n, M B Lond DPH Consiiliing Plnsicnn (hie Med Supt) Cornwall County Sanatorium 
Terms 3 to 7 guineas weekly ’Phone Pen^co 598 

THE COTS WOLD SANATORIUM 

Tirsi opened in 1898 and rebuiU in 1925 On the Cotsvvqld Hills seven miles '*'”l>or'c° b^ 

Tc available when 
Electric light Radiators, hot and cold 


and all other forms of Tuberculosis Aspect SSW, sheltered from North and Eis', elevation fOO 'eel 
Spu 1 \1 Triatment bv Vrtificial Pneumothorax (\ rav controlled) Tuberculins aml^ Ultra-violet Rajs arc a ^ l 

nec(,ss.irv wiihoiit extra charge X-rav plant Fiillv equipped Dental Department 
basin'- and NNirelcss in all room'- Up to date main dram igc . , 

FuU Tnt! nichi Simini; StafI Trrn»< ■* cn to ‘"1 TDC/M ^ 

\frt SifPf Gconuc^ \ notFM\S n\ mb ICOub Astr thM MVRGSRET a UARRIbOS MB f [ ond ^ S 

n\M\ MB HCh Cinmt, Iari,s,Uttt C \Sbl\>^ DL W C IBB F R C S I dm Cpr»H///«r nental IforiMAN fUrDttr 

R C S Ut nd ^^Ph Sci.tciir> Ibt. Cotswcld binatcfium Cnnham CkuccNfcr Tet 81 anJ 8- WircoMftc Grams 




JUL\ 2 193S 


THE BRITISH MEDICAL JOURN'^L 



TKe Spas and Health Resorts of Czechoslosakta with their centuries old tradition of healing reinforced 
experience and researches of local specialists invite jour serious consideration 

In addi ion to places of world wide repute such as 


h\ th*" 


MARIENBAD FRANZENSBAD 

(Marianske Lazne) (Frantiskovy Lazne) 

LUHACOVICE SLIAC TRENCIANSKE-TEPLICE 


PISTANY CARLSBAD 

(Piestany) (Karlovy Vary) 

ST JOACHIMSTHAU TEPLICE-SANOV 
(Jachymov) (Tcphtz Schonau) 

with their medicinal springs and mud baths there are numerous smaller spas and health resorts adn irablv 
equipped for the treatment of many disease® including those in the follov ing groups 

Anaemia and Chlorosis Basedow s Disease Bronchial Catarrh Constitutional Disea es 
Scrofula Rickets Digestive Diseases Diseases of the Bladder and Unnary Organs 
Diseases of the Kidneys Diseases of the Nose and Throat Diseases of Women 


Disorders of Bones Muscles, 
and Joints Disorders of the 
Heart Disorders of Meta 
holism and Gout Gallstones 
The aTTan!»ements m the bath estahh hments 
are up to dale in every wav the cleTnlnets 
and neatness proverbial the service attentive 
and courteous 

It 1 accepted that a spa cure to be fully bene 
ficial hould provide a complete change of 
urrounding< and a breih with the patients 
'normal everyday life 

Further infomialwn from cnu Ofice cf 

THOS COOK & SON, LTD , 

■* end other leading Tourut Agencies 



Leucaemia Nervous Diseases 
and Post Hemiplegic Condi 
tions Tuberculosis of the 
Lungs 

The Czechoslovak Spas lulhl this 
*.dmirably ccraforlible hotels 

cla s orche«lras and dance bands 


port — tennis 
etc 


-olf 


pjfft c 
r>i t 
every 


facilitv for 
ridinc fishin" 

There are al o numerous fuliv up to dvfe homes 
for convale<cencc and re I cure* 

at 

CZECHOSLOVAK TOURIST 
INFORMATION OFFICES 
— m London 2t Regent Street SN/1 


DOCTORS OWN SPA /o% 

RHEUMATISM 


Mud from Pisuny in packs ready for home use S mplesc safeic and 

most economical trearment may be entrusted to any pat enc. 

Cost 20s for 20 treatments Literature on re<;uest from P stany 
Agency 

SEND YOUR PATIENT BY AIR 

has been specialty founded to facilitate the transport of nval d$ either on the 
equipped planes Apply for speoat folder 

KLM ROYAL DUTCH AIR LINES and CLS 



The smoothest most restful vny of tra e'l ng is 

a modern Air tner The K LM Medial Serv ce 

refular services or n espectal'y 


CE5KOSLOVEN5KA 


VOLCANIC-SULPHURIC 

MUD SPRINGS 

in delightful surroundings 

21 ©AYg 

INCLUSIVE CURE 

Special facilities for doctors vnJ 
their viT e 

FIv thpr* hv the 

BLUE DANUBE AIR EXPRESS 

Lordpn to Ptstanr *“1 10 0 j rle 

70 REDUCTtOM n rtu n f tfl 
under ALA uhrme 

LETECKA SPOLECNOST 


PISTANY AGENCY LTD 310 Reeenc Street London W 1 

Fa ticutars ffom 

Tet LASf:hcmA2t4 <jr PISTANY SPA BUREAU 25 Cockipur Street SW1 V WH te»^e / ^A 

— 



IS Unique 

among Bnhsh Spas 


WOODHALL SPA 

in having a Broiiio-Iodine Wnler (for iU form® of RIicuniali**ni, clc ), an INnVL.kRIU3I with FO(^-ROO^I for llic 
treatmenl of Catarrhs of the Recpiralorr Tract, and an entirely RURAL and therefore, RESTFUL QualiM 

Slieltered drv and sunnv, with a gravel snb-soil 
Information and Literature on application to the Spa Director Woodliall Spa Lines 


HOTEL GREAT CENTRAL 

Manlebonc Road, N W 1 

The Hotel Great Central i« within a few 
minutes walk of the London Clinic and 
Harle\ Street 

Specta! terms for fnends visiting Nursing 
Homes in vicimlv 

\pplv Manager Telephone Padd 1220 

Tcl aod Tclcsraras Hayres Brcnm&odj^ - 

LITTLETON IIAIX, DRENTWOOD ES«EX 
Larce treunds 400 ft. above <ea. HOME fc 
lad cs Men jlly -fO ted. N cluntary BoanJ t 
teccived Sju cn Brcnnsccd aad ShenSed 1 
aUe Uverpocl St 26 nua Arrh Dr Uaynts, 



rcD r* re P ^ Trmt— *« tn r 

r ^ «. D--J 

VLZrr n— r* ^ ± 

Cut- l -icC; - r r r t I ^ 

I^eU *■ f-» - 1- I -- 

Lr*t.Ar- d ST- r } F*^ 

I — V r- *.1 I - 1 

"C "t- —3 ■” t. V 

ejjn_ er i- •'v a I r> r* 

i-e ^ t^J-— * iL 1- r ■»'* 

A r“„i_ t e e. 

Terra 13/ tc 15 6 div L r? b-i d. 
nizstri ti U « rtq~ett. 

Fr J ^ r r- - j 

G C R- lURErvQON MR. P CN. TLO 
(R.EJ) IL M* LELUVND M-0 f- I 
f 17 C r- I 


I * 





46 


IHE BRITISH MEDICAL JOURNAL 


HOLIDAYS ON THE NORFOLK 
BROADS OR NORFOLK COAST 

LIU FAIN b DRIItjT CUM VTE 


Mr J R C Draper LTnd Agcni Wroxhim 
No folk (.Life Governor Norfolk and Norwich 
tiospUal) will send free on application lUusiraicd 
Book of rurnished Houses and Rivc’^ide Bunga 
lows 10 Let for the Holiday Season Also 
a ‘■election of Houses and Bunsilows for Sale 
Grams Draper Wroxham Phone SVroxham 35 


TORQUAY 

GRESHAM COURT HOTEL 


RECENTLY OPENED Luxurious 
comfort combined with nn earnest desire 
to please 

The resident proprietors will be pleased 
to quote special terms to members of the 
Medical profession on receipt of request for 
Illustrated Brochure M ’ Tei 36*18 


EPILEPSY 


Attendance at school is a necessary part 
of the satisfactoiy treatment of Epilepsy 
in Children 

COLTHURST HOUSE SCHOOL 

metis all the requiiements of children 
of middle class parentage Extensions 
made necessary by the success of the 
school have created several vacancies 
Only bright and intelligent boys and 
gills are eligible for admission 
Apply to the Director, CoKhurst House 
School, Warford, Alder j Edge 


PRIVATE NERVOUS AND 
MENTAL PATIENTS 

LONDON COUNTY COUNCfL Accomnrod-i 
non for MMc niicnis sulTerms from Nervous 'ind 
meniTl disorder (voluni'vri lemponry or ''criified) 
IS provided in the prjvTic section of CLA^ DUR’t 
HOSPITAL. Woodford Oridce Essex Terms 
cx-^lusivc of clothing Tnd spcchl luxuries 49/ t 
week for London ctscs 53/ J n week for others 
Tor mrticuhrs Tpply to the Medicnl Supcrmtcndcni 
It the llospiiil or to the Chief Olliccr Mcnnl 
HospiivU Department Shell Mex House Strand 
W C 2 


NORMANSFIELD 

For Mental Defccti\cs of cither sex 
Unedr pruate management 

Apply to Dr Langdon-Donn, 

Normansficld Teddmston 


HOME FOR EPILEPTICS 

MAGHULL (near LIVERPOOL) 
rAUJHNG and OPEN AIR 
OCCUPATION for PATIENTS 

\ ft** Tnnrlt In 1 i nntl 2nd llou e 

I res Isi CHbS (men onI>) from £3 p up 
NS ird 2nd Claxb (men Tnd women) 32/ pw 
For iurihcr varnculars appb 

C EDGAR GRISE\\OOD, AC A. 

‘"eertt »rv ^0 I-xrliange Street tTst Llstrpool 2 


HERMOSA, TEIGNMOUTH, 

S DEVON PAYING GUESTS 

Hishts recommended Restful home Good garden 
icnm courts Hot and cold in bedrooms South 
aspovi Terms from x guineas v.ccMj Phone 84 


BlSllOPSTONi: HOUSE, BEDFORD 

A iclcci Private Mental Home for Ladies Ccruned 
a^d Volu"Ur> with scrurate House and Gardens for 
\cljn«ar> Bearden Urdcr personal supersision of 
B Rcsit:eni Mental Spceuhst and FSyehuin t — 
Medea) SLt.t Dr J Lasgh^vi Mvcaulky Tel 
Pcdlurd 279Dv. 


JuLt 2 193 S 


KENWORTHY’S HYDRO HOTEL, SOUTHPORT 


All Hydropilhic Treatments mcliidins Turkish Russnn Vichy Ait Scolch riomb.ire Niuhcira 
Soapless roam md other rcmcdnl Baths 
A fully equipped Massage and Electrical Dcmrimcm with Cumnca'lcd Attcndints 
Diets under specnl supervision 

Resident Physician R G Clements MD DPH FRCS 

AnnlT''TL"k?!n!.;L.« Special Icrms for lone period Res, denis 

/sppiy inc Manasercss so,„hpo„ y,,. 


MONTANA HALL, Montana, Switzerland 

OPEN ALL THE ^ EAR 

THE ONLY SANATORIUM IN SWITZERLAND UNDER B^RITISH OWNFRSlIlP 
‘ AND CONTROL AND WITH A DA\ AND NICHf STAFF OF BRITISH TRAINED 

NURSING SISTERS 

INCLUSIVE TERMS — from 7 guineas (sterling) per week 


Met! Supt HILARY ROCHE M D (Mclb ) M R C P (Lond ) Tuberculous Dis DIp(WyIcs) 


CITY OF LONDON MATERNITY HOSPITAL 

iincorporaied by Royal Charier) 
cm RO\D,. LC 1 


The Hospiiil olTcn lacilitics to POSTGRADUATES for observing the work of Us AnlcnYiTl 
N Postnaiil xnd Dcnnl Clinics and to male MEDICAL STUDENIS (md Pr'iclitioncrs desiring 
a Refresher Course) o two oi tour weeks Midwifery Course (Rcsidcmnl) Ncxrly 2 000 
patients anniiTlIy 

RALPH B CANNINGS Secretary 


QUEEN CHARLOTTE’S MATERNITY 
HOSPITAL 

MARVLEBONE ROAD, NWl 

Mcdital Students md Qinlilicd Practitioners idnmtcd to thu Pnciitc of this Hospiiil Umisinl onnor 
tunnies Trc afforded ol seeing ObstcincM ComphcTiions md Opcmtivc Midwifery (Tboul one hiif of 
the totTi idmixsion bcm*. pnmiparous exsev) Over 2 700 pitanis ire Tdmittcd to the Ward* 'inninlfy 
and in the Ante nit il department there arc over 20 000 Tttcndmccs per mnum ClinieM dcmonstrxiion* 
arc given by the SnfT di ly 

For rules fees etc apply H B Stokes Stcrcnrv Superintendent 


UNIVERSITY COLLEGE HOSPITAL 
MEDICAL SCHOOL 

itvDcniFF cuockm TU\MinNr 

SCHOI VRhHIi in DIRM\T0L0(1 

The Commmec of UNIVERSITY COLLEGE 
HOSPITAL mviic 'ipplic'itions for the KhdehOe 
Crocker Travelling SeholarNiip in Dcrmiioloev 
The Scholarship is of the 'ipproxmnte viluc of 
EI^O tenable for a period of twelve months to be 
vpent nc some phcc of study mmed by the School 
Committee outside of ihc Umicd Kingdom 

Candidnlcs muM be British subjects students of 
T London Medical School and gradintcs of i i 
University in the United Kingdom 
AppTicmons must be submitted on or before 
Tucsdxv July Lth I9T8 

For further pxriiculars ipplv to the Dc n 

V H SLOLEN Secretary 


DIPLOMA IN ANAESTHETICS — D A 
DIPLOMA IN CHILD HEALTH— DC H 

1 Courses ot Postal and Oral preparation 
Coi these examinations mav now be 
commenced 

For full details write to the SrcuriAKY 
Mcdjcai Correspondence College 19 
beck Street London W 1 


DIPLOMA IN PUBLIC HEALTH I 

The Royal Institute of Public , 

Health and Hygiene i 

The Course of Instruction cun be commenced i 

Ti any time Special provision is made for j 

students who can give only part time to the j 

work , 

A prospectus and (urthet particulars can be 
obtain^ trom the Secretary 

Telephone Langham 2731/2 ! 

2S Portland Place London VV 1 ( 


pr FR.es (Edm ) { 

CDiyBUKGIl FOST AU COURSES j 

Full details of abOTC and Oral Oasscs — J 
H C Or»in FRCS Surgeon sHall Edinburgh | 



THE LONDON SCHOOL OF DEnMATOLOCY 

St John’s Hosp/tal for Disetsas of the Skin/ 

5 Lisle Street Leicester Squirt WC- 

Conducted by the Hononry Snfl ol the 
Hospmf together w/th the Physicians in 
chxrgc cl the Dctmaiologicil Depirimcnis of 
the London Tciching Hospitals Letiiircs and 
Dcmonstritions twice weekly during October 
ind Nmcrni/tr nnd again during J ininry and 
Fcbrinry nnd four times weekly during Mxy 
Gcritnl Pmciiiioncrs ucsiring to nicnJ uw 
pinicithi ''dure or occisiom) feemres on do 
VO without plying a fee Clinics diiJy at 2 p m 
nne o p m SYturUxis 2 pm only The 
Labor <fo> iv particnhrly well equipped anJ 
arnngenunts can be made for classes 
individual instruction or for research woik 
Enquiries The Dc n or Secretary of the School 

FELLOWSHIP 

The rUGCNICS SOCICTT offers t LTON \IU) 
DVRWIN rCLLOWSlIIP o( £:<0 lor oni. )cjr 
from October 1st I93S renew ibic for a second 
year tenable in ’'ny approved In'ititiinon In the 
Unitcc kingdom for Research on suhctis Icarint 
on Eugenics such as the qiiantualivv. study of 
genetics and evolution human heredity vifJ 
siaiistics fcrlihiy the eugenic cITccts of economic 
conditions and legislation etc Forms may tc 
obtained from the Business Secretary fhc fueeni 
Society 69 Ecclcston Square I ondon S \S I lu 
whom applications for the Fellowship should b 
sent on or before July 31s t 193S .«««. 

GI ASGOW rOST GRADUATL 
MEDIC AT ASSOCIATION 

CLINICAL OBSTETRIfi 


Special facilities ore offered ni the Ro/jI 
laicrniiy and U omen s Hospital for (he study 
f Clinical Dhsicirjcv meludinc Arte naui 
,ork during the months of Augu l ord 
cmemlcr 

Paniculars may be obtained horn the Moitve 
uperinlcndcni Royal Maternity and Worn ns 
lospital Rottenr ow Olasgow 

Pi climiiKu } EsMiinuilioiife 

The COLLCGE OF PRFCEPTOHS hoMi Pre 
mmary Examinations for Medical and H n ' 
fudenfx m London and at Provlnvial 
I March June September and December for 
cgulaiions apply to the Secretary 
re colors IRoomsbury Square London w (.■ * 






Jun 2 193S 


THE BRITISH MEDICAL JOURNAL 


yi\!i¥ERSiTY QF LO^DQM 

POSTGRADUATE a'JEDfCAL SCHOOL 

PATKOLOG" 


BRITISH 

• i_ ownn-njl- DEP\RT\'ENT OF F\THrLr.rH 

DIPLOIV3A IN CLINICAL 

A COURSE OF STU DA m the academic \ear 19 jS 39 \mII be held for this Diploma comirentn- cn O. obcr rd ! 

The Course \mII occup\ twelve calendar months Tbe subjects embraced will be 

HAEMATOLOGA AND CLINICAL PATHOLOGY BACTERIOLOGA 

PATHOLOGICAL CHEAIISTRA MORBID ANATOMA AND HISTOLOGA 

The Course wall commence with Haematolocv and Clinical Patholocv which will occupv about is weel -rd v d! bv 
followed b\ the Course in Pathological Chemistrv which will occupv about the same time The Cours»s in Bacte io'cw rd 
Morbid Anatomv and Histologv will nin concurrent! and o-cupv about siv. months Fo- the Lst three months ot the Ceiir 
students wall be occupied in the practice of routine work in the laboratones of the Department ard in revi on worl The 
number of places in the Course is limited and students wall be selected shortiv before the Course is due to commerec 

Fee forl\ guineas 

In addition to the full Course it will probabh be po ‘iible to enrol a liniied number of ^^udents for the ub^euis l 
P athological Cheml'itn. and Clinical Patholog\ and HaemaioIog\ <eparatel\ the Course in eich subjeut b imc bent 
weeks. Fee for either Course nine guineas 

Further particulars ma\ be obtained from the Dean Bnu^h Po igraduate Medical School Ducane Ro,-d Shtpberd s Bu h 
London W12 


UNIVERSITY 

EXAMINATION 

POSTAL 

INSTITUTION 

17 RED LIOX SQ,, LOXDO% lA CS 

- FOL’VOtX* IS I ^ 
b> E. S Wn'siOCTii \t A (Lend J 
POSTAL OK ORAL PBEFARATIONS 
FOR ALLSIEDIC AL EX A^IIN ATION S 

M.RX.P "LONDON 

October examination 

SPECIAL CLASSES 

commencing 

Aug 2nd Medicine 

Aug lOthMicroscopeDemonsfrabons 
Aug 11th Physiology 

Sept 5th Mnsenm Demonstrabons 

Specicil attention is paid to 
recent work 


Further parttcularf can be obtained 
from the Principal 

MEDICAL PROSPECTUS (47 pp ) 

CONTENT^ The nethod and the cc't of enter 
lac the Vledtcal Profession Pan culurs cf all 
^fedical Exa ttranons Postal CourN«s ard Oral 
Cla^c«: Sugsemon for the Higher Med cal 

Ex^juinauoni, Sugi.csuon< fer the Higher Sur 
Cica! Lramination. Sugge5tions for the Special 
Diploma Examination Refresher Courses Open- 
ings for W cTcn Hints for wntmg theses 
Medical Prospectus gnus along with ts^i ct 
Tutors etc on apphcaiicn to the Pn-srpal 
I" Red Lion Sq London \\ C 1 (Tclcphopc 
He born 6 1 ) 


STAriMERING SPEECH DEFECTS 

BEHNKE METHOD Estab Ca es non 
resident treated at *'9 Earl Court Sq 
S o ard in re idence in the Surmer boh 
dars at Ml s Beenks s hoa a. on the Cbilterr 
** 1 re^’nlnert success in edc tica and trea cea 
cl stamirenng aadethe re*“h dc ec ” — ‘Trae 
"Thcrcaghly phr,^o o I'-xl p me p’^"— La^'ce 
"■The is c eat fi al x cerre^ and pe c It 

e'^ectire — “Goj Hospital Gactte*' 

Slamnennf Cleft Palate Speech Lupms 
3/9 cl Miss Beh^kc. 39 Earls Coart Sq. S.W,S. 



Are you preparing for any Medical or 
Surgical Examination ? 

Do you wish to specialise m any Branch of 
Medicme or Surgery 

Send Coupon helntr for our rn/iioMc publicntioui 

“ Guide to Medical Exammabons ” 

“ The M R C P , and How to Obtain It ” 

“ The F R C S Eng , and Other Higher Surgical 
Examinabons ” 

“ How to Write a Thesis for the M D Degree ” 

“ Guide to the M D (London) ’’ 

“ Guide to the D P M Elxammabons ” 

" Guide to Dental Examinabons ” 

" Guide to Higher Examinabons for Nurses ” 

Any of the above will be sen! post 
free on application 

I eafiet^ dulling vvnh tbv. tollowing c-vamin'iin have "’No I n j rir re I 
and V ill be vent fovt tree on aprlicaiion 

“ Diploma m Child Health ” 

" Diploma m Anaesthebes ” 

“ Diploma m Radiology ” 

“ Diploma m Laryngology ” 

" Diploma m Ophthalmology ” 

“ Diploma m Bacteriology ” 

We specialise in COACHING for ALL 
MEDICAL EXAMfNATfONS 

Send Coupon brimr for nnr hooUet and all in/ormatioa rrlatin- to ur 
Frrminrtion 

The Secrct-irr MEDIC VL COURE^PONDENCT COIfhrL 
19 Welbeclv Street London W 1 

Sir— PI < IC I jiU I r r ^ r r 

Erdiitno i f ti It I V rt n 
Ptihhcci rt jii ud 



48 


THE BRITISH MEDICAL JOURNAL 


JuL\ 2 1918 


UNIVERSITY COLLEGE, LONDON 
FACULTY OF MEDICAL SCIENCES 


srcciM coimsr ion iiu primvra 

tWMINMION OF III! rO\ 
COLLLCI 01 SURCLONS 


Spccnl Short Courses in AN \TOMY ^nd 
PfnSIOLOGV will commence on TUESDA^ 
SEPTEMBini 6ih 1938 in prcpifYiion for the 
December Eximimtion 

ANATOMY Professor H H WOOLLARD 
M D D Sc r R S 

PHYSIOLOGY PHYLLIS M TOOKLY KER 
RIDGE M Sc PhD MRCS 
L R C P 

The course m AnTtomy (incUidmc Embrvolopv) 
will comprise lectures dcmonsir-itions practicil 
dissection 'ind oral cvTminaiion Each week pipers 
will be set corrected and discussed Member of 
the class arc invited to use the facilities of the 
Dissecting Room the Anitomical Museum the 
Radiographic Department and the Reading Room 
of the Medical Sclcnecs Library 
The CoursCf in Physiology includes Biochcmistrv 
and Histology and is made up of lectures 
demonstrations and \t\a locc classes held daily at 
9 am (Siturday excepted) beginning on Septem 
her 6ih 

riill particulars may be obtained on application to 
COG DOUIE 

Secretary 

Univcrsitv College London (Gower Street \V C 1) 


THE 

ROYAL CANCER HOSPITAL (FREE) 

(Incorporated under Royal Charter) 

Fulham Kond, Fondon, S AV 3 

A COURSE of STUDY in PHYSICS and 
MLDICAL RADIOLOGY qualifying for the 
Diploma in Medical Radiology of the UniNcrsuy of 
London and the Royal Colleges of Physicians and 
Surgeons will begin on MONDAY OCTOBER 3rd 
1938 at The Royal Cancer Hospital Fulham Road 
London S W 3 Full particulars can be obtained 
on application ai the ibo\c address to the Sccrctars 
CLEMENT CODBOLD Secretary 


^ADMINISTRATIVE COUNTY OF ESSr\ 

LSSE\ COUNTS HOSPIT\L 
Wanslead 


APPOINTMENT OF RESIDENT MEDICAL 
OfFICCR 


The County Council of the Administrative County 
of Ev.c\ invite applications from Registered Medical 
'Pr iciitioncrs not over 45 years of age for appoint 
mcni as Resident Medical OfTiccr at the ibovc 
Hospital which will shortly be opened as a 
County Hospii il for the accommodation of 
ipproximatcly 200 chronic and infirm patients 
The salary will be at the rate of £3^0 per annum 
and will rise subject to satisfactory service by 
minul increments of £25 to £550 per annum 
together with residence board laundry md 

itiendance valued for siipcranmniton purposes at 
£1^0 per annum 

The person appointed will be rcouircd to devote 
his whole lime to the services of the Council to 
perform such duties and to fiirniNh such advice and 
issistancc appcttamlng to his ofiicc as may be 
reamred md to reside in the quarters provided 
it the Hospital Tile appointment will be held 
b\ the successful candidate during the pleasure 
of the Council and will be dctcrmmible by the 
ofilccr by three months nonce in writing 
The person appointed will be rcquirLd to pass 
I niedKal cxammition and to contribute five per 
cent of his salary to the fund established bv the 
Counu Courcil under the Local Government and 
Other OfTiccrs Superannuation Act 1922 

Ihc appointmLni will be subject to the Council > 
Sick Pav Rules and Regulations a cops of which 
will be forwarded on application 

\pplications on the prescribed form obtamabR 
from the undtrsigncd and accompanied by copies 
rf not more than three testimonials which will not 
le reiurn'*d should be addressed to me and 
delivered at the County Hall Chelmsford not 
liter thin 10 am on N\cdncsdav Julv 6ih 193g 
County Hall L S HOLCROIT 

Chelmsford Clerk of the County Council 

June :ist iu;s 


B 


RmSH 


roSTGR \DL \TC 
SCHOOL 


MEDICAL 


, “ vaeanev for a G^SSECO 

lOGtCAL HOLSL SLRGLON lo commenee 
duly on Vueuet Im 19IS 

SiUrv at the rate e( tJDS ptr annum veiih 
I >jrJ and laundry 

\ppli all nx aeecnpancd bs copies of tc ti 
rr n tie shouU be addrcx cd to ihc Dean Bnii h 
I i« adi ate 'fedj al Vhiv I Dt^ane Road 
Shepherd X Biixh Lond n S\ i and jrn>c nat 
lit r than the firxt p-»xt m Mtndiv Julv lith 

Id X 


C 


ITY of BIRMINGU 


Cn \ MENTAL hospital 
WINSON GREEN DIV'ISION 


A M 


J^ANCASHIRE COUNTY COUNCIL 
PUBLIC \SSISTANCC COMMIT! EE 


medical superintendent 


The Comm ucc of Visitors invite opplicsilons 
Rotn cfiilj qtnltitcd niethcnl men for the position 
of Medic'll Supcrmicndent of the Winson Green 
Division Ql the City Mcnnl Hospinl nt -i com 
mcncing salary of tl 100 per annum plus emolu 
mcnis V lined for superannuation purpescs at £300 
per annum 

Applicants must be not more than 45 years of 
age must possess a recognized degree or^diploma 
in psychological medicine and prcfcrcnctT will be 
Riven to a holder of one or both of the following 
qualifications — Doctor of Medicine of a British 
University or n Member of a Royal College of 
Physicians experience in the treatment of mental 
disorders and in the administration of a Mental 
HospuiJ i!» essential 

The candidate appomted will be required to 
pass a medic \\ examination and to contribute 
under the Asylums Oflicers Superannuation Act 
1909 He must also devote the whole of his time 
to the duties of the office and must not engage 
either directly or Indirectly In private or con 
suiting practice 

All fees received In connexion with panel work 
will be required to be paid into the Doroush funds 
but for making insurance reports reports on com 
pensation eases and coroners inquests the fees 
can be retained 

The appointment is sublcct to one month s notice 
on either side 

There IS a Chief Medical Officer of the City 
*' Hospital who Is also the 

of the Rubery Hill and 

Medical Superintendent 
NS'^inson Green stating age full particulars of 
qualifications experience and appointments held 
accompinicd by copies of three recent testimonials 
must be addressed to the undersigned so as to Ijc 
received not later than Friday July 8th 1*^38 

Canvassing either directly or indirectly will be 
a disqualification 

F H C WILTSHIRE 
Clerk to the Committee of Visitors 

Town Clerks Office 

Birmingham 1 June lOlIi J938 


^ITY or BIRMINGHAM 

MATERNITY AND CHILD WEI I ARE 
DEPARTMENT 

Tlic Pubiu. Health Comniiiicc Invite applications 
from qualified medical women to act as MCDICAL 
OrnCtR m the above Dcpirimcnt (two 
vacancies) 

The duties iKltidc utcndancc at maicrnitv and 
child welfare centres and practical obstetrics 
Applicants should have had a six months rcsi 
dent appointment m a children s hospital and in a 
muernity hospital Tlie DPH wiU be con 
stdered an «4dditioinl quihfication 
The salary scale is £500 rising by £25 mnuaHj 
to £700 per annum the commencing sahry within 
that scale depends on the medical oflltcr s obsictri 
cal experience A car allowance is made It 
will be necessary lo reside tn clo'c proximity' to 
one of the City maternity homes 
The appointment will be sub cct to membership 
of the Birmingham Corporation Superannuation 
Scheme and to the candidate passing a medical 
examination and will be subject to three months 
notice on either side 

Applications endorxed Medical Ofiiccr for 
Maicrnitv and Child Welfare and accompanied 
by copies of three recent testimonials to be mad 
on a form obtainable from the Medical Officer 
oi Health Council House Birmingh im 3 and 
returned to hi m on or before July 9ih 193S 

R OTAL N7 society for JHC HEALTH 
or WOMEN AND CHILDREN (INC) 
(PLUNKET SOCIETY ) 


APPOINTMENT OF MEDIC NL ADVISER TO 
THE DOMINION COUNCII Of THE 
SOCIETY 


The Dominion Council of the Royal N ? Socittv 
for the Health of Women and Children (Inc) 
(Plunkct Soeiciy) mvitcx applications from mem 
bers of the British Medical Association for the 
ippointmem of a Medical Adviser to the Society 
The sutccs fill anp’icini will require to reside 
at Dunedin New Zealand to enter into a contract 
for a period of five years and to devote hiv whole 
lime to the work 

Salary £1 200 per annum New Zealand currency 
T urihcr particulars mav be tbtaincd from Dr 
R C JrwrsTiLRY MD FRCP 5 Wimpolc 
Street Cavendish Square * London W'^ or from 
the Hint CoMMissio'^FR lOR Ntw Zfvisso New 
Zealand House 415 Strand LonJon W'^ C 2 
The sucv.essf«l applicant will be required to take 
up duty early in 1939 

Applications giving full particulars as to aec 
expenenee and qualifications together with copies 
of recent tesumoaial will be rceeued not later 
than September loih 191*1 and should be addressed 
to 111“ Dosfi>ioN Pursinf'iT PtunVet Society 
Queen s Uiufdtnsrs Princes Street Dunedin New 
Zealand 


I AKF HOSPITAL AND DARNTON HOUST 
INSTITUTION 

Ashton under Lync near MnnehLster 


APPOINTMENT OF SENIOR RLSIDTNT 
MLDICAL OFFICER 


Sahrv £300 per innum together wuh the usual 
rLsidv-ntial LmoUimtius The person 'ippoimtd will 
be required to take up d ity on September 1st 19ls 
Applications ire invited from Registered Medical 
Practitioners for the above appointment at the 
Lake Hospital md Darnton House Institution 
Ashton under Lvnc comprising 300 and 5^5 bed 
respectively The Hospital is recognized as a 
complete Training School for Nurses 
Candidates must be unmirricd Preference will 
be given to candidates having previous hospitil 
experience cspccully in the adnunistraiion of 
anaesthetics 

The appointment will in the first instance he 
for a period of six months the successful candidate 
being eligible for reappointment for n hiriher 
period of six months at the end of that period 
Forms of application may be obtained from (he 
Counti ^felllcai O/ficer of lleoUti Piihllc Aw^fance 
(Ho^pHol anti Medical) Dcpnrlineiu Coiml\ Oir\cc\ 
PrcMon to whom all applications accompanied Iw 
copies of not more than two recent testimonials 
must be forw irded not later than ^n/iirdni 
Juh \6fU I93S 

County Ofiiccs GEORGE ETHCRTON 
Preston Clerk of the County Cotineil 

June 24th 1938 


y ANCASHIRE COUNT^ COUNCIL 
PUBLIC ASSISTANCE COMMITTEE 


WinSTON COUNT\ HOSIMTAI 
Near Prtscoi 


RESIDENT MLDICAL omCTR 


Applications arc invited from Registered Medical 
Practitioners for the appolniment of Resident 
Medical OlTiecr at the above Institution (500 Beds) 
Candidates must be unmarried 
Preference Will he given to candidates having 
previous Hospital experience particularly in 
Midwifery 

Salarv nt the rate of £350 per annum together 
with the usual icsidcnthl cmoUimcnis 
The appointment will in the first instance be for 
a period of sK months the successful appluani 
being eligible for reappointment for a fiirifier period 
of SIX months at the end of that period 
Forms of application mav be obtained from the 
Comio Mcdica] Ofdat of Utalth VaUUc A^stuaucf 
(tfo^pifal and Medico)) Deportment CoinU\ Offices 
Preston lo whom all applications accompanied 
by copies of not more than two recent testimonial 
must be forwarded so as to be received not liicr 
than Satmdav Juh \(dh 1938 
County omcLS GLORGE LTIICRTON 
Preston Clerk of the County Couneif 

June 27lh 193S 


QJT'i or MANCHESTER 

BOOTH HALL HOSPITAL FOR CHHDREN 
(760 Beds ) 


The Iiibhe Health Committee invites applica 
tions from registered medical men for the post of 
RESIDENT ASSISTANT MEDICAL Of I ICl R «l 
the above named hospital 

The alary for the appointment is £200 pvr 
annum with board residence and laundry in 
jddjiion sub cct to the Mmclicsicr Corporuion 
cohdiiions of service 

The appointment will be made in the first 
insianec for i period of six months rcncwabft fi’r 
a furihcc six months but not renewable there 
after 

Tull information and forms of application mav ht 
obtained from the Medical Officer of Heihh 
Town Hall ManUicstcr 2 and npplicaiionv for tlK 
post must be received by him not later than July 
h 1938 

r E W'ARBRTCK IIOWTLI 
Town Hall Town Cfctk 

Manchester 2 

June 17th 1938 


ITT 


O I 


BIRMINGHAM 


DUDLEY ROAD HOSPITAL 
(9'’6 Beds ) 


\ppf( ations arc Invited from fully quahhcl 
•disal Practitioners for whole time appointment 
JUNIOR MEDiCkL ornCTR (male) a fhv 
idley Roid Hospital Birmingham Ihc appoint 
•nt will be for a period of six months but may 
extended for n further rcfiod of not cxcccdmz 
months Salary at the rate of £ (X) per annum 
J full residential emoluments 
[ ufther particul irs may be obtained from inc 
•dical Superintendent it Dudley Road llovpujl 
sshom applications snnng age esp^nen e anr 
alifiLations with copies nf 
mid be forwarded not later than Ihirsday July 
- 1935 



Jui,v 2, 193S 


THE BRITISH MEDICAL JOURNAL 


INDIAN MEDICAL SERVICE 

RECRUITMENT OF EUROPEAN OFFICERS 

Applications are Invited from Medical Men for Permanent Commi<isions in His "MajeNn s> Indian 3Iet2icaI S'^rvue 
The terms offered include a fiTatuit\ of £1000 on retirement after siv %ears service, or of £2^500 after 12 \ears s-ervire 
together with free return passages for those nho no longer desire to remain in the Service In other re^pec «, ttc 
terms will be as detailed below 


Bntish subjects of pure European descent uho are under >2 
^ea^s of age who are registered under the Medical Acts m 
force in Great Britain and Northern Ireland are eligible to apph 

CAK3SERS 

The Indian Medical Ser\ ice offers a permanent carcerwith wide 
opportunities of medical excerience including clinical prevcn 
ti\e specialist and research work At the beginning of his career 
an officer is employed on the military side which has medical 
charge of the Indian Arm\ Promotion is on a time «cale up to 
the rank of Lieutenant Colonel and b\ <;eIection to the ranks of 
Colonel and Major General An officer ma\ appl\ after one 
xears Indian ScrMce to ha\e his name registered for transfer to 
the ci\il side from which appointments are made to Civil 
Surgeoncies which are established at the principal civil centres 
to provide for the medical needs of Civil Officials and for general 
medical administrative purposes to specialist (for example 
public health and bactenological) services to research posts 
and to professorships at the \IedicaI Schools 


KATES OF PAT 


^ears of 
Senm 

Rank 

Basic Pav 

Rs per 
mensem 

O crscas 

Pj) £ per 
month 

Total 
i per 
annum 

1 

Lieuienan 

4*0 

15 


*» 

Cipia n 

00 

25 

7*0 

3 


5*0 

25 

795 

4 


S50 

25 

"95 

5 


600 

25 

£40 

6 


600 

*0 

900 

7 


-no 

•50 

990 

S 


700 

jO 

990 

9 


700 

35 

lOsQ 

10 


700 

35 

10*0 

It 

Maior 

£00 

j5 

1140 

12 


£00 

40 

1200 

13 


SCO 

•rO 

1-00 

14 


£00 

-0 

t-OO 

15 


£00 

40 

1.00 

16 


9'0 

40 

I33S 

17 


9S3 

40 

1335 

18 


9 SO 

tO 

1335 

19 


1100 

40 

1470 

20 


1100 

40 

14-0 

21 

Lieui Col 

13^0 

tO 

1695 

22 


1350 


169S 

23 


13 0 

40 

1695 

24 


1^00 

40 

IS 0 

25 

- 

|S00 

-0 

ts-o 


\oi — (1) The rupee « at present siahihzed -t a rate equi>alcr to If €J 
(2) An oflicer promoted to the rank ofLieut -Col rel before co-np e 
lion of -0 >cars crM-e % ill recenc r-' -t lb*' rate of R-» 1200 per 
mensem (basic) plus £t0 per iron h c\er cas ra> 

Ext Of — In addition to the abo%c rates various -llowarces ^re wdmiss b e lo 
a larpe number of appointments on both the m litarv and the ci il iJc 

'shich n’3> be held by members ih Indian Medi'al Sersicc Spcv.J h e-h 
rates of ptN are a!^ ati ched n the rumerou admini traiive a’^poirtmei ts 
Opftn to oflicers in both brars-hes of the Ser\N» 


ANTEDATES IN CO^^DnSSION 

Candidates possessing certain higher medical qualifications or 
holding the Diploma m Public Health mav be granted an ante 
date m their commissions Past service m certain hospital 
'ippomtments mav aEo render candidates eligible for an antedate 
Persons holding or about to hold resident p® ^ recognized 


hospitals mav be seconded in tho e po s fer a p^rud U e 
maximum period of antedate secondrrent or anted- e '*0 
secondment combined admi sible Lnde^ th s pcra.vr^ 
limited to IS months 

OUTFIT ALLOWANCE. 

Officers on appointment will receive an allowar e o*' 
towards the co t of outfiL 

PKn ATE PRACTICE 

U ilh the exception ot Administrative Officer^ mhi \o sml 
and officers holding certain special apporntment ofi i.e's rci 
debarred from t-kmg pnvate praaice o lo-'g -s it cce rj 
interfere with their proper duties 

LEA\'E 

Leave can be taken at rea enable irterv*.! ard -det-i - e ra cs 
of leave pav are provided Extra le*.\e il no vn a« udv!-'t> 
which mav not exceed twelve r*0’'th in *.11 dnr, *.r cT c' 
<ervice mav be granted to officers desiroJs o pu'^u n- pt 1..I 
courses of studv of a postgraduate n-ture Darinc s_^n ’ca c 
<tudv allowance at present fixed at the rate E *. d- m the 
United Kingdom tl a dav on the Contircat o' Europe rd 
£! lOs a dav m the Lni ed States o' Amern.a ard C rad' i 
granted to an officer in addition to 0 dina v rates 0' !'a e p”* 


PENSIONS 


he rates of 

pension are as follows, — 

Per arm n 

After 

ITvears service for pension 

£ 72 

C> 


18 


£-00 

0 = 


19 


£-28 

O ' 


20 

r* •» •» 

£-6' 

0 


21 


£_02 

05 


■>2 

n - 

£j'9 

IC- 


23 


£576 

10 


24 


£61- 

0 


25 


£651 

Os. 


26 


£697 

10 s 


27 


£7— 

0 


There are additional pensions ranginn from £6'* to £_50 per 
annum for offiuers who have held administrative appoinirre’'is 

PASSAGES 

An officer on appointment is provided with free pas age to 
India The families of officers v ho are m'’med prior to the d t'* 
of the oflT cers embarkation on first appontmert will al o he 
provided with free pa'^age to India skhieut lo the p- mt-pi of 
messing charge Officers ard their families are -1 o el ■’m e 
for passa-c conce^ iO''s under which ihev -re '*d a ccr'-m 
number of return pas aces home at Govemncni e^per e d- i*'- 
their service 

INSTRUCTION PKIOF TO E’lT XPKATION 

Officers are rccui ed to u'^dcrco co r es c' ir t vI ai i' « 
Roval Arr-v N cdical College ird at Aider hot 1 ^ re -p'* cvi 
match three month pnor to ihcir cn ^ tn- n for l^d - m 
first aproirlm'‘nt Irfo mat on as to ihc 'a cs o' p ‘-’e 

dunne this penod *-nd sab^equ'‘r I up lo iv-I '■ I’"i. a is 
cort lined ir the m-no -rdan re'e co to beKv 


A memorandum giving tuH detafis regardm- these appointments vnd forms of appJic-tica ’-as be cbtaired from - 

OF STATE FOR INDl \ MlLITXRX DEPARTMENT INDIA OFFICE LO DOS S VV 1 T-c S irciion ' lee *> r- 

OfTice about Jul> 26th next and the selected cand dates unless seconded for hospital appo ntm rts b r q c^to J ^ < 

of mstruct on commencing about September 1st pner to sailing fer Ind a in December ls>3S sat ens i rrae t 

As soon as possible. 

INOU Cffici. jfx.- 19 jS 




50 


THE BRITISH MEDICAL JOURNAL 


Juc\ 2 193S 


HIS MAJESTY’S COLONIAL SERVICE 

COLONIA L MEDICAL SERVICE. 

1938, the Secretary of State for the Colonies proposes to select a nunnber of Medical 
Officers to fill vacancies the majority of which will occur in Tropical Africa and Malaya 

QUALIFICATIONS — Candidates must be British subjects of European parentage under 35 years of age 
-and must possess a medical qualification registrable m the United Kingdom Preference will be given to 
candidates who have held Hospital or Public Health appointments, or who have special knowledge of 
anaesthetics, radiology, surgery medicine, ophthalmology, gynaecology and midwifery," diseases of the 
ear, nose and throat venereal diseases, etc 

SALARY — Initial salaries vary from £600 to £700 and rise by" increments to a maximum of between 
£1 000 and £1,200 

PRIVATE PRACTICE — Private practice is not allowed as of right, but in the case of some appoint 
ments it is permitted on certain conditions 

QUARTERS — In Tropical Africa free quarters, or an allowance in lieu, are provided In Malaya 
quarters are provided at an annual rental not exceeding 6% of the officer s salary 

PASSAGES — Free first-class passages are provided on first appointment and when proceeding on and 
returning from leave Assistance is also given towards family passages 

TERMS OF APPOINTMENT — The appointments are pensionable, subject to a probationary period which 
varies from two to three years 

COURSES OF INSTRUCTION IN TROPICAL MEDICINE AND HYGIENE Selected candidates will 

normally be required to attend a course of instruction leading to the Diploma in Tropical Medicine and 
Hygiene before proceeding overseas 

DUTIES — Although Medical Officers are appointed in the first instance for general service there are 
opportunities for work in special branches of medicine and surgery, in public health and in medical 
research 

Further particulars and forms of application may be obtained from the Director of Recruitment (Colonial 
Service), 8, Buckingham Gate, London, S W 1 


ROYAL NAVAL MEDICAL SERVICE. 

Vacancies e\ist for Medical Officers in the Royal Navy, and applications aie invited for entty 
in September, 1938 

Candidates below the age of 28 years arc preferred, and they must be registered under the 
Medical Acts No examination m professional subjects will be held, but candidates mil be 
required to attend for interview fay a Selection Boatd 

Selected candidates will be entered for Service for a period of three years, which if desired is 
usually extended to fi\e years at the discretion of the Admiralty 

At the end of three years’ service, officers may letire with a gratuity of £400, but those v'ho 
SCI VC fot five years uill receive £1 000 

At the end of five years’ Short Service, permanent commissions will be given to selected officers 
uho wish to make the Naval Medical Set vice their permanent career Officers transferred to the 
permanent list will receive a gratuity of £1,000 (less Income Tax) 

Full opportunities exist for transfei to the permanent list, and periods of unemployed or Inlf 
pay arc vciy rare The assistance of private income is not necessary foi the pm pose of supplementing 
official p.ay ahd allowances 

Opportunities are available for officeis on the penmnent list foi post-giaduate study, to specialise, 
to take higher examinations and to obtain further qualifications 

Na\ a! Medical Officers are included in the Scheme for Mairiagc Allowance under the same 
conditions as for other Naval Officers 

Copies of the regulations for entry and conditions of service, including latcs of pay, alloivaiices 
and retired pay, may be obtained from the Medical Director-General of the Navy, Admiralty, S W 1, 
and from the Deans of all Medical Schools 

Applications for entry from intending candidates must be received not later than 
31st August, 1938 


1 


JUM 2 1938 


THE BRlTtSH MEDICAL JOURNAL 



Appomhnenh foi Medical Ojficeis 
III the ROYAL AIR FORCE 


MttJinl men irc iiiMt< d to ipplv foi Slioit ^cimcc CnnimiH^jons m tin Ro^ il \ir lone 
mu''J be ic^i tetcrl urulci die Medic d Acts niid be not inoic i/i in 31 n-. 

of i«c on cntr\ 

JJic pctiod of vciMcc j*. 3 e\i< iitlibic lo 5 A gruuifv of l-lOO oi v] 000 

1- pi\nblc il die trrniiintion of 3 oi 5 \cir'v re-pccin<K Penn mriU eomini ion nt 
ou iidcd in 1 mniilici of lo i *• flic e offei n pcn'‘ioinI)fe.cnn or uiili die op|>ortiiim\ of 
e\li I Icnc on full pn\ for '•peei d -tudx Xpplicini'^ who bold— oi lie IiKcIn to bold 
— po^l griduTtc oppointniciH- in cimI ]io pitoU ni i\ on joining ilic I{o^ il An lorn bi 
«C(onded niitrl tlic trinnnition of tbeir 'ippointnitnt«* (foi i pttiod not cxcutbn^ om 
xrni) \n inlt dole of eoinrni'-*ion up lo lueKc nioiidi'* 1*^ illowcrl for ippoinlinent'* field 
It ippio\< rl lio-pil iK 

Fuller information can he obtained from The Director 
of Medical Sertices^ Air Ministr^^ London 



QOVSTV BOROUGH OF WEST BROMWICH 
HALLAM HOSPITAL. <472 B«<Js > 

(1) RESIDENT obstetrical OFFICER 

(.) RESIDENT assistant MEDICAL 
OFFICER 

Appli-^iions arc incited from dul> aunlificd 
(unmarried) male Registered Pracjiiioncrs for the 
abo\c appomunenis 

(1) Candidates for the Obstetrical Officers post 
musr hast had previous resid nt hospital experience 
in both general and maternity wor» The dunes 
viill mclude conduction of certain aatc^oatal clinics 

The appointment will be for 12 tronihs at a 
s-ilary of £>00 plus usual resident emoluments 

The appointment is determinable bj either rany 
gving ISO months nonce 

(2) Resident Avtstant Modi al 0'*icer — for 
general duties Salary £.00 together with u ual 
resident emoluments Appointment i for six 
months and renewable for a funher six months 
but can be terminated b> either part) gi mg six 
weeks noucc. 

All feei received by the pernors appointed will 
oc pa -aole into the fund of the Council 

Applicxtions stating -gc cxpcnctwc ^nd qiiali 
ficauom ro'vthcr mth copies of three reexm tcsri 
monuls must bv forwarded to the Medical Officer 
ol Health _ Lod c Road West Bromwich so 
« to arrive not later than b) first pewt on 
Wednesday )ul> 6th 193S 

Town Hall G F DARLOW 

West Bromwich Town Clerk 

June 16ih 1938 


^OUVn BOROUGH OF BLACKPOOL 

APPOINTMENT OF MALE ASSISTANT 
MEDICAL OrnCER OF HEALTH 


Atirhcaiiors are invited from dul qual 6cd and 
regntered medical gcniJcmco foi iht above appo nt 

ment 


The xat ry offered is at the rate of £500 per 
<*nnutn rising by annual increments of £.5 to a 
nvaaimum ot r*CO 

Details of the conditions of appomtnent l*s 
dunes and form of arrbcatnn may be 
obtained on application to the Med cal O^Vee of 
_Hc3tih M mtciral Health Cent c BIaclrvx>I 
Canvaxsme of any dcscnrtion will be deemed 
• dKquali icauon 

TRENOR T JONES 

Town Oerk 


Town Hvfl Blackptol 
June 19X8 


jgOROLIGH OF CHESTERFIELD 

assistant MEDICAL OFFICER OF HEALTH 
AND assistant SCHOOL MEDICAL 
OFFICER (Male) 

App’ications are invited from duly qualified and 
registered m-Ie medical practitiorcrs for the above 
appointment 

The salary will be £600 per annum ri'ing by 
annual inctcmems of £25 to ir“0ci annum 

The appontmem will be object to the pro- 
VI loru of the Loal Covemmem and Other Officers 
Superannuation Act, 19^ and the sucecs ul 
candidaie v»/ll be rcQai ed to par-lfte pexress-rj 
medical examination 

The duties of the post in«.Iodc work in conr'^on 
with the S«.hooI Medical and M-ternity and Child 
W eJfare Seni es and s i h other duties as may be 
required by the Couo~i 

Further deuil of the jrpomtrrenr and recial 
application forms can be obtained from ih Xfed cal 
Officer of Health Health Department Tonn Hall 
ChestcrTcld to whom all applicaticns should be 
4ubmiti*d foecther with three recent testimonial 
not later than Thursday July N h 19^8 

Town Hall T M JORDAN 

Chesterfield Acting Town Clerk 


QITA OF SHEFFIELD 

NETHER EDGE HOSPITAL 

Applications ~re invited from duly Qca!'’cd 
med ml women for th appontmert of ASSISTANT 
MEDICAL OpriCER at ibe above bosp til 

The Mcdiw..! O^-cr ap-xnated w I be required 

to reside in the bo^plral -nd avsrst m the j—d oa 
and maternity cctions She w 11 a «o t-ke pan la 
the M-tcmi> and Child Wolfar- wok ot the 
Corrorauon laktn Arte Natal Poe* Natal c 
Child Welfare Cln -s dat at e^e AUierr-j -nd 
Child 'A cUarc Centre 

Cand d«tc hOw^K. bavc previous bo^r *al Ctpcn 
and postgraduate CT”er mim n M d« ery and 
Arte-Nat_l wo k i .al 

The saLry o-'er-d n £ O pC an-am. rs - by 
£25 to 0 with ia.-a! rev dcr .at ..I 
The r"xs r»r'e^ w II be $—*" ec* to t^'e p o rv o^s 
vJ the Local Go emmer r- O h-m O'*’ cr 
Su'^emnn.-ti n A« I9_ apJ dcu-- w 1 be 
made un-er tbs Acu 

Ap-' ca c^N, s at-pg arc. Qua’ -•sJ 

cxrcri'mcc „cecm‘*x3n ed by (h cc recce tcv.>- 
mcnial ^houd be cri to the xi cd cal S •xr'i 
ten ent C ty General Hc«*''t3l ShefS^ J ca cr 
beftre Ju y 6th 19 S 


gURREY COLNTA COLNCIL 
PUBLIC ASSISTANCE DEPARTMENT 

RICHMOND iNSTtTLTlON 
U«0 B-d«) 

APPOINTMENT OF RESIDENT ASSISTANT 
MEDICAL OFFICER 

Apph'wtions re inv ted f cm revnfc'td r~cd».al 
praetiiJoneTS fo* the arpe r ”"cnt c Re^ 

A vi«wnt Medal Officer at the Cr » Prud 
Institution RichmorJ The In rution iv d 
nni tered by the Pu'-> Av t_r e Ccr-m f-e cl 
the Counal 

Appli^nts should have bad exper^Je^ c a a 
House Surgeon or Ph lO-n Tb a'-’v " i 

fur a period of six i-'or hs rerewab c fer a f nher 
penod of s T r^er bv rnd tbc r i t tb- 
rate of £2 0 per ar- m tf—c Am « h fi 11 
restder lal emcline- »’i-cu at a**- 

Apn cat >^5 si_t 1 qu..! cat n a*' c per e 
and en lo n" co~ s of r l •" •* t ib t r- cn 
le. ir;o"ia!s Arm’d be crv-c'v u ** Pev w'—t 

A a ed ..I ©•'’’'mr ru xer to c C c > 

Medical OT cr C unt> H II K c-^'^Thar'es 
so as to rmch bi"" c I_ er tA.-n July 1 A l ji 
Cou- y H If Di.DLC\ AL^LAVD 

KIn~stO't-on Tba.— es Cc k c tb-C"* — i 

Jnr- -,ih 19 s 


VA- c-t r> 


ANCASHIPE fENTAL DLMClENCY ACTS 
-r COAlXflTTEE- 

An additional ASSISTANT rnit^AI 
OiriCFR - - I t e er^ * yean r r^ rd 

ty lAe aS-^e Cr— “ tier f r ** P" ^ '' 

nd ccri M Dc'c-i ^ ^ 

Cxu- > of L- aa e I'-c » - 
pj u n Cen rev and tbe cany r c 

e- m - I Cc— r* e- r-ay -m t • 

re-L re 

sj_n pe a i* J 1 

(TsD~--itr., 

D-rrc« in r *• -= v -u -- i 

Ln erv i r -e ti - - — ’c 

_ — _t — — c ■* x •N." *“ 

T^e a— -■ % —tt'- 

ro *“ t "■ e- h ^ 

ft ra ..“v f " — 

d-.es e' rt_> e c^-a ““ 

cu ml -r“ ~ -T 

r- c tA-- t -r te* — - '“it 

nn later t'-a- 1 > . 

f O*'" ^ GLoi r E^Tif 

p-^T n C*c~i 


■ r — 



52 


THE BRITISH MEDICAL JOURNAL 


JuL\ 2 19JS 


SUSSEX COUNTY COUNCIL 

JOINT COMMITTEE Of 
HORSHAM URBAN AND HORSHAM AND 
fCTWORTH RURAL DISTRICTS 


ASSISTANT COUNTY MEDICAL OFLICER OF 
HEALTH AND MEDICAL OFFICER 
OF HEALTH 


Applic'ilions arc invited for the }olni whole 
time '^npomtmcni of an,As<;isnm County Medical 
Ofheer of Health for the Administrative County of 
West Sussex (salary £340 per annum rising by 
annual increments of £50 to £^40 per annum) and 
Medical Officer of Health for the Hbrsham Urtian 
District and the Horsham and Pctworih Rural 
Districts (salary £460 per annum) 

Applicants who should not be over 45 years of 
age must be duly qualified medical men with 
experience in Public Health duties and must hold 
the Diploma m Public Health or its equivalent 
The officer appointed will be required to reside 
m Horsham or such other place as may be 
approved As regards his duties as Assistant 
County Medical Officer of Health the offiCLr will 
act under the general control of the County Medical 
Officer of Health and will be required to per 
form such duties as may be from time to time 
presccvbcd and vs regards hi$ duttes as Distvtct 
Medical Officer of Health the ofheer will be sub eel 
to the sole control and direction of the Local 
Sanitary Authority 

Office accommodation ard clerical asistancc will 
be provided by arrantcmcnis to be agreed upon 
bv the appointing authorities and an illowancc 
will be made lor travelling The lomt appoint 

mem is subject to the aproval of the Minister of 
Health and the Board of Fducation and also so 
far as the oIBlc of District Medical Officer of 
Health IS concerned to the provisions of the Sam 
larv Officers (Outside London) Regulations 1935 
The joint appointment is designated under thci 
Local Government and Other Officers Suncrannin 
tion Act 1922 and the selected candidate will be 
required to pass a satisfactory medical cxamina 
tion 

The joint appomimeni will be determinable by 
three months nonce on either side sublcci so far 
as the oflicc of the District Medical Offictt of 
Health IS concerned to the consent of the Minister 
of Health 

forms of applications together with a list of 
dimes and conditions of appointment may be 
obtained from the undersigned A D Robinson 
and accompanied by copies of not more than three 
recent icsiimonnls should be rcturncd'"lo lum in 
the envelope provided not later than July I2th 
IW 

A D ROBINSON 
Deputy Clerk of the West Sussex 
County Council 
F TRASCR HADDOCK 
Clerk to the Joint Committee of the Horsham 
Urban and Horsham and Pciworth 
Rural Districts 
County Hall Chicliestcr 
June 20ih 1938 


NORTHAMPTONSHIRE COUNTY COUNCIL 

Appointment of Assistant Countyr hfcdical Ofiiccr 
and District Medical Officer of Health 


Applications arc invited from registered medical 
practitioners holding a diploma in public health 
or Similar qualification for he appointment of 
Assistant County Medical Officer of Health under 
the above County Council and District Medical 
Officer for the Borough and Rural District of 
Bracklcy The officer appointed \w ill also act as 
temporary District Medical Officer of Health for 
the Bnwvorth Rural District but iiUimatcly he 
will vacate this appointment and will lakx over 
other districts adjacent^ to the Bracklcy area 
The inclusive silary will be at the rate of 
per annum with a travelling allowance on the 
scale from time to time approved by the County 
Council Office accommodation and clerical assist 
ance will be provided The present allocation of 
the annual salary is County Council £520 Brix 
worth Rural District £175 Bracklcy Borough £30 
and Bracklcy Rural District £75 
The appointments under the County Council 
and the Bnxworth and Bracklcy Rural District 
Councils are designated posts for purposes of the 
Local Government and Other Ofiicers Superannua 
lion Act 1922 and the salary attaching to those 
appoinimcnis will be sub cci to a deduction of 
5 per cent per annum for superannuation in' 
accordance wuh the provisions of that Act 
The officer appomted will act under the 
Sanitary Officers (Outside London) Regulations 
1935 and ihc Local Government Act 193^ and 
the oHicer appomted will be required to perform 
in the districts of the Local Sanitary Auihontics 
referred to all the duties imposed on a Di irict 
Medical Officer of Health by Nhc relevant Acts 
Orders and Regulations 

The officer will be required to devote his whole 
lime to ihe duties of the office and to reside in 
a place approved by the Aiithoniics 
The candidate appomted will be required to 
pass a medical examination 
The appointment will be dcicrmmabJc (sub cci to 
the relevant provisions 'of the Local Government 
Act 1933) upon three months nonce on either 
side 

Apphcations stating age quahhcations and ex 
pcricncc together with copies of not more than 
three recent testimonials should reach the under 
signed not later than July flth 1938 
Canvassing will disqualify 

H S» MARTIN 
Clerk of the County Council 
Countv Hall Northampton 
June 21st !9a8 


^OUNTY BOROUGH Of CROYDON 


WARLINGIIAM PARK HCTSPITAL 
(for Nervous and Mental Disorders) 
\\ arhngham Surrey 


APPOINTMENT OP JUNIOR ASSISTANT 
MEDICAL OniCER 


J^ONDON COUNTY COUNCIL 

Applications invited from MEDICIAL PRACTl 
TIONERS of at least one year s standing to under 
mentioned positions Candidates must have held 
resident appoinmcnl in a general hospuil for 
at least six months Married quarters not avail 
able 

ASSISTANT MEDICAL OfflCERS (Grade 1) 
—Salary £350-C425 with board lodging and 
washing 

(a) H \CKNEY HOSPITAL Homcnon High 
Street E 9 Dunes mainly medical 

(b) HIGVIGATE HOSPITAL Dartmouih Pvrk 
Hill N 19 Dunes mainly medic il experience in 
anaesthetics desirable 

(c) LLWISHAM HOSPITAL Lewisham SEH 
Mainly anacsthcncs with medical duties 

(d) MILE END HOSPITAL Bancroft Road 
Mile End E 1 Duties mamlv surgical 

(c) ST GEORGE IN THE EAST HOSPITAL 
Rainc Street Wapping E I Dunes obstcmtal 
gynaecological operative surgical experience 
essential 

ASSISTANT MEDICAL OfflCERS (Grade II) 
— Salary £2*=0 together with board lodging mil 
washing Appointment for one year only in first 
instance (renewable for a second year under 
certain conditions) 

(f) MILE END HOSPITAL Baneroii Road 
Mile Fnd E 1 General medical duller cxpcri 
cnee m anaesthetics desirable 

(g) ST CHARLES HOSPITAL St Charles 
Square Ladbrokc Grove W 10 Medical duties 
and male tuberculosis wards 

•(hi ST P\NCRAS HOSPITAL Pancras Road 
N W 1 General duties experience in anaesihttics 
essential 

• Male candiilaii r ofil> 

Application forms obtainable (stamped addressed 
foolscap envelope ncccssiry) from Medical Officer 
of Htalih Staff Division 2a County Hall SEl 
returnable by July llth Canvassing disqualifies 


ONDON COUNTY COUNCIL 


CONSULTANT AND SPECIALIST SERVICES 

Application invited for appointment as PART 
TlMb EAR NOSE AND THROAT SPLCIALISI 
for one session a week for duty at St Andrews 
Hospital Bow 

Salary £125 (C75 a year if already employed ns 
a part time consultant or specialist in hospital s 
service) and additional remuneration at rate of 
£2 12s Cd a visit for cmcr^cncy Msiis made in 
excess of number of routinb sessions 

Application fonns containing full parilculirs 
obt unable (stamped addressed foolscap envelope 
necessary) from Medical Ofliccr of Health (6) 
County Hall ST) returnable by July 9ih Women 
eligible Canvas,sinp dn^quahlics 


M 


IDDLLSEX C O U N T \ COUNCIL 


NORTH MIDDLESEX COUNTT HOSPITAL 
Silver Street Edmonton N 18 


I^ALOP COUNTY COUNCIL 

(0 DLPUrV COUNTY MEDICAL OmCER 
or HEALTH AND DEPUTY SCHOOL 
MEDICAL OrnCER (Male) 


(b) ASSISTANT MEDICAL OfFICER OF 
HfA-l'^H and '.GStsrA.MT SCHOOL 
MEDICAL ornCfR (Male) 


Apphcations for the above posts arc invited 
from duly registered medic il practiiioncrs who 
possess i recognized qualification in Public Health 
uid hivt had at least three years experience m 
the priciicc of their profession 

for the position of Deputv previous experience 
IS cs^,tntial in Maternity and (Thild Welfare and 
School Medical Inspection work ind very desirable 
in the administrative work of i Public Health 
Ocpiriment The commencing salary will be at 
tht rate of £700 per annum rising by annual 
increments of £25 to £750 (together with a travel 
line allowance in accordance wuh the County 
scale) 

The duties of Assistant Medical Offiecr will 
include medical inspection of school children 
M ucrmiy and Child Welfare work and attendan cs 
vt associated elinics The sal irv will be at the 
rate of u 00 per annum rising bv annual mere 
nvcnis of t s f-po per annum (together with 
a travcllm allow incc in accordance with the 
Couniv cvlc) 

Bull tppi in mcnis will be dctcnmnablc bv three 
m mhs notice on cither side and each officer 
appointed Will be required to devote the whole of 
hv lime to the p rfcirmance of the duties assigned 
to him bs the County Medic il Ofliccr 

B th ipp mtments arc designated post for the 
purp -N f the Lo al Covernment etc Ofliccrs 
inipef »nn ntion \tt 1) 

\pph iu ns mpanicd by a copy of three 

T's.vnt te‘st»m sTia* shiuld be submitted not liter 
than Iii*sdiy July I ih to the Cttmiy Med cal 
Oi’e. r C ninis H alih Oflieo Shrewsbury from 
\hem t!iv n CCS ar\ firm and ei ndi ilu of 
Service e «a I e lit lin'd 

W L fDGf 

Clerk of the Coimi.ll 

Sh reh lU St r.A tniry 
June \ lots 


fhe Visiting Committee of the WarUngham Park 
Hospital arc prepared to receive applications from 
medical men for the appointment of Junior 
Assistant Mcdiea! Offircr No married quarters 
arc provided Age should not exceed 35 ycirs 
The salary will be at the rate of 1400 per annum 
rising by annual increments of £25 etch to a 
maximum of fsOO per annum A further £50 per 
annum will be paid if in possession of the D P Nf 
rurnishcd *ipirtmcnis will be provided with board 
and laundry and for the inimosc of superannuation 
will be V tilled at £150 per annum 

Candidates must be registered under the jvtcdical 
Act and preference will be given to those tandi 
dates who havt held the post of House Surgeon 
or House Physician at a Generd Hospital 
Previous experience m a Mental Hospital is not 
essential Ific appotmnicni will he sub cct to the 
provisions of the Asylum Ofliccrs Superannuation 
Act 1909 

forms of application may be obiained from me 
by sending a stamped aeldrcsscd foolscap envelope 
to be returned not later than 10 o clock in the 
forenoon of Tfiursdiy July 14ih t93S Canvassing 
in any form is prohibited 

Town Hilf r TARCRNER 

Croydon Clerk to the \iMtmg Committee 
June 25th I93S 


\T \ or WESTXfINSTER 


ASSISTANT MEDIC \L OfflCER 


\pplicaiion arc invited from registered n dica! 
practitioners preferably holding a Public Health 
gualificaiton under -*0 year, of age for the above 
appointment The post is of a temporary nature 
and the sutcc sfol candidate will have to devote 
part of hi lime to duties connected with Air 
Rad Precuitions The salary will be £600 per 
mnum I 

\ppli aliens on forms to be obtained from the 
undersigned toeciher with copies of not more ihm 
three lestimonril should reach the undersigned 
nil liter tb»n July 9ih I9tx Canva sing either 
dire tl> <ir mdircetly diequahfics 
City Hall I \RkLR MOl RIS 

Westminster Town Clerk 

June 1) 3 


ASSISTANT MEDIC kL OmcrR required (nr 
Casualty and Receiving Room duties Candidaies 
must be registered medical praciiiioncrs hive held 
posts as House Physicians ind House Surgeons and 
with considerable general experience 
Salary £350 pa with board lodging and 
laundry or cash allowance of £100 pa in Jicu 
of residential emoluments Appointment non 
pensionable but subject lo medical cximinailon n 
for period of six months with possibility of ex 
tension for further six months md n tcrmimblc 
by one month s notice on cither side 
W'hole time services required under direction of 
Medical Superintendent Hours of duty 10 a m to 
r pm daily with Siturday iftcrnoons and Sundiys 
free 

4ppheaiion forms not provided Applications 
stating age qu ihneaiions md experience togcincr 
with copies of not more than three rcecni tesU 
monials must be received by the undersigned not 
later than July 16th In cnvclorxs endorsed 
C M D North Middlesex Rchlionship to 
any member or ofliccr of the Council must f’c 
disclosed in the applieaiion and cinvassing 
directly or indirectly a disqualifitaiion 
C W' KADCLlffE Z 

Clerk of the County Conn u 
Middlesex Guildhall 
W^cstminstcr S W' 1 

June 20th 193S 


O K O U G U OF \V O II I II I N Fi 


nCrUFY MLDICAL orilCLR OI IIFAIIII 


\ppl( ations art invited for the above appnn 
lent from duly rcti icrcd medic i! bractufint-r 
o> cssin" a efipfoma in ianitary Stien e 
[calth or Stale 5itdi me Salary if'O per 'fo 
me by annual increments of £25 to a miximnm 
{ £7(>o per annum , . _ 

Terms and conditions of iprointment and Iftm 
f application will Ic supphed on rt cipt d 
:amp-d and addressed foo scan envelope 
AppholiorH v.lh not Itun 

:stjn innN must be received by the unJer 
ot liicr thin Jtify ffdi S' . 

fiwnHiII J KLNSfDV V 

Worthing fCAnLi 

JiiOv 191*. 


JUL\ 2 J93S 


THE BRITISH MEDICAL JOURNAL 




QITY OF PORTSMOUTH 

SMNT MAR'i S MUNICIPAL HOSPITAL 
(1 0^0 Beds ) 

■\pplKaiiorss are in\iied for the fclJowmg 
appointments at tbc abosc Hospital 

1 SENIOR ASSISTANT RESIDENT MEDl 
CAL OFFICER Applicants must be in^Ic dulj 
qualified and resistered not exceedin'* 30 jears 
and must base had two icars hospital expert 
cnee Preference will be *mcn to iho^c basin? a 
Lnotvledec of *.nd experience in general medi-'a! 
work The appointment ta limited to a term ol 
not exceeding two >cnr> Sal rj for the first jear 

and for the second 

2 JUNIOR ASSISTANT RESIDENT MEDI 
CAL OFFICER Applicants mu t be «mcl 
duly qualified and regLtcred not exceeding 
^0 years and must ha\e had at least one 
\ears expenen c of Iiospiial work Experience in 
anaciihcii*s will b- an additional qual fication 
The appvintmem is limited to a term ol one jear 
and the salary will b* £250 per annum 

-•The aboxe appointments in Iud“ s rxT e at an> 
institution belonging to the City Coun il that nav 
be required The residential emoluments arc 
xtilucd at ^lo per annum and the appo nimenis 
wTll be subject to termination by on month s 
notice on either side 

\ rcsidert Medical Superintendent ts in 
atiendan e 

Api icatjon forms, may be obtained from and 
must be returned to the Medical OrTcer of Health 
The Guildhall Ponsmouth not later than 10 a m 
on Thur day July 14ih I9^S 

Can>a s rvg cither directly or indircaly wall b 
ceemed a disaualifi'ntion. 

The Guildhall F J SP\RKS 

Portsmouth Town Clerk. 

June 0th J9^S 


C m AND CObNTy OF NEWCASTLE 

UPON Ti'NE 

APPOINTMENT OF ASSISTANT CHILD 
welfare medical officer (MALE 
OR FEMALE) 

Applications ar insited from dutv rcci tcred 
Medical Pra'itucners for the pot of A latant 
Child Welfare Afedical OiTi tr The person 
appetnted wall take pan in the ordia ry routine 
work of tlTe child welfare centres but will not 
be required to assist in the working of the raaternitx 
scTMces 

Applicants will te required to base held a pc t 
as Hou e Physician m a recocnired teaching 
hospital (General or Children) ^rd some expen 
ence of method* of rredi*al or pathoUeical r ’search 
IS dex raWe. The possess on of the Diploma m 
Child Health granted join !y bs the Royal College 
of Phy laans and the Royal Co lege of Surgeon^ 
will be regarded as an additional qualification 
Salary i*^00 nsing to £“00 per annum by annual 
increments of £25 

The appoinimeni will be sufcj'ct to ihi. proxtoions 
of the Local Gosemmem and Other Ofin cr 
Supuannuation Act 19-.. and the u-xessful can- 
didate Will be required to pas* the necessary 
med cal examinatioa 

Application on the prescribed form whi h can 
bv obtain-'d on application to the Medical Ofrtcru 
OF Healtm Health Depanment Town Hall 
Ncwcasile-upon Tyne I must be submitted rot 
later than ^turday July 16tb 193S 


QlT^ 


OF LIAERPOOL 


ASSISTANT RESIDENT MEDICAL OmCER 
cm INFECTIOUS DISEASES HOSPITALS 


Applicati ns arc invited for the above appoint 
m nt for a period of one year at a saliry of £—0 
per annum together with the usual roidential 
■"allovvanccN The person -ppomted will mt be 
allowed to engage lO pnvatc rracti*e and will be 
required to- devote whole-time seni c to the duties 
of the ofli e 

Candidate^ will be required to jw sess a regi 
t red Medi'vl and Surgicil qualification and shctild 
have a knowledgt of Bacteriological method 

Application to be m-dc upon form obtainable 
Irvn the Med cal Officer of Health Hoxpu 1 
D ranment Muniapal Annexe Dale Street 
Livcrpov! to be t.ndon:'*d \$ rnant Resident 
Medical OTi cr and returned to th i nder isned 
o as to be r'cci ed rot later than Wednesday 
Ji ly I th 19^*^ 

Municipal Buildings W H B\fNES 

Dale Sirmt Laverpool Town Clerk 

July 19 


CORPORATION OF GI ASGOW SERA ICF 

JUNIOR ASSISTANT MEDICAL OFFICER 
tmalc) wanted for the Hawkhcad Mental Ho ** lal 
ptev us tretital ho p tal expenen “c lt*c cs-sorv 
bat preference will tx given to re who has cn 
tagxJ in -p3t*''»logical w rk or ha been hous*. 
physician ample c-'P^nunty afTorccd f r res .ireh 
sjlarv to crmmcn'c at £ (A) per an**im with 
b vard lodtmB ard Jaurdrv 

I (ill rani*.ulars on nr"!! cat n to the Medical 
SurcnniciH-crt Ha V.h'md Mental Hovp tal *10 
CrocVsicn Rcud Gla row S AA _ 


QOUVn BOROUGH or ST HELENS 

ASSISTANT AIEDICAL OFnCER OF HEALTH 
(Fcna e) 

Appli'ativns -re muted for the po't of A « tan 
Afedical O^cer of Health (female) 

The duties will be mainly m with 

Afatemity and Chi’d AAelfarc ard th- S..boo 
Afedi-al Sermee together wuh xu'li cth-r d ncs 
a the Afedical cr of Health may d reel. 
(Candidates mu.t have xpeci t expen r-e i- Af d 
ttifery and tn the di ca^cs of rfiPdren 
Th- xafary will be at th- rate of £500 per -ra-m 
plu travelling txper e* nain- by annual ircrcmert 
of £-5 to a n-xir"um of £“00 per arnam -cd m 
the cave of a cardid-tc no*v in the nice of 
another Authontv m - n ir»- <calc rect.— it. n 
may be given to past vcrvicc with su h Autb ntx 
in fixing the commemn- salary 
The ap’'ointBcnt r» ub — t to the prov to s o' 
the Local Govemnsent -cd O her O'^ctrs Super 
annuation Act 19 ard to the <LTXssful candi- 

date pa ing the ncce>Nary medical cx-ni-atton 
FoTB of application may bt. obt-ired fiv.-! 
the Afedtcal Ofli*er of Health Town Hall S 
Helens ard completed application aci:x*nna"icd 
by copies of not more th-n three recent levtinonial 
shouM reach him not later than July !-th 19 
Canvm ng members of the Cour nl o Com 
miitees of the Corporation v ill be a d *qualJ^Cition 
Town Hall FRANK HALVAAELL 

St Helen Medical Oii~ef of Health 

Jont '*4ih I9a^ 


^URREA COLNTA COLNCIL 

PUBLIC HEALTH DEPARTMENT 

REDHILL COL-NTV HOSPITAL UM B*v. > 

RESIDENT ASSISTANT MEDICaL omCER 

Appli'aion arc invited from rcguicred M-MicaJ 
Pracdtiirers for tbc appontnnt c' Revden 
A -lant Afcdiml 0‘*ic r at the RedhilF C uniy 
Hcrpitaf EarlwoM Common Redbill 

The Afediol OtT er appointed mu<t bavc bad 
pre nou expenenec as Hou e Surgeon 
The appointment is for a r-nod of tx nontb 
renewable for a furth r penod of six mon hs and 
the 'w'ary i at the rat of *‘-.0 per -pputti 
to-ether with full re^identL-l emoijmc” s valued 
at '1-5 per -nnum 

Applications tatirg ace gcal-ficatior -rd 
cvpericn e -nd en-IO'i-g ctoic* of re nr than 
three r'cect e^timonal hcjld be -ddr^ved to 
the Afedical Sup-nnterdent Redhill County 
pttal Earlswocd Comr-on RedhiU so - to be 
r'ueued not later than July Pth 19t 

DUDLEY AUKLAND 

C univ Hall Clerk of iht Coun n1 

kingston-upon Thane* 

June - th 19*^ 


^OUNTY BOROtGH OF SOUTHAMPTON 

appointment of assistant SCHOOL 
DENTIST 

Applimiion are invited from full qualified 
gcntlerncn for ibe above pO'.mon 

The Local Government and O her Offi erx Surer 
-nnuation Act 1°— will K appl cab e to tht 
appoiruncnt and the so ce<sful canddat wi‘J K 
required to pas* a nediml examination. 

SaLrv ^-.*0 per annum 

Applications on the pre<-rib-d form to K 
obtair-d from the Medical Officer of Health Civ 
Centre Southampton and enderved V tart 
School Denti i mu<t be delivered at the Town 
Oerl Offi e Civic Centre SouiEnp on on or 
before July 10th 19^5 

R RONALD H MEGGESON 

Jure * th I® To n Clerk 


gRISTOL ROV IT.RMARV 

Apr C3IIOP are invited fo th pO't of HOLSE 
SURGEON to the Fnctcre Deparmen Saj-y 
at the rate of '*0 per arrunt Card date* who 
nu t be re— ter d Alediml Pr3aiuc''c-« to sc"d 
in th r app «— no- usnn ace rd -C''-*nan *d 
bv no r'orc than three textm? nial lo ibe un-cr 
pcd 

The clnned und-tEt nut be-v.— e a n-nber 
of the Afedical Def n c Ur n bef e takir up h 


.iP'x. ntm rt 


ELLIS C SMITH FCIS 

Secrei-r> a-d HoJ^ Govorr., 


vIT'i HOSPITAL CHESTER 

JUNIOR RFSIDENT MEDICAL OFFICER 
ia!c> required f r ibe aNv c gcr-ml h-'^-tal 
Salary wi I be *^1*0 per arnjn p f rni 
•n ul cm .inert Tbe ar*' -i—ert w 1 be i ^r 
: r- r b o 1 a-d will be ter-*-a’'c at i 
"e b one m-h no c c c- bn - 
Arr -ca iO'*v .aii—g re cj— ' aa i 

-> ouv cx*^ i-n e t-*fci er wi h v. **—> of t’^rec 
cert tcM— otjK be vm: l be Med ml 

T-xr f Hcahh Tiwn If- CbjMcr f-. 
cd e^ay Julv 1 th 1*' 

J H DICKSON 

Town Cle-k 


gARRA URBAN DISTRICT COLNCIL 

ACCIDENT AND SLRGICAL HO«’'ITAL 

Apr icatic-s are i-v ed for th -r^ 

RESIDENT SURGICAL OmCER t o 

d..t cs IP (X'^cS: rex’ S la'y -t t e r* c v. — * 
re -n-L—i r t r-vo i—rcr— s 
-r_mto Ot— b w^'bju a-- 

lb- ac-v r ~ n t be t-i 'a ed bv .. — j 

r— we cn e »'tT <'u 

Card o-tc* ra_ r-' be c ~ y-- -v 
a.-d n_'' be ca**’'* c cf per* — - r--. 
opcraticnv Pref'-'c c wi 1 be g-vc- t_ - - 

bo .. g b che^ _ -sil q _ aa a _ 

V t in carryj vt.t th- f ray w l c 
Ho*' Lil Tbe a— v-j’-— t t • ro O 

vi-o-w o t - Lcol G-\— — r O rm c 

Sj- rarn at an Act 19 - - t 

ea d d fc « 1 be ret. t i — 

cxin nat v-' 

Tbe r ccx ui ca-.. dat wi ! u r ? 

di cai n -v t A --cal S r^n - — i 

Surgeon 

App ca noN w. - _-d ( p 

f*-ard to cxperc- c«h crew- 

tesu~* n-.f to -It D E I D v r 

Medical O* e f H-'lih P •> H.- O’' - 

B..rTy Gian «-> a t rc^-n b‘~ r t ' t a 

Jul Jbth fM 

Coarc-1 ex TO HOWELLS 

B-m C k to th C u vi 

Ju**- _“ih 19 


^ITA OF .MANCHESTER 
CRLAfpSALL HtiSPlTAL 0 4 B -v. i 

Th Pub Health C — i— i ^ _ 

fr -n rc- ered r-cdiva* p ci *• r f t*-- px-s 
/ RESIDENT SLRGICAL OFfUFR : 

ab e naned h'^-it-I 

The VI ary f r t'- ap- nr ’ r 

aenun r b i-5 a— t I v t a r-jt — -• i 
t4 0 per ar-u-*J with bwrd re^ -t' .rJ li r n 
tn a'*dmor u'* n t n M.i h -v cr C rn r u n 

V.“. l -S of -TV c- 

Arr -an rjvj bJahhrc ' -tn 
jrg-rv rd ru t b VC b J r c ex-v-i n- e 
rgwdfcji ul b'--.a! iv^t 

Full i-f _ a ard f rr cf -r n -n > 

be o'-au-d fro**’ th Afn. .. ()■»■ er He h 

T n Hal Afa-Jir>ter a J — at - f r tl e 
po-t t-u be rcxcJ ed by h n r t cr iv-in 
July Ifth 19 

To-vn Hal! F E AA aRBRECK HOAA ELL 
M-r hnter - T n C eiE 

Jur ih 19 


QOUNTA BOROUGH OF WaLLASEA 
HIGHFIELD AfATERNlTi HOSPITAL 
consulting OBSTFTPfClAN 


A— 'luati - -rc tnv to- fir h v pwi (r r-' 
gvntlen n of rewo-nj’ed C - ur ran Ib 
gentlenar ap-x n eu vmJI be req cu t r e-- i e 
bovpt al every other week The s-iary w N. t 
P a 

Full partinilan m 5 be o‘'j -d f c— ' tbc Al -v .*1 
OT cr i Htsalth Ttwn Half W.j^vey 

Appl catinns utin? q-a '^aal o ard etpci 
.nd er-. *<1 g c p e\ of te'-*' - a iru*T be f r 

wa ded l the u-Mervi'—ed n la cr lb n 
July 1 t*7 19 

T wr H fl EAfRAS EA ANS 

A\ alfa e Tow-i Clerk 


Hoxr 


GENERAL HOSPITAL 


HOA E 


Ap- .cation -re irv eu for tb a-^ - nen ' 
HONORARY gynaecological SI ROEOS 
Appl car nj't bi- th derreu cr of 

Surge- T- be Pef ow of t~- cf i‘“e R 
Cc Je-*^ cf Sarreo 

Ap- cau - i ether w i*- co- -v c three rev nt 
l-vtim nu«! n- t rc-cb th u-’-'e-v — -nJ r f Ltcr 
th-n m J-dav n Mc-d-v- Ju 1 h 19 Car 
\ c- I r t a^owe- 

K C BOOKER 

See' tary Si- r - rv-rf 


D oncaster royal infirm apy 

(IS ikj > 

(Rev'— *'Cd -v-T tb rc~u )>n> f :‘'c DO 
-no D L O J 

HOLSE 5LRGEON (n-^c) I £ c aru U N^ 
r- Thfut D*-3rtr" - rc- *d 
Sal_rv 31 r cflorera-'-w 

bs jru re'v-'n d Ltr-'y 

Ap-U-ai n — - H r - r- -e 1 

t tbc-c-toi 

V LANCASTfP 

•ie— u ) 9 -- 


C 


Afv-N VkA ONSHIPL 
JsriKA vy 

V Ct — 


AND 
P\Nf O 
H - t 


ANCLI'' Y 


SENlti-' HtYl *-£ SL Gf()N w 

Sa - rr f " -V r 

b -v-v D..- -v I c \ 









54 


THE BRITISH MEDICAL JOURNAL 


JuL^ 2 19J8 


r\E\VSBUR\ AND DISTRICT CENTRAL 
^ INFIRMARY 

Dewsbury (IDO Beds ) 


The Senior Post is rccoRnucd b> the Roj-il CoIIcrc 
of Surgeons (Enpland) 


Anplicntions arc in\iicd for the post of STNIOR 
House SURGEON (male’) vnenm September 1st 
next Salary £200 per '•annum with board 
residence md laundry 

AUo fo the post of SFCOND HOUSE 
SURGEON (male) tacani AuRUst Ki next Salar> 
£150 per ann im with similar emoluments The 
dunes arc principally tho^c of a House Ph>sician 
and Casualu Ofheer 

The Infirmary is a modern Voluntarv Hospital 
and has the usual Special Departments with 
Visitma ConsultuiK Specialists in attendance 

Applications staling for which post age and 
hospital experience logcthcr with copies of recent 
testimonials to be sent as immediately as possible 
to mv oflicc 

FRED SMITH 

Sccr».iar> Superintendent 

C HRISTIE HOSPITAI AND HOLT RADIUM 
NST ITUTE 

Withncton Manchester 20 


Apphe itions are iiuiicd for the post of RESI 
DENT SURGICAL omCCR at the abotc 
Hospital 10 commence duties on September 1st 
I93h 

The appointment is for a period of six months 
bill will be renewable Previous Resident Appoint 
ments cssentui 

Salary at the rate of £1‘'0 per annum plus 
residence board and laundrj 

Applications With full details of previous ex 
pcricncc tOLClbcr with comes of testimonials 
should be sent to the undersigned immediately 
PERCY N GLASS 
Superintendent and Secrctari 


ULL CORPORATION HE\LTH 
DEP \UTMENT 


BEVERLEY ROAD INSTITUTION (HOSPITAL) 
(400 Beds) 


ASSISTANT MEDICAL omCER (WOMAN) 


Applications arc invited from unmarried or 
widowed Women Medical Practitioners for the 
above appointment for a period of one vear 
Salarv £T50 per annum together with I ward 
residence and Iaundr> 

The Hospital IS equipped wUh \ ra> and Ultra 
Violet Light Departments 
Application forms etc may be obtained from 
and should be returned duly compkted to iht 
undersigned not later than 10 a m on blcndav 
Ju’j ISth 

NICOLAS GTBBIE M D 

Medical Ofliccr of Health 

Health Department 
Guildhall Hull 
June 27ih 


((^LASGOW n O A A L INflRMAin 

RESIDENT MEDICAL OmCER rcouircd at 
C inmcsburn Auxiliary Hospital Salary £20<1 
per annum with board lodging and washing 
Applicant with previous Hospital tcsidt.ni experience 
preferred 

Particulars as to duties etc may be obtained 
from the Superintendent Glisgow Royal Infirmary 
Castle Street Glasgow C 4 Candidates arc re 
quested to lodge applications and three tclitlve 
testimonials with the undersigned not later than 
July dth 193S No canvassing either directly or 
indirectly 

R MORRISON SMITH CA 

Secretary tind Cashier 

Royal Infirmao Office 

ns Buchanan Slrcct Glasgow C 1 


I^OYAL 


BUCKINGHAMSHIRE HOSPITAL 
Aylesbury (115 Beds) 


L iverpool- open-air hospit\l ior 

CHILDREN 
I casowc Cheshire 


Applications arc invited from qualified and rcgis 
icred candidates for the post of 
JUNIOR I rSIDENT MEDICAL omCER 
Salarv £la0 per annum with quarterN in newly 
built fiat board and laundry provided 
The post will be for a period of five months 
commencing September Kt after which it 

will be permissible to apply for the Senior post 
Applications staling age qualifications and ex 
penence with copies of three icsiimonnls should 
be sent to the undersigned by July 6th 1938 
I O DAWES 

Secretary 


iOSSHAM M E M O R I A L HOSPITAL 
Ktneswood Bristol 


A vacancy will appcir at the end of July for a 
JUNIOR RESIDENT MEDICAL OFnCER 
Salary £120 per annum with board and laundry 
10 remain for six months in the first Instance 
Applicants (male) should be British nationality 
fully qualified and rcgisurcd 

Applications with copies of recent testimonials 
to be sent to the Secretary 


lOSSHAM MEMORIAL HOSPITAL 
' Kingywood Bristol 


Wanted an additional HONORARY SURGEON 
for general surgical work 

Apply with full particulars to the Secretary 


B ARNWOOD HOUSE HOSPITAL FOR 
MLNTAL AND NERAOUS DISORDLRS 
Near Gloucester 


Required SECOND ASSISTANT MEDICAL 
ornCER (mile single) Commencing salary £50(t 
per annum with board residence and laundry 
Expcnenec m P vchothcrapy a recommendation 
Applwants must po^se^s the D P M The hcwpjial 
ba^ Its own non-eomnbutorv Pensions Scheme 
Applications wuh copte of three rceent tcxti 
moniaU to reaeh the Mcdieaf Supermiendcm not 
later than Jul' Hth lots 


H 


I RLTORDSHIRL 
Hereto d 


GENLU AL 
(is: Bed ) 


HOSPn AL 


Applications uc invited for the post of JUNIOR 
RESIDENT MEDICAL OmcCR at the above 
liospital for a period of six months commencing 
August 1st next Salary nt the rate of £200 pvf 
annum plus board re idcnce and laundry 
The hospital has 240 beds for treatment of 
Surgical Tuberculosis and orthopaedic conditions 
and has one ward for adult patients 
Applications stating age ex nalionaluy quali 
ficaiions nnd cvoetiencc together with copies of 
three recent testimonials to be addressed to the 
Slcrftarv pot later than July ICih next 


L oughborough and district 

GENERAL HOSPITAL 


Applieations arc invited from duly registered 
candidates (male and unmarried) for 
a HOUSE SURGtON salary £1^0 per annum 
from August Ut 

a House PHYSICIAN salary £125 per annum 
from July 1st 

The appointments arc for six months and include 
apartments board and laundry The House 
Surgeon must be an experienced anaesthetist 

All applicauons stating age etc with copies 
of testimonials to be sent to me at once 
TRANK H TOONE 

Q Leicester Road Stxrclary 

Loughborough 


P 


ETCRBOROLCH AND 
MEMORIAL HOSPITAL 
(IS4 B<.dN> 


DISTRICT 


appointment or honorara assist an i 
Pinsici AN 


Applications arc invited from registered Medical 
Praciiuoncrs for the abo'c post The succe sful 
-‘pplicanl must fc ide within a radius of seven 
miles of Pcierboroukh and be prcpircd la com 
mcncc dutv on Augu t iM PIS 

Applications staling age qualifications els ind 
accompanied by copies of three rcscni icsiimoniaK 
mu t rcash the undersigned on or Ufore JuK Pth 
next 

I RANK A C TAALOR 

Scerei ir> Superintendem 


K 


EM \ND SDSSrx llOsmAL 
liinlriJsc Wells CIO Utils 1 


the _ followmq Depart 
Tar Nose rnJ Tluoai 
GynvccoloRieal \ ny 
Massage Puhological 


in'ilcd (or iht post ol HOUSE 
SURGEON AND C\SU\LT\ OH ICLR Snbr) 
4.PU per annum with board rcsuleUee ami laiindrv 
in the Hospital 
The Hospml includes 
ments —Medical SurgKal 
Ophthalmic Orthopacdie 
tind Clcctro-ihcrapcutie 
A cncreal Diseases cte 

Applications vi'iimg qualifications together with 
(Certificate of Registration uul copies of not more 
than three rcCem testimonials should be sent to 
the undersigned as soon as possible 
, TOM B HARRISON 

June 27th 19Ts Supcnnlcndcnt-Scvrctary 

OOAAL DEVON AND EXETER HOSPITAL 
hxcicr 


HOUSE SURGEON (MALE) TO THE 1 \R 
NOSE AND THROAT DLIARTMENT 


Applications arc invited for this post which K 
shortly becoming v acini The appointment i\ for 
MX months but candidates arc eligible for re 
election Salary at the rate of £150 per annum 
with board lodging and w-ishing 

Applicauons giving parlicuhrs as to age and 
qualifications together wuh copies of three recent 
lesiimonials should be sent to the undersigned on 
or before Mondiy July 4th 

S S COI E 

_ Secretary nnd Manager 


^OAAL INTI KMART BRADFORD 

RESIDENT SURGICAL OFFICI R (mate) re 
quired to supervise the work of six House Surgeon 
and be gcncraltv responsible for the surgical work 
of the hospital CanJidites must be single hive 
had previous hospital experience and a speen! 
surgical qinlificaiion Salary £250 per annum with 
board residence and washing There arc 345 
I cds nnd ten resident olliccrs 

Applications sitting ape Qualifications and pre 
vious experience with copies of not more than 
three recent icsiimonhls to be received by the 
undersigned at esnee 

H TRUSSON 

func I4th 1938 House Governor and Secretary 


J^OAAL EAST SUSSEX HOSI ITAl 

Apphcmions arc invited (or the post of 
HONORAin JUNIOR SURGEON to the above 
Institution 

Candidates must be rcUow of the Roval College 
ol Surgeons of England Edinburgh or Ireland or 
a Craduaic In Surpery of one of the Universities 
of the United Kingdom or Ireland and also be 
duly registered under the Medical Acts 

Applications accompanied by copies of three 
recent testimonials should reach the SeNretarv not 
later than Friday July I5ih 1938 

WILFRID G KEMSLEA Secretary 


IVyTONTAGU HOSPITAL MEXBOROUOII 
(113 Beds) (3 Residents) 


Applications arc invited for the post of RFSI 
DENT HOUSE I HYSICIAN (Lady) Commcncini 
salary £125 per annum with the usual residential 
emoluments Ttic nppolmmcnl is for six months 
and vs subjcti to renewal 

Applications stating age nationality qualifica 
lions and experience accompanied with copy 
icsUmomals to be sent to the undersigned 
JOHN N DRAKE 

Secretary Superintendent 


M idland hospital 

Easy Row Birmingham (50 Beds ) 


Applications arc invficd for the post of HOUSE 
SLRGIOS Duties to commence August hi 
Salary £200 per tnnum with bnrd residence and 
laundry 

Applications stating when at liberty age qtiah 
ficitions together wuli copies of recent lestinionhb 
to b addressed to the undersigned 

OLIVE rURMAUX Sccrciary 


M MOENHCAD HOSPITAL BTRLSIIIRI 
(«6 Beds) 


Apph aiions »rt invited for the r''''* of 
(a) REAIDLNT SURGICAL OFFICER (malL) 
(h) HOl/SI PinsiClXN (male) Sahrv at the 
r\K of t|5o and £U-P rcspCLiivulv p^r annum 
wuh Ih ard rcsidtnct ind laundrv 

Apphs. kii ms vi iting avc and qualifications 
8tihk.r wuh copu of three recent tcsiirromal 
hou d b'' (.nt !(,'> the undtrsigntd on or before 
Jcd> 

T W L PTON Seurvlarv 


RH \M 


CtHMA AND NDERL AND 
LA L INTIKMARA 


HOVsl SLRCtON rtqui tJ I’nm (JiUvlv 
Mvf i have Or^tha’mi cxr>-ri n <. SaUrv I '0 
ps.f annu'n ns nt b\ t\\v> arawal la^r rrent t*0 
Non rcsid nt Mi dew c wh'' tim ti th-* 
duties t tb Ir Uu » n Xpn ai a \ ib c pies 
of re* xn tes "n »' » > I v.rt t> Joiiv Iti.nt» 

luio Lye Inf tr'ary b ^ vti n Rv id v; j rUnJ 


LW SLSSEX IIOSIITAL FOR WOMEN 
W indie han Road Brighron 
(60 Beds ) 


Applications arc invited from q» ihfied MeJi d 
Wimcn for the pot of HOUSE PHASICIAN lor 
a period of mx months Stlarv at the rile of 
£I(Hl per annum Dunes to tommcncc immediaicK 
App I anon lo-cthtr with copies of recent tcMi 
monnls to be ent to the Stcxrrvxv New Sn sex 
Mopuil W tndlcshara Road Brighton 

Jun. 2*.th I9's 


jyjAPPERLEA HOSPITAL NOTTINCH AM 

LOCLM TENTNS MEDIC Af omCrK (mak 
single) rcavufsd at oa^.c Sal ts seven ginneav per 
week att f nmJ 

Npp’t att n immediat ly ta the Sfcdi af Super 
inttnJwru Mvpfa.rt \ K pital N< tinkham 


Appluaiion arc Invutd for - the post of 
RLSIDENI MEDICAL OI riCER (female) vacant 
August 1st for a period of six months Safarr 
il^O per annum with board residence and htmJr) 
Applications wuh copies of testimonials >hotifd 
be rcvvivcd bv the undersigned by Jul' ITtft P*!** 

R J FANNING 

June ’Oih PDg Superintendent Secrciary 




AND CANTERBURA HOSI M Al 
<fgl Beds 4 R M Os ) 


HOUSE PHASICIAN required male unmarncJ 
IX months appaintmcnt commen mg July 

S ilary £1-5 per annum wuh board rcsid r* 
nd laundry , 

ArpIi«.ationv together wuh cdPics of icstmunu » 
jotilJ be seni to the iind rsiencd 

J I KI NT 

i>upcrin!cndi.nt and Vcictifr 




JvL\ 1 1938 


THE BRITISH MEDICAL JOUPVAL 


^0\AL UNITED HOSPITAL, BATH 
HONORARY STAFF APPOINTMENTS 

The Board of Manaperncnt inMtc applications 
ftr the undermentioned honorari posts 

ASSISTANT DERMATOLOGIST 

PHYSICIAN FOR MENTAL DISEASES 

MEDICAL registrar 

Applicants mij>t be graduates m medicine of a 
Lnncrsit} of the Bnttih Empire or a Fellow or 
Member of the Rova! CoIIc'*c of Phsscuns or a 
Licentiate of the Ro>ai Collase of Ph> tcian 
London 

Applications statins age qualifications and cx 
reritnce- together with three testimonials to be 
addresesd to the undtrsicned b> first po i Jul> 1-th 
I9^« 

Canras mil t^fll be deemed a d squaf ficaiicn 

The names and addresses of members of the 
Board of Management uill be sent to applicant 
m order that tbcj raaj send a cop> of their 
application and tcstimomaU to each memb<.r 
J LAWRENCE MEARS 

Secretar> Supcnniendcnt 

June iStb 19JS 


I^OA AL 


MCTORIA AND WEST 
HOSPITAL Bournemouth 


HANTS 


CASUALTY OFFICER (uith ome Hou e 
Surgeon dun') male Bnti h naiionaliij required 
to commen-c dutj immediatelj Salarj £1-0 p^r 
annum and addiuonal fc« with board lodgin'* 
and washing The appointment i tenable for it 
months and candidates must N. r gi ler'd accord 
me to the prosi tons of the Medical Act 

Appli-aiions stating place of binh and aee 
s ith copies ol three testimonial to be sent ira 
mediatclj to the undersigned W omen and 
mamed men arc tnefigihle The appointment i 
rci-ognued b> the Council of the Rojal Collet 
*f Surgeons of England in cormexion with the 
final Fellowship Etamination 

GORDON M SAUL 

June -4ih 1939 Secretarv 


T ROYAL 

A INFIRMARY AND EY^ INSTITUTION 
GLOLCESTER 
<-3- Bed St Rcs.dcrta ) 

Applications are unted fo the pest of 
CASLALTY OFFICER ferale) Salary at i*'“ r* e 
of £1^0 per -nnjm with tc-rd re>dcr-c 
laundry 

The appointment i f r sit month wh h may 
be tTtcnd*d for sim Ur i*entx- by re-e e con from 
lu-t to time 

Applicants must ba\e h d a r'Nident -ppi. 
rnent and ha\c had etpener c in ff-c*ure w "A 
The elected card d-ic w I aj o bt r*qi.t ed t 
d*ruii c for the Res d ct Sarg-cal O'^i.cr d 
h*i ab c*nc 

Application stating age Qcafificat r erren 
crxe and nat onality with cop « of ret le* ih_n 
three recent tesinnomal sb ufd be cot to the 
tinder ign-d not la er than Tuc«»-iv July <lh 

The lectcd candidate will be requ fd to en er 
upon hi dutt'ik at or c 

F I SYMONS 

June ->rd I9^J> Secret-ry 


’J'HE RETREAT YORK 

A REGISTERED MENTAL HOSPITAL 
under the Man- ement of a Committee of 
the Societ of Friends 

A MEDICAL SUPERINTENDENT wHI ho'il 
be required at the abosc Hov*'ital and apnlicax m 
arc in'itcd for the positicn 

The imual alary will not be less than 000 
per annum with a house -rd o h'r erroljments 
satued at £.00 p- for Pen lOn pufpo'Cs* 

Facilmciy wfll be gi\en if desired for obtaining 
some special ctperiert e rfof fO tatan-* up the 
appointment- The doctor appo nted will be cr 
P'ctcd to work in synpathv with the idml of the 
Soaeiy of Fnends 

Appli'muon- with not mote than three testi 
moniats should be ent before Augu t -"th to the 
Chairman of the Committee The Retreat Y o k 


T^e 


KO-i \L LUXRPOOL CHILDPON^ 
HOSPITj^L M t c e— 

There wi I be cr O- ‘-r I rcr i 

Tw RESIDENT HOLSE PFYSrCf \S5 - Fu 
resident H 0L9£ SLPGEONS C 

fi~' '-h rl T-* — “'c*' y u 

ft a p*-' f IT r- - S l_-\ !-«-*•<:- 
the r- c o *\rr A**- ca - 

CP'* -s pr rev-m lot — ^ j j 

Secrc*ar> Pc\a’ Ln -rp'' O ^ H''~ 

Mvtt e S — Li •* p V - 

Jul Ilih lo 


Tb'-- » be ccr"'^ c-" Of '"t I t r \ 

O RESIDrNT MEDIC \L OFFICEP - rj 
RESIDENT SURGICAL OFFICEP c t‘' 

Br cf Ir I t t -.i beu ) T** a-'-N 

m rt wil b- f r a per x. cf x v - *■ S 
e'*ch ciLc a th rat 0 f! 1 pv j 
Ap** call - w t** - -N r-' cr 1“% — - 

be <e- to t*’ Sv T tary R 1 Li e’^> O 

H'*'ptal Myrt S rec D erp o - t 
Mo-d Jj Jlih 19 


T he ROYAL LIYEPPOOL CHILDRENS 
HOSPITAL M - 1. cm 

Th Cc—m tree m\i e a--' -t “y f a o 

wuh p cv js Hewp uJ CT'^ •* c f r i p- i 
me"t cf RESIDENT CkSLYLTY OFFlCEk 
tm e^ The -•'“O »— g*- m ] t a 

IT mo tb from Ot ‘^rr ! t Ar i e**- 

ih t nm-* the ho m o t*' pc.'Nt w be c e c 
app y for rc-e'ccti a f r a f-nber t rm "" c 
Salary at ihc rate of per r~ m F n 

cart T. rs ma be o** - — d from u c S a 
Ro al Li crp-vl Chi um y H '*'*• _ Ylyr*! Sir -i 
Lucrpco to wh m app -a w** v j >*« — 

a/th o" o« of men r-<ii.'*'C"-. b-r r 

Mcnd-y Jjl llth lo 


T 


HE SLSSEN Maternity and women 
HOSPITAL 

Bnghton fFo sded I 0) 


S 


R ochdale infirmary and 

DISPENSARY 

(110 Beds Three Residents) 

The Beard of Management in\ife npplicaticn 
from gentlemen for the appointment of SECOND 
HOUSE SURGEON 

The salary attached to the appointment u at 
the rale of £1S0 per annum including board 
rcsid n*e and laundry 

Application!) statins age natiooaiiiy etc 
ro>.efhef vnth copies of three recent restrnoniafs 
I y be ent to the Secretary endorsed Hou e 
Surgeon 

Conditions of the apcointment may be had on 
application to the Secretary 
InfirmaiT Office W WTNNE 

Rochdale Lancs Socreuo 


R oyal surrey county hospital 

GUILDFORD 


gOUTHEND-ON SEA GENER.\L HOSPITAL 

(-35 Bed ) Eight Residenu 
Hon Speciali t Suff of 0 Members 

Appheattons are imited for the pc>j of 
<l) RESIDENT ANAESTHETIST (naJ ) Salary 
£1— pa With bvard residence and laundry 

Previous etpenence in admini-tntion cf n-e>- 
theucs cy«enital 

t_) FIRST HOUSE SURGEON (male) Salary 
£100 pa with board re<id*p e and L»u dry 

The Ho>FitaI t> recognued b the Poyal CoTe-e 
of Surgeons in respect of thi post 
The appointments -re for «*t month frtra 
August 1st, 19^9 

Applications with copies of two recent lesu 
menial hould K. ^nt to the undersigned net 
later than July I^ih 

P H CONSTABLE SccTct-ry 


Tb Ccirmitte- cf Mana •t-er cf i^^e -S 
g e r c that al a m'—t *— to be b 
at the H>'ptal *0 Bj kifl** am Po-d Brighter 
cyJuly ih 19 til Dam towiJe-c: 
HONORARY OBSTETRIC AND GYN\ECfV 
LOGICAL SURGEON Ca-^ — r* t- dv, 
rem ered u- er L e AI-J cal \-i 

Apol caitc'* wi b cop m cf imt a' cukI 
be cr to ihc Secretary f B ki e — m R o 
Bn him no b f re JuU *' a i 

r t per-itted 

B ard R cm PERCY F ^rnoNER 

0 B km-b m RMd tj y 

Bn ‘'to- Jur- If h 19 


V ICTORIA HOSPITAL BLACkPoOI 

tl - Bev ) 

HOUSE blRGEON tMAlEl TO IHL MLClAL 

departments 

(E e E- Ne'e and Throat ar^ Omirr -x > 


-- Wanted Augim I t 

HOUSE SURGEON (MALE) 

General Surgery Onhopacd -* and Ca^alty 
Six monihs appoinincnt recognized for th 
F R C-S Salary £150 per annum with board 
residence and iaundo Applications taiing age 
and essennal parti 'ulars with copies of not more 
than three testimonial to reach the S’cretary 
Supcrintendcm not later than July ^ih 


p^OYAU BERKSHIRE HOSPITAL READING 

Applications are inyitcd for the post of 
CASUALTY OFFICER (male) which fall s cunt 
on Augu t 1st 19’S 

The. appo/otmenr n for sit month and mndi 
datci must be fully qualified and rcgi tered 

Remuncntion at the rate of *'!*0 per annum 
with board residence and laundry 
Applications stating age and ctpenencc with 
copiex of testimonial to be ent to the under 
signed immediately 

H E RYAV 

Seerttary and House Go\ernof 


T 


HE CHILDREN S HOSPITAL SUNDERLAND 
ro Bed ) 


Appli'ations arc insitcd for the following ro«t 
and hould be addren cd to the undersigned 
ogether with copies of tcstimonial- 
I HOUSE PHYSICIAN (female) for six monih 
from July 31si 

- HOUSE SURGEON (female) for stt months 
from August ^th 

Salary in each case £1-0 per annum with board 
residence lauridry etc 

M J HUNTLEY 
House Go emor and Secretary 


^ O T H E RTl A M 


HOSPITAL, 

Warned CASUALn HOLSE SEIRGEO'' 
male) aualitied Salarr £I 0 per annu^ »il!l 
•oard residence and laundry To ha\c charge of 
)ut-p3tieflts (DO bedi.) 

ApphatHns with copies of recent. tcstimcniaU 
o be sent to the Swoary G W Ko f«tS 
f Moorgate Streei. Rotherham 


T he ROYAL iNFIRAfAKY SHEFFICLD 
( f»0 Bed ) 

Application are muted for th ro't f 
CLINICAL assistant to the OpMh Ir-j 

Oepanment (male or female) The O^h h Imi 

Department containx (> Bed ar*d an Out 
Pauent Department whi h i open daiU 
Salarv £300 per annum 

The appointment will be for one year ub eci 
to two month rctice ard the offi cr cected wyll 
bt eligible for-'reapponfncnt Letters tatj"g 
age and gi'iiR full qualification prctioti 
ho pital ctpcnencc etc to be forwarded to th 
General Su»'erintendcnt arnS Secretary iramed tcly 
June Uih 


T he babies hospital 

Sewcas le^n Tyne. 

NOS RESIDENT MEDICAL OFFICER required 
August 1st The duties are those of a Hou^ 
Physician with time and cprc*ti.n ties 10- research 
w rk The -pnoinimeni K for vx r~‘ori-h subject 
to reappointment Salary £I 0 per anci^a 

Apphcaiions with two tcst.*noa.aI and par 
ticulars of pretnoue appo nti-ents he’d to be 
lodged b July Sth with the S'crcury The Babes 
Hosp tal 3 West Par-dc Ncwca.tle-oo Tyre 4 


T he s ta FFO r ds h I r e general 

infirmary STAFFORD 
( 1« Bedx m Judm- Ptt ate W- u Thrx. 
Rcs.d r s ) 

HOUSE SURGEON requi ed SaLrj I" rcr 
annum with board re'idcnce 

A— tieaiice taii-g are a-d expenc*x.e 

paned b> copes cf three recent tex -n "jI 
houIJ be cm to me f nj-ith 
Stzfford ' COLLI S 

Jure t' ^ 'C'LC'JC 

T he HON MEDICAL SULF 1N\ I TE APPLI 
entitn f r lA i-n -t cf HON CON 
SL LEANT PHASICIAN -ed HON CONSULT 
^VT SURGEON 1 the M r*^ld Afcr'orui C tuce 
H>*ri3l Ar-*c3ti'*rs to be (*rwa ded t P-c 
H n SccrcAary F J Bro n»rNT Cro i 
Miff eld Yerks 


Applicati n -r in i eJ f r i*‘e abo\ ap’N 
men: There are lour re^iJ "t o"" cr 
Apr ntmimi i f it mrrih Salary i iS 
ra c ^ tl ^ per an -am u :h bt rJ rc' u ^ 
ard laundry 

Applicatjon w ih co"ic« cf l*- re revc-t i *x 
m nnl h J d be e^t is’-'d tcly co t’-c 

Gcrcml S “vri-tc-- nt 




SUFFOLK 
Bi-D St- Ed" 


GENERAL HOSPITXL 
--d (11 P-ds) 


Apn caul arc iom cu fer t’^e f * r pox 
HOUSE PHYSICIAN D-ticx i dc c^-art-c f 
the 'fed cal 'Iat“r-'t y Wad zdCai-y 

at!d \dm n trat of \r_jcx h-* t S 1 nr ri 

per annum w N'xi d lx? " -d Lt-rdry 

\ acanev Ji- c f' b 19 

AppT art- f r th n-^t be rm ef d 

Praaii r-T Vp- at n at n "c c rcTieT'- c 
ard rationalit with cop o' of th e^ recen text^ 
nonul to be 'em to tbe Secretary The apr-^r 
ment i e mo- '•s 

Ma O'h 19 » 




MOUTH AND DISTRICT HOSPITAL 
W eyme^th 

(92 Beds and ( 2 ctt ) 


Wared J l> 2 h HOLSF St PCFON im 
iTurcpeani Sa-rv it o per r- m i» h b 
rx dcr- c arx, la "x-r^ 

Ar- o- Jt ate qja -r --x * 

At—es c texi m—T-i to be e— (o tly* **-> e 
r-d n- laicT Ji-U f 

MORRIS LOD'^F 

H - ry > 


T he POYAL INflRMAF-Y S ''r)‘')L' D 
( Be ' » 

^ ^ c it P 

casu'LTY orriCEP and i n 'i s^Rcrt 
I'-- lar N •A T’' - * * 

' " rtr t — 


pcri <• m 

« th b-xaiJ rrtr 
.td C- CT- I > 


-•y o' ^ I 
5a — _rv c* i 

M^J^in NTin 
<■ err ■" a- ' 









56 


THE BRITISH MEDICAL JOURNAL 


JUL\ 2 19LS 


gRiSrOL ROVAL INFIRMARY 

ApphcatJon^ irc iPMied for the foUowmg Resj 
ocni Medii. il Appointments for the six months 
commcnct '' 

' (one of s\hom 

3J''0 to the Cnnccr 

Department) 

\ our HOUSE SURGEONS -tnU One \SSIS 
FANT HOUSE SURGEON 

One HOUSE SURGEON to the CastnUi Depart 
meat 

One HOUSE SURGEON to the Ear No‘>c tnJ 
Throat Dcpartr'cni 

One HOUSE SURGEON to the rnctnrc Depart 
mem 

One SENIOR OBSTETRIC HOUSE SURGEON 

One 3UNIOK OESTErUlC HOUSE SURGEON 

SiUncs nt the rate of £S0 per nnnum cxcvni m 
the case of the Senior Obstetric TloubC SurRton 
%sho will rtccuc. a sjl ir^ at the rue of £100 per 
annum and the Senior CasuaUs Howsl Surv.i.on 
\ ho \mII rccciSL a salar> at the rate of £t'^U per 
rnniim 

Candidates who must be duU quahfied to send 
m their apohcuions on forms to be obtained from 
he undi.r'uencd which must be returned on or 
b-fore JiiJ> l^'ih I9;>S topcihtr with copic'* of not 
more than thuc tcstmonnls 

The elected candidates must become mcmbcr^ 
af the Medical Defence Union before takine un 
iheir appomimcnts 

ELUS C SMITH F C 1 S 
Sccrciar> and House Guvt.rpor 


D tSIRlCT INTIRMARN ASHTON UNDER 
L>nc fCetiLtal Ho'^pua! 200 Bed ) 


CASUALTV HOUSE SURGEON (mile) ftcjiurtd 
immcdtatcR _ 

\nphttnfs must h?i«. had prettous ctpeficnce 
Sal ta at the rate of £1'^0 wuh the umuI 
residential cmolurTn.nK 
HOUSE SURGEON rcciuifCd immcdiitcU 
Six. months appointment which max be renewed 
The Staff compn^(r» a Rcsidcm StiCRical OfTitcr 
a Casuali) OfTiccr and two House SuTgeon-' 
Sahrx it the rate of £1*'0 pec annum with 
bo ird residence ^ ind 1 umUcS 
Apphtatiohs with testimonnU to he sent at 
once to the undersigned 

FRANK OLI\ ER 

General Superintendent and Si.».rtfirv 


JJlSTKICr 


INURMAR’i ASHTON UNDFR 
L>nt (200 Beds) 


RESIDENT SURCICAE OFFICER rsquued 
tmmediatcb . , , 

Sue months ippoimment with po mIiua ot 
'renewal ^ ^ 

Silir> at me rate of i200 per tnnuni with the 
tisu i1 rcMdcnti il cmoUimcm^ 

\ppliciitons with K timontal ti bs sent at 
onsc to— 

FRANK OLIMR 

Central Supcnnitndcnt md Stcri.nr> 


W (>RCESirR R D A E JNFIUM \RA 

tU^ Beds) 


Applications art in'iied for tht posts ot — 
SICOND HOUSE SURGFON Salirs at tht 
rite of £120 p-r innum 
HOUSE PHYSICIAN S liars at ths rate of 
£lso per annum 

CASUAUtV HOUSE SURGEON Silin »t 
the rite of £140 ptr annum 
Ml the ahoK «anr/e> JUtludc board rv^idta^'c 
and laundr> 

Applications stating full particulars as lo apt 
% htihtr married or sinsK qualdicititms ett and 
atcomp m cd bs copies of three recent testimonial 
should be sent to the undersiRntd bx Juli 7lh I9ts 
H S Cl OUT 

Scccctarj 


^REUDECN RO \ A L INFIRM aRT 

The Boifd of Dircctor> mute applications for ihc 
past Of SURCICAL KCGIS'rRAR The po i is » 
fuR pmw onv and the stt cs ful applicant will be 
rcQuirtU to pvrlorm the duties of a Junior Asm tani 
burkeon tuached to a gtn-'ral Sursical N' ard ^ 
Sahr> i 00 p r annum with quarters or an 
allowan c m lieu Six copies of appUtailons (md 
if three testimcm ilsl siadwi. ace quarfitatioo^ 
md cxrs.ncncv should be kdeed with the under 
I ned bv IP a m m Mondax Jul> lllh 19 S 
I \IOn PJatt JOHN \ McCONACHH 
Mv.rd'arn Clerk md Trta urtr 


^IU>)Df>N CINFRSL hospit\l 

xp''} C3U ns art msiicd frira Qualified ard rtg» 
lercd Ms.dn.at Men for ibe post of HOL St 
stUClON Salats tU* psr annum with Ward 
tcs»d».n(.c ind laurJrx 

Apr “au n tail-- aCt quafifj anon ac ora 
pin td b% to^cs It hf h will r< : bt I'wtuf^cdv of 
t^rcr tell'*' n i* t tea h the unJtf umM r i 
I f r fptn Ibarvja JtUt “ib W s 

Ihc fs tt, 4- /cd t r th f ft C S txam a i 

' ^ CUiRCi H OXMS 

H i vC C ictP f and N.vt ir> 

Ji ' rJ l‘i s 


R 


OV\L SOUTH H\NTS 
SOUTH tMPTON HOSPITAL 
096 Btds 1 


\N O 


Applicaiicm ire inriicd for ihe lollowme 
''ppomimcnts 

Ont RESIDENT ANAESTHETIST 
One CASUAL I T 01 FICFR who shall hisc 
had some cxpcntnsc in tht rtduction and 
treatment of Iratmrcs 

for tht siv months commenems JuK Ut 195S 
cich at a salar> of £150 per innum with board 
Icidtmp ard I imdrx Candidate^ must be malt 
md unmarried 

Applications accompamed h> not rnott than 
th tc It iR should tc sent to the under 
*^ieiud iramedi ncly 

S W n MINES 
House Goxernor and Stcrctai> 


R 


0 \ \L BERKSHIRE HOSPITAL RFADJNG 
O "I Dtds) 


VppUtations arc inxittd for the next of RESl 
DEN F ANAESTHETIST (malt) xxhich falls \ icani 
on AuRiKi 6th 193*1 

The appointment is for sis months in the First 
in'^tancc Candidates miiM be (uUs qualified and 
rcgistcftd and ba'c had consider iWc experience 
in tht adnimtstration of anaesthetics 

A salary of £2^0 pa With boird rcMdtncc 
md 1 lundrv wdl be paid to a candid >it possess 
in/i sinraWt Qtl'lhfic^tlons for ibt post 

Appheahonx muting agt and experience with 
copies of not tro c than thrtc rtccm tcstimonnls 
to bt xent to tht undersigned ns soon as possible 
H E RYAN 

Secretary and House Goxernor 


O 


L O H \ M 


R O T A L INC IRMAR\ 


SENIOR '■HOUSE SURGEON required for a 

period of MX months to takt charge of the 
Caxualtx Department and to work under the 

Honor irx Surftton in charge of the Eraciure Clime 
Ca\'5agc attendance of 1507170 eases per week) 
PrcMoux hospitftl cxptfltncc c scniial 
Silarx at the rite of C250/C300 per annum 
accordme to qualificaiions ind expentnte with 

boifd residence and laundry 
Appfications stating igc experience and qu difi 
cations lotcthcr with copies of thrct rcccm tvsw 
n*omal to bt forxsardtd to the undcrslftned 
H EWART MITCHELL 

General Supcnntcndeni 


TTHE 1 1\ ERPOOL SAN \T ORH M 

■*- Dclamcrc Forest I rod ham 

3 ja Warnnsion 


(1*5 HtU tor the Treatment of raiicnts SufTtrmj. 
from Pulmonary Tubertulok) 

ASSIST \NT to the MEDICAL SUPCRlN 
TENDCNT 

Applications art mxiicd from male practitioners 
With simablc qualificationx (or the iboxemmtJ 
appointment Candidates must be unmarried inJ 
preference w 11 bt gixcn to applicants who have 
held rt idem medical appomimcnts since qinlihti 
OOP and have had practical instuutionaf capctitnet 
tn the treatment of pulmonary tubtrtulosis 
Salary will be at the rate of £225 per ^.niuim 
vxith board quarters and laundry 
The appoimmtm is normdK tenable for tuchc 
montha but may be extended 

Particulars of dutits and full information to* 
cclh“r With forms of application can be aui\.d 
front the Sccrciarx Hospital for Consumption 
Nfauut Pleasant Liicrpool a 
Forms computed with copies of thrtc recent 
ttstimoniafs should be tclurncd by July 7th 
to the Secretary Hospital foe Consumption Nfoiint 
PUasant Lticrpool a 


'Y O K K DISPENSAKA 

Applications nrt mvjtcd far the vo^X ot 
RESIDENT MEDICAL Ql FICER (Icmalc) to 
commence duties as soon as possible As there art 
TWO VACANCIES nppheattons from doctors 
Lnovxing each other would be xxcfcomcd 

Tht resident medical staff consists of two medical 
officers whose duties arc to visit and affend (he 
sick poor in ihcir own honfes and lo assist the 
honorary sialT 

Candidates must be duly QualiFicd rCRistcred 
nnd unmarried Txpcncncu m tht adnxlni tntton 
of anaesthetics is essential 

Salvy £200 per annum with board lodeme md 
attendance xvitli an nHowanct towards tar expenws 
and for laundry 

Applications with tcstlmonliN fP le sent on 
or before j«l> 9th to 

JOHN C PETERS 

4 New Strtct T ork Secretary 


YORK 


COUNTS HOSPITAL 
(204 BtdO 


M anchester northern hospital 

Chetiham Hill Road Manche:>ttr 8 
(Gtncrxl Hospital— llj Bed^ ) -s 


“ ■'* (or the posts of RESl 

IAN md RLSIDENT 
dary £100 per annum 

The appointments arc lor six months from mid 
Aufiust I9^S (successful candidatc^> arc eligible 
for re fppoinmicni (or a (imhcr six months) 
Applications stating age qinlificitions and 
naiionahiv wub copies of not Jess than ihruc Jcccni 
UMinionials should bt sent to Mr Jsvtcs C 
DxMfLS Sccrtlars as; Barton Arcade Manchester 
by July I3lh 


Appointment of 

H(TN0 RART surgeon TOTHrr\R NOSl 
AND THROAT DEPARTMLNT 


Aopheations arc invited for the poM of Honor iry 
SutKcon to tile Far Nose and Throat Dcratu*ent 
Candidates should send t copy ot their apphea 
tion (stating age) nnd icstimomvls towether with 
diplomas to the undersigned not later than July 
Mst 1938 

Candidates may send such printed or written 
testimonials to the members of the Elective Com 
mutec as they may think dcsirvblc Inn canvassma 
personally or otbcrvvj c will be considered a dis 
qinlificaiion 

J U MACKRILL 

Secret ir> 


M SNCHESTER northern HOSPITAL 
Chettham Hill lUud Manchester 8 
(General Ho pital — ^1(3 Beds) 


T 


HC ROYAL HOSPITAL WOLVLRHAMn 
(Incorporated under Charier ) 


OS 


Applications arc invited for ibc post of RESl 
DtNT SURGICAL OF(ICER' tommcncuig salary 
tMR per jnnum with board md rcMdcncc The 
appouitrrv.nt l^ for twsl>c momhs from mid August 
19 S 

Ypphcationv stating auc qualifications and 
nitionihty with copies of not less than tlirtc 
rui-cni itstiraonials to be sent to tht Secretary 
Mr ixMCs C Ds'iirus ^8 BarKo Arcade Man 
ebe ter 3 not IiRr th m Jul 13ih 


H 


LPDCRSrfELD 


ROY AL 
021 Beds ) 


INFIRMARY 


Yl \LF HOU5r PHYSICIVN required to com 
msn c duty on \ugwst 8th 19ts 

Svl r> £00 per annum with board re idtncc 
md laundry \ppcumm<.m (or six months suMtci 
to tLntwal It the o* truion of the Board of 
Management 

Npphcaiions with copic> o( thtce icccnt tcsti 
monuJ to be iddrcsscd to the undersftned imme 
di ltd} 

H J JOHNSON 

Cen Supi and Ssc 


L eeds public dispensary and 

HOSPITAL 

HOUSE PHYSfCfVN (Male) 


HOUSE SUROrON requited (Ccncnl SiirtCfyl 
duties to commence August 1st Fbe Hospud 
eontains 300 beds Includes the UMial spccivl depart 
ments and'.^s rccognircd by the v irious Examining 
Bodies lot a part of the requisite attendance on 
Medical and Surg^c^l Practice 
Candidates rnust be rcg/stcrcd under Ihc Medjcjl 
Acts and anmarnal 

Tht. appointment i> for six months Sibry at 
the rate of £100 per annum Board futn/ bed 
rooms and laundry provided 

AppUcaiions with copies of icstimonnfs to be 
forwarded to the undersigned 

Wolverhampton %V H HARPER 

June 27lh 1938 House Govern ir 


YHE royal infirmary RRADfOKO 

ASSISTANT RADIUM OFFlCFR (Rcsidcmf 
male wanted for August 1st Twelve months 
appointment Candidates must be smgtc snJ 
legally qualified 

Salary £175 per annum with board fcvJtJcnLC 
jnd washing Appticationv stating age quah* a 
lions and previous experience (not neccssariU i*' 
Radio-Therapy) with topics of recent tcstimon ah 
should be sent to the undersigned at once 
H TRUSSOS 

June ind 1038 House Gu'crnor and ^cactjtr 


H ir (cd at on c 

\poo aimeni for six momhy Hilary »i the rate 
r»( tl il per annun with b art! residence and 
/ iffnJrv 

\pp( jtiin With copes tyf Ihrcv recent tcsli 
ni »n s to bu xmt l> Ih'* undersigned Pubh 
D per ry nd UoN'snat Nqrih Street Leeds 2 
CflARtrsf ! M\URY 

St re jry and 5ttptnn(cncf nt 


'ME SUEIMFID Utl'i SL ItflSPIf'l 

AppliLJtions ire inMtrf for the poii ot " L 
ME CLINICXL assistant in the ' 
rirc or Ihi Ho hiiM fJOO ref 

n rcMiltnt Appummcpi in ihc lif'r k" 

H H BOOTH 

and I>CttC(irt 





JUL\ 2 1938 


THE BRITISH MEDICAL JOURNAL 


APPOINTMENTS— Important Notice 

Medical practitioners are requested not to applr tor am appointment reterred to in tlie .nlb\ u 
mie without hiving- first communicated uith the Secretarv to the British Mvdicii A- otntmn B M \' 
House, Tavistock Square. \\ C 1 (m the case ot Scottish ippouitments with ihe Scottish Sccrctarv 
/, -Uruinsheugh Girden^^ Edinburgh) 


(a) Bnnsh Islands 

Town or Di tnct. 

Town or Dpin t. 

Town Of Drstnet 

CONTRACT practice 

CONTRACT PR ACTICE— ) 

PUBLIC HEALTH 

ABERTVSSWG MEDICAL AID SOClETi 
(Med/co? Office ) 

MID RHONDDA MEDICAL AID SOCIEVV 
(Asttuant \fedcal Officer) 


BLAENaAON MEDICAL SOCIETY 
(Chief ^fedical Officer ) 

NEATH AND OlSTRKTT 


(XfedicaJ Aid AsSoaauon ) 

counts of roablpgh j 

GILF\CH GOCH GLAMORGAN 
(11 o kmen s Met# cal Scheme ) 

llvvynypia clvdach vale, 

PENYGRAIG GLAMORGAN 
(U'ortmen s Iftdical Scheme 1 

OGMORE \ ALLEY GLAMORGAN 

lAuistanJ Medea. Off e ci lieu, h i 1 

<11 andAam Collier) Medea! Aid Sooefr } 

<11 o kmen t Med COl Scheme ) 

DISP£.NS\Ri APPOINTMENTS ' 

OAKDALE. AlON 

0>ledicat Offirer far^ Medical Aid 4ttoaa on) 

LIMERICK cm 1 

tnjfWerme D speniory Me ca. O^xe s i 

Cl.) Overseas j| 


Medical practitioners are requested not to apply tor any appointment reterred to in the foIlmviiN 
table without having first communicated with the Honorarv Secretarv ot the Division or Branco 
named in the second column or with the Secretary to the British Medical Assoaation B M A IIou_e 
Tavistock Square, \V C I 


Towti or District. 

Hon Sec- of Division 

or Branch 

Town or Dtsirici 

Hon Sec of Di tston 
ot Braowh. 


Hon Sec cf D w n 
CT Brarv-h 

VEW SOUTH 
\^ALES 
(All Fnendh 

Soaefy Avvoint 
ments ) 

The Medical Secretary 

Sew South N%ales 
Branch ]35 Mac 
quane Street Sydney 
NSW 

\ ICTORXA 
(Alt fntt fuie or 
Med cal D ipen 
WKS 1 

The Hcno'sry Secretary 
Vnonan Branch 
Bnttab Medical A- o- 
ciation Medical 

Society Hall Alten 
S\ East MtlbouTct 
Aictoti- 

WESTEEN 
AUSTR AUA 
(Cent act ard 
Lodte Frsciicea V 

The Hon Sev. Wc»terr 
AuitralLUt Bran h 
Bnir«** Meu4-al A o 
cution She! Ho •♦c 

05 St Ceofz 1 Ter 
race Perth Wet ern 
Australia 

The Hon Sec Oueens 
land Branch Bntah 
Medical Association 

B M A House 2-5 

W ickbam Tcracc 
Brisbane B 17 

QUEB^SI-A^I> 

(Brisbane Assoaaie 
Friendly %Soeiciies 
Institute ) 


June 29 1938 By Order of the Council G C AXDERSO\ Stcrctar\ 


^DDEVBROOKES HOSPITAL CAMBRIDGE 

Aoolicanons are for ihe followinc 

posts — 

(a) HOUSE SURGEON from Auffust Is: 

(b) HOUSE PHYSICIAN from August 1st 
Eath nppointmcnt i> (enable for a period ol stx 

months but i terminable at an carh^ date by 
ont month a wnitcn nonce on either side 
The <al3n if each o'liccr mil be at the rate cf 
iCno per annum \ uh board residence and laundry 
Candidates (m Ic") who mu t be unmamed and 
dulA rcEiicr-d arc requested to forw-ard their 
applications tating age, qualihcations etc 
topcihcf ' »th copies if not more than four icsti 
moniil to th under lencd on or before SVednes 
da> July 6th 

I \ BEARDSALL 

Secfctan Supenntendeot 

B irmingham \sd midland E^E 

HOSPIT\L (114 Bed ) 

Xppii'ation ar niited from diJl> qualified 

M'dt-al praamt ners for the po^t of HOUSE 
SURGEON at the above Hospital Salary £I 0 
rcr annum »rt intr i-i £1*^0 at the erd ol « months 
sati faanrs cm ci and £10 laundry allowance 
The Resicl ni Su,fl con t ts of a Resident Surircal 
OfftLCt ard three House Surccon 

AppUcatitn v\tih testimonials and evidence of 
recivtration hould be forwarded immediately to 
the undervumed 

Church Street J \\ PE\RCE 

B rmineham General Supennie ndent 

URTON ON TRENT GENERAL 

ISHRM \R^ 

Applications arc invnted for the position of 
CASU\L1^ OFFICER AND HOUSE 
PH^ SiriAN salary at the rate of £1'0 per arnum 
ith board residence and laundry Du ics to 
c mmen c July J t 19^S 

ApplicatKn Rivin-' ape qua! ficauons and 

national ty tomhet with Copt's o( lesum nul 
to b«. ent ts E \\ Thornles Sccrciiry 


B 


C HESTERFIELD AND NORTH DERBS 
SHIRE R01AL HOSPITAL 
(—0 Surgical ard Medical Bed ) 

HOUSE SURGEON TO OPHTHALMIC ANT) 
EAR NOSE AND THROAT DEPARTNlENTS 

Apo'tcations are msitcd front fully qual hc4 irtrt 
for the above post The ap'cntmenr e for 
nonili from July Oih 19’^ 

Salary at the nt of €1 0 per annixt 
Apoheawon stajng a-'O together with cop es 
of three recent icsnmon—Iy hould be «eri to 
the unc-crsi-*n~d ^s Joon as pos tb’e. 

M H BOONE, 
SJpetioicndent ard Secret-ry 
June X93$ 


XlORrOLK AND NORAMCH HOSPITAL 
i A Norwteh (4l“ Bed ) 

Applications arc invited for the post cl HOUSE 
SURGEON Salary £1-0 per -rn-m wuh bc-rd 
res den c -rd 1 u-'dry C-nd dates (rule) t-tr: be 
unmarried and ntu*t possess rofjtercd oujI *£a 
HORS 

App caijors sjung age -vd TsatiO''al\N Ck- 
together w ih eo^ e« ot lev ♦~on-l vh*' d be 
forwarded to the under i red r Jt Utcr than Tuev- 
jcl, *h PR INCH 

Hod<c Go err*'^ S — rctarr 

June “^-th lo S 

UTE HOSPITAL. LUTON 


B 


H 


OSPITAL OF SI CPOSS 
fI-0 BCV.S ) 


HOUSE SURGEON (rva* ) wa-trf t-i o -r e 

duties on July 1vi or a ocn -iter av pc' b e 
Sa ary £I 0 "cr arnam w th bo d rcsd—cc 
laupJry , . 

Ap’-hcat *-t c ace. n^ti oil and ei-^^ 

cn c t -c'hcr wi h coro of ^ « 

rcccni testimonials sh uW be sen »r''"“cu .*i /v t 
the Sevretan cf the MediOl Ad y 
at the Hospiul ^ 

R E LING ARD I 

Secretary B le Ho- jI * 


Apr C3tic~-^ arc n ed (cr i * pi'^t of ONf 

Male resident medic \l officep nh - 

P M O ) 

Salary to cc'~'-crcc at t e rate of £iri p'-r 
arnum fo tbe Ft r t tee r-cr hv per -r- m 

for second ih e- rr-'rbt ..-d at th rare o 1 
per ..p 'Ti fo* V tseq er nv.-ths 
Full b'l rd washrn e* pro >-cd 
Sty r-o ths ap-ci j~cn atJ cLr - cn cc-^ 
p ctjon of se^ e for fu'th-r a e^ cn cf v 
p'o- h 

C-ndjda es mu i be r'crarnJ to cc^n:c- e d f ^ 
early -s pcss t c 

The p'a't c of d- Hi~‘*'tal c^'en cacc 
optsonum tes lor w vc ctpc e- c 
Cert ^cates «rd cth-r fees v._r-d bv R M O 
Ap'--3tc"n na I-* - rat-ona f) a-d 1 

dct~i *, w th CO*’ cs cf three recent lecpn''- a i 
be sen to tt- usders—ned 

fS^nJlU COCKBUPN 
S " cn- cn-n* ar— 

0\ \L MSNCIIESTFR CMILDRfN ^ 
HOSf ITAL 

Penu c*'* ry rear rv^’cr cr 
C-t P'1. ) 

RESIDFNF HOUiE SLPCIOS 


R 



H HU'f-r vS 















THE BRITISH MEDICAL JOURNAL 


Juu 2, 19uS 


TO ADVERTISERS 


The British Mcdical Journal has 
T lirgei circuhtion than that of 
all other British weekly medical 
periodicals combined 
This issue 41 000 cojDics 


TERMS FOR ADVERTISING 

small prepaid advertisements 

The Minimum charge is 9s which 
cosers up to 30 words Extra words 
tre charged Is 6d for 5 or less e ? 
33 words would be charged as for 35 
Name and address should be 
included when counting words for 
cost 

If Box Number is used, u should 
be reckoned as 5 words rn the total 
Advertisements accompanied by 
remittance, should reach this office 
not later than NOON, TUESDAY, 
for insertion in ensiling number 

DISPLAYED ADVERTISEMENTS 
Whole Page, £2A and pro rata to 
_ one eighth page 

Special and facing matter positions, 
£30 and £25 


EVCRV EFFORT IS MADE TO ENSURE 
THE ACCURACY OF ADVERTISEMENTS 
" N*- IN THE JOURNAL NO 
S IMPLIED BY 
^ » s the BRITISH 

N reserves THE 
INTERRUFT THE 
> NDVCRTISCMENT 


Advcrtiscmcnt Manager, 
British Medical Journal 
B M A House, ^Tavistock Square, 
London, W C 1 
Telephone EVSion 2111 


NOT CLASSrriED 


CIGARS (ENDCUT) ALL HAVANA 

TOnsCCO GOOD SMOKES ai j Ions pnee 
Ouatii> RuaranlccO Bojt ol ^0 for 7^1 post Irtc — 
Sole M imifactiircr; 3 3 Trlenun ^ Co Ltd 
so f jccadifls London W 1 (GRO 1529) 


‘ BIZIM’ CIGSnrTTES 

■’Ursi luxunom dcliciousli ^aiisDins ^mokts <0 s 
ot 10 <ls aV on pec 100 ^b/C> ret 1 000 PCM 

free —Sole Manufaciurtr^ 3 3 fftrsiss V Co 
Liu EwLAdiUs London 1 (CRO 1529 ) 


‘ <?oi \rr ciKCi rs ” tobaci o 

flfC fincxi combrnaiton c'cr dt^osefed of Choice 
'sjruril Tobacco Esers pircful n indotrib be 
pi t'urc l2/6 Pcf i lb tin p>'t free —Sole 
sijnufakiuicrs 3 3 Tmcmss L Co Ltd 

Iv'.t.adiUi London f (GKO f^»9) 


M I C -T n t S t DCSIGV \TOR^ 
t *3 letters after -i CIUROPODISTS 
n tnji -tic that he of she k a MEMCCH of 

‘ socim Of CffiRO 

»'»I)JSrs loti^dcJ PI- Patron Hi Grace the 
D ^ f ( rtLrd KG PC GC \0 Panel 

I I xjr'in fN n sIcvIiltI Subjevts -pprosed b> vhc 
* ( c 1 1 Ihs^i^tjns and Royal Colkcc of 

s - f f n [jnJ fct--c it\ fb.- rcRulatfOn' 
’ <*•- S V Ct JKOHfnjT stenbers from 

a ’ -ftt 1 0 I rj'Te^ and add ctstrt cf Ch i> 

ts i-x t*'tf L. Tt t v.** ati. r'c'^bers o( the 

S I ' a-'T afNJ^ tr*" rr'at t tceiTc nit tta ntr5 
f miv b<r /ror- rl~- 

s*- r- a ^ I- p aicd S-xiety < f Clii i s 
21 Ca rd n bu tre L ■"J n I Te ■* 

- -- I T'' •'■un ' ) 


A rdara —least known most lovely 

hohdav report in Ireland Best tree TishinR 
Touch ^hooimff Rolf bathinc an artisi «; paradise 
rirsicb*:^ ACCOMMOD\noN proMded bs 
dolors widon Fevs puc^is taken Vacancies now 
— Xddrc'is No 700^ BMA Hou^^c TaMstock 
Square W C I 


pOR all income tax complications 

^ or di{'[i''uUics consult or communicate w»ih 
Mr C G C KILNER (late H M Inspector of 
Taxes) 7 St James Street Ficcadilly London 
S kV 1 Telephone WhUchall 9278 for appointment 


N ational adoption society 4 baker 

STREET Wl Telephone Wclbcck 7211 
OFFERS ASSISTANCE m the legal adoption of 
fUegJttmatc and orphxn babies into suitable 
F'imij> lift Oiairman The Lady Gweseth 
tCXNENDISH 


T \ PEWRITING DUPLICATING TRANSLA 
TIONS —Experts in Medical work TESTl 
MOSlALS THESES etc accurately copied in 
style that'^comm mds attention — Wocuns Bureau 
D raJion House Gordon Street London WCl 
(close DMA House) EUSion 1775 


T ypewriting —specialists in Tk ping 

Medical and scientific papers lectures 
theses and books Shorthand typists ilways 
a\ai ‘•’c Proof reading Indexing — Margaret 
\ kATsoM Ltd 16 Palace Chambers Jlndgc 
Street S W I WHllchaB 3838 


\X JHCN YOU COME TO LONDON STAY AT 
VV the HAMPDEN RESIDENTIAL CLUB 
FOR GENTLEMEN Hampden Street N W 1 
Close King s Cross and Euston 300 bedrooms 
15/ to 22/6 pvv includ baths attend and boot 
cleaning All meals \ la carte m dlnmc room 
Mod tariff Large club rms reading rm study 
for students Ulus pfo^ See Custon 2244/5 


ASSISTANCIES 


W ANTED IMMEDIATEU MARRIED 
ASSISTANT (British) for South Waia 
coUiery practice niih carfj vien 30 35 Salary 
£450 and ear allowance or car provided with 
(fee unfurnished house— Apply with phoiograph 
Address No 6634 B M A House TaNvstock 
Square W C I 


W ANTED IMMEDIATELY — INDOOR AND 
outdoor ASSISTANTS for town and country 
practices with and without ticw to partnership 
Good Mlarics offered — Snte hilt patticuWrs 
BRtTisu Medical Bureau t3 Cro^s Street 
Mxnchcstcr 2 


W ANTED IMMEDIVTrLV OUTDOOR 
ASSISTANI male Mnglc British Pro 
tcstnnt for practice m County Durham Salary 
£>00 per annum and £50 car allowance — Address 
No 70^6 BMA House TaMstock Squart 
3\ C 1 


W ANTED IMMEDIATELY RECENTLY 
qualified male ASSISTANT single lor mixed 
pritaie and panel practice near London Work 
light — Address No 7WJ B Al A House Txyjsiock 
Square \y C i 


W ANTED— OUTDOOR ASSISTANT IN 

Colliery Pf^cti-c In Glamorg'in One with 
car preferred Salary £400 p a and £50 car 
allowance with room and auendaocc — Address 
No 6811 DMA House Tavistock Square W Cl 


W/ANTED OUTDOOR MALE ASSISTANT 
X ^ for panel and pnvate pracficc in the Mid 
lands Salary £400 per annum Must be reliable 
Cir supplied (jsoiI bond — Address No 6S28 
n A House Tavistock Square WCl 

W/’ANTED \SSISTANT OUTDOOR SkL-kRV 
YV £4X0 with view to partner hip Hxlf lo 
thud hare m £' OOO practice at two years purchase 
Mixed rftcftcc Midland suburb Prospects 
decidedly good — Addrc>v No "007 B M A 
llou c Ta'*^iock Square WCl 


W anted— M\LL assist \nt indoor 

for mixed London practice S daty £3*^0 per 
annum Recently qualified man considered — 
3ddrc V No 7019 D M A House Tav stock 
Square W C 1 

W anted wom\n doctor as assis 

TANT in Saniior vm Previous exper cncc 
no nccts try — AdJrcs No 6'‘ 6 D ^l \ House 
lav lovk SqiMtc WCl 

W \NrrD INDOOR ASSIST ^N^ M\LE 
« Jh »ic» pjpN arJ p iviie C^mbr d^c 
t xj p iix *• jfd arj Icwi m* ard car allowance 
C( vl — \ilJrcss No “&tj P M V 

III I Taxi t Nt t«fc WCl 


A SSISTWT RCQUIRED IMMEDIATCL'l FOR 
^ »■ rracti e m Manchc^lcr TuU ixrnonal -ind rtev- 
icssional paniciilars required — lloicn Hoxrxxos 
Avo Co 1 TD Manuf-ctunn-' Chtmists Sun 
Building Brdgc Street ^lancbcstcr 


r ads assistant indoors e\s\ reach 

of CirdifT Work light tine for study il 
desired SxUrv accordingly —Tull particulirs 
Address No eS23 B M A House Tavi>tcNk 
Square WCl 


T AD\ ASSISTANT WANTED COUNTRY 
practice Dorset Salary £2^0 all tound 
Able to drive car live in— Address No 7023 
B M A House Tavisiock Square 3V C 1 


O utdoor m\le (unmarried) assis 

TANT wanted m agreeable South Wales 
colliery district near Cardift Pnnclpal young 
work not oncroiii car rrovided hahty £t*^n to 
£400 (according to experience) with furni hed 
rooms and attendance — Applications to Address 
No 7016 B M A House Tavistock Square W C 1 


(QUALIFIED LADY MEDICAL REQUIRED 
to 81 'c HELP tn small practice country 
£150 all confinements fees board and lodging 
Sign usual bond — Address No 6''3I DMA 
House lavisto%.K Square W' C 1 


Q ualified assistant wanted out 

door Panel and club NonhumhcrbnJ 
V Jew to succession — Address No 7040 B M A 
House Tavistock Square W C I 


LOCUMS 


Y^kNrCD LOCUM FOR MONTH AUGUST 
YV »^nj possib»y occivional \veck*cndv in panel 
and working-class practice SE London Acme man 
with cxpcncncc c scniial Scotch preferred — 
AddrcNS No 7042 B M A House Tavivtock 
Square W C 1 


W^^ANTED— LOCUM \UGUST ST JOHN* 
YY Wood No midwifcrv Panel Private 
Prospects future work State age and experience 
Elderly locum not obected to — Address No 7017 
BMA House Tavistock Square %V C 1 



W/ANTED POSITION AS LOCUM IN 
Yt general practice for first three weeks m 
August in Scotland or North England 10 years 
experience — Address No 7001 BMA House 
Tavistock Square W C 1 


W SNTED B\ LOCUM TENCNS WORK 
from July 18th to Aug 4ih Booked after thai 
date to Sept 8th Scnur man with large cxpenencc 
of private and panel patients*— Address No 70’^ 
BMA House lavistock Square W' C 1 


H OSPITALITV locum orrERED (kVTTH 
wile and child) for August Small pracucc 
Pane) 700 One appointment Car necessary W'otfc 
light £2 2s weekly allowed for expenses — 
Address No 7044 B M A House Tavivfock 
Square W C I 


L \DV DOCTOR E^PERfENCED GENERAL 
pncticc available LOCUMS early hily to 
Sept Own car Eight guineas per week jndoor 
—Address No 7003 B M A House Tasisto-k 
Square W C I 

M O D 17 INDIAN r\P G P AND 
*1a. w X Ci*^ Panel desires fortnurht ♦ 
LOCUM WORK in fondon or suburb Kfween 
July 2trd and August Tth Own car — AeJJ^s 
No "006 B kf \ Home favisiock Square W C I 


M P Ch B ex US II P 

tS j G P own car REQUIPLS 
LOCUM July 3mh 14 days approx coast town 
— Address No 703^ BMA House Tavutuck 
Squ ire W C 1 


ME we AT POSTS, mSPKNSKRS 


A L\D'i DISPENSER BOOkKEEFER SOI 
p'j'd iTHCdnio OT tcqucTt R-'-’' , 


/TL p'j'd I'TPCdjito OT tcqucTt R-'-’' , 

inj with rraci'CTl CT-^-uen c m po'dfi: r« ’ ' 
Jfd djspc-«rs Kofl Tl!o iraircd ("Fjcicrio "t - 
Oatoratofi'T of ihc LONDON COLLEOr 

pharmacy for women PKPira om ^ 

Cx^ninTlioni — W tut ■wiit ot rfioo' ‘‘"Jl 
»3!cr 00C9> S'crtuo 7 Woibojrn Mr* 

Poad W 7 


























JuL\ 2 19^8 


THE BRITISH MEDICAL JOURNAL 




A COURSt OF TRAISISG IS DISPENSING 
^ anJ Pharmao is snen at GORDON H.\LL 
SCHOOL or PHARMACY ^nd Secretary Di» 
pen crj> can be upplicd lo Doctors Sessions 
Januarj Apnl and September — \pph Pnncmals 
School of Phirm c> Dnjton Hollc Gordon 
Niieet ^\ C I Phoo* Eu ton "*9 0 

r\ALGHTER OF DECEASED RAMC 
■«-' ofli'tf urRtnil desires poxt a SECRETARY 
CHADFrELSE Compt^tent dn>"r Refcren~c'. 
— App') Hon Mrv Dv'O 6 Bedford Girden 


ClTSPENSING CAREER FOR \OUNG LADIES 
FULL TRAINING for Apcthe^rcs HaU 
Certificaic Enrolment cs'eri three months — 
Apply The Principal Central School of Pharmacy 
Morcton Street London S 1 Telephone 
Avaoru 1641 


r^OCTORS REQUIRING QUALIFIED 
Dispaiscrs Nurse-Dispen^ers Secretarj 
Di pettNers or Chaufreu«e-Disrcfuers are muted 
to note wire or ph*inc Temple Bar The 

Dispesser s Bureau ^ Lind:Ci} House 17l 
Shaftesbury Aycou* London \V 


T ADA DISPENSER BOOKKEEPER DESIRES 
po«t with Private Pra-tiuoner 10 xear e\p 
Pnsatc and N H 1 di pensine Shorthand and 
typing if ncceS'ary ov\n machine cxcell ref — 
Address No "0 4 B M A Hou e Ta\i tocL 
Square U C 1 


r ADA DISPENSER REQUIRED RECENTLA 
qualified Counirx practice Kent r-ar 
London Age -O- Educated man adaptabl 
t illin^ 1 arn list in di tn t full paniniUr 
salary photo— Addrtrx No "0 B M A Houm. 
Ta\i took Square A\ C 1 


L ada doctor wanted for private 

Mental Home near London Salary £ 00 
Expen-nce e^eniial — Addres No “Ol^ B vi A 
Hou'C Tat-totoek Square W C 1 


M DpC LRCP I A EARS GOOD 
V-' O j famil' ^ oall in lined par 
tully enpp 'd left wmt through llln«^ dc^ircs 
unable EMPLOAMENT bu ine*s or profes lonal 
— Addres No “ft B n 1 A H^u c Taxi tock 
Square W C I 


postgraduate wasted at OSCE TO 
■A ip,t at 'surgery near Bart EMERGEsca 
WORK onl\ Rent free — Addr'ss No "004 
B M A Heu e Taxtsiock Square W C I 


P SA CHI ATRIST —HONOR ABA ASSISTANT 

wanted Uf CHILD GUIDANCE CLIMC 
INv hi tn etp ri d c n'^'^vry and paediatnc if 
PON iNc Hoiorafium •^-5 per -nnum — Applx 
Honorarv Director Ea t London Child Guidance 
Chnit Jews Ff'e School E I 


T he roaal arma medical corps 
association Ecclcston Square 

S W 1 (Telephone A ictoru -.T_) supplies 
qualified Disp naers Bookkeepers Laboraterr 
Assistants Sanitar' Assistants Mai* Nurs s 
AIcntal and Special Treatment Orderlies D ntal 
Clerk Orderlies I oters C-retakers etc wnifiout 
charge to prospcctixc employers 


PA^RT>ER SHIPS 


W ANTED P\RT>sCR TO DEVELOP NEW LA 
built aren Midland ti> uc ecured for 
m.\s hou c and urgers Exi tire pra h in rex 
ing tcadih Premium £ 0 for hare kuarantced 

minimum ard n rem nis Etc Hem pportunitx 
fir youn" encrecu man— Addrev No "0t9 
B_N! A H u Taxi ti^ck Square W C 1 


L ancashire town— half share in 

o(d-c<tabti h M middle and wcrkuiR-cla s 
practice. ReccipL £-f(H> Pun 1 00 Pre 

lunmarx i lant hips *' m’Uh — Addre^ Ni 
0 9 B M A Houv. Ta\i lock Square W C 1 


N ear Manchester half share 

wenh £l —0 one and thr c auanc* xear 
pur ha e PxncI ox f - <X) in Tea rt GoxS 

h j u rent Of bux rapidl grxx me di fn~t — 
AddrcN No I) 6 B M A He Taxi t xV 
Squxr W C I 


P ARTNERSHIP PKELIMINARA ASSISTANT 
hip Midland m bix praT c Ho* tal 
c n ral urc rx and mid if r> oxcnti I— \d»^ o 
N 01 B M A Hou el ix>.k *kjiarc W C 1 


S HARE AALIE £! iV IN FIRAT 

cl ^ c ur rx praTi m W c't W ' r jr 
vea c'oa t Wei h ir Vitch pr ' rrM Pr-x t 
carx pur hx c — Audres N ^ 10 BM A 
Hixi e iaxi tixk So arc W C 1 


S outheast coast resort— partner 

SHIP in pTicticc detng £.0 0 pa Pan 1 
iXW Good ho'p nl appoimr-tm cn taiT 
ured Gc*d schools Premium half *'are 
t OOO— Addres No 6610 BMA Hoik Taxi 
t xk Squire \A C 1 


P'OR SALE OLD ESTABLISHED Pk XC 
TICE North E.. L-r.a h c Ir- t ^\ 
and middlc-cla Recc r 1 - * 

1 *> 0 GohJ hui. e urper vepuraic t 
Carden can.— — Adu cs No "( 1 BM V H 
Ta i uxk Square W C 1 


COUTH MIDLANDS —THIRD SHARE OF 
^ £1 00 m groxxin* to n rraett c — Adc. 

No 0 " BMA Hcu e Tax lock Square AA C 1 


T hird partner required resi 

d n lal icxxn northern coa t England Share 
worth £I ^00 at first on* and ihrce-quancr years 
purcha Good house Capital ex CPtial — 
AdJros No (/ I BMA House Taxist-vk 
Square AA C 1 


PRACTICES 




L, la IX uisrnsAL — 

I- PRACTICE n r^arkcl i 
xil.^ CN ca t r*)J _M p - i 

erm I Cciiarc Hckp al Pxpc! 1 I r 

ho d hot. c III bed a i > E*- 

tion_I Kn tj*x — xd^r-N No 0 t DM \ 
Hue T^xi texV Sq^a W C 1 


^LASGOW SOUTH SIDE— IFACTHf 
^ prix te and p rcl I r vj c he. c n re 

tc ren in —e app n\ •* t x tl per ~ 
a»er ced oxer la : three x -ar gxv rc* f 
di pOsal a-equate miroc.unicn — Ftr f nh r r r 
tl ul rs applx Cr vvrniiD Hcuros vr> C ri» 

S ! It rs W c»t Cc r L S rcci O C 


W ANTED IMMEDIATELA IN SOLTHERN 
MidUnd -it Home Counttn. un ppo ctl 
country PR AtTflCE I 000- I «00 Pane! and 
good houM. and garden cv cntial — Addre< No 
/O " BMA Houxe Taxi tock Squar W C ! 


W ANTED COUNTRA PRAfTTlCE SMALL 
cr large AA Kent or E Sii< ct W ill pur 
cha good hou c with large gard n Pan I 

minimum — Addrev No 6 60 BMA Houxe 

Taxi tock Square AA C I 


A NUMBER OF SMALL PRAtmCES AT 
low premium EtceOent op'NOftumtics for 
rractiiioncrx xxLhin* lo get a practi e with <vOpc 
— Apply Pc-xcocs. A**r> Hcdifx Ltp 6 /6^ 
CThandox Street Strand AA C 


K ent DEAELOPING PART — PROMiSiNt 
NUCLEUS Receipt I i r* nih« P 
Comer house ca x term mcnca Prem n 
tor pract c ^ Excel *i c** riu* t\ — Pr t k 
so Hcdlfx Ltd 6 ( Cha - Street Sr 

W C 


L arge midland town islblrb) 

PRACTICE held 16 years Rcxcr a cr c* 
nearly £ lA) p a * xJ panel Attract e h irn 
rental Premium alxut 1 fi— Pi rrx k s 
H Dirx Ltd 6 f s Cb r- 'n Streei Srr rt. 
W C 


M idlands— LADA doctor has well 

fttabi hed PR VCTICE f r sale C r 
in <r tlvtiO Pan I i — A*'"l» Afcoi o 
I-^ Edmund Street B rmir ham 


^iiiiiiiiiiiiimiiniiiiiniiiiiiiiiiiiii^ 

= The Nameb and Xddresscs of S 
5 Ad\erli<;ers U'lng ST 

I BOX NUMBERS | 

S are held b\ us in sinct con S 
S fidence and ma\ notbedisclosed s 
TS Applications should be S 
S separateh enclosed and clearl> — 
^ addressed ^ 

S Address Ao S 

S B Af A House S 

g Tmisiock Square II' Cl — 

« All cornmuolcaiiorts are forw-arded — 
M to adxentsers und r plain coxcr 

illlllllllllllllllllllllllllllllllllillllirF 


F ashionable se coast resort 

PrcNcnt o ncr h-nd 10 xears £600 p i 
nett 2 years purcha e 5 x bedroomed hou t and 
garden Freeh Id C 000 mu t bs biucht — 

Addfo No (6.0 BMA Hou c Tasi tock 

Square AA C I 


F or sale— SCOTLAND EAST COAST 

toxn O d-<stablt hed PRACTICE Panel 
I 0 Rcccmts £I *00 Little Midwifery 
Hosptal Go'xJ scope Ex cllem bouse K sale 
£l iW 1 year purchase — Addre*v No 669’ 
BMA Hou Taxi t xk Square AA C I 


F or IMAfEDIATE DISPOSAL — COU-NTRA 
PRACTICE in S AA England axcragme 
nearly 1000 pa panel 6 ^ Cho c cl two 
cxcillent m^Jcmircxf h u m to let charm n 
xillakc and di tnci Irtrodo“tion - required 
Pr -c pr3Cl>~c £. 000— Addrexs No *01 D hi \ 
Hou * Tax lock Square AA C I 


F or sale London s\a 
VA cNt Erd Ov.^taSl hed 
Rccxim ’ yca*» ax-ra-e '‘.4 
ircTC rie Trxrvf rab c apm ^ 
a um S ab c b ’ 
rvrNC> I W _ car P n.ha 
A jrcN N 0 0 D M ■ 

Squ r MCI 


Ic-v. 
to. h 
H J 


minutes 

PR VCTICE 
I ncl 

t L. per 
I.. L 
n ar-rt — 
T *«> vk 


F or svli 
TICE 


in 


r _r a 
jr*"* n — f 


!h eleor I 
t Pr f r ' 


I NOrrOsED COl n TF A pp \c 

beat iful %*i,‘‘wcxcTr cm -ty 
I rce I wn Pa* 1 £ L 

Rc* c" *'"*'t 1C -a H_ 
wy ct s. « n 

. t e i < H - th r-.-M, n f 
N “01 n M V H T 


M edical praoice for sale in 

ccuBtry d tr t m Dumfri'N b t do 
vacancy HounC to let Aver e r-'cip £* 
Exp n *'311 — p n u r fr m HrvotT v 
Mvckxx Solntorx Lockerb e 


M iddx suburb —steadila incri 

ing PRACTICE r*xx rea p t Lt I 
rronths PO panel 00 ap*ont*' nt * I 
lent hou e cp rate bn k built ptx r-r p 
good garden Fruchu d £1 r hi Prr* m tl ‘ 
— Addres No 6 1 B At A H i c T '' n 
S quare W C 1 


N orth East COAST on terms jaa li 

ab e to parch r C<xJm*..''Nl pia 
PRACTICE Pan J tro AN i tl " ft 
Hiu e wuh xj pcTv Cl 600 — G trr tm Du »y n 
KsirUTiNG Solmiors Ne - tl lcnjo T rc I 


N ear fllhaai sw — w ell LsrABiisMED 

PRACTICE Rccuc I t xcar o cr C o. 
panel ncarl <00 merca n Ni h u rmal 
Premium £1 f) ^ — Apply Pr coci. nd M pilx 
Ltd f* 6*^ (rha*i.m Street Sira d AA C 2. 


N ucleus lock up slrgera panel . i 

•Prermum t 0 A er\ r*cm r*r corn r h 

W Hou c above now xa nt rent o yc r f i 

b th or urp r xion fS week Ph n Bay 

water a" 6 


O LD ESTABLISHED AHXED PR ACflCI 
near Mar h-Ntcr Rc c'“*v axerarre £’ < 
parcl rcarlv I 'OO N e di tn t w ih n. in 

prem urn two year pjrch e c rear c"cf i 
able fer tx o men Two h u 'n i ren v r •< 
— AddrCN No 6 10 B M A H C Ta rl <k 

Sq arc W C I 


P RACTICE APOUT 22 REOl IPFr 

wji T I< n K f B m n t-1 pf fer b > Of 
-SuULh S.I-C Par f\b o r i V' r cd i* 
axailabl — AdJrcv No H A lit 

tcvk Sq ar AA C I 


OCOTLAND - LNiArRSlIN CJTA tlX! 1) 

O med cal PXAl-11X_i- 

( T at 


C'Ub b-J —I- -xJ r c * 

t VX, 


^ nJ r -xj J 

-» — 


-( IMA Hx-''' T 

xk V. 


^^OA AN Df *CK> < S 

SI CLTl 

S riNIRM 

r * -> -IAS S 

“ 

’ .4 

Elf v 

r — A >. r N 

K 

MV I* 

\ AS A C 1 



F-b \I u! in > 

Nl -IF 

< 

r ! i 

p- r , - - 

s- b .. t" 

£ 

H 

„ s 

{ 

vA A C » 



























60 


THE BRITISH MEDICAL JOURNAL 


Jun 2 1938 


HOUSES, CONSULTING BOOfllS 

For a\ntlob]e 

CONSULTING ROOMS 
PR0^CSS[0^^\L HOUSES & FLATS 

m Harle> Street and the medical 
Tfci ficncralb includmR Mayfair 

LEY CLARK & PARTNERS, 

ALfCTIONECRS SURVEYORS VALUERS 
“la Wimpolc Street Cavcndi^ih Square W 1 
Telephone Langham 1095 6^7 
Represented at Cannes Nice and Monte Carlo 


A rrw DOORS prom the clinic 5H0P 

ro LEI in the centre of the Medical Pro- 
fession Safe openinR for dealers and manufac 
lurers of medical appliances — AppK the Landlord 
27b DeNonshirc Street London W I WclbccK 
1094 


D fXONSHIRE ST \V 1 — AN EXCELLENT 
CONSULTINO ROOM n one of the finest 
ho ices in the street available Tmc sessions per 
NSeck Rent 1125 pa inelusiec — Address No 
f 156 B M A House Tavistock Square W C 1 


F or SALE OR LC \SE —DOCTOR S COM 
modious HOUSE 147 Narboroueh Road 
1 cicestcr £1 000 or £I2*» p i rent — Addresa No 
70jS B M a House Tavistock Square VV C I 


H AMPSTEAD riNCHLEY ROAD —COM 
foriabie RESIDENCE occupied by medical 
man durins the last 1U ycirs 6 bed 3 Tcccpi 
OiraRC can be nude £1950 — Apply ntrssLEa 
AND SiYtR Chartered Surveyors 321 Tmchicy 
Road N \V 3 


HARLEY STREET 

AND MEDICAL DISTRICT 

Tor all types of tvailtblc actommodaiion 

BERTRAM & GO., 

59 Connaiigtit Street W 2 


Surveyors and Estate 
Agents 

Paddington 1G42 3 


H arley street and district— a num 

ber of excellent CONSULTING ROOMS arc 
available for full and part time use at moderate 
rents Particulara on application — Elcood and 
Co 10 Henrietta Place Cavendish Square 
VV 1 Lang 2601 

H arley street— large consulting 

ROOM bcautifullv decorated will be con 
verted into suite lo rcQiuremenis all amenities 
and services Also furnished treatment rooms 
available — Address No 7043 B M A House 
Tavistock Square WCl 

L ondon vv i min tube tine house 

16 rooms 3 bath garden park adjoins 
Receptionist bookkeeper available Scveril vears 
with Hulcy Street Dr — Addicss No 7010 BM A 
House Tavistock Square \V C 1 

N ottingham city —double fronted 

RESIDENCE for sale Freehold shrubbery 
rockery rear entrance Rooms reception surgery 
breakfast halt kitchen dining drawing b ith 
three bed store Mahogany R G K staircase 
excellent decoration £87^ — BAVVTRrr 133 N 
Sherwood Street Nottingham 

O phthalmic SURGEON having retired 

from practice now wishes TO LET his 
HOUSE The house is modern and situated m a 
charming residential district on the Lancashire 
coast A suitable oculist would soon recover the 
practice Full particulars — Address No 7003 
DMA House Tavistock Square VV C 1 

P ARK LANE — ADVI RTISER WISHES TO 
meet consultant with view to LI 1TING 
ROOM Use of vv ming and ladies room 
also sm ill V rays £135 pa References — Address 
No 7011 BMA House Tavistock Square VV C 1 

Q ueen anne street —only £4o pa 

secures exceptionally fine CONSULTING 
ROOM for use when required with ittcndance and 
all services Re Idential accommoduion available 
—Address No 6355 BMA House Tnvi>tock 
Square VV C I 

Q ueen annc street— large first 

naor CONSULTING ROOM available Full 
or part timt with attendance and all services — 
Address No 70’0 BMA House Tavistock 
Square W C 1 


IMPORTANT 

to MEMBERS of the 
MEDIC VL PRO^ESSIO^ 
clothes or DlSTlNCrfON for GENTLEMEN 
of DISCRIMINATING TASTE SpecialU Cut 
Fitted and Moulded to each individual figure 
made from Finest Quality Materials and in the 
Best Povsible Style cost no more than miss 
producticn ready made clothes 
Tlic mvaluab’e Practical Experience and Advice 
of our 14 Expert W'est End Cutters and Fitters 
IS always at your disposal 

ML IIVIL/ONI 1 radurltun** arc- IIVXB 
FIMSIILD IN FVIin EssENflVL Dl I kIL 
Sit cm OFthK 

JVCKIT & VIST (in bhrk or j^rey) tl t 

lined be 1 quality Vrl Sitin \rl ''ilk wr 
‘^OI m riNCV BORSTID rROtl‘'IRS « 
Th»* Ide »1 Suit for I rofe ion or Pu Inc >sear 
lOUNCl blflTN lo ineo ure from CC (» 

ovmcovr^ i* 

DINMR MJITS iH lU 

niiiss cfTITs from CIO \0* 

nUb FOUR sun^ from iO Oh 

Till IDT \1 Suit for ( ounlry mtl kporilng Wear 
roil) MTDVl niDIM imi 1 till " from 12 .h 
RIDIiNr IIVIIITS tn fi 

niDIM BOOTS £3 1 

tOSTUMIb & ION( COVrs Cf 0 

UNSOLIClTFP APPRECIATION 

7 stronfiJ} ai!\isc at} meihco) wrn mA/j //> 

Jin\e salisfnclion lo polrom e Horn floU LUl iif 
nil fhe clothes I ha\e hnd front them durhtf: 3s 
have hem perfect in Fit Cut and Fiimfi 
(Signed) S J A M A MB F R C P S 
PAFTLRNS POST FREE 
Perfect Fit Guaranteed from Simple Self n eastift 
ment Form or Pattern Garments 

Vlnliors lo 1 ondon can order and fit h line day 
Special Pallernn would then be cut and Pcrfcri 
Fitting Clotlic Kuppited after vithoitt trving on 

HARRY HALL, LTD. 

Governing Director Harry Hall 
T lir Coat llrcechc Habit and Cojftiimc 
Spcclall t 

ini OXFORD sr vv i iiy cm \Pt»U)i i ( - 

Telephones 

GERrard 4905 4906 and 4907 NATicnil 8696/7 
Makers of Finest Quality Bespoke Civil Sporting 
and Hunting Clothes for Ladles and Gentlemen 
liiy.hri«t Vwardii 12 Cold Medal 
1 t over 10 yearn 


SMALL ADVERTISEMENT FOR INSERTION IN 

BRITISH MEDICAL JOURNAL. 

The Minimum charge is 9s which covers up to tO words Extra words are charged Is fid 
foi ‘t or less Example 33 words would be charged as for 35 Name and address should 
be included when counting words for cost 

If Bon Numolr is used it should be reckoned as 5 words in the total 

PI EASE WRITE Cl EARLY— ONE WORD IN EACH SPACE 

1 







•) 







3 







D 







■ 












(30 words) 

91 

■ 






10/6 

■ 






12/ 

i) 






13/6 

10 






15/ 

j lo tlK \d\crtts.iiunt \! imccr BRITISH MEDICAL JOURNAL BMA House Tavistock Squire 1 ondon WCI 

1 f* L tsc IP ert ittv ulvcriivemcnt in 

issues Name 







Address 




I tMTcD 






I C" 

.lo c ren ut u .c vaUi- 

t 

Dale 























July 2 1938 


THE BRITISH MEDICAL JOURNAL 


ri 


MISCEtXAVEOLS SAUS etc 

INCOME TAX 

lOlTR burden i OCR bu Ine 
Tax ‘^peeialLls to the ^led fal P ofe Ion 

HARDl S. HARDY O 

49 C^4^CE^1 L.\VE I.OM)0> U2 

Telephone Ilolborn 6659 
Jf nf for free cop\ of Ad ice on Iitcot} 


pOR SALn,--FULL TRIAL SET LENSES 
walnut c^sc (Curri and Pa.xion> adjustable 
trial frame etc " m good condition £ 0 — 
Address So “00 B M A House Tatis ock 
Square NA C 1 


X R AY INSTALLATION FOR DISPOSAL 
from pnvate P aaice Compn mz 0 mA 
Semen and 'Ansht mobile unit 6k AA radntor 
tube Bii k) dnphragm table cones ca. ettes 
«ereens and complete dark rcom actessories Fo 
further detail — Addr’v So “OO'J B M A House 
Tavistock Sqiiar AA C I 


COVERS FOR BINDING 


Vols J and II of ihe BRITISH 
MEDICALJOURNALfor I9 j 7 
and preAious a ears can be had 
price 2s 6d bA parcel post 
2s lOd each 

Orders Avuh appropnate re 
miiiancc should be addressed 
to 

THE SECRETARY 

BRHISH MEDICAL JObRSAL 
BMA HOLSE TAAISTOCK SO 
LOSDOV AA C I 


QOUSTY of SOMERSET 

APPOISTMENTS OF MEDICAL OFFICE? OF 
HEALTH FOR THE UREAS DISTRICTS OF 
FROME AST> KE^’SSHAM ASD THE 
RURAL DISTRICTS OF TROME 
ASD BATHAVOS and 
ASSISTANT COUNTY MEDICAL OFnCER 

Applications arc invir-d from du > qaal -nf 
Medical Pra'ninon'*fs »ho are fcm ered n ibc 
Afedical Re icr as hoMcrs of dp en- in 
Sj jt^rj Science Pub Health o Su-ic Mcdcne 
for th aNive -prxnn'^cnj »h h i k r* er-cv 
shall be held b> the same person 

The duii'n as A s^ant Coumj Medical Of*^ er 
nill in lude chool medical in pection and crercar 
dues c tvork 

Th officer ap''oin ed will he reau red to devc c 
hi whole ti»*' to the dities of the a^' e 
rrentron d aproimnentj nd ail! be rc»trct-d 
from cnrapin n pnv tc pracli e as a med cal 
practiiion r Ht. ml be required to perfom -II 
the duties pfc<cnbcd b> st-tutc or rcmilation and 
u h othm duties as may fr iri t m to t-r~ be 
as jsrncd to him by the Counts Cour il 

The a jtre^ate ccnrrcn--in2 a jry w tl be 50 
n me bi annu-l tn •rements f £2- to fccil a car 
Trascli p~ allow-ar c for the u c of the oPi er s 
motor car will be pud n a confant with the 
County cal- and effi e a ccmmodati n rd 
clerical a sistar e w II he provided 

The succes ful cand d-tc who must pj s sa •>- 
f-ctonI> a medical cxamnaiicn will bt requ cd 
ro reside m or rear the Cty o Bath 

Aprlicaiiofis tatin- ave cuali'ications dip or*as 
and cTpenencc must be a-contpan ed by cope of 
not more than three recent cestim -uls -rd m t 
be sent to th- Clerk of the County Courcl Ceu-ty 
Hall Taunton o as to reach him n t later t a- 
Juh I^ih 193® in ca elopes endorsed D nr t 
Afcdiml Officer 

Fufther paninilars and conditions of ippcirt 
ment may be obtam-d fr m the Clerk of the 
Court) Cojo-n! on receipt of a st-mpcd addres cd 
foolscap envelope 

Canvas in- directly or i-dircctl w 11 be deemed 
a di qualfficaiion 

HAROLD KING Clerk of the S'-’crsct 
County CcumI 

H J ALL ARD Clerk to tbe Frome 
Urban Drjtnct Council 
AA B K^T Clerk to the Frome 
Rural Di met Coupcil 
GEORGE R ASHTOV Oerk in the 
Keyn bam Lrban Di tm Ccuml 
R H AAHITTISCTON Clerk to the 
Baib-von Rural Dim t Coun il 

lune f9t$ 


APPOIVTUtEVT^Contd 




ROAAL AAATERLOO HOSPITAL FOR 
CHILDREN AND WOMEN 
Waterloo Ro-d SE 1 


HONORARY ASSISTANT PHASICIAN 


L 


ONDON JEAAISH HOSPITAL 
Stepney Green E 1 
(General Ho piial —109 Beds ) 


The C un il of Mampcmcni arc about to appcini 
an HONORARY ASSISTANT SURGEON to th 
l^f Nose and Throat Dcpanmeni Candidates 
who should he Felows of the Roval CoIIesc of 
SuTpeons of Eng and Edinburgh or Ireland or 
Ma ters of Surgerv of i Bnii Ii University should 
send twenty four copies of ibeir appl cation with 
copies of three recent tesimionials to the Secretary 
of the Hospital from wh m particulars of the 
office bias be ebnmed on or before July - nd 
JQJS 


gT MAR'i S HOSPITAL AA- 

CASUALTY HOUSE SURGEON 

Applications are incited for the above pc^l from 
duly Qualified candidates 

Candidates muvt have been House Surgeons for n 
fill penod of office to ihi Hospital or to omc 
cihcr General Hospital approved by the Board 
T^e salary i> £ltX) per annum with beard and 
rc»idcn c and the appointment is for s« month 
Applications with cipics of tcsumonials not 
etcccdmg three in number should reach the under 
igned (from whom particulars may be obtained) 
CO o before Thurvdv June CJrd 

AA PARKES Heunc Governor 




GENERAL 
Bootle Liverpool 
<103 Beds) 


H OSPl T A L 


ONE HOUSE PHASICIAN 
TAAO HOUSE SURGEONS 
ONE CASUALTY OmCER 
April ation arc invited f r the above P'"! 
tenab'e for ix momhs from On her It re\t 
The salary attached to ca h post i 0 per annum 
With board redden c md lau-cry 

Arrhcani mus be duly qual icw- ard r< i lercd 
und r the Mcdi-al Acts 

Apphciti ns with c r»e> f t«M - r-il hud 
rc h roc by r,b..i J..., 

® rctary Super r eru nu 


There ts a racaPT for an Hon A* i tant 
Phy-sician at the above Hospital The candidate 
should be a Fellow cr 'I mber of the Royal CcUc-e 
of Ph> t-iars and a graduate of a Uni'cr«ity 
rccoenizcd bv the General Medical Cousnl He 
should also hive pccl-I fcnowl-d e of the di eases 
of children 

Applioa'ions ac ompanied by three te^tj~cn % 
hould be cni to the uiKfcrnsmed from wh m 
further paruculars can be obtaned nor later than 
Ju’y l®th J H TEASDALE Secretary 


S T PANCRAS DFSPENSARA 
t9 Oakley Square N W i 

There ts a vacar-o for an HONOPaR'V 
GYN AECOLOCIST who ri $t pos css tbe quah 
ficaticns and cxpcner-c appropnate to vi h 
description The dunes w ]| ipv ode the ccnv-uct of 
a weekly cln of two hours ft-r ail rr r-oth-n 
and cbi dren Ca-C5 arc referred to this cl me from 
the AA elfarc Cen res m the Bo cj-b ard in respect 
of advice ard treatment jn'en to su h ca es 4 fee 
ol One ard a half gvnreas per ession w i ] be 
paid App cat n accompanied by test mort—I 
shoo’d reach the Hocor-o Secretary at the 
Dispea-ary not later th-n Saiuruay July 9tb 19 j 


T he hartlepools hospital 

<9s Beds ) 

ApnfKaticris ar* invited fo' ibe ro on ef 
HOUSE SURGEON at a <sUr> c £1 0 p a pli^s 
bcN-rd re> d *n c -r^d Lur^lry 

Ap"0 ntment for six merths si b cci to renewal 
ard dot es to cmi’**cr e Inly Urh 

Apr icati - to be mad lo the upv.erT"-n r--d 
NORMAN O DE.ANS 

Sec-et-.T 


T he casseu iiodriTAL for puNcnoNAU 
neraous disorders 

Sway ard Pc-^ ^ Kcc 

LOCUAf TENFNS fr'-e) red -cd f i" Nve 
He -tal f f-ree mr-Cts from A” O'! 1 r 
V HI ev-ene'" e c*-'^ *-1 S. — T c* t r--— s 
a week w ’* K-rd rev <-er e 3~w L. 

V— ' PS ti b- e- » t*- M-u— ’ D r- 

cn I - lo- — n- I rt t la c th n A' cv- -'u y 
J V 1 ih 




ASH UPFAN D NT’' 
COUNCIL AND EDLCATION 
CO 'imTE. 


assistant medical OFF'CE’’ 


Ap- ea -S re I-V “d I — ■ O a 
Fern D <.tr s fr r c”— 

tant medjcal o^'ncER O'- fr 

ASS’STANr*' -CflOOL. AfEDICAL 
erd r t - S.rt--> a_ - El. *a — A 
tb above area Tn c'^ sr ar~\ r- 
Re- acd V» - — ' r ct — i-w 
qaired lo des'- be** »*• v — 
dLt cv -d to rou-c w c 

pi spal d-U“s b 3 --a 3 

B-N S ••''rf - c C 

Ir -ect n L-f S -cl Ol d ~ l - 
t cn r t — r - -*« e rr*s r 
th- prevc" - - o* 1- — N c< 

pu*' - hes d* d -s Th- r-* 

u-der tbw d evr - * t a -x. 

Hcj b w*"© 1 V S r A - 

the a-p- 1 r'e-i r*-v be t —-a - b 
ei jr- lb c t s -e 
Tb- salarv wii be t 

- r b - ! 

n;-.v nJL'- of “lO <- ~ t 

in VAary w 1 t- l _ r 
n respect ct ea ** y -r v-cr— 
were up a m-.x — — p <_ 

Ap-’ -afic-^ -it r e a - • 

VI t expen r j-'-.a N- ^ 

r*o e t an lb ec re^-r t--- -r* - r- 
n t late' ih-“ th f i p'' r- S 
9th 19 s 

Can a — e t*- r d rc-t y -- 

d '-qua! f> 

CYRIL F THATCHFR 
(Tie t d ®rl C* f ir 
Town Hal a{oju o A h 
Jim- 9th 1939 


VI 

V r ASN 
“A-tl - 
O'Ti’F'' 
r —V 

- r* be J 


A -N 




d-V 


T he glolcestershire ro> m 

JNF»RA!aPA and eye INSTIC llON 
G u r» r 

t Bed S T Res -r ) 

Apr tat ars ar inv cu f r h p •• Pf- J 
DENT SLRGfCAL OFFICER i-“-e' S > t 
the rate of ce » -am w b b -r f" e 
ard Lundry Cardd tes p-js b I « nl 

and immjTtcd --d bave fc d r c n b 

arro-Timens Tb a— ct- —— t i> f tec 

r*cr b wb ch may be ct c-wed 

App atinpiS all - - - - at -> 

naLorjh y n- th r *t no -ss i an i e r en 

lesti— cnt-I bo-w be rt t> t ir* -n -'N 
TTie el— ted carv.idate w be req i cd ' - 

upon b*s d tie^ a er -e 

r J SYAfoss 

Jure ft h 9 « Ac- 1 


TT/LST END HOSPITAL FOR Ntf-AOU 
V> DISE.A5ES 

inpatiest department 
G lMJces Gate Pe-ent v P rk s AA I 

The Comm t-e of ATiroi -r- -t m -< r- a 
ticns for the f>*i cf RESIDENT HOLSF 
PHYSICIAN fmale) D-l es to cetr — xc S<- 
tc-nNcr Is 19 9 Sa-aD at i e rate 1 r<- 

Lm w h board rcsi. --e a d 1 - -s-t 
P re'eresce » 11 be r cn tn ca-d -atm wh h- c 
bell* a res d w ppcc-— — m e re.al b'-~a’ 
Appl aai-c- wi h enp « o' three recer tc' 
mcnal must be rcv-ived by tb- c-t-er' “ev* e 
UtcT ih-n Aforday II r I -h I9i« 

J P WETENTJALL 
Secretary --d Hi-c^c Gc ct-'T 
- A\ dbeck Street AA 1 


T he radium isseitete 

R d n- Hoqsc Street, Lcs-on W 1 

Apr aat.o- arc i vi cd fc- tbe <' 

RESIDENT MEDICAL OFFICER Cacd^atm 

must be t mamed ^ ^ 

The salary wil be at t*— ra e cf £— v. ret 5 
berard res uesac ani. Uunv-T be - pro *-«? » *- 
tbe ap-s: carer is f r s x mrrthv c ’cp-'erv- 
Jl T lllh pcxt , 

Ac- a cnv. ^t-r — ag- r-t><-« y cr-^ ^ 

1 ens a-d o— “-e--®® w -h cr- es c vb ee 
tc5i-'-''r-. J c* nt be r-cci ed at tbe f - ^ 

la er than i e f-v po ca J ) '■ rcii 

Camav -x e -be- d-tm-y c- v tv r 

^ THOS A rAFNFP 

See— *T 


T he national te r-RANCE urr^niA 
Hi ct p - L -- » 

A— -- i - - t - 

hoi AE r lY A <TAN 


N e 









THE BRITISH MEDICAL JOURNAI 


DOLINCnUOKE HOSPITAL 
LJ W ^nd^\^orth Common S N\ 11 
(135 Beds) 

HOTjSC physician (nnlc nnmnrricd) re 
qiiircd 

The ippornimcnl is for six months commcncinr 
August ls( 1938 SThri £120 per innum with 
boird residence niid laundry 

CtnUidates must be full> qinhlicd and reRtsicrcd 
Apphcacions sniinc see qinlifications and ex 
pcncnce xvith copies of not more tb^n three tc^tv 
Tiont ils should be sent to tlic undcrsisncd on or 
teforc July I3th 1938 

W S RANDOLPH BISS 

Secreta ry Superintendent 

C onnaught hospital WALrHAMsrow 

t 17 

(118 Beds with Tour Resident Medical Officers) 

CASUALTY on ICCR (male) required to com 
mcncc duties July ISth 

The appointment will be for six months with 
remuneration at the rate of tllO per annum with 
board residence and laundry 

Applications stiimi, asc nationality quaUUca 
lions and experience accompanied by copies of not 
more linn three icstimonnK must be dcliscrcd to 
the undcrsisncd not later than July 8ih 1938 
R HALTON HARRISON 

Aciinff Secretary 


E VST HANt MEMORIAL HOSPHAL 
Shrewsbury Uoid C7 (100 Reds) 

The General Committee intitc applications for 
the post of lIO\ORAH> NATCOLOGIST 
Cindidiics must he Fellows of the Uosal CoIIcrc 
of Surccons md eni^iRcd so’cly in GynaccoloRy 
Apphe uions staims ape and full pariiculars to 
rcthcr with copies of three Icstimonhls should 
Tcich the undcrsicned on or before July l<lth 
C indid lies will be expected to send copies oT 
ttieir appUcation and testimonials to and cal! upon 
numbers of the honorary medical stalT 
RtCINALD PrUR\ 

Secretary 


S \INT MAin S HOSPITAL FOR UONfCN 
AND CHILORTN 
Phlsiow L 13 

AppUcaiions arc tnvicd for the post of RfSI 
DIN I SURCilCSL OIlICrK male or female 
I he ippomtrncnt is for six months Coird anj 
residence arc prosidcd Silny at the rate o! 
£1^*' per annum mcludmc £^ dlowancc for 
I uindry 

Utsonal canvassins not dcxired Anphcnilons 
r nh copies of three rccenr tcstimon/aN to be 
sent (0 the unJtrsIpned as soon as possible 
A ruNCST WHKCS 

Secretary 


H OSffT\L FOR 7ROMCAL DISF \SES 
Gerdon Street \\ Cl (Seamens llopuil 


Gerdpn Street \\ C 1 
SOeiety ) 


HOUSf PinSlCl\N (male) required (or six 
months from \urusi 1st in s Siliry il20 per 
inniiin with boirvl resdenee and J lundrs 

\pplt uions with copies o( three te umonids 
to b sent m on of b fore July 16th 1918 to the 
under uned 

D A C lUlCL Secret try 
llospiiil for Iropkil Di eases 
C e rdon Street C I 
June "’sth l-JK 


H \MrsrL\n cimrm mosiital 
ni\(.rswcK Hiff N U 3 

(OiiiPakm n pirimcm Cmideii Town N N\ I ) 

\ an \ i dccHred in flic oPite e»f SURGEON 
TO OUI I Mil NFS CiPdklites must Ic UBows 
it the (vwl C itfcKC o( Stirreons Lnpfand and 
arr n pnr d ta call up n m~miers of the Honor 
us Med it Si ff t f the ll ^spiui 

\t pi «fii ns St utn~ ICC qujtiffLallt ns and c' 
pvf n T. ssiih copes tl three icstimoonl should 
i u vP>. tnjer i ned bs July ixili ftk m whom 
tl I r*rii idu ni jy bt obtained 

kl SNITH A I Mil rs 

Scereflfy 


H x)isif\i) rrsLKM nt)sfir\i 

llaxcrsHxtk Hill N W ^ 

\"r ^ \ p are insited fri n in-'le m 1 j) men 

t I t i vn p i ttiiuiiM nnsiciNs 
<l lltilsf si. I ( I ON (if SIX rr mbs \je~inl 
V I f sous tu ) per innum ssuh beard 

I ' ^ «aj \ in^rs 

Xi s r a i*’v rrcv^ri^'cd f rm with three 
t ’ r i ! tv fell ri 'd to »h S ercliry by 
i t 


H )l xi SI K( f ON ir** » t ) rca red f r tf far 
a” ' arl O'^b *54 - n 'sart'^ r x 

S*' *' *' 1 f s \ m n (nm Ju V 

I r ''t si. > V i «, a xh- r e ( £4a pe.r 
" 1 c lx B cn t > crn5Jai(r* 

s f c cfx- '' ’ n ap'v - f , 

\r t r** s e J y p '' tit t i»'ia 


pO\AL NOUrHFRN HOSIITSL 
Holloway N 7 

Applications arc fnsitcd for the followinR appoint 
nicnts 

HOUSE PHYSICIAN \ team September 1st 
The appomimcn is for nine months (three months 
as Ouipiticnt Medic tl Oflrcct and Anicsiheli t 
and six moniht» as House Physician) Srhry at 
the rate of £70 per annum with board residence 
and laundry 

OBSTCIRIC HOUSr SURGEON vacant Sep 
tember l^th The appointment is for nine months 
(six months is Obstetric House Surpeon and three 
months as C s\t\Uv OBicet) Salirv at the rate 
of £70 per annum with board residence and 
laundry 

Applications with copies of testimonials should 
be sent by July 8th to the undersipncd from wfiom 
the ncee sarv forms of application anti rules can 
be oblamed 

GILBERT G BANTER 

Secretary 


H OSPllAL FOR CONSUMPTION AND 

DISEASES or THE CHEST 
Orompton S \V 3 

»■ . . . X 

The Committee of Manapcmcni Invite applica 
lions for the post of HOUSE PIUSfCfAN (for 
which there arc three v icaitcie ) Hie dunes 
include work in the Out patient Department as 
well ns in the Wards The appointment is for 
SIX months commcncmc on AuRust Isi wiifi an 
honorarumt of £80 

Appliearionv with copies o1 icsUmonlaJs must 
reach the undcrsiencd not later than Smirdiy 
July 9lh 1938 

Brompton S W 3 F G ROUVRA^ 

June 1938 Secret \ty 


I^ONDON HOSPITAL Cl 

AnpJicanons ire m»«td for the post of 
MIDICXL FIRST ASSlSlNNl AND 
REGISIRAR Ihc appointment is for one vear 
but IS renew ible anmnllv on ipphcition foi two 
further periods of one >c»r Sdary £300 per 
innum pavable by (he Hospital and Medic d 
Collecc jointly 

C'mdidites must be futly qualified medic illy 
Xophcitions should arruc at the Hospital not 
liter dim ly the first pom <m Siltirday Juh Iblh 
Further pirtieulus may be obtnncd from the 
House Governor 

ARTHUR G ELLIOTT 

House Governor 


J^ONDON UOSPIIAL El 

XppUcitions arc Invited lor the post of 
NffDlCAL OUTPAIIINIS FIRST ASSISTANT 
Cindidates must be fully qiialihcd medically 
The sal try of the post iv Cl8o per annum 
I he dunes involve vticndance m the Medical 
Gulp mem Dcpirimcm on every weekday ifter 
noon 

Apphearfons with tcstiniomds should be sent 
to the House Governor (from vshom further pai 
ticubrs miy be ol tuned) ind should irrivc not 
fuef (fun on July I6tlj 

ARTHUR G ELLlOn 

Ifouse Governor 


NATIONAl 

JlOSPHAL 


OinilOPALDlC 


Apphcitions ire invited for the postN of HOUSl 
SURGION tivso Mile unmirntd) »t Diis Hos 
puds countrv brvneU it Broeklty lliU Simmorc 
Middlesex Beds (ICO cases Of sufRieil tuber 

ciilosiv) 

halirv Cfso per annum with boitd qurttcTs vuJ 
laundry I he appoltiiments are f<»r six months 
Duties to commence one on \w vvsi Ki md one 
on September 1st \ppliciiions with copies of 
rcspmonials should be sent to ilic Scerctiry 2^4 
C rsat Portland Street london \\ 1 not liter thin 
Jutv I3ib 


T lir 01 1 FN S HOSPITAL FOR CHH DRLN 
Hackney Road I 2 

A Temper irv \aeancv has occurred in the 

nnxRiMiM 01 rs^cHoi oricM medi 

CfNL 8brh atiom ire invited and should be 
Sent with eopics of recent testimonial to the 
under lened a soon as possible Six monllis 
anrointm ni Attendan c two bvlf-days vvceHy 
Honcftrurai of < nc cuinci per sc sion CmOi 
d It s mu t be mcdi ally qualified 

CHNRLfS H nCSSELI 
Junk. 21si 193 Scerctiry 


T he south iondon hosiitxl tor 

^ WOMEN 

Cfapham Cammon SW 4 (140 Beds) 

(A General Hospital for kkomcn and Children) 

Spplxatiors ate mvited from medical women for 
iS undcrmcntiorcd appvvirtmert 

HOLSf SURCrON for a period of six monihv 
Ijom Vrternber Ut IQ's Salary at i)ic rate of 
sir'') per annum with ba^rd residcr c and laundry 
C jnJ Jai(ra arc requested in call on Slcmbers of 
th“ H »n STedr ‘41 S iP fxforc Saturday Jtify ITlh 
by wb h date Dn»%|ivjii rs and e n»cy of lesii 
r-* p jl mu t rea h Bk Scerci'ry at the H<rip itl 


juL^ 2 

S t ptrrRs hospital rou stone nc 

HcnncUa Street Covcm Garden \N C 2 

The ofiicc of HOUSE SURGEON will fall vacam 
about AuRust '’Oih and applie itlons arc invited 
from mile candid qcs nub previous experience in a 
simil ir oRiee at a Ocncrvl Hospiial TTvc Nvlaty 
olTcrcd is at the rate of 175 per annum witii boanl 
loJRinc and himdry 

On April lat 1939 tvud sublcci to the rccom 
nicndation of the Medical Committee the House 
SufReon will be adv meed to the oBlec of Ucsidem 
SurUcal OfEccr for a period of six months 
Candidates shptdd tficrcfore be prepared if sue 
ecssful to remain at the hospital for nboul thirteen 
months in all 

Applications accompanied by conics of icsil 
monials should be forw ifdcd to reach the urulct 
sfsncd not later (hut the first post on Wednesday 
July CdU 

BLECHE\ ROGFRS Secretary 


Q ueen maio s hospital toa thi 

EAST LND 
Stratford E 18 

Applications arc invited from fully qualified and 
TeRVstered medical men (<udi) for the post of 
CASUkLT\ AND OUT PATILNI Oil ICER 
The Hospital contains 219 bed (ncfiKlinj. 80 for 
Maternity pavvents 

The appointment will date from July iM 193s 
and will be for &ix months Silary it the nte 
of Ct<0 per annum 

Candid vies vvlio must be single nnd who should 
prcviouslv have held hospital appointmcms should 
send ipplieatious accompanied by icsilmomaK to 
the undcrMf.netl at once 

RAPHAEL JACKSON Mvlor 

Secretary 


T HL GORDON HOSPlEAl FOR DISIASIS 
OF THL REC^U^( AND COIGN, 
Vincent Square S \V I 

present accommodation 62 Beds On completion 
of RchmldiuR leeommodation will be 10. Bed;* 

SURGICAL REGISTRAR 

(he Committee of hfaniRcmcnt invhe appheafions 
for the appointment pf Surcicil Recistrir Camh 
Onus must hold the I KCS Dlplomv or the 
Sis decree of a rocognl/’cJ UpMtrvitv 
Applications with copies of three Tcccni (csu 
monials should be submitted h> July 'dih uext 
addressed to i)ic Secretary it the Hospital (tom 
whom details coneermnR duties and terms of the 
appointment can be obtained 


THE CENTURY 
INSURANCE COMPANY LTD 

7 LEADLNHALL STRCCT 
LONDON. E C 3 

16 CHARLOTTE SQUARE 
EDINBURGH 

Assists Doctors 
TO PURCHASE 
A PRACTICE 
OR 

PARTNERSHIP 

NO GUARANTORS REQUIRED 
REPAYMENTS ARRANGED 
BY EQUAL QUARTERLY 
INSTALMENTS WHICH M 
NOT VARY WITH PLUCTUA 


TIONS IN THE BANK RATE 
pirAsc vrniTr ron 

VARTICVI Alts, STATING 
AGL NLXT liinTUDAY 

MENTION ' B M J 













JULI 2 I93S 


THE BRITISH MEDICAL JOLPNAL 


PERCIVAL TURNER 

LTD 

AIEDICAL AGENCY 

— — — i « E > TVGLISIt ’=' 0 -60 ^ F \ r^i — 


-25, 3IAIDE^ STKA^D C Z 

(Comer of Bedford St tei) 

Telegram tp om n Lrn Ion 

PI one Temj ?e Da 9011 (3 I n< ) 

After office hou'^ \\ altoo-on-Thame^ I 
A SI nnts nnd Locums Prcvidcd % iihoui fee to 
Pnccipals Pfaaices in\esijc-tcd BooV, keermr 
Debt CoIIcctinp etc 

MWniLM INCLl«nF COMMI-^ION FOD 
''OLE VfENO ON s\Ll OF PKICFICL OR 
bH\RF E\Cll‘-nL OF HOI -E PROPERTY 
roO FLLL lERM^ ON REQI LbT 
ANTED 

BY MB ChB MIDDLE CLASS PR AC 

TICE in or near London or Provin lal Tovad Ir 
come to £1 000 to tl 00 p a Capital to t- 09 
FOR DI'-POSU 

YORKSHIRE DALES— BEAUTIFUL 

ccuniT> Aicrape £I WX> pa Panel 7/fOO Pre 
raium £1^00 Large hou c and ground enU £60 
pa Suit residcrt patients Smaller heu e as<.iJ 
able — 1 

KENT WITHIN 20 NflLES — ABOLiT 

f 00 p a Panel Pfemiun £ '0 or near Nive 
house, for sale or rent — _ 

DEATH VACANCA — GLOS — £900 

pa or more Pan I oser ®00 PreitHum £®00 
Scrav-deta hed home ^ bed er large garden 
£^^00 freehold — 

MIDDLESEX SUBURB — HALF 

SHARE of about £- 000 p a Increa mg panel o\er 
600 Dcscloping area Oiticc of house Premium 
£.000—4 

GUILDFORD— NEARLY £700 PA 

fast increasing Small pam.! Scope Small hou c 
to rtm at CO p a — ^ 

LONDON N E — £1 460 P A PANEL 

2,300 Ample scope H\lf share with ucvcssion 
oon Rent £•* pa — 6 

DEVON— UNOPP COUNTRA OVER 

£I 100 pa and increasing P,.ncl \ onh £’C0 pa 
Appts £60 fO Premium £I '•*0 ELTcellcnt free- 
hold hou e 6 bed garden etc — * 

LONDON N 12— OVER £200 IN- 
CREASING and scop^ Panel 0 Fees -/ to 
JO/6 Conv hou e m eTceJleni pc inon to rent — ^ 

NEAR BIRMINGHAM — AVERAGE 

£7/800 pji Panel ^00 Premium <“1 00 Hou^c 
4 bed garden etc Price £900 or let —9 

LONDON W —AVERAGE £1 260 P A 

Better<lass non-panel Fees -1/ Premium 

£I 7*0 or near Excellent hou e 6 ^ bed et to 
renL — 10 

SCOTLAND (HI— COUNTRY OVER 

£1000 pa inc! panel of £^0O pa \iu» * to 
*s Premium 11 scars purcht e of offer Good 
hou<e rent or sell — U 

MIDDLESEX— SUBURB £I OaO P A 

Pane! 600 increa mg P NI S £100 IVemium . 
years purch.s Comf hou c (4 bed > Sell or 
Iti —12 

-MIDLANDS — AVERAGE £1 06S 

Panel nearly I (KXl Prem 1 1 sears pur hasc Good 
detached hou e 6 bed nice garden eit £1 - o 
freehold — ix 

LOCK-UP LONDON SW— HELD BY 

<‘4«;* pa Panel abi PO Prem IJ 
years purchase — 14 

LONDON \V 2— AVERAGE £1900 

pa Panel 1 00 Fees */ to .1 Lea c of im- 
posing hou e for di posaf — I* 

LADY DR S PRACTICE— EASTERN 

SUBLRB £1 400 £1*00 pa Small panel and 
P S Premium U sears purchase Well-equipped 
urgery and living accom tsO pa — 16 

KENT SUBURB— ABOUT £'00 FA 

increa ing Pinel 1 0 Fees j 6 to fb Pre 
mium £,00 Detached m-*dcrn residence 4 bed 
and good garden — 

LONDON W 12— AVERAGE £S00 P A 

Selected panel of 900 ope \ i its 6 to * 
Premium _ sears p ireha e Large hue pan let 
off at over £ 00 pa — iv 

LONDON N IS— £i00 PA WITH 

scope Branch PRACTICE Pane! .t*' ''•ice 
hoiiNc to rent — 1*5 

CO DURHAM— AVERAGE fl 2-.0 

No panel or d: pen mg Premiim *‘.000 Semi 
det ched 4 bed etc and large garden Price 
£1 tX)— .0 

K ENT CO AST TOVVN — tORASHARE 

receipts £- 6*0 r a Panel o er . IXX) Good hue 
on r(.ntal xi fS5 p a Prerrmm ears purchave — I 

CROYDON AREA — NEARLA £700 

pj Pane *.00 ircren mg Ou'' ei Pr^ um 
about tS 0 Semi-dctach “d hiu c to rc"t — ' 

NO charge to PLRCH^SERS 
riNxNCI\L \SSIST\NCE \RR VNCEP 
ASSISTANTS— A AC ANCIESINTOWN 

and Counirx Ird'AT «nd Outdvr Lit i.n 
arpitcatjcn 


THE MEDICAL AGENCY, Ltd 

DUDLEY HOUSE 3G-3S SOUTHA3rPTOA ST^ STF AVD U CS 

TeUp) f.m~Temr’c Bar 10 -r-io 4 E -bi-h-d t- k j ^ 


^^roOLESEX WEST — Wel-establi hci.rr xedG P 
Deta hed hou e <pc II bui' L-r e ga c-n 
Receipts .pprox £ 00 Pa cl 1 00 Fees 

6 up Premium 2 \ears perebase 
lORKS — Mixed GP si u.ted r-.r Lr-e Cit 
Re-eipis £1 00 Panel 2 1*6 Sui ab,c hue 
available Fees j 6 up 
Prcr-ium for Prucu-c. 

£2 *00 

ESSEX (Near London) — 

Well established G P 
Receipts approx £1 C03 
Porcl over “00 \fediurti sized house av-ailaH c 
Garden p-raue Fees - 6 up Premum 1 * tears 
purchase or near offer 

LONDON N W —partnership— G ood cLss 
non-dKpen ns PRACTICE CoT-r hot. e 
Receipts approx £2, *00 Small pan-! Prerngm 


. e--» r H-s 
LONDON W_-_\ 
d rtul t 
Rece 1 *-0 
H use .-d P- 


ca PP\CTl''l 
- h 'C . 

1 S. -c 1 

- *•■*' T 


LOCOIS AND ASSISTANTS 
ADM AYS AA AXLABLE 


LO''"DON S E — (W ihn 10 r* - L -- 

Ml d C- ^ a r 
PRACTICE C - 
to re -1 1 < R - 

rea — i ■* P e 
- f* nc-ea 1 — 

r'c- P 

** h,*se 

GLOLCESTERSHIRE. — PARTNERSHIP 

4 1 ta- 1 p Se— ru-a OP C 
Icca’i: HAu.ctorer Re e - - 

* sh ,. n ; . p . ac ^ 

man .bo 0 


MANX OTHERS FOR S\LEL DETAILS ON REQUEST 


ENTXBtlSMED Ifc77 


LEE & MARTIN, LTD, 

The Birmingham Medical Acencx 
71 TEYIPLE ROM BIRTHNOHAM 

r frgrums refcpfione 

LoAum Birmingham 96 j Mid and B hart 


TRANSFER OF PRACTICES AND 
PARTN’EKSHIPS ARRANGED 
MXXIMLM FEE EO if C-x lusivclr 
ertrusted to u- 

4CCOL\T<: /\1 rsr/G/l7TD 4ND /SCOHE 
TAX RCILRSS PREPARSD 
RELIABLE AND EFFICIENT LOCLTMS SLT 
PLIED AT SHORT NOTICE al o ASSISTANTS 


H ANTED TO PIRCH4SE 
1 BlRNllNGHAM tor «i»hn 0 niJe* th reoO — 
Gocxl Mixed PRACTICE v ith a Panel o I ih 
oter and reccipc of from tl,500 to t 009 
LRGENTL^ REOLIRED CAPITAL A\ NIL 
ABLE 

- REOLIRED Good ENGLISH SCOTTISH 
and IRISH LOCUMS mmedtatelv Lo g^cd 
assistants re*t> to offer with or » ihcui 

xtevv 

FOR DISPOSAL 

1 GLOLCESTERSHIRE— Death \.caro tu 
etsfabli hed country PRACTICE Re c *- 
average £®P0 pj P.rvel *0- Good houve 
with all service* 

- staffs — Rapidly growing mxed 

Prtvute and Panel PRACTICE m pJcav-ni 
suburb Receipt la t sear tl 0*0 Pare! I 100 
Excellent hou*e with -II service* 
GLOLCE5TERSHIRE — W ell-establfhed nidd 
ard worLin <li PRACTICE Revcipfs av 
£I 0 pa Pan I 1 -00 Coed scope to in- 
crea. e Good houNC 

4 LANCS — O d-esi3blt*bed triddlc and workiog 
cU * practice Receipt av -3 t-0 pa 

Panel ^ 000 Excellent heu e with all *cm cs 
* LONDON -OJd-cstabli hed mixed Pn "te and 
Panel PRACTICE Reccir s £1 ' S pa Panel 
906 ample scope ard giod hcuNC 
6 LANCS — Old-establ-*hcd middle and wero-mg 
cla practice. Reccir ar I 40») pa 

Panel I 00 Good cope to imcase and good 
bou_e 

FINANCIAL ASSISTANCE aff rd-d to ap- oved 
apnficants for the purch-se cf Praetwes or Partrer 
hips on vers reasonable term Full r-nicubrs on 

3PP leauoti 

RELIABLE AND EFFICIENT LOCUMS 
SUPPLIED AT SHORTEST NOTICE. 


Telephone Welbcck - * 

Telcmarts Asstsrn to, Lovoov " 

NURSES 

VI VLB OR FEVIVLE 


TRMNED NURSES FOR 
MENTAL. MEDIC VL SURGICAL, 
AND FEVER CASES 

\ li trt rf I*J. r f ’»* c J c c 

a G lab c lor urperi cG t D T ^ t t 


THE NURSES' ASSOCIATION 

(In terpurct s with the MALE NURSES* 

ASSOC! ADON ) 

29 Y'orK SU Baker St-, London, t 

Mr* MILLICENT HICKS > t 
\\ 3 HICKS Sc-ru 


THE WESTERN 
MEDICAL AGENCY 

LON-PON and BRISTOL. 

Dr K H Bennftt -g Dr W ] r x i 
give Dcrs raJ -tt r m to evc-y c 
F 'lU—:- 4f sta-^ce fe i d i f t 

ct ^led ca' Ir j e g jmred 

LOCLMS AND ASSISTANTS SEPPLIED 
WITHOLT CHARGfc TO PPlNCIPlLS 
For ex fu IV A^cr-v j — — ^ 

ivbivh ir Ilwcs c ervth v d ex ep h e tv 


I DJRSET COAST DEATH \vC\SCv , 
del hifu! p'f' Ne- s £1 U > p F e i 
1 >«r*r pLT ha e tiood h re 

- WESTERN CITA —Weru rPACTICL I 
n ailed o-genu t> wuh ex e \s 

c" j"!! relu -d R p d v t m 
Over pj C *v, he e 

DEV ON CO AST — *-ar PP VCTICF 

•oed i''c n dc » r n C 
fer <-!e Re cnily r i r* 

1— 0 U scar H r T 

4 LONDON E — Lar -h PR^mcF Pj 
• 41 tv _ t f, a Pre^ M 

rert 

« COAST —PP ACTICE n rv" - 
P'P ! I 0 9 t-_ 0 p j e j 

pu ha e Heu rr“ P >ral j 
6 CORNW all— C eur r\ PR XtriCE r h 

ful r-iix A l PC'* P- F e N * I 

pa scars p h e Hv-ve r- 
" SOMERSET COAST — rAPTNFP*-HlP 
c umrv town Pa el I ) Over i.*l pa 

Th rd hare <t - scan •'u h— Hr e c T 

8 CORNISH CO VSTT— PRACTICE t- ^ re 
pan. Groutp pare! Abe it *^*1 p Pc 
miura tl Fits Heuve - e r re** 

9 LONDON NW —Pare! U9 p Pr 

nur^ £I OOl Heave a!c cr rert 

10 LONDON SU — P cl f' Ovc i pa 
Prem jm *1-0 Hcm^ tr*! 


22 CLARE STKEFT BRISTOL I 

T }eg Mcdgen Br el Te! B r » 9 

15 BEDFORD ST., STRAND \\ CJ2 

Tel Tct'c c B-r 


E*t k I iirr I 

PEACOCK & HADLEY Ltd, 

TIEDICYr TR4.NSFFR ACFNCY 
67 68 OiandosSr BedfordSt Strand \\ C,2 

Trie G^r" Herharou Lir**. .are Lr-u — 

Trl Tcm- - E- r4 

Th-* ow-rr-uh -d tre-'v r- ■* ra t'-r A 
of fACTICIIS rd P\P fNERSHIP^ o- re 
ab e terr- » *• ca b- c*- - - rr a-'' - 

LOCUM TENLNS -d ASMSfANTS — - free 
c chjr-c t rr — uH 

CAVTNDISH NURSES 

.*• VLVI,E VND FE-VLVIL 

jj 

-I nrtl VONT -TTtllT lOMOA r } 

F= es 1“ ov 

CLA'^Cn i * "e 

DirLI\ ^ L '■ f 

Te t r t L-n " 1 “ V c r 

V. — At 

nu-fr c “D 

Tt er e-- T Le-- _ t U 

T fc- v I 



THE BRITISH MEDICAL JOURNAL 


Juu 2 1918 





{The SCHOL^iSriC Cl ERICAI A MEniCAL \SSOCIATION 

<IoUSDLO IbbO) 


Sea, 


Tele Address 

Triform IVcstcent — London 


TAVISTOCK HOUSE SOUTH 
TAVISTOCK SQUARE, WCl 


Telephone Enston | 


The Assocntion has long been faNonnblj known to the members of the Medical Piofession is a Ihoronshiv 
truslworths and successful agency foi the trmsaction of e\crj description of Medical Scholisltc, and Accoiinlancj 
business and the BRITISH MEDICAL ASSOCIATION has e\erj confidence in recommending its members 
to consult The Manager in all transactions requiring the ser\ ices of a Medic il Agent 

Members of flic British Medical Association ma> take adaantage of a reduced scale of cliargcs apnlicalilo 
to them ^ ~ 

REDUCTION IN FEES 

In cases whcie the Buieau aie sole Agents the commission in 
lespect of any sale of goodwill, book debts furnituie dings 
fittings and othei effects (e-scluding sales of any fieehold or lease 
hold piopeitj oi of piactices, effects etc, outside Gieat Biitain) 

IS limited to a nia\imum fee of Fifty Pounds 

FUIL TERMS ON ATPLICATION 


Pracfites and Partnerships for Disposal 

1 S COAST — Better class non dispensing PRAC- 
I ICE in fivounte witeiinu place Receipts £2 4‘i5 pa, 
including general surger) and ear nose and throat work 
Excellent non basement house Purchaser should hold 
r R C S Hospital and chance of appointment Premium 
one and three quarter >cais purchase 

2 SW ENGLAND —Country PRACTICE oxer 
tl,400, in beautiful part Panel about 1 100 Exccptionall> 
nice modern house standing in own giounds for sale Hunting 
and shooting Scope Premium two years purchase 

3 EASTERN COUNTIES —THIRD PARTNER 
required m Piacticc is 200 pa in market town within 
90 miles of London Panel o\ei 4 000 House to icnt 
One fifth or one fourth share two years purchisc 

4 CENTRAL LONDON PRACTICE —Bettei -class 
part at comfortable West End family Hat Largci lock up 
brineli 10 minutes distant Both incrcising Pinel 1 6S0 
Receipts past scar £1 698 ( iscraqc £1 460) 2ycirs piiichasc 

5 SE COAST— PARTNERSHIP m Practice 
axcriging £4 100 pa in growing resort Panel I I'iO Good 
house (4 bedrooms) to rent One fifth shiie at first at two 
years purchase 

fi MIDDLESEX— PARTNERSHIP in Practice 
o\er £4 000 in growing town Panel 2 100 Modem detached 
liouse for sale or rent One fourth shale it first it two and 

I quirter yeirs purchisc Prehminaiy Assistantship 

7 Consulting Car Nose and Throat PRACTICE 
in industrial eily Rcccipis 1917 £l 192 Centrally situ tied 
house to rent Pureliiscr should hold I RCS and luxe 
speeialist experience Piemuim two ycirs purchase 

8 KENT — PRACTICE in dex eloping district 
12 miles from London Receipts pist year oxer £100 PincI 
ibout 461 House (1 bedrooms) to rent Ample cope 
Premium £710 to include drugs etc 

9 BIRMINGHAM —Medical Womans PRACTICE 
ixeraeing £1 269 p i Panel nearly 400 Good house xxilh 
eirice iiui gaideii Priec £100 le isehold Seope Premium 
one and three quarter ye-irs purchase 

U) S AFRICA —PARTNERSHIP in lucratixe 

PrieUi.e in Natal Shire xxorih ‘bout £1 800 p i il one year s 
piireh ise Appheant should bi. compelent surgeon and pre 
ter iblx in I R C S 

II WEST END neir Lords Cricket Gioiind — 
PRACTICE ixer ging ibo it £1900 p i in ideal residential 
pill Pinel ibout I 10O with prospects of good increase 
XX ell built detiehed double fronted house xxilh garage md 
nn.e I’ed euden Ciood introduetion Premium £1125 

i: MIDIANDS -PARTNERSHIP in mixed Prae- 

ii^e £- siK) p 1 in prosperous toxxn Panel oxer 1100 
Modern I ib uir s,ix in„ bouse to rent Premium one third 
shire £1 1IK1 Us ir hide drugs eU Hospital 

1 1 S W or ENGL \ND —PARTNERSHIP in mixed 
eo mtrs town Prae'iee oxer £6 400 Pinel 4 100 Share xxorih 
£1 'i') at Ixxo xeirs purehise Prehminarx Assistantship 

14 W M1DL\NDS— PARTNr.RSHlP m non dis- 

[xr la^ Pravli e iboi t £1710 pa in beautifully situated 
ei’i lx tovn Pinel 2 '•00 House to rent One foiirlh share 
It lit 1 1 iwo xeirs purehise Aced ihout 0 with TRCS 

p e erred Prel nun rx \s isiinl hip 


Full P articiiliars sent free 

15 MIDDLESEX —PARTNERSHIP in sletdily 
incrcismg toxxn Practice about £2 000 p i Pinel 1800 
House to lent Premium one half share txvo ycirs purcliasc 
Applicant should be English or Scottish 

16 SURREY— Medical Womans PRACTICE in 
outlying subinbin district Receipts last year £140 House 
foi salexir lent Scope Premium one ycirs puicliasc 

17 S AFRICA — Medical Woman holding D O M S 
lequiied in Ophlhalmic Practice Experienced in operatise 
xxork and not over 40 preferretL SHARE about £1,000 olleied 
after ASSISTANTSHIP 

18 SUSSEX —PARTNERSHIP in good class Prac 
ticc nearly £1 000 in favourite market town Panel about 
1 200 House (4 bedrooms) etc Rent £80 p a Premium 
one half share £1 000 

19 S COAST— PARTNERSHIP m Pnclicc over 
£1,000 p a , in seaside resort Panel about 2 000 Semi detached 
house (5 bedrooms) for sale or lent Premium one hilf shaic 
£1000 Excellent hospital and scope for surgciy 

20 MIDLANDS— Country PRACTICE over £1,300 

pa m hunting district Panel 146 Good house (1 bed 
rooms) garige md good garden Mam water ind electricity 
Price £1 400 trcchold Premium two years purchase 

21 N'E ENGLAND— PARTNERSHIP in non panel 
Pnctiec, doing ibout £6 000 in one of the chief towns 
House aviilablc One sixth share at two years purchase 
Partner should be surgically inclined 

22 LONDON, S E 1 —PRACTICE about £1,150 p i 
in populous district Pinel 1800 Corner house Rent 
£101 pa Scope Premium two years purchisc 

23 LONDON, SE13 — PRACTICE averaging over 
£610 pi Pinel 800 Accommod ition avail ibic Premium 
tl |10 oi near olTei to include waiting room fuinmire etc 

24 LONDON, N W —Medical Woman s PRACTICE 
oxer £800 p 1 in growing district Panel 740 House for 
silc or rent Premium I) years purchase Appointnicnls 
xxorth £210 p a idditional possiblv Ir insferable 

25 S COAST HEALTH RESORT— PARTNER 
SHIP in Praetiec ibout £1 100 p i Pinel oxer 1 100 House 
(1 bedrooms) garage md garden to lent Premium two 
fifths share £1 210 to include drugs etc 

26 N OF ENGLAND INLAND SPA— PARTNER 
SHIP in Pnctiec ibout £1 900 p i Panel 1 200 Excelicnl 
house (8 bedrooms cte ) forsile Scope Premium one half 
share £1 800 

27 S COAST— PARTNERSHIP in non dispensing 
Pnctiee oxer £S 600 pa in health resort Pinel about 600 
Shire Xxorth about £900 il two yeirs purchase rurlhcr 
share in two years 

28 S OF ENGLAND— Easily worked PRACTICE 
about £1 OOO pa in C ithcdnl city (clubs xxorth about £160 
ind panel 1 06s) House (6 bed and dressing rooms) for s.ile 
Premium H years purcliast or xcry ncir offer 

29 W'EST END OF LONDON —Good class non 
dispensing PPACTICE about £1 HO No P mcl 1 oge 
house to rent Premium lease and practice £1000 

10 BUCKS— PRACTICE in growing town Receipts 

list vear £894 Panel about 790 House for site Well 
equipped hospit il Premium £1 10O 



JUL\ 2 I93S 


the BRITISH MEDICAL JOURNAL 



(The SCHOLASTIC CLERICAL 4. AIEDICAL ASSOCLATXON 

(Fot-VDEO 


Tele Address 

■Triform Westccnt — I-ondon 


TAMSTOaC HOLSE SOLTH 
TA\7STOav SQUARE Cl 


Telephone Eii*ton 


Mk 


Practices and Partnerships for Disposal (continaed) 


W 6,— Non-dispensing PRACTICE 
tl OW) pa Pleasant suburb No panel Hou <. <5 bedrooms) 
garage and garden Premium hou^ and practice £2^00 

32 ESSEX — Countrv PRACTICE about £700 pa 

Panel about 4‘iO Verj good house (■: bedrooms) garage and 
garden Rent £65 p^ Premium £I 0^0 

33 LONDON, S W — Medical Woman s PRACTICE 

about £960 pj m outlvmg suburb No panel Suitable 
accommodation available Premium £9^0 

34 SURREY — Medical Woman s PRACTICE about 

£500 in developing distnct No panel Rent of hou e £100 
p a Scope Premium £500 

35 SMALL RADIOLOGICAL PRACTICE m 

pro^^nclal town Good opponunii> for voung able man 
Pro‘;pect of hospital appointment later Premium £1 600 to 
include modern plant (value about £I 100) 

36 PARTNERSHIP in increasing Ear Nose and 

Tliroat Practice in provincial town Partner muit hoid F R C S 

37 MIDDLESEX— FOURTH PARTNER required 
m Practice over 17 600 pa in rc^>idertial distna on the 
Thames Panel 3 600 Hou c (5 bedroom^) to rent Scope 
Premium 6/jOthb share £^ 100 

38 LONDON N W— PARTNERSHIP in Practice 
averaging about £^ 200 pa Panel about 6 000 flat onettc 
(2 bedroom^ etc) to rent One filth ^h«rc at fir^t at two 
vear«; purchase 

39 NE COAST — Middle and better uorking-class 
PRACTICE over £1 UO in seaport town NoT panel 
Pnvate residence for ale Premium £7'0 to include furnish 
mgs etc of consulting rooms 

40 LONDON W9— PRAtmCE doing between 

£900/£9^0 pa in residential di tnet Panel about 60 but 
pleniv of scope Rent of maisonette (4 bedrooms) £200 
Premium £1 0^ or offer 

41 S WALES— Chiefiv non-dispensing PRACTICE 
£8*^0 pa in seas de town Panel "^80 Centrallv s tuated 
house Pnee £I 250 Good •'Cope Premium £1 4*>o 

42 LONDON N W 4— Middle-class PRACTICE 

about £800 in developing part Panel jOO Hou e (3 

bedrooms) for sale or rent ScopKi Premium £1^0 

43 LONDON SW 16— Medical Womans PRAC 
TICE over £1000 pa Panel ‘r 0 Semi deu-ched house 
Pnee £950 freehold Scope Premium £l 500 


44 HOME COUNTS —FOURTH PnRTNEK 

required in PractiLC m growm, town P-r I ir l— - 

partner must be cn^rg^tiu aged abot 0 (man -’ll p f 

with a leaning towards netficir-* Imira! h^rc 
P-a Prem um £3 (XX) Prelim narv -i m -t' ^ p 

45 S 3\ OF ENGLAND — Non-dispen^ ng PRAC 

TICE averaging £16 6 pj n Lvounte w^ p’_ce 

Small pa^el Seni-detauhed hou e fo •'ol'* o re^ ~ Gc J 
hospit*.! Premium £2 

46 CORNWALL— PRACTICE, averag.r^ m 
market loen on West coat. Pare! 2IX> Ho^ ^ tMi lx- > 
garage ,.nd carden for ^le or rent S<.op^ P tm'lL'n ■* 
and a quL-rtc' vears purchase ihalf downi 

47 LONDON SE22— PRACTICE in Miburp n 

district ReLcip > p_st vear £1 _£4 F,.pel 70i> Gcod ho v 
with ga-^ge and ni-e gard n for o rtrt Prem um 
two vears purchase 

48 HOME COLNT\ — PARTNERSHIP rn PniL icc 

averaging £ JOO p-. n beautifu b itu,. *<i uo-- -v 
Panefabou 1 0 Choice o hou'C Intcmn. pan-c 

be CTpcnenc^d and ac'^d wbeu -0 Prcm,-n f' 

«hare two vears purtha e Hen-pt *.1 

49 LONDON N 7— PRACTICE averaging 

£2 000 pji rcluding vJuab'e ‘inpo r rr*''i -'"d p-r 
Sm„ll hoi.N^ {j b-.Jroomsi ard mall care - 'vr 

or rent Premium t-* -tO o re-r offer 

50 LONDON SV —PARTNERSHIP in m!\cd wl,. s 
Practice about £- n pj tP rcNid-mtial a^-rb ^ "-I _ 

\erv ni^e houe vtth carage *.nd quwr*e - n. e*- d •* Ic 
ale Two fifths h-re at hr t at two sea p- h- c 

51 N MIDLANDS— PRACTICE m revdi.r 1 

distnct rear progressive tow" Reueip- 19 * P " 

about 100 Hou c t- bed ) fo w t Gv.od Pte*^ v. v ^ 

OZ LONDON SW9— Non pane! PP \CTICL 

averaging over £I ^ 0 pji Hoj e on natn re d lo c*' 
lease" Premium one vea“s p-rcha e 

53 S LINCS— Countii PRACTICE n^u-Iv rj 

pj m agncultural distnct Hou c to ren Premiu'^ -I '"O 
to in\.Iude sur_er> fumitu e Mom S Sali.O’* ca e w e c 

54 CORNISH COAST— PARTNERSHIP m non 

di'^pen mg Practice nearlv £ 000 in favoune roo'* P-** t 
1^00 House obtainable 0"e tn d sha v. at teo ve r 
purchase Good anaesthstit requ red Short A hip 

COLONIES — Number ot Cofonial PRACTICES 

Incomes ranee from about £7'0 pjj upwards. 


■'Ou 

-D 


Purchasers can raise additional capital for the purchase of approved practices or shares 
Particulars will be forwarded on application 


All communications fo be addre<sed to The "Manaijer 


Vfoncsrr 
V\ M SCOBIE. 


SCOTTISH BRANCH, 21, Alva Sn-eet, Edinburgh, 2 

FOE DISPOSVL. ' I=raiVTDrtD,-U I ra^-,r.r 

A SCOTLAND— Old establisned Cit\ PRAC 

TICE Receipts approxirmtds £2 JOO Panel 2 ‘^'X) Hou c 
price £900 P crmim two tenr purcrasc or ne’e ofler 
B YORkSHIRE— Countr\ PRACTICE Receipts 
£1 200 Panel SOO Excell nt houbC with garage Price £1^00 
freehold Premium one and Ihrec-quaricr \cars purch_ e 
C E OF SCOTLAND— Manufacturing town Rc 
ceipis about £12110 Panel 1 I'O Auraclwe hou c prce£! sno 
Prem im one and th ce qinfter vearx purebaee or nc^r oll^ 

D EUINBLRGH— DEATH VACANCY —PRAC 
TICE \en_in" In X Amp c scope for pniaic and panel 
CxLclIcnl hoj n I r ap An' rtaxonahlL offer 
E E OF SCOTLAND — Ccuntrx town Receipts 
last sear »6SX (appomtmen 4112 r^nel ‘6') Exccl^t 

house walhgirage and sirden Price £I 4^0 Prem cm £I ooo „ 

Fo" further details applv Tl e la-ager ojs a ^ " 

Terms on which the business of the Emnch i= wall be sub 

Mananci to whom all commumcatiors should be addressed 

“ to LOCL^IS AVD ASSISTANTS ARE LBGENTLA EFQXTFED BA 

letuais OFFICES OF THE BLELAC 


Tt ’•e 


EDINBURGH— Lads "Doctors PRACTICE 
Rceei- s las' sea £f;<4l P a-l e/) Su h - hr ~e l " . 

or ra ah' !e Premicm c-" a^d a scar p e'a^ 

G N OF SCOTLAND— Counirs PRACTICE 

Lo-- cstab'i b d Rc c p ap- ox -_i '£!'■£' P-"'! - 

H \\ ALES— PAPTNERShIP m co atr to n 
Rccei- s £I^nO P- — I oscr ' foo S' ' ''as ' c 

££10 O c haK s'-- c al o'- sc- r - r 
I EDINBURGH— PRasCTlCE do rc £-1 I H. 
rrc t I" b ah p cm — - l ’r- - -i ' ' 

K EDINBURGH— PRACTICE ag-c -102: 

P-r-I SO Pacohe c--rl ---s' r- -I - ' 

■C arJ s --c--" r s- p- s_>- c ' c‘'er 

EDINBURGH —PP ACTICE 'fcs L' £al>^i Si 

be- c lo r— Pea o'-h c r"c' c " c cd 


C- 

L 

ab^ 


♦ ed applicnt c-" 


to hp B-urr 


THE BRITISH MEDICAL JOURN \L 


JUL\ 2 1938 


f.8 


INDEX TO ADVERTISEMENTS 


PLULisiirus 

Unttsh McJic il m 4 

6 16 19 


ChurcliiJ^ J ^ \ Lid ^ 

H K L Co Ltd " 6 
Lmriv, stone CCS 4 

Mitnnlhn 4 

Osford Un»>crsiT% Pfs^s 6 

] n mioncr 2 


S^iin-lcrs U n C Co Ltd 


ASSUU VNCE & INSURANCE 

Ccnlurv Insunn c ^2 

AJrJj IXftntr Union Sopp i 


BVNKS & nWNCe 

Hriti Medivil I irnn c Ltd 


CHEMISTS 

Abh 'll L iboratones ltd 2^ 

n uvf Pf< duels Ltd Coicrm 

H sU Pure Driu C o 20 

nni 'h OrUs Hoiiv^s Ltd 2124 27 
flriush f-ct <'f Cs» Ltd Coscrii 


1 riudi Ooi’^n Co Ltd 


It 

Burr 

uv fu W tlL me L Co 


13 

C lb 1 

ltd 

Cover 

in 

Ct 11. 

t k Cc >pcr I td 


16 

C ont 

inentiJ 1 ib ninncs Lid 

12 

Dmn 

1 rd A Cl Lid 


20 

lilt 

iHv CCd 111 


29 

1 t X 

C t VCo ltd 


n 

t 11^ 

H <in Ltd 


2\ 

C IJ 

1 at rji rte 1 id 


14 

III.* 

Vi l 3 1 A C > 1 Id 


14 

It 

1 t C J L S n Ltd 

Svipp 

IV 

Ir n 

J t id C 1 ltd 


16 

f 

^ 1 Id 


1 7 

M jri 

1 nji» W 


IN 

I ,1 1 

c l>Ji IV C (. 

C Tver 

(V 

I CJ 

11 kC Ltd 


17 

} 1! 

F; ' > 1 1 J 


17 

I If 

J K L rj n 1 Id 

14 


Chemists — cotjunurd 


Kiddcll Francis Ltd 

21 

Roche Produs-ts Ltd 

21 

Simpkm ALL Co Ltd 

6 

Snmh Mirtm H Co 

19 

Spirklets Ltd 

U 

rOODS, REVCRVGES 

Aden & H'l/iburii Lid 

31 

I airchdd Bros L Foster 

21 

Hovis Ltd 

16 

Hushind J k L Co Ltd 

IS 

Marnuie Fo^d Ext Co Ltd 


Mitcliellidfi Biscuits 

IS 

Nestle s Milk Products Ltd 

16 

rotfci LCo Ltd 

40 

Robb \lex L Co Ltd 

19 

RvvifaCo Ltd 

'0 

\ ileniinc s Mem Juice Co 

19 

W'lndcr A Ltd 

Co'cr II 

MOTORS & ACCESSORIES 

HenUs 

9 

Lodqt Plui,.s Ltd 

IS 

Minn FikCrton L Co Ltd 

Supp 1 

N VME PLATES, etc 

Co«>Ve s (Finsbiirv) Lid 

40 

Mall ! n LCo 

40 

M rd S J LA 

40 

Lew IN, H K L CiT Ltvl 

40 

Ovbornc F L Co Lid 

40 

W hitc Bfonre C< 

40 


PRINTING, TV PEW RITERS, 

etc 


Tt'lor s Tvj'^.vvrucrv 

40 

SURGICU ARPVRATUS 


C ompfi 3 cm Ltd 

40 

Curiis M r Son Ltd 

12 

Pc outicr Bros Lid 

15 

Milliard 

40 

S ill L Sv n Hd Supp 

III 

Smith L Nephew T J Ltd 

15 


TAILORING & CLOTHING 
etc 

Burberrs-s Ltd 19 

CHrk C C 3 Lid Supp u 

Recent Dress Co 40 


TOBVCCO & CIGARETTES 

CiTTcns Lid Supp u 

PlascrsNo 3 

VACCINES 5. SERA 

Elans Sons Lcschcr C \Ntbb 
Ltd 26 

Gtnaiosin Lid 24 

Heineminn \\ Lid 6 

VRAIS & Cl LCTRO- 


MEDICAL 

Allen C Binburss Ltd 10 

Gcncril R'idtol<>t«cal Ltd 12 

Hinosn Lid 13 

Port iWc \ Riss Ltd 40 


\ I tor \ Ri> Cs rponiton Ltd 37 


HOMES & INSTITUTIONS 

rjtfs -to 41 42 4'> 44 4<! 4f. 


HOUSE AGENTS 

Pjs« 60 


HOSPITALS & CLINICS 

London Clinic 44 


S VNATORIA 

Cornnh Rnien S m 44 

CoIswoIU San uonuni 44 

Monnna Hill 46 

MnndesL^ Sinaioriuni 44 


SPAS, HCVLTH 
& m DROS 

RESORTS 

C?cvhoslQ\ akn 

43 

kem\orih> s H\dro 

46 

Fisiam Spi 

43 

Snudlcvs Msdro 

43 

WoodhMl Spa 

43 


MEDICAL SCHOOLS, 
TUTORS, & LECTURERS 

Pices 46 47 4\ 


NURSING, etc 

Pice 61 


TRANSEER AGENTS 

Bovnl Medic'll Acciil) b7 

British Mcdicil Bureau 64 6' 66 
Lee C Mirtin Ltd 61 

^fed»cl^ Agcne> Lid 61 

Peacock C UrHIci Lid 61 

lorncr rcAinl 61 

Western Medical Aecntj 61 


CONTRACT PRACTICE 

Paw 


HOSPITAL VACANCIES, cle 


Pages 


48 49 60 61 62 61 
54 65 66 57 61 


62 


CLASSinCD 

ADVERTISCMCNTS- 
(Wanlcd & Vicint) 


GENERAL 

Dridsh Comnirikial Gas A«n 7 

Brilish Elcclncal Dev Assn 0^ 

Driiish Motor Boat Co LtJ '6 

British Taspijcrs AssocijIk'h ^6 

FnnVlands L J C Co Ltii 
White 61 M6i. Co Lli) 


IN 12 EQUAL MONTHLY PAYMENTS 

STRICTLY CONFIDENTIAL 

TKtb practical con\enience is praised by 
medical men 

y 

V/RtTE BRITISH TAXPAYERS’ ASSN LTD, GRAHD BUILDiNGS, LONDON, W.C^ 

: 2 1 n S 'l 1 e'e" 1 1 c' 4",';;; T.. \^oi'vsi "ro"’ oCc 


9TFUL DEBTS 

CAN BE TURNED INTO 

CASH 


A specialised department is maintained for 
collection of medical accounts 


JUL^ Z 193S 


THE BRITISH MEDICAL JOURNAL 



PHYSIOLOGICAL SLEEIF 







SPECIFIC IN NERVOUS 
INSOMNIA and AGITATION 

OF THE OVERWORKED 
NEUROPATHIC PATIENTS 

ANALGESIC IN CHILDBIRTH 






\'N 



By AcJminislralion of 

EHRLICHS Original 5ALVARSAN preparations 

ISO DOUBLE AMPOULE 

containing the necessary amount of sterile redistilled wafer for 
preparation of soiulions ready for use 

NEOSALVARSAN 

T D t Neoarsphenamine D 

{Ehrhcbs O igina! 9J4l 

Also Double Ampoules 0 15 0 3 0 45 0 5 0 75 gm 

MYOSALVARSAN 

Tr,-D Sulpharsphenamine ^ 

For w^ranuzcular ard subcufareous i^iecficn 
Iso Double Anpocles wilb glucose solution 015 
__ 03 0 45 0 6 gn 

/bayer products ltd 

AFRICA HOUSE KINGSWaY LONDON WC2 


NOFTHZFM OfriC' 
t *'e c f* 

'lAOTFlA-S S-OJS' 
Pr,'SONAGE 
,, r CHfSTEP 3 


DU'Li O '1C 
I OLE5\ ORTH t-CJS' 
I 2 STH f? D rICr ST 
D U E L I N 



rii/ RVjTTirxiD I 
r’sUDUcn 






I\ 


THE BRITISH MEDICAL JOURNAL 


Jl,l\ :: 1935! 



RESEARCH LABORATORIES 

In a building is Inch stands apait fioin the mam manufaclui mg plaut 
the Parke-Daiis llcscaicb Laboratories house a staff of scientific 
norkeis engaged m the search foi neiv medical knoivlcdge^and m the 
elucidation of pioldems coiiiiecled nith the tieatment of disease. 

Each of the sepaiate phases of rcseaich ivork, such as bacteiiologv. 
bolani. chenustij pliai macologi. idnsioiogi. phaimac^. etc is 
suptiiised In a scientist of specialised tiainmg and fiequentlv of 
national oi intci national leputatioii Uiidei him is a staff of skilled 
le(hintian<- noikmg mill uii-lo-date cfjiiijmient in an endeaioiii to biing 
to light non knonledgi and to exploic nei\ a\enues m the conqiust 
ol di»c i..e 

I 111" muk of le^eaich nliicli ha« been m piogiC'S in the Paike-DaM" 
I ihojafoiU" foi inoie tb iii half a ceiiliiii. is not tonliolled In tune 
"(lit dub Ol t ill lid 11 — often mam iiioiitlis and even vcais aie spt nl 
in tin "ohition of a pioblem uul the onlv stipulation i? that the nmk 
"bill III done eon-i n nlion>.h and mil 

ca.. .50. miAii w.i 

I I'lui lUirn" ni>iin>I(»t Mid(I!<"(s. Inc V Li diilitv Llil 





BRITISH 

MEDICAL JOURNA 


JOURNAL OF THE 


se. 



ASSOCIATION 


SATURDAY JULY 9 1938 


PRINCIPAL 


Prostatic Enlargement and 
Its Treatment p 53 

Anaemia and the Gastro- 
intestinal Tract 57 

Benzedrine 60 

Placental Extract in 
Measles Epidemic 65 

Sight Acquired at 22 Years 
of Age 67 

Moulds and Asthma 68 


CONTENTS 

Leading Articles p 74 

Correspondence go 

Surgery in General Practice 
Shoulder-joint Injuries — II 80 

Reviews 71 

Tuberculosis Conference 83 

Charge of Procuring Abortion 97 


Plymouth Meeting Programme and 
Exhibition (in Supplement) 


WITH SUPPLEMENT AND EPITOME 


LONDON 

BRITISH MEDICAL ASSOCIATION 
TAtlSTOCK SQUARE 


^o 4M4. WEEKLI, PRICE 1/3 


Copyright 


REGISTERED AS A NEWSPAPE? 






n 


THE BRITISH MEDICAL JOURNAL 


Juu 9 193S 






^\j^0lCAL SERWCf 


Readily Adfustable; 
Consistently Comfortable— 

SALT'S MATERNITY 


/ Omrznitet 

' ^yuarantccfyaJicr 
‘^on^cracapUfK j 

‘Tnot rot«kf5i,ihii^ 


BELT . . . . 


• Ail the es*;enUals for comfortable and | 
effective support during pregnancy are | 
incorporated in Salt’s Maternity Bell ! 
Its design is the cutcome of many ycarc’ . 
experience | 


9 Facilities for easy adjustment are 
prosided by lacings at both sides As 
a result the Belt is at all times com- 
pletely comfortable affording support 
that IS highlj beneficial to the physical 
and mental well-being of the patient 


® Salt s Corset &. Belt Book contains 
Mcasure/Ordcr forms for the Doctor « 
U'c Interested Practitioners will receive 
this Book post free per return upon 
reque I 


I 


Mi 




:! . 
j 1 

1 \ 


‘I ! tj 


/N/'tJvX 


isALTArR^i> 


SAlTe SOH 




JLL\ 9 1938 


JOURNAL 


TABLE OF CONTENTS 


ADDRESSES AND PAPERS 
A Sunc\ of Prostatic Enlargement 
and its Treatment Kenneth 
Walker frcs sT 

Anaemia and the Gastro intestinal 
Traet Janet M Vaughan dm 
At R c P 37 

Further Obsenations on Benzedrine 
E W Anderson m d m r c p 60 
Placental Xxtract in an Epidemic of 
Measles T N Parish aid 65 

A Woman Blind from Birth uho 
Acquired Sight at 22 Tears of 
Age R COLLEA MB ch B 67 

Moulds and Asthma E M 
Fraenkel At D 6S 


SURGICAL SERIES 
Injuries to the Shoulder-joint — If 
R Watson Jones ai ch frcs 80 


CLINICAL 3IEMORANDA 

Sulphonamides for Meningococcal 
Meningitis A H Winchester 
F RC s Ed 70 

A Case of Streptococcal Meningitis 
Morris Schaaartz, mr.cs 70 


MEDICO LEGAL 
Charge of Procuring Abortion 
Mr Aleck Bourne at Marslebone 


Police Court 97 


OBITUART 

Sir Cohn Mackenzie M D 99 

Hugh W oods m d 99 

Professor Georges Marinesco 100 

John Watterson Miller M D 100 

E \\ Grifhths mrcs ercp 100 


GENERAL ARTICLES AND 
NEATS 

Tuberculosis Conference Sj 

Tlie Human Skin Lecture bj Dr 
Leonard V iLEiAAis 86 

Mental Welfare or En Sera ice 
Patients 85 

Enchancf Holidaa Visits 87 

Corporal Plnishmenm 87 

Lux Asserance Medical Conc rlss 87 
PRLI ARATlONS AND APPLIANCES 73 

Medical Notes IN Parliaaient ICO 

Liniaersities and Colleges 104 

Medical Nfaas 10a 


LEADING ARTICLES 
Rockefeller and the Frontiers 74 

Management of Phthisis '3 


ANNOTATIONS 


Changes in Teeth foIIoAAing Para 
thA roidectomA 76 

Pos Aaccmial Encephalitis 76 

Trea rnent of MAotonia 77 

RoAal Medical BeneAO*ent Fund 77 

The Heart in Relation to iis Blood 
SupplA 78 

Rural HAgiene 78 

Traumatic Shock 79 

Refucee Doctors from Austria 79 


SUPPLEMENT 

PU MOUTH PROGRAMME 


Anslal ExHiBrrtos Plymouth 
The Colonial Medical Ser 
\ ICE AND THE B M A 
IsstR^NCc Acts Committee 
I ssuR.fNCE Medical Service 
Correspondence 
Postgraduate News 
Meetings of Divisions 
AsNocntion Notices Vacancies 
and Appointments Diar\ 


REPORTS OF SOCIETIES 
Associvtion of Clinical Pmho 
LOGISTS 8S 


LOCAL NEWS 


Scotlvnd — 

Universitx of Glasgow 89 

Koval (Dick) Vetennarv College 89 

St Andrews Universnv 89 

Englvnd and Wales — 

Minister of Health at Shefheld S9 

Aftercare Work of the NlerNcv 
Mde Hospitals Council ^^9 

Health Congress at Portsmouth 90 

Welsh National Institute of 
Radiolherapv 90 

Conditions of Nursing Service 90 


EPIDEAllOLOGT SECTIO^ 

TvBLr OF iNFECnOLS Dinesses \nd 
Mtvl Ststistics 102 

EriDEMIOLOGICvL NOTFS 10 


CORRESPONDENCE 

Uterine Rupture toiiov inKCjt. „ t. n 
Section Cn\b'N\p Moip id ‘O 
When to Start Sjlphonamide in 
Gonorrhoea l olonel L W 
Hvrrison b 

SulphanilamiJeTreaiment of Conor 
rhoea W' Gillies Annsn fi c ^ 9i 
Su phandamide in Staphs IoaClc d 
Skm infections M Maptls mb 92 


The Origin of Cancer J \ 
Fiddun md 9 _ 

Cancer and Hcrcditv P ^ Goplp 
B sc VI R c S L-P-C P 9j 

Treatment of Apoplew Frew in 
Moor m d 9 

Emergenev Bed Service -k R 
Montgomery mb 9 

The Unconscious Mind Harpy 

Cvmpbeli md 9j 

1 chio pubic Osteochondritis G 
Edoar Church vi b O O 

Tippett frcs 94 

Anil venereal Measures Alison 

NriLANs 9f 

Anatomical Terminologv D F 

Ellison NvsH frcs 9*' 

Tuberculin in Diagnosis John R 
Gillespie m d 9r 

Medical Relief for China Mili vis 


Cllpin md W C W Ninon 
M d and H J Seddon frcs 9f > 
Schopenhauer and Svphilis J D 
Rolleston m d 96 

The Psvchologv of the Medical 
Profession A J Brock vi o 9“ 
Assistance to Students from Austria 
Victor Constad l m s s v 97 


REVIEWS 


Pol operative Radiographv of 

iht 

Bilian Tract 

71 

Differential Diagnosis 

71 

Yearbook of Urologv for 1937 

71 

The Paget Tradition 

71 

Diseases of the Blood 

72 

British HetUh Reiorls 

72 

Notes on Books 



THE SERMCES 

EfTiciencv Decoration 10 

Deaths m the Services lOs 


LETTERS AND VNSWLRS 

Case for Di-ctio is !0' 

Recurrent Ulcers 10 

income Tax 106 

Sterilization of Hvpodcrmk. 

Needles 106 

Histidine m Peptic Ulcer 106 

Death from a Wasp Sting 106 

Aspirin Poisoning 106 


A KE\ TO CURRENT MEDICAL LITERATURE will be found at the end of the JOURNAL 






THF BRITISH T^IEDICAL JOURNAL 


luu 9 I9'S 


THE PRACTITIONER 



Edited hv 

Sir Humphry Rolllston, Bt , G C V O , K C B , M D , 
FRCP, <ind Alan MoNCRinr, M D , FRCP 


PROGRAMME-Jaly-Ociober. 1938 


JULY 

The symposium m this issue deals with psychology in 
general practice Anxiety, obsessions, hysteiia, suicide, 
and the common beltaviour problems of children, are 
some of the subjects which are discussed by experts 
Articles of general medical interest include “ Corns and 
Cillositics,” ‘ Infectious Diseases and Disinfection,” 
and ‘ Diet m Allergic TDiseascs ” Price 4s post free 

AUGUST 

This number will eonmn i leally practical guide to the 
correct prescription of physiotherapeutic measures in 
gcncril pratlicc Articles of general medical interest 
include Aflections of the Nails, ’ Vertigo its Causes 
and Treatment, ‘ Tropical Diets in Health and 
Di>-casc, etc Price 4s , post tree 

SEPTEMBER 

Disorders of Sex will be discussed from the point ol view 
of the general practitioner in a senes of six articles 
clcihng with marriage difliculties problems of celibacy 
in imn and woman homosexuality, and the sexual 
developments in childhood and adolescence Price 4s , 
post tree 

OCTOBER 

Spovieii 

I liL 'dv ol ihx vx ir in di ignosis and ticatment will 

rcvi^wt-d b\ twentv contributor-- This grcatlv 
cn! ir_i.d Sp^ci il Number will prove indispensable to 
lv^iv dov-tor in iclivc pr icticc Price 7s 6d , post tree, 

II irnii 1 ^nl sLnption wIiilIi iikIiuIl-. two Spcci il Number-- 
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Medical Prvctitiom rs’ IlandhooU 

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Report of Committee on Nutrition 

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Familv Meals and Citcrint; 

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Facts about Small-Fov and Vaccination 
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Report of Committee on Imnninirr 
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Report of Committee on Tests tor 
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Report of Spcci it Committee on tlip 
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10 pp Sio trice 2tl posi frtc 

Rclationstiip of ttio Trnate I’rirtI 
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Ills ilnlilv 

77 pp S\o 1 nee fd pr-d free 

Report of Mental Ilefitienev Coninnltpi 
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Tlic Esscnliils of a National MedlPal 
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40 pp S\o Price 3il pint free 

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The Osteopaths Bill ' 

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R< port of the I’siclio \nnhsis 
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Report of Committee on I In sled 
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Tula 9 I93S 


THE BRITISH MEDICAL JOURNAL 


JUST READY!-AiTcir« 



The '\tn. (2;frf) Edition ot Dr George C Andrews hook on Di'Ca-es ot tlie Skin i- ; tsf of f- -.s Not i [n^e 
escnped reeision \ew imternl In- been ndded to e\en cl apter 75 dutOitr ->re di'cu -d tn- the ti-'i 
time while tlie \er\ latest applications ot tests diagnostic procedure' and the nci est >.pp'i\el therspi t'e 
gnen in the tullest detail 

Dr Andiews first takes up those subjects ot more general nituie devoting 'tpante chapters to an to u 
pathologv sv-niptomatologv general diagnosis loentgen therapv radium therapv and surgieal dntherim Then 
he describes indnidualh the various diseases and conditions, vvith spceihc emphasis on the ehnie 1 i jieets 
and the measures ot treatment indicated Aou will find toll discussions ot industrial dermatitis dru^ th it v lu e 
dermatitis, eczema, pruritus, tuberculosis ot the skin di'ea'C' cau'ed In filter ible virU'C' di c i e u h iir ml 
si m appendages, neoplasms ot the skin, and a monographic presentation ot si/"/ i/is th it e ners I ts 

Dr Andrews gives vou o<,t.r 100 actual prescriptions He telK vou lU't what the pitient 'hi ml 1 e^t ss well is 
what he should not eat He tdl' vou how to U'C the lU t tlurapetitu a / nts sueh a' 'ulph mil imide lever 
thcrapv, diatherinv, malaiia therapv etc, etc He c ills import int points to vour attention bv the ii e ot it die 
tvpe gives the skin manitestatioiis ot othei disc I'Cs stresses the importanee ot pn)phvla\i~ There ire '^i- 
illustrations that constitute a veritable atlas 

Dv George Cli\-to\ A^DRCvvs, AD MD A"Ociate Professor ot Derm itulo^v College ot Ihvsieiiiis an' 
burgeons, Columbia Lniversitv Octavo ot 899 pages, with 9o8 Illu'ti itioiis Clodi, 4ss net 

PRACTICE OF UROLOGY 

B\ Lfon HER^r\^, Bb MD Profe^^or ot Lrolosrv Lnivcr-iti ot Penn'\Udnn 
Graduate School of Aredictne Octa\o ot 92o page'* with 7^6 Illu'-tration^ on 
SO-1- figures Cloth 4*'" net 

Dr Htrmans orl is ciacll\ ' hat lit inttiidi it to In — a tr altsi of dtSta.> i t>/ // 1 tir ijti ital i it m f r *{ 

tin' of. Qtiural praLtitioin.rs and surgeons l!u subfi.tt tnatlt-r ts slilftilh arrai gid and tl t rt t H till itrat d 
— Tuf L\ncet 


PRACTICAL PROCTOLOGY 

B\ Loots A. Buie, AB MD FACS, Head ot Section on Proctolog\ the 
MaNo Clinic, Prote^sor ot Proctolog\ the Ma\o Foundation Octa\o ot ^12 
page" with 152 Illustration", including 6 m colour" Cloth 30" net 

j Its tith «/» to tliL hilt It ts abo t all praett al It ritt it in o stinfU and attraitrc man r it o m th I tf 
fcld of prot,tolog\ in smh a vJi that r'c/j a bigmiitr can ha t no t vciist for blnndtr^ in diagnosis at d tr aln it I h 

book JT tonfidintl\ rtconnncndtd as a stimulating and btauttfult\ frodiutd ork lu tht fit. Id of fro tolog\ — S » th 

MfIHCAL loi! NAL 


PRE- AND POST-OPERATIVE TREATMENT 

B\ Robert L M\so\ AB MD, FACS As"i"tant in Surger\ at the 
Ma""achu"ett5 General Ho"pitaI Octaao ol 495 page" Illu"trated Cloth 2^" net 

gath rs tog llur a considtrahU amoi nt of r\ its ft I tnfoni atioii aid prt^ nts tl ui an (7rr j-/r;rr/ and tut r tma 
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10 


THE BRITISH MEDICAL JOURNAL 


Jui’i 9 1938 





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THE BRITISH MEDICAL JOURNAL 


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JuL-k 9 193S 


THE BRITISH MEDICAL JOLRNAL 


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THE BRITISH MEDIC \L JObRNAL 


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THE BRITISH MEDICAL JOURNAL 




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16 


THE BRITISH MEDICAL JOURNAL 


JviA 9 1918 


Alphidine and 


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JUL\ 9 I93S 


THE BRITISH MEDICAL JOL'RNAL 


37 


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64 July 9, 193S 


FURTHER OBSERVATIONS ON BENZEDRINE 


or two cases there was an increase in the depression when 
the effect ot the drug was wearing off, and it is important 
to bear in mend that Davidoff and Reifenstein mention 
a case of manic-depressive illness m which the patient 
impulsively attempted suicide One of our patients {the 
alcoholic depressive) became very much more depressed, 
and the question of suicide was uppermost in our minds 
for some days, and in another (C 5) the depression was 
considerably intensified This might, of course, just as 
well have been a usual constitutional intensification in the 
first case, but it appeared to be a definite effect of the 
drug in (he second 


Tut Rmtimi 
MiDICaL JOl ASW 


Summart 

Thirty-three patients suffering Irom diflcrcnt forms of 
menln! disorder and eight normal subjects were gntn 
benzedrine orally in doses of from 5 to 4S nig In MMo.n 
the drug had (o be discontinued because of iimowanl 
effects, mental or physical, and in two more because no 
beneficial effect was produced In eleven (one-third) the 
drug appeared to be helpful In five no effect menial 
or physical, was produced Dosage, contramdieaiions, 
and the general value of benzedrine in psydiiatrj are 
discussed , 


Comment 

It must be admitted that, so far at least as these results 
are concerned, it is difficult to claim any great therapeutic 
value from benzedrine Nevertheless, if its use relieves 
the depressed patient even transiently and gives him a 
few hours respite, the drug has a place in psychiatry 
To claim more than this from it at the moment, however, 
IS impossible, and there are many limitations to its useful- 
ness^ not the least of which is the variability of its action 
A small minority of cases seem to benefit definitely from 
benzedrine, and us greatest usefulness perhaps is in those 
cases of depression in which a clinical improvement has 
already set in Here it may be helpful in giving the 
patient a temporarily increased insight, which has been 
of use psychotherapeutically Apart from this, the drug 
IS of doubtful value as an aid to psychotherapy It was 
difficult to resist the impression m one or two cases that 
the speed of convalescence from a depression was in- 
creased, but this is difficult, if not impossible, to establish' 
objectively Indeed it is almost impossible in many cases 
to separate the changes of the normal process of recovery 
from the effect of the drug, which makes any pro- 
nouncement of its value in such cases very dubious For 
those patients who have clinically improved but who for 
economic or other reasons are unable to stay in hospital 
and must return to work, benzedrine is sometimes of help 
in’ enabling them to face their days work The drug 
should, howc\er, be controlled by frequent examination 
of the patient afterwards For those depressed patients 
who may at any time get w'orse and perhaps contem- 
plate suicide, suitable doses of benzedrine may enable 
one to keep them in a hospital or even in evervdav life 
without extra supervision Here, again, they should not 
be given a bottle of tablets and allowed to go their 
way 

With regard to dosage, 10 to 40 mg in ordinary cases 
should be enough, and a divided dosage — say, 15 mg at 
9 am and a further 15 mg at 1130 am — is to be 
recommended , and certainh, unless the patient is under 
full in-patient supervision, this dosage should never be 
exceeded The drug is admiltedlv still in its experimental 
stage, but enough work has now been done to mike it 
doubtful how far, if at all, it is likelj to be of greater 
value in psvchiatrv than it is at present The contra- 
indie itions are now being established but from my cx- 
pcritnce it would appeir to be unwise to give benzedrine 
to anv subject with cardiovascul ir disease in any form, 
or to those with prominent anxietv svmptoms The initial 
dose should not exceed 10 mg and the optimum dose 
should be determined carcfullv I agree with Davidoff 
and Reitenstcm that it should be used cautiously in 
ccriain deprcssives because of the possibility of mtensi- 
fvinc the depression with consequent suicidal risk This 
risk has not been sufficicntlv stressed 


I should like to thsnk nn collcagiic Dr W C M Ssott 
for having furnished me with his obscrvvtions on seven! 
patients in this senes and some of the controls, and also for 
much V ihiable help in the preparation of this paper 

1 would like also to thank Messrs Mcnley vnd lames the 
dislnbutors, lor siipplving me vvilh a generous supph of Ibi, 
drug with whieh to einy on this work 

Refercnces 

Anderson, E XV , and Scott, W C M (1936) L<incct 2, 1461 
Brtlisli Medical Journnl (1937), 2, 62S 

Davidoff, E , and Rcifcnstem, E C (1937) S liiicr iiifil tsu 
108 1770 

Gutlmann, E , and Sargant, W (1937) Bniisli Mcdual Joiirmil, 
1, 1013 

Korns, H M, and Randall, \V L (1937) /liner llinrl ), 
13, 1, 114 

Mjerson, A , Lom'in, J , and Damtshek, \V (1936) tinier J 
Hied Sci 192, 560 

Rinkcl, M , and Dameshek, \V (1936) iVrii Cue/ 1 Aful 

215, 1005 

and Ritvo, M (1936) / 4iiicr iiiul /Iss 107, 24 

Prinzmetal, M, and Bloomberg, W (1935) 7 /liner niiil 4i)i 

105 , 2051 

Scarano, J A (1933) Afed Bee 140 602 
Schubc, P G, Raskm, N. and Campbell, E (1937) A'en 
J Med 2 16,922 

Solomon, P, Mitchell, R S, and Prtnziuciil, M (1937) J dMtt 
iiied Ass 108, 1765 

Ulrich, H, Trapp, C E , and Vjdgotl, B (1936) dim mw'i 
Afcd 0, 1213 

XVilbur, D L , MacLcan, A R , and Allen, C V (1937) I’lei 
Maxo Chit, 12, 97 


The following medical promotions in and appointments to 
ihe Venerable Order of the Hospital of St John of Jcriwafcn' 
are announced in the London Giizillt of June 24 As 
knighis Major A \V Anderson M B , Major W 0 rvaiu 
MBE, LRCS , as Commanders D W A Bull 
C Armstrong MB, as Officers L L XVestrope M 0 > 
H Riddell, MB, E H Knowles, L RCP andSEd B 
Banks ERGS, A P Marlin, MB, 3 Vaillancoiirt, M». 
Lieutenant Colonel T A \ oung, MD, Major Genera! P 3 
Mills, CIE, W T Thomson MRCS, C A Vcrco 
tv G Shcilshcar, MB, Colonel J L Hamilton, MC.JB. 
M D , K S Maunec-Smith MRCS Lieutenant Colonel 
L L Dunn, CIE, J K Milligan 'MRCS, A T ''RBay, 
MD E Lewvs Lloyd, M RCS, Hon P P Debono M (L 
FRCS Professor J Ellul, M D , E I D Parrv, M B 
\ssociale Officers Colonel D H Rai MG , jV.f 
Brothers F M Longson M B , E Ringrosc, M D , J R ^ 
MB, G Fisk MD (since deceased) G H rdgceo r 

MB, L A Williams MD, W O T Sinclair. MB l > 

scales, MRCS, J C P Bavlev, I MSS A J B McKa , 
M B , F C Cozens, M B , W W A Kelly, M B ^ 

MD T D Delpnt MB, A F Janes, MR, H \ - 

Donovan MB J MeK Woods MB,C S '' 

r L Firkin, MB P D Braddon FRCS. .as Sem 

>iMcr Frances C B McKav, M B 



Jot.\ 9 I93S 


PLACENTAL EXTRACT IN MEASLES 


fi5 


THE USE OF PLACENTAL EXTRACT IN 
AN EPIDEHHC OF MEASLES 

BY 

T iN PARISH, M A , M D , 

Medical Officer to Benenden School 

This IS an account of an epidemic of measles in a 
girls school m which placental extract was used as a 
prophj lactic 

The girls xar> in age from 13 to 17 jears There had 
been no such epidemic m the school for nine jears and 
at the beginning of the Easter term 193S of the 205 
girls under m% care eightj nine had not had measles 
On Januarj 18 a few hours after the return to school 
one child was found to be m the incubation stage of 
measles She came by the school train and school 
bus so that contacts were widelj spread throughout the 
school Prophs lactic measures were discussed and in 
\iew of the difficult} of obtaining convalescent serum 
it was decided to use placental extract in an attempt 
to modify the subsequent attacks and to lower the com 
plication rate Moeller (1937) maintains that this 
extract is as effi 
cacious as convales- 
cent serum and of 
greater prophylactic 
value than adult 
serum Parents were 
circularized and 
forty -seven asked 
that their children 
should be given the 
injection some of 
them requesting that 
this should be done 
at once WTien the 
time of injection 
was left to our dis 
cretion the injection 
was given as soon 
as a case occurred m 
either the girl s house 
or form All were 
given between January 27 and February 16 The term 
ended on April 3 

Dose and Reactions 

The extract used was Lederles immune globulin, and 
It was given m one intramuscular injection of 4 ccm 
into the buttock There were no immediate reactions 
but after a few hours stiffness and some pain at the site 
of injection were usual The stiffness persisted for about 
two days One child had a temperature for twelve hours 
but m no case was there constitutional disturbance of any 
severitv nor did any deWyed reactions occur 

Course of the Epidemie 

The case incidence throughout the term after the 
initial infecting case (which is not included in these 
statistics) IS given m Figs 1 and 2 Fig 1 shows the 
dav of onset of rash in the unmodified cases and Fig 2 
the dav of onset m the modified cases 

Taking into consideration the larger number of cases 
in which the prophylactic injection had been given it 
does not appear that the extract had any effect in 
delavmg the onset of the attack 


Bv the end of the term seventv five of the cich \ air- 
susceptibles had developed measles as well as' fu,. of 
the 116 said to have had measles previousK of whom two 
had also recetved a prophv lactic injection The dis i 
button of cases in the modified and unmodified groups s 
shown in Table I 


Tvble I — Incidence of Measles 



PrcMOus Meas es 
(116 Ccses) 1 



Modified i 
(2Cssa) , 

L^’~odl^■*d I 

(IlACases) ' 

1 MoxuF*d 
' ("tS C-A=3> 


Measles de\-eIoped 

2 

3 1 

1 - 1 33 

No in«3»l£s 

0 

lit 

3 

u 

) 


It IS obvious that the extract had no effect whatsoever 
in preventmg the attack of measles On the contrarv 
the above figures show that among the susceptible cases 
measles developed in 93 per cent of those who had been 
given the modifving injection and m onlv 75 per cent 
of those who had not The two children who had 
previouslv had measles and who had also been injected 

both developed 
measles 

The epidemic was 
of moderate severitv 
although there was a 
most remarkable 
freedom from senous 
complications Tern 
peratures of over 
103 were present in 
66 per cent of the 
total cases The 
onlv complication 
of anv severity was 
one case of sup 
purative otitis media 

Effect of Extract 
on Attack 

The effects of the 
prophv lactic injec 
tions were much more noticeable in the first half of the 
term It is not possible to convev a clinical impression 
bv statistics but the impression received by all observers 
was that those cases in which the attack developed within 
three to four weeks of the injection suffered far less con 
stilutional disturbance A few of these showed a slight 
rash of small discrete papules with no tendenev to 
coalesce but on the whole little difference was observed in 
the rashes of the modified and unmodified cases 
The most noticeable feature of the recentlv modified caves 
was that although the temperature was high and a well 
developed rash was present the patient remained sur- 
prisingly cheerful and undisturbed, and did not p-esent 
the tvpical woebegone facies and prostration 

The cases were classified ffable If) as thw occurred 
as mild moderate or severe this classification being 
based on the degree of constitutional disturbance This 
IS necessarilv a somewhat arbitrarv classification for the 
degree of disturbance did not appear to have anv 
relation to the tempierature or nature of the rash 
The effect of the extract in reducing the seventy of the 
attack IS most noticeable in those cases in which u had 
been given within three weeks of onset of rash 



Fig I — Unmodified cases ( 6) 



Fig 2 — -Modified cases (44) 


66 July 9, 193S 


PLACENTAL EXTRACT IN ^lEASLES 

Mcdicm. Jpv,s,l 


Table II — l\pe of Attack 



r 1 

Toni Ctscs 1 

Mild 1 

Modcritc 

ScNCre 

Unmodifictl ^ 

36 

t7‘„ ' 

as'-o 

5% 

Modified 

Modified wiihm 3 1 

44 1 

1 

-0% 

•45S“„ 

4 5% 

weeks of onset 

19 

74 "o 


“* 


Table III contrasts the behaviour during the attack, 
of the unmodified cases with that of the total modified 
cases, and with those cases in which the extract was 
given Within three weeks of the onset of the rash 


Table 111 — Com^e of Attack 



Kophk s 
Spots 

Dass under 
Obscr\Tiion 
UcforcOnscl 
of Ra*;!! 

Diis Tern 

1 perTtiire 
: After Onset 
^ of Rnsh 

TempCT'iiurt 
o\cr 103* 

Unmodified 

61 ’i 

26 

34 1 

72% 

Modified 1 

36% 

28 

26 

61% 

Modified wifhrn 3 | 
weeks of onset 1 

26% 

25 

20 

74^0 


The most noticeable features of this table are the 
lowering m incidence of Koplik’s spots and the quicker 
fall in temperature after the onset of the rash in modified 
cases Both these features are more marked in the 
recently modified cases The temperature of the recently 
modified cases is noticeably high, which is anomalous in 
compaiison with the other results, but may be related to 
the apparent increase in susceptibility following injection 
of extract 

Complications 

Apart from the one complication of bilateral suppura- 
tive otitis media, there were no serious complications 
The complications given in Table IV are chiefly accounted 
for by the persistence of what may be regarded as normal 
concomitants of measles Apart from the one case of 
suppurative otitis media in which paracentesis was per- 
foimed, all cases of otitis were of the catarrhal type 


Table IV — Complications 



tr 

o 

rt 

u 

o 

f- 

•o 

iu 

a k. 
p 

05 

C rt 
20 

> 

V 5 
< =. 
c 
o 
O 

Of 

V 

' .c 

C e" 

a rt 
!2U 

« C, 
^ 
2 

3 

C 

v5 

Ca 

c 

C 

r 

U 

c c 

w xj 

^ c 

^■5 

o? 

Total Compli 
cations percent 

Unmodified 

36 

61 

8 

2 

3 


— 

8 

5 

75 

Modified 

44 

25 

I 

I 

2 

I 

2 

3 

5 

34 

Modified within 3 weeks 

19 

5 

— 

— 

— 

— 

— 

— 

I 

5 


There is a remarkable freedom from complications 
in the modified cases The one complication in the 
rccenth modified cases was the case of suppurative 
onus media and this occurred in a child who had pre- 
kioiisU sulTered from bilateral otitis media and mastoiditis, 
find who had received her injection onh eight da\s before 
the onset of the rash 


attack In a large girls school there are min\ oppor- 
tunities for contact with cases in the incubation shLe, 
but these contacts may be briet and not sullicieni "to 
produce an attack 

It was unfortunate that the epidemic started so soon 
in the term , for it seems probable, trom a stiid\ of other 
reports (McKhann, 1937) and from the results obiained 
during this epidemic, that the pissive imnnmitt conferred 
IS of short duiation and that immunity decreases ripidlj 
after three weeks 

By mid-tcrm it is probable that most of the imnninitj 
conferred bv the placental extract had vanished For 
innately it docs not appear that the extract in the dosis 
given prevented or delated the development of measles 
Crosbie (I93S) found that 4 c cm ol phcental extract 
was not always suflicicnt to ensure a modified attick, 
although It did prev'cnt complications and sequelae It is 
probable that it a dose larger than 4 cem had been given 
in this epidemic the immediate modifv'ing cflect would have 
been more pronounced but there would then hive been 
a greater risk ol postponing the peak of the epidemic 
until later in the term, by which lime the modilying power 
would have been grcatlv diminished In i school 
epidemic it seems vvisci to recommend for “ modification " 
a dose which may m some instances fail to modifj, 
although preventing complications, for such a dose will be 
less likely to bring about complete prevention 

There was a remarkable freedom from serious compli 
cations in the epidemic, and this lenders the estimilion 
of the value of the exirict in reducing the complitalmn 
r.ate less conclusive If however, by the use of the 
extract, the reduction obtained in the number of somewlut 
trivial complications may be taken as in indic,ition of its 
power in preventing major complications in some less 
fortunate epidemic, then the value of the extract is iiii 
doubted 

Apart from deliberate exposure of susceptible cases 
with a coincident modifving injection, the ideal course 
to adopt in an epidemic would be to immuni/e susceptihli, 
cases at intervals qf three weeks until an attack developed 
This would involve considerable inconvenience mil 
expense, and in an epidemic of the type described, m 
which serious complications were absent from the start, 
It does not seem justifi iblc to advise this procedure 

Sunimarv 

An epidemic of measles in a girls' school is described 
in which placental extract was used in an endeavour to 
reduce the severity of the attack and the siibscqiiint 
compile Uions There were no serious reactions following 
the injections The extract did not have the cfleel of 
preventing or postponing the attack it aitdercd lla 
attack milder, the duration of temperature shorter and 
lessened the subsequent complications It is probibk 
that the immunity conferred diminishes fairly rapid!} 
after three weeks 

RrrLHrNCcs 

Crosbic \V n (1938) British Mcduai Journal 1, 1003 
Mcklnnn C K (1937) Nih Lm.l“"il J ''trd 710 
Moeller, U (1937) Msilir Ktiulirhcilk 00, 101 


Discussion 

The great defect in prophvlaxis of measles whether 
bv conv ilcsci.nt or adult scrum or bv placental extract, 
lb the diflieultv in estimating when exposure has been 
iniimile (.nough to ensure subsequent development of an 


Tlie next annua! meeting of the Socieiv of German 
legists and Psvchiatrists will be held it Cologne from ^ir 
tember 25 to 27 when the subjects for discussion ^ 

Meincrt s Wernicke s and kracpclin s doctrines and ^ 
importance in modern psvchiatrv Further 
be obtained from Professor Nilsche Pirna licrirk, Drc' 



9 19’S 


ACQUISITION OF SIGHT BY WOMAN BORN BLIND 


6" 


A ^^OMAN BLIND FRO:\I BIRTH \AHO 
ACQUIRED SIGHT AT 22 TtEARS 
OF AGE 

' B-i 

R COLLET, M B , Ch B , D O M S 

Honorary Oplillwlinu Siirfcon Ro\al Limed Hospital 
Bath Senior Honorar\ Surgeon Bath Eye 
Infirmary ' 

P 

Ven few cases base been reported of a person who blind 
from birth has obtained sight m adult life I base been 
able to find records -of onl\ four cases although I base 
no doubi more ma> have been published 
I saw this gir! for the first time on March 8 1932 
She had been blind from birth as a result of congenital 
cataract and had been educated at a blind school from 
10 to 19 jcars ot age No operation on the eves had been 
performed 

Condition of Eves before Operation 

On March 8 1932 she could distinguish light from 
darkness with each eje and could tell when an object was 
moved m front of her face especiallv if a bright light was 
behind the object The projection of light of both ejes 
was good Tfaej evhibited marked njstagmoid move 
mcnts best described as shuddering There vvas con 
vergent strabismus possiblj the nght eje being the one 
more usuallv turned in Both lenses were completelj 
opaque Slight epiphora was present the lacrimal sacs 
having been removed during childhood There vvas no 
historv of blindness m the familv and she vvas the onl> 
blind member out of seven children 

Condition when Blind 

Before the operations she vvas a totallj blind person 
earning her living as such She was unable to get about 
without assistance and had to be led when not in her 
own home except for the fact that she used occasionallv 
to visit a friends house and a shop about two minutes 
distance to reach which it was not necessarv for her to 
cross a street She had never seen a human tace a flower 
a motor car or anj thing which a sighted person lakes for 
granted All her ideas about the world had been obtained 
from reading braille from information given to her b> 
others and bv the use of her other senses She had 
scarcelv anv preconceived ideas of things which she could 
not feel When reading in braille she took no interest 
in the description of things or places but onlv what 
people said and did 

The other senses were well developed "She had vcrj 
acute hearing — better than the other members of her tamilj 
Similarlv her senses of smell and touch were verv good 
She sajs she was unable to detect the presence of a person 
in a room if he kept afasoiulelv still but could recognize 
members of her familv bv their cough the wav thev 
walked etc 

While at the blind school she had learnt braille which 
she can read fluentiv She had b.en taught machine 
knitting and chair seating as well as the ordinarv school 
subjects — English historv geographv music and arith 
nvctic up to fractions and decimals etc She vvas verv 
hippv while at the blind school as b^ing with blind 
p^opL she did not realize anv disabihiv but on returning 
home she felt her pavilion in comparison with those with 
si^ht After leaving the school she worked at home at 


knitting and chair seating She came to convult me m lb. 
hope that something could be dom. fo' her 

Operative M<xisurcs 

Both lenses were needled several times and a caret, 
evacuation vvas jverformed on the right L,.ter the cap uLv 
were needled 

coxoiTiox ox OErrviBEP S 19 ■ 

Right eve Vision with - IsD sph and - 1 D c ! 
axis 60 = 3 60 add — 4D sph re„db J 12 with dun 
cultv Left eve Vision with - 16 D sph and - 1 D tvl 
axis 135 = 6 60 and — 4 D sph reads i x Bo n 

mediae are clear and the fundi appear no^m„) Her zontai 
njstagmus is present in both eves but tar Rvv n^ried 
than before the operation The axis ol ihe evev iv usu„llv 
parallel but occasionallv one eve uvu..ll he right iv 
turned in 

On account of the tvpe of the operations pertormed h^r 
vision returned onlv verv slowlv— from appreciation o. 
light through blurred vision eventuallv to ssein^ ihm-s 
reasonablv well with the aid ot passes Having built up 
a vvorld of her own it is verv difficult to appreciate h^r 
thoughts on being presented « tth the sight of the ordinjn 
things of life 

Psvchological Observations after Operations 

PERCEPTIOX 

On graduallv obtaining her sight the first thing she 
noticed vvas a white apron worn bv a nurse then the red 
colour of a dress Next she saw a window and a door 
wav The window had no shape but appeared as a bright 
area and the skv white Later she saw her hands and 
fingers but could not distinguish her nails Mter this she 
saw chairs and tables Then she saw a face The second 
colour she noticed vvas green and the other colours later 
She had to be told the name ol each colour Even now 
she has difficultv with some of the different shades 

When she first saw a building it appeared a dark object 
with no shape After she got her glasses buildings looked 
huge but she had no preconceived idea ol their shap. or 
the appearance of the different ivpes She did not recog 
nize a ciiurch although she knew that it had a to ver or 
steeple but this did not con'ev am thing to her She had 
read descriptions of different things but did not appreciate 
what thev were going to look like 
At first she had no estimation at all of distance ^nd 
could not judge the position of objects in relation to 
herself Cars seemed to be coming straight at her and 
people appeared to be walking into her She still OeCa 
sionallv thinks a car is coming straight at her but she can 
cross roads and is usuallv able to tell how far awav a car 
IS and whether it is safe to cross In going upstairs she 
could not judge the height of step, and sometimes raised 
her fool too high She fell both when going upstairs and 
when coming down E'cn now if stone steps arc wet she 
has some difficultv WTien blind she did not bump into 
a door but when she first relied on her sight she did eo — 
similarlv with tables and chairs She could sec ihe door 
wav but had no idea of its relalion lo herself sh> could 
not tell how far awav it vvas Now howevc' she has no 
difficultv m avoiding objects 

Ai first she had no app.eciation o’' solid objcc.s prob 
ablv the outline onlv being seen Sh> had no perception 
of form She thinks that at first she could not have to'd 
a briek from a ball except bv touch but is able to do so 
now and she can also app'eciale depth and can disim 
guish a solid object from a fiat one Also m the b'lrd 
state she had no knowledge of the relative size of different 



68 JuL\ 9 1938 ACQUISITION OF SIGHT BY WOMAN BORN BLIND 


things and on seeing objects such as houses for the fust 
time they looked enormous She thought some animals 
were much larger than she found them to be when she 
went to the Zoo She had imagined that bears were as 
large as elephants and the latter much larger still Cats 
and dogs did not appear largei th m she expected prob- 
ably because she had touched them when blind She 
knew that dogs were of different sizes Looking at a cat 
and a dog of the same size she could not distinguish one 
from the other unless the dog barked, but she could do so 
quite easilj b\ touch Objects which she could feel 
she was able to recognize, and thus learn to know by 
sight 

She is intelligent and has a good memory She has 
asked many questions and on being told what things were 
she has remembered Looking out of the window at the 
Bath Eye Infirmary she saw an object going up the road 
outside She knew' it was some kind of motor \ehicle as 
she had prexiously seen cars but this was different On 
describing it to another patient she was told that it was 
a motor van Similarly with all the objects she saw — she 
had to learn what they were 

Faces at first looked alike but she is now able to dis- 
tinguish one from another She was greatly disappointed 
with faces, as she said she had thought all people were 
beautiful and had “ happy-looking faces In looking at 
a print or photograph she has difficulty in telling the fore- 
ground from the background Coloured pictures at first 
appeared just a mass of colour, but now she is able to a 
large extent to make out the subject of the picture She 
likes bright things and thinks flowers are beautiful 

She IS a fluent braille reader but of course did not 
recognize the ordinary printed word or figures and had 
to learn the ordinary alphabet and figures before she 
could read the printed and written word 

As she did not understand what she was looking at she 
made progress bv (1) asking questions (2) recognizing 
things by touch and then by sight (3) recognizing things 
by smell and touch — for example the different flowers, 
where of course colour helped (4) recognizing things by 
knowing what she had read or been told 

MSI.\L1ZIN0 SSSOCIATIOX ETC 

She had no Msual images until she obtained her glasses 
The association ot ideas in a person who has never seen 
ire by sound — including sound of w’ords — touch and 
smell Thought in the blind state is mainly word thinl ing 
but in the sighted it is mainlv picture thinking Her 
associ ition of ideas is now that of a sighted person — 
that IS dependent on visual images She is able to describe 
objects which she has seen earlier 

At first she was very depressed and wept a lot — in fact, 
she must have gone through a great emotional strain 
Prob iblv she had not realized that she would have to 
learn ill ibout visible objects and more or less start again 
It the beginning She w is so to speak between two 
worlds Fvcntuallv, as time went on she gamed con- 
fidence as her vision improved and her sighted Inowlcdge 
increased 

On Much '0 19'6 she obtained a post at a factors, 
St irting at 10s i week After three months her wage 
w IS riistd to 12s at six months to 14s , and at a xcar to 
U<s Now she is earning 19s a week Normallv i girl 
Living school starts it the age of 14 vears at 10s a wcci, 
rising to 18s It 16 

Before the opcritions she had to he brought from her 
home to sec me in Bath but now she can find the wav by 
I erscU, trivcllmg bv bus ind walking to the Eve Infirmarv 


Tiir nmim 

M.iiccc iHiva 

She has joined the local company of rangers, and does tlic 
ordinary field work and plays games, but has diniciiltv in 
catching a ball She can do general housework, dustinc 
polishing floors and making beds , and when washini, lip 
does not break more things than a sighted person She 
has not vet done any cooking She goes to the ciiienn, 
and on her holidays enjoys sea-bathing She watehes licr 
friends playing tennis but cannot pliy herself as she 
cannot hit a ball with a racket Although she can write 
well and rca^d the printed word she still finds it quicker to 
read braille She has also visited Lopdon — seen Madame 
Tussauds the Zoo, and the theatres, etc 
More detailed psychological studies arc being under 
taken, and will be published later There seems no doubt 
that at least in the cast, of a person of the intelligence 
of the present one, it is possible for a previously blind 
person to make a fresh start in life as a sighted person, 
though in some of the cases described this has proved too 
hard a fask 

BlDLIOGRAniV 

Lain, R (1904-Sy Bnl J Pstthol 1, 135 
Ramccy, A Maitland (1903) Lancet 1, 1364 
Talmey, Mix (1910) N ) mcilJ 01,592 


MOULDS AND ASTIDIA 

BY 

E M. ERAENKEL, M D. 

I ohiiifrirv worker at the LCC Southern Gioiip Lnf’ointorv, 
ParL Hotpiiol London S P 

In a previous communication (1934) I published a list of 
allergens which had given rise lo positive skin reactions 
in 522 cases of asthma observed by me m Germany 
Of these patients 290 were males and 232 lenialts The 
reactions most often obtained were those given by cxtricls 
of house dust, bed feathers, and mattress stuffing The 
next most frequent reactions in this scries were tiiosc 
obtained from bacteria (108, 20 7 per cent) and moulds 
(84 16 1 per cent) This latter figure is ilmosi identic il 
With Hansen s figure of 15 per cent given in his record of 
asthma cases in Germany 

Storm van Leeuvven was the first to suggest tint 
moulds, especially A\ptr(>illiis funitgotiis mucor, and 
pcnicilliiim, play a part as “ miasms ” in (ri) climativ or 
(b) house allergens In my own observations the patients 
were usually tested with aspcrgillus, pcnicillium, md 
mucor extracts, the original cultures being made from 
the residence of asthm itic patients 

More recently a number of papers have been published 
in the United States on the problem of moulds as a 
cause of asthma ind hay-fever Some of these mvcsligi 
tions deal with mould extracts as supplied by the Arlington 
Chemical Company, who made preparations of four lyp'“' 
of ispcrgillus, and one type each of altcrn iria, chac 
tomium, monilia, mucor, and pcnicillium , in all, nine 
different types With these extracts Lamson and Rogers 
(1936) working in Los Angeles, found that of 1,- 
patients tested 154 gave positive skin rcictions (12 2 pr 
cent ) Of these sixty six were positive towards alicr 
naria twenty-four to chaciomium, twelve to /ftpfrj,i(“* 
fitnugatur and fifty-two to others On the other h’'n 
Balveit (1932) who carried out his invcstig itmns n 
Oklahoma found th it only 1 per cent of 480 padcn ' 
give reactions tow irds moulds Fcinbcrg (1935), vvoriir 
in Chicago, found that sixty-eight piticnts out of a 



Juu 9 1938 


MOULDS AND ASTHMA 


Tk»’ fin-txrr 
'Lro CXl 


of 243 (28 per cent ) ga\e positive reactions to'vards one 
or more of several fungi 

Schonvvald (1938) on the other hand reports from 
Seattle that out of a total of ISO patients 77 per cent 
gave positive skin tests to one or the other of ten 
tjpes of moulds Reactions were obtained most fre 
quentlj with Pemcilliiim expmistim (77 per cent ) Tri- 
cboderma kernwgt (72 per cent ) Ahernana tenuis (70 
per cent ) and Aspergillus mger (68 6 per cent ) and were 
procured b} means of scratches and intradermal reactions 
The latter were of course comparativelj the most 
frequent 

Brown (1936) tried si\t> eight different tvpes of moulds 
and )easts in twent>-four cases He found that twelve 


Another cladosporium— CWojporuin juh urn Cooke— has 
previouslv been mentioned as a cause of asthma bv Cob' 
(1932) 

I have examined IS5 allergic patients in England of 
whom 148 suffered from asthma and twentv-ona from 
hav fever and rhinitis The 148 asthma patients w..rt 
made up of ninetv two males and fiftv six females Of 
these males eight> were tested with moulds and positive 
results were obtained in fonv-one cases Ot the females 
fifty-one veere so tested and twentv-eight gave positive 
results Of the males seventv five were tested with 
bacteria fortv six giving positive results Tests with 
bacteria were also carried out on tortv five females twentv 
seven positive results being obtained 


cases were sensitive to saCcharomyces and six to alternaria 


compared with four who were Sensitive towards asper- 
gillus Prince et al (1937) tested twentv nine different 
moulds in eighteen individuals in Texas obtaining eleven 
positive reactions of which he considered eight to be 
significant Feinberg (1935) has pointed out that apart 
from moulds yeasts gave positive results in about II 
per cent of the total number of cases tested It has 
also recently been established by Wagner and Rackemann 
(1937) that old kapok which had been subjected to the 
acuon of moulds produced certain allergens to which 
patients were sensitive when they were not sensitive 
towards either the kapok itself or the mould alone This 
indicates that not only are the moulds themselves a source 
of allergic reactions, but that these are produced in 
addition, by some products of the action of moulds on 
other materials 

The great variation in the frequency of mould reactions 
in allergic patients apparent in different parts of the 
United States is explained by differences in the climate 
and the resulting frequency of the occurrence of mould 
spores in the atmosphere The incidence of air borne 
fungus spores varies in different places according to the 
humidity and other climatic factors It has been pointed 
out by Schonvvald (1938) that there is a far more abundant 
growth of moulds in Seattle with an average morning 
humidity of 85 per cent and evening humidity of 51 per 
cent, than 300 miles inland where the average humidities 
are 42 per cent and 27 per cent respectively These facts 
explain the great part played by moulds in the aetiology 
of asthma in this district of the United States this is also 


Table giitae the Incidence of Posune Skin Peutii tonordi 
\Ioulds and Bacteria in England and Germane 



1 stales 

} Fema’es 

T 


Mou/dJ 

Banena 

Moulds 

1 B-ctena 


Bjci na 

Ergtird 






( 

Tested j 

«0 

*'5 

5! 

1 

1 131 

i U) 

Positive 

4U5) ) 

46(61 > 

23(^5 ) 

Uirso ) 

( 

) 'TilHi t 

Gerrran} 







Tested 

290 

290 

2j2 

23- 

<22 

5^ 

Positive 

43(|S ^ 

M(1S J 

|4((IS 1 

jvia-i 1 

'■*4fl6 ) 

1 I04( 1 > 


The table shows that positive skin tests with moulds and 
bacteria were obtained with comparative frequency in 
England the figures with moulds being about the same as 
those reported bv Schonwald from Seattle On the other 
hand the figures obsened in Germanv which are similar 
to the 15 per cent reported bv Hansen tor that countrv 
compare with the results reported from the interior of the 
United Stales It is most probable that this is due to the 
damp climate of England and Seattle corresponding to 
their similar geographical situation in the two continents 
The relative frequenev of positive skin tests with bacteria 
cultured trom asthmatic sputa is also probablv due to the 
fact that infections of the respiratory tract are more 
common in wet climates than in others 

References 


proved by the success of desensitization treatment with 
mould extracts m eighty six patients 

In hav fever and in asthma the mould spore is an 
important factor because of its abundance in the atmo 
sphere and because being much smaller than grass pollen 
It IS more easily inhaled and absorbed This has been 
pointed out by Durham (1937) who working m Chicago 
found that there are more alternaria spores in the atmo 
sphere than there are 'particles of ragweed pollen 
Observations were made in a number of towns during the 
months of May to November From a total of over 5 000 
obsenations made by an average number of fiftv stations 
he comes to the conclusion that alternaria spores are an 
inhalant comparable in importance to ragweed pollen 
The View that moulds are of importance is supported bv 
Feinberg Prince Lamson and Underwood whereas 
Brown Credille van dcr Veer and Rackemann have a 
more conservative view of their importance 

Bernton and Thom (1937) found that dadosporium acts 
as an allergen causing asthma or hav-fever in tomato 
growers This mould is responsible for the colour of 
decaving vegetables It is also mentioned bv Cuba (1946) 
as causing the asthma associated with tomato plants 


Baljeai R M (t932) / Aliens) 3 Z27 

Benilon H S and Thom C fl9t7> Ibid 8 VSi 
Brown G T |1936) Ibid 7 -,SS 
Cobe H xr (19321 Ibid 3 VS9 
Durham O C (I9:>7> Ibid 8 v^SO 
Feinberg S M (193^) H weonjm med J 34 
Fracnkel E M Sc/t*^et^ meti If schr 64 1193 

Cuba E F {I9,>6) Florists Rf\ 78 53 
Lamson R and Rogers E L <19 6) / 7 

Prince H E Selle W A and Morrow M B (1917) Tfx 
Staff J Med 30 17 
Schonwaid P (19,55) J Allergy 9 17'' 

Uagner H C and Rackemann F M (19^7) Ann inrerr \feJ 
^11 50^ 


The thineenlh Ilahan Congre s for OwCup-uonal Disease 
uill be held ai Ban from September 10 to 13 urd- Ibe 
presidencs of Profe^hor L Ferrannjpi wb^n me folloutne 
subjects among others will be di cus cd occupational p-tho 
loc% of asntion cccupanonai p-iholo-s of athletics sil cosjs 
adaptabihlN of the Italian Vvorkrpan to the climate of Fast 
Africa and results of the *.pplication of cororulso'% msurarcc 
against industrial diseases m tbe first four sears Furlber 
information can be obtained from the secrciarv Dr M 
R Clinica Medica Ban 



70 JuLi 9, 193S 


CLINICAL MEMORANDA 


Tiir HmTuit 
MttllC-Xl. JOUSKV 


Clinical Memoranda 


Sulphonamides for Meningococcal 
Meningitis 


References (o the success ol the sulphommides m the 
treatment of meningococcal meningitis are still not verv 
numerous A report of two cases so treated mav be of 

CSSE I 


A male child aged 7 months \^as admitted late on 
No\ ember 24 1937 unconscious consulsed on the fourth 

day of illness, uilh a diagnosis of probable pneumococcal 
meningitis A bead onK of fluid uas obtained on lumbar 
puncture The child uas conscious ne\t da\ 

A Gramnegatire diplococcus giving the sugar reactions of 
the meningococcus was found ^nti meningococcal scrum 
was civen intraihecalU and intramiiscuhrlv on November 28, 
and subsequenth 150 c cm in all were given bv December 16 
On that da> the cerebrospinal fluid contained 115 cells per 
emm the direct film showed pus md meningococci chlorides 
were 648 mg per 100 c cm and meningococci grew on 
culture .he child s lempenUire was 104' F, pvilse 172, 


respirations 54 

One c cm of per cent soluscptasme (M and B 1 m 4 c cm 
anti meningococcal serum was given intrathceallv and half a 
tablet of soluseptasinc bv mouth During the ne\i forlv- 
eight hours the infant was cxtrcmelv ill the temperature 
rising to 106 F On December 17 the cerebrospinal fluid con 
tamed 60 cells per emm and the film showed Gram negative 
diplococci On December 20 there were '^9 cells per emm 
a film showed no organisms but culture revelled a Gram 
negative bacillus (found to be a contamination from a supplv 
of supposcdlv sterile water) The (empeiature fell to under 
100 F on the 19ih and did not rise again 

The child was discharged on Februarv 5 1938 well but 
With paresis of right arm and leg which has since cleircd up 


CAsr II 

A child ot 11 months vv*is seen on Mav 7 1938 with head 
Tctntlion and absent abdominal reflexes 1 took him into 
hospital at once bv car (mainlv hecavivc it was a Saturdav 
and the labor iiorv closes at noon) ^ lumbar puncture was 
done and 1 ecm soluscptasme given mixed with aspirated 
cerebrospinal fluid and 4 c cm 5 per cent soluseptasinc was 
tiso given intramusciilarlv The cerebrospinal fluid showed 
2 400 cells per c mm and meningocotci 

The child was transferred to the local isolation hospital on 
Mav S 4 cem soluseptasinc was given thil dn and hiU 
a nhlcl of soluseptasinc bv mouth twice a da\ On Mav 9 
the cerebrospinal fluid contained tOO cclB per c mm chlorides 
were 660 mg per 100 ecm -“nd culture was Menlc Next 
Ctw 5 c cm 'inti memngococc'fi “icrum p\cn mVminccvn'* 
ind ^ L cm intrnmii^ciihrlN SoUi^ept'isinc 
mouth until M iv 14 The cerebrospinal fluid on Mav 1 J 
contiincd 1^ sells per s mm chlorides were 717 mg and 
culture was sicnlc 

One severs and one mild case ot memngoccccal tnemn 
Ills ire reported Both recovered The severe case vv is 
lot ippirtnilv helped bv serum, but npidh improved 
umisr trs itmcnt bv suiphonimide 

In the mild case a sterile csrcbrospin tl fluid w.is 
obtiinsd lortv eight hours after siilphommidc was given 
ind prior to inv serum treilment 
Curio\is\\ caouLh ihL^c 'irc the onU ciscs of 

msnmgococc il meningitis 1 hivs seen in twelve vears in 
pcnstal pricticc 

I mi indtblsd to Dr P I .7 .riis B .rlow lor the p .iholosis .1 

rcroi" ^ WivtiitsTER MB St \nd F R C S Ed 

Bsxhdi or Scj 


A Case of Streptococcal Meningitis 

A girl aged 7 was admitted into Loughborough Hospittl 
with definite signs of severe meningitis She had a historv 
cvf a discharging right ear for ten da^s toUowmg in 
attack of influenza There was no evidence of mastoid 
involvement The ear was dry on admission 

Lumbar ptincliirc performed on the first diy producvd 
a ceiebrospinal fluid which was undei great pressure and 
cloiidv The report describes it as “ i lrankl> purulent 
fluid with a picdomimnt polymorphomicicar leiicocwc 
reaction Cultural examination Ins yielded a growth of 
streptococcus A further report on the same specimen 
stated that these were haemolytic streptococci The next 
dav before the repoit was received 10,000 units of 
meningococcal anlitoxin were injected intramusciilarh 
With the result that the temperature of 104 4' F dropped 
to 99' F eight hours later On receiving the report 3 000 
Units of streptococcal antitoxin (scarlitinal ttpe) were 
given inlramuscularlv This was repealed the next daj 
The temperature was then 101' F The loliovving d ly 6 01)0 
units vvere injected intramuscularly but the temper iiurc 
begin to svving between 104° tnd 99' F We then gave 
three daily intravenous injections of 9,000 units (30c cm) 
The temperature fell to normal tiler the first injection .and 
stayed down for the two davs following The next div 
9000 units were introduced intramusculirly. with the 
result that the lcmpera,(iire lose to 102' F Four dulv 
intravenous injections of the scarlatinil antitovin were 
then given in decreasing doses of 9 000 6 000, 6 000 and 
4 500 units respectively — a total ol 25,500 units (85 cem) 
Since the first of these four injections the tcniperahire Ins 
remained normal 

Lumbar punctures were done dailv, and the ccrcbio 
spinal fluid only became clear (pathologically) after ijie 
first scries of intravenous injections of aiililoMn The 
lempcralure and pulse are now normal and the child is 
behaving normally There was a slight scrum rc.iction 
on the eighth d.vy of treatment, in the form ot er^thv 
matous patches and occasional wheals The antitoxin 
injections were given daily but three minims of adrenaline 
were injected siibcutaneouslv on the day the rash was lust 
seen and iliis disappeared in two days The cir conu 
tion seems to have subsided completely as well On inc 
first lumbar puncture done under open ether anacstliwn 
paracentesis of ihc right drum vvns performed, and apari 
from i slight discharge which stopped after four dijs, 
the car Ins kept dry and there has not been an> ns 
comlort from it since The child has been disclnigw 
from hospital and has since been well 

The rapid response to intravenous antitoxin llisfiP' 
indicates thu this form of treatment is worthy ^ 
sidcriiion in cases of meningitis following middk i 
mfcciions The total dosage of scarhtiinl antitoxin 
245 cem or 73 500 units of which 1 75 cem were P' 
mir ixcnouslx 

The scrum used was Parke Davis and Co s strep « 
coccal antitoxin (scirhlmil txpc) 

Morris SnixxARi/ M R (- *’ 

Gcm-ril Movpitil I ougliborouRli 


The fifteenth concrevs of the Association of Lrench f 
Dostors of North America will be held m 
September 6 to 8 under the prcsidcncv of Dr J » f 
further inform ition cm be obiaincd from tnc 
32( r i‘t Botilev ird Si Joseph, Montreal 



JUL> 9 193'! 


REVIEWS 


71 


Reviews 


POST-OPXRATIVE RADIOGRAPHY OF THE 
BILUR\ TRACT 

L Exploration RadioloQiqnd Post Optratoire de la \ ote 
Biltaire Pnncipale B> B De^plas P Moulonguet and 
P Malgras (Pp 130 40 figures 40 fr) Pans Masson 
et Cie 

This \olume deals with the radiographic exploration of 
the biliary passages after operation and opens up a new 
field in surger) The method employed is the injection 
of either hpiodol or tenebr)! into a drainage tube left 
after operation on the gall bladder or bile ducts So 
impressed hd\e the authors been b> the value of the results 
obtained that it is now pan of their routine treatment 
earned out a few da>s after operation In some cases the 
operation itself has been of a complete nature with the 
remo\al of stones m the bile ducts when the object of the 
injection was to ensure that the passage was clear and that 
no stones had been left behind In other cases a pre 
limmar> drainage has been deliberaleli performed and 
the radiographs ser\e to indicate what further procedures 
are required 

The monograph is amplj illustrated with actual radio 
eraphs of injected cases the interpretation of which is 
greath facilitated bj ke> sketches The> demonstrate 
the evtraordmarj ramifications of the bile ducts the 
extent of which is reallj astonishing The\ also show the 
free communication which commonlj exists between the 
bile ducts and the duct of Wirsung while certain of them 
show with great beaut\ the mechanism of the sphincter 
of Oddi The subject is so entirel> new that we are unable 
to form an estimate of its possibilities but we haxe no 
doubt at all that it is one which demands the close con- 
sideration of e\er> surgeon operating on the bihar> 
passages The monograph is equallj remarkable for its 
origmaUi> and its admirable presentation 

DIFFEREiNTlAL D^AG^OSIS 

Differcntialdtagnose m dtr Inneren Medizm Bs Professor 

Df Med O ^acgeh Part 111 (Pp 732 *‘9 lUusiraiions 

RM 10 801 Leipzig Georg Thieme 193/ 

The third part completing the whole of Professor 
Naegeh s book on differential diagnosis in clinical 
medicine has now appeared The earlier portions of the 
work were fa^ourabU commented on in this Joiinwl 
eighteen months ago and the present section continues 
on the high standard alread\ attained The book has 
700 pages of text and 22 pages of well arranged index 
Professo, Naegeh whose recent death we deplore, has 
e\er\where impressed it with his own personahi> and 
experience and it is thus one of the best books aiailable 
on the subject of differential diagnosis In dealing wjth 
the diagnosis of the febrile state the author points out 
how much has been gained b\ the application of sero 
logical and other laborator\ methods in differentiating the 
fe\eri of hitherto undefined origin There is no sure 
diagnosis from the course of the temperature cur\e itself 
Of the simple continued fe\trs tvphoid is still the most 
pteNaleui the \arious aspects and complications of 
txphoid are therefore used to contrast \sith those diseases 
wh'ch max simulate them though certain acute febrile 
diseases with exanthemata haxe characters of their own 
The tropical fevers are included so that a reference to 
the book should enable anxone to be aware of the salient 
points leading to a correct diagnosis Joint diseases are 


Tir*' B — 
XfT* It 


dealt with under the broad headings of those «ith l>.\tr 
and those uhich mav be accompanied b\ fescr A. 
separate section on the differentiation of diseases o the 
aertebrai column is speciall} useful The final sections on 
diseases of the kidnet and urman tract of the n.n s[.s 
sastem and of the organs ssith internal secretion are 
equalU good 

It IS remarkable how much information the author has 
been able to pack ir o a small space the essential features 
of the normal and abnonnal elec rocardiogram are 
gnen m about ten pages Throughout the book there is 
esidence of the critical facultt the teaching capacits and 
-the research spirit which brought Naegeh to a respc-c'cd 
position on the Continen' not onh lor his work on ih^ 
blood alone but also m general medicine 


■iEA.RBOOK OF UROLOGY 

The 1937 3 ear Booh of Lrolo?^ Edited bv John H 
Cunningham MD {Pp 473 130 figures 3 '0 dollars 

lOs 6d postage 6d ) Chicago The ’^ear Book Pub 
lishers London H k Lewis and Co I9_7 

This handt well printed and well illustrated lolunie mam 
tains the high standard of its predecessors m offerin^ a 
succinct and critical compendium of current urological 
acmtties The good result of a bilateral plastic operation 
for hidronephrosis after ten >ears makes one wish that 
more late results of such operations "ere published The 
transatlantic lose of scientific accuracj is reflected in such 
classifications as pus grade 3 erjthrocites grade 3 
But when it comes to tenderness grade 3 (p I si) are 
we to look forward lo headache grade 2 constipation 
graded etc’ The surprising statement that iheadmmis 
tration of chondroitin sulfuric acid is the best known 
agent for pretention of stone formation may reflect the 
mefficac) of most soolled pretentites It is noteworiht 
that most children with vascular obstruction of the 
ureter are treated for months for chronic ptehtis and 
that in the absence of infection the renal changes are 
reguIarJt interpreted as interstitial nephritis although a 
correct diagnosis can usualh be made bt complete 
urological etaminalion Criticism is nghtlj expressed of 
those gjnaecologisls who sat If one does not know what 
to do then cut the presacral nerte Ptelitis htdro 
nephrosis and male slerihtt are mentioned as observed 
sequelae The confession of 1 10 perureihral resections with 
sixteen deaths at a reputable clinic is a refreshing change 
from the monotonous and largelj incredible reports of 
hundreds ot resections without a death Another valuable 
commenlarv ts the statement that cjstostomv followed bj 
resection is the safest prostatic procedure \\ ith regard 
to bilateral crjptorchidism the report that of fifteen 
patients in whom orchidopexv had been done in childhood 
nine were fertile is verv encouraging All urologists should 
read this book 


THE PAGET TRADITION 


The Poeei Trmhiion Bv G Grev 
3s 6d 1 London Ca^vell and Co 
lOXX 


Turner (Pp 14S 
Simp! m Marshall 


James Paget (savs Professor Grc> Turner) phxsiologist 
pathologist surgeon and man of honour was one of the 
greatest ornaments of the \ icionan era As the leader of 
the prolession in his da\ he stood for rectitude m surgery 
Hts example has become a tradition not onU at St 
Bartholomew s Hospital where he was nurtured but m 
all ihost- parts of the world where it was carried b> his 
mans ■pupils Of this tradition Professor Gre\ Turner has 
wntlea three charming essaxs m language xxhich docs 



72 JuL^ 9, ms 


REVIEWS 


Ta>£ 

'fttnCAL JoVASVt 


credit lo his knowledge of English The first essay is the 
address he gave m Boston when he was presented with the 
Henry J Bigelow medal It tells the story ot Paget s life 
and shows how he came to exercise so great an influence 
upon his generation He was a teacher and consultant 
in the strictest sense of the word Through the two small 
rooms of his little house m Harewood Place, then a dead 
end with locked gates into Oxford Street, passed for many 
years ail that was interesting or obscure in English suigery 
The second essay is devoted to Stephen" Paget, the 
youngest son of Sir James It is entitled. What Research 
Owes to the Paget Tradition,’ and is the elesenth Stephen 
Paget Memorial Lecture Much of his useful and all too 
short life was spent in the service of the Research Defence 
Society It was well said that ‘ when it is one man s 
business to propagate a delusion and nobody s business 
to destroy it. Truth is apt to find herself more than usually 
hampered ” Stephen Paget set himself lo free her from 
the shackles The third essay is entitled “Opportunity,’ 
and was the winter address given at the Welsh National 
School cf Medicine in 1934 

The publishers state that the little book has been jrub- 
lished at the request of Professor Grev Turners past and 
jrresent students ‘No profit whatexer is being made by 
the author, or in fact by anyone but the bookselteis ’’ 
Even they cannot be much in pocket, because it only costs 
half a crown , the money is well expended since it contains 
much of inteiest for every reader 

DISEASES OF THE BLOOD 

T/ic Diagnosis and Treat went of Diseases of f/it Blood 
Bv Thomas Ordwav M D and L Whittington Gorham 
MD Rexiscd bv Raphael Isaacs MD (Pp 60*1 33 
figures, 15 coloured plates 32s 6d net) London New 
York Toronto Humphrev Milford, Oxford Umsersity 
Press 1938 

The textbook on Diseases of the Blood by Ordway and 
Gorham is described as revised bj Dr Raphael Isaacs 
and the foreword bears the date December 1937 The 
reader is a little surprised to find that the pages arc not 
numbered consecutively, some having been interpolated, 
and that there is a supplementary index His surprise 
deepens into concern when he finds that the section on 
agranulocytosis contains no reference later thin 1927 
and makes no mention of amidopvnne under aetiology or 
of nucleotide, liver, or bone-marroiv under treatment An 
article on the hypochromic anaemias has been inserted, 
but the original chapter on chlorosis has not been altered 
to suit and still mentions cases of atypical or chronic 
chlorosis Mitchell and Schmidt are quoted as finding 
that ferric chloride and ferric ammonium citrate, which 
arc soluble, w'ere much more effective in building 
h icmoglobin than ferric oxide and ferrous carbonate, 
which are insoluble without indicating that their 
experiments vvere^jferformed on rats and that in man the 
errous saltsyTre more efTeciive thin the feme The 
ewunu oT ’^anaemia m pregnancj is antediluvian md 
pernicious anaemia of pregnanev is recognised dcfinitcl> 
s an hacmoKtic anaemia, probablv produced bv a toxin 
vm the placenta ’ Treatment b\ hjdrochloric acid and 
md transfusions is advised and the number of cases 
sated b\ liver is said to be still too few to draw con- 
elusions No mention is made of nutritional deficiency 
under letiologv or of marmite under treatment In the 
treatment ot leukaemia more stress is laid on radium 
than on v ravs and on benzol and malanothcr ipv than 
on ar'^cnic In the ch ipier on haemophilia the v due of 
snake venom is not indicated Nciiher the original 
index nor the supplementary index refers to scurvy 


Enough has been said to show the mnnv deficieneics 
of this book ‘ In few fields of medicine,’ savs Ihc tore 
word, ‘have more important advances been mide m 
recent vears than in the diagnosis and trcitnitiii of 
diseases of the blood ’ We can only vvarn our re tilers 
that no adequate iccount of these advances is containecl 
in the volume under rcvievv 

BRITISH HEALTH RESORTS 

Official Handbook of tin Biitoh Hiahh Resorts Issotin 

lion t2s 6d net ) London ] and A Chiircliill 1 td 

The new edition of the handbook of the British Health 
Resorts Association contains a vast amount of know 
ledge succinctly set out, concerning the spas and the' 
seaside and inland health resorts of Grcit Britain This 
year a section has been incoiporated giving particulars also 
of spas and climatic resorts in the Dominions and certain 
of the Colonies 

The coasts of the British Isles include five distinct 
climatic regions — north-western, south-western, soiillicrn, 
south-eastern, and eastern Nearlv all the places helongmg 
to the first four groups may be described as winter is 
well as summer stations Many seaside places in the soiilh 
md west have a warm and equable winter climate, being 
largely unaffected by the cold polar currents, and protcewd 
from easterly winds by hills or wide spaces of intervening 
land In addition lo what may be called these regmml 
climates there are mmimcrablc local climates depending 
on the aspect, shelter, geologic \l fornntion, even the 
vegetation of a given place, and this may be of import inve 
from the medical point ot view If looks as if, instcid of 
the general advice lo go to the sea, or the moors, ot the 
mountains, or lo a spa, the practitioner will have to pre 
scribe health resorts vvith something of the parttculvrdi 
with which he prescribes drugs In that event the hind 
book bids fair to form an evcellcnl equivalent to the 
Pharmaeopoeia Under the editorship of Dr Fortcsciic 
Fox, It IS an authoritative and impartial publtcation, 
packed with detail, and the happy illustrations on every 
page almost mike one vvant to be an invalid The fullest 
information is afforded of the twelve spas of the Bntoh 
Isles (meaning by spas places at which establishments for 
medical use hav’e been set up at the source of rccognuci 
natural medicinal springs) Particulars arc given of the 
situation and history of each spi, its geology, chnnte me 
constitution of its wilcrs, and the bathing and other 
lacililies When so much is given it is rather churlish to 
ask for more, but a few more particulars of spa hospitals 
would be useful 

This spreading volume, which began m my years ago a 
an inset m the Medical Dinetoiy is now owned entire v 
bv the British Health Resorts Associatton which intends to 
secure for it a gre ifly increased circulation, largely among 
members of the medical profession It is well on its iv 0 
to becoming one of those few publications winch ue 
indispensable 


Notes on Books 

>/»(/(( V on the Plnsifllogs oj thi Eve by J 
3vRNfc MD LLD, IS reissued with ' ^ 

lew index by H K Lewis and Co at fl' . 

rollection of papers each more or less self comaincd 
leahng with a large vancly of xubiecis but ^ 

Ihc innervation of the pupil and the Ini and ' 
proprioceptive system of the external ^ | 

rhe work recorded deals csscniiilly with expenm " 
ibscrvations on the cat and much space (.< 

he paradoxical reactions Much in this collection 



]UL\ 9 193S 


NOTES 079 BOOKS t»i d inc» 


, papers departs from accepted teaching It is possible to 
indicate onij broad!} the authors conclusions He holds 
that the primitue response is of a chemical t\pe the 
stimulus acting directly on the muscle It is this t}pe 
of reaction which is responsible for paradoxical reactions 
A later deselopment is the chemico neural response the 
chemical stimulus acting mdirectU through the neural 
centre The highest state is the reflex response 

A valuable book of reference for all who have occasion 
to inform themselves about the London hospitals is The 
Hospital Guide which has reached its fourth edition 
(price 3d ) It is published bj the Advisorv Hospital Com 
mittee of the Hospital Saving Association (30 Lancaster 
Gate H)de Park \V 2) and naturallv has been compiled 
from the point of view of the contributors movement 
One table shows the progress of the Hospital Saving Asso- 
ciation Itself which m 1937 reached for the first time over 
one million pounds m contributions and had over one and 
three quarter million contributors Contributions and con 
tribulors have almost doubled since 1931 But the bod> 
of the Guide is full of information regarding all the 
voluntarj hospitals of the metropolitan area giving details 
of accommodation charges or terms hours of attendance 
in 3he different departments and even bus routes and the 
like 

Fermeiile Hormone Vitamiiie tind die Beziehiingeii 
dieser iVirhstoffe zueiiiander b} Robert and Wilhelm 
D iRbCHERL IS published at Leipzig b} Georg Thieme at 
the price of RM 30 For ferments hormone^, and vitamins 
the authors propose the generic name of ergines 
According to their definition ergmes (efficient subslancesi 
are such organic compounds as are formed in the living 
cell and necessarj for the normal course of hte in plants 
and animals Thej act m such small amounts that their 
effect cannot be due to the energv produced bj the com 
bustion of the molecule The book under review deals 
with the three groups separate!} and comprehensivelv 
and adds a chapter on the relations between ferments and 
ferments ferments and hormones ferments and vitamins 
hormones and vitamins hormones and hormones and 
vitamins and vitamins The literature seems to be taken 
into consideration well into the }ear 1937 but a biblio 
graphs would have been a ver} useful addition 

hot So Long Ago A Chronicle of Medicine and 
Doctors in Colonial Philadelphia b} Cecil K Drinler 
M D Sc D is published in this countr> bv the Oxford 
Universitv Press at 15s Professor Drinkers great great 
grandmothef who was a member of a Quaker famiK 
which moved to the site of Philadelphia a few }ears before 
W'llliam Penn founded that citv of brotherlv love in 16S2 
kept a diary there for nearl} half a centurv until her death 
m 1S07 Parts of this footnote to hmorv have been 
ahead} published and Professor Drinker made use of 
other parts — and they were mans — about disease as a basis 
for a series of lectures at the Lowell Institute These 
lectures have been utilized in this publication The text 
ot the diar} has been scrupulouslv copied with all its 
abbreviations inconsistencies and mistakes It tells the 
slot} of the large tamilies which look up all the time 
of married women if thev lived at a time when so man} 
men. had a succession of two or three wives There is 
much about the diseases — tuberculosis small pox )eIlow 
fever fever and the bloodv flux (d}senlerv prob 
ablv bacterial) — then rampant m Philadelphia and the 
medical men especial!} Benjamin Rush who wrote a small 
pamphlet about Old Drinker who lived to be 103 
Professor Drinker has added an extremel} interesting 
running commentarv on the records of a time when 
medical men were kept busv and responded with a great 
armament of S}Stem and thcorv but with a minimum of 
fundamental knowledge The contrast between medicine 
then and nov is graphical!} displajed 


Preparations and Appliances 


SIMPLE PORTJiBLE SLCTION PLMP 
J Euart Plpves fBromle\ Comnon Kent) ev 
Even surgeon has felt the need for a simple portah'-* 
suction apparatus which could be counied on lo give a ^lurp 
suction stroke when required \ motor tv re foot pump 



seemed to present a good basis for expenment Me rs 
Down Bros b\ carefulh balancing the reversed non return 
valve have produced a cheap and e/^iLieni suction apparatus 
which can be rehed on to clear a throat of mtcus or blood 
clot and to remove fluid from an abdomen or a cvsi which 
has to be tapped If manipulated carefuilv it can al o 
replace a Potains aspirator The bottles are of reasonable 
size and the stand has been kepi verv simple to make the 
ensemble cheap and light 

PROTAMrSEZINC 

Protamine insulin (with zinc) suspension has been produ''ed 
conjoimlv bv Allen and Hanburvs Ltd and the Bntish Druk 
Houses Ltd It ts a sterile suspension of protamine invulin 
(with zinc) with a reaction of pH 7 1 The p cp^ration is 
slightiv turbid and the phials must be shaken before use 

The introduction of the slow acting protamine zmu insulin 
was an advance of verv great importance m the treatment of 
diabetes but hitherto its has been hampered bv the fx^ct 
that It was necessarv to mix separate solutions •^hortlv before 
use The manufacturers have surmounted this technical dilTi 
culiv and have produced a preparation which will keep for 
SIX months after manufacture and for a fortnight after the 
rubber of the cap of the phial has been pierced Thi*. 
represents a technical improvement of considerable practical 
importance 

The manufacturers issue a ver> useful pamphlet ei;plainmg 
the special properties of proiarune zinc insulin and the 
manner in which it should be used The value of protamine 
zme insulin depends on us «;low and persistent action but 
this involves certain special dancers The fall in blood suenr 
IS so slow that warning svmptoms of hvpoclvcaemia ms} not 
arise and a severe attack mav follow suddenlv moreover 
the action is so lone that u wUl outla<:t a single replacement 
of carbohvdraic 

GONADOTROPIC HORMONE 

Gonadvl (Rou Laboratories Ltd) iv a p cparation 
of the gonadotropic hormone prepared from precnanl marc ^ 
scrum The preparation ts in powder fo’Tn in ampoule 
and IS dissolved imm^^diatch before use Each ampoule 

contains 40 rat units i = 160 mou c units) The gonadotrop c 
hormone has been used with pronounced success in the 
treatment of cnptorchidjsm It his been ined m a v^neu 
of di orders of menstruation and is also being fo' 

azoo>permia and impo ence 



74 JuL\ 9, 193S ROCKEFELLER AND THE FRONTIERS , TutPxn.™ 

MEMCAI. JOEKVEl 

another fifth to public health, and the rcmaindtr 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDAY JULY 9 1938 


ROCKEFELLER AND THE FRONTIERS 

The story is told of a revolution i\hich broke out 
in a Central American city some twenty years ago 
A medical investigator was engaged there at the 
time in studying yellow fever control and deter- 
mined to continue his researches in spite of the 
hostilities Every morning with a flag of truce he 
crawled through the barncades to collect his 
mosquitos on one side of the fighting line, and 
in the evening crawled back again to gather up 
his specimens on the other Neither army molested 
him, but both thought him crazy — a man who, 
when great issues of human destiny were being 
fought out, spent his time catching insects To day 
in that part of Central America the revolution is 
forgotten, but the name of the investigator, Emmett 
Vaughn, is remembered as that of the man who 
helped to stamp out an age-long pestilence Which 
is of course, a parable But a sorrowful footnote 
has to be written, that such is the piesent intensifi- 
cation of nationalism and racialism in various parts 
of the world that even the collecting of mosquitos 
IS now sometimes impossible Mr Raymond B 
Fosdick, the lawyer-president of the Rockefeller 
Foundation, m his Review jot 1937, writes of 
the new international barriers which interrupt and 
cmb.irrass the pursuit of philanthropic purposes and 
the advancement of knowledge Objective scholar- 
ship, he says, is possible only uhere thought is 
free and freedom can exist only where there is 
tolerance uhcre there are no “keep out” signs 
against the inquisitive and questioning mind Dis- 
interested research cannot survive in an atmosphere 
of compulsion and repression In some fields the 
Foundation is finding it profitless to go uherc 
formcrl> it went It is stopped at some frontiers, 
not because the frontiers have any greater geo- 
gr.iphical significance than they had a few years 
ago but because behind them the search for truth 
b\ eager and sceptical minds has been made 
impossible 

fs'e\crthcless the benefactions of the Founda- 
tion continue on the grand scale In 1937 — the 
}ear of J D Rockefeller s death — the Foundation 
appropriated for philanthropic purposes a sum of 
ne iris two million pounds Of this amount nearly 
one quarter was gnen to the medical sciences. 


for work in other social and natural sciences and 
the humanities The largest single appropriations 
were £80,000 for the maintenance of Peiping Union 
Medical College, China £70 000 to Harvard 
University for research on industrial hazards and 
£60,000 to Yale for the Department of Psychiatry 
The benefactions to public health took the form ol 
aiding various health departments, education in 
public health and the study and control of specific 
diseases These diseases included yellow fescr m 
South America and Africa hookworm and schisto- 
somiasis in Egypt, tuberculosis in Jamaica and 
Austria, scarlet fever in Rumania, influenza in 
Hungary and malaria m a number of countries 
Diseases know no frontiers and arc no respecters 
of flags “ In this field of public health ’ com 
ments Mr Fosdick “ more clearly perhaps than 
in any other phase of human effort one sees 
the complete inadequacy and meaninglessness of 
the conception of the absolute sovereignty of tl>e 
State ’ The field studies undertaken during tlic 
year have added a good deal of information rc 
garding the conditions under svhich jungle yellow 
fever occurs The absence of Acdcs acgvpli from 
infected areas has been amply confirmed and 
further evidence has been accumulated suggesting 
that human cases are not essential — even that they 
are relatively unimportant — in the maintenance of 
jungle infection The biological control of the 
insect vector so successful in the case of urban 
yellow fever, is not applicable in this field, and 
the elimination of animal hosts is not economically 
possible throughout the vast regions of South 
America, where jungle infection abounds The 
only hope of prevention at present lies in mdividu.il 
immunization of exposed populations by vaccina 
tion, and during 1937 well over 40,000 persons 
were vaccinated in Brazil and Colombia 

At present, in its appropriations for nicdu..il 
sciences, the Foundation is concentrating on assis 
lance to psychiatry The comment is made that 
mental disease is only now slowly being dncsled 
of the opprobrium meted out to misconduct Mr 
Fosdick speculates as to the attitude to the common 
cold if one of the early signs, along with sneezing 
and chills, was a transitory attack of kleptomania 
‘ The ancients saw mental abnormality as a posses 
Sion by demons , the quasi-modern layman still sees 
it as a disgrace , the modern man is coming to 
recognize it as a disease ” It cannot yet be s ik 
that the development of psychiatry' has paralleled 
the development of other branches of medicine 
As a new science it has not yet gathered about 
Itself a body of knowledge or trained personn 
comparable to that achieved in other di'Ciplim. ^ 
and to its frequent isolation from the rest O' 



Juu 9 193S 


THE \IA\AGEMENT OF PHTHRtS 


medicine must be ascribed tlie fact that it has some- 
times run to strange cults and theones The 
Foundation is tr>’ing to infuse medicine with 
psjchiatry and neurology Since 1932 it has gisen 
roughly £1 200 000 for this purpose The appro- 
priations for 1 937 included £8 000 for the support 
of the Department of Experimental Medicine at 
Cambridge with a view to aiding m the develop 
ment of psychosomatic studies in this countrv 
A discerning tribute is paid to J D Rockefeller 
who was no mere distnbutor of largesse but a 
man of far reaching vision He did not hold the 
view as so many benefactors have done that 
\ isdom came to an end with his own generation 
He was not under the illusion that what seems 
important to-day will necessarily be important to 
niorrow Therefore he did not tie up his Founda- 
tion to rigid and unchangeable purposes Nor did 
he believe in the maintenance of the Foundation 
m perpetuity — “perpetuity’ he was apt to sa> 

“ is a pretty long time ’ — and therefore the 
Foundation can and does spend its capital as well 
as Its income It has adopted some liberalizing 
provisions whereby, ten >ears after the date of a 
gift the income from it may be used in whole or 
part for some purpose other than that for which 
the gift was made, and after twenty five jears the 
principal m part or whole may be so used subject 
in both cases to the qualification that the new 
purpose shall be as reasonably related to the 
onginal as may be found practicable at the time 
havrag regard to interv'ening changing conditions 
This explains the occasional redirections of Rocke 
feller policy which have puzzled some people 
Rockefeller and those who come after him have 
been anxious to free their work from the em 
barrassment of “ frozen ’ funds and tired en 
dowments of which those who have to do with 
ancient — and some modem — foundations in this 
country know too much 


THE MANAGEMENT OF PHTHISIS 

Much of recent discussion on the after-care of the 
tuberculous patient has been based on little more 
than vague surmise A report' compiled by E 
Bneger and edited bv Sir Pendnll Vamer-Jones Dr 
Bachmann of Switzerland and Dr Bronkhorst of 
Holland for the International Union against Tuber- 
culosis gives for the first time a comprehensive 
account of carefully sifted evidence from which 
more reliable conclusions may be drawn In this 
countrv it is generally agreed that both the imme 
diatc and the remote results of sanatorium treat 

'^tirrCare and Rrhihdiraiion B> E Bncmr Publi bed b» 
the Sniuh Jmirnil o/ Tiib-rciilosi! as a special supp'-ment, 

o-tow mr 


7u Er-' 'n -"C 

Vio 3 r Ki 

ment are bad The proportion of oatients who e 
sputum contained tubercle bacilli discharged with 
negative sputum tests is disappointinglv lov P'at 
It could be improved is brought out cluiriv in the 
report This has been achieved bv what Bru_.r 
calls combined intensive treatment He dviincs 
this as including prolonged rest hvgienic measures 
chrysotherapv collapse therapv and surgKal pro 
cedures used m vanous combinations and -equenscs 
with one object in view — healing the lubsrculous 
lesion, which implies that no tubercle bacilli .an 
be detected bv culture of the sputum or .ulnre 
andiOr animal modulation of the gasirw ^ont^nts 
At the Bilthoven Sanatorium in Holland tor 
instance the proportion of patients admitted vuh 
positive sputum tests and discharged with them 
negative has been raised from about 20 per cent in 
1921 to over 70 per cent in 1936 
More time is needed before a true estimate can 
be made of the final results of combined intensive 
treatment but it is claimed that the proportion of 
relapses in the patients discharged as spuiurr 
negative or conditionallv arrested is not m 
creased In such of these patients as remain under 
observation any relapse is detected earlv and cm 
also be dealt with bv combined intensive treatment 
The proportion of untreatable good chronic 
cases IS, however increased Lawrason Brown 
and H L Sampson have dehned this group thus 
‘ A cavitv 2 cm in diameter or larger must be 
present The general condition must be favour 
able The temperature and pulse must be normal ^ 
during the period of observation of several months 
The appetite and strength must be good and the 
patient must sleep well Expectoration mav be 
present but must not be excessive He is usuallv 
able to take some exercise The number of tubercle 
bacilli in the sputum is not taken into considera 
tion The net result of applving combined 

intensive treatment is therefore to save lives to 
increase the number of patients with healed lesions 
and to enlarge the group of good chronic cases at 
the expense of the ‘ bad chronic cases which ire 
those not conforming to Brown and Sampsons 
criteria The problem of after-care anses not with 
those patients who are well enough to return to 
their work provided thev can be trusted to live 
reasonablv nor with those in whom the disease 
IS so advanced that isolation in hospital is nccessarv 
but vvith a large intermediate group After-cart is 
needed for the ‘conditionallv arrested patients 
who must be rehabilitated before reluming to their 
onginal jobs or to new occupations and for the 
good chronic cases For the latter permanent 
settlement in an appropnatelv developed village on 
the lines of Papworth is indicated for the former, 
a trainms'ccntre 



76 Juu 9, 1938 CHANGES IN TEETH FOLLOWING PARATHYROIDECTOMY TutT\MUMt 

_ Mtt'jCKV JaiRsM 


The training centre and the village settlement are 
not alternative solutions to the same problem 
Each meets a different need and has a different 
object in view, though there is no reason why the 
two should not form part of the same unit It 
has been found necessary at Papworth to add to the 
village a large sanatorium-hospital section well- 
equipped laboratories, and a surgical unit, and it 
has been thought that the period spent in a village 
settlement might be limited for the completely 
arrested case, so that in these instances the village 
settlement would function as a training centre 
These things lead us to suggest that perhaps the 
whole problem of after-care might be approached 
in an opposite direction, beginning with the sana- 
torium and hospital, adding to them the training 
centre, and allowing the village settlement proper 
to evolve around these institutions What is 
needed is a departmental unit completely equipped 
for the treatment and after-care of the tuberculous 
poor , for treatment and after-care are indivisible 
parts of the same entity A' patient cannot be 
expected to submit to prolonged treatment unless 
his livelihood and that of his family are assuied in 
the event of his becoming as a resdlt of combined 
intensive treatment, a “ good chronic case ” It is 
fortunate that more than half of this group are un- 
married The falling mortality from tuberculosis 
gives no ground for complacency Tuberculosis 
remains an important economic and social problem, 
the solution to which may partly lie in the evolu- 
^tion of units in which one authority has the sole 
responsibility for both the treatment and after-care 
of cases of tuberculous infection of the lung 


CHANGES IN TEETH EOLLOWING 
FARATHA ROIDECTOMY 

The incisor teeth of the albino rat arc sensitise indicators 
of fluctuations in the metabolism of calcium and phos- 
phorus ind ire therefore useful m studs ing the physio- 
]og> of the piratlnroid ghnds Schour Chandler and 
1 uctdi ‘ in 1 recent rc examin ition of the influence of 
piritlnroidcctonn on the structure of these teeth ln\c 
confiniu-d sonic of the eirher findings of other uorkers 
but not ill Some of the presious work was earned 
out on r Us led on diets now recognired is dehcicnt in 
\itimin D e ileiiim ind phosphorus which probabl> 

J eeounts tor the differences now obsersed b\ Schour 
hel his eo workers who used a diet idequate m calcium 
hosphorus proteins eirbohvdnte fat and almost 
eeri iinl\ in vit imin D though the content is not stated 
C ileium formed 1 41 per cent of the diet and phos- 
phorus 0 '■'s p^r Cent The eh inges in the structure of 
the leeth Were eMmincd in respect to gross ind micro- 
s-opie il eh mces m (Group 1) eighteen nts which were 
iF(o\td to siirM\^ 4 to 20 dus m (Group Jl) Ofty- 
‘ (r } iit}, 19m, 13 tt-s 


seven rats w Inch siin n cd i9 to 1 59 davs in (Group III) 
fourteen rats w'hich sursued 105 davs and were sub 
jected to fasting every seventh dav in (Group IV) 
eleven rats which survived four months to one vear and 
which underwent lepeatcd pregnancies and lactations 
and in (Group V) twenty-seven controls In Group I 
(short survivals) the dentine formed after operation was 
more densely calcified than noimal It is demarcated 
from the dentine formed before operation by a distinct 
ring (the calcio-traumatic ring) which appcirs to be 
an acute response to a shock to calcium metabolism 
The denser calcification of the post-opciativc dentine 
may be a lesult of the calcium retention that is reported 
to persist during the early survival period In Group II 
(longer survivals) calcification is defective the longer 
the survival the more defective is the calcification The 
dentine shows an irregular and accentuated alternation 
of zones of different densities in cnfcificition nfiiefi is 
probably responsible loi the readiness to fracture of 
the dentine of parathyropnvic rats In Group 111 (long 
survivals with fasting every scventli dav) the hisfologitai 
changes were found to be aggiavatcd In Gioiip IV 
(long survivals with repeated pregnancies and lactations) 
there was no evidence of vvitlidravvai from tiic ealcifnd 
tissues of the teeth Schour Tweedv Chandler, and 
Engel" have also compared the effects of paiatlivraid 
extract and of calciferol on the incisor of the para 
thvroidcctomi7cd albino rat The effect of the paia 
thyroid extract given to twenty-nine rats is the sime 
as that observed m normal dentine — namely, a short 
primary hypocalcificd region (staining with cosin) and 
a secondary hypcrcalcificd region (staining with haema 
toxylin) — but doses which were ineffective in normil 
animals were enough to produce the typical response 
in the experimental animals In some animals wliieh 
survived longer than si\ days, however the deeper 
staining reaction icccdcd and blended with the staining 
reaction of a normally calcified dentine Generally, a 
calcio traumatic ring was found, and cytological changes 
m the active enamel-forming cells were found in one 
half of the animals Similar changes were found m 
thirty parathvroidcctomi7cd rats which were given 
single doses of 46,000 to 644,000 intcrmtional units of 
calciferol In this group of rats the serum ealcium rose 
during the first three days aftci administration of 
calciferol then declined slowly to the original level 
The maximtin height and the npidity of the rise 
increased with the dosage The earlier findings of these 
workers — that the presence of the parathyroids is not 
needed for massive doses of calciferol to exert their 
effect — IS therefore confirmed 


POSl-VACCINIAL ENCI FHAEITfS 

The incidence and fatality of post-vaccinial cnecpln 
litis formed one of the subjects recently discussed at 
the International Office of Public Hcallli ’ when Pro 
lessor Reiter the Gcmian delegate stated that during 
1936 ten suspected cases after pnmirv vaccinalmn Ind 
been reported In five the di igno* ^ s was supporic djn^ 

’ liner J Pdili 19^7 13 971 
‘Bull Og ml Ihr lub! 1938 30,737 



Jt,x\ 9 1939 


TREATMENT OF \nOTO\T\ 


clinicii examimtion but m none b\ necropsv Three 
patients reco\ered and two died The one necrops\ 
which was performed showed meningitis but not 
encephalitis According to Dr M T Morgan the 
British representatne fise cases of post-\accinial 
encephalitis of which three were fatal were reported 
in England and Wales in 1936 and three more in 1937 
up to September 15 which were all fatil The ages 
of the children ranged from 4 months to 1 5 t ears As 
m the German cases the encephalitis was alwa\s the 
sequel of pnmar\ \accination No mention is made 
of a post mortem examination Professor G Petragnani 
the Italian delegate stated that of 1 104 520 priraarj 
\accinations and 1 205 971 re\ accinations performed 
in Ital\ in 1936 and in the spring of 1937 onh fi\e 
cases were reported in 1936 and six in 1937 In e\erj 
case the intradermal method was used Of the eleven 
cases four were in the north of the kingdom two m the 
centre and four m the south Ten occurred in the 
spring and onlv one in the winter Six were fata! and 
m two pareses appeared as sequels The ages of the 
patients ranged from S months to 8 jears and no case 
occurred m children vaccinated at the sixth month in 
accordance with the law concerning pnmarv vaccina 
Uon According to Professor Klmg the Swedish dele- 
gate m the period 1924-36 inclusive there had been 
fortv three cases of encephahtis following pnmarv 
vaccination with eight deaths and eleven cases with 
two deaths following revaccination As regards age 
distnbution most of the cases appeared dunng the first 
two vears of life and immediatelj before school age 


TREATMENT OF MIOTOMA 

Recent work on the chenistr> of the changes which 
occur at the neuromuscular junctions on discharge of 
the nervous impulse has led to important advances in 
the therapeutic field especially in pnmarv disease of the 
muscles The action of phv sostigmine in delaving 
the destruction of acetv Ichohne bv the cholinesterase 
has been found of specific benefit for example in 
mv asthenia gravis In that group of diseases in which 
the cardinal feature is mvotonia — inabilitv to relax the 
muscles after thev have been contracted — a drug having 
the preciselv opposite effect of phv sostigmine has re- 
centlv been used with much success Those who attended 
the Section of Neurologv at the Oxford Meeting of the 
B M A in 1936 may remember the cinematograph film 
presented bv Foster Kennedv of New York which 
demonstrated strikingly the difference in the muscular 
actions of a man with mvotonia congenita (Thomsens 
disease) before and after injection of quinine dihvdro 
chlonde In the report' on this film Foster Kennedv 
showed ciearlv that the action of quinine in abolishing 
the mvotonic reaction of muscle could be antagonized 
b>' subsequent injection of phv sostigmine which rapidlv 
reproduced the original mvotonia A further studv of 
the action of quinine in mvotonia has been published bv 
Kolb Harvev and Whitehili " who have studied the 
effects of oral administration of th is drug in ei ght cases 

Briiiih Jourral 2 ''^6 

* Johns fio 'v J/oip hull }9 i 62 1^5 


Th *'>rr 

^ rs' J > i> 1 

of myotonia atrophica and in one casv of 'Ti%oMnn 
congenita Although perhans the least incardcnaiin^ 
svmptom of that hertdo familial disease b-tt^r Irwvn 
in this countrv as dvstrophia m\ooni.-j mvotoni* 
li the one of which the patient is most conscious and 
relief from it mav help to compensate him for th. w..t 
ness occasioned bv the gross atrophv of the mus.l.'s .nd 
the premature semhu which is so chanctens ic of th. 
disease Kolb and his co workers found that bv go me 
0 6 gramme of quinine sulphate bv mou'h thre. x 
four times dailv patients with mvotonia atroph i 
could be kept free from the svmptom of mvotonn 
There was no resulting increase in strength «n th. 
muscles as recorded bv the dvnamomet.r lihoj.h 
several patients declared that the musel.s worled 
better After treatment wuh quinine hid proved 
effective these patients were given mteetions ot prosti. 
mm whereupon the mvotonic reaction unmediatc v 
reappeared even if quimne were given at the sam. 
time as the prostigmin which thus direetlv aniagsnizeJ 
the effect of the quinine Converselv quinine counter 
acted the effect of prostigmm in mvasthenia gravis 
increasing the signs of that disease Other therap.un 
agents were investigated in the cases of mvotonn 
atrophica but none was successful No svmptoms ot 
o'erdosage of quinine appeared with the large dose* 
necessan to abolish the svmptom of mvotonia It was 
found that smaller doses than 0 6 gramme three tim.s 
a dav were ineffective and that if the drug was discon 
tmued patients complained that the rigtdiiv of muscles 
was worse than it had been before treatment was 
initiated It would seem therefore that once begun 
this treatment must be continued almost indehniteU 
Whether prolonged dosage with quinine will eventu 
allv have deleterious results has vet to be seen N. 
senes of cases has been under observation long enough 
for anv conclusions to be reached In the meantime 
there can be no doubt that a valuable therapeutic agent 
has been found for the relief of a distressing symptom 


THE ROAAL MEDICAL BENEVOLENT FEND 

Annual repofis are usuallv drv enough documents and 
the one hundred and second to come from the Roval 
Medical Benevolent Fund is no exception for 200 of 
us 220 pages consist of lists of subscnptions and dona- 
tions But even these have their interest because not 
onlv are the subscriptions shown for 1937 but also 
the total amount which the subsenber had given before 
that vear and it is encouraging to notice how maav 
faithful friends this charitv has enlisted In several 
cases the accumulated total against a subscriber s name 
is over £100 It is also shown what considerable and 
vvidelv distnbuted support the Fund reecives from the 
Branches and Divisions of the Bntish MeJi.al Associa 
lion Citv companies masoni. loJg.s and chapters 
medical societies hospital stalls and Pan.l Committees 
Over seventv Panel Commitices subsenbed during 1937 
one of them (Norfolk) making a gift of £117 and fiftv 
Divisions and Branches of the B M A contnbuted 
directiv But the purpose of an annual report is to 
remind subscribers that their subscriptions for th. 



78 JuL\ 9, 1938 


THE HEART AND ITS BLOOD SUPPLY 


current year are due, and as there is always a tendency 
for such documents to go the way of circulars and other 
ephemeral liteinture the Fund this year is issuing rvith 
the report, but in a separate envelope a letter from 
Sir D’Arcy Power chairman of the committee of 
management, and also a selection of typical stories 
of persons benefited Sir D’Arcy Power describes 
briefly the activities of the Fund and the number of the 
giants and annuities He mentions that the income 
from subscriptions has been doubled during the last 
ten years, yet still it only represents something under 
seven shillings for each medical practitioner in Great 
Britain The great need is to enlist a larger number 
of annual subscribers , this would make it possible to 
raise the meagre amount given as an annual allowance 
in often very pitiful cases Volunteers are also requested 
for honorary local secretaryships 


THE HEART IN RELATION TO ITS 
BLOOD SUPPLY 

The clhciency of the myocardium depends largely 
on the quantity and quality of the blood in the coronary 
ciiculation, and two recent studies on this merit atten- 
tion because of their practical importance Kountz 
and Smith' of St Louts have tried to assesi experi- 
mentally the flow of blood in the coronary arteries of 
pathological hearts The information was derived 
from perfusion and heart-lung preparations of revived 
beating human hearts Under the conditions of their 
experiments the average coronary flow for normal hearts 
is estimated to be about 1 4 c cm per gramme of heart 
per minute In the heaits of persons dying of cardiac 
disease the total flow through the coronary artery was 
often greater, especially in greatly hypertrophied hearts, 
but when reduced to the terms of unit weight it was 
found to fall below the level of 0 75 c cm per gramme 
per minute, which Kountz and Smith regard as a 
minimal safe flow for the function of the heart In 
subjects with i history of heart failure the flow ranged 
from 0 15 to 0 6 c cm per gramme per minute The 
lowest figures were encountered in arteriosclerotic 
hearts Kountz and Smith consider that their work 
shows that hearts fail in chronic cardiac disease because 
of a limited flow through the coronary arterv, w'hich 
nn\ result from either increased muscle mass or 
narrowing of the coronarv vessels In dilated hearts 
lengthening ind stretching of the coronarv vessels may 
bw the chief factor Tung and his associates" in a 
c ireful investigation into the effect of severe anaemia 
on the heart point out that in this condition the 
function il efliciencv of the heirt is of the highest im- 
port into since increase in the cirdiac output is an 
csci.iunl compcnsUion for the diminished carnage of 
owgen in the blood The ten patients studied had 
Severe chronic aniemia (haemoglobin values 1 5 to 3 5 
gnmmes per 1(X) c cm or averaging about 17 per cent ) 
iiid no oihv-r discovenble cause of heart disease vet 
in vi’ilv one of them was the heart normal In six it 
w IS eonsiUerihlv enlirged and there was definite con- 


Tilt llMTmT 

MtDlCM. JotRWt 

gestivc failure, the venous pressure being elevated 
Three patients had much enlarged hearts hit little or 
no evidence of congestive failure The degree of 
cardiac enlargement was assessed radiographicalK , and 
the difference between the measured area and the 
estimated normal area expressed as a percentage The 
increases in cardiac area varied between 25 and 143 per 
cent The v-ray illustrations reproduced in the piper 
leveal the gross cardiac dilatation which occurred in 
these anaemic subjects In the light of the findings of 
Kountz and Smith in regard to the decrease in coronarv 
blood flow caused by dilatation the viciousncss of the 
circle IS apparent The poor state of the heart in severe 
anaemia explains the not infrequent fatalities attending 
lapid transfusion of blood in such cases The dilated 
and failing heart cannot take on the burden imposed 
by a sudden augmentation in the total blood volume 
Such fatalities not long ago fornied the subject of articles 
b> Plummer'' and Pygott' and of correspondence in 
this Join ml The work of Tung and his colleagues 
throw's light on these deaths Transfusion in such enso 
may sometimes be essential, but it must be by a verv 
slow drip method 


RURAL HYGIENE 

Representatives of European countries arc to meet in 
a conference summoned by the League of Nations for 
July 1939, to consider the subject of rural planning and 
hygiene The Council of the League amid the graver 
preoccupations of its recent session at Geneva, approved 
the report of the preparatory committee for the eon 
fercncc which has been sitting under the chairmanship 
of M Wanters, Belgian Minister of Public Health A 
similar conference was held in 1931 and drew up a 
programme of studies to be earned out under the aus 
pices of the Health Oiganizaiion The conference 
recommended that another European conference should 
be summoned after an interval of a few years to examine 
the results achieved and adapt the proposals made to 
current problems and to the progress ot public health 
technique Such is the real origin of the conference 
to be held next year One section of the preparatory 
committee s work deals with mcdico-social policy The 
previous conference it is stated, has exercised a con 
sidcrablc influence on the organization of public medical 
and issistance services in the rural parts of Europe m 
countries but it remains to extend the study to disc ises 
which arc still all too frequent in rural areas such it 
typhoid and tuberculosis togcthcr'vvith diseases vvhith 
affect both human beings and livestock The con 
fercncc will have at its disposal further studies carrivl 
out on the international plane by the Health Orginin 
tion relating to sanitation, the cost and cfficicncv of 
medical and sanitarv assistance prevention of diseis 
and the “ medico social protection ” of the rural popu!' 
tion bv which last IS meant nutrition housing and rural 
planning The Health Organization has lalcK Ktu 
undertaking jn conjunction with public hcafth lutliori 
lies national nutrition committees and Europsin 
institutions and schools of hvgienc some furtl r 


J Cl, InM-,! IS® 17 K? 
•c/ 1937 52 


* Kffiiicn} J(>uriUi! 2 1180 

* Ibid , 1937, 1, 496 



JUL\ 9 1938 


RURAL HTiGIENE 


studies on nutntion in order to ascertain the effectue 
consumption of particular groups of populations to 
consider whetlier their dietanes are sufficient and to 
e\ohe measures for combating defects These studies 
ha\e taken place m Belgium France Finland and half 
a dozen, other European countnes The composition 
of bread, and accordingh its nutntional \a!ue has been 
found to \ar> much from one countrv to another and 
c\en within particular countnes A studv of bread 
dealing with the species and sifting of cereals the form 
of consumption and so forth will be available before 
the conference meets As to milk the Health Organiza- 
tion alreadj has copious matenal at its disposal on the 
place which milk should hold in a svstem of nutntion 
together with the hvgienic questions ansing in connexion 
with its production and distnbution and this matenal 
is being extended and completed It is hoped that the 
participating Governments will later be in a position 
on the basis of these extensive international studies to 
give more detailed particulars in their several national 
monographs as to the nutntion of the rural classes in 
their respective countnes On this subject of nutntion 
the Council has decided to invite the eighteen States 
within the League which have set up national nutntion 
committees to send representatives to Geneva for an 
exchange of views on subjects of common interest dunng 
the coming autumn League countnes which have 
national nutrition committees include the United King- 
dom with Australia and Canada among the Dominions 
France Belgium Holland Soviet Russia Poland 
Czechoslovakia Latvia and all the Scandinavian 
countnes also outside Europe Eg>pt and Iraq The 
first meeting held in Februarj 1937 denved great 
benefit from the participation of a representative of the 
committee rccentlj set up in the United States and it 
was decided to invite an Amencan representative again 
to participate m the forthcoming discussions 


TRAUMATIC SHOCK 

Recent experimental work on the nature of traumatic 
shock has demonstrated the relative unimportance of 
toxaemia at least m the earlv stages of the condition 
Toxaemia from infection particularlv bv gas producmg 
organisms which so complicated the picture of cases 
of shock in the last war does not anse until a later 
stage It IS unlikelv that the absorption of crush 
products is a potent factor though as Sir Henrv Dale' 
has suggested these niav have some effect on capillarv 
walls and so contribute to the loss of fluid which is 
apparentiv an important if not the most important aetio 
logical factor Ifie older surgeons looked upon the part 
played bv nervous impulses as all important — for 
example Fumenux Jordan in the second edition of his 
Surstca! Enquiries (1880) regarded the condition as 
the result Of a powerful impression applied to the 
nervous centres or to a portion more or less consider- 
able of the peripheral nervous expansion Concen- 
tration on the factor of fluid loss has of late led to 
neglect of the nervous side of the question Shock can 
be prevented bv complete occlusion of the arterial 


Tr B '-TT' 


blood supplv to a limb befo'c it is injured and as 
Slome and OShaughnessv have recentlv pom'ed oat 
not onlv IS loss ot fluid prevented under th.sv tor 
ditions but the limb mav b^ rendered an-'estheti „rJ 
the nervous factor eliminated An examina'un of th. 
action currents in the nerves pa-sing from a traum,.! ?,.d 
limb showed that no abnoma! impulses could H,. 
recognized for three-quaners of an hour after the iniurv 
but that subsequentlv an almost omtinuviuv h 3 rr,,c,. 
of impulses developed There is some evidenes to 
suggest that an initial fall of blood pr,.ssurs in a sas^ 
of traumatic shOs.k is caused bv loss of fluid and ih t 
a later and cononued drop is due to the e srtina e di> 
charge of nervous impulses Control bv ^ppropna’e 
analgesia or anaesthesia is therefore neeessarv as well 
as the restoration of the blood volume in 'he treatm-rt 
of shock 


REFUGEE DOCTORS FROM ALSTRIV 

Sir Samuel Hoare the Horae Secreiarv whowasacvom 
panted bv Lord VSinterton the Chancellor of th^ Duehv 
met at the Home Office on Julv 4 representatives of the 
Bntish Medical Association the Rova! Colleges of 
Phvsicians and Surgeons the Lniversitv of London and 
the Soaetv of Apolhecanes to diseuss the question of 
the admission of some Austnan doctors to pr,.ei se in 
Great Bntain It was agreed that it would onlv be 
possible to admit a limited number that anv such 
admissions must be the subject of careful selecuon and 
that a committee representing the medical profession 
should be set up to assist in the seLction The Roval 
College of Phvsicians of London was represented bv 
Dr Robert Hutchison and Professor J A RvL the 
Roval College of Surgeons of England bv Sir CuthKrt 
Wallace the Universitv of London bv Sir William 
Girling Ball and Dr A M H Grav the Soeietv evf 
Apolhecanes of London bv Mr Hugh Lett and Sir 
William W'lllcox and the Bniish Medical Association 
bv Mr N Bishop Harman Dr H Guv Dam Dr J W 
Bone Dr G C Anderson and Dr A Macrae 


Professor Sigmund Freud now living in exile in 
London was elected a Foreign Member of the Roval 
Societv in 1936 As his health does not permit him 
to visit Burlington House to sign the anaent Charter 
Book of the Societv the President and other officers 
have paid him the high honour of lal mg the boot to him 
for his signature 

Professor Frank C Mann who is D rector of the 
Mavo Foundation for Medical Education and Research 
of the Universitv of Minnesota will deliver in the 
Tiieatre of the Roval College of Surgeons of England 
on Fndav Julv 15 at 5 pm a sjxecial lecture on the 
Mechanism of Peptic Ulceration which is to be a review 
of the results of experimental investigations Professor 
Mhnn is well known for his research into the problems 
o*' peptic ulceration and the College is pleased tO invi e 
Fellows and Members to attend Those who are neither 
the one nor the other will be admitted on p'esenting their 
pnvate visiting cards 


* Proc ro\ SiX. 19,>5 28 lt93 


Bnt J Surg 1933 2 5 900 



so July 9, 1938 


INJURIES IN REGION OF SHOULDER-JOINT 


Tnc British — 
MiDiCAL Journal 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

Tins js one of a senes of articles contributed by invitation 


INJURIES IN THE REGION OF 
THE SHOULDER-JOINT 

n BONE AND JOINT INJURIES 

BY 

R WATSON-JONES, M.Ch.Orth., F R.C.S. 

One of the most important principles of the treatment of 
dll fractures applies with particular force to fractures and 
d slocations of the shoulder joints which do not need 
to be immobilized must be actively mobilized from the 
first day If immobilization is not essential, mobilization 
IS imperative A fractuie of the clavicle should not 
cause more than a few weeks’ incapacity But many 
healthy men have been incapacitated for a year or even 
incapacitated permanently by simple fractures of the 
clavicle treated with Sayre s strapping, which bound the 
fingers and hand flat against the chest wall In other 
cases abduction frames have been used with a palmar 
^splint so situated that the patient could not fle\ the 
fingers normally With the tendency to oedema which 
exists immobility of the fingers for only two or three 
^ weeks may cause such a degree of adhesion formation 
that the patient is fortunate if he recovers m a year The 
stiffness of the fingers is not only serious in itself, but tt 
adds greatly to the difficulty in restoring shoulder move- 
ment where some stiffness may have been inevitable 
The only stiff shoulders which are really difficult to treat 
are those associated with severe stiffness of the other 
joints of the limb If the elbow, wrist, and fingers are 
normal th*” patient has an incentive to use the limb, and 
l> _<ctlonal activity rapidly restores movement to the 
- sfioulder But if every joint, including the fingers, is as 
stiff as a board, it never occurs to the patient to use 
the limb at all , he gives up the impossible task, and the 
difficulties are greatly increased The first principle, 
therefore, m the treatment of fractures of the clavicle 
and neck of the humerus, and of dislocations of the 
shoulder and acromio-clavicular joints, is that the patient 
must actively move the fingers, thumb, wrist, and radio- 
ulnar joints throughout their full range many times every 
day 

Fractures of the Claticle 

Fractures of the clavicle occur most commonly in the 
middle third following a fall on the outstretched hand 
The inner fragment is displaced upwards by the sterno- 
mastoid, and the outer fragment is displaced downwards 
and forwards by the weight of the limb The fragments 
can only be realigned by pulling the whole shoulder 
girdle, and with it the outer fragment, upwards and back- 
^ wards and outwards Scores of methods of immobiliza- 
tion have been described, and this in itself suggests that _ 
one of them is really perfect Fortunatelv, however, 
■ese fractures almost invariably unite firmly in a few 
weeks, and the thickening which may result from imper- 
fect reduction is usually absorbed and disappears in a few 
months On the other hand, over-zealous attempts to 
miintain anatomical reduction by immobilization of the 
shoulder for many weeks may cause far more serious 
trouble from adhesion formation round the shoulder-joint 


Method of Tieatment — The figure of-8 bandage method 
IS simple, and if carefully used will give excellent cosmetic 
and functional Tesults The patient sits on the front of 
a stool, the operator standing behind with one foot on the 
stool and his knee between the patient s shoulder-blades 
A large pad of wool is placed in front of each shoulder 
extending into the 'axilla Several long bandages five or 
SIX inches wide are now applied in the form of a figure 
of-8, passing in front of the shoulders under the axillae 
and crossing between the shoulder-blades With each turn 
of the bandage the shoulder girdles are pulled backwards 
and upwards as strongly as possible without compressing 
the axillary vessels (Fig 1) The bandages may be 
stitched together to prevent slipping and it is advisab'c 
to reapply them every second or third day for the first 
fortnight The tension of the figure of 8 bandage pre 
vents the outer fragment from displacing forwards, and 
the weight of the arm acts as a lever over the axillary 
pad, distracting the outer fragment awayTrom the mid 
line and correcting the overriding For the first two 
weeks the shoulder is elevated by a triangular sling tied 
over the opposite side, but after that time it is left free 
for exercises The finger-, wrist-, and elbow-joints must 
be exercised frequently from the first day The figure 
of-8 bandage may be discarded after three weeks when 
there is clinical evidence of union , there is no necessity 
to wait for radiographic evidence, which is much more 
delayed - , 

COMMINUTCD rRACTUHI S 

Occasionally the fracture is comminuted and a smill 
fragment may be tilled out of position so that>a sub 
cutaneous spur develops These fragments may be 
replaced’ by direct pressure after the main fracture has 
been reduced by the figure-of-S bandage Even if iIilsc 
attempts fail operative reduction should still not be con 
templated The sharpest of spurs usually absorbs and 
becomes rounded, and if any symptoms do remain it is 
very much more simple to remove the spur after union 
of the fracture than to attempt open reduction The 
only indication for operation in recent fractures is the 
exceedingly rare complication of compression of the 
brachial plexus or subclavian vessels by displaced 
fragments 

Dislocation of the Acromio-claxicular Joint 

If the ligaments of the acromio clavicular joint are 
torn the weight of the arm displaces the shoulder gudlc 
and acromion downwards beloW" the level of the outer end 
of the clavicle If the injury is confined to the ligaments 
between the acromion and the clavicle subluxation of the 
joint results, but if there is also a tear of the ligaments 
between the coracoid and the clavicle still more serious dis 
placement develops The dislocation is very easily reduced 
by elevatm? the whole arm and shoulder girdle, but it 
just as easily redisplaced by the unsupported weight of 
the limb 

Immobilization by Stiappiiig — The limb must be kept 
elevated by strapping which encircles the clavicle nbo'c 
and the elbow below A small pad of wool is placed 
in the axilla, and the wrist is slung from the neck bj 


Im,\ 9 I93S 


INJURIES IN REGION OF SHOULDER JOINT 






T collar and a cufT \siih the elbow at a right angle A 
pad of adhesise felt is placed below the elbow to protect 
the bon> prominence of the olecranon and the ulnar 
nerte with a second pad orer the outer end of the 
c'aricle These two points are now pulled together b> 
strips of brown strapping four or fi\e feet long applied 
as tightl} as possible (Fig 2a) While the strapping is 
being applied the humerus is pushed upwards to derate 
the scapula and the acromion and the claricle is pulled 
downwards The strapping is easilj stretched b> the 
weight of the hmb so that fire or sis larers should be 
used one on top of the other It is a common mistake 
to appK the strapping orer the top of the humerus and 
the shotilder-jomt itself instead ot orer the claricle and 
supraclaricular triangle (Fig 2fa) In these circumstances 
the surgeon is attempting the impossible task of com- 
pressing the humerus in its longitudinal asis If the 


uninjured the muscle is felt contracting <.ren ahhougn i’'. 
shoulder is not actualh mored 

Mellwci of Reducno! — The head the hime'i-j » 
held m its inwardlr displaced and inwardir ro a'ed po mon 
bv the tension of the subscanularis To reduce th. dij 
location this muscle must be !o sir and c adi dls 
stretched The patient lies on a couch and ihe r„ c rn 
stands at his side Fo- a dislocation ot he neb rhou'dcr 
the surgeon takes the elbo r m his nghi hend ^nd th- 
rsTist in his left Strong smooih traction is applied to e 
humerus br pulling with the right hand The ni is no r 
rer> slorrlr and genlh exiemallr rotated br mormg i*’- 
rrrist outwards until the norma! limit ot 90 d-^ri-r 
external rotation is reached The hmb bemg kept m < !' 
external rotation the elbow is brought to ward n I rt 
of the chest Finallr the limb is internalh rou'ed and ihe 
hand brought orer to the opposite shoulder Th- mmipu 



Fio 1 — Figure-of S bandage with large 
axitlao pads for fracture of cbricle The 
outer fragm"nl is pulled back br the 
bandage distracted auaj from the mid line 
b> the tererage of the weight of the arm 
orer the axillary yiad and derated b> a 
tnangular sling 




Flo 2 <a and bt — (a> Correct and tbj incorrect m”thod of strapp ne a-rotn o 
clavicular subluxauon and distocaiion The strapping mu't parr orer ih" -tan- -r« 
not orer the top of the shoulder U must be tightened on atiemaic dar> and retain'd 
for three to five weeks 


strapping is applied in the right place and if the method 
is used conscientioush excellent results ma> always be 
obtained and operatise measures are unnecessary It is 
however essential to tighten the strapping every second 
or third day by applying additional s’rips on top of the 
original and to continue the fixation for at least three 
weeks in subluxation of the joint and for at least five 
weeks when the joint is completely dislocated 

Dislocation of the Shoulder-jomt 
Since the head of the humerus does not occupv its 
normal position immediatelv below the acromion process 
there is loss of the normal rotund outline of the shoulder 
The acromion is unduly prominent and there is a hollow 
beneath it This hollowing mav not be obvious on inspec 
tion owing to the marked swelling but it is quite evident 
on palpation vvhen the shoulder is compared with the 
normal side All movements of the shoulder are limned 
and painful and there is particular difficuUv m putting the 
elbow to the side owing to the locking of the head of the 
humerus in its mwardlv displaced position 
The limb must be carefully examined for nerve injunes 
The deltoid muscle is often paralysed bv injuries to the 
circumflex nerve the posterior cord or the outer trunk 
of the plexus The examiner palpates the muscle hehv 
with one hand and instructs the patient to attempt 
abduction raovemcm igainst the resistance of h s othe' 
hand over the patients elbow If the nerve supph is 


lalion is performed so smoothiv chat the head at ih' 
humerus glides mto position and often the surgeon does 
not know at which stage the dislocation was reduced 
There is no necessity to elicit anv click or sudden jerk 
Frequently such a click does not indicate successful 
reduction but is due to movement from one dislocated 
position to another It is essential that the accuraev of 
reduction should be confirmed not onlv clmicaliv but also 
bv radiographic examination 

After treat ment — \ small pad of wool is placed m the 
axilla well powdered with talcum and a wisp Ot woo! 
IS similarlv placed m the fold of the elbow to prevent 
intertrigo dermatitis The wnst is slung from the neck 
bv a collar and a cuff and the whole hmb is bandaged to 
the trunk to prevent external rotation movement of the 
shoulder The fingers hand and vvn»t imsi not be 
covered and these joints are constaniiv exercised •Ml 
bandages and slings mav be discarded in three weeks and 
the patient regains movement at the elbow joint and 
shoulder joint bv his own exercise If the shou'der i 
inimobduted fo" a shorter period there is a d-nge' of 
recurrent dislocation necessitating ope a ive treatmer. 

Dislocation 1 ilh frccitire of tie Taherimts — Radio- 
graphs mav sho v that a large fragment of the great 
tub^rositv has been tom off at the time of the dis'oea loa 
IFic 3> As a rule the fragment is m perfect pos ton 
vvh--n the dislocation is reduced An axtlla-y pad some 
vv-faat larger than usual may be applied but an abduction 



82 July 9, 1938 


INJURIES IN REGION OF SHOULDER-JOINT 


TucUrttisu 
Medical Journal 


frame is not necessary Active movement of the shoulder 
IS begun m three to four weeks, exactly as if there was jro 
fracture 

Dislocation with AmiIsioii of the Supiospiiiatiis — ^In a 
proportion of cases Uie siipiaspimtus tendon has been 
avulsed from the tuberosity The complication is laiely 
recognized until several weeks have elapsed After the' 
bandage and strapping have been discarded it is found 
(hat passive abduction is recoveiing more rapidly than 
active abduction A greater range of passive than of 
active abduction in the presence of a normally contracting 


must be employed to fix the trunk part of the frame and 
to hold It up the turns of the band ige being hitched under 
every hook screw and bar and passed over both shoulders 
Stiffness and Myositis Ossificans due to Passne Stutih- 
titg — In the after-tieatment of shoulder dislocations 
passive sti etching by masseuses and manipulation under 
anaesthesia by sutgeons must be rigidly avoided There 
IS no more certain means of converting temper iry into 
permanent stiffness than by pei nutting passive stretching 
It IS now well recognized that myositis ossificans after dis- 
location of the elbow is due to passive stretching and that 




a b C 

Pic 4 — ^Threc types of fneture of neck of humerus (i) contusion crick friclurc, (b) idttuclion fncUirc, (c) iliduction fnct 


deltoid IS clear evidence of rupture of the supraspinatus 
tendon This complication was fully discussed in the pre- 
ceding article IJoumal July 2, p 30) 

Dislocation ssitfi Paralysis of the Deltoid — If there has 
ecn an injury to the circumflex nerve or one of the cords 
the brachial plexus the paralysed deltoid muscle must 
relaxed by abdueiing the shoulder in a frame If the 
atienl s arm is firmly bandaged to the frame but the 
trunk part is loose and can slide down, there is a danger 
that the joint may be re-dislocated For this reason some 
surgeons defer the application of a frame for two or three 
weeks but if It IS skilfully applied it is safe to use it 
E%en earlier At least sesen or eight six-inch bandages 


IS practice delays the recovery of elbow movement 
le only pathological difference between disIociUons 
e elbow and dislocations of the shoulder is tint ' 
30 W is usually dislocated in children, m whom > 
nosteum is loosely atlachcd, whereas the shoulder 
iially dislocated in adults, m whom the . 

mly attached For this reason elevation of 
nosteum and ‘ myositis ossificans ' arc more ^ 
the elbows of children than in the shoulders of 
ae myositis ossificans is merely one evidence of t ic ■ 
me to the child s elbow by passive 
issivc stretching is just as harmful to the adults si < 
'cn allhough there is no outward and Msibic b 


JuLV 9 I91S 


INJURIES IN REGION OF SHOLLDEP JOINT 


Movement must be recovered b> the patients own exer- 
cise Attempts to accelerate recoverv b\ stretching 'he 
joint or b\ manipulating it under anaesthesia will have 
exactlj the opposite effect to that which was intended 

Fracture of the Iseck of the Humerus 

Three tvpes of fracture must be distinguished fl) con- 
tusion crack fractures. (2) adduction fractures and (3) 
abduction fractures (Fig 4) 

Contusion Crack Fractures — ^The injurj follows a fall 
on the outer aspect of the shoulder and the crack across 
the neck of the humerus is often associated with a com 
minuted fracture of the tuberositv Complete immobiliza- 
tion IS not necessary The limb should be supported m 
a sling for two or three weeks throughout which time the 
finger-, wrist- and elbow joints are exercised \s soon as 
the swelling and bruising of the shoulder have begun to 
subside active exercises are practised * 

Adduction Fractures — ^These occur equally commonly 
in adults and in children, and the fragments are impacted 
in such a wav that the shaft is adducted on the head If 
the displacement is not corrected abduction movement is 
permanently limited by a degree corresponding with the 
degree of angulation In elderly patients this is unimpor- 
tant and the impaction should not be broken down by 
manipulation Treatment is carried out exactly as for 
contusion crack fractures In younger patients the dis- 
placement is reduced by traction on the limb m the 
abducted position so that the adduction angulation is 
corrected The limb is immobilized on a frame in right- 
angled abduction for four to five weeks 

Abduction Fractures — It is a serious mistake to believe 
that every fracture of the upper end of the humerus should 
be treated in abduction Although an abduction frame is 
harmless or even advisable in adduction fractures it is the 
wrong treatment in most abduction fractures The shaft 
IS already abducted on the head and an abduction frame 
will perpetuate or increase this displacement As a rule 
the displacement is not of serious degree and does not 
require manipulative reduction The limb is supported in 
a sling in the adducted position by the side of the trunk 
Movements of the finger wrist, and elbow are begun at 
once and shoulder exercises are instituted in two or three 
weeks ! 

Very rarely the degree of abduction displacement at the 
time of injury is so extreme that the shaft is driven 
Inwards beneath the head and completely detached from 
It There is now no apposition between the fractured 
surfaces, and the loose head is completelv externally 
rotated and abducted by the unopposed pull of the muscles 
inserted into the tuberosity It may be possible to reduce 
the displacement bv angulating the fragments on each 
other adducting the shaft across the chest, and pu'hing 
the upper end outwards by a hand in the axilla until the 
fractured surfaces engage The arm is then brought to 
the side and immobilized m that position for four weeks 
before active shoulder movements are begun 

If the manipulation fails to secure engagement of the 
fractured surfaces the proximal fragment remains fullv 
abducted and externally rotated It is now essential to 
abduct and externally rotate the distal fragment but recur- 
rence of the original displacement must be prevented bv 
maintaining constant traction An abduction fracture must 
never be treated in the abducted position unless continuous 
traction is applied and a special frame is emploved Skin 
traction by adhesive strapping is all that is neccssarv 
Skeletal traction bv olecranon pins should not be used 
The traction must be of sufficient degree to prevent inward 


displacement of the shaft below the head I. th s s nc 
prevented the fragments will unite m this po iticn a'd it 
will be impossible to bring the arm do in to the s d- 
Frequent checking bv radiographs is the'eio'e n-ccs _n 
The frame is jointed so iha elbow moveai-n s mav b- 
practised and the torearm wrist and finger join.s m i t 
be regularlv exercised 


PRFV'EMION OF TLBERCLLOSIS 

AAJI0i>4L CONFERENCE LN LONDON 

The twentv fourth annual conference ol the National 
Association for the Prevention of Tuberculosis was h M 
last week at the British Medical Association Hoe e in 
London and was largelv attended bv d-'egates trom loeai 
authonties and other public bodies The siibj-eis ot ois 
cussion included the organization ot anti tub.rculo' s 
activities in rural areas the discoverv and piot-ction ot 
contacts the control of tuberculosis in tropical and sub 
tropical regions (to which delegates trom Inaia and 
Tanganvika contributed), and the mental asp-cts of tuber 
culosis The conference was preceded bv the -nnu„l 
meeting of one hundred affiliated care committees a 
which manv suggestions were made for the emplovmt-nt 
ot tormer tuberculous patients 

The conference ot which the Marchioness ot Titvh 
field was president was opened bv the Miniswr ot Health 
Dr Walter Elliot who quoted some statist cs showin_ 
the great improvement which had taken place m ih- 
tuberculosis death rate since the middle of the nineteenth 
centurv The rate had now fallen to about one fifth of 
what It was then He also spoke ot the multiplication of 
facilities for prevention and treatment In 1911 there 
were onlv some 5 000 or 6 000 beds in England and Wales 
available for tuberculosis cases to dav there vvere nca-i 
31 000 and nearlv 150 000 persons were examined for thw 
first time m English dispensaries last vear The p.obleTt 
of rural housing to which he was giving p-rsonal aiten 
lion was of great importance in tuberculosis preventicn 
and the legislation passed last vear for the provision ot 
new houses and reconditioning of soundly built old 
cottages could be regarded as a notable contribution m 
this held 

Tuberculosis in the Rural Areas 

The first subject of discussion was the rural areas 
where said Dr G Lissvvr Cox in opening all the 
tacililies for modern treatment isolation of infective ca-^es 
with unsalisfaclOA home conditions education and pre 
venlive measures examination of contacts and 'o cn 
ought to be available just as much as in the towns even 
though admillediv the tuberculosis incidence and mor 
lality are tower in the country He stressed as of first 
importance co operation between the familv doctor and 
the tuberculosis officer It was po'sible to measure in 
England at anv rate the different degrees of this co ope a 
tion not bv notification of cases, but bv the number of 
persons sent to the official doctor or consultant before 
notification for an opinion as to diagnosis In his own 
countv fLancashirel 92 per cent of all new c^ses were 
so dealt vvith Dr Lissant Cox discussed the organizniion 
of the dispensary and the institution unit in rural 
localities 

Dr A M Fr-xsek also stressed the importance of the 
cencral practitioner but questioned whether the general 
practitioner as he was turned out to-d-v vvas as well 
mtormed as he might be m these respects Post 
graduate training was of the utmost importance ..nd 
raciliiies should be availabL to all doctors at certain 
intervals It seemed a pitv that in the organization of 
postgraduate schemes for insurance p'actiiioncrs local 
authorities vvere not given an opportumtv to hold a stake 
so that the schemes could have been made more' compre- 
hensive and include an intensive studv of tuberculosis 



84 JuLV 9 19'?S PREVENTION OF TUBERCULOSIS CONFERENCE 


The administration of a tuberculosis scheme in rural 
Wales was described by Dr V Emrys Joncs Among 
other things, he mentioned that the inhabitants of North- 
West Wales — Dr Joncs is tuberculosis officer for Anglesey 
and Carnarvonshire — were mainly a cultivated, well-read, 
and intelligent people, but highly fatalistic, and tending 
to regard tuberculosis more as a disgrace than a disease 
The “spes phthisica ” or optimism of the tuberculous was 
not as evident among them as it was in their neighbours 
oser the border The incidence of the disease was very 
high, the average annual late for the last ten yeais being 
over 1,500 per million 

Discovcrj and Protection of Contacts 

In a discussion on the discovery and protection of con- 
tacts, over which Dr R A Young presided. Dr G T 
Herbert said that the pertunctory examination of a 
contact was of little value, and might even be harmful 
in giving a false sense of security A careful clinical 
inquiry must be supplemented by x-ray examination, at 
least screening, and usually by the taking of a film as well 
ft was unlikely that a single examination would coincide 
with the date at which incipient disease first became recog- 
nizable and continued medical supervision seemed to be 
necessary, particularly during the susceptible age period 
He had discovered active tuberculosis at the thirty-seventh 
dispensary attendance of a contact first examined as a 
child some ten years before 

Dr G S Banks said that it was disappointing to have 
to acknowledge that even now the first introduction of the 
tuberculosis officer to a tuberculous household was ob- 
tained by the haphazard and variable route of the private 
doctor With a few exceptions — where, for instance, the 
doctor was swayed more by symptoms and perhaps by 
the knowledge ot contact with an infective case m the 
household than by the chest signs — the average case of 
pulmonary tuberculosis sent to the centres was little less 
advanced than it was twenty years ago There should be 
a more general method of case-finding, a wider net should 
be cast All school children should be tested as a routine 
measuie with tuberculin, and all who had reacted 
positively should be kept under observation by the tuber- 
culosis officer, with whom the insurance practitioner 
should be associated, through the dangerous age periods 
of adolescence and young adult life 

Dr C H C Toussaint urged upon administiators and 
sanatorium superintendents the grave danger of returning 
sputum-positive cases to their homes after only compara- 
tively short periods of treatment Prevention should be 
the basic policy of all the schemes, and too often preven- 
tion went by the board 

Mental Aspects of Tuberculosis 

At the final session of the conference an interesting 
discussion took place on the mental aspects of tuber- 
culosis from the point of view both of the effect ot 
tuberculosis on the mental life of the normal person and 
on the mentally disturbed patient Dr A J Morland 
asked whether people who got tuberculosis were any 
diflerent mentally from those who did not Why was 
It that the child with pulmonary tuberculosis tended to 
be precocious in mind and adult m manner"^ It had been 
suggested, in explanation of the number of men of genius 
who had been tuberculous, that the bacterial poison could 
actuallv increase mental activity Much more likely was 
it that the possession of exception il mental powers, which, 
as seen in writers and artists rather militated against a 
egulated and temperate existence, made a man mote 
kUy than his fellows to de\elop tuberculosis Perhaps 
Keats s trouble was due to the laboui of his poetry super- 
idded to the medical curriciiUim Again, a normal person 
was more adaptable to his surroundings In treatment 
the mam problem was to get the patient to sec his case 
in Its proper perspectise Many people when told they 
hue tuberculosis start b> being incredulous and refusing 


TiiEBmuii 
AlEDICAL J0UIIN.M 

to accept so unpleasant a fact , others go to the opposite 
extreme regulate their rest hours to the exact second and 
become so completely wrapped up in their symptoms and 
treatment that being a patient becomes their life work 

Dr A ,A W Petrie gave an analysis of (he type of 
major mental disorders occurring among 126 cises of 
tuberculosis in an institution for certified mental cases 
The manic-depressive type accounted for thirty five, 
schizophrenia for thirty-hvc, and paranoid types for 
twenty-five It had been suggested that schizophrenia 
was in Itself a manifestation of tuberculosis, but it was 
doubtful whether there was any aetiological connexion 
There was, however, no doubt as to a lowered resistance to 
tuberculosis m the case of schizophrenics , given exposure 
to the disease, a high proportion would contract tuber 
culosis There had also been shown a definite diniinution 
of resistance to tuberculosis in the siblings ot schizo 
phrenics 

On the other hand. Dr J Brander said that figures 
which he hbd been able to investigate showed that in 
reasonably favourable surroundings schizophrenics did not 
develop {iiberculasis in any striking degree, though their 
susceptibility was suggested by the tact that six out of 106 
patients submitted to pyrexia! theiapy by means of sulphur 
compounds developed pulmonary tuberculosis m fatal lorm 
within relatively short periods after the treatment In the 
hospital of which he was medical superintendent (Friern 
Hospital, formerly Colney Hatch) the post-mortem records 
showed tuberculosis in the middle of last century to haw 
been the cause of death in the institution in between 
40 and 50 per cent of cases At the beginning of the 
present century the tuberculosis death rate was 12 pi.r 
cent and during the past ten years it had been S per 
cent Great changes m hygiene and improvements m 
dietary having taken place in the intervening period, it 
might be inferred that the old special susceptibility of the 
mentally ill to be victims of tuberculosis was a myth, 
and that the problem was merely one ol hygiene , never 
theless he believed a certain liability persisted 

Tuberculosis Death Rate in Mental Hospitals 

Sir Robert Armstrong Joncs mentioned that the 
resident medical ofltcer at Papworth had stated that the 
niimbei of cases in that colony which had developed 
mental symptoms and had been sent to a mental hospital 
was only one in 500 over the couise of twenty years At 
Claybury he had had experience of 16,000 insane persons, 
of whom 5 000 had died, and ot these deaths over 800, 
or 16 pei cent , were fiom tuberculosis Deaths from 
tuberculosis in mental hospitals’ had gone down enorm 
ousiy during the last ten years — from 6 6 to 4 5 per 
1,000 patients resident In his experience at Claybury 
haemorrhage was very rarely seen m the tuberculous 
patient Both in insanity and in tuberculosis there vws 
low resistance, also a tendency to run in families He 
regarded tuberculosis as a serious complication of insanity 
and vimost, as a natural termination of chronic brain 
disease 

Dr E Risi of Pans recalled that Laennec, writing 
about tubeiculosis more than one hundred years ago. 
mentioned the importance of what he called the sao 
passions meaning worry and anxiety Dr Rist n'lo 
carried out a study of conjugal tuberculosis It wis 1 
striking fact that when one marriage partner was (uoi.r 
culous the other rarely became so On the other Jnoo 
when tuberculous husbands died or were removed to 
sanaloriums it was not infrequent for the widows or wne 
to de\ clop tuberculosis, perh ips explainable on the 8™” 
of increased economic insecurity and responsibility for i- 
children Dr Noel D Baudswell commented upon iR 
irritability and fussiness of sanatorium patients, ’"Oi^ 
he thought this might be attributable to the scgrcgi 
rather than to the disease for it was seen in other isoii 
colonies even of normal people 

Sir PrRCiVAL Hartlex who presided said it had 
claimed that just as the tubercle bacillus stimulated 



Jm.\ 9 193S 


■JIENT^L WELFARE OF EX SER^^CE PATIENTS 


thermogenic centres and caused p\,re\ia so it could 
stimulate the higher centres to increased crealne facuin 
It «as Worth remembering that Robert Louis Steienson 
wrote or finished Treasure Island while a patient under 
strict regime at Da\os and that John Addington Ssmonds 
did some of his best work while a patient at the same 
resort 

The subject of the control of tuberculosis in tropical 
and subtropical regions was dealt with b\ Dr C 
WiLCOtKS htels tuberculosis research officer to the 
Gosernment of Tanganjika Terntort Dr E Cochrane 
of the Colonial Medical Senice Major General E 3V C 
BR-'DFJeld of the Indian Medical Sersice and Dr N D 
Bardswell medical commissioner m Csprus for the 
National Association for the Prevention of Tuberculosis 
and Professor LiT-E Cuvlmins discussed the general sub- 
ject At the annua! meeting of the National Association 
Dr W M MacPhail medical superintendent of Burrow 
Hill Sanatorium Colons gave a short address on the work 
carried out at the Colons 


MENTAL >mFARE OF EX-SERVICE 
PATIENTS 

A luncheon was gi\en bv ihe Ex-Services Welfare Socielv 
on Jul> 1 at the Grosxenor Hotel following a medical 
conference at which the mental sequelae of head injuries 
sustained during the war were discussed Admiral Sir 
Reginald TvRWHrrr presided o\er the luncheon and Lord 
Horder a Mce president proposed the principal toast 
Lord Horder congratulated the Society on the worlv it 
was doing for exser\ice men he assured the Pressmen 
present that the Society was a good stor> In the 
medical sphere u was doing exactly the field work which 
was wanted Laboraton research was all 'ven well but 
without obser\ation of the patient medicine could not 
advance He quoted the remark of the great French 
phjsician Trousseau Le malade touiours le malade 

ISeurasthenia and Cmplovmenf 

Sir Admr Hore Permanent Secretarv of the Minista of 
PenMons m responding to the toast said that to-div the 
Ministn had 45 000 neurological ca^es on its hooks of these 
29 000 were cla^^sed as neurasthenia and the remainder as 
mental case« some certifiable and others not epilepsie< and 
other The original shell shock case had practicalh dis 
appeared The caseb of neurasthenia and other troubles such 
as were now encountered were in men whose menial and 
nervous balance was — -to use a nautical metaphor — just on the 
Plimsoll line of safetv In all treatment the occupational 
interest had been emphasized It was mo«l desirable to take 
the patient out of the atmosphere of what had been called 

fireside gloom the besetting danger of the neurasthenic 
Sir Adair said that he wanted in the name of the Minister of 
Pensions to make one suggestion Great Britain had m ns 
social svstem the biggest scheme of economic ^ecuntv vet 
evolved— nameh social insurance of vanous kinds The 
evpenence of the Ministrv was that the majoritv of the men 
remained vvathm this svstem but a certain number tended to 
dnfi out of it and the neurological cases were the most Iikeh 
so to drift If such a man got into intermittent emplo'ment 
he tended to lose confidence in himself It was verv important 
to gel hold of such men and if possible get them back into 
insurance at full benefit It was far better for «uch men to 
be m social insurance than for them to be m the insecure 
position of depending upon the success of an application for 
higher pension or for a grant from the Sotiel' \ scheme had 
been devised m the Mmi^trv for assisting the c men to get 
back into social insurance 

Afenfar Sequelae of Head Injuries 

M the conference prcccdinc ibe luncheon the general «.ub 3 cct 
of di^^cu^Mon v'as the mental sequel e of head injuries Ur 
Edw vRD MvroTHER Profc^^or of P vchiairv London Lnivcr 


Tirr 

V = A* I-t, «S. t 


«m and chief consultant to the Socictv v^ho pc 
2 ddre«ed the conference at orre lerg h o" thi« top - 

Profes or Mapolhe' tb^t it cemed p obub’e jUu.-. 
from the ca^es of head inji-n. in civil life that ibc A 
equelae of head irjunes m war had been u'^dc e< cd b 
the Nlinistnes of Pen ions m this ard Othe' cc-''irie' He 
proceeded to «ome <pecuLtjors about the p^v *.1 s c*" 
iho e mental <equelae which were cHarlv c-caru k- t 
summer he had analv ed «orre 2 0 civil ca<es ir v^bub 
disorder ot <ome degree Was aunbutv.b^e to head ir^w ' Tb^ ** 
included both the ca«es m vvhivh the relation \ ps\cbop’- 
and tho e in which it was phisiogeriw Ar^org rhe pvebo 
genic ca^es the fir t group was the hv ten^ ^nd ibe c o'* \ 
what he called the affective cace> tbO'C n which ibc c \ a 
an outstandme deviation of nood related to ib- n tn ^ 
emotional experience The ca<es which uncus 
a phvsical ba is fell from the psvchi^tn t point 'i^v n o 
two mam groups tho e m which ih‘*re wa a peciulucd 
mental disabilitv of <ome kind with no general impv.irr'c*' 
and those with a generalized menial <vndrone Tb- fr 
of lhe<e groups included conditions on tbe borderlire bciv e-n 
organic neurologv and psvchiatrv It might be divided in’o 
two subgroups the first of which had a verv good p ogno iv 
«nd the <econd a ven bad The fir i included «uch cond i?or 
as apraxia’^ agnosias and aphasias both motor ard cn o-w 
also pure amnesia for current events There might be tailurc 
to distinguish the remo e from the recent and ihe in cin*.r\ 
from what nad been perceptual expenence Such i.mre 
might coe\i<t with perlect perception and conp ehe^ tr 
good memorv of recent events good association ot idea- good 
reasoning insight and entirelv normal conduc Sue i 
svndromcs tended to clear up to a surpn^ing decree ihouJi 
thev might leave <Iight residues The <ecord ubgro^r o' 
specialized svndromes which had an cxacilv oppOMi'* 
prognosis included epilepsv epileptoid mental paroxv m< 
demoralization The econd mam group con i< cd of ^vn 
dromes in which the mental di<wbiliiv wa< generalized In 
respect ot the e ca^es Dr Svmonds had emphasized a 
principle of great importance not onlv for undcr^urdirc them 
but for the theorv of psvchiatrv m general — naireU that durne 
the progre-s towards normaliiv after a head injurv the rent I 
state passed through a <enes ot stages The total duration 
of mental abnormahiv might be an hour o evera) month 
the halt which procre s made at each «lage was quite variab’* 
and anv '^lage might be protracted as to cor<-tiiuie '» 
psvehosis but the order remained al'vavs the ^me c\.*c 1 
the reverse order to what was ob^^ervable in progre-’^ive merl-l 
disintegration due to anificial mioxication o" anihcial hvpo 
clvcaemia thus indicating that the svndromes or stages vkh ch 
could be di«icnminalcd depended upon the •structure cf the 
central nervous svstem and not upon the specific nfiuencc of 
anv cau*^! factor 


Effect of Fracture of tbe Skull 

After discu«sing the sequence of svndromes v\hich <eemed 
to correspond to ‘Stages of integration that no'^mallv ^iicteedcd 
one another in mental acuviiv and de cribing mcnt**I cctivii 
Itself as a elective balance of reciprocal activations and in 
hibilions between the cortex and «ub-conicai centre^ Pfofe-<or 
Mapoiher vvenl on to point out that the degree of mental 
disturbance immediate or late had verv incon lant reLlion<. to 
the amount of damage to the skull A fracture might be 
pre^^ent in a patient who had never been unconscious ard b«d 
no sub equent mental compl cations On the other band the 
wor t result- might occur m the ab-ence o 
could all the mental comphcaiiors be a^enbed to b~emo b g 
of anv kind He believed lo s of con cioLv-e« to be d.e to 
o' .v.b-co -,.01 ce-ares .h.cfi ^ - 

mstantancousli at tbe mo-ieni of injurs H p rercl co 
rre' lOT of the content' of the Aull o b 'i ret o- Tr-ic 
tore de'rH't 'h' f-=' d.'O de' c I-e sC- -c 

rrocc-'e^. Ihnt wns pen-eued it v.-s n d\' ur ic- o b_ u 

centre-, that "S' p innn Fne reco'e- o' I*'"' cO c\ fcl Co 

accordinc to the rule th-t tc-'t o-' ir\c' in" I'" i-p’" "J 
mo t prim ti'c iptecnitio''' cen-e b-ck f 2"d I'-o e "'C "p 
complex "d i-p-c rcccn m cc -tio"s re c-r-d 1- -"d " c 

mo I apt to be left inpc-fe.,! 



86 July 9, 1938 


THE HUMAN SKIN 


TiiEBumsit 
Medical Joukskl 


In civil injuries, such is roid traffic accidents, one com- 
monly saw fissured fractures or comparatiselj localized 
depressed ones in war, smashing might occtii by shell frag 
ments spent bullets and high-velocitv bullets fired \erv close 
It might be that the head injuries of war were less-likely to 
start mental disturbances of the generalized organic kind 
because their effect was more commonlj confined to the hemi- 
spheres and they were less likeh to produce the instantaneous 
general compression of the contents which would damage 
basal centres Penetrating wounds by bullets of medium 
velocity need not be associated with loss of consciousness or 
retrograde amnesi i, but many war wounds like those induced 
ba a large fragment of shell or a blow on the head b> a rifle 
butt, were liable to bring about results exactly comparable with 
those following civil injurj 

Representatives of the Services and the Ministry of Pensions 
participated m an informal discussion One point mentioned 
was that among the 200,000 people non-fatallv injured in motor 
casualties a vear the insurance companies reckoned that 4 per 
cent had a serious head injury There was general agree- 
ment as to the seriousness and the prevalence of minor nervous 
disabilities following head injurj, and the opinion was ex 
pressed that many who did not have any gross breakdown 
were none the less incapacitated for their work owing to the 
injury, and that this incapacitj increased as time went on 


THE HUMAN SKIN 


DR LEONARD WILLIAMS’S LECTURE 


The thirteenth annual Macahster Lecture (in memory of 
Sir John Macahster, secretary of the Royal Society of 
Medicine) was delivered at the National Temperance Hos- 
pital on June 30 by Dr Leonard Williams The lecture 
xvas entitled ‘This Moital Coil, and in explanation Dr 
Williams reminded his audience that German^^ com- 
mentators— good Shakespeareans— took the word coil 
to mean the shuflled-off skin of the snake The lecture 
was a provocative and delightful discourse on the skin— 
what Dr Williams called the largest oigan of the body, 
and, with the exception of the brain, probably the most 
complicated 

Phjsiologj of Pigmentation 


Those who took the trouble to trace the skin backwards 
evolution, he said, could not fail to be struck by the 
iicitude with which Natilre undertook its protection 
om the slings and arrows of outside attack But when 
the genus Homo was reached Nature seemed to have 
exhausted her protective expedients, for man had, even 
m individuals in whom it was most profuse only a meagre 
amount of haii and a capacit,v,,lf)r_produc.n£ 
w'htch in many case': V.'Js’''altogether msufficient , and it 
had to be^rCj^ienibeVed that from the point of view ol 
protecivg'n hair and pigment were to some extent inter- 
■' changeable 

The question of capacity to pioduce pigment in response 
to solar stimulus was of great interest, and, in 
modern means of transport, was likely to grow m practical 
importance Why did the quite healthy young human 
being react so naturally to the wholesome stimulus of 
sunlight'’ The answer xvas not simple but it might be 
said that inasmuch as the laying on of colour in the skm 
was a physiological act demanding a great deal of energy. 
Nature^ would not undertake it except 
obliged to do so for the preservation ot the race Ihe 
negro s black skin enabled him to thrive in any coloured 
man s country whereas in a white man s Innd that , 
black skin shut out the solar stimulus to xvhich the negro 
was accustomed and to resist which he xvas properly 
equipped The real black was b> no means happy m 
Soifiht-rn Europe and in Aberdeen he was miserable not 
onlj because he could not make any monej whereivith to 
get out but because there was msufficient sunshine to keep 
Ls phvsiological fires burning 


Unfiltcrcd Solar Rajs 

The cult of sunshine was by no means confined to 
nudist cranks The therapeutic xaliie of the sol.ir ravs 
had been recognized for several generations What had 
not been recognized until comparatively recently was that, 
as in Ihe case of most measures potent lor good, thi. 
unfiltered rays vveie very potent for evil The anaemic 
children who were sent in shoals to the seaside every 
summer doubtless benefited enormously in the long run, 
by being subjected to (he sunshine and other cosmic forces, 
but it was undoubtedly the case that in many instances the 
exposure vvas sudden and intensified when it should be 
gradual and partial The summer sun vvas very powerful 
in northern climates and il beat pitilessly upon the full) 
exposed skins of little children causing them to react by 
fever with nervous and intestinal symptoms which were 
usually attributed to eating raw fruit or something eqiiall; 
harmless Brunettes, though they might suffer m some 
measure, quickly acclimatized themselves by becoming 
swarthy, but the true blonde was seldom capable of offer 
ing effective resistance to solar onslaught If blondes in 
general, and especially blonde children, either were given 
a separate course of medicinal iron or were to increase 
their intake of iron-contammg foods before the suns 
lays became piercing there vvould be more harmless 
enjoyment of open air conditions 


Compatibilitv of Odours 


After Its colour the most important attribute in the 
human skin vvas its odour, which might be very delicate 
and highly agreeable Undoubtedly said Dr Williams, 
the more delicate smells played an important though only 
partially recognized part in Ihc life of the individu u 
One succumbed to the magic of a gracious lady s charm 
even as she entered a lOom The element which decided 
the sympathy oi antipathy m such cases was ttjtnosl ter 
tamly the compatibility or otherwise of the body odours 
If Jhat element could be operative in the case of perfect 
strangers, how much more ceitainly was it likely to 
operate in the case of married people and candidates for 
wedlock’ Indeed it was high time means were invenleu 
for classifying people s bodily odours much as their blooti 
gioups were classified "So that that powerful factor m the 
suitability of two people for marriage might be accordeo 
the place it deserved In the matter of heavy odours as 
opposed to the delicate no serious student of the siioject 
could be found to deny that odours irradiated from me 
human skin had a Freudian significance There was 
really no escaping the fact that the human skin wa 
intended by Nature to be odoriferous, the odour oeing 
intensified qi decreased according to the stage of litc 


The Facial Skin as a Record 

After a brief reference to the other 
of the bkin. Dr Leonard Williams concluded by urfiing 
his audience to bear in mind that both stimuli a.n - 
?lLl.ons ktl a record o„ .he ,k.n wh.eh ""'X' 

indelible but progressive In sp'‘e of the ma k jn 
people opposed to the outside world *ere was nom^^b 
so revealing as the skin on a person s face its 
its rexture, and the folds and fissures into '^b'ch 'I 
drawn by the individuals indulgences, ® ’ ,lcss 

Sotlons"^ The skin of the lace came ‘o carry a m reilcss 
record, not only of the gross material s'* "i 
but ot the more subtle thoughts By middle Nau ^ 
had stamped upon the features *c oumo^ h 
struacles Indeed ‘the mortal coil resembled a 
bearing the record of the fate of ‘alcnB 
an individual had been entrusted w ' , , | con 

used, which misused, where the 
quered and where faltered and, perchance, fallen 

On the motion of Mr Herbert Paterson seconded by 

Dr H Sa^liuine.ti Dr Williams -s accorded i most 

hearty vote of thanks for his stimulating lecture 



Jll\ 9, 1938 


EXCHANGE VISITS WITH FRENCH DOCTORS 


Th E — 
rr*CAL J-' 


CORPORAL PLMSHMEXT 


E\CH4^GE HOLIDW VISITS ^^ITH 
^RE^CH DOCTORS 

We ha^e recei\ed particulars of a scheme for improve 
ment m the knowledge of and the relationship between 
the English and French peoples Few will disagree that 
in these limes a better knowledge and understanding 
between our two peoples is much to be desired and »n 
this members of the medical profession can pla> their part 

The Scheire Outlined 

Bnefi\ the idea is that an Englisn doctor is. put into touch 
with a French doctor of corresponding age and position with 
a Mew to exchancing holidav visits as guests m each others 
homes thus avoiding hotel and other incidental expenses 
which are such a costlv item to the visitor abroad At the 
same time the visitor has in his host a reliable guide to the 
countrv The communitv of inieren between guest and host 
Will It is considered add to the interest of the holidav and 
mitigate to a large extent the difficulties v^here such mav 
exist of the two languages 

The organizers of the scheme have arranged with the rail 
xxaxs on bovVi sides ol \Vie CViarmeV for a 4^ pei cent leducuoTi 
in the ordinarv fares to be given for the joumev throughout 
thus reducing what is in effect almost the onlv cost to the 
M^Jilor apart from pocket monev This 40 per cent reduction 
aho applies to wives and children 

The idea is not restricted to the medical profession but is 
open to all the communitv of vocation hobbv or denomina- 
tion being the kev to the contact established between the 

opposite numbers In practice the scheme operates in the 
following manner 

An English or French «ecretarv acting for his profession 
establishes a list of applicants desirous of exchanging visits 
with 1 colleague m the other countrv From the<e lists the 
secretaries choose to the best of their abilitv a suitable 

opposite number in each countrv The applicants so paired 
are put into touch with each other and left to make their own 
arrangements When dates of the visits have been decided 
the applicants obtain from the secretan in their own countrv 
an eligibiliiv voucher entitling them to a ticket to their 
destination at a reduction of 40 per cent on the ordinarv 
fares The visitor will be met at the foreign station bv his 
or her host and henceforth all residential expenses will be 
defraved bv the host on the explicit understanding that the 
latter will meet with reciprocal treatment when he or she in 
turn becomes a visitor and guest in the other countrv 

Information from Applicants 

The scheme has alreadv been put into practice with much 
success for members of various occupations The organizers 
Will be pleased to hear from anv doctors in this countrv who 
would like to take advantage of the scheme Applicants 
are requested to state in their letter 

1 Their age n 

2 The desired duntion of their hohdaj abroad with approxi 
male dates 

The part or parts of the foreign countrv (including Algeria) 
which thev parlicularlv want to see 

4 Their willingness at the end of their holidav to return the 
hospitaliiv of their host for a like period and at a mutualK ton 
venicnt lime al ihcir own house wiih approximate da 2 e> for 
receiving the visitor 

The places of local interest v\hich ihe\ can show iheir visitor 
on the Occasion of the return visit or generallv the wav in which 
thev propose to entertam their visitors 

Letters of application should be addres ed to Mr D 
Moodman Anglo French Exchanges Ccmmillcc 27 Eus on 
Square London Is 1 


Under the auspices of the Howard Leacue fo' Pi.n-'l 
Reform (Parliament Mansions Victoria Street S \\ II th. 
letter printed below has been addressed to Sir Samu-l 
Hoare Secretars of State for the Home Dcparimsnl It 
IS signed bs men and women prominent in public life ard 
m \arious professions The medical sicnatories are Dr 
Alfred Salter MP Dr Haseicck E'lis Lad\ Barrett 
Mr C J Bond Dr A Helen Bo\le Dr William Brown 
Dr C L C Burns Sir William Collins Dr Ralph H 
Crowlev Dr Lelilia Fairfield Dr Kate Fraser (med cal 
commissioner for the General Board of Control for Sco 
land) Dr Edward Closer Dr Thomas S Good Dr 
R G Gordon Sir Somers ille Hastings Professor D k 
Henderson Dr E T Jen'en Dr W illiam Mocdie Dr 
J R Rees Dr Jane Walker and Dr T Drummond 
Shiels 

Letter to the Home Sic retard 
Three sears ago sse signed a letter to the then Home Seere 
tars appealing for an inquirs into the question of corgoml 
punishment Some of the signalones to that letter held that 
corporal punishment under the criminal lass could not he 
justified on ans grounds others that it could onls be jusii*Sed 
if It ssere prosed to be essential for the prelection of csiets 
The recenlls published report of the Departrrcnial Com 
mitlee on Corporal Punishment has prosed conclu iseis that 
It affords no better protection to societs than other form of 
punishment The onls possible argument for us contmuan e 
therefore falls to the ground To maintain it in these circum 
Stances implies the acceptance of delibcratels imposed utfer 
ing that serses no useful purpose Such attitude is sse teliese 
foreign to the whole spint of our penal code 

We recognize ssith gratitude that sou sour elf arc follossing 
m the tradiuons of the penal reformers ssho beliesed m 
reformation rather than retribution We therefore confidenils 
appeal to sou to implement the recommendations of the 
Departmental Committee at the earliest possible date 


LIFE ASSLRANCE MEDICAL CONGRESS 

The next International Congress on Life Assurance Mcdi 
cine ssill be held in Pans from Mas IS to 21 19 j 9 under 
the patronage of the Minister of Public Health The 
honorars presidents are Dr P Hornig IBerlin) and Sir 
Walter Langdon Brossn (London) The chairman is Pro 
fessor M Loeper of Pans and the general secretars Dr 
P A Carrie 8 rue de Bellos Pans XVI The follossing 
subjects in relation to life insurance ssill be discussed 
(1) pulmonars tuberculosis (2) hsperlhsroidism (') 
obesits (4) addiction to tobacco (5) albuminuria and 
(6) the salue of statistics The contribution for members 
of the congress ssho must be medical practitioners 
engaged sshole or part time in lile assurance ssork is 
fixed at 200 francs each max be accompanied b\ cn_ 
person pas mg 100 francs These pasmenis gise the right 
to the banquet the esening parties and excursions and 
(for members) to a full report of the congress 


The se»-ond session of the loternational Concress of 
Anthropological and Ethnological Sciences ssill be held m 
Copenhagen from August I to 6 under the patronage of the 
Kmg of Denmark and Iceland The saenlific meetings ssill 
be held at the Lmsersits Scsen sections base been organized 
phssical anthropolocs ps chologs demographs cihnologs 
elhnographs sociologs and religion lincuisiics and ssrilnc 
The concress ssill be followed bs a ibrec-dass excursion to 
plasres of historical mlcrcsl in Denmark Xrrangcmenis for 
Irasel and hotel accommodation are in the h_rds of Wager- 
Ills Cook (Thomas Cook --nd Son) olb-r comm ncaticrs 
should be sent to the Secretars Cj neral o' lb' Corg t 
Kationalmuseet 10 Ns \e'tcrg-de Copcnb„cen k 



8S July 9, 1938 


CLINICAL PATHOLOGY 


The B^rnsii 
Medical Jouilval 


Reports of Societies 


CLINICAL PATHOLOGY 

The summer meeting of the Association of Clinical Patho- 
logists was held at the Nuffield Institute, Oxford, on June 
25 The chair was taken by Di AG Gibson and more 
than seventy members and guests were present The 
special discussion on the technique of medico-legal post- 
mortem examinations was opened by Sir Bernard 
Spilsbury 

Medico-legal Necropsies 

Sir Bernard Spilsbury pointed out the importance in 
every case of a thorough examination of the organs of the 
head, neck, chest, and abdomen He referred also to 
conditions which rendered it necessary to examine other 
parts of the body, and laid emphasis on external inspection 
as an important part of the examination He described 
methods of recording injuries and of searching for hidden 
bruises by incision of the skin The routine method of 
removal of the organs, ensuring that no important 
structure was overlooked, might have to be modified to 
meet special requirements — tor example, in infants he 
removed m one mass all the structures from the flooi 
of the mouth to the pelvis A special dissection of the 
neck might be required in cases of sti angulation or cut 
throat It was important to open up the heart while it 
was still attached to the lungs and to open the intestines 
from end to end, noting the character and distiibution 
ot their contents Finally he described the method of 
removal in one mass of the pelvic organs and their exam- 
ination m cases such as those of abortion 


Use of Fresh Preparations 

Dr A H T Robb-Smith read a paper on the use of 
fresh prepaiations in post-mortem work He illustrated 
the value of these preparations in the identification of fat 
emboli, of pigments, and of deposits in the kidneys Foi 
the recognition of fat emboli a small snippet of lung tissue 
was placed on a slide, moistened with 2 pei cent potas- 
sium hydroxide, and examined with a partially closed 
condenser diaphragm after the application of a cover- 
shp The pulmonary tissue was rendered transparent 
though the elastic fibres were not dissolved The fat was 
seen lying m the alveolar capillaries, either as cy}ii7ders 
or as droplets radiating in a fan-shaped manner The tat 
could be distinguished from air bubbles, since the latter 
had a broad dark rim with a bright centre, whereas the 
fat was uniformly colourless to the edge of the globule 
The application to fresh specimens of reagents such as 
acids alkalis, hydrogen peroxide, and silver nitrate enabled 
a distinction to be made between hacmosiderin, haema- 
toidin malarial pigment, and melanin These methods 
might be used also for the identification of small deposits 
in the pyramids of the kidney These might consist of 
bilirubin, acid sodium mate, sodium bnirate, or calcium 
ciibonate Bilirubin infarcts could be recognized by the 
characteristic rhombic or fine needle crystals and by 
Gmelin s reaction This was earned out by rinsing thin 
slices of the kidnev in weak potassium hydrate then 
apphing a cover-slip, and placing a drop of strong nitric 
acid at one side and drawing (he solutions through with 
blouing paper , the bilirubin deposits changed colour from 
green through red to blue Uric acid infarcts had usually 
an amorphous form and were soluble in dilute acids 
without the formation of gas calcium carbonate infarcts 
could be recognized by the formation of needle-shaped 
cilcium sulphate crystals on the application of strong 


sulphuiic acid or of calcium oxalate crystals after the 
addition of hydrochloric acid and ammonium oxalate 
They were also soluble in hydrochloric acid with iIil 
evolution of carbon dioxide Gouty deposits of sodium 
biurate were identified by iheir characlenstic crystnllme 
form Dr Robb-Smith did not advocate the use of un 
fixed frozen sections, as these seldom supplied information 
which could not be obtained from a careful observation 
of the gross characters of the organ 

Status Ljmpliaticus 

Dr E WoRDLEY opened a discussion on the subject 
of status thymico lymphaticus He mentioned that the 
older textbooks on pathology were quite definite in their 
descriptions of a condition characterized by enlargement 
of the thymus and lymjihoid tissues and associated with 
sudden heart failure and death They accepted the asso 
ciation between such post-mortem findings and sudden 
death without any reservations, except to say that it was 
difficult to explain exactly how and why death occurred 
He then briefly discussed the findings of a joint com 
mittee on status lymphaticus, which came to the con 
elusion that an enlarged thymus m itself could not be 
consideied as indicating status lymphaticus, and that there 
was no definite evidence of general hyperplasia of 
lymphoid structures in cases with an abnormally Urge 
thymus Dr Wordley then. discussed seven cases in which 
the original criteria justifying a diagnosis of Status 
lymphaticus were all present He gave ceitain figures 
which seemed to indicate (hat some cases showed an 
abnormal proportion of Ivmphocyles m films made from 
blood taken post mortem and suggested that this point 
might be further investigated He himself was inclined 
to the view that a diagnosis of status lymphaticus as 
the cause of death was justified in a limited number of 
cases 

In the discussion which followed the general feeling 
of the meeting was that sudden death after comparalivclj 
trifling causes was often found in individuals with an 
enlargement of the thymus and lymphatic glands and 
hypoplasia of the circulatory system It was thought that 
it would be helpful if some scientific body, such as the 
Association of Clinical Pathologists, were to imdertikc a 
combined investigation of the cauSe of death in these 
cases and make recommendations as to nonaenclaturc It 
was decided to refer the question to the Council of the 
Association 

Before the scientific meeting at the Nuffield JnsliUile a 
dernonstration was arranged in the pathology department of 
the Radclifle Infirmarv Here Dr ] G GRECNfirLD demon 
strated his method of removing the brain and spinal cord 
Dr A H T Robb Smith shotted Graffs technique for 
removing the upper air passages and pharynx and Dr A G 
Shera exhibited an electric rotarv saw for the removal ol 
the skull cap and exposure of the spinal cord m post mortem 
work 


A meeting of the North of England Obstetrical and 
Gynaecological Society was held in Newcastle on June I 
Dr W R Addis (Manchestei) described two cases o 
pseudo myxoma of the peritoneum with lesions m m*- 
appendix Mr St George Wilson (Liverpool) ga'c a 
account of a case of carcinoma of the vagina f 

to carcinoma of the colon Professor FarQUHAr . 

(Newcastle) discussed a case of a large sloughing uDr 
in a nulliparous woman associated with 
bilateral white-leg and detailed the operative p 

of a case of absence of the vagina in a girl aged D 
C G Pain (Sheffield) showed a film, BTiift 
Action of the movement of normal leucocytes ano 
phagocj losing of streptococci 



JULI 9 1938 


SCOTLAND 




^0 


Local News 


SCOTLAND 

Unnersitj ol Glasgow 

Al the commemoration da> graduation ceremonj of 
the Unnersitj of Glasgow on June 22 the Principal Sir 
Hector Hethenngton conferred honorars degrees upon 
sixteen recipients of whom one Professor Matthew John 
Stewart is a member of the medical profession Professor 
Stewart graduated MB Ch B at Glasgow in 1907 and 
is professor of pathology m the Umxersilx of Leeds and 
pathologist toXeeds General Infirmars He is a member 
of the Medical Research Council and has published 
\anous studies on pathological subjects including gastric 
ulcer, the cellular reactions induced b> cholestenn 
deposits and sacro-coccsgeal chordoma 

Roial (Dick) Vetennan College 

At the annual prize gixing of the Rojal (Dick) 
Veterinars College Edinburgh on June 27 Lord Rose 
ben who presented the prizes said that leterinarj science 
was doing an enormous amount of work to ameliorate the 
condition of animals in this countn and to help their 
owners He announced that the Totalisator Board which 
distributed a certain amount of mones for purposes apart 
from racing had gisen £1 000 towards this College and 
the Board had also gnen £1 000 towards research work 
in connexion with grass sickness m horses The chairman 
Sir Thomas Hudson Beare m a short resiew of the work 
of the College during the session referred to the death of 
Dr Charnock Bradles the late principal who had guided 
Its destinies for o\er a quarter of a centurs His final 
illness had been largels due to oserstrain and overwork 
and the governors had decided that the new principal when 
appointed should be freed fbom teaching work He hoped 
within about a week to be able to announce the new 
principal and the new professor of anatomj 

St Andrews Unnersih 

At the graduation ceremonv on June 30 of the Untvcr- 
sitv of St Andrews the Vice Chancellor Sir James C 
Irvine conferred the degree of LL D upon five recipients 
including one member of the medical profession Professor 
E D Adrian FRS of the Chair of Phvsiologv m the 
Universilv of Cambridge Professor Blvlh Webster in 
presenting Professor Adrian for the degree said that he 
was a graduate of Cambridge Oxford Harvard and 
McGill and had done valuable work on the phvstology 
of nerve and the integrative action of the nervous svsiem 
Bv experimental work of unusual dehcaev he had brought 
the complexities of this subject within the range of 
analvsis for which m 1932 he had been awarded jorntlv 
with Sir Charles Sherrington the Nobel Prize m phvsiologj 
and medicine Since the foundation of the Nobel Prize 
in 1901 out of more than eighiv awards about a quarter 
had gone to scientific men m Britain and it was a rarer 
honour that both awards in the same field should have 
fallen to this countrj in one vear 

At the same ceremonv Professor Gordon Campbell was 
installed in the Chair of Dental Surgerv being the first 
professor of dental surgerv m Scotland The Vice 
Chancellor said that the foundation of this chair was the 
culmination of long vears of patient effort and thanks lo 
the generositv of some public citizens m Dundee and to 
Ihe enthusiasm of a group of able dental praclitioners in 
that citv the Dundee Dental Hospital had come into 
being and had prevented an opportunitj for the Oniver- 
vitv to join in the new movement vvhich had resulted m the 
present satisfactorj position Special thanks were due to 


Mr William Bovd wheve liberal endowment had enabVd 
them to found this chair Twelve diplomas m Dental 
Surgerj and two m Public Dentistrv were afterwards coa 
/erred bv the Vice Chancellor the recipients beiac he 
first Universitv graduates m this department in S<.o'!_nd 
The number who received the decrees of MB Ch B wav 
fortv SIX while two received the \I D 


ENGLAND AND WALES 

The Minister of Health at ShefR Id 

Dr Waller Elliot Minister of Health visilcd Sht-ffivid 
last week to open the Firth Park Matemitv and Child 
Welfare Centre and the Coislev Hill Sewage Wor* s wh ih 
have been provided bv the corporation Ai the op^ninu 
of the new sewage works he said that hi. ideal ct 
sewage engineers meant that the rivers ol the eoiinirv 
should receive onlv what was right to flow down them 
to the sea We were recovering though viowh lo dav 
from one of the worst features of the industrial revolu 
tvon — namelv the throwing into our rivers of unireaied 
waste products of all kinds Punfication of sewage bv 
helping to clean our rivers was pari of a bigger thin,. — 
that of preserving the counirvside ot being a good neigh 
hour of preserving health and of doing what wav r ght 
If evert bodv showed the same care and was as up to d e 
as Ihe Corporation of Sheffie'd and its allv the Chester 
field Rural District Council much more would be done 
to make our rivers clean Nothing could b. more 
beautiful than a beautiful river and noihing could be 
more loathsome than a river which was loul polluted 
and dead At the opening of the malernilj and chi'd 
welfare clinic Dr Elliot referred to the decline m the 
infant mortalitv rate per 1 000 live births from 136 in 
1885 to 58 m 1937 and to the recent decline m the 
maternal mortalitv rate The problem of maternal mor- 
lalitv still required however to be attacked m everv 
possible wav and much was to be expected from the 
recent Midvvives Act and from the steps which his 
Department had taken following the publication last vear 
of a report on a series of intensive investigaiionv bv 
medical officers of the Minisirv Team work vvas ihe 
kejnote of the attack The Firth Park Clinic marked 
in Sheffield the beginning of a scheme of decentralization 
and he commended this example to other local autho 
rities Clinics should be established m the oulijing parts 
of big towns so that the entire population could b,. 
served ft was vital that when health services had been 
provided the people should be told of iheir existence and 
he congratulated the Sheffiela Corporation on ihe efficient 
manner in which it had joined m the recent public health 
campaign and had told the people of Sheffield in no 
uncertain manner what it was doing for them 

Aftercare 33ork of the Afersevside Hospitals Council 

The headquarters in Lord Street Liverpool of the 
Mersevside Hospitals Council is the centre of a depart 
mem concerned soleh with the transfer of patients from 
hospitals to convalescent homes and with the allied aspects 
of after care There vs an all too prevalent impression 
that the work of the Council begins and ends wilh the 
pennv in the pound scheme That is a viial part of ils 
work and is the foundation of and fargefv the justification 
ot its existence But it is not the whole slorv The 
Council has a variciv of co ordinaled acliviiies ,.nd this 
after-care department is one of ihtm Es abiisv>cd eleven 
vears ago it is a do -li knit piece ol o ganizaiion dome 
Its own specific work as an integral pari of the en c 
aclivities of ihe local group of thir v hcspoals Af c 
care has a much wider applicalion ihm convalesce-!! 
home treatmenl and ii is ihrough the uor) o' ihc d^par 
mcnls visitors to the homes of the p_iicn's— sv illcd ard 
svmpathetic full lime social service w criers -ih,.t die 'u 1 



90 July 9, 1938 


ENGLAND AND WALES 


•; The British 
Medical Journal 


possibilities of after-care are realized These home 
visitors, -many of whom have made a close study of 
social science, divide much of their time betsveen the 
hospitals and the homes of the patients Their services 
are m constant demand, and the information they gather 
becomes the basis of action by the department in the 
way of arranging for convalesceni home accommodation, 
or in some other way supplying the urgent needs of those 
who have just passed through hospital wards and are 
fit subjects for some form of after-care In this woik 
of mercy medical men hospital matrons sisters and 
nurses co operate with the department’s visitors 

Health Congress at Portsmouth 

Nearly fifty papers and addresses will be read and 
discussed^ during the week of the Health Congress, which 
'opens at’Portsmouth on Monday next In tne section of 
architecture, town planning, and engineering, over which 
Sir Raymond Unwin presides, town planning and the 
safeguarding of public water supplies will be discussed 
Air raid precautions will be dealt with in the conference 
of representatives of local authorities, and m connexion 
with this discussion a mimic air raid has been'arranged 
' for Wednesday evening, July 13, in which the full ARP 
organization of the city will be seen 'in action Among 
other subjects to be discussed arc rheumatism, introduced 
by Lord Hordei, the future of the general hospital, the 
Food and Drugs Bill, defects found in school entrants, 
meat inspection, and health propaganda among natives m 
the Tropics During the week a Health Exhibition is 
being held in the Connaught Drill Hall As recorded 
in the Journal of June 25 (p 1373), the Duchess of 
Gloucester opened an exhibition at the Imperial Institute 
a short time ago of more than 200 photographs illustrating 
progress and activity in Kenya A supplementary series 
of photographs deals with some aspects of the work 
of the Medical Department in Kenya with special refer- 
ence to the part played by Africans These photographs 
will be on view in Portsmouth next week at the Health 
Exhibition of the Royal Sanitary Institute 

Welsh National Institute of Radiotherapy 

The chairman of the Welsh Board of Health on June 23 
convened a conference, which was attended bv representa- 
tives of county councils, county boroughs, and boroughs 
in South Wales, and of the .Welsh School of Medicine 
and the large hospitals, to discuss a proposal to establish 
a Welsh National Institute of Radiotherapy to serve the 
whole of South Wales The proposal is stated to have 
the approval of the National Radium Commission 
During the discussion on the scheme Sir Ewen Maclean 
mentioned that the Miners Welfare Fund of South Wales 
had donated £5,000 towards the project and the Cardiff 
Royal Infirmary had announced its readiness to give 
£15,000 from its Centenary Fund Appeal 

Conditions of Nursing Scnice 

The Interdepartmental Committee on Nursing Services 
which with Lord Athlone as its chairman, is investigating 
conditions of serxice in the nursing profession, is issuing 
a questionary to all hospitals The object of this is to 
obtain statistics for the country as a whole on such matters 
as the hours nurses have to work, the salaries they receive, 
and the length of their annual holidays This is the most 
comprehensive survey of the kind ever undertaken in this 
countr\ the committee which has been receiving evidence 
from various bodies and associations since last January 
has found that its consideration of several important 
problems has been seriouslj handicapped by the lack of 
an> general statistics Other matters dealt with in the 
questionarj arc the numbers of nurses of the various 
grvdes emploved by each hospital the arrangements in 
operation for the training of probationers and the reasons 
which cause so man^ probationers to leave the nursing 
profession during their first years in the service 


Correspondence 


uterine Rupture following Caesarean Section 


Sir — The paper on “ Uterine Rupture following 
Caesarean Section ” by Mr C E B Rickards iJoumal 
June 25, p 1359) is timely and instructive For better 
or for worse. Caesarean sections are being performed 
moic frequently each year, and this late complication of 
the operation consequently becomes a more and mors 
common emergency of obstetric practice 

Mr Rickards quotes Eardtey Holland as saving that 
4 per cent of Caesarean section scars rupture during v 
subsequent pregnancy or labour, and this figure is 
now also quoted in various textbooks of obstetrics 
The statement is taken from Holland’s analysis of the 
after-results of 1,605 cases of Caesarean section, pub 
'hsbed m 1921 (/ Obstet Gvnaec Brit Emp 28, 
488) but, as so often happens,’ the sentence taken from 
Its context is misleading and has caused many people 
to underestimate the frequency of this accident 
The following is an abbreviated table taken from the 
article in question 


Delivery by mturat pissagcs 78 ciscs 

Repevtcil Caesarevn section ItZ , 

Rupture of the sevr ' 18 „ 

- It vvlil be seen (hat out of Jhe 448 cases listed there 
were eighteen ruptures, which is the origin of the “4 per 
cent so often quoted But a little consideration will show 
that this figure is easily misinterpreted The majority of 
women in this group were subjected to a repetition of the 
Caesarean section (presumably before the onset of 
labour) and were therefore deprived of the best oppor 
tunity of rupturing their scars On the other hand, it 
would be equally fallacious to say that eighteen women 
ruptured their scars out of the seventy-eight who 
delivered by the natural passages for many of the 
luptures may have occurred befoie labour, and the 
number would therefore be artificially loaded by cases 
which should, in a sense, belong more rightly to (he 
‘ repeated Caesarean section ” group 

In short, although 4 per cent represents the proper 
tion of vvomen who did in fact suffer from rupture of 
the uterus, this figure does not represent the percentage 
of wom:n who would rupture the uterus were their 
pregnancy allowed to go to term and to end in natural 
labour the actual number of ruptures can be counted, 
but It IS impossible to find a denominator by which the 
real frequency of the accident may be estimated Tlieie 
IS little doubt that the figure of 4 per cent seriously under 
estimates the average risk which a woman runs of 
rupturing her uterus during subsequent pregnancy ena 
labour after a classical Caesarean section — I am, etc, 


Chassar Moir 

Department of Obvlctiics and Gynaecology, 

University of Oxford July 4 


When to Start Sulphonamide Treatment m 
Gonorrhoea 

Sir — ^T he published results of sulphonamide treatment 
justify a hope that in this group of remedies may even 
tually be found the “ 606 ’ of gonorrhoea, but it seems 
possible that at first their misuse may lead to an 
in Us incidence As everyone with experience of t 
form of treatment knows, in a large number of cases o 
acute gonorrhoea it causes a rapid cessation of disciiarg , 
which leads the patient to believe that he has been cure 



Juu 9 19^S 


CORRE.SPO>.DFNrF 



Unfortunatel\ in i certain proportion of cases when the 
(realment is stopped the discharge returns as profusels as 
ever In such cases after resumption of treatment the 
same thing ma> be repeated a number of times and 
esentuall) the duration of the attach mas be found to 
ha\e been longer than it would probabh ha\e been under 
ordmart treatment It seems not unlikeh also that when 
the treatment has to be resumed a number of limes on 
account of relapse the germ mas become sulphonamide 
resistant Further in one of the periods sshen such a 
patient sees no discharge he is apt to resume sesual inter- 
course, passing on the disease to his consort 

For these reasons alone it seems to be most desirable 
that there should fas agreement among practitioners as to 
the method of using the sulphonamide remedies which 
w U result in the minimum of relapses after the administra- 
tion of such an amount as causes the least possible pro- 
portion of toxic effects and in this connexion the point in 
the course of the disease at which the treatment should 


result m a reduction of the incidence of fresh mfcc'iois 
I am encouraged to hope that I mas be si pporied mbs 
recoimendation b\ the knowledge ih„t scire di enters of 
clinics in this countn have alreadv adop ed such a nue 
I have brought the matter forward d this stagu m th- 
hope of provoking such discussion „s will p „c i 
tioners clear guidance on ihe best melhcd ol using „ vc v 
valuable group of remedies 

Mav f add that I think ihal ihe p C'eni chsmoih r„p\ 
IS likeh to fail in anv case where ihe local drain,.ce ' 
defective — I am etc 

London S V\ I JlIv I F " HsRPIson 

RtFfStM ES 

Felke H I I9V‘| Dtn h nt€d U hr 63* ’ u 
Fisher C tl9 7> For rhr d I € k3 
Grulz O <19 71 \tii’ ch nett II tr 64 ' 

Hans Fell H M ||9S| Bn J cte D, 14 s 

Herrold R D tin "I In' ett cn Be 41 -f 
Sshteus H rh lin 7l -Ir fc' hr Rhe , 34 .s, 

\sn Stile C J lhaver J D and M-Fore 1 t ijv “i t 
JPo Into rrrnim 16 -t~ 


be Started seems to be particularlv important 
In a discussion on sulphonamide treatment of gonor 
rhoea which was opened bv Dr Hanschell at a meeting 
of ihe Medical Societv for the Studj ot Venereal Diseases 
in October 1937 I drew attention to the views of H Felke 
(1937) to the effect that treatment with the sulphonamide 
preparation ‘ uleron ought not to be started for at least 
two weeks after the attack began otherwise the result 
would be indifferent He considered that in order to obtain 
the best effect of the remedv the tissues should have 
acquired some of that resistance to the gonococcus which 
we know IS essential to natural recoverv Felke s views 
seem to me to be supported b\ results previoush reported 
bj Grutz (1937) with the same remedv, and further evi 
dence to the same effect has been afforded bv other 
German workers notably Fischer (1937) and SchreusH937) 
The latter worker recommends in fresh cases that the 
patient be prepared for the sulphonamide treatment b\ 
administration of gonococcal vaccine during the first six 
days treatment with uleron being started on the tenth 
Mv own experience with uleron here and recemlv m 
Jamaica in collaboration vvith Dr S E Ferreira the 
Island VDO supports the view that if one vil! wait 
until the attack is at least three weeks old before starting 
treatment compirativelv little uleron (tour or five 
davs treatment) brings the attack to an end in the 
majoritv of cases, and toxic effects are verv few 
Using another sulphonamide remedv sulfandamide 
(which apjjears chemicallv to be the same as the prepara 
lions known as sulphanilamide and pronlosil album 
m this countrv) Herrold (1937) m the USA doubted if 
more than one-third of acute cases would be cured in 
one to three weeks vvnh even maximum doses but believed 
that two thirds of the chrome cases would be cured in 
two to four weeks with moderate doses Van Slvke 
Thaver and Mahoney (1937) also in a recent paper have 
reported results which seem to show the advantage of 
waiting Counting as acute all cases with infections of 
less than twentv eight davs duration and as chronic those 
with infections older than this with given amounts of 
treatment with sulphanilamide thev had fifteen failures in 
sixty three acute cases and only one in Ihirtv six chronic 
ones 

On the strength of this evidence I suggest that it is 
better m all cases to wait until the attack has lasted Ihrct. 
vvijcks before starting treatment with anv of these remedies 
In this period verv few men indeed would indulge in sexual 
intercourse and the greater certainiv of cu'e out of hand 
when the treatment is started then makes it possible that 
universal adoption of a rule to wan as suggested would 


Sulphanilamide Treatment of Gonorrhoea 

Sir — I should like lo allude hr eflv lo tciu' illi s 

Irative of two condiiions whieb n mv cp a I'n h„\c 
resulted from the sulphanilamide ire,.lmtni ot ,.i.ou 
gonoeoccal urethritis In e.sh case lollcvv ng he,.dvuij<. 
adm nistration of su'phaniUmide lab’cls vviih suitabiv w ' 
iherapi the urethral discharge dried up and .he Lf.n., 
became clear bv the tenth dav Mttr a turiher ourictn 
davs of local treatment onlv all lour patients were un 
treated for fourteen davs ^t the end ot this time pro' 
latic smears were examined In t'vo ol the aases there 
was a slight bogginess of the right lobe of the prostate 
which subsided with massage and ihe smears showed 
pus epithelial cells and well formed gonocoeei occurring 
both intra and extra-celluLrlv These tests have been 
repeated on several occasions during the past lour weeks 
with verv similar resiilis and at no time has .here been ..nv 
reappearance ot urethr,.! discharge or haziness o. he 
urine Such a finding would suggest prcstatic latertcv 
the dangers o! which cannot be overestimated 

Dr A E U \facL,.sh!an director of the NewcaslL 
upon Tv ne clinic meniioned this lendencv earh n l^v" 
m correspondence and will shorlK be publishing a full 
account of his observ aliens The oiher two cases having 
V ndergone varied provocalive measures saiistaeicnh were 
provisionallv discharged ..rd lo'd to report ag,.in m six 
weeks lime Both returned within ihirtv six hours wiih 
evidence of a slight muco purulent urethral discharge and 
a slichllv hazv first urine with threaos The smear test 
showed a few epithelial cells fairlv numerous pus cells 
and evlracellular gonococai in large numbers 1 did not 
consider the possifaiiitv ot a ncwlv required inleclion m 
either case because the average mcuba.ion period m ih's 
area is five davs and I have never known it to be less 
than two davs After washing out the urethra wuh a 
weak silver solution a urethroscopic examinalion revealed 
a definite cvstic littrilis This had obviou'h existed with- 
out giving rise to the usual signs and despite provocaive 
mstrumentation it mav therefore be referred to as c 
latent littritis 

TTie moral would appear lo be that it i' most esse ,al 
to examine prostatic smears repeafedh and to car c 
routine urelhro'ccipv in all cases even where iht ei 
no definite indications for 'u‘h procidures fh 
infinitelv better than beme Jiilkil mlu .t fi' c.-'~ 
scLuritv bv the ‘appnrenlh <lr iiuiue curt 

H (.iiiirs Axsix fC* 

< lli.lvdl M J ( 

IJiut.ari ti I e' 


Xturb^m Jure Is 



92 Juu 9, 1938 


CORRESPONDENCE 


Sulphanilamide in Staphylococcal Skin Infections 

Sir — It would seem to be generally held that sul- 
phanilamide IS of little or no value m the treatment of 
staphylococcal infections in man, though laboratory work 
has shown that, in mice, the drug has some slight pro- 
tective action This unfavourable view must obviously 
be based on good clinical evidence, but inasmuch as 
this evidence may perhaps be drawn from the -moie 
serious and late cases that are treated in hospital, it 
appeared to me worth while to try the drug in some of 
the common staphylococcal infections of the skin which 
in the first place at all events, are seen by the general 
practitioner The results in a small fiist series of cases 
are given below, and may be tentatively summarized by 
saying that in multiple lesions such as Bockhart s 
impetigo sycosis barbae, pustulous acne, and multiple 
boils the drug had no effect When the infection 
however, was a localized one, as in carbuncles, solitaiy 
boils furuncles of the nose or of the external auditory 
meatus, styes, or whitlows, the lesults were often 
astonishingly good Provided that the drug was given 
eaily before necrosis had occurred, it was surprising 
to see how quickly resolution took place Boils 
furuncles, and, whitlows generally healed in about thiee 
days and carbuncles in about seven to ten days Where 
some days had elapsed before treatment was started the 
lesions invariably ran their natural course 

The results were particularly gratifying m infections 
of the upper lip , in the few cases in this senes it was 
remarkable to observe the rapidity with which pain 
and swelling disappeared and to note the almost imper- 
ceptible seal that was left Equally good results even 
in diabetic patients, weie obtained in boils and cai- 
buncles of other parts of the body Furuncles were 
quickly aborted, and subcutaneous abscesses, after 
incision healed more quickly Three patients were 
treated foi chronic whitlows — pain, tenderness, and slight 
redness and swelling having existed for some thiee to 
four weeks — and all cleared up in a few days on 
sulphanilamide ' 

The dosage generally used was 15 to 2 0 giammes 
daily by mouth in tablet form If an improvement was 
not manifest within a day or two no benefit was seen 


Condition 

[ 

1 

1 No of 

1 Cases 

1 Results 

1 Good j 

Failed or 
Doubtful 

Boils (including 2 of upper hp) 

1 

22 

IS * 

4 

Bockhin s impetigo 

3 

0 ' 

3 

Furuncles (of nose 3 of ear 3) 

6 

6 

0 

Sots 

6 

4 

2 

C irbuncJes (upper Jip I necK 3 thigh 1 
chin J) , 

S 

f 

5 

I 

NMiuIonns (\cutc 3 chronic 3) 

6 

6 

0 

Inkciions ot hand and foot 

4 

2 

2 

Subcuuntous abscesses 

3 

3 

0 

Ab^itebS ot brvabt 

2 

0 

2 

>cobis barbie 

3 

0 

3 

Acne pusiulosa ' 

1 

0 

1 

Total 

62 

44 

IS 


to result from larger or long-continued doses Cyanosis 
w is not obsersed but other of the well-known toxic 
symptoms were occasionallj complained of , these were 
intense weakness, palpitation, diarrhoea or constipation. 


TiirBMTisir 
'fEDICAl JoURV^t 

and were sometimes severe enough to make it necessaiy 
to stop the administration of the drug The tabic abase 
sets out the results in a first series of cases They ai, 
described as good when resolution was more rapid thin 
previous experience would have led one to expect md 
when theie was less scarring than usual A second and 
larger series is being collected, which too, so lar seems 
to justify the more extended use of sulphanilamide m 
certain staphylococcal infections of the skin 

Some of the patients in this series were treated with Messrs 
Bayers brand of sulphanilamide — pronlosil album— for a 
generous trial supply of which 1 should like to express nn 
thanks The rest were gisen sulphanilamide made In other 
well-known firms ' 

— I am, etc , 

London, E t, June 27 M M\RCUS 

The Origin of Cancer 

Sir — I n a letter in the Journal of June 25 (p 17941 
Suigeon Rear-Admiral Charles M Bcadnell avers thal 
my statement m a previous letter — that conjugation occurs 
among the cells of malignant growths — requires correc 
tion He goes on to siy on the authority of Dr \V E 
Gyc that conjugation of cancer cells “ is no longer 
believed m My aulhoiity for stUing that conjugation 
occurs among the cells of malignant growths is the 
first scientific report of the Cancer Research Fund pub 
fished in 1904 There m an unsigned article which I 
learnt from other sources was the svork of Bashford, 
the following clear description of the observed phenome 
non appears They were studying nuclear changes ii\ 
young transplanted mouse epithelioma (p 31) 

' In one case towards the end of the first week nuclei arc 
found which are drawn out into blunt finger like processes as 
if amoeboid (Fig 31) One of these processes can frcquentlj 
be seen applied closelv to the cell wall which separates the 
cell from those adjoining In isolated instances this amoeboid 
process of the nucleus filled with condensed chromatin, is seen 
closets applied to the nucleus of the adjoining cell and iilli 
matel) the two nuclei become continuous through the cell will 
(Fig 32) The process is identical with the process of con 
jugation in mans protozoa and losser plants and probablj has 
the same significance — namcls starting a nesv cscle The same 
phenomena base been obsers'ed in a tumour of sesen ssccU 
grosvth 

He goes on to shosv convincingly that, though conjugation 
occurs rarely and is seldom demonstrated, svhen it is 
seen it is ins'anably associated svith rapidly growing 
tumours and that transplants from such tumours gw's- i 
scry high proportion of rapidly grosving daughter 
tumouis in striking contrast to the transplants from 
tumours svhere conjugation was not observed 

I do not see hosv observations so clearly made and 
dcsciibed and figured by highly competent observers can 
be wiihdrasvn subsequentls', as Rear-Admiral Bcadnell 
says they svere There is no reference to them in sub 
sequent publications of the Cancer Research Fund thit 
1 can find Conjugation once observed cannot be got 
rid of by “ not believing in it ” That it has not but 
seen moie often is not remarkable svhen one considers 
that a single conjugation provides the rcproduclisc 
momentum for the grosvth md all the tissue changes o 
a hletime What other possible explanation can be gi'cn 
foi the apparent immorlalilv ol a tumour that irans 
planted, from mouse to mouse, produces a total mass o 
tissue many thousands of times the bulk of the origim 
mouse on svhich it grew th in the very natural cxpl inaimn 
of periodic rcjus'cnescencc by conjugation^ /i/iit roii 
jtu;atioii lias heeii ohuiud — I am, etc 
Ashton under Lync, June 28 ^ IDDIA 



JuL\ 9 ]9iS 


CORRESPONDENCE 


Tkt 


Cancer and Heredin 

Sw — I would be obliged if vou would allow me to 
correct a slight inacciirac\ that occurred in \our leading 
article on heredilv and cancer in the Journal of June IS 
I have never made the statement that the serum ol an 
animal with a regressing tumour contains antibodies 
directed against the tumour cells On the contrarv it was 
shown that iso haemagglutmins were formed The latter 
finding has been independently confirmed bv Lumsden 
(193S) The conclusion drawn bv me was that the 
dominant genes concerned m the fate of transplants of 
normal and malignant tissues were preciselv those which 
de ermined iso antigenic differences 

At the present juncture two questions concerning the 
antigenic structure of tumour cells and the antigenic basis 
of tumour transplantation demand discussion (I) Are 
nnlignant cells anligenicallv different trom the normal 
ceils from which Ihev arise"* (If If such differences e\ist 
do they plav a part in transplanntion'* There is some 
evidence that the answer to the first question is in the 
iffirmalivc For example it is Known that virus induced 
tumours in the rabbit or fowl wilt regress spontaneouslv 
(see discussion bv Kidd, 193S) Funhermore it has been 
shown that the members of a pure line can be immunized 
against leuKaemic cells derived from olher members of 
the line and the immumlv can be passivelv transferred 
(MacDowell ef al 1934 Potter ei al 1937-8) However 
the balance of evidence doss not indicate that these differ- 
ences play anv part in transplantation as ordinarilv carried 
out For reasons that were suggested m a previous com 
munieation (Gorer 1937) and that have been consider 
ablv amplified in a paper recemlv sent to press it would 
appear that the fate of transplanted tissues (normal and 
neoplastic) is determined to a very large evtent bv iso 
antigenic reactions — 1 am etc 

ILivicr Insliiute of Preveniiie Medicine P A GORER 

June N 

References 

Gotcr P A (t9j7) J Path Brel 4* 691 
Kidd J G (193S1 / evn Med 67 ssi 

Kunisden T (19 S) Anier J Cancer 32 "9S 
MuDov ell E C Tsvlor M J , and Poller J S (19*4) Free 
Soc e\p Biol \ 1 32 84 

Pouer J S Tailor M J and MacDovvell E C (lUj7-S> Ibid 
37 6S5 

, In an attempt to compress m a relativelv short 
space a number of observations on the problem of canter 
and heredity m the leading article which appeared on 
June IS we misquoted Dr Gorer, and apologize for doing 
so— E d BMJ 

Treatment of Apoplexj 

Sir — Tht Ireatmcnl of apoplew bv infiliralion ot the 
stellate ganglion described in the Journal of Julv 2 bv 
Mr W A Mackev and Dr L D 3V Scott lends support 
to the iheorv that cerebral haemorrhage is an active rather 
than a passiv e process The passive theorv is that haemor- 
rhage results either from weakening of the vessel wall bv 
sclerosis or aneurvsm or from a sudden caiasirophic rise 
m blood pressure such as might be supposed to occur m 
straining at stool or from a combination of the two 
The active theory is that cerebral haemorrhage is the 
result of a temporarv local flushing ot the ancncle- o 
the brain 1 venture to put forward the following sue 
geslions in favour of the latter view 

I Massive cerebral haemorrhaec is seldom a stncle lesion 
around the main mass is an area of smaller peiechial sgois m 
Ihe brain subslanec The e mav not be noticed if the brain is 


C' 


cut up al onsc and it ought to be a rule ,.!u„s5 oh ic- i 
in formalin first If this i done the pciCsNiae ,.rc ca H et- 

2 High blood p essjre ^jic-e is ro supLiert to n r n c 
the cerebral se sels Fi nberg fourd th t i s;o r— i cf 
meraurv ruptured tne cerebral \e sels in oaK two tv c' 
thiriv cadavers 

There is a dm sal as cs^taiion between escrc pori*vrcs 
epistaais and cerebral haemonrh^ce I -r-oi c \e h ere 
but I have ofien noticed that p_iienis ir„nisuLrl c'cc I 
women) to whom 1 have reen called on js,.oupt cl b etc. p- 
from the no c subsequenllv die o apoplpvs In ept las t -c 
sees a pul aitng vessel surrounded bv „n e- o n oo -- 

mucous membrane Applicalion oi ihc elc in- ncsc 

the main flow and blanches ih* reddened ^rc, „s wei 
not necess,.rv to touch the bleedm. point r’erei o c ‘ c 
Ihe affccied area is sufficien in mo i ca-e ue- -c '■ i sc 

action of the cauierv is refiev rather i*- p ti-c c - e„ - 

of Ihe vessel 

*, Dramatic results m apoplew h- e reen cps -vi bss h 
from venesection and trom Icmbar punc ure -ope nc" 
whicn must surelv have a diameiricaliv oppo iie efied on irc 
ipiracrani-l pre sure I uggesi that bom oi ihe ere’ 
as thev act at all land mv own evpe-ierce ha no bec- 
happv m this respecii do o m - reflev nanrer Inh i „'f 
of Ihe siellaie ,,anghon is al o an indirect ncihos! bi 1 retc 
that Mr Mackev and Dr S-oII cnsis^ce an ate^ oi cb cr a 
around the haemorrhage and noi an area of flu hire 

s Sudden death ai stool in mv experience one ec- c i c ■ 
evacuation and not uch as vvould rcouire irainnc J bcie c 
that Ibe call lo siool in these ca e is a vmpton oi the 
cerebnl lesion and not its c-use In one of nv ca es i dden 
and evere head-che was followed bv call to siool rd a 
waters cvacualion the paiiem quickh Lp ed mo unccr 
ciou'ness and died ot a ce-ebral haenorrhage 

If cerebral haemorrhage is he'd to be an active p oeew 
It cer ainlv 'ugges's that indirec attacks cim ng a' 
altering the uonduion ol the blood vessels in the v citiitv 
of the lesion offer the best hope ol su,.ce‘s —I am e c 

Norwich Julv Frewes Moor 

\oluntan Hospitals' Emergency Bed Serstce 

Sir — I should file to cvpress through vour colunn* 
mv appreciation of the recentlv inaugurated cmergencv 
bed service which 1 have found most useful in ceding 
urgent cases into hospital 

This organ zalion is a great time saver fo' the b iw 
practitioner and 1 feel sure that there will be p'cniv ol 
demand for us services as soot as Ihe advan ages are 
realized Lp to the present however I unders and that 
there has been onlv a fraction of the inouines ihat were 
catered for as regards office staff etc It suggests that 
the majoritv ot London doc.o's are doiibiftil of me 
value ot the new svsiem or are so used to their lormer 
methods that thev are loath to change It seems apparent 
that this valuable scheme for co ordinaiing hosp id 
services sponsored as t is bv the Brit>sh Medical Asso 
ciation and financiallv supported bv King Edwards Ho' 
pilal Fund dese'ves general si ppor and encouragemeni — 
I am etc 

Lc-ldon N - Jure d ^ R MoniGOMers 

The Lnconscious Mind and Medical Praettee 

Sir — O ne ot he difficulties I have aluavs cxpcnerccd 
in connexion vi h ihe i nccnscio 's of ih. psveho 
anaivsis is tha thev _ve no p-eci'c dcfmi ion o* *■- 
icrm 1 5m rtmirded of ns djfhvuh\ the ol'ov ’'c 

owcu-rsne quue e*. h m Dr F'n"*- < 

paper in the }< u t jure 2^ Tr** 

nc oa e re*aUiv 1 *^ fc' 'ong p Cveded ^ w 

Dcriod m \\hjch he mird is ru^cii bv 2 s ^rd u- .. 



94 July 9, 1938 


CORRESPONDENCE 


Tnc DMTmt 
^tED!CA.I. JODRNM 


of such a grotesque and exaggerated natiiie as to seem 
quite incredible to our conscious mind This is one 
feature of the unconscious ’ But surely fantasy implies 
consciousness rob it of all consciousness and what 
lemains’’ 

I do not desire to initiate a controversy on this subject, 
but I feel that we need a precise definition of the teim 
“unconscious as heie employed — lam etc, 

London, W 1, June 28 HARRY CAMPBELL 

Iscliio-pubic Osteochondritis 

Sir — After a careful perusal of Mr G D F 
McFadden s able description of a case which he describes 
as one of osteochondritis {Joiiineil, June 18, p 1309) I 
would suggest that it is only fair to your readers to ask 
him to explain why he considers that such a diagnosis 
should be made The diagnosis rests on clinical, patho- 
logical, and radiological findings The clinical history in 
any case of osteochondritis is at best inconclusive, and 
that in his reported case is not of help in diagnosis, is 
both trauma and infection could have originated the con- 
dition His pathological findings are not of any great 
assistance, but rather point to a blood-borne infection 
The radiological findings, in the light of reproduction in the 
Journal, do not suggest a condition similar to Perthes 
or Osgood-Schlatter s disease, as he thinks probable 

The whole field of osteochondritis has in recent years 
been reviewed with doubt The verv term “ osteo- 
chondritis ” is a misnomer The moic modern “osteo- 
chondropathy ’ IS preferable Within the last few years 
Kummels disease of the spine has been relegated to its 
rightful place tn the group of post-traumatic conditions, 
as have Kienbock’s disease of the semilunar and Preiser s 
disease of the carpal scaphoid A few years ago all were 
called ‘ osteochondritis ’ Why then should Mr McFadden 
add a doubtful entity to an already dubious classification’ 
I submit that from a perusal of his case history and an 
examination of the reproduction of his radiograph no 
resemblance to Perthes’ or Osgood Schlatter's disease is 
presented The condition rather indicates a juxl i-epiphyscal 
lesion 

I would suggest that the condition he describes is a 
juxta epiphysitis, as seen in other general infections or a 
metaphyseal ‘ dystrophy ” similar to that shown in the 
rickets group (renal, coeliac or due to an avitaminosis) and 
I would ask him to examine his case at a later date, when 
the synostosis should show the broadening and shortening 
seen typically in the femoral neck in Perthes disease, 
if osteochondritis is present, or the more normal aneta- 
physeal appearance shown in a well-tieated rickets if it 
is not I trust that Mr McFadden will treat this note not 
as a criticism but as part of an attempt to simplify 
classification — I am, etc , 

Lncrpool, July 1 G EdgaR Church 

Sir — I was much interested in the case reported by 
Mr G D F McFadden in the Jouinal of June 18 
(p n09) 

Last month (no doubt while Mr McFadden s article 
was in the press) I showed before the Orthopaedic Section 
of the Royal Society of Medicine some radiographs of 
the condition and discussed this rather unusual site for 
osteochondritis There was one radiograph of an adult 
CISC which revealed bulbous swellings not only at the 
cpiphvses of the descending rami but also two at the 
middle of the horizontal rami The appeal ance strongly 
suggested symmetrical fracture of this part of the pelvis 
There was however no history of my injury or disability 
in youth I also showed another radiograph of in old 


lediiccd congenital dislocation of the hip joint in i child 
aged 6 Heie the head of the feimii was flattened md 
distorted, the ippearance being similar to that seen in a 
case of healed Perthes disease, but on the same side as 
the hip abnormality there was an osteochondritis at ilie 
site o( the ischio-pubic epiphvsis on the descending 
ramus The usual condition as Mr McFadden pointed 
out is a unilateral ischio pubic epiphysitis without any 
other abnormalities 

As regards symptom itology and physical signs, it is rather 
difficult to interpiet such well-maikLd ones as limji, spism 
of muscles, and pain in the hip Rarely is there much 
discomfoVt m Kohler’s disease of the tirsal scaphoid, 
yet the stresses that this bone undergoes in the foot tre 
enoimous m comparison vvith those affecting one ot the 
pubic bones In discussing the reasons for the occurrence 
of an osteochondritis ol the pubis I showed a slide 
depicting the way in wJiich ossifying bone growing fioni 
the body of the ischium pcriphcially along both the 
horizontal and descending pubic rami met, the ossificalion 
extending centiipetally at the same time from the body 
of the pubis At the site of the union of these separate 
ossifying processes powerful groups of muscles are 
attached — the rectus abdominis and pectineus on the 
horizontal ramus, and the adductois of the thigh on 
the descending ramus There is also a vascular anisio 
mosis at these sites with the pubic branch of the deep 
epigasliic artery at tfie epiphysis of the horizontal ramus, 
and the obturator artery at the epiphysis of the descending 
ramus \ Possibly an explanation of why the normal union 
of the ossifying processes at the site of these epiphyses 
IS upset IS to be found m some imbahncc of these three 
factois Certainly it is diflicult to sec how any other 
pathological theory dragging in even sephs oi tuber 
culosis, can be made to fit Yet in nearly all textbooks 
these two factors arc pul forward after trauma as possible 
causes of the analogous Perthes disease vvhicli is an 
osteochondritis of the epiphysis of the head of the femur 
— J am, etc, 

London, \V t, June 27 GO TiPPLTT 

<« 

Anti-vcncreal Measures 


Sir — D r Robert Foigans letter on this subject m your 
issue of June 23 (p 1389) questions the accuricy of tl'c 
conclusions of the Ministry of Health Commissioners in 
their recent report on ' Anti-venereal Measures m Cvrliin 
Scandinavian Countries and Holland In pirlicular ilw 
conclusion the accuracy of which Dr Forgin questions 
IS the following 


‘Considering that in the countiics cmploving compulwr) 
treatment ind in those which rely on a voluntary system ipr 
degiee ot success in reducing the incidence of syphilis and o 
relative failure in gonorrhoea are broadlv similar compulwr 
treatment does not seem to us to be a major factor inmicncinc 
the results of the anti venereal measures in the countries wnci 
It IS employed 


The item which Di Forgan stresses most as i reason 
'or questioning the accuracy of the above quoted con 
fiusion IS that according to him, England ind Nknm 
lave reduced the cases of syphilis between 1922 and U ’ 
ay less than 30 per cent , whereas Denmark has reduce* 
he cases by 300 per cent At first tins seemed to 
i possible misprint but he repeats these figures acam 
Here are his two comments on this point 

‘According to the Ministry of Hcilths 
lumber of cases of svphilis fell from 25 000 in 19— ' 

n 1936— a rednelwn of less Dim 30 per “"t In 
luring the same period tlie figure fell from 2 4TO to 
iOO— a reduction of over 300 per cent „„T nf ll ' 

:vcrj respect for the clinical acumen ot the personne 



JuL\ 9 1938 


CORRESPONDENCE 




Commission one ma\ be forgiven for questioning the accuracv 
of conclusions based on the assumption that 30 per cent and 
300 per cent are even broadh similar 

Dr Forgan is right m sajing that the decline in England 
and Wales between 1922 and 1936 was less than 30 per 
cent — actually it was 28 per cent — but the decline in 
Denmark on the figures he quotes was 66 7 per cent 
nor 300 per cent E\en so on that basis Denmark 
certainh achieved better results than England and Wales 
in that period but does that prove that our Ministry of 
Health Commissioners were inaccurate in stating their 
conclusion that as regards the countries which emplov 
compulsory measures and the countries which emplov ncn- 
compulsory measures the degree of success in reducing 
the incidence of svphihs are broadly similar If we 
compare the cases of acquired svphihs the rate for new 
infections m England and W'ales m 1936 was I 40 per 
10 000 of the population (Table D p 238 Annual Report 
Chief Medical Officerl in Denmark the rate was 2 I per 
10000 and in Copenhagen the rate was 5 5 per 10 000 
(Table D I p 28 of British Commissioners Report) 
Even though this is in our favour does it prove anything 
satisfactorily to compare England and Wales with 
Denmark^ The total population of Denmark is 3 723 000 
whereas the total population of England and W'ales is over 
40 million The population of Copenhagen is 672000 
the population of London is over S million Our vast 
population IS mostly concentrated m great cities whereas 
the Danish population is largely rural yet England and 
W'ales have a rate of 1 40 per 10 000 of fresh infections 
in 1936 while Copenhagen has 5 5 per 10000 
Those m favour of Great Britain abandoning non 
compulsory measures and imposing compulsory measures 
may comment on these figures that Denmark notifies all 
cases and we do not notitv so that our figures are not 
necessarily accurate That is true but if we look at page 
23 of the Commissioners report it is obvious that the cases 
reported in Denmark each vear do not include everv case 
Dr Krag of the Danish State Serum Institute had evidence 
that 1 713 cases of svphihs in alt stages had been tested 
for the first tune in 1936 while the cases acluallv reported 
in 1935 and 1936 were respectivelv 834 and 835 
Dr Forgan also refers to the much quicker decrease of 
syphilis (as notified) m Sweden between 1919 and 1935 than 
in this coumrv and savs that not even the most ardent sup- 
porters of our English come and go as you please methods 
will dare to claim anv thing comparable for England and 
W'ales True they would not but can he prove with 
accuracv that the better results in Sweden are due to their 
compulsory methods'’ Actually it is impossible to prove 
anv thing definitelv on this point on the statistics available 
but ought we not to realize that there are other factors to 
consider than the venereal statistics'’ First population 
Sweden is under 7 million total and we are 40 million 
Second the results of war on our enormous and largely 
industrialized population Svphihs rose in Sweden as a result 
of the war but it had n6thing comparable to our prob'em 
to deal with in this respect it had 5 976 cases in 1919 
the peak year for Sweden whereas we had 42 134 in 1920 
which was our peak vear It naturallv was more difficult 
'ot thiscountrv to deal effectiveh with the post war health 
problems than it was for two small and largelv rural non 
combatant countries such as Denmark and Sweden There 
IS a third factor — namelv the differing characteristics of 
nations it is doubtful if drastic compulsion vvou’d be 
helpful in Great Britain in the matier ot venereal disease 
and also it might not be applied so equallv and demo 
ctalicallv between all classes and both sexes as it seems 
to be in S<.andinavia 


In anv case the choice before us is to go on to- 
tmuouslv improving our national figh against 3 0 0 - 
xolunlarv melhods or of abandoning our p"ese“i v c" 
and going all out for conpulsicn In o ir view er 

course would do infinite damage ^nd moreover wt. v-" 
see nothing m the statistics ot other coont^ies to r ove 
that there is anv reason to oiffer from the Minn rv c 
Health Commissioners ccndusicn ih.it compi.'si 
treatment does not seem to us lO he a m..i •• tae c 
influencing the results of the anti venereal measu es r ih> 
countries where it is emploved —I am eic 

■3LISOS NtiLvss 

SecfCtarv A l-s. ...tto” ». •- 

Lumg^conc House Bre-dA^v 
S 1 June -■* 

\natomieal Teiminologx 

Sir — ■St this time ot me vear w^-en pvt o-’a 
loaiions arc rite the topic o „r.. om icrm n i g 
suggests itbclt The summ-r exam n^i ons o the 

Chanered Societv ot Massage ana Mea Ovmn.. i s 
have finished Students have b^en a _hi h-- «. d ' 
possible lermino'ogv and have ^een od lO b..v i d 
editions of anatottv. books The evond M B cv»m i 
tions at Oxford and Camb-idge have been w nu ^ -a n 
the Basle \onuna Anatoinua ana ne -a -d M B 
Fart II will take place in London ih s wee) c vne i cd 
m the British revised terminologv The Conjo nt Bev d 
examinations m anatomv are also m p og ess nd m. 
final Conjoint examinations are i sted ter nex week 
The utter confusion into which academic anatomists h-ve 
thrown then ovvn subject is now prov ng lo be a serious 
obstacle to the mutual understanding and the education 
of members ot the medical massage and nurs ng p o 
fessions 

It seems quite clear that the m..t er ot uritormiiv I es 
in the hands of the examiners of these three p ote sions 
and It IS incredible that some ..rc exam niOj; 'o mere 
than one board and tolerating the teaching o mo c h_n 
one terminologv So tar as the medical siudents ..re 
concerned in London at anv rate the Bn sh Revised 
15 being taught in the anatomv schools the p o n^ial 
universities varv The clinical teachers are incons sier 
registrars have a knowledge ot all three— the \ icto'ian 
the BN A and the British Revised — and ihev .each a 
triple confusion partiv for the students s-le and par.iv 
to escape the wrath of the older teachers who love the 
more romantic names The student of to-dav h..s to 
learn all three terms for anv structure in o'der to pro cct 
himself so far as is possible from bwing dubbed a dncc' 
head bv his learned clinical chief 

A complete ignorance even of the B N ^ predo-n nates 
in the massage and nursing protessions so that Ih. con 
fusion IS increasing as the s uden s of the last deccd. 
qualifv One often hears compla n s that the averaj.e 
doctor knows nothing of modern phvsiotherapv and 
efforts are constantlv b-*ing made to secure a g-ca cr 
cooperation between doc.ors and phvsio he-ap s s ba. 
one difficultv is the language bar Must vve teach re 
nerve to the serratus la eral s (pc vvar sema i 
magnusl as the long thorac c nerve cm' the resp ra 
torv nerve of Bell ’ Will the s s'er m the uU'.l dcp. 
rnent appreciate a request fo- a pharvego. ripar c 
catheter ’ 

The massage .nd nursing p o‘'css o"s cou'd be 'ned-rn 
ized at once n their teach ng The m-di.al p o c' .sn 
I'self mav equ re mo e »elf s.c ticc rc m c. c b„'d 
clinicians th.n ihev .re luc \ to c e t* cx."^ 

haxe .he lev .o the so u jcn 1’ "‘n .t .u .g 



96 JuL\ 9 1938 


CORRESPONDENCE 


TiiEBumsn 
Medical loi wi 


the profession were introduced to three or four new 
terms weekly in the Joinnal the more impoitant items 
would soon be covered, but the terms would have to 
be in bold type I understand that the whole question 
of the teaching of anatomy to nu’^ses is at present under 
survey by the General Nursing Council Peihaps the 
council will find it possible to state a policy on ter- 
minology It may be an anatomical Utopia that I am 
suggesting, but it affects us all It will mean that even 
the physicians with have to talk of atrial flutter — 

I am, etc , D F Eluson Nash, F R C S 

St Birtholomcw s Hospitil, June 30 

Tuberculin in Diagnosis 

Sir — I am sorry to see that Dr J R Forbes (Joitnial 
June 25, p 1389) has been unable to find in my paper, to 
which he refers, any evidence of the diagnostic value of 
the subcutaneous tuberculin test ^ Skin tuberculin tests 
show that in the British Isles the great majority of the adult 
population has been infected with tubeicle , but only 
a small minority of the infected require treatment for tuber- 
culosis It is as an aid in determining whether in a par- 
ticular case, with symptoms and/or signs suggestive of 
pulmonary tuberculosis, treatment is required that I find 
the subcut ineoiis tuberculin test of great value Of course 
all tuberculm-positive cases require treatment, but so also 
do many tuberculin-negative cases 

Speaking of the intracutaneous test, Dr L S T Burrell 
(Recent Advaiicei in Piiintonary Tuberculosis 1929, p 26) 
says “ A negative tuberculin test is by no means un- 
common, and IS of the greatest importance in diagnosis 
A positive test is of less value m diagnosis, as it indicates 
infection only ” Now the subcutaneous test gives a much 
laiger proportion of negative results than does the intra- 
cutaneous test , and is on that account more useful, if one 
may safely eliminate all the doubtful cases that do not 
react to this test The facts stated in my papei, published 
in October, 1932, which have a bearing on this and on the 
need for treatment of the otherwise doubtful cases that do 
react are as follows 

‘ From January 1913 to March 1932 I have used the sub- 
cutaneous test in 798 doubtful cases In 344 of these there 
was no reaction and the patients were assured that thea were 
not suffering from tuberculosis This does not mean that thev 
weie immune to tuberculosis for life Of 344 non reactors 
fi\e did suffer later from pulmonars tuberculosis with positnc 
sputum The 454 patients a\ho reacted to the test doses were 
ads ised to take the matter senousls and have either sanatorium 
or tuberculin treatment and most of them did so From 1913 
to 1922 inclusive there ssere 165 reactors of svhom 130 got 
at least three months treatment at a sanatorium or ssilh tuber 
culm and 35 got neither In March 1932, the condition of 
these was as follosvs 



Total 

At work. 

Unfil 

Dead 

Treated at sanatorium or with 
tuberculin 

130 

87(66 9^) 

6(4 6);' 

37(28 5/) 

TrcTKd otherwise or untreated 

i 

' 35 

1 

|S(42 9/) 

2(5 7^) 

IS (51 4/)' 


As the aserage time that these cises were under observation 
ssas fourteen and a quarter sears the deaths among those 
treated at a sanatorium or ssith tuberculin were not much in 
csccss of those of the general population the deaths among 
the others being much greater 

1 lease it to readers to judge sshether Dr Forbes is 
justified in dismissing these figures as ‘ no evidence — I 
am etc , 

Bslfist June 2S JOHN R GiLLESPIE 

V This correspondence is now closed — Ed B ] 


Medical Relief for Cliina 


Sir— Nine sveeks ago you weie good enough to publish 
a letter from us asking the profession in this cotmirj to 
help in the provision of medical supplies for relief work 
in China The response was so gratifying (£100 hning 
been received) that we composed a second letter, more 
detailed than the first intending to ask you to publish it 
as the basis for a wider appeal However, at this juncliirt 
we were delighted to find in your issue of June IS (p 1339) 
a letter signed by some of the most eminent members of 
our profession, describing with simple eloquence the heart 
breaking conditions m the war-stricken parts of China and 
asking for donations to be sent to the Lord Mayor s Fund 
for the Relief of Distress in China, 121, Westbourne 
Terrace, London, NV 2 

We teel that since this matter is now in such competent 
hands there is no need for our second letter to appear WV 
have decided to hand over the sum of £100 to the Lord 
Mayors Fund on the understanding that it is administered 
entirely in favour of the Hong Kong Division of the 
Chinese Red Cross Society, to help which our appeal was 
specifically made 

A number of our colleagues have given generoiislj we 
thank them whole hcartedly Others have not jet 
responded , for them we feel bound to reiterate the urgency 
of the need and to commend to their notice the kttir 
signed by some of our most distinguished brethren — 
We aie, etc, Millais Culpin 

W C W Ni\o\ 

July 2 H J SCDDON 


Schopenhauer and Syphilis 


Sir — T he statement made in the Journal of July 2 
(p 22) that Schopenhauer contracted syphilis and tint 
this disease accounted for his pessimism rests on a sonic 
what slender foundation This accusation was first rnadc 
by Iwan Bloch, the well known syphilologist and medic il 
historian, in a paper read before the Berlin Society for 
the History of Medicine and Natural Sciences (A/iim/i 
iiieci JVsclii , 1906 53, 1374) mainly on the ground tint 
some posthumous papers showed that in 1823 Schopen 
hauer was undergoing mercurial treatment — both intern 
ally and by inunction — associated with tincture of 
guaiacum, which in those days was in vogue as an/anli 
syphilitic drug The sensual propensities of the philosopher 
made it seem highly probable to Bloch that fie was often 
exposed to infection and that syphilis was the chief cause 
of his pessimism Professor Wilhelm Ebstein howcscr, 
whose work on Schopenhauer I reviewed many years ago 
(Rei Neurol Psvcliiat 1907, 5, 660), disposed of this 
argument by showing that Schopenhauer had been a 
pessimist from his youth onwards Another objection 
to Bloch s theory was that brought fonvard by J "’o" 
(Munch med Wschr 1906, 53, 1818) to the elTcct that 
the first volume of Schopenhauer s duel work, Du 
IVelt als Wille iiiid Vorsiclliinc; was published in K to 
This fact excluded the possibility of a disease contractc 
five years later having had any influence on the dciclop 
ment of Schopenhauer s philosophy Moreover Ebstein 
points out that mercury both internally and by inunction 
together with tincture of guaiacum was strongly rtcoiu 
mended by Rust, a celebrated medical contemporars o 
Schopenhauers as a remedy for joint ilTcctions from 
which Schopenhauer suffered Similar charges o^ 

syphilis based on inadequate grounds hue et 
brought against Voltaire and Goethe, as I halt s on 


elsewhere — I am, etc 
London, July 2 


J D ROLLCSIO'' 



Jui.\ 9 193S 


MEDICO LECAL CHARGE OF PROCURING ABORTION 


The Psjcholog^ of the Medical Profession 

Sir — M aj I be allowed to thank Dr N Howard Jones 
for his useful contribution Uoimtal June 25 p 1^91) to 
the problem which I raised in rour issue of June 6 He 
appears to sa\ in effect that the therapr adrocaied b% 
the industrial chemical hrms is more trulv scientific and 
therefore more commendable than the treatment b\ stock 
mixture so much in faxour with the aterage practitioner 
Assuming then (H that scientific treatment of disease con 
sists essentialK in the administration of chemical or bio 
chemical specifics and (2) that the arerage practising 
doctor IS emmentlj suggestible I again ask Wits should 
medical students hare to studs for five or six rears at 
cxpensire training institutions rrhen all the information 
reallr necessarr for their practices could easiU be purvered 
to them br sar a rreetlr news sheet issued br the 
reputable drug firms'* — I am etc, 

North Queensferrr Fife Jut> 3 A J BrOCK 

This correspondence is nori closed — Ed B VfT 

Assistance to Medical Students from Atshna 

Sir — ^The embittered protest of Dr Vincent Norman 
(June 25, p 1394) on the subject of assistance to medical 
students from Austria is perhaps not so surprising m 
an age rrhen the teachings of Christ appear to be but 
a non-Arran delusion but as one who trequentl> comes 
in touch rrtth some of the refugees I would like to 
assure Dr Norman that he need not worrj his head 
orer the possible likelihood of enforced sacrifices on the 
pan of himself or of his colleagues for nothing of a sub 
stantial nature has been done br an>one to help these 
wretched people and, indeed there is no reason to suppose 
that ihej erer will The political ramp to which Dr 
Norman so dramatical!} refers is ceriatnh mMbicat so 
far as the refugees are concerned and one can onI> 
suppose that vour correspondent has culled his mforma 
tion from a certain section of the sensational press — I 
am efc Victor Const vd 

London S\\ 3 June 27 


Medico-Legal 


CHARGE OF PROCURING ABORTION 

Mr Aleck Bourne at Marrlebone Police Court 

At Mar}lebonc police court on Julr Rliefore Mr Iran E 
Snell Mr Aleck W Bourne obstetric surgeon to St 
Marv s Hospital London and consulting obstetric 
surgeon to Queen Charlottes was summoned br the 
police on the charge of unlarrfullr using an instrument 
rriih intent to procure abortion Mr Bournes defence 
rrts undertaken b} the London and Counties Medical 
Protection Societ} and Mr G A Thesiger counsel 
appeared on his behalf The Director of Public Prose- 
cutions rvas represented bj Mr H A K Morgan 
counsel 

The Charge 

Mr Morgan said that this rras a case of unusual char- 
acter in that the defendant a surgeon rerr highlr regarded 
m his profession had deliberatelv and openlv defied the 
law for reasons which he thought good and sufficient On 
June 14 at St Man s Hospital he p-ocured the mis- 
carriage of a woman b\ the unlaw lul use of an mstru 
ment The law of this countrv did not specificallv 
recognize anj interference with pregnanev as jus'ifiab’e 


Such mterlerence appeared to be perm ^ b e ea ' lo 
grounds onlj— first to save the h'e oi ihc mo be d 
secondlv to save the life o, ihe ch d It w s - 
to be done for the sake ot lanuiv hi-Tvi. i o 
ethical reasons The deivndan among o t-*r n o > 
men and others held the view Ib p v- n 
ought to be altered or at anv ^le rei„\ed m r d r 
to ventilate this opinion he had op“n!i de'i-d t'-e 
and had committed a crime tor whiah I’e n_\ m - 
penaltv presc-ibed in the s alute w,., pen,.! e v i 
life He had been excepiionJlv lo tun..te m c- '•e - 

to find what trom his point ot v.eA vas „n „b o v 
perfect case The girl was under 1' \e_ - c, 
and was pregnant through no taul ot he- own F- 
was not the case ot a loose woman who h»d uv ■’ 
the familv wav through carelessness o i _ 't ^d 
woman who did not want a child B;a..u e v d *' 
inconvenient It was not his bu n-*ss „ o irs"' o 
discuss the arguments tor or aga n ^-i,. i , n ta 
merelv on behalf of the Director o' P osccl' ons to -ss 
that the case be sent tor trial 

The facts were undisputed On Ap.il 2~ this g rl ih.n 
14 jears and 9 months ot age vvas raped in a bidding 
near Whitehall The case had arou ed g e^ m ..rc * 
and her assailants had received long erms o np m n 
ment b\ sentence ot the Central Criminal Lo 
Following the rape the girl missed one ot he p-r • c 
and was taken to see Dr Joan Malleson wno v„s - 
member ot the medico legal council ot the Abortion L- 
Reform Association Having seen the girl and hc„rd 
the circumstances of her case she wroie to Mr Bourne 
who was a member of the same council and he epued 

I shall be delighted to take her in at St Marv s nd 
curette her I have done that belo'e and sh„ll have no* 
the slightest hesitation in doing it again I have said 
that the next time I have the opportunnv I will write 
to the Attornev General and invite him to take action 
On Mav 31 the girl was taken bv her mother to «ee 
Mr Bourne a letter of consent to the operation was 
obtained from the girls lather and afterward-. Mr 
Bourne saw Dr Wingate then resident obstetric offi-er 
at St Marv s told him about the case and gave h m his 
reasons lor doing what he was about to do — namelv th.. 
the girl was under the age of consent and h_d been 
raped On June 6 she was admitted to Si Marv s 
She underwent the Ascnheim test tor pregnanev whi-n 
was positive and on June 14 \Jr Bourne emptied her 
uterus On the same dav m an interview with Che' 
Inspector Bridger at the hospital Mr Bou-ne related ihe 
facts and said I want vou to arrest me The 
inspector said that he would report the matte- to ihc 
proper authorities The onlv defence up to now which 
Dr Bourne had put in was that m his op nion as an 
obstetric surgeon it would be dangerous for a girl o, 
her age to bear a full term child He did not think Mr 
Bourne put that forward seriousK as a real dctencc 
As the law now stood if it were a defence then it 
might be held dangerous for anv woman to go to term 
and the law of abortion would be a dead let er 

Evidence 

The girl whose name was suppressed then gave 
evidence Mr Morgan gave a guarantee on behalf of 
the Director that no proceedings against her wou'd be 
brought as a result of her evidence and therefo'c she 
was not cautioned Her father however wno was inc 
next witness was told bv ihe magisi-ate iha' hc-c 
was a possibihtv — although almost negligib'e— bn n 
answering certain questions he m cht lav h<msel' open 
to a charge and ihe-e'orc he w_s nc compel ed lo 
answer ihosc questions He stated th_t on \Lv '! he 
wro.e to Mr Bourne giving his consen, to ibe op- a on 
bui he had asked that no pub'ici’v o' anv so -id 
be given tb the case and Mr BoL.rn. h-d rep I'c 1 
no'c whai vou sav abou sec-e- ard I c-r _s , ^ ^ , 
that tht'c vviJl be no effo sp_-ed o I >ep m- - 
secret His reason fo- dc' ing St, clv w..s ' 'c 


100 July 9, 1938 


OBIIUARY 


TiitBRnmi 
^!EDIC\L lOtUVAL 


^ GEORGES MARINESCO 

Professor Georges Mannesco, the eminent Rumanian 
neurologist, known in his own country as Georghie 
Marinescu, of whose death a short notice appeared in 
the Journal of June 4 (p 1240), was born at Bucarest on 
February 23, 1863 He received his medical education 
at the Brancovan Hospital and then became assistant to 
Viktor Babes, the professor of pathology and bacteriology, 
with whom he collaborated in the publication of articles 
on transverse myelitis, hysterical mutism, and dilatation of 
the pupils in pneumonia At Babes s suggestion he was 
sent by the Rumanian Government to Pans in 1889, where 
he studied under Charcot at La Salpetriere and became 
assistant to Pierre Mane, with whom he collaborated on 
acromegaly After visiting various European countries he 
returned to Bucarest, where in 1897 he was appointed 
professor of neurology in the medical faculty and head 
of the department for nervous diseases at the Pantelimon 
Hospital In addition to a pionograph entitled La Cellule, 
published in 1909 with a preface by Ramon y Cajal, and 
articles- in Gilbert and Ballet s System of Medicine on 
diseases of muscles (1910), and that of Roger, Widal, 
and Teissier, on trophic disorders and chronic rheumatism 
(1927), he was a prolific contributor to periodic literature 
on the finer structure of the nervous system, nerve 
regeneration, painful neuromata in amputation stumps, 
salvarsan treatment of syphilis of the nervous system, and 
many other neurological subjects Like his colleagxie the 
late Professor Cantacuzene, to whose memorial volume he 
contributed an article on rejuvenation, Mannesco was an 
excellent example of the saying that every man has two 
countries, his own and Fiance In recognition of his 
contributions to French medicine he was elected a member 
of the Academic de Medecine and of the Societe 
Medicale des Hopitaux de Pans Mannesco had also 
many friends in this country, where he was elected a 
corresponding member of the Section of Neurology of the 
Royal Society of Medicine in 1935 and Honorary Fellow 
of the Society in 1936 He worked with Mott in the 
laboratories at Claybury Asylum and the Maudsley 'Hos- 
pital, and in I9IS published an article in the Local 
Government Board Reports (N S 121) on the pathological 
histology of encephalitis lethargica The high esteem in 
which he was held in his own country was shown by the 
fact that not only was he made professor of neurology for 
life but also had dedicated to him by the Rumanian 
Society of Neurology, Psychiatry, and Endocrinology on 
the occasion of his seventieth birthday in 1933 a jubilee 
volume with a preface by Ramon y Cajal, to which con- 
tiibutions had been made by the principal neurologists of 
Europe Mannesco remained active until the end, his 
death taking place on May 14 within a fortnight after 
delivering an address on the life and work of Babes on 
the occasion of the celebration of the fiftieth anniversary 
of the opening of the first Pasteur Institute m Rumania by 
his old master ' 

Dr John Wattebson Miller who died at Llandrindod 
Wells on June 19, took his MB Ch B degrees m 1899, 
his M D Vict in 1903, and his M D Liverpool m 1904, 
ln\mg obtained the Cambridge D PH in 1901 He also 
qualified as a barrister-at-law (Middle Temple) in 1915 
and was the Junior Lyon Jones Scholar During the 
cirlier part of his career he served as plague medical 
I'thcer for the Punjab Gosernment and subsequently 
RiUcred the public health ser\ ices at home, first in the 
vest Riding of Yorkshire later becoming MOH of 
Blackburn of the City of Hereford, and in 1921 of 
Radnorshire Dr F A Anderson writes The death 
01 Dr J \\ Miller ii ihe ige of 62 cime as a great 


shock to many of us who remember him so recently as 
an active member of the Shropshire and Mid Wales 
Branch of the British Medical Association As medical 
officer of health for Radnorshire and school medical 
officer he devoted himself with untiring energy to the 
public health services of the county, and at the time of 
his death whs engaged on the development of the new 
service under the Midwives Act He was a keen and 
active member of the B M A , and was elected to the 
presidency of the Shropshire and Mid-Wales Branch m 
1935 He was also a member of the Royal Sanitary 
Institute and a Fellow of the Society of Medical Officers 
of Health, serving as President of the Welsh Branch in 
1933-4 Among his many interests were included the 
British Legion and the Boy Scout Association, to both 
of which he rendered valuable service Dr Miller was 
a man of great ability, undoubtedly well fitted for Ihe 
executive work to which he devoted his life, and an 
excellent committeeman ' and ehairman , indeed he was 
singled out for these positions in every movement with 
which he was associated To his widow and daughter will 
go out the heartfelt sympathy of a large eircle of col 
leagues and friends 

Dr Evan Williams Griffith, who died at his rcsi 
dence m Bath on June 4 after a long illness, had been 
a member of the Bath Division of the British Medical 
Association since 1922 He received his medical ediica 
tion at Cardiff and University College Hospital, obtaining 
the diplomas MRCS, LRCP in 1914 ' He served 
through the war in the R A M C (T ) with the rank of 
captain He had been house-surgeon at the Bristol Genenl 
Hospital Dr Griffith s later appointments included those 
of suigeon to the Western Dispensary and anaesthetist to 
the Eye, Nose and Throat Hospital at Bath He was also 
for some time assistant medical officer to the Monmouth 
shire County Council and assistant school medical officer 
foi Newport In his youth he had been a keen athlete 
playing Rugby football for Christ s College Brecon, and 
winning many sports prizes, including the Victor Ludoriim 
silver medal After the war he was to some extent m 
capacitated by illness, but he retained his athletic interests, 
and was a member of the Bath Rugby Football Club as 
well as a vice-president of the Lansdown Cricket Chib 
He was very popular with his colleagues and a large circle 
, of patients, many of whom attended his funeral at West 
bury-on-Trym Parish Church on June 8 


Medical Notes in Parliament 


The Mental Deficiency Bill and the Registration of 
Stillbirths (Scotland) Bill were among the measures set 
down for consideration in the House of Lords this week 
The British Museum Bill was read a first time in the 
House of Lords on June 30 Its purpose is to enabk 
the Trustees of the British Museum to accept, under the 
will of the late Lord Rothschild, the museum at Tring and 
to administer as part of the Natural History Department 
the collections assembled there by him 

On July 5 a return relative to experiments on living 
animals was presented to the House of Commons un 
the same day there were laid on the Table regulation 
under the Factories Act including the Night VJork to 
Young Persons (Medical Examination) Regulations an 
the Protection of Eyes Regulations 
The Parliamentary Medical Committee m^ al I ^ 
House of Commons on July 5, Sir Francis Frctmn 
presiding, and considered a suggestion that an opp 
lunily should be sought during the autumn for a deniv 
on a motion m favour of a general medical '' 

discussion followed with Dr Copeman and Sir n , 
Smart representing the Empire Rheumatism „ 

with Mr Tom Smith and Mr Parkinson MPs snm'i’ 



Jll\ 9 1938 


MEDICAL NOTES IN PARLIAMENT 


Ti't E» 

" tTv-A- I H.N L 


for coalmining constituencies The subject \\as rheuma- 
tism among coalminers From the discussion it appeared 
Iikeij that the Aimers Welfare Committee womd be 
interested m the proposal of the Empire Rheumatism 
Council to establish clinics for immediate treatment of 
rheumatism occurring among miners The meeting 
agreed that it would be better to establish one 
experimental clinic first to pro\e jis \alue for that 
purpose It was also agreed to ask the Secreiarx for 
Mines Captain Crookshank to recei\e a deputation from 
the Parliamentary Medical Committee the Empire 
Rheumatism Council and the MPs for mining con- 
stituencies It was hoped to meet Captain Crookshank 
on July 12 for the purpose 

Progress of Bills 

The Baking Industr\ (Hours of Uork) Bill was read a third 
lime b\ the Hou’^e of Lords on lune 30 
The second reading of the Nursing Homes Registration 
(Scotland) Bill in the House of Lords was set down for JuU 14 
The House of Commons on June 28 agreed to the Lords 
amendments to the Street Ph\grounds Bill 

The Milk (Extension and Amendment) Bill was read a 
second time in the House of Commons this week 

Pennan^nt Legishttoa Pastpo7}sd 

In the House of Commons on Juh 4, Mr W S Morrison 
mo\ed the second reading of the Milk (Extension and Amend 
menl) Bill He explained that the Governments proposals 
for permanent legislation were issued in a White Paper and 
were in an advanced state of preparation but owing to 
pressure on Government business it would not be possible 
to pass this legislation this session The Government hoped 
to introduce the legislation earlv next session It was neces 
sarv to retain (he present svstem of assistance to the miJk 
industrv for another twelve months and the pre<ent Bill did 
that The Exchequer grants were extended for twelve months 
and included that for the milk in schools scheme Before the 
scheme began about 900 000 children were receiving milk 
in schools and n was estimated that now about 2 7^0 000 
children were participating Over 23 0(X)000 gallons of milk 
were consumed in England and Wales under the scheme during 
the vear ended last September and it was Iikelv that in the 
next twelve months the consumption of milk would be 
2’»000 000 gallons The scheme had undoubtedU proved its 
merits and the Government attached grent importance to it 
It was hoped to introduce in the autumn a scheme which 
had been foreshadowed in the W^hite Paper wherebv the local 
authorities would be able to secure milk at reduced prices for 
their mafernitj and child welfare arrangements Local 
authorities would thus be in a position to extend ibeir present 
schemes and to make milk available to expectant and nursing 
mothers and to children under school age either free or at 
reduced prices as circumstances might require 
The Bill was read a second time 

Opium Imports into China 

On Julv 4 Mr D Adxxis asked the Pnme Minister whether 
his attention had been drawn to the repU bv the Japanese 
delegate at the committee on traffic m opium at its meetings 
at Geneva dunng the present month to the effect that 1 ^00 
chests of Iranian opium transported bv a Japanese ship from 
the Persian Gulf to China were imported bv the Manchukuo 
Government for consumption bv the registered addicts of that 
coimtrv and if he would endeavour to ascertain whether 
the numbers of such registered addicts were increasing under 
Japanese guidance Mr Bltlhr who replied said that this 
information was communicated to His Majesix s Ambassador 
at Tokvo bv the Japanese Government He was not in a 
position to make anv statement on the second part of the 
question nor was it Iikeh to be poNsiblc to obtain the 
information desired 

On Julv 4 Mr D Adxxi*; further a ked the Pnmc Mini*^lcr 
whether his attention had been drawn to statements bv the 
Japanese delegate at tbc committee on traffic, in opium th^'J ^ 


ir>! 


of 2 900 cheats ordered bv J^-pane^e mtcrc i m ibe fr^i in ec 
morihs of 19 8 ^00 chest*, were impored bv a J«par- c ^rr\ 
through Shanghai the e "00 chest;, teinc pemrt ed fv t^e 
North China Provisional Government in conform! v\jih 
existing opium conventions and whetber in view of tbe f tt 
that existing conventions appeared to allow an 
import of dangerous drugs into parts of Chin*- under Japurc<c 
control the British Govemrrent would prcNS for the nrt 
rigid interprciatjon of the e conventions wuh view lo pre 
venting a svsiematic demoralization of a ven large number 
people Mr Bctt-ER replied that this slateircni was made, bv 
the Japanese delegate at Geneva As however he declared th l 
the Japanese firm acted solelv as shipping agents no teLb'‘!cal 
breach of the 1925 Convention had been commuted bv the 
Japanese Government As al o the Convention of I 
which limited the amount of manufactured drugs ih*-i muht 
be imported bv each countrv dunng the ve-’r dtd not ipph 
to raw opium the tightening up of exibiing reguLttons \ olM 
not achieve Mr Adams s object 


Chemotherapx Max and Baker s New Product 

On Julv 4 Mr D Adwis asked Lord Winierion if the hrm 
of Mav and Baler Limited were obliged to refu e reque ts 
for supplies of newlv discovered chemical compounds bec'^u e 
of the dangers involved until further research had been c rried 
out and what steps he was taking lo expedite the necc n rv 
research in this and similar cases Lord Uis-terton said B 
IS the ordinarv and necessarv practice m the case of new drucs 
that ihev should in the first place be subjected bv specialists 
to carefulh controlled tnals as regards their value and afen 
to ascertain whether the medical results warrant production on 
a large scale for general distnbuiion Mr Aidams mav hive 
partKularlv m mmd a new compound which is being tned in 
the treatment of pneumonia and about which the firm narred 
recenilv published a statement that the work was suit in an 
experimental stage The manufacturers have not 'o far 
thought It necessarv to seek the aid of the \Iedical Research 
Council in this case but it is understood that the requisite 
invesuca ions are in active progress 


Registration of SfiBbirths in Scotland 

In the House of Lords on Juh 5 Lord ALsE^s moved the 
second reading of the Registration of Stillbirths tScoiland) 
Bill which has passed the House of Commons He said that 
stillbirths lo-dav were registered bv law in everv civiuzcd 
countrv with the exception of Palestine Ireland and Scoi 
land The measure could be justified not onlv on stati iitxl 
but on medical and humanitanan grounds 

Lord Dxwson of Pen'* m supporting the Bill said that 
even babv who died represented a failure and the muse 
could onh be discovered bv a sludv of the whvs and where 
forei* of the failure Jn 1934 43 670 infants in England died at 
or soon after birth and in 1936 in Scotland it was estimated 
that there were 4(X)0 such deaths Civilization had brounht 
down the death rate but it had aPo brought down the birtb 
rale with the result that the turnover to dav was much smaller 
No one vvanted a hopeless infant to survive but there were 
a number of potentialU fit children who through want of 
knowledge and care were lost to the communitv The Bill 
would secure that more lives were saved 7*he lo's of children 
at or just after birlh occurred in all classes of the com 
nwimtx and was therefore m all probabilitv due in large 
part to lack of knowledge In addition to obtaining more 
statistical information it would be of advantage if the 
Department o? Health for Scotland nould inMituie = 
stud\ of selected groopc of children and "ould a'l the 
Research Department to lahc action No imc<tipetion m 

connexion wih the-c death, nos north rnu.h ‘■"'f ' T'"', 
mortem evaminations oerc earned out and it would be o 
\alue if post mortem eraninaliors were ercotiraced 

Lord STR.Titcos, ,nd Motvr Rot cL .aid lh_t the Gotern 
roent \iewed the Bill .\mr-ihet calK ^rd would wel omc it 
paccace He would bnne Lo d D-w.ons ob ert_tior' on f-e 
quevtton of re<c-rch to tbc no icc of the Dep PmenL 
,^e Bill was re-d a sceond time 



102 July 9, 1938 


EPIDEMIOLOGY SECTION 


. Tilt nRmsH 
Medicai. JouRsa 


INFECTIOUS DISEASES AND VITAL STATISTICS 


We print below a summary of Infectious Diseases and Vital Statistics in the British Isles during the week ended June 25 1938 

Figures of Principal Notifiable Diseases for the week and those for the corresponding week last year, for (a) England and Waks 
(London included) (b) London (administrative county) (c) Scotland (d) Eire (c) Northern Ireland Median values for the 
last 9 years for (a) and (b) “ 


Figwa of Btillis and Deaths, and oj Deaths lecoided iindei each infectious disease, ate fin ( i) The 126 great towns (124 in 1937) m 
England and Wales (including London) (b) London (administrative county) (c) The 16 principal towns in Scotland (d) TIil 13 
principal towns in Eire (e) The 10 principal towns (9 in 1937) in Northern Ireland 

A dash — denotes no cases , a blank space denotes disease not notifiable or no return a\ ailable 


Disease 

1938 

1937 (Corresponding Week) 

1929 37 (Median Value 
Corresponding Weeks) 











(a) 

(b) 

Cerebrospinal fever 

Deaths 

23 

2 

1 

9 

1 

B 


B 

6 

3 

fl 

b 

^B 


Diphtheria 

Deaths 

989 

22 

146 

4 

191 

6 

H 

22 

958 

27 

104 

1 

184 

5 

41 

1 

26 

882 

161 

Dysentery 

Deaths 

39 

15 

37 

1 

■ 

26 

3 

8 


B 



Encephalitis lethargica, acute 

Deaths 

5 

2 

— 

■ 

■ 

3 

B 

B 

1 

B 



Enteric (typhoid and paratyphoid) fever 

Deaths 

H 

■ 

E 

3 

1 

21 

1 

B 

B 

B 

B 

31 

— 

Erysipelas 

Deaths 

■ 

■ 


6 

5 


1 

66 

1 

B 



Infective enteritis or diarrhoea under 2 years 
Deaths 

32 

9 

11 

5 

4 

50 

12 

12 

6 

2 



Measles 

Deaths 

10 

1 

173 

~ 34 

2 

5* 

14 

4 

142 

1 

■ 

■ 



Ophthalmia neonatorpm 

Deaths 

97 

10 


— 

96 

10 

47 


■ 



Pneumonia influenzal § 

Deaths (from influenza) 

758 

20 

76 

2 

5 

2 

1 

33 

1 

495 

14 

33 

6 

8 

' 

■ 

6 

1 

704 

51 

Pneumonia, primary 

Deaths 


19 

192 

II 

7 

14 


7 

158 

5 

8 



Poho-encephahtis acute 

Deaths 

3 

i 




— 

— 

i 

i 




Poliomyelitis, acute 

Deaths 

4 

■ 

8 



8 


■ 

■ 

— 



Puerperal fever 

Deaths 

It 

1 

It 

11 

5 

— 

34 

7 

It 

13 

2 

— 



Puerperal pyrevia 

Deaths 

187 

20 

30 


1 

139 

20 

i 

B 

— 



Relapsing fever 

Deaths 

— 

— 



— 




■ 

B 

— 



Scarlet fever 

Deaths 

1,765 
, 3 

171 

1 

355 

3 

79 

78 

1,631 

2 

170 

379 

99 

44 

1,628 

232 

Small-pox 

Deaths 

— 

B 

— 

— 

B 


— 

— 

— 

— 



Typhus fever 

Deaths 

■ 

B 

— 

, 

Bli 

B 

— 

— 

— 

— 



Whooping cough 

Deaths 

IS 

J 

123 

4 



^^1 

10 

5 

164 

61 



4 

1 


Deaths (O-I year) 

Infant mortality rate (per 1 000 live births) 

301 

49 

45 

37 

58 

23 

21 

285 

47 

51 

42 

86 

29 

21 



De iths (excluding stillbirths) 

Annual death rate (per 1 000 persons living) 

4 084 
100 

789 

100 

607 

124 

160 
10 8 

130 
11 5 

3,905 

97 

752 

9 5 

585 

120 

185 
12 6 

145 

139 



‘c births 

Annual rate per 1 000 persons living 
stillbirths 

— Rmc pei^l OOP total births (including stillborn) 

7 397 
18 2 

1,407 

179 

949 
19 3 

396 
26 8 

,254 
22 5 

6,902 
17 1 

1,294 

163 

977 
20 0 

346 
23 6 

232 
22 2 



276 

36 

42 

29 



$ 

296 

41 

45 

34 







• 2 cases in Belfast alop» 

t Nfter Onober I 1937 nucrrvRr-.i r . .. . ^ . • i 

adminisirainc counl> ol Londou *" notifiable ortl> in the 


t Death from puerpenJ sepsis 
i Includes primar> form m figures for Cncjland 
trativc count)) and Northern Ireland 


and Wales 


London 


























































































































JuL\ 9 193S 


EPIDEMIOLOGY SECTION 


Tfft r>'r^ 

Cal *.VIL 


EPIDEMIOLOGICAL NOTES* 

Enteric Feecr 

Twente ci^es of enteric fe\er were notified in England and 
Wales during the week under reMeii compared uilh !5 in 
the prcMous week no ca^es were recorded in London In 
Scotland 6 cares of lephoid fever were notified — 4 tn Roxourch 
Countv and I each in -kvr Countv and Lanark Countv — and 

1 case of paratvphoid fever in Sttrlinc Counlv 

Diphtheria and Scarlet Fever 
In England and Wales notifications of diphtheria ro c from 
889 to 989 dunng the week under review and in London from 
115 to 146 Increases were noted in Scotland and Northern 
Ireland but in Eire there was a marked drop in notifications 
Deaths tn the 126 Great Towns of England and Wales fell 
from 29 to 22 while in London thev rose from s to 4 Of 
the 22 deaths from diphtheria recorded in the 126 Great Towns 

2 each occurred in Bradford (0) Liverpool (2) W’lgan (0) 
There were 6 deaths from diphtheria in the 16 pnncipal towns 
of Scotland during the week under review — 4 (t) m Glasgow 
ard 2 (0) in Edinburgh There was an increase in the number 
of notifications of scarlet fever in England and Wales during 
the week— 1 76s as against I 746 — and in London where 171 
cases were recorded compared with 1^6 in the previous week 
In England and Wales the figures vvere in excess of the median 
value for the last nine vears but in London thev were appre 
ciablv less There were 4 deaths from scarlet fever in the 
126 Great Towns of Encland and W'ales dunng the week 
under review compared with 5 in the previous week of these 
I occurred in London Notifications m Scotland fell from 
383 to tss with ' deaths but in Eire and Northern Ireland 
thev rose from 76 to 79 and 77 to 78 respecliveiv 

Pnmarv and Influenzal Pneumonia 
Notifications of pnmarv and influenzal pneumonia m 
Fnghnd and W'ales fell from 787 to 7'8 during the week under 
review but in London thev rose from 49 to 76 these figures 
vvere above the median values for the last nine vears for 
England and W'ales and for London There vvere 20 deaths 
from influenza in the 126 Great Towns of England and Wales 
during the week under review compared with 20 m the 
previous week while in London the number remained at 2 
in the West Riding (Yorks) 103 (881 cases were notified of 
which 43 (27) vvere in Sheffield 24 (21) in the Administrative 
Counts 20 (i') in Leeds 9 (6) in Halifax In Warwickshire 
39 (48) cases vvere notified of which 24 (29) were in Bir 
mincham and 10 (10) in the Administrative Countv Of the 
P6 (167) casts reported m Lancashire ’7 each occurred in 
Liverpool (42) and Manchester (42) Of the 20 deaths from 
influenza recorded in the 126 Great Towns of England and 
Wales during the week under review 2 each occurred in London 
(2) W’lllesden (0) Coventrv (0) In Scotland 192 cases of 
pnmarv pneumonia were notified compared with 205 in the 
previous week while there vvere s cases of influenzal 
pneumonia — as against 2 in the previous week— and 2 deaths 

I each in Greenock lO) and Kirkcaldv (0) In Eire there were 

II (17) cases ot pneumonia and 7 (8) deaths 6 (6) of which 
occurred in Dublin There vvere 14 (II) deaths from 
pneumonia in the 10 principal towns of Northern Ireland 
during the week — 11 (10) in Belfast 2 (0) in Porladovvn and 1 
(0) in Lame 

Measles and Whooping-cough 
In the 126 Great Towns there vvere 10 deaths from measles 
compared with 14 in the previous week of these I (5) 
occurred m London 2 (0) in Barrow in Furness and I each 
m Bamslev (0) Blackburn (0) Keighlev (0) South Shields (0) 
Tvnemoiith (0) Birmingham (0) Dunng the week 422 cases 
were reported from the LCC elemeniarv schools compared 
with 680 tn the previous week The average dailv admissions 
to the LCC fever hospitals were IS compared with 2-. in 
the previous week and the number of ca cs of measles under 
treatment in Ihc c bospilals on Fridav June 24 was 860 
compared wiih 971 o n June 17 On ihe s-ime dav there were 

Except where otherwise mcmioaed hpures m paren hcscs refer 
to the week preceding the one under review 


10 ' 


under treatment m tbe LCC fever bo p taK u-O i 08 ,i ca •• 
of diphtheria 761 (776) ca'es ot scarlet fever 26 (2 6i 
of whooping-couch Nolif cations for the week ended h — 
2s in the eleven meiropoliian toro*.gh' m wbich i — 'cs is 
notifiable were 2-,l 1.26) disinbuied as follows B. er ca - 
(18) Bermondsev U t3') Fin bun 16 i2‘l Fclbari 27 i (ii 
Greenwich f 7 1107) Hampstead II il't Lambeth 6 i.Oi S 
Pancras 4 i23) Shoreditch s (6i Southw„ k I' il2i S ep-cv 
8 tl4) In Scotland 17a cases of measles were rotificd ctn 
pared with 2^8 in the previous week the ficu cs fo GLs-o ' 
Were 7 I'O) Dunfermline 0il2i Falkirk 28 (-ii Dundee 22 
140) Lanark Countv 21 (--8) Edinburch 8 i|6t Dunne tl . 
Week there vvere no deaths from mea ies m the 16 p-m ip 1 
(owns of Scotland in Eire there were 2 deaths from mci '-s 
in Dublin and m Northern Ireland there vvere no deaths 

In England and Wales there were IS il'i death from 
whooping cough during the week of whwh 2 i i ssssu ed in 
London In Scotland 123 cases ot whoopmc uo luh were 
notified compared with 119 in the previous wees while ibcrc 
"ere 4 deaths — 1 each m Glasgow Edinburgh Motherwell and 
Mishavv Hamilton In N'oribem Ireland 22 i at cases o' 
"hooping-cough were recorded with no deaths 

Cholera 

The seasonal return of cholera was recorded ai Shanch i 
and Siiaroii beruee/r Mai 18 2/ and ui Kon. .a' 

Hankow between Mav 22 and 28 During the wee) enetd 
June 2s the number of cases notified at Shanghai ro e ibrupu 
from 66 to 4)9 wuh 39 deaths in Hong Rone 9 ca es uiih 9 
deaths were reported In the same week in Burma iO ca es 
With 10 deaths vvere notified in Calcutta 6- c- es wuh I 
deaths in Bombav (Presidencvi 66 ca es with a deuhs in 
Delhi 4 cases with 4 deaths In the Central Province I 2 " 
cases with '69 deaths were reported during the week unde 
review m the Northwest Frontier Province 164 cases v ith 
65 deaths m Madras tPresidenev) ill ca«es wuh 99 dc-ths 
m the Punjab 168 cases with 101 deaths in Smd 66 ca es with 
0 deaths and in the Lnited Provinces 2 cases m Allahabad 
and ” cases with 4 deaths m Cawnpore In French Indo 
China during the same week 18 ^ cases of cholera vvere reported 
m Annam 184 m Tonkmg 16 m Hanot 

Plague 

Dunng the week ended June 28 m Burma 1" c es cf 
plague vviih 9 deaths vvere reported In British India lb" c 
"ere no cases m Bombav or the Central Provinces but in 
'ladras tPresidenev) rhere were 3 cases with 2 deaths 


Small pox 

Dunn,, the week ended June 2' there was 1 ca c of smah 
PDx with 1 death in Hone Kong and in Shancbai 1 case wuh 
'1 death In the same week in Burma 5 cases of snuP pox 
"ere reported in Calcutta 26 cases vvith 28 deaths in Bombav 
tPresidenev) 238 cases with 44 deaths m the Central Provinces 
8x cases with a deaths m Madras iPresidenev) 62 cases wuh 
15 deaths in the Northwest Frontier Province 18 cases wuh 
6 deuhs in Sind 47 cases with 6 deaths In the same weel m 
French Indo China 36 cases of smallpox were reported n 
Tonkmg Dunng the week ended June 18 276 cases were 
notified m the L S A 


Txphus 

Dunng the week ended June 25 in Egvpt 5 ca cs of ivphus 
Were reported in Cairo and 97 in the provinces In the s.jmc 
Week 46 cases of Ivphus were notified in Shanghai wuh 13 
deaths During the previous week m Xforocco If 6 ca cs wuh 
2l deaths were notified riainlv disirihuied as folio 's 
Marrakesh 6 cases 2 deaths Chaouia 28 ca es - deaths 
2 each in Central \tlas 16 dcathsl and Dukkala I-. deathsi 
Rabat I" cases Casablanca 18 cases Sous 6 cases During 
the same week m Turn la 77 (1021 cases of tvpCus were 
di<-inhuted mamlv as foDoivs Tozeur Thata H 
Susa 12 Kainsan H SuU-cl \rba 10 Beja 5 During the 
"cck ended June 11 in Algena c3s«n of tvpbus M.cfc nolifc 
dWnbuted a'i follows \lcicr< (department) I i k c' 
Cor*-t rune fdcparimcnt) 23 lo the 


Acek ended U'- 


11 tn 

Poland' 6r(97)'««s ’with 4 d) d«ths were repo cd na'rf 
distnhuted as follows Polcsia 23 ca<es. I de.ih )>'' 


104 Juu 9, 1938 


UNIVERSITIES AND COLLEGES 


Tiic 

'lEDICAL JoLRStl 


cases \Volli>nn 7 cases Bialvstok 6 eases Waisaw 5 cases, 
I death , Lssow 4 cases Stanislawow 4 cases 2 deaths In 
Yugoslasia during the same week there were 39 cases of t>phus 
with 2 deaths In the USA during the week ended Ma> 28, 
26 cases were reported Georgia U, Alabama 3 Florida 3, 
Texas 2, Louisiana I North Carolina I, Tennessee 1 


Universities and Colleges 


UNIVERSITY OF CAMBRIDGE 
The Appointments Committee of the Facultj of Biologs “ B ” 
will shortly proceed to appoint a Unisersity Lecturer in 
Anatomy, and also a Unisersitv Lecturer in Phvsiologv if a 
suitable candidate applies The person appointed to the latter 
post will be expected to take part in teaching and research in 
mammalian physiologj , and should possess a medical qualifica- 
tion Furthei particulars of both appointments mar be 
obtained from the secretarr of the Appointments Committee, 
Dr F I W Roughton Depaitnaent. of PUxsrologv Cam- 
bridge to rrhom applications should be sent by July 25 
The Board of Management of the Frank Edward Elmore 
Fund will shortly proceed to the award of a studentship for 
medical research It is open to male graduates of any iinirer- 
sity in any country rvho rrere born at anr place within the 
British Empire other than Scotland The student appointed 
will work in the Department of Medicine of the Universitj 
of Cambridge under the direction of the Regius Professor of 
Phrsic, commencing salary £300 a sear, appointment for 
two years in the first instance Further information mas be 
had from the Regius Professor to svhom applications together 
svith three testimonials, a statement of previous appointments, 
and copies of published papers, should be sent b> August 1 
The Benn \V Levs research studentship in biochemistrv 
has become vacant Applications for its tenure should be 
addressed to the Professor of Biochemistr>, Sir F G Hopkins 
at the School of Btochemistr> before Jiils 16 

At a Congregation held on June 21 the degrees of MB, 
B Chir were conferred on H J Wallace 


UNIVERSITY OF BIRMINGHAM 
At a Congregation held on Jul) 2 the honorais degree of 
LL D was conferred on Dr Robert Hutchison President of 
the Royal College of Phssicians of London Sir Cuthbert 
Wallace Bt President of the Roval College of Surgeons of 
England, and Sir Edward Mellanby F R S Secretan to the 
Medical Research Council also on Viscount Nuffield Sir 
Bertram Ford and Mr Harry Vincent 
The following medical degrees were conferred 

M D — J F Shrewsbury {e\ officio) J H Ebbs 
NIB, Ch B — *fW G Mills, fJlA G Arnold tRatharinc M 
Banks, t|lJ D C Gowans, tl|D R Humphreys fP Parry, 
ffA B Watson J OD Alexander, C S Astiwell L W' 
Blundell A E Chaplin Dorothy M Cooper, T W B Cull, 
I'J E B Elliott J B Farquhai, R E Gibbins, Rita Glciberman 
H W Hickman J H Hicks, D B Jagger P H Kendall, 
Dorothy E Maikhim A T Marshall T J Montgomerie J F 
Newman G R Newns Cithenne M Osier Marian L Owen, 
A M Wadsworth J F Wilkinson, Winifred Wynne 

* Fust class honours t Second class honours f Distinction m 
medicine and surgery (| Distinction in medicine rDistinction m 
midwifery and diseises of women 

The following scholarships medals and prizes have been 
awarded 

A E Hills Postal aduale Scholarship in Medicine C Parsons 
Queens Scholarship (third yeai), M C Binnie, (fouith year) 

J C White, (fifth year) P H Davison (final year) W G 
Mills litglebi Scholarship A B Watson Arthur Fosuell 
Memorial Medal Sampson Gamgee Memorial Medal and Russell 
Memorial Prize W G Mills Priestlei Smith Prize in Ophihalmo 
log\ P Parry Leith Neumann Prizes m Pathology (fourth year) , 
Medical J C White Dental I H Jones Peter Thompson Prize 
III Anatomi (third year) M C Binnic and E\elyn M Roc 
(equally disided) John Oarritt hfelson Gold hfedal iii Plnsiology 
(thud year) M C Binnie 


k UNIVERSITY OF LIVERPOOL 

W he following candidates ha\e been approx ed at the exam- 
Fanuions indicated 

M B ~Cii B ■’“""'I.U c Has C 


H SlcvsAtt Hess 


If ^ A j ^ Hunt ‘ L SalingTr Part III 

PitrP.n M ^ Alstead H Angelman C T Baynes 

PiiriLia Nt Bennett Jones A L Black D W Bnce> H Bi 


B H Brindlc, B Cirruthcrs, J W Crowther H Dilm n n 
Danes J Donnelly, D W Forgan, Marx W Gaskell K B 
Gibson, J Griflith Anne F Nf Heaney D R Holden R S 
HolgUe, E P Houghton G O Hughes Brenda M Jons 

? •’x, C-Leathr 

J Mills J Moroncy A Nachmanoxitz J H Newmark P 3 

O Flynn, E N Owen RAC Owen Geraldine M H p,,,| 

B 1 Phil bps, Hilda C Podmore J G Pritchard \V Pntelurd 

E B Riding D J Roberts R H Roberts G M S Rxan’ 
G Sanderson Joyce M Scholcficld V k Summers R J D 

Temple, Lucy H E Walker, R Wuson, J H D Wetlnnll 
R H White Jones A H Williams, C J Williams Gwendoline 
Williams, 1 P Williams Joan S Wood, E G Wright G Wynne 
Griffith M Wynroe Part //CD Alercant, G E Bidman 
‘Frances E Brierton R F Browne J Collins, E H L Cook 
E T Downham Margaret Edge, ‘T S Eimcrl, R M Exans 
H B Forrest *D M I Freeman Thelma R Gaunt, C kl 
Gregory, G C Grifliths H Hall ‘J Harders F Hedlev BeesiC 
Hoxvarth, ‘H Ingham C T Jenkins, W Kulke ‘A L Lalncr 
P C Laxxson Pearl Lyons ‘Anne E McCandlcss D 11 
MacCormack, Sylxia Makin, Eileen E V Martin E F Mason 
R J Miller G W H Millington ‘J D Muir T Murtoek 

AGO Malley Margaret E Parry Edwards R Paul Eleanor M 
Pearson L G Poole A G Porterfield, T Price D Pry sor Jones 
V A Rogers C Roxxlands C R Slummg W O Spena 
Lucy M SutchfTc Catherine S Thomas, Megan E Thomas 
J N Threlfall Olixia S Turner, Gertrude O W Watson J A 
WctbETcd K M Wihis Emihe M Winter Piuaed in Srpnrait 
Siibyects J S Hindley, G O Thomas and Joan P Thomson 
(Public Health), R J Parry and Kathleen M Pugh Jones (Form e 
Medicine) Part I I Ansel! S C Barnes, H N C Blcisdih 

D J Browne, Helen M 'Carmichael J L Chisnall E A Cookson 
NAG Coxell, G H Daghsh Gnce T Daxxson L Flet Lr 
W E Gill J G Gow H G Griffin E L Hamm J B Hannah 
R Hermon ‘J R Hughes, W J Hughes Jean G Huntley 
C Ibbolson, ‘C N Hand I Levinson M G McColI J H H 

MacRac, A K Milting, J G Mott, G V Osborne ‘W 11 

Patridce R Paul Lcitice M Robertson Kate E Rxmer T A 
Sale ‘C C Slack R A Smith F L Thomas E E Vaiiqh n 
G R Wadsworth Man Williams *E H Wmterbottom Pnurl 
in Separate Siibiccis Catherine W L Harries S B Nellcs and 
C W R Rosebx (Pharmacology and General Thcrincut csl 

DPH— Poit / E W Exans Part 11 A B Concinon 
L R L Edwards A J Gill A L Smallwood Marcircl C 
sWintcr 

Diploxix IS Troi ICXL MroiriNE — P B Pillay M H Shah 

Diploxix iq Tropicxl Hxgicvc — F Jacusicl K Jilani J L 
Lanceley, J R Robertson 

Dipt 0X1 X IN Medic XL Rxdiologx xnd ELLCTooLort — End ' 
B O Jarrette Part BOB, Chureh B O J irrclle N A Lnxhr 
F Pvgott , ^ ^ „ 

' Second class honours Distinction in Surccrx „ " 

in Obstetrics and Gyniecolocy * Distinction in Public He’ i 
* Distinction in Forensic Medicine and Toxii o'ogy Dislm hon 
in Pharmacology and Gcncial Therapeutics ' With distmclion 


UNIVERSITY or MANCHFSTCR 
Dr Rupert Sxkes has been appointed warden of I 
House and Dr S T Cowan lecturer in bacleriologx 

The Sheridan Delepine Felloxvsbip in Piexenlixc Mcdieine 
has been awaidcd to H L Settle M B Ch B 


UNIVERSITY OF WALES 

The folloxxmc candidates hax'c satisfied the examiners at the 
examination indicated 

VPH—Parl / Jennet Ex ms S H Graham Anm. E M 
Herbeit E W Kinsey Mary M M Llewellyn 

UNIVERSITY OF GLASGOW 
At a graduation ceremony held on July I the folloxxini, 
medical degrees xxere conferred 
MD— ‘R Macf Millen ‘J P J Palon 
MB, Ch B — C A Kilpatrick, Jean D McMillan 
* W'lth commendation 


UNIVERSITY OF ST ANDREWS 
At the graduation ceremony on June 30 presided oxer '’J 
Vice Chancellor, the fionorarx degree of LL D con 
upon Edgar Douglas Adrian M D FRCP ^ ^ j 
fessor of Physiology in the Unixcrsity of Camhride 
Felloxx of Trinity College 

SOCIETY OF APOTHECARIES OF 1 ONDON 
The folloxxing candidates have passed in the snbjccts indicate! 

Surgery— M Becker P H Daxics RED Elh' R 
Pirkinson T O Vilgoen ^ n it 

KIedicinf — J Brcwis I J Matlins, O Roclilin 
Forensic Medicine— I J Mathias O Rochhn _ 

MiDxxirrRY— E M E Dccottignies R E D J^ljncl on 

N A Joxons D Maepherson J R Rose. ^ 

H Woolxxach un.'lihn 

The diploma of the Society has been granted to O ko- 



JUL^ 9, 193S 


MEDICAL NE^^S 


T»rr 

Mn> CAl Jc-TLV L 


10' 


The Services 


Efficiency Decoratiov 

The King has conferred the Efficienc\ Decoration of the 
Territorial Ann\ upon Lieutenant Colonel J T K\le and 
Majors D C Afaclachhn J \\ Wa\te, R G Addenbroole 
and G W W igg R ^ M C (T A ) 

DEATHS IN the SERVICES 
Major Herbert Stl ART Bucicaiore OBE RAMC (rel) 
died at East Sheen on June 25 aged 51 He uas bom on 
luU 2 1S86 was educated at Unuervitx College Loadon 
and took the L D S RCS m 1910 the M R C S LRCP 
in 1911 and the DPH of the Ro\al Colleges m 1913 
Entenng the RAMC as lieutenant on Juls 28 1911 he 
became major on Juh 28 1923 and retired on Juh 28 1931 
He ser\ed in the war of 1914-18 in Iraq and Afghanistan and 
on the North ^^est Frontier of India receiving the OBE for 
his serMces After the war he served for seven vears in the 
Chemical Defence Research Dejiartment Porton and after 
wards m the Air Raid Precautions Department of the Home 
Office to which he was appointed in March 1936 He also 
sened in I93&-7 on the Bniish Nfedical Associations Com 
mittee for the Recruitment of ^ledical Practtiioners in Time 
of W'lr 


Medical News 


On the occasion of the forthcoming MSit of the King and 
Queen to France the Academic de Medecine has sent its 
greetings to the Rosal Societs of Medicine and the Avhole 
medical profession of the British Empire 

The next meeting of the Paddington Medical Societs amII 
be held at Paddington Town Hall on Tuesdas Juh 12 at 
9 pm when there will be a discussion on The Place of the 
Medical Practitioner in Air Raid Precautions Schemes to be 
opened bs Dr N W Hammer Dr J Naim Dobbie and 
Mr E \V Thom Bannister 

The twentieth annual meeting of ihe Mental Hospitals Asso 
ciation will be held at the Guildhall on Tuesday Juh 12 at 
II am After the Lord Mas or of London has opened the 
proceedings the report of the Executise Committee will be 
presented and difficulties in connexion with the proMsions 
of the Matnmonial Causes Act 1937 will be discussed at the 
request of the \isiting committee of the Durham Counts 
Mental Hospital Dr EdAsard I-arhin amU then read a paper 
on insulin and cardiazol treatments of schizophrenia 

The French Association for the Adsancement of Science 
AAiU meet in Pans from September 22 to 27 under the 
presidencA of Professor Guilliermond Further information 
can be obtained from the secretary 28 Rue Serpente Pans 

The report for 1937 of Papwonh Village Settlement will be 
presented at the ParL Lane Hotel Piccadilh NX on Tuesday 
Juh 12 at 3 15 pm The Marquess of NNilhngdon chairman 
of PipAAorth AAill preside and a ncAA PapAAorlh film aatII be 
shoAAn Communications should be addressed to the Organ 
izing SccretarA Papwonh Village Settlement 16 Grossenor 
Place SNVI 

Dr N\' J Vickers and Dr Carol Sims (Inner Temple) and 
Dr C F Brockingwn (Middle Temple) Aserc called to the Bar 
on June 29 

The issue of the Bulletin de I Office huertwuonal iTHigiene 
Puhhque for Mas contains articles on the epidemiology of 
poliomyelitis supph of mfecung matenal for malanoiherapy 
in England and Wales prophylaxis of tuberculosis in schools 
m England and Wales France and Germany legislation con 
ccming tuberculous teachers m Noiasay and eomparatiyc rural 
and urban mortality m France in 193' 


Seyeral cases of psittacosis h^ye recently ccci rred ^t La 
' Rochelle so that the exhibition and sale of p„rro s t-aye b— ' 
prohibited there 

Immunization against diphthena with anatox n has b-ca 
made compulsory in Hungary for all children aced from 
2 to 6 years and m France for all children in the se^erd _rd 
third years of hfe 

The New fork banker Mr W Child has left tbe 
Umyersity of Tale ten million dollars for cancer re-earch 

Dr F de Qneryain the aacII knoycn professor o' surccry 
and director of the surgical clinic at Berne will retire this year 
and be succeeded by Dr Hermann Maiu 

Thirty radio coast stations of the United States arc p o 
yided yyith a doctor to gtse medical adsice to passing hip< 


Letters, Notes, and Answers 


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Holse TwictoOv Sqlvre W C 1 
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with their nam'^ not nece>sanlv for publiijtion 
Authors desinng REPRINTS of their articles published m the 
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BMA House Tavistock Square \\ C I on receipt of pfooN 
Authors overseas should indicate on MSS if rernm> are 
required as proofs are not '•ent abroad 
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be addressed to the Adveriiscrrent Nfanager Orders for copes 
of the Journal and communications with reference to vub enp- 
lions should be addressed to the Secretarv B MA Heu c 
Tavistock Square \\ C 1 

The Telephone Ncwber of the Bntiiih Medical Association and 
the Bnitsh ^^edlCol Journal is ELSTON 2111 
The Teleor-vphic Addresses are 
EDITOR OF THE BRITISH MEDICAL JOlR\AL Aiuo 
If esteem London 

SECRETARY Medisecra If esteem London 
The address of the B MA Scottish Office li 7 Drum heugh 
Gardens Edinburgh (telegrams Associate Edinburgh tele 
phone 24361 Edinburghl and of the Office of the Irish Free 
State Medical Union (I^I A and B MA ) 18 Kildare Street 
Dublin (telegrams Bacilluz Dublin telephone 62^'0 Dublin) 


QUERIES \ND ANSWERS 

Case for Diagnosis 

F\g has a patient aged 77 He is of spare build and has 
been \erv active all his life Tweniv vears ago he suddenU 
became alarmed at a constant vvorrving loIic which appeared 
on sitting dovvn but disappeared when walking It dis 
appeared as suddenlv as u came Twelve vears ago this 
condition reappeared palpation auscultation and a varietv 
of r rav examinations revealed nothinc The tongue is 
clean but there is some anorexia Except for some con 
stipation — relieved b\ salines— there is no evidence of 
obstruction Three weeks ago these svmptoms recurred and 
the same invc tications have been undertaken with the same 
negative results It should be added that the patient has 
been a martvr to manv forms of rheumatism nbro itis 
etc Fag asks for sucgcstions as to diagnosis ••rd 
treatment 

Recurrent Ulcers 

Mr C A MoorC (Bristol) wntes I hould have no be lUtion 
in offering to “Borderer'’ (Jourt ul Jul 2 p ^1) the 
ucgcstion that the mv serious uKcrs he describes arc 
arfcfacts In two similar ca es m own each patic'*! 
indicnantlv denied bavins: tampered wath her tissues bv-l 
m neither ca'c was the^c anv further ulLC'^tion aftc^ sbe 
discovered the game w-as up "'Borderer'’ mav vvcll c*. n 
the admiration real but unexp-es ed of his p^iicrt for 
l^mg astute enough to make the correct diaencsis 


I 



106 July 9 19^8 


QUERIES AND ANSWERS 


The Bmiisu 
^lEDlCXL JoURN^t 


Income Tax 

Additional Expense of Residence 
Claim holds an appointment under the terms ot which he 
must reside in the borough of X The only house available 
there costs him £30 a year more in rent than one otherwise 
quite as suitable in a neighbouring borough Can he claim 
to treat that £30 as an expense of his office"^ 

’»* ‘ Claim is assessable under Schedule E and the 
allowance under that schedule is very restricted — that is 
to “expenses wholly, exclusively, and necessarily incurred 
in the performance of the duties of the office There is 
of course a debatable field with regard to which Rowlatt, J 
said (in Nalder v Walters) ‘ it is the duty ot the Com 
missioners to watch claims of this kind very carefully - 
The point raised by our correspondent has not been dealt 
with specifically in the courts and he might succeed before 
the Commissioners , but we think that that prospect is not 
a good one 

Replacement of Medical Instruments 
PitACTiTioNCR inquires ‘ whether the full cost replacement 
of a medical instrument by one more up to dale and four 
times as expensive is allowed ’ 

%* The cost of icpiacemeiit is allowable, but not the 
cost of improMng the equipment — the latter expense 
represents further capital outlay and not running costs 
of the practice Where a single transaction includes both 
elements — as in the case put by Practitioner — the total net 
cost must be divided and the replacement portion only 
allowed That amount would usually be the cost of a 
similar instrument at the time the new one was purchased, 
less the amount, if any, obtained bv its sale 

lush Flic State — Saxings Ccitificatcs 
Medico is residing and has always resided in the Irish 
Free Stale He asks whether he is liable to income lax 
there in respect of the additions accruing on British War 
Savings Certificates, and if so when the liability becomes 
effective 

%* The interest — for the annual accretions are of the 
nature of interest — to such certificates are specificallv 
exempted from British income tax, but would be liable to 
Irish' Free State tax in the hands of a resident there We 
agree with Medico that as the interest cannot be drawn 
without the encashment of the certificate itself, it does not 
arise to the holder so as to make him liable to assessment 
until the certificate is cashed In that respect it is analogous 
to interest accruing on deposit receipt — the Scottish form of 
bank deposit — which is not liable to assessment until it is 
uplifted ” 

Earned Income Relief 

‘ S J asks what is the basis on which earned income relief 
IS calculated If, for instance the gross earnings of a practice 
are £1 600 the expenses £900 and wear and tear allowance 
£100 IS the one fifth based on £1,600, £700, or £600'^ 

*** On £600 The matter is governed by Sec 15 of the 
Finance Act 1925 which provides for a deduction from 
the amount" of his earned income of a sum equal to one fifth 
of the amount of that income Any jgther basis would 

be at variance with the phrase of that income 


-solder of the needle melted The firm that had siinphsd 
the needles then informed me that the metal hninc had a 
melting point of 215'' C and advised me to use a thcrnio 
meter and not to allow the temperature ot the oil bath to 
exceed 160 C, but difficulties in the way of high tempera 
tore thermometry prevented me from following this adiice 
It would be more conaenient to employ a liquid with a 
boiling point of about 160“ C, but 1 cannot think of one 
suitable for the purpose Alternatively some other indicator 
than a bread crumb might be employed 1 hase not tried 
the method of sterilizing the syringe with boiling oil for 
fear of cracking the glass, and 1 should explain that 1 
immersed the needle in a small oil bath Is there not also 
a risk of melting the soldering material when a plalimmi 
needle is (lamed? 


Histidine in Peptic Ulcer 

Dr Sexmour W Davies (Wallasey) writes After reading 
Dr A H Douthwaite s remarks on the treatment of peptic 
ulcer by histidine (Journal May 28 p 1143) 1 am tempted 
to record a case A man in his fifties had had symptoms 
suggestise of duodenal ulcer since 1923 He had undergone 
a-rav examination four times but definite signs of ulcer 
were lacking though his gall bladder was said to be palhd 
logical Upon the advice of a consultant he was treated 
dietetically and medicinally as for an ulcer In 1936, after 
the radiologist had reported duodenal irritation with a 
normally emptying stomach he was started upon a tivcnly 
one day course of histidine with the approval of the con 
sultant After thirteen doses he said that he was no better 
but suddenly began to improve, and^ on completion of the 
course said that he had never felt better In September 
1937 he had a recurrence of pain etc and it was arranged 
that he should be v rayed on September 17 Late on the 
night of September 16 at operation a perforated duodenal 
ulcer was found near the pylorus After a somcwlial 
stormy convalescence he recosered he is now about 65 

Death from a Wasp Sting 

Surgeon Commander A E P Cheesman R N writes from 
H M Dockyard Malta With reference to Dr f 
Alexanders letter in the Journal of June 18 (p 1548) I 
would suggest that the cause of death may have been 
anaphylaxis While in the West Indies a few years ago 
a doctor a friend of mine told me that he had found a mah 
unconscious by the side of the road there was no apparent 
cause for this Eventually the man recovered and staled 
that a bee had flown into his open mouth and had stiinc 
him The mark of the puncture was on the inner surface of 
his lower lip without any obvious swelling So far as I 
can remember the man explained that he had had a similar 
seizure some years before when stung by a wasp and that 
he had trouble with injections under his skin ’ There was 
no added cardiac disease or hypcrpiesis in his case 

Aspirin Poisoning 

Dr M C Andrews (Wembley) writes The note by Dr X 
Biddle in the Journal of June 25 (p 1365) reminds me ot 
two cases of aspirin poisoning which 1 saw about ten years 
ago In each case the patient claimed to have taken (>- 
grains of aspirin Both patients recovered completels m 
a few days after a short period of restlessness swealm!, 
thirst nausea and oliguria There may be something m i ' 
claim that the potency of different makes of aspirin vanes 


Life Insurance Relief 

Lonicera took out an endowment policy on April 2 1938, 
and inquires which is the earliest financial year for which 
he can obtain income tax rebel 

*,* The year ending April 5, 1938 The local inspector 
should be informed at once so that the appropriate deduc 
tion can be made from the second instalment ot lax now 
becoming due 


LETTERS, NOTES, ETC 

Sterilization of Hypodermic Needles 

Dr O Ecclcs (London W 12) writes with reference to Dr 
J Sandison Crabbe s letter in the Journal of May 14 
(p 1070) I recently adopted the boiling olive oil tnd 
bread crumb method which Sir Almroth Wright showed 
me many years ago and to my surprise I found that the 


Disclaimer 

)r J Nbii Leitch writes I notice that my name w^ men 
tioned in a certain case which came before the 
Medical Council recently and was reported in sour 
nient 1 had no connexion whateser with the ' 

clinics mentioned I met one of the gentlemen f***”^' I 
three occasions of short duration during svhich 
conversation took place The other gentleman 
merely telling him of an opening which might care 
avail himself of 1 deny absolutely the "hole slor' P“ 
foryvard in Ihe case so fir as it concerns me Inc 
pTper report quoted »n the c'lse did not refer to 
Tn> wav 

Vc have just receded a svell prepircd T 

hormones in gynaecology ..'" booklet on 

British Drug Houses who yvill supply the bo 

application 



^ KE^ TO CURRENT MEDICAL LITERATURE Tn^r.^. c 

i- f *L Tiv I 

KEY TO CURRENT MEDICAL LITERATURE 

GENERAL JOURNALS 


Deutsche Medizinische ochenschrift 

BcrJm- 64 il 9 

•\auous Clmtcal Tjpes of Hacmorrhzirc Hinis cn Re cynuon cf a Litfbi*ii> 
lo ThrcmboMS — R Jurgen^ 

Fo cixu. Sipnifi*ance of Haemorrhagic Diathesis m Chi'dhcod — G Schr dcr 
Opemuons and Pregnanev — A Benihin 
1 \\ inter Peak of Diphthcna due to Dim notion of Sjvxific Imnur %** — 

E Ha sicr 

C-rbon ^^o^OTIdc Pseudo-hacmoglcbin Late Dcrrcr tration cl C iN.tt 
Monoxide Poi on ng and ^aion of Cartxn kforoxide on the mal 
Organism — G Barkan 

Unus«4.1 Course of a Breslau Entcriti aiJi a Suduen Late Dc-th — K 
RicthmuDer 

In tiJIations for ^cutc Midd c^r Infiammanon — K Ganter 

New \icws on Consumption of Mcohol «rd Cap«icit/ to N\ork — J F -ig 

\ irus Di cases — E Gildcmei ter 

Expcnn'cn s on Ltsing mals — H Neupert 

Right to Work in a Doaor s Home — C Lommel 

Hnemorriiope — It is chnicalh possible clearh to distinguish 
from each other si\ different t\pes of haemorrhage There 
arc those due to vitamin deficiencv and to haemophilia and 
tho e which mav be classed as thrombopathic thrombopemc 
capillarv toxic or hormonal in ongin 

Diphtheria — No confirmation is found of the Gallenkamp 
theorv that the winter peak of diphtheriSL is due lo ? dtminu 
Hon of specific immunitv The fundamental causes of this 
peak remain as obscure as those of the late summer peak of 
pohomv ehtis 

Journal of the American Medical Association 

Chicago >cl 110 Xpnl ’0 19 s 

Siamu's pn Deaths from Rheumatic Heart D^ea e — H L Lunn ..od O F 
Hedle> 

Po<t-opcrattTC Coronarv O elusion— -A M Maser S Dack *nd H L J (Tc 
B sal Anacsihesu Esipal Soluble bj Rectum— A E Jonc 
Eirergen^j Treatrocm in Asthma —G L Waldbott 
Lop Ear— D W MacCoIlum 
Obesitv in Adolescents —H Gras 

Action of H>pogl>caemu on Central Nersous S ■'tem — E Gelthorn 
Tr hiQOSts Epidcrnc Stxi> four C cs — T L Fererb-ugh L Seg I ard 
H A SchuUc 

4(^olescent Ohesu\ — Obesilv in ndolescenis is being treated 
often indi^cnminatelv according to Grav bv piluitarv or 
testicular extracts In certam'cascs good results are obtained 
but It should be remembered that this mav be due to natural 
causes and not the injections and that deleterious bv effects 
mav occur Diets for obesilv of carbohvdrate SO grammes 
protein 60 grammes and fat 40 grammes dailv have given 
excellent results 

Khnischc ochenschnft 
Berlin sol 17 April 0 19 S 
\ M mins and Premature Scniht> — W Kollaih 

Van bilit> of Aulomati Vasomotor Rcgulaiicn — ^W Fj h-ucr and H J 
Octicl 

ColUpse «s a Re<ul of Erect Po*turc — R J2n..en 
Fxiigue-clcctrocardtogTam m Children — P Laurent us ^nd K Svbu In 
Influence of Acetone on 0\ buivne Aod Con cm of the B ood M — Em-cr 
and r Poliak 

Elimination of Potassium and Sodium b> D sea cd kidrej^ — H S edek «rd 
R Herb t 

EJimmati n of Ccramnc in Animal — M Hanmarn and H I er 
\ aluc of Prcciptiaiion Reaction for Demo*' traticn of Adu leralTn of Hun-n 
Tviih Ammal Milk — H Lrba h 
D«cnicr> Bacnii -nd T-rgesm — H Lippeli 

Japanese Contributions to Stud> of Rctulatin of Bl>Jd Supply to Ccrir-I 
Nenous Sjstcm — F Hoff 

D^sen^er ^ — ^Targcsin (a complex colloidal diaccivl lannin 
'liver albumen compound) has been tried in two ca c*- of 
bacterial dvscnterv with remarkable '•ulccss The preparation 
when given bv the mouth was well tolerated the general 
svmptoms cleared up in a few davb 


Larcct 

Lend n xcl *3 Spri! f 9 « 

XI 'ignani H pener cr — X Ellrs 

Njin ion ard the Nei> os S cm w ih Srcvia' Refc-er e t P ’■'* 
ard Subacute Comb cu Deg^e a - — C C L r -s 
Trcji rrer of Xfcnr-occN ^ x e- *-'*•*•< ^ >* r —r. — T Cr « ~»i. 

and G B FIcm g 

Action cf Testes cro-e Prcpon-ie ^ t c Fen- c — G L To* 

Lru_i-al Case Le^d Po or n — J N vf c>- m ♦s a-d S L T ” 
Presenuon of Corrljcsiiic"^ da"'T* God Tbc r n T t-- "“-v 

Anhr IS — K. Sc he 

Complications of Goh’ Thcrop\ — Atcording to 
loxic svmpfoms ansinc during treatment with gold of tube 
culosis and arthritis are not due to ibe mci*.) but to ibc 
liberation ot toxins from the lesion n ell After expLinnc 
his reasons lor this belief he states that toxic reaciions can 
be prevented or checked bv the energetic adminisiratior ut 
the Same time aS the gofa of vitamins ABB and C 
In 1*^0 paiients so treated he bas seen no case c* ihrombc 
pcni«i and fwo onfv of d’crmi.fjfts 


Medical Journal of Australia 

S d c> scl 1 Ap p 16 19 fi 

xi^temiT ard S* tre of its Pret er* — H S Xf Lc .ard 
Refr cicmetty ard Cc’* entran''P c' the B e — W f Perfe’d *rd J SutherUnd 
Med cal O ganuaticn with Xlchara-d FerTr— tiom — C G Sh w 
Pmnt n a -d Catb hydrate xJc -bcl m II Ipfluer e f Pri tin— C x 
Ardcr on 


Medmnischc Klinik 

Berlin T 1 3^ Ami 9 19 S 

Nfmal -rd P ihr cgR»l Xnat -m) Oc Age — L A h ff 

Changes in ihe TtcaiTrent c Hspenr ph o the Prestan: — T Hr t k-k 

Ldc* ^nd Bi e Dj is t~ SeptJ Co^d-i • —A Binged 

s>r*ip cmatc’ciT' ^rd Trc4tne**t of L^n** u n — G Porges 

A hlo hsdna treated b Errs-n — R Bauer 

Swe t SecTciicn ir P ona.i' — W Klcir< hm dt 

Treatment of lrr.ar*rtatoT -"'d P j cm Infeeticns w ih LeulNb — 
W D Mur^ 

Nomencl icrc of Pharn*.. cl G eni’* Prcr^rati r — A X! )rbc^cr 
Arr^njlco'iC'S.'S — A K^h stc f 
K c Czu c of lod n Peron rg — R Bj klen 


MediziriKrhe Welt 

Ecrlir \oI I** -AprJ 0 19 ' 

N^crl rd Loci,! Rcr~ed*es ard Lccal C 'r'atc in the P ca.c*< cf He ' g — 
XV rf<n ec t cJ 

Foro e I "co og> — H L»r-pert 

Ne^ know edge ard Pr t em m Ealrede* — J kuhn^u 
Sor^baih I tbc Sea — H Cu 
D Cl i the Spa — H R on e 

Ad\ancc> in D^grtew of Card^'' C t c — A VV eb^ 

Human B oclimaio’cn — E. s r*'r jr^bcT 
Bn'cI Rc'^rch — H P** n. rc 

Pbcu-naih. Pauent «l Aacbc** — A SUuwk 
B Irec eg cal In titu c at Bad P>nrr-i — H --Fefb I 


Munchener Median sche Wo-hensclinn 

XIi,r-h I IS Xpr r9 1 t 

SutabtU cf R c B c-c — G Lemr-cl 
Treairicnt cf B o-vb-»l Ast**— — C Stra be 
LU n — H Ed-^ar Et rr 

\ Ra> E A*n nat c- r t‘‘e A '“c-^rr Car,*! - C -e J Ft r^e — % 
KaofP*a~n 

i: nt cm-ta pr <1 cd b> Eu— u — F Tc rr'ctm 
Trcitr-ert cf X vr b> Ex r* — R Ttw—- 

Nece* t> f I>c c* “g ** E ' F'crni.ncv -n*. -s C c t, ' " 

CU '^e fr'-*“ Pa c Pr^^ xc Hr-'*^ l-^;.n.-A.e — H F 

Xfr crrc" 1'“’* e r* t t Cb d — A Y- 
Men C.I S^b X tn Xi-—' u— O Ham’” 

](•< 



10 July 9 1938 


KEY TO CURRENT MEDICAL LITERATURE 


TiicOMtuii 

Medical Jovaam 


N-iture 

London vol 141 April 0 I9E'? 

SoLul Rchiions of Science — r Sodd> 

Complex formiiion m Lipoid films -J H Scluilmm E SicnhaRcn nnd 
t K Ridcnl 

Dmicron induced Radio 'ictivity m OxyRcn — T ^nsiKi ind S Wiimnbc 

Amino dcnvativLS of Penn cryihnio) — I G Minn ind A I ithtrhnd 

Pi jFied Uncisc — J N Davidson 

Lacfonaiin m Fish Eyes — E Adler and H \ Euler 

Spore Formation in n Viforio — R L Starkey 

Salaries in Soviet UnlvtrMlics — M Kuliemann 

A Binociihr IlluMon ~H H Dixon 


New Enghnd Journal of Medicine 

Bosion vol 218 April 28 1913 

•familnl Aspects of Cmccr—H L Lomb ird ' — 

Pcritoncoscops — C B Benedict 

'Condition of Cervix on Vapiml Lxinnnuion A True Index of iIil End of 
PrcRn incy — R S Titus 

An Unusinl Case of Gout in a Woman — J A Hilstcd 

Cancel — As the result of an extensile sntistical study, 
Lombtrd considers that individuals among, whose immediate 
lelitives cancer has occurred have a slight!) greater chance 
of contracting the condition than hts the remainder of tf)e 
population The difference between the two groups is not 
sufhcient to cause undue worr), but further statistical studies 
are desirable 

Crn /1 in Pugiwnc} — ^Titus urges the advisabihtv of routine 
vaginal examinations vn the last few weeks of pregnane) 
This is a safe procedure when proper!) performed When 
labour is imminent the cervix is an obliterated soft patulous 
oigan this condition of the cervix is the onl) index upon 
)\hich induction should be based and the onh line index 
of the end of prcgnanc) 

Nordisk Medicinsk Tidsknft 

Helsingfors vol 16 April 0 19 


Presse Mcdicale 

Ians vol 4a April 27, 

fi«.mim,r‘' ANiOurovLu MrnicisT 

♦EIccIroenccphilokMm m Ccrtiin Pilholoeicil Cooditionv-r \hrmcv,o 
O SiBcr mil A krcimller "irmcvui 

Toiil Cxiirmiion of PmcrLiiic CjMs— I Hcpbovici 
Anaiomo physioIoKical Oiiilinc of Veseiaiivc Ncrvmiv Si-vtcm Rcmihnns 
Mccliiinivm of Vesentne Tonus —DaniUopolu 
OriimcL of the Hipophisis tomrefs ihc Hypoihahmus — G T Iona 
C fc/ioiioxaUa 

C-tsc of AtIcnomT of Islands of Lanserh ms — A JinseV. and O rusinntxfcj 
Cancer of Limp m Miners of Joichiinsnl — H Sikl 
So called Haemolytic Icterus — M Nciousck '■ 

Qinntitativc DcicrmimUon of Lead in Blood — J Tcismgcr 
} iicoi7oua 

Newly Ascernmed Expcnmcnnl Data on Function of Spleen — \ kosutch 
ririophoid C Kunzendorf — K rodoroMlch 

Tfeitmeni of Spistic PTnI>sis Posterior Rhizotom> — M \o\lchiiJi 
Ncunnomvta ot Pcriphcnl Nerves — S D-\vido\ic s 

CUitio cnccphalograpin — The authors describe the resulK 
of their examination b> means of electro cncephalognplw o! 
eight cases of epileps) one of tetanv one of hemiplegia four 
teen of aphasia thirteen of cerebral tumour (of )\hich eight 
))ere verified at operation or necropsy) and ten of conn 

Pins vol 4B April 30 1918 

•UfCT Clcanncc Test (Van Slyke s Cocflicicnt) in. Studj of Rcnil Fufuncm — 
r Vallery R idot P Dclafoniiine and } F Porge 
Shortening of Mean I'cnod between Age Incidence of Prinnr> Tubirsiiloib 
Infection md A)vC Incidence of PulmotV’vtj Tuberculosis is n Diciv 
PnetJeal Consequences — E Bcrmrd and J Wcil 

Una CIcaiaiwc Test — The authors, after a detailed account 
of the urea clearance test and a comparatue stud) of Van 
Sljkes coefficient and Ambard s constant conclude that tlicw 
tests are complementary One of the chief ad)antagcs of the 
urea clearance test is that it is eas) to carry out and fiirnisliLs 
esidence of the functional elasticity of the noriinl as 
against the “ ngidit) of the diseased, kidne) 

Scluteizcrisclie Medizinisclie Wochensclirift 


Vinmin C Contcni of C'lbbigcs nnd BrusscI Sprouts— II LiccK 
Liver Rupture Amonc the Newborn 'iftcr Normal P-iruirition — H L 
Kottmticr 


Norsk Magasiii for Laegei idciisKapen 

Oslo vol 99 Mtv 193S 

*\Vas Radcsvkcn \ Vu imln dcficicno Disease’ — F Gron 
Case of Paridoxical Air Embolism — K Tlionnsscn 
♦Blood in Respiratory Pissages after Tonsfllcctomj — T Lcegaard 
G isinc Acidiii Determined by Fractioinl Aspiration of n Tc^t Meal — B 
Freihcim 

lumours in the Poterior Cranial Foiisa — A Torkildscn 
Psoriasis Bacillus — a Coryncbacicnum ’ — E Aascr 

‘ Railesiiken — This chronic disease ))as a national scourge 
in Norway fiom the beginning of the eighteenth till about the 
middle of the nineteenth centur) It )vas more important than 
iepiosv and )vas at one time thought to be a manifestation of 
tertiary svphihs Gron hovoer, thinks it ma) base been 

SCUD ) 

Blood in Rcspiialoi} Pamiges afUi TonsilUcloiin — Indirect 
larsngoscopy of 109 patients on whom tonsillectomy ))as per- 
formed under local anaesthesia mostly in the sitting posture, 
shoved that a large amount of blood and pharyngeal secretion 
flovs down into the lover respiratory tract This process 
IS to a certain extent prevented when tonsillectomy is per- 
formed in the recumbent posture Onl) t)Vo cases of slight 
bronchopneumonia foUo)ved a total of 1 007 tonsillectomies 


Policlinico 

Rome xol 45 April 2 S 191S (Sez Pni ) 

TrcTimcnt of Chronic MonOTrticuIar Rhcimntism by Novocain Infiltration — 
M Tnpodi 

Ptrcrt.atic Lithnsiii — M C^ace 

106 B 


Basic vol 68 April 30 193S 


pEST'icimirT TO Proussot F or Oufrvain 
S jmptomatolofiy of Givlrotohc FisiuJa — B Brcilner 
Wife cxtcpMon — M Kirschner 

•L^tc SvmptomTioIofiy of Pigcis OvicodyMrophy of the Spine — G UoyfcV 
Sircomin of Muscles — C Lcnormani 

♦Excision of I irst Lumbar Ganglion for Painful Sequelae of Lower Limb 
Phlebitis — R Lerichc 

Two Cvscs of Gastric Tuberculosis — R Ales'sandn 
Post operative Illness — M Donati 

Infection or Verminous Protccuon of Wounds? — D Giordano 
Case of Cerebral Prolapse into Frontal Sinus — O Uffrcduzzi 
Hisio pathology of Synoviil Diseases — von Vcrcbtfl) 

Return to Billroth I in Secondary Operations on Stomach— P Clurmont 
Abdonuno perineal Excision of Rectum — P Decker 

Simple Analysis of Mclh icmoglobm by Pvdfcich s Stufophottmiticr —A 
Gigon nnd M Noverraz 

Opcrition for Dislocation of Lllna at Inferior Radioulnar Joint —C Urn chca 
Destruction of Femoral Neck bv Aberrant Pscudo-arthrosis Kevtonhun — 
H Tsclin 

Cure bj Castrition of Invert and Dchihilionisis — A Jentzer 

Non iodine Trcitment of Experimental Hyperthyroidism —H AbcUn 

Nervous Regulilion of Tlivroid Activity — L Asher 

Rare Abnormalities of Anenes of Thigh and Pelvic Floor— H niunt'Chh 

FfTect of Chlorophyll on HciIing of W'ounds — E Bilrgi 

Ergot Extrecfs — P Casparis and J Bullet 

Expression Injuries of Skull —3 Dcitling 

Indications for Osicotomv it Upper End of Femur— M Diil>ois 


ndcmic Infantile Paralysis and Trauma— W Frey 
.arsen Johansson Disease of Patella and Schlatter s Disease C O an 
cacl Localization of Ocular Foreign Bodies — H Goldmann 
cthods of Operative Sterilization rn Females —H GuRRtsberg 
rigm and Purpose of Self mutilation — J Klacsl 
election of Small Pleural Effusions —A Licchti 
evclopmcnts in Oio laryngology —E LUscher 
atboicctomy in High Origin of Ancrn Profunda Femon v^nhin 
H Mam 

adophlebim Obliterans Ilcpatica— \ Schdpbach 
•numaiic Jntcrml HacmotthiRic Pichymcninciiis -C W«k m 
etilis ot Trmxurcihnl Electric Prostatic Rcxcctfon -H 'Y 
axiro enterostomy on Pyloric Side of Lov\csi Point in i 
T Johner 

poid nnd Cincer — H Buchlcr _ . , a, n„o, 

cparm in IrLtcntion ot Post-operative TItromboscs — J de fuor 


Juu 9 193S 


KEY TO CURRENT MEDICAL LITERATURE 


Ftj X f» 

'litres }(rt\ I 


POetts Spinal Osleotf\^irop/i\ — The ca<e<; iKu^lraied in- 
clude (1) hi^ion of bodies and nrehej* of cenicnl \er ebrae 
uiih ndicular pain f2) gibbuj* and fu«ed ihoracic ^er*ebrae 
(3) Spastic paraplegia from ad\anccd thoracic \eriebral Paget s 
disease Pathological fractures occur at a much earlier ^lage 
Nvnen porosis predominates o\er sclerosis 

Lumbar Gan^itoncctonix jar Past phlebtUt Petn — Lcriche 
describes a special evirapentoneal approach to the first lu-rhar 
ganglion uhich he has remo\ed with lasimgU good results 
in three cases in which ser\ «e\ere crural pain accompanied 
h^ cutaneous atrophs threatening ulceration followed phlebitis 
oaling ‘^ome a ears b'^ck On the other hand no operaii\c 
treatment he finds permanenih relieves poM phlcbiiic 
ulceration 

Patebar Osteochoiuintis — Glanzmann de cribcs the ev entpl 
features of ju\en'Ie osteochondritis of the patella which w*.s 
dc'cnbed indcpendentK b\ Lar en •’nd Johan« on in 1921 
Both their patients had in adoition Schlatters diAea<.e of the 
lioial apophAsis Other cases in the literature are <ummdrized 
some were complicated bA Perihess di^^ea^e \ coosm of 
Ghnzmanns own patient A\jih patellar osteochondritis had 
Schlatters disease the coi sm s father h^d tartiHginous 
CAosloses of the lower ends of the femora The clinical igns 
and relation to trauma are discussed 

Science 

\ori. April 19*S 

P) o fj al SiudY cf Rind Ca our of Cen- n Caru Fruj a — E \ Mi Icr 
Moeular ^\eIChls ot Lfca^e Cana>a)m ConcwnaA^’n \ -nd Con n 

B —J B SoRinff N Gralen and 1 B Erik Aon Qjc- el 
Sirrc Effc\i< cl \ndro< crcnc on Swu 1 Dexeforment ct fcrraie R is — 
R K Greene M \\ Bumll ..nd a C tvj 

Ugesknft for Lacger 

Copenbajen >cl 1C3 Apnl “s jo $ 

Treairrent of EridcrmoniA C5es of Hands and Feet «ah Jer d s /rnttrbu e* s 
— A X» inoTT 

Are AsanaHc Fakilaics for DJ»sro*tnfi O norTfi«« in Women «tw*.tj 
Exploiied to ihe Eatcni ihe* De'cne*'— t LomhoU 
G ca8> 3rd Dr) Hair A Si ti itcal Soncj — ^ PeuI en 


V 


Ca e P* Field e- Alrt « De-n-rt — T Jer er 

A ti-F tc lie I A u c T. r c— -n-cuGc-rx-Lr ii c 

w h Irfcm-I Rcn-d - — O ^ J r - cr 

1. on ard Derev'-^ fsT Ct - t <- E f® o A j C — T E 
L ron n ib' Trca — er cf Gc t** « —A Ce-- 

DtCfosis of Gonorr! OH — \ »L<i of the ma en^l a i 
able at the Ric hospital m Coper^ii«'*n Avowed ih^i i-adckL c 
u e IS still m-de ot a careful hi ton rc^o d of ^ biv c o 
logical examination of the di charge from t^c cervix rd 
urethra and of the complerreni fixation ic*-t In p te ihe 
general agreement as fo the cre^t diagno ru v^/ue of ihi tc t 
in gonorrhoea it is still the exception rainer th r ihc uie 
for It to be applied to ju t those ca es m vn h ii wui 'd fu 
parucularh A**luarle — narrelv iho e in whi h oiner eMdcPwC 
of gonorrhoea is doubtful or in^cequaie 

Wiener Khnuche Wochenschnft 

Aierr^ ac 51 ■'T'” i** 

S rve or* arc. P* S cnee rR/t" w f 

C ^ rc -d J a er ^ Nar — k Z - "* 

Tfatme*' cf LfifU"\ l"re Xc— TM 

Omt-aJ Pi t c t Tu *.-aer* _ — O B ich 
bntp c Rciction for De e-l ''** I A et -cr-i — AA L c rt 
Xoiar-rs n L rc CC — R Chaa'-s 

AAh rrACtuie^ 1 A We d Fnt t** Gc P cr Trc i ^ 

P 

Trcatme-t of Tutcr u •n L* cx fh r-x rc XI — E We 

Acetonn ta — A imple redeem con i t nc or I gr4.mme of 
2 4 d!nilrophenAlh\dr«zine with cum of conveniritcd 
hxdrochlonc acid and 2''0 cum of distilled w».fer is u cJul 
in detecting the presence o' aue one m the innc 2 uvn oi 
reagent is mixed with 2 c ct oi unne und m the rrcsence 
of acetone *. thick vellow cloud irpe*.r Libbrechi ^ 
the <ensiti\ii\ of the test ,js ) s o(i(> 

Wiener Medizimsche W ochenschnft 

\ cr- V iS Ar p 
Brencha! Asthma— <5 He cr 

$unl (ht rd OiFci F rr» cf R o i n TFcr r) n SV n Dpc- c« it Crrc a 
Pr- T c Ken ad 

Alexiausi cf Pair in Or<cin — L Krul 
TFcr-f ef Fema?'* Gurc’rrce^ — R Hcf raucr 


SPECIAL JOURNALS 


Ada Chirurgica Scandina^rca 

» SilxEhcfnj xcl SO April I 1® S 

Aru icmosis of Bfliiri p sjpcA for ObNiru rne J undi c Tbirrj>*e'cn C» es — 
L Nonlm 

Po't-Arerainc Thlcsmonnus Ga«fri{’s — xf Per n 

B-ck ard DtUvaiion of Aila Axid iojiw x iJi Fr^ciurc cf Od red — 
C Stindelin 

Spina Bifda Prc'Tic«i and Hcrediw — S HindeNjclcn 

Spina Btfiifa — ^Thc authors material consists of s'>7 cases 
collected from Dimsh hospitals The prognosis and paiho 
genesis of the disease were inAcsiigaied Onlv mcningocelcb 
■should be submitted to operation and as a rule the children 
should be transferred to neurosurgical depinment It is 
AcrA probable that a complicated hereditarv factor plaAs an 
important part in the causation of the condition 

American Journal of Public Health 

Ncn ^erk >c’ CS April 

CcTJain Crncria in OualJicanom aru rrepam n f Hc-.iib Of 'c-s — 
ttenri E xtcleno 

Phx luian 5 Srateneni of Cau e of Dc th — A HardM> Sc erx 
O'panKmx inxthed tn Polluiton cf AA «ter fr ~i Lone c«l F«c c? — L AA Parr 
riextriti c A peew ct CnrP’mc Di ca e< — H E HT 
PirM V Health Nunc and OnhepacA.! Surx -c C-rc — D ro *i i Carer 
s<xisl AAptk *nd rhe msi-allv Hand -apred Ch d in Dexe -*^cr cf « 
Noa Slate PrcitTanme — D rtJi B». Vner 
AiQuircd Tvibcr-ul nw »n PriTraics in Latctatcncx *nu 2 v op -i C ect ra — 
C. R Svhroedcr 


Irdu trul H^rfc rr icd Octh rr taruf^ iurj'*e lodu fr> — lA i mcr H 
S*-rul7e 

Ne r r'> Eviucr c u- Rcl t n f SmtXj Atn '«-rere t F-r nTC » — 
S..r*ijel R Haxibo ’•ad H-^r-) B Aftl cf 
Ph> <;jc -nd Heal h — le^ e Fei r'r AA > 

Prepen ct Cau<c> uf Sn Iftnh — Eh I C D nh m Elczapeth C Taru 
Ed n F Oaf nd CL E Haxes 

Exicri ard Sei,o -1 A^naltcrx 1 Ir e rrrtte-* c in Gru ih — C E Tu -cr 
wOd Alfred Nerd trLT" 

Qualifications of Htdif Otiicrs utaca of medical and 

other qualifications held bA whole time and part time medical 
ofticcrs m counties dislncts Lrgc cities and «mll cities \ 
larce proportion of men have medical decrees onlv and no 
public health qualification Some tup to per cent in two 
groups) haAe no degree at all others, hold degrees m anifarv 
enginee in- vciermarv stierce ..nd even pbarnwcA Lpon 
this unahsis is based a for b-s c qualification speut-li t 
training po igraduaic course '•nd full time crvicc for iho c 
Avell qualified 

Clothmc In^iis:r\ ‘unc\ ol ihc hazard.; lo health 
common to tactones ir cere-al showinc ih-t the d-rger of 
c rbon monoxide pci oninc tircm ga fired h-rd ircns etc) 
js highest m the cloihin-v mdusirv HAgicrc service o cr a 
period of five Acars (1^2-”i bas reduced this ~hc*nrd 
from " r«r cert to " pe- cent Simlar red ictic^s jn c her 
n ks srd dancers cxccp ir-t o! cLre from wrti''s.t I 1 ghtir^ 
h^Ac b-^n cficuted 

Sff^s Atntspitrt n i* } i til i i i u — Piitsburgh ha acorn 
f*.fatiAcK high preumo''ia rate and an -trre p^erc laden wiih 

JW c 


32 JuL\ 9 J93S 


KEY TO CURRENT MEDICAL LITERATURE 


TllEBRinsH, 
Medical Iodrnvl 


dust md smoke As a result of 3 000 necropsies nothing 
tangible was found to connect pigment deposition in the 
lungs with the high incidence and high mortihU of pneu 
monia The association of seiere anthncosis and healing 
b\ organization was verified 

Caiisa o} StiUhiilh~\r\ the USA 27 000 stillbirths aie 
registered annually Products of conception prerious to the 
fifth month are not registered as stillbirths m most States 
In addition there are 63 000 infant deaths of which 89 per 
cent occur in the first month and are largely due to natal 
and pre natal causes A plea for uniform reporting a 
standard certificate post mortem examinations an acceptable 
method of classification, and co operation between phtsicians 
lA made 


Annales de Dermatologic et de Svphihgraphie 

PariA \ol 9 Apnl I<1J8 

SjplHli'* ciuMng Rupture of \ tscerA iponiincoiK Rupture of Gumniitous 
Kidnci — M Tavre P Croizai and R Miriinc 
•Subacute Ciuancous L>mnho8r'inulcimaioMS — S Nicolao 

Subacute Cutaneous LMuplwt;i aiuilomatosis — Nicohu points 
out that hmphogranuloma inguinale is rareh a skm 
disease and in fact onis se\en cases of subacute cutaneous 
1\ mphogranulomatosis could be found in the literature He 
himself describes fullv a case (with photographs) with mvohe- 
ment of a large area of skm oxer the left lower part of the 
abdomen left inguinal region and the upper part of the left 
thigh The first signs of inguinal bubo occurred in February 
but the skm did not begin to show infiltration till the following 
September In the case described the affection did not spread 
along the Emphatic channels but seemed to traxerse the 
reticular tissue, and in this respect presented an analogx xxith 
those cases m xvhich I>mphogianuloma inguinale causes long 
fistulous tracks in the depths of the subcutaneous tissue 


Annales d Hygiene Publique, Indusfrielle et Sociale 

Pins xol 16 April 191S 

•Report on Appiratns for TcndcrinR Mt'it— Mbcrt Besson ^ 
Cianficaiion of Waters of the Loire Conditions of Usngc nnd CotPptnson 
bciNsccn Sulphate of Alumim and Pcrchloridc of Iron as Plocculuion 
Ascnis — O Dudes ant M E Lasnunc 'ind L Froenm 
•Two Epidemics of Diphihcrn al^Bctiijcu Preventorium nt an Inicrvil of 
Five "Vtars — ^Marcel Bronfimari 

Training of Hygienists and Medico socisl Control of Public A’lsisnncc^ — 
A Dupuy 

Teadenag Meat — It is customarx among Frenchx 
butcheis to use an instrument furnished with numerous small 
thin steel blades for beating meat so that the tough fibres 
are cut thereby producing tenderness It is submitted 

that meat thus tendered is sold bx misrepresentation, and 
that such an instrument max readilx conx'e) infection The 
use of these instruments has been prohibited in the, Somme 
district and a plea is entered for extension of the prohibition 
throughout the countrx 

Two Diphtheria Epidemics — ^The Preventorium is a country 
conxalescent home for delicate (citx) children In spite of 
prcliminarx examination of the throats of entrants, outbreaks 
of diphtheria occurred in 1931 and 1937 The results of 
bacterial and other mxestigations the effect of immuniza- 
tion with Ramons ‘ anatoxine the pan plaxed bx carriers 
and suggestions for prexentixe measures of a practical nature 
are discussed in detail 


Annals of Internal Medicine 

Baltimore \ol 11 April f9JS 

Grave Sequelae of Blood Tr'Vn'xfuMonji 1liiric.«.n Caso in 3 ''1)0 Trin>fosions — • 
E L DlGo'auv 

Chionic Atrophic AnUritiv — H E TliompNon B L and R A Hicks 

Turn Hirs of PuImonar> Apicc and Ad/actnt Rcgionn involving Brachial 
PRxus — H C Habcin J M MilRr and J C Hcnihornc 

106 D 


CHLUlinon Time DnenDsiic A,<1 m Hvpcrtl.sro.dDm -S J Cdustrs 
Mhcnpciitic experiences piih Cobn Xenom— D I Michi 

Wixhburn" Anuniia-II M ^ ^ 

'bpper Lobe Pnenmonn ,n AduKx -M B Rosenbhii xnd A Iliehnnn 
HcliothLnpy of TuberculoMi* — E Ma\cr 
Svndromc of Extnrtnal Azomemn — H J<.fthcr^ and H J JhkM 
Large Pcnc'irdnl EfTusion complicating Acute Coromrv TliromboK—r s 
Nicho) 

Hypcrinsiilinism ALSoentecI wnh Hypaihyroidixm Tap Cixcs— I t 
Cxcmichacl 

Mu culo xpinl PxTxIvxu affer Scnirn Iniccbon (Rccumni: itier Second In,-, 
tionl — L Bnhds 


Cohia Venom — ^The claims of French xxorkers that eohn 
xenom has a xaluable analgesic action are confirmed ami 
extended In (he doses employed cobra xenom is no more 
toxic than many xxidely used alkaloids In comparison xxiili 
morphine its action is of sloxxer onset but much mort cn 
during, lasting for one or more days It is of especial usl 
in cases of intractable pain due to inoperable cancer It w 
also claimed that the xenom is useful in rclicxing the pun 
and rigidilx of Parkinson s disease 


Uppci Lobe Fiiciimoiua — Upper lobe pneumonia was found 
in 24 per cent of a senes of 180 cases of lobar pnenmoma 
and the mortality rate xx'as 42 per cent The condition w 
remarkable for the infrequency of phy'Sical signs of con 
solidation and (he simulation of pulmonarx tiibcrculoxix 
the marked toxicity and the frequent occurrence of mcnincitic 
sxmptoms, and the infrequency xxith which- pneumocoLCi of 
a definite ty pc could be isolated Excellent radiographs ot 
typical cases are gixen 


Arclincs of Internal Medtcmc 

ChiciRo \ol 61 April J93S 

•Laurence Moon Biedl Sjntiromc Rchiion to GtiKnl Problem ol Rcimiuv 
,^J['iRmcni05'i — J Marmor and R K Lambert 
Mctabohi^m of Vitamin C m Khuumatoid Arthrim. — J f Rinehart L 0 
Greenberg T Baker S R Mctucr F Brnckman and T Chvv> 
Mctabolnm of Vitamm C m Rheumatic Fevur — J F Rinehart L D Cri.cn 
berg M OJnc) and F Choy 

♦Comparative Evaluation m Clinical Practice Compicmciu Fixalion in 
Amocbiasiv ^ — M Paulson and J Andrtvvs 
Hvpcrmsulinism and Cerebral Changes Case of IMcl Cell Adenoma o( 
lancrcas — N Malnuid nnd L C GroMv 
Clinical Studies m Circulaiori Adjustments IV Oblncratinft Pulmoniri 
Aricrms wuh Secondary Pulmonary Changes and Right ^ cntnctil-ir 
Hjpcrtrophv Case Report with Nccrppv> — M A Roihskluld anJ 
A A Goldbloom 

Renal Insumcicncy from Blood Transfusion \\ Anatomical Changes in Man 
compared with those in Does with Experimental Hacmoglohmvitia — 
L L DlCowui r D Warner and W I Randall 
Hyptnhvrojdism and Pulmonarv Tuberculosis Review of Lucraiutc an3 
T\vtni> three Casci—E Rose and H U Hopkins 
♦Piolongcd Mcningococcicmia Tbreu Case’s— A CatboncU and C P CimpbcK 
Luer and Biliary Tract Review for 1937 —C II Greene ht Pkur 
S A LoCalio 

Lain ciice-Mooii Bud! S\iidronit — Two cises of Ihi' 
sxndrome are reported and the present knoxx ledge of iL 
condition is rcxiexxed and its assocntion xxith rctmiUs pti. 
mentosa discussed The x icxv is put forxx'xrd that the 
sxndrome is a congenml anomaly dependent on an inherited 
chromosomal factor 

Complement Fnatioii in Amoibiasis — The results of tlu' 
test and of clinical examination xxith microscopical inspeciion 
of the stools xxere compared on a senes ot cases of amochi 
dxsentery and of diarrhoea due to other conditions II w 
concluded that in the indixidual case microscopical cxaminx 
tion of the stools is still the most rchahlc diagnostic method 

Prolonged MLiiingococcal lipticaimin — Three cascx ire 
reported and the American literature on this condition ij 
rexiexxed Fexcr of tertian or quartan txpc of proloncc 
duration associated xxith mxalgia multiform erx lliennloii' 
rashes and the absence of cachexia arc significant feature' 
Meningococcal endocarditis is distinguished by a high anJ 
sustained temperature 



JuLV 9 1938 


KEY TO CURREN’T MEDICAL LITERATURE 


1 


inclines of Neuro!og> and Ps\chialr\ 

Chfcaco %of 59 ApnJ i99S 

Pcnancniis Nodcxa Cl ni o-rathofcjn-a! Sti.‘d> v.iib Special Re/cfcncc lo 
Ncnoirs S)-stcin — J \\ Kernohan and H NV W pitman 
^uclcu< Laicralrs McduIIae Expcrimcnjl Study of iis Anatomical Ci.nrea»cns 
in \1acccus rhesus ■ — G A Blakcs ec J S Fre*m-n and S E. Barrera 
In ulm SboeV. Therapy in Schizophrenia n> H Rerse and ^ \andcr\ecr 
McirarpI Shock Treatment of Functional P\jcho<c5 — A A Lofi J R 
Sonenthal F Blaurock \f Caplan T Sherman and F C Wht emb 
Mechanism of Misrainc Headache and Action of Erjrotamine Tartrtc — J R 
Graham and H G olT 
Re^Jcwncss in Children — P M Lctin 
Bad Ta^tc (Cacoseusia) — H H H-^rt 

Human Auiononic Pharrracoloifj \I EfTect of Benzednne Sulph le on 
^r|:JII Robet on Pupil — Abraham Mjerv'n and W Thau 
Autonomic ».nd Vfotcr Localiz non in the Hjpoth lamus — L Ector< \ L 
B ooken and R \\ Gerard 

Exccnmcnial Encephalitis prcduced bv In ratencus In eel ion of \-rcus 
Ccagul rts — P F A Ho fer T Putnam ard M G Gra 

Fen arteritis Modosa — In this paper after a general discussion 
of ihe disease kernohan and WoWman gi\e a detailed clmical 
and pathological discussion of five ca«es of pen artentis nodosa 
with neurological svmpioms Thev conclude that the de- 
generation of the peripheral nerves appears to be the result 
of the occlusion or marl^ed narrowing of the lumen of the 
nviinent arteries and is not due to inflammation in the ner\e 
or to the effects of the toxins of the di ea e 

Expinmcntal Encephalitis — Hoefer and his co vvorker^ have 
produced m animak neurological svmpioms and patholo<’icaI 
"hanges in the nervous svsiem b\ means of sublethal do<es 
of coagulants given mlravenou«lv Jn the successful expert 
ments such '•vmploms as blindness and paralvsis of the limbs 
were produced and Tn intent degenerative reparative and 
exudative process involving both the grev and vvhiie matter 
vv-as found in the cerebral hemispheres These changes were 
most intense round the venules and it is stated that the lesions 
closelv resemble those of post vaccinal and post measles 
encephalitis 

Archives of Ophthalmolo© 

Chfca^o \cil 19 April 1998 

Ca e if Chofoidal ScIcfoMS m Coronary Aricn >5cleroin — -Vfanin Cc^hen 
Psretoiherapj tn Ophihalmoloj^ — L Hambresin 
Prob cm of GJauoma — -Bemamm L Gordon 

InTscap^uter Cataract Extraction Further Scries of Ca_es — ■Leifhton F 
Applcroan 

- Di-minant fj^c Clinical Srpnificance — W H Fink 

P\ntothtrap\ — The difference between pvrctolherapv and 
shock therapv is emphasized The former mav be produced 
b\ mahnal therapv Dmelcos vaccine pvTifer sulphur in oil 
short waves and the hvpertherm of ketlenng It is the onlv 
treatment of anv value m svphihtic optic atrophi though the 
results are onlv fair sulphur and malarial therapv are most 
efiicacious Dmelcos vaccine is useful for acute and sub 
acute inflammations it being sometimes helpful to use shock 
Ihempv at the same time Short waves and the Kettering 
hvpertherm are still in the experimental stage 


\rchnes of Pcdiafncs 

Xcw Xerk \cl 4 Ar n 19 8 

S"^ urn Thi ■•'Ulrhaic Trc lircni in S« Cases of AUcrfy — J E Klc r» 
Vuanins and Minerals in Sutnticn of Children — A T Pn itcra 
Hereditary Ecrodermal Gj’sria.u Afihid ctic, Son-scc linked T>ro — C C 
Kcfle> 

lirprocd Sanitarv Cap f r Nursinu Bottles — O J Kahn 

\ fubliij of Fjrdinirs >n Tuberculous Mcnnn is — H E. Thcarvcr «.nd 
J Baldwin 

Oul nc for Diacnc<t^ and Tre-incm of Allcrr l D'ca-cs of Cb uren — 
A E. Kaih rem R C Cuti ».nd A \ Steeper 

Sodium Thiosulphate Treatment o] AUerc'^ — ^Thib brief 
scries of clinical studies indicaies that sodium thiosulphate is 
a valuable drug in the treatment of allergic reactions It mav 
be given intravenoiislv and orallv for micrainc ur i<r m rd 
'I ch severe serum reactions as ccca lonallv ansc after im 


Thi FrrTHF 
virr Cat 1 t\ t 


munization against carlei fever The relief of vnricn is 
quick and often dramatic Cases ?re de enhed where 
drug uas given with good results ifs r'cdc c icn n ..[ e g\ 
IS doub*f 1 


British Journal of Experimental Paihologv 

Lo’-d n V I 19 Arnl fs 


Menmsxxcal Brcih-cu turc Fi frates Fj re Fr 
B G Macrraiih 

7u-i urs in Rat' ard M c fo ns Ib\ ir t In c i 
H rh pi-HCT Vficro<cor l, \2 p ^ 

Htirmclwcit 

Cl •‘m -a! C icn cl Ac* »c Ajr t c R i, 

FirmAnidc Meihod fo Ext aion e P t, fr 

c xxi — A T Fu ler 

Effect cf Sulrhon-n dc Cmp urts cn Cena ^ u 
Bn to** 

P tpar'C on of P^o c^ivc Sera -afair^ Hacrr Si cr 
Speafe Ccmnienc-r Fivatjon »'*h S''trc s F r V 

to X 1 u r -tralJirg ProFCrtic* cf Jrrm-r s — 
Scrolo-iwl Pr pcnies of ♦. P 1 ^ ha I '■a cl. — 
H-cr-o/>ti Srrcpioccs—; — H t 'c«cr Xj 


c •* Eire "“s 

V. _F p s f ^ 
\ *'r' 

X ! V r ^ 
— H c— 

u t r I 

% H L * - 

Pc-i 

V l: P r 

M -i. i 


I 


ri 


Ji{enm<!'ococcus Antitoxin — Sc-vvlkd rreamcovvswv •- 

aniiioxin from both cotriTn^ru^] ^nd oiher ourtc doe ror 
inhibit the lethal action of the toxis ub un*.e m nlir le ot 
meningococcus broih cultures when ihe two ^rt in;eitetl 
together miracercbrallv into guinea pij. The c ioml filir c 
have a poor capaciiv for exLiiing antibodv forrration of o rcr 
kinds m the rabbit and hor<e The author cnrKize_ the work 
of Fern on this subject and submits Ihwi ihcre is ro reli hit 
experimental evidence at pre enl in uppori of ihc use o' lu'' 
toxic fillralea for the prepantioT oi iherapcuiit era 


Ettects of Thoroirast — R^i and mice were given two do c 
of Oo cem and 01 cem re^pectjvelv of ihorotravi bv vb 
cutaneous injection with an interval of a fortnight Among 
survivors for one vear or more *'8 per cent ot rats and 26 per 
cent of mice developed a tumour .^*1 the ite of inowulaiion 
manv of these tumours were malignant and ol eve-al different 
tvpes although a spindlc-ceJIed sarcoma occurred most torn 
monlv The structural changes preceding this result v ere 
stidied and it is suggested that the m'thgnanwv is the com 
bmed result of radio acUMiv and of ihe mfl-mmaiorv rc-tticn 
caused bv the presence of thoroirast 


GvTiecoIogie et Obstetriquc 

Parri \cl 37 April s 

Treatir ni of Puerperal Inlcctitn b> Ini’a^env.j^ Irjcvi •s t G k 
A ttholii Scrum — p TnJ i ^ru- R B th au t 
K'-roprach Appararuv lor Tubal Invir’^j ot — L ou v B«.r ci 
Clir*c2l M-«hc>(l for Dcierm^ tS Do^ape cf Fc ubr Hrrrrcrc^ — A D ‘T 
P~c'cml In lOT of Foe u in — O C c t 

Cmycnit^! D-'ca c of KnJrcy m Tbrec Slv.cr> or-pl^ rc P'c t-to — J ht-r 
Thcrarcun-- \_tu^ cf oa r — ct n TupaJ O c r “ — R k c T '“-r 

3rd J H»ldre 

Prepn^r > at Term CaovCT ot the Cervix — S I Sicrn 

Hy^terosatpins^ogrophx — ^Thc ai thors h\ stress on the 
therapeutic as compicmentarv to the diagnostic v».ltc of 
tipiodol injection of the Fallopian tubes »,nd oucte everai 
ca cv m which the operation has been succeeded t pregmnex 


Journal of Bone and Joint Surgerv 

Bwtem ^cl 23 Ar I ^ 

Orrr-'i n it Ihc Thm**' — S cz n- B cl 

Dt'c-'C cf t*'c Apoph '»cal llrrc-xcriehran Af l c- — A r>-pcr>-<— e 

Orc^r t Ir""* o e O^-ur ers P ra • — C C V - 
Sps-djlvlo i I -cr 1 

Sj. -c _J dc M 1 -n O icrf -o 

Crarrer-e of the L pa-c- cm P — A Cat c Lr-c. P, l f » 
SK.ti ^ RaC>-t m — H » c. A Pf »r 

Corrcci n c I- crral Rp-.i m cl ib T> r\ m -v P —Hr-p* i A 

D P 

E rc *-00^1 rC-'' — fS -AVP — 

rrTd TCHDiC 

P-fc*^ rrc rper ^ h '1 be Kr<c A f C 1 v 

Qa c» 


it' L 



16 JUL\ 9, 1938 


e 

Rndiolog'N 

St P^ul Mmncsan \ol 30 April tO^S 
ncdsidi. Mmncr m R idiolocj — B H OrniioB 

inttt,nt(on of ClmtcTl ^^d R^dlo!o!^^^: d finOwss in Dupnoii’: of Cirtinomi 

oi OcsophasHs 100 Cws — J T r-itrcll nm 

Itidiolocical Demonsintioa of Tinucs (Aornni and PadioiOBica!) IminR a 
UcHtivch Lon Difftruntul Absorption —3 llus'idl Cariv 
*IniiTtLdi'ilc and Cnd Rcsufts of R idiation flicrapi in Certain Brnii^n Boot 
Tumours— H P Doub r Vi' Hartman and C L MitclitSl 
Skin Metastasis in Post oper itiii. Irridiated Brsist Canter — r U O Brien 
CioloRical Basis of riactionaicd Method of Irradiation of MiliEnint Tumours 
— 3 Borak 

Tissue Necrosis — A G Schnack 

UadicilOBical Studies of Tnins and Triplets — L G RiRlcr 
Spontaneous Pncumolhorair — D F Ehrlich and A Scliomet 
Racial \atiaiions in Incidence ol C meet —Sir G Lcnthal Cheatit and M 
Cutler 

Cluneal Obstriations in Trtalincni of Cancer bi Supcri oUaci. \ Rais — 
S G Mudd C K Fmcrv and L M Lc\i 
Sharpness of Shadows m Radiocraphi of Limes — R R Newell 
Petircwal Inicctions of Gas in Radiological Siiidi of Adrenals — C Giantiirco 
and C H Drcnckhahn 

RaeiioliiLi ap\ of BtitiQii Bone Tmuoms — The mijor part 
of this papei is deioted fo t description of the technique and 
results of radiotherapj in gnnt cell tumours of bone The 
statistics show i high proportion of cures with the method 
recommended A benign giant cel) tumour mai degenente 
into osteogeijetic sarcoma in some cases the degeneration can 
be traced to injurs It is possible that frequenth' repeated 
small doses of \ ra\s ma> have a stimulating effect on the 
growth It would therefore seem advisable to use less frequent 
larger doses at longer inieivals The authors are against the 
combination of surgerv and v ravs for giant cell tumours as 
this mav possiblv favour malignant degeneration The paper 
includes also a short discussion on bone cjsts vvith special 
reference to v-ra\ tlterapv In the case reported malignant 
degeneration occurred after eighteen months in spite of ex 
tensive calcification of the original tumour under the influence 
of radiotherapv' Benign ehondromata are also discussed 
these tumours are seen to be radio resistant and large doses of 
V ravs are required to destro> them 

Schmerz Narkose-Anaesthesic 

Leipzic vol 11 April I93S 

•Scopi. anil Indiciiions for Positiic Pressure Pnliolosicat and PuiSMotPRicsl 
Foundations — tvilii in 

Present Position of Gas Anacsthesu II Ethylene — B Wilde 

PosUiie Picsslire Anaesthesia — ^The conditions present in 
open and closed pneumothorax and their effects on the diffi- 
culties and dangers of chest operations are fullv discussed 
The mobilitj of the mediastinum is the most important factor 
and means for estimating this before operation are outlined 
The effects of the analeptics coraminc cardiaZol, etc on the 
lespiiatory system are shown to consist of a general mcrea'C 
in muscle tone with consequent enlargement of available 
lung area as well as central alterations of the rate and 
depth of breathing Recent work has shown the Brener 
Henng reflexes to be similarl' concerned with alterations 
in muscular tone rath*'! than with automatic working of the 
lespiialory cjcle The starting position of the muscles of 
respiration is thus modified in orde" to correlate the available 
lung a/ea with the oxvgen needs of the bodv 

Transactions of the Roval Socictv of Tropical Medicine 
and Hvgiene 

London \ol 31 Annl 20 _ 

♦Oimaiic Oubo or Ljmphosrinnloma Ineuinale— H M Htnicht.il 
•CUmTUc Bilbo or LiniDhok-ranuIorna Wiguimlc m AfrJcm Nniuir' — Ckment C 
ChcutrmTn 

•ChrmtiL Bubo or LjmphojrrnnuipinT /nRuim/c E>Pi.nmcmtl Invt Ci^iiion — 
G M Findh> 

Antimony Rcstiunct m Uiccnrive GrTtiuiorni — K Eirfc 

Scorpion Poisoning in Trinidnd — -J A WTicrman 

Ccrtbrospin il rUiid of pTiicnls ChuiCM. SfrTtn of fichp Fever — 

Huci I an CbunR 

Dc ith Rite md Lpidutnulog^ ot Sn\’\U poe m Hopk kooR — k. H Oirlej 
Tropicil Phigcdacniv Ulcer in cht Paci/ic — R Kirk 
Somd Ciscs ol DiiscminTicd SektOMe — \ \ D^ce Slnrp 

Schi lotomiasii in Kivironrfo DiMnci of ktnji Coon> — R M Dowde uelt 
Amoebic Hepapc \bscc s and Assoented 1 ric irdut^ — F V FuncA 

106 ii 


'icnicAL ioiTsa 


Bubo Dunng the fist U\ent\ \e'\rs out of 17 9fKl 
male cases of genita inainnal lesions HO cases of clmnL 
bubo hive been diagnosed onlv in four was the pnnnn 
lesion present An account is given of the general and spvi.nl 
diignostic points If response to protein shock iherapi js noi 
obvious within a fortnight excision of the affected glands 
should be considered operation mav he neccssarv m )s per 
cent of cases ' 

In Afiican native women the pnmaiv lesion is an iikcr on 
the labm or vestibule Subsequent evolution occurs bv chronic 
ulceration with induration and but little epithelialization pro 
diicing perforations adhesions, or stricture Inguinal adeno 
pathv IS rare and rectal strictuie and various fistnlae arv 
commonlv associated with the vulval lesions 
Twentv SIX strains of virus have been isolated bv inira 
cerebral injection into mice The snaall cytoplasnaic gramiks 
found in the inguinal lesion of-man in the brains of inkclvd 
mice and monkrevs and in experimental buboes in guinea 
pigs ilmost certainlv represent the aetiologicil agent Similar 
granules are found in the ciiono allantoic membrane of Vhv 
developing cliivk embrio infected with h mphograniiionia 
inguinale in the qells of the rabbits cornea grown in tissue 
culture and in Tv rode tissue cultures of the virus Tli" 
dimensions of the virus as shown bv filtration through cradij 
collodion membranes appeir to be about 0 125 » to 017' » 
but larger forms occur and it is possible that the virus nn\ 
undergo a cvcle comparable to that of the psittacosis virus 
An antiserum prepaied bi injection of material from whivh 
the elemenlarv coipuscles have been removed bv dilTcrcninl 
centufugation contains no virucidal immune bodies on the 
other hand an antiserum prepared bv the injection of con 
centiiled saspcnnons of elcmcnltn bodies rchtnelj fret 
from tissue elements contains virucidal minuine bodies li 
thus appears that the presence of elementarv bodies is esscninl 
for the production of virucidal immune bodies 

\ 

Zcitsclinft fur Kmdcrhcilkundc 

Berlin sol 59 April 2 191S 

riiritivr Report on Lsiil icmnn) fM iizv Fotsoiiinc) m Ctiililrvn — C Mri ihola 
ind B DrnsiMc 

TreMmtm of Dicftiic Dburbmci*' 'in Inhnts '»MUh \scotbn, AciJ— E 
Urb'initzk) 

Smus ThromboMi (oUoi\tns Diriu \ Mcnr 

ExiKniHi.m'tl Rc'scnrcli on Diphtlikm ot Mucous Nfcmbrincs m AninuU (ttB — 
F \ BoTmann and H Diuon 
Alltrcjc M inifotTtlons m Rhcunntic loFcifions — J Duken 
LMstenct of Lobir Pntunjonns of AlftrRic or Von in<.rsii. Cbmeur— H ^ 
Simon 

Xmer c Aniph>h\is^ — C ^ ois ' 

Ctrt.br>! DJ'itTses nnO Tumours or Anonnlics ol the Blood Vc stb— r Ko* 
Ctrbohjdnie TokniKc m Dnbcnc Children on Dirfettm Ditl — H Hirkf 
lind 


Zcitsclinft fur Ivrcbsforsdnmg 

Berlin \ol 91 April 21 BUS 

Espcrimcntil Inscsiiciiions ol Scliiusbct^ LiinR CaiKsr — H R Dulineu 
Sisnificancc of Proicins in ProUucium of Canci-r — R Redme 
•Mulripic Tiirooiirs and aissuc Milloiniwion Sniislwil Inicslicaii n- 
I Holmqiisi snd A Nelson 

Improicd Inociihiion Method for Cancer Uese-itch —M Koh'iiI'HI ^ 
Clinical Consideralion of Occiipaiional Cancer of A'bisloj VVoikcri- 
HorniP 

•Oeeupavional C nicer of Asbcsios W'orkers — 5f Nordtinnn 

Multiple Tuinoiiis — In a senes of 9 000 necropsies 5s p.r 
cent were cases of tun our formation and in 90 per cen^ 
of these there were multiple tumours The frcqticnci 0 i 
multiple tumours was greater m women than in men in 
increased with ape Multiple timaurs were more oi'cr 
benign than malignant and there w is evidence of a conns vion 
between benign tumours and malformations The ibcoreli 
implications of the results arc discussed 

Liiiig Cancel in Arhcrior B opAcm — Nordmann 
previoiislv recorded cases of lung cancer assopalcO 
asbeatosis idds two new cases (the clmival features ot on 
them arc described in detiil in the paper b\ Hornic) 
discusses the connexion between asbestos and the cancers 


KEY TO CURRENT MEDICAL LITERATURE 



JuL-i 9 1938 


THE BRITI«:h MEDICAL JOURNAL 




TRADITIONAL LONDON 



The Collegt xctis founded by Lxnacrc. H'rry \71I s phyraar ord trccYporat J in ISIS 
ard until 1S60 tht CoUes.c met in Ins house. Trom that daU it migrjt d to Amen 
Corner ard er'enttialh ocatp cd the fine Qiutdrtngular building sboxr aho v d'Sigrcd by 
I? rnt tn U<iru::cfc Lone, until 1825 \\r r s buildtrt pulLd dovm tr IS66 

London Hospital Catgut has no less finer traditions behind its 
de\elopnietit to a leading place in the esteem of Surgeons the 
^^orld o\er Jt is a product of scientific research, made throughout 
at the London Hospital under hcence of the 'Ministry of Health. 



LONDON HOSPITAL CATGUT 

OETAINrBLt FFO rLL I y-C C ‘U'3 CQjlF ^ 


40 


THE BRITISH MEDICAL JOURNAL 


MILTON 
AS A 
DOUCHE 


Patients often ask for advice on a suitable 
antiseptic In the many cases where a 
douche IS indicated, Milton is particularly 
suitable 

1 It IS alkaline viith a pH ot about lo, due to 
sodium carbonate and not to caustic soda 
On dilution it lorms a mildly alkaline solution 
which corrects any acidity, but does not harm 
mucous membranes 

2 E\en at considerable dilutions, it is still a 
hypertonic solution 

3 It IS miscible with mucus and pus and 
dissolves semi-solid proteid matter, thus acting 
as a cleansing agent 

4 As will be readily appreciated from its content 
of I per cent ofjiypochlorite, it has a powerful 
germicidal action on any micro-organisms likely 
to be found in the vagina or uterus For 
B coh for example, it has a R W Coefficient 
of 2 12 

5 It is a deodorant witli immediate action, 
destroying the organic gases by oxidation 

Owing to Its reasonable price — Milton is sold by 
all chemists from 6d per bottle upwards — it can 
be recommended even when expense is a mam 
consideration 

A copy of the Pease Laboratories’ Report on 
Milton, some notes on the xalue of Milton in 
Gynaecology, and a generous professional sample 
bottle of Milton will be sent to any medical 
practiuoner 


MILTON PROPRIETARY LTD , 

JOHN MILTON HOUSE, 
LONDON, N 7 


S' 

Sthi 

Amotl 


10 


JuLy 9, 193S 


AS AN 
ANTACID 
OR IN 
FEBRILE 
CONDITIONS 



LEMBAR JDSTIFIES THE DOCTOR’S 
HIGHEST RECOMMENDATION 


See our Exhibit 
at the 

B M A. Exhibition, 
also 

Diabetic Lembar 


RAYNER’S 

LEMBAR 

Made fioni finest ficsli lemons, good Scotch 
bailey and Glucose (with cane siigai) Iiloic 
efficient, belter flavom and moic economical 
tli''n oidinai}' lemon and bailey A hotlk makes 
a qallon It keeps indefinitely 

Tested and appioved by a leading London 
Hospital Presciibe it for any condition in winch 
lemon juice and bailey watei arc allowed 

SAiVIPLE sent with pleasiiic ilso useful bookltl widi 
special diet sheets and sickroom recipes from a I omlon 
Hospital Write to Rayncr S. Co, Ltd, Medic 
Dept B, London N IS 

2/- a holllc at all leading chcnnslt and groren 



( 

j ntffrr 


JUL\ 9 I9’S 


THE BRITISH MEDICAL JOURXAL 



formative 

fitting • 

Notice how perfectly little feet fit 
into the mtunl ‘ ground plan of 
Chrks shoes This sandal photo- 
graph clearly shows the principle 
upon which all CHrKs ‘formative 
fitting shoes and sandals are model- 
led There is adequate support, the 
shape is right, and there is 
length for the fast growing toes 

SHOES AND SANDALS 
safe for growing feet I 

tlhi'^lratid Icnflci B I amt tuuni o; load laC' i cfi i'l\ 
sapplud on request CLVRks siRirT voMrpsrx 



INDUCTOTHEMIY- 

To-daa‘s Most Efficient Method 
Of Producing Tlicraptulic Heat 

loii'cii u- at recent piper- "ii lien 
pelitic heat I- tint Indueliithe-nn i- the 
method 01 choice init ' nh bee lu e it i- mu-e 
eftecine clinic ilh but al o bee'ii e it i- aic 
and conituri ilile tir the patient The-'- 
prominent pin lotlura])! t- piper -hro ele 'h 
that Inductothernn i t hort u tee circuit iitili- 
in^ lUrlroinatii itu i ui i/unl i mu'e etleetiee 
becau e It develop' I 'r 'uat II! ! tii i ere 

I' Is most I'stt il — in the v i cuhr u ue- 
necau-e Induetothei m\ belt- ti- ue- eleetiveh 
aecordin,; to their eonduetivitv gentle lothm,: 
vv irmth i- induced uihout the Ji-eouton ol 
other method' and rehneii control p rnnt' 
adjU'tin^ till- deeji heat ir-iantlv to pertect 
tolerance \ on will hnd too that Indueto 
thermv relieve' pi n quiekh siving p tient- 
immediate evidence ot the bind thev under 
'land that vou aie benehting them 
The 'tore ot Indueloihermv i- f.iven in in illu' 
trated booklet that i- tree tor the a-king implv 
write tor Pub \L 2 - vou will i i( be otih^atcd 

at lial lour roIIeaEMC' '-ae aljoitl Infliii rollierno 
Urst Fnrni nf II* nt 

the I I ut tt I r rf i 

t cn cj J J J - t I L \ -k LI I f- s 

^Iost Effrcttrn 


J 


H t cLt del *• cl t 
{■ o J f I 
/ * I t S l S I SITl 

Sa/t* Sintplf 

J 7 ’ 

t It / -* 

cof J s — *• I n ' 

f if t f 

c t I 

, —I UTl IT \ll 


I r I » a Tf 
Sih ni 


Mi 


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r 


VICTOR X-RAY CORPORATION^ Ltd 

15 19 Cavendish fiAC£ vv i 

ifl» 5t I i» NS ■> Cl C • M IN f 

CaA UI S Litres • M T*t N .o t — - - 



42 


THE BRITISH MEDICAL JOURNAL 


Juu 9 



THE NATURAL MINERAL WATERS 

OF 

KARLSBAD 

Spiudel Muhlbriinnen, and Schlossbiiinnen 


These waters art 

( ^ ) By immediate contact with the mucous membrane of thfe stomach 
and alimentary canal, allajung pains and spasms in these organs, 
and -stimulating the digestive organs into actirity 

(2) Through the blood Thrt is, they change its condition b3’ in- 
creasing the proportion of alkali in the blood as well as in all . 
derivative secretions (gall, urine, etc ) 

Largely prescribed in cases o} 

Clironic Gastric Cat.iiih, H3peraemia of the Li\cr, Diabetes, 
Gout, Gall stones, Renal Calculi, Diseases of ‘lie Spleen, ami 
of the Ki(lne3 and Uruiai} Oigans 


Bolllcft andcT Officin] Siiperi isinn nf httrldinil and rrpnlnrly inilinrtpd l>) the Sale dgmlt 

INGRAM & ROYLE, Ltd., 

BANGOR WHARF, 45, BELVEDERE ROAD, LONDON, SEl. 

And at LIVERPOOL and BRISTOL 

Samples and Descnplnc Pampldct fornardtd on apphcntian 



BALANCE 
THE pH 


and tone up the 
entire system with 


COMPOUND SYRUP OF HYPOPHOSPH ITES 

“FELLOWS” 

Scientifically compounded to correct mineral deficiency; 
and as an unequalled tonic. 

Samples on request 

FELLOWS MEDICAL MANUFACTURING CO., ltd. 

285 ST. PAUL STREET WEST MONTREAL, CANADA 








Jlli 9 193S 


THE BRITISH MEDICAL JOURNAL 


Specially recommended for Nursing Homes and Institutions 

Boreicl 5 Cold Water Lemon Barler is made main IS MADE FROAI PURE NATURAL BARI EA 
feu seconds needs no bodine nor the addition of I AND LEMONS AND CONTAINS NO \RT1 
an\ thing e\cept cold water Refreshing msigorating j FICIAL ESSENCE WHATSOEAER iPn-'t 
md IS guarnntced nbsoluteh pure ' j 4iu l\si s Report) 

BORWICK’S 

COLD WATER ^ POWDER 

In 7 d 10 d la and j im Le.rgcr &i 2 fr» for In obtainable frera lead n Chetr ts ^rd S r ci 

S'anin e % i// be ftrtt erii or appl canon to 

GEORGEBORN\lCKtSOSSLTD IBunbiiiRo London EC I CEsiablishcdrcarl>aCenir 





The Safest and most Reliable Local 
Anaesthetic for all Surgical Cases 


The oldest 
and still 
the best 


Cocaine 

Free 

Local 

Anaesthetic 



^ \ 


'►V . .1^ 


* net Co jn C ^ 


iOVOC^TfT' 

J >j«s 


__ ®°>-D MEDAL 1913 

'“-SACC-.r^ CCK“'‘''*T-.*» V nS- I 


Does not 
come 
under the 
restrictions 
of the 
Dangerous 
Drugs Act 


• o ta p ^Taf T i «'• ' 


Write for 
Literature 


THE SACCHARIN CORPORATION LTD, 72, Oxford Street, London, W 1 

Teteerams SACARINO RATH LONDON Tsttphon. \tU£ELM 

. I I RROUS A CO Zesisnd \,fnl TIlLOrsTALA TDICAL St, Pi ut tO LTD 

2V.^tLn^r^rRo<^^^- w N ‘ t ' U„Lcs-dSo... ^W■ . .. 



THE BRITISH MEDICAL JOURNAL 


Juu 9 1938 



For the Comfort of your Patients 


Long jcirs of experience ^IIlctl-_lo n modern 
conteplion of coniforl lm\c giicn Corns mcdie tl 
appinntes i reputation second to none Onr pro 
ducts are designed to tlie medical practitioner’s 
evict insiinctions nith i ireful attention to 
details ind strict coinpli nice nitli ctliu il iiilcs 
Doctors and surgeons mil find the Cuitis Book 
of Appliances i useful guide to oiii com 
prehensile range It gnes full inform it ion 
me isnrenicnt I onus md priics of — 


Ahdomin d Supports 
Special Coisets 
Colostoni) Appli lines 


Vhdomin il Belts 
Siirgic il Tni'.scs 
El istic Hosier! 


// you Jiaiw not alrrat/y reel ivrd a copy oj the 
latest (ilition, tee shonlil In pUaseil to seiul yim 
one on n ceipl of n can} 


Cttrtis appliances mil iig ini he cxliihited 
It the British Alcdii il Association, 
Pl> month, Jiih 18 to 22, 1938 Onr 
St ind No IS 51, ind lie mil ghnil) 
Mclcoine nil \isitors ^ 


E. CUMTIS & LTD 

7, MandeMlIe Place, Wignioie Sit eel, London, W 1 


Syxcin/iils in Alnloimnnl ‘ippliances 
Tclcgiaiiib Ciniis \\clhcck 2921 


Telephone NVelbcek 2921 



Valentine’s Meat-Juice 



Jn Typhoid and other Feveis, 
Extreme Exhaustion, Critical Con- 
ditions, Before and After Surgical 
Operations, when Other Food Fads 
to be Retained, Valentine’s Meat-Juice 
demonstrates its Ease of Assimilation 
and Power to Restoie and Stiengthen. 


Clinical Rcpoits lioni Hospiiah and Gcncial Piacti 
tioiuis of Ciiiope and America posnd on application 


For Sale bj European and American Chemists and Druggists 


VALENTINE’S MEAT-JUICE COMPANY 

RICHMOND, VIRGINIA, USA 



in 98 



July 9 1938 


THE BRITISH MEDICAE JOURNAL 


FOOTWEAR 

& NATIONAL FITNESS 

M edic VL men InYe of course lone realise*! 

llie imjiorlance lo fitness of jiroperN niatle 
mill accurateh filtid footiiear 

It has been saitl that niaimfaLtiirtrs and 
shoe retailers lia\e failed in the past to pro\a*It 
Mieh footYNcar anti that retailers ha\e lacked the 
necessari kiionlctltre ami skill to fit shoes eorreetli 

e nonld draiv attention lo the f let that we 
line Ion" hcen aliie to the importance of this 
111 liter and haYC eonceiilrated for maiiY \ears 
nptin the prodnclioii of shoes the co'rect construe 
lion of nliicli meets itatli the approial of nie*hcal 
men ami yyIucIi can he fitted walh jrreal accuracY 
liY propcrlY trained assistants 

There are moic than 300 relaileis nho are 
fnll\ trained and qualified lo fit our shoes 
correcllt 

Clmrcli's Arch Moulded Shoes are made in a 
Hide YarietY of stiles for men and uonieii (there 
IS nothing of the ‘ surgical ’ shoe about them) 
Tliei contain fixed supports for the longitudinal 
ami inetalaFsal arches, and tliei are aiailable in 
a full range of graded fittings mIucIi include six 
different uidtlis in si/es and half si/es — iipuards 
of 100 fittinss III all 

We mil sladU send particulars lo aiiYOne 
interested 

Clturcli's 

AWCIH-MIOIUILIDIEID 

SIHOIES 


“ Like a {trm 



supporting hanrf 


CHURCH s'*- CO LTD >ORTH \MPTO^ 

Cf 




elt 


The Belt for correction 
of Ptosis Obesity Faulty Posture 
and for post-operation 
wear 

It Y as on the adiicL 
ot medical men that the Lima Bel. 

M-'s CYolved trequent tc't' I \ 
doctor' were earned out betore it 
was made atailahle tor 'ale Th^t 
Is wh\ It I' the recooni'ed belt tor 
men ' wear 

Made to mc->'ure tor e\cr\ ca e 
the Lima Belt i' pre'erilied t 
obe'iti tor Yariou' pi itic con 
dition' tor pO't operation 
wear tor \ ear bt the older 
man during golt and 'O 
on The front i' ot thin 
non eh'tic tneot the bach 
ot strong eh'tic It is 
fulK adjustable be slide 
buckle' 


YOU CAN ORDER 

BY POST 

Pcriect fttin** cua’^nteel or 
non } refunded «n luJI We 
dike a T Huction of m the 
£■ on yurcha for per o’'a) 
u e to renV<r-< ot the 'led c I 
Pro lon M3\ we end roj 
I fi !Ij mpLnatoo f-ookJet 


PRICES 

Lini^ Pel ircludir n I inta 
Jock ''tran lopilir Mo el 
3^ 'ni (CI.-ck 4 cn ’* fJ 
Lure Mo^eJ »n furc il 
extra It ht nualit> C -n 
(Plick " pns ) S-n^Ari 
Modi 2 en COD 1/ 
extra 

★ if si t he fl s d M 
i s t Cir 3 B if 

f r yenr ex n ir tcr oi 
c^''ro*^.7 



The Lima Belt is on Sale Only at 
J Roussel, Ltd (Dept ME), 

177, Regent Street London, W 1 

T r p rl - 

\t I > 3 Cl ea; ’c E-C _ a" I n - o r I o- n k '■ 

M o at — Belfast I ''t ct B rimnsham J \ w r t 

Bournemouth H m r H t B slot I Par^ re f Edinburgh 
1 h 'crcK t Clas-ow 3 ch r all '•f*' Hov 

t \\ te r Ro Le cester 1 C r c (1 ) f 

Liverpool s To " ^ c-- anchester 1 

Nottinsham -A M Ron -c Southport 11 

- r r - 


I 

!>- 


J Fee cl Lt (P IE 1 P 
-i'-aL-aPe c 

Tc<k ^ r M- ' 

tre 

I - - c ( ” r 


- f*- r - 


t 


★ r 

in Y 


■“'-'aifC-'c TLl 
- t I I 

My narre ard full sddrciw ar* atiawh’fd. I 



THE BRITISH MEDICAL JOURNAL 



J(/[^ 9 19J8 


A Comprehensive Financial Service for Medical Men 

T HL scope of the facilities offcicti by tUeCominny his been gieitly cMukIkI nntl fiiniicc cm non he 

n f"' ®""ccfed Mith the lunnmg of his inactice oi his house Ihe 

inrps -lie uniisinlU loi% ninl the sen ice is strictly cotificlcntnl is hctnceii the Compiin mtj flic doctor 
t iiitlici pirticul irs mil piopasil foiiiis mij be obluncc! from the Cominny 

BRITISH MEDICAL FINANCE LTD. 

TAVISTOCK HOUSE SOUTH, TAVISTOCK SQUARE, LONDON, W C 1 


ALUZYME 

NON-AUTOLYSED YEAST 


Profesilona] samples tle^ctiptht 
maiter and prices an requesi 

ALU2YIWE PRODUCTS, 

PAtlK BOYAU BOAD LONDON N W 10 


TOTAL VITAMIN B ACTION 

Ahizvmc supplies nil the members of the Vitinun B Complex in i full) 
active stale The B Vitamins foim i synergy, the separate factors of 
which iccentuite or facilitate the action of the others (Mat Ilc^carch 
Councils Special Repot t 167) In all B deficiency conditions, the bed 
lesults may be anticipated from administration of the entire Complex which 
Aluzynie provides B, potency 1140 Internal Units per ounce Acinc 
I esponse to tests for nicotinic acid flavin and gbitalhione 


CATALOGUE OF SECOND-HAND SURGICAL INSTRUMENTS 

§ OSTEOLOGY, MICROSCOPES, POST FREE T^nJirLor, 

I 

Half Sets of Osteology, Aiticulated Skeletons 
and Disarticulated Skulls and Microscopes " 

MILLIKIN & LAWLEY, 67 & 68, CHANDOS ST , STRAND, W C 2 

( Vtlj'iconi to Otnrlng Cran* llow^ltnl Medical School ) 


FURNITURE OF 
QUALITY 

AND DISTINCTION 


The contents ot Fainovis Maniions the elcpnnt 
appointments oi numerous Tonn 1 Inis cto 
roinoied for conienicnce ol Sale h\ Prn itc 
ireati^- now beidp disposed ol nt cnonnoui. «acrj 
fico On Sale Dadj 9 till 7 Stored and dcluered 
Ircc 

The entire contents of 5QQ bedrooms comprising 
suites- of super qinlitv in WTlnut MTliOr.An\ Onk 
I Tcqucr "^itinwood etc incliKhm: An Exception 
ally Fine FiiJJ Figured Walnut Suite oj ExauisHe 
Design and of Finest make, comprising Piiliy Fitted 
Wardrobe with Bow Centre large Pedestal Dressing 
Table with Shaped Triple Mirrors Puffy Fitted 
Gent s Wardrobe Doupfe Bedstead The complete 
set 45 gns fie s tliin eo'tt 35 month'i rgoj 
T'noiinous' ‘^election of fine old Winirobo from 
£8 10/ Bou anil Squire ( Uc ts Dre'isiiip 7 ible*; 
in YAalnul nnd Mabogauv rxllboN'? Toilet Ml^rol^ 
Tt 25 Double and Siugk BcdbtcTd m M ilniit 
Mihoginj an<l Oik at 27/G 

The Dining Rooms Libraries and Halls com 
1)11 e lutes and pieces ol c'vct> period rudnr 
Qiu-cn \nnr bcorgnu \ud luodcrn sUlos jnclnflint. 
'lotuc evccptiomliv tine cels in Pigurtd Oak loin 
pn lUg Old Dresser Refectory Table and set ol G 
Old Rush Scat Ladder Back Chairs at 28 gua 
Bit oil Stipoiitinc Malioganj Snlcbo rd 10 nv 
on GAOTpnii Dining Tables £8(15/ logdiitr 
uilli 150 sct<5 ot fine I hau of lU pinod in'’liidiiig 
a rare set of 4 small and 2 Arm WheeJbacJis in 
Elm on Cabriole Legs at 15 gns Fine Selection 
Super Sprung Luxuriously Upholstered Settees and 
Club Chairs in Ta pe Hide ind Silk DimasUs 
mtUnlmg Elegant Knowlc Suite In Beige Damask 
as new at 42 gns ‘^lupur Sets in Broun Hide at 
,15 pn 1)0 \ Magnificent Spoon Back Suite in 
kRert Morocco ol Rare Onahty 50 Super Easy 
fChairs at 27 G Settees to match at £3 15 
I uliv (niruiiccl Super Library Furnishings 
n '/( I c I’cdt t il Disl Bnreauv tcgotlier uifh 
the < mipletc ho« chf I I effect Future Cliina 
I I < I I i)t I rN tal ttc olo 

Carpels of Every Description inrluding Plain 
Wilt u m tU Cc louT^ made up and lai I Free 
Phone CAN 2141 Buses 4 19 30 143 pass door 

THE FURNITURE & FINE ART 
DEPOSITORIES 

Isliiijjton Turk St, Upper St, 
Islington, Is 1 


Motof ^oaf/nq 




Do >ou krow thnl motor boating co«>t'=i very 
little? Suprisingly little! And of nl! 
pastimes it is the heMthicsl and mo-^t 
exhilarating 

FREE MAGAZINE Send post caul for ficC 
copy of om motor booitntj mauactuc I Uasiiris 

Aho\ 

BRITISH MOTOR BOAT MFC CO LTD, 

Dept 2 Bnf vuma Home \mpl«nSt J ondon W Cl 




NAME FLATE§fiT„le«“su%^ 
REDUCED PRICES 

Send for fist fP to l/io fc/ii«f lf«/ rr 

F OSBORNE & Co , Ltd Tcl Euston4824 
tt7, Gower Street, London, W C t 


NAME PLATES tmmcl 

Snmlcss Siccl Bnss or Chromium 
Aclui) MiXets Quick Dclivcti Low Price 

The WHITE BRONZE Co ‘"ci'iov'no ’ 


NAMEPLATES ttriSi: 

Send for tlliistraied DrocUurc and Price List 

PR M ALL PR ^ic^CrossBd ,S E 14 I 
FB riM.I-l.&Ca r/Dcnas 3818 i 


Ftte liookt on 

OBSTETRICS ARD GYNAECfllOGV 

A SHORT TEXTBOOK OT MIOWIFERV 
Bi 0 r GtBBEKD JtS, Hits 
lU C O G IS" Illnslniion. IS 

TEXTBOOK OF GYNAECOLOGY 
Bj Will RIO SltWV Ml) IltCS 
} COG 2-1(1 Lihtioii 4 Col Phlei anl 
2->3 Tt\t ficiirts 181 

EDEN AND HOLLANDS MANUAL Of 
OBSTETRICS 

kll( hdtlipu 12 Pixies (x Col) xud 
figures 2ti 

THE QUEEN CHARLOTTES TEXTBOOk 
or OBSTETRICS 

4lli I ililioii 1 Cot I'Ixtcs xnil ’’51 T-rt 

fiRxitLx (Sr 

ANTENATAL AND POSTNATAL CARE , 
lb I T BROWNL Xtl) IKCSI 
1 C 0 G 2m( rrfilieit 70 llliinnlroin 18> 

I l'il(»r, T,o(fO»u<f lo ottr Klitnit le t) ”1 
ifip It If I f «/ii/ il/ori, I Unit ttih 

J & A CHURCHILL LTD 
lot Gloucester Place LdiuIou Vv I 



Wr.to A L SIMPKIN & CO LTD 
Barley Sugxr Work, (Dept BMJ) Hu""'' 

Sheffield 6 

Addmctcr Honey AOOIMG ff ACHfNCS T7 C 

TAYLOR’S typewriters ,, 
SELL H/ne Hint pun ock, Tawnji 
CHASE, EXCHAllCE, j ,, 

BUY and nEPAIR ALL igjj /} 

MAKES o( Typcwrllcrs 
OupficatOrs and Calcu 

/ol/ng Machines ym; 

U me for HarpaUt f fif 32 DIJOU ,V/ 

or I hone— Dolborn 3793 'ikeliMt 

BUY A BIJOU FOB tomifclr mj'’ 

1S( a Monlh rad) 

14 CHAHOCRY LAKE (HolBorn toll 


JuL-i 9 193“? 


THE BRITISH ''lEDlCAL JOURNAL 


OUR 50 YEARS’ REPUTATION 



a 10 



FnVNKL.\Vn s MTVL PLLS-E W\TCH (Reed) 

(For Doctors) Fully les^cllrt Ic cr novemcni. 

Sihcr chrome 60 or 13 payrncnis o1 5 -» Gold £S 1' 6 or IS 
do^\-n and 11 pajTnenis of 10 10 YEARS CUARAHTEE 


years guarantee 

land Ixf Bd the^e 
«>at he OCered l >9 
Do torv and Nor** 
foe imme 1 ate po r 
on thoat d pla 
meat <,f eap tal ih e 
repre ent the bieh t 
po tbie value and 
I e feet on of **o k 
man h p and a c made 
e^pee allv fo vou 
p ofe ional need 


1 


n howroom 
^eleel on 
on \pprova) I 


I DEPARTMENTS — Furs Fur Coats Jewellery 

Plate Cutlery Furniture etc 
R ntf for Cetatoxuf 


PBOTECm'E 'MOVTHLrl 
PWADSNT TER5IS 


E J FRAMvL\ISD & Co Ltd <d ept M ) 42 S” Imperial Rq Id nc*- 

I Estab Ifi^ PhoTif Central Lud*at C" u London E.C -t 

CRICHTON ROYAL, DUMFRIES 

FOR 

NERVOUS AND IMENTAL DISORDERS 

T^is Hospital has esery Lciliu for comple'c mves:ij?ation of ibe abo'c cordinocs ard provnfes all 
fonns of modem treatment includins rsychoiheraDy physiotherapy occirpational aed rccrcauc’tal therapy 
Cases of alcoholism and drug add ction are admitted. The Physiotherapy Dep-nmert b-s eparatc ensts 
fully equipped for X ray work heliotherapy hon ware therapy electro-therapy ard hydrotheraFT 
Xtwjnminfi bath prolonged baths Scotch and Vichy douches PIomb!-*tcs treetraent, elcctnc and Tu-kish 
bath cabinets etc ) There ts a fully cqLipped gymr-^iurt und r qualified instructors F-o’ ties ate 
pro\Tdcd under special recreational therapists for all indoor and outdoor garner tr^ludmg goU cour^ 
cncket football and hockey ground lawn tenon, and squash courts croquet -nd bowling greers 
The Hospital has «s own Cmcma Library -nd Hatrdrc^ lOg Saloon Terms ipciude remitat rector dn\es. 
Private ro<»ns siuies or villas arc available, and special nurses can be proitded 
The Hospital grounds citendin^ to nearly I OCO cres are situated tn delightful country ,.rd includ 
eatensive farm (TT herd) gardens and orchards 

As the Hospital ts well endowed terms are exceptionally moderate et First Dcrartstcci 3 to 30 
guineas per week Second Department 2 and 2i guineas per w-ek Voluntary and cerufied r-tien,s a-e 
received Medical Cenificates given anywhere in the Bnuih I les are valid for dnissioo cf paucots For 
prospectus necessary forms and further informauon apply to 

Physician Sapenntendem P K Mccowan Jp MD FRCP DPVt BamsteratLaw 
3ub 1st, Tel Dumfries 1119 

SHAFTESBURY HOUSE, ' 

hpcctalJj built and licensed (or the care and ireaimeni of a li^uted mrnifccT of Ladi« and 
GeniJemen su'Ienng from Nervous and Mcnul breakdown Voluntary and ctrufied paticms recaved- 
Ladies also admitted as Temporao Patients w thout Certification Tentu. moderate. 

Apply REsiprvy pjrysKws who may be seen at 31 Rodney Strict. Ltveircoi ty appcirimcnu 
TeJ No a Fonrbr 


FREQUENT MICTURITION 

‘ YBWET ABSORBENT BAGS 

Male day panern 35/ 

New Model Female day palicm 42/ 

‘^DUPI.EX” BAGS 

Male or remalc day and eight Xl/ 
"S^aXUBE” 

For helpless bedridden paiiems "0/ 

Our baps catch all leakage eanng mind and bodv 
Inwible under clothing and easily emptied Now 
worn world wndc Special paticrm for metonsts 
atxl avTators 

D agrojfu ere on request from 
HILLIARD Douglas Street Glasgow C.2 

NAIVIE PLATES 

in BRONZE and ENAMEL or BRASS 
^end details for sketch or leaflet. 

S J ^ 4 HERD Tel Clcrkcnwcn 2441 

30 CLERKENVVELL ROAD EC-l 


HALLlFORD HOUSE, UPPER H.ULLI- 
rORD, SHEPPERTON ,n I^i 

This tundseme secluded residence, stand ng la a 
p ark of tf acres situated 16 miles from London b 
licensed for the rccepuon of a Imitcd rumN:r of 
Patients ot the nrrer and middle cLs^es su'^enng 
from nenous and mental aflect-ons 
Vountary or ceriuicd ca.es received Tcrirs 
moderate Paucris are under the c n u.nt personal 
care ot the RcsNlcni Med cal S,.ccnaterd-nt 
Dr R \ Stewart frero whom full ron,cuL-*s can 
be obtained Tel Sunbury-cn Th-mes 0 

SPRINGFIELD HOLSE 

Near BEDFORD ( Phone Sll" ' 

To M nial 11 o a rv with « vilh nl O 1 C s»l*^ 
Rc'idcni Fh Kian CLDRIC W ER 

Or»l n Tr n f • om p^r 

n* Separate Bcdt > ms where sui,-h c ) 
IntCTMcv'i in Loruoo bs tmcri 


CHISV^TCK HOUSE, 
PINNER, MIDDLESEX 

Telephone PIANEP 234 

\ Pnvate Hospital for the Treatment 
and Care of Mental and Nervous inne« cs 
in both •^exes 

A modem countrv house 12 miles from 
Marble Arch in beauufuHecludcd grounds 
Fees from 10 guineas per \'-eek inclusive 
Cases under Certificate Noluntarv and I 
Temporarv patients received for ircaimenL 
Douglas Macaulay M D D P ( 


THE GRANGE, 

near ROTHERHAM 

A HOLSE li erved fot the reception f a 
I mitcd ptmbcr of L.^.i'^ ‘;u‘*'er''- fro^ Ncn, u> 
^nd Menu! dKonJerv Buth ccrtir-*d a-d ulir* 
ury patiert received Xp*' oved f r ter'perary 
Paticrts Tb,. iv a L.rge cuur ry bou c. wi h 
beautiful mmjmJv and P-wT fie r-i cv fr m 
Sh Field Tel No 40u 0 Ecdr^ted Res P- v 
Giieest E MoLtd LPCp MRCS 
Cra rCe Lare L N E Riy 

VVATE HOUSE, BU'XTON i 

For I*"- t a ~crl cf Lades C— • >er' r 

r'crjtPv a"l ~t-u V urjty B a dc* reve cu 
S mated 1 CO ft abo e vea el f a-r b 14 
acres of trojTsJv— For ter" a*-* t t*- Ro a - 
M^ at S o W \V H roy M D Na Tc t 

TiiF r nine iini ^e. 

< m RCH •'TKFTTON '‘lIROr'TIIRr. 

\ r - Home f” t*''- a, c t ca ~e-i 

rf I •“ n. r l—d^ •- v -u 

\ c *■ afy rx. Te*’»*>.Ta'\ p s le^e- rd u’w.r' 
the new Mcma Treatment ^ci I** 
cv *al himmi** cm-cr-.^ I> fcCi 



HOME FOR EPILEPTICS 

^tAGHUIX (near U^ EFTOOX » 
FARXnNG and OPEN AIT 
OCCrPATIOX for PATIENTS 

V few a an nil rd Pnd CTa (Ir>n-e 

FEES } 2 CJ- i-*-r - y rr^ p •» 

ward To CL- s r— -d w r~— c 

F c t the - a ct 

C EDGAR GRISEWOOD A C„A^ 

*‘««mar* 20 E* hane **t eei Ej t Lj eri.e»«l C 



OTHER DRUG HABITS, 
FUNCTIONAL NERVOUS 
OISORDBRS^ IhlSOMNlA 


Old H01 House Chislehorst <25 
mins from London) is charmiagly 
situated in noiet, secluded grourdv 
Bollards and outdoor recreat o-s 
Under new management, wi fa add d 
accamciodation tadies and gentlemen 
are admitted for treatment Fees € 
to S gumeas Snecial terms for lor- 
periods For illustrated prospectus 
wnte to the Medical Supenrterdent 
or Matron Phoce Cbislehurst 451 

Old Hill House 

CHISLEHURST - KENT 


ASmVOOD HOLSE, 

KI>GSBTNrORD STVFFORDSUlRr 

An o d-^iL.^'Usbed PRIV ATT HOME f r i^c w c 
ard ireaun-^i ct Lades ard Gentler‘-n r-cr~. 
a“ aed pTo*^tio-iry ca^cv a-nj r m-^.er ed 
palienu arc recesved * wcU a i o^e re— a 1 
cenifed 

The home i bouufu !y i uai-d m v cwr 
rrou-u of -0 acres 

Fu» parti uUrs as to fecer im teTm< ct m-a/ 
be rbjmcd from the Reva— t Med cal tr 


RUSSELLS 

HEMEL HEMPSTEAD RD tVVTFORD 
T lepfaone ^ATFORD S91- 
A convalcu.en bo-- fe the care ard oca —m*! 
cf m d ard rccovem*' e rervous cc-ia t op ir be h 
cxcv Tbc hpjse ts s tuated bisb up n a-'cs 
cf gro^nu 1' rnJes from Lcp.-..^r at i c t— j 
con of the Wat ord ty r-ss O-e Vfcd.cnl ct « 
m res denee a'^ two oth-rs are in da t ai c*--<— -cc 
Fees frem ten pui-cas a wTck c. 

A'—ly Resident sIec cac Oincra 


‘ ECCLESFIELD StapTehunt Ken 

(Re— uved A c d V d- mex 1 


PR/\ ATE HOMF f~* t - CAPE a-x. Cl FL c 
ALCOHOLIC PATIENTS <L-dc*> Larrc m-p- 
n bcaa fu. s -a ed m li a-fm r pa k 
Lrd Ette- e v cws Horn far— P C O-rd 
Lrdm I'-e -apa' — ler c t S. cn f t*‘e 
Cot-d SNcr^ rd V— J> Rr ft! 

Sta"* 61 


Tc a-i- Te -rm — n ^ P”— " » «i - 

iiTTi.rTON HVLu rnfNT«oori t ix 

_ 3 »'<' - vm HOV F f- 

i“*-u V j F-i-'x 

tece cJ - *■ - I 

m Li cT-> _ m V—' II' H w 


BISHOPSTONL HOLSE hFDrORO 

Mc-al He I La ^ Cr- 

■^ \ c -—-v w *• AC“- a •* H ''■'42 w r 
V ,r-a.-v iJaafaiT" L 
a Fmh.c'-t Mer-. v-e-i- a-' I 

y paJcaJ Dr J L NTH VI *‘t 

Ecdf /u . 





the BRITISH MED ICAL JOURNAL 

ST. ANDREW’S HOSPITAL 

FOB MENTAB DISOKDBRS 

NORTHAMPTON 


FOB THE UPPER, AND mDDUE Cl ASSES ONIl 
Till, Mo^t Hoh Tiir MARQUESS OF ENETeR CMC ADC 
AWicflf SiinnimiMrfeiK Tiiosus TrNNr'.r MD MU CP DPH DPM 


■'■lualcd m MO Jcrcs of p-vtE and pRasure uounds Volunniv pulcni!, 
"'‘•ipicnl menial disorders or wish to prevent recurrent iinckt of incntil 
itm , t P'J"':"" ipO cetnricd paucnls ol both sexes ate received lor trcvlmcni Cnrcful 

L , bioerioloaical and patholoeical examinations Private rooms with special nurses 

male or female m the Hovpilal or rn one of the numerous villas in the sroitnds of the various hranches 
CTn PC proMucu -- 


WANTAGE HOUSE 

This n 'I Reception Hospiial in dct'iclicd Krouncl-i with n ^icpiraic cnirince lo which p^lIents cm 
be li IS equipped with ih the ippmttis for the most modern irturntni of Mentn? nnd 

Ncrious Disorder? li contains 5,ncuTl dcmrimcnis for h>drothcnp> by mriotis mcihod> incJudmR 
Turkish and Russnn Inths the prolonRcd immersion bilh V»chi Douche Scotch Douche E\cciricn\ 
bath P/omb«^rcs ircaimcnf etc There is m Operiting HicTtre n Denn) Sur^terj m X ra> room m 
Ultn Violet Apparatus and a Department for Diathermy and HirU rreqtienci treatment It iNo contain? 
Laboratories for biochemical bactcnoloeical and patholopical research 


MOULTON PARK 

Two mile? from the Main Hospital there are several branch csidbhshrncms md mUis situated in o 
park and farm of 6^0 icrcs Mdk meat (nut and Ncgeivblcs are supplied to the Hospital from the farm 
ttardens and orchards of ^!ou^lon Park Occupation Therapy is a (caiure of this branch and patients 
are given every facility for occupying thcmscKcs m farming gardening and fruit erovving 


BRTN-Y-NEUADD HALL 

The vCaside house of St Andrew s Hospital is beautifully situated »n a park of acres Llanfairfecliaii 
amidst (he finest scenery in North Wales On the North West stdt of the Estate a mdc of sea coast 
forms the boundary Patients may visit this Branch for a short seaside change or for longer periods 
rhe Hospital has us own private bathing house on the seashore There w trout lishmg in the park 
At all the branches of the Hospital there arc cricket grounds football and hockey ground? hvvn 
tennis courts (grass and hard courts) croquet grounds golf cottr cs and bowling greens Ladies and 
genilemen have their own gardens and facilmcs arc provided for handicrafts such as carpentry etc 
For terms and further particulars apply to the Medical bupermtendent (Fclephorc No and 

Northampton) who cm be seen m London by appointment 


THE COPPICE, NOTTINGHAM 

HOSPITAL FOB MENTAL DISEASES 

This Institiilion is e\clusweiy for the reception of a limited number of Pi Dale Patients 
of both sexes of the Upper and Middle Classes at moderate rates of pavment It is 
beautifully situated in its own grounds on an eminence a short distance from Nollmg 
ham and from its singularlv heatths position and comfortable arrangements affords 
eveiy facility for the relief and cure of those mentally afflicted Occupational 
Therapy Voluntary and femporarv Patients received 

Tel 64117 For fcrttif etc apph w the hfedtcal SiiperuiieiuU m 


haydock lodge 

NEWTON-LE - WILLOW S LANCASHIKE 

TetcE Street Ashton m Mikerfivld Plionr Ashlon in MiKcrlielil 731 1 

For the rcecotion and treatment at PRIVATE PATIENTS ol both sexes ol the UPPER AND 
MIDDLE CLASSES smUrins from menia and nerveus diseases ciiher voluntars lemporarilj or 
under Ccrtificnte Patients a c clai* died in scpiraic building? iccording to »hcir mental condition 
Situated in bark and grounds o 400 ncres Self supported by us own farm and girdcns in which 
patients arc cncounged to occupy themscl c? Every facility for indoor and outdoor recreation for 
ttrms prospectus etc apply MEDICAL SUPERINTENDENT 


NORTHUMBERLAND HOUSE, 

GREEN LANES FINSBURF PARK, N4 

A PRIVATE HOSPITAL foi the treatment of mental and nenous illnesses ConxenienlU 
situated and easy of access from alt parts Six acres of ground highly situated facing 
Finsbury Park Voluntars and Temporarv Patients received without certification 
Occupational Tl “ ’ and other modern forms of treatment 

Telephone ST Telegrams SUBSIDIARY LONDON 

Convafestent Home -R For further parncol'irs apply to the Mcdicil Sup 


COURT HALL, KENTON, near EXETER, 

for the treatment of eight Ladies, aohintnrj, temporary, or certified patients 
, ^ Large gardens and on n dairy 

CLIFFDEN TEIGNMOUTH for earlv and convalescent cases A well appointed 
house with spacious balconies and exaensive views of the South Devon coast- 
Sub tropical gardens own dairy in 2S acres Private road to beach 

Telephones 

. BERTHA M MULES M D B S Starcross 59 

Resident Physicians aNNE S MULES, MRCS.LRCP Teignmouih 289 


JuLy 9 ]9\S 


HILL END HOSPITAL AND CLINIC 

ot IHEXTVL A.xD MinoLs nisoiiiiiiis 

C-O miles from I ontlou) 

^ 1 *^ ntcc'ctl (ot ircitmcm on nimlcrn 
lincx IS tolimnrv Tcniponts ot CtriilnJ 
Pm lie Pviicnis n, ,y,c Hm tnd !lo™^‘r 
? t’' ‘''VIM n 

a dclichifiil coiinlts nnnvion vviih cvichmic 
grounds tnoivn is 

HIGHFIELD H4LL, 

sinnic iboui i m/Jc miy from Hk 
EELS IVVO ao THREE GUINESS l ER vmk 

P''""'!''"' ■'PPb '0 the Mtv!) 1) 
iunt J r kiMiiCR LRCP DPM 

ST ALB<INS. in.,BTS 

BARNWOOD HOUSE 

- GIOUCESTEIl 

A REGISTERED HOSPITAL tot the CARE anO 
tREAlMCNT or LADIES mil OrNIUMtX 
siilTcrinE from NERVOUS mU MENTAL DIS- 
ORDERS VViihin ivvo miles ol ihc G V\ Rail 
vvis md EM V. S Rulmj Simons ai 
Gloucester the Hosninl is cvsiiy ncccssihU |> 
mil from London md nil ntis ol the VmnI 
Rinitdom It is bcmtifulls silinicd it Ihc Ion 
of llie Cotsvvold Hills md simdv m i/s ma 
eroiinds of over 300 nercs \oliinnr) rnicnn 
of both sexes nre also tcccitcd for ircnmcni 
Spccnl nccommcdMion tor Latlv Volimlan Pvinnb 
15 also provided at the MANOR HOUSE which hii 
ns own private Rroimds ind is eniirclj semnic 
from Ihc Main Hosninil Eor partlcuhrs as to term, 
cic applj lo G VV T H TLEMING M II C S 
E R C P DPM Medical Siipt 
Telephone No O'O? Rarnwood 


STRETTON HOUSE, 

Church Stretton, Sliropshirc 
A PRIVATE HOMC for the trcitment ot 
Genilemen sufTLnng from Menial md Nervous 
nine ? Including the nllwd disorders of 
Alcohohvni ind the Drug Hibit All types of 
c'idi Mtnn) Tnd Nervous ciscs are receneJ 
without ccrlihCTics ns Vplumvry laticnts uadef 
the provisions ot ihc Menial Ircatmcni \c! 
IWO Bncing lull country Sec Mfd< al 
Director) p 2^28 — Apply to the MedKil Surer 
intcnUcni Phone 10 P O Church Sirgiion 


FENSTANTON, 

CHBISTCHUBCH ROAD. 
Streatinm Hill, SAV2 

A Prlv'iic Home for the Core and Treaimcm 
'll 1 limited number o( Lidlcv wnh Menial and 
Nervous Disorders Certified Vohinivri anJ 
Temporary Paiicnts received Latgc Mmvion 
with 12 ncrc of grounds (See 
Director) p 2312) Apply Kcsidcni tlnv'cun 
Telephone Tulsc HtH 71S| 

BAILBROOK HOUSE, 
BATH. 

Pot sufTcrers from Nervous and Menni D'* 
orders with or wUltoui ccruliCTtc? ^ ^ . 

Thu house i gloriously sUuMcd In nncK/v 
grounds of 20 nercs with imRmficcnt ^ 

the City and the Avon Valley 
Dire tor) page 2322 ) 

For terms npuly A Guirpiiw* ^ 

BCh DPM Resident Phi svim 

ItJcpljonc D athevston 8lSv — 

HEIGHAM HALL, NORWICH 

A PR1V,XTE MENIAL HOME ') 

acres of well wooded prounUs I or Ejcics 
G entlemen siiirerinB from Nervous , 

lllhess Vohimaty Palicnis i r r 

ana Pa lems under Cenificaie are 
treaimeni Fes from_4 sumess^a 

at reduced Rev o" ' 
latienis own “ 

Aoplv to Dr 7 A OVMLI. Tcicptmr’c 10 >' 
Telegrams Small *>0 Nor wich 

TYKEFORD ABBEY, 

NE\\TOKT PAGMirU ® irrH 
FlINCnONVI NUD ous DIMYKIU BJ* 

AND CO>\^Li^CyNT 

The Home Is a Miovlon f’* 
stTnding in IS nercs of S/ynhi-"^ ’ 

and i? shinicd 14 mile? , 

and 12 miles from Bedford to 

10 Northimpton Hoad fi,fiy niilcs ,r-h'V|^ ^ 
Both sexes nre iccomniodatcd ‘ ^ ^ 

pcuuc TrcTimcnt Is used V ^ ‘ '' 

iascs Radnnt Hen S ny DW ^ 

I iclii Diathermy and Toam B-»nv 

^-^rpnlv^'Dr D C M 

Tcl-plionc ’Newport latncu i 




THE BR[T[SH MEDICAL JOURNAL 


JuL\ 9 19’r8 


MINERAL 


SPRINGS 


H arrogate specialises in the treatment dealing with the large group of disorders 

of Disorders of the Liver— congestion, amenable to Spa treatment The Royal Baths 

cirrhosis, jaundice, cholecystitis, at Harrogate is one of the finest Spa establish- 

cholehthiasis, and tropical liver Also in ments in Europe, and the Corporation has 

Diseases of -the Skin — eczema, psoriasis, the embarked upon still further extension at a 

coccal infections-of the skin etc Other types cost of £66,000 

of cases suitable for Hariogate treatments DIET Prescribed diets for Spa patients may be 

are — The Chronic Rheumatic Diseases — obtained at hotels and boarding houses without 

Arthritis, Fibrositis, Neuritis, Gout, extracharge Compfimentary and reduced 

Hyperpiesis, Mucous -Colitis, Functional Dis- price facilities foi the Cure, Accommoda- 

orders of the Heart, Pelvic Disorders of tion, and Amusements are available for 

Women, Convalescence from acute illness Members of the Medical Profession 

At Harrogate a wide range of Sulphur waters. Full details of Harrogate for Cure and holiday 
strong and mild, and of Iron ,, IT’S QUICKER BY RAIL” upon appli 

v/aters, both saline and pure cheap monthly return fares to Harrogate cation to Spa Manager, Infor- 
chalybeate, is available for from all parts Any tram, any day mation Buieau, Harrogate, I 

HARROGATE 


TOR-NA-DEE SANATORIUM 

MURTLE DEESIDE ABERDEENSHIRE 

FOR THE DIAGNOSIS AND TREATMENT OF ALL FORMS OF TUBERCULOSIS 

Mmnguiff Director DAVID DAWSON, BID, FBSE 

Southern aspect Low rainfall Pure bracing air Sheltered grounds Beiiiliful surroundings All modern cquipmcni 
for diagnosis and treatment including operating theatre No extra charge for \ Kii>s, Artiflclnl riieuniollionr 
^ Ultra-Violet 'Light, or other specml frentmcivt 

Day and Night Nursing Staff All bedrooms ha\e central heating elccific light liot and cold riinninfc water and wireless 

(headphones) Comfortable and air\ public rooms 

Medical Superintendent J M JOHNSTON MB MRCS DPH For teims and prospectus appl) to the Secrctar) 

Telephone CULTS 107 


THE COTSWOLD SANATORIUM 

First opened in 1898 and rebuilt in 1925 On the Cotswold Hills sesen miles from Chclti-nliani for the treatment of 
and all other forms of Tuberculosis Aspect SSW sheltered from North and Cast elesation 800 feel Pure ‘ 

Special Treatment ha Artificial Pneumothorax (X-rav controlled) Tuborciihtis and Ultrn-aiolcl Itajs arc aaaihwc ^ 

necessary svithout extra charge X-raj plant Fullv equipped Dental Department Electric light Radiators, hot ami r 
basins and Wireless m all rooms Up to date main drainage , , , . . 


Afrrf iijpr OEOrrREa'' A^'HO?rM*AN M B T C Dub ,4iii P/im M XRO AUCT a' H XRrTsON MU B' 

DAXEI MB BCh Com,, II Loruirolomt CASSIDX DEW GIBB ERCSCdm Co„m„„rDnn.,/,,„rx GEORGE X <' 

.RCSLoncI Anpty Sccanri llic Cof-wold Simtomim Crinlnin Gloucester 7 r/ SI pud S. WiTtosirr Gra„is uoo 


7 “ ffOH to 


PENDYFFRYN HALL SANATORIUM 

PENMAENMAWR, NORTH WALES 

All Modern Mefhods of TreatmenJ Available ^ ^ ^ 

IcIltIU situated for the treatment of Tiibcrculosu. Sheltered from E nnd NE vmds CUmatc mtld Tnd bractne n-r'r’J 

TTit Samionum 15. sttuated m its own park There *irc miles of cradtntcd wtiks ihrouch pine Rorsc and hcuher rislne to _ ^ ” 

txtensue set and mountain mcws Ccntril heatme electric hchi X ra^ mstallnioo Wireless in ’ill rvioms lull day Tnu men n 
supply from n tupcrctihn tested herd Lastly accessible from London (4 hours) \f\NrnrsTrit Lisrtroof Bipstisrifty ind inc t or 

Resident Phjsitnn!. Denmson PIcRering M D , J W PURhi ?<1 B 1 C Cn j*' 

For particulars apply to the Secretary rendydryn Hall Penmaenmawr North Wales 


JULI 9 193S 


THE BRITISH MEDICAL JOLRNAL 


Choose a Spa in 


m 


XHe Spas and Health Resorts of CzechosIo\ak]a wth th^ir centimes old tradition of healins reinforced b\ thr 
e'^penence and researches of local specialists in\ite \ot)r serious consideration 

In addition to places of world wide repute such as 

PISTANY CARLSBAD MARIENBAD FRANZENSBAD 

(PiEStany) (Karlovy Vary) (Mananske Lazne) (Franliskovy Lazne) 

ST dOACHIMSTHAL TEPLICE-SANOV LUHACOVICE SUAC TRENCIANSKE-TEPLICE 
(Jachymov) (Teplitz Schonau) 

wnth their medicinal springs and mud baths there are numerous smaller spas and health resorts admirabl> 
equipped for the treatment of man> diseases including those in the follownng groups 

Anaemia and Chlorosis Basedow s Disease Bronchial Catarrh Constitutional Diseases 
Scrofula Rickets Digestive Diseases Diseases of the Bladder and Unnary Organs 
Diseases of the Kidne>s Diseases of the Nose and Throat. Diseases of Women 


Disorders of Bones Muscles^ 
and Joints Disorders of the 
Heart Disorders of Meta 
holism and Gout. Gallstones. 
The arrancements in the bath e<lablt hments 
are up to date in eieiy isaj the cleanliness 
and neatness proierbial the erMce aiienine 
*ind courteous 

It L. accepted that a pa cure to be full} bene 
ficial hould pro^^de a complete chance of 
mrroundmgs, and a break with (he patient j 
normal c>cr\daj life 

Further in/er/iialion from onj, Office of 

THOS OOOK & SON, LTD 

end other /eadin® Tourist A<'encies 



V 


Leucaemia Nervous Diseases 
and Post Hemiplegic Condi 
tions Tuberculosis of the 

Lungs 

The Spjj fvih) ihr pvrp^e 

dmirablv comfortible hotels fin! 

da s orchestra ard dance bands e\er> 

facihtj for port — tennis golf swjmmin'* 

riding fishinc etc 

There are al o numerous fullv up to dale homes 
for convalescence and rest cure* 

and at 

CZECHOSLOVAK TOURIST 
INFORMATION OFFICES 
—in London 21 Regent Street S V/ l - 


DOCTORS OWN SPA foh 

RHEUMATISM 


Mud from P stany in packs ready tor hone use S rnplest safest and 
most economical treatment may be entrusted to any paoenc 
Cost 20*. for iO treatments. Literature on reeueat from Pisun/ 

Agency 

SEND YOUR PATIENT BY AIR 

has been specaify founded to fac f ute the transport inraf ds either on ihe rejufar serv ces o in esoecaff) 
eQu pped planes Apply for special folder 

KLM RO\AU DUTCH AIRLINES and CLS CESKOSLOVENSKA 

Part cula s j o^n 

PISTANY AGENCY LTD ulO Rerent Street London W 1 Tef UNj:*-om 42M or PISTANY SPA BUREAU 25 


VOLCANIC-SULPHURIC 
MOD SPRINGS 

in delightful surroundings 

2 t ©AYS 

INCLUSIVE CURE 

Sp**ci9l facilil e for doctors and 
ibeir wiles 
Fly there hr the 

BLUE DANUBE AIR EXPRESS 

Lrrr^on lo Pur-ny <■!. 10 0 i nt/r 
70 REDUCTION r" er n r e> i 
!/'• e ALA ir/ r”»r 

LETECKA SPOLECNOST 

CocksPur Stree ^ V/1 T i V'H e^ 77iA 


A SPA UNDER ONIE ROOF 

In Rock ide are cembmed all the amenmes 
of a modem r-a. including treatment rot aod 
entenainment 

SHELTERED SITUATION SPlCIO’ ^ 
GROUNDS H!GHL^ QUALIFIED ^AFF 
The Baths and Treatment Roms cccup 
»r«i-l I'ini; acco^ib e b' lift from all floori 
and arc full> equipped fo cicry form cf 
rh>''ical ircatrrcni in luding the most modem 
h drefcjrcal atKf cfecir-al method manage 
and rcreedul cscr'isei, dicteti'’ and occuro 
iicnal iher3p> Temw £d 4s Od to £6 6s Od 
IrKlusivc lerm. for corrtuUaiion fcc« treatment 
b<WTd reshicnee and aitendan-e from £6 6» 
rite for Tariff to the Sccrctarv 
C<'nj»i/rne Th\ucicn 
C R L estrange 
ORME MR BCh 
tCamh) MRCPfLind) 

MATLOCK 

cm or LONDON mentil no-riTiu 

DVDTTORD KFVT 

Lac m and Gentlemen rccei ed fc ircatmert 
tndcT crnifi~itcK and wib-nt ceni -ati n 
c iherNOLUNTAR^ or TEMPOR AR^ PATIENTS 
at a WTCkly Ice ol TVNO GLINE.AS ar^3 u-wards- 



J 1 H— t f r-« r-d 
► -IT'! I -A , 

.{ - r r*~ F.* ^ i 

L.— . I .a- I 

\ r* \ rt 


Terras I3f to IS 6 per «U irvdowe board 
lUintrated Croehure 'U oo reevert. 

r« r Ti r~J*« 

C C. R. HARBINSON AID C CIu B_A O 
fR.UI) R. NlacLELLAND MD CAT 
pi,r^rT No 1" C cmr M— >jck 


HOLIDV^S ON THE NORFOLK 
BROVDS OR NORFOLK CO VST 

imiTAIN*^ DRIIvr aiMlTE- 

Nfr J R E Land Ar— ' NN r 

No fo k (Life Gerr^ro N / A erd Nr'v A> 

H ^ *11 Kcnd free oti ap** tcai •* 1 raicv. 

B->rK cf rL*Tdjcd and Ri emidc B-a-a 

lew lo Let f-e the llo “d-i ScaKca A v> 

a cle— - c II-KT^cc arvj RjcraW-^ It Nat 
Grtm Dntrer NVitnham Phene WruAhamJ^ 


TORQUAY 

GRESH VM COURT HOTEL 

RECENTLY OPENED I uxurioiu 
comfort combin'^ ■with an c:.rnc dc'ire 
lo pica'ic 

The resident propne orA will he p’eaKcd 
to quote <peaal icrmA to r'cmbcrs of the 
Medtcal profc> ion on recciplo^ reque t ft. 
IlluAiraied Brochure M Tli 



54 


the BRITISH MEDICAL JOURNAL 


^ 4i,; ^iJinARneuina 


r - Spa of 

^ - ■ '-.m t* 



KINMEL HALL 

ABERGELE 

S ITUATED between the lovely Welsh foothills 
and the sea, Kinmel Hall commands a thousand 
acres of its own parkland and golf course 
Exquisitely furnished and equipped with every aid to 
comfort It IS an ideal residence for those needing rest, 
recreation or modern Spa treatment, including the 
Continental Pistany Mud and Scotch Douche 
All Spa treatments for Rheumatic and similar disabilities 
are given in a separate wing of the building under the 
supervision of a fully qualified Resident Physician 
The cuisine is first class and careful attention given to 
special diets 

A visit of inspection is invited 

* Recnation jacihtics inchidt oun Qolf 
com sc femiis 'iqiiatli hadiiiintoii 
iidim, fishiiii’ open mr swimimiig pool 
Cotinlii Club adjoiniiiq (licensed) 

Erochure, photographs and full particulars from Secretary (Rheuma 
Spa Ltd ) Kinmel Hall Abergele N Wales 

Elestdent Physician C Noel Davis M O (London) O P H (Camb 


JUL\ 9. 191S 


^BDE CHOICE OF 
a suitable resoi t 
for 

con^Mlesce^ce and 
recuperation will be 
made easier by frequent 
reference to this section 
of the Journal 


Phase meiitiov tin 
^ BM f xohen 'outmg § 
to advotucn 


Chartered Society of Massage and Medical Gymnastics 

ChARTCRCD MASSEUSES ond MASSEURS receive Ho«pitnl Trnining Thev are q«nhfi{.d to ndmmiiler AJASSNLf 
REMEDIAL EXERCISES ELECTRICAL nnd LIGHT! REATMENTS 

The Society was granted a Rovn) Charter in 1920 in recognition of the Ingli standard of work mainlnined M M C 
Members do not advertise individually and pledge them elves to tr{.nt p’^ticnls only xmder medicol direction Al l 
members of the Soc iety ore -eligible for enrolment on the Natioml Register of Medical Auxiliary Services 
Nomos and nddrt^^m of mtmhvrs in n»> dtstrirt tn th%s r«iin/r> or nhronil enn tr oftmntd /r< m 

THE SECRETARY. C S M M G , TAVISTOCK HOUSE (NORTH) TAVISTOCK SQUARE LONDON W C I 
f hono hualon 1076 7 ft - 

GLASGOW POST-GRA^ATE MEDICAL AsioCIATIOtf 

POST-GRADUATE TEACHING m Glasgow during ihe Summer of 1938 comprises principally 
A General Practitioner’s Medical and Surgical Courses from July 18th to August 27lh, nnd 

B Clinical Assistantships in General and Special Hospitals ^ 

Sylhbuscs and any other information may be had on application to the Secretary, Post Graduate Medical Associalion, The tfniversily GUigev^ 



CITY OF LONDON MATERNITY HOSPITAL 


Uncorporated b\ Hp\a] Chart ef'l 

cm no ID I c 1 


Hic Hospital olTcrs facilities to I OSTGRADUATES for obscrvinc the work of uv Antenatal 
Postnital and Denial Clinics and to male MEDICAL STUDENTS (and rractmoners doinnu 
a Rcfrtbhcr Course) a too or four weeks Midwifco Course (Rcsidcnual) Ncar!> 2 000 
patients annually 

RALPH R CANNINGS Sccrct-iry 


STAMMERING SPEECH DEFECTS 

BrilNKL METHOD ib IbeO Ca^e^non 
ro'Uthnt tn-itcd \l 33 Court Sn 

^ 5 and in residence in the Summer holi 

dll j it Mf'ij BEHShE b hon«c on the C hiJtern'’ 
Jitimintnl nri s jn clticalMj ml tnatnunt 
of tantmering m 1 >thor ptoi b tiefcrl — rnni 
riiorouphh pin ‘cHkhiI prnujpK — I mrel 
I lie nutJu I i f icntilu alh correct ami fcff (lb 
e(fiH.tne — Gin He pUal O* ttc 

Summering, Cleft Palate Speech, Lupmg 
3/9 of Mi’^s Ceunke 3® Laris Court ijfj U 5 


A DVICE ON THE CHOICE OF SUITARLE 

^ SCHOOLS AND TUTORS 

for BO^S and GIRLS wnb prospeciincs of 
recommended CNtablnhmcntN will be p»\cn free 
of charge to parents stating aec of pupil di 
met preferred ranee of fct.^ and t»p<. of tbooJ 
rtqiiircxl 

J & T PATON, 

I4T Cannon Street 1 ondon E C 4 
Publi hers of 

Pa ton b List of Schools 1. Tutors Pvst free 5/6 


M.D. THESIS 

sKiffpo” c'd'ic.i.';'?' 

AD>JCr ^ 

from Special Tutors In coniMnity 
Che Rccuhtions of the 
Apply for partfctilars anJ 
[lints on Wntins a Thesis for , , j 
Dcprcc to the SicRrTAjr 
Corrc^pondcncc (Tot cjrc 19 

Street London W 1 ^ 


^ORT^-I.AST V 

rOST-GKADljATr 
PRiNcr or wALts^ r.isruti 

The Pr.ciicc of Ihc llo^rhat !' ' " '/ 

kicdiwl Praciitiom.rs Pirtiunr 
Rfouv vr Atr\<vDi'* ^1 D Dean — 

P’ F.R CS (E din ) ^ 

j cDI^n^JnGn post al covitsr--' 

I Pull details of nboir and Ora' 

I H C 0 «« 1 N r RCi iurseonslfall *“ 




Jll\ 9 10.8 


THE BRITISH MEDICAL JOLRNAL 


MEDICAL 

CORRESPONDENCE 

COLLEGE, 

19 W clbcck Sired Lon Jon W J 



- i 


Cunclidiie* enleniijr for Part I in 
\o\citiber 1938 or for Pnrts If 
ind in in 1939 under jhc 

'Neu Rc;rulTMon« **liould \«rite for 
full dctniK of new colIr’*e^ of 
po-i il prep ir ition Lonfomnnp to 

I he new requirements of the 

syllabus 

qu'ilifictl Tutors i»ijh 
atcurate kiiovtledae of the pcciel 
fe itures of ihe^e e\ iniin ilion« 

II ntc at once for booklet Tbt 
Problem of the fmrl \f B B S 
LonPon Smt free on appheatton 

Atldross The Secrelan, 

MEDICVL CORRESPONDENCE 
COLLEGE, 

19 ^\eIbeck Street, London W 1 


-LONDON SCHOOL OF HYGIENE 
AND TROPICAL MEDTcINE 

l'•C0RF0RArI•,O THE ROSS ISSTITOTt 


POSTS OVERSEAS FOR 
MEDICAL MEN 

A register is kept m the School of 
medical men who are prepared to be 
considered for posts overseas -and the 
School IS frequently asked to advise 
plantation and mining companies when 
such posts fall \acanL 

The sahnes offered arc aiiractne 
conditions of serMce are go\emed b> 
standardised forms of contract and 
many of the posts offer to medical men a 
most interesting field in which to practise 
their profession 

It IS desirable that candidates for posts 
oier'Jeas should hold a diploma in 
tropical medicine and hygiene The 
course provided bv the London School 
for the Conjoint Boards Diploma lasts 
SIX months and the tuition fee is £40 
The course may bc^ taken from October 
to March or from January to June; 
There are generally more vacancies in 
the course commencing in January 
^ The Director of the Ross Jnslilute is 
alyyavs glad to interview medical men 
who would like information regarding 
rhe possibiliiies of a career ov ericas if 
they yyall be good enouch to make an 
appointment to call on him Enquiries 
may be addressed to 

The Director 

Ross Institute of Tropical Hygiene 
London School of Hygiene Tropical 
Medicine 

KcrrcL Street Goy\CR SisrcT W C 1 


UNIVERSITY j 
EXAMINATION I 
POSTAL 
INSTITUTION 

Foundfd is 

17 RED Lion sq^ lovdon ci 


EXPERT PREPARATION 
FOR 
ALL 

MEDICAL EXAM INATIONS 

ORAL CLASSES 


POSTAL COURSES^ 


PRIVATE TUITION 


THESIS GUIDANCE 


MUSEUM DEMONSTRATIONS I 


THE PRINCIPAL WILL ADVISE 
ON ^N-i DIFFICULT'i THOSE WHO 
CARE TO WRITE OR CALL 
AIEDICAL PROSPECTUS (4* pp ) 
CO**T€^rS Hte rrcihod and xhe com f enter 
»ae the Vledtcal Profevsion Fart cute, s of c!t 
\fcd cal Cxami lations I cr>tai Cour^ and Oral 
Classes Sus-cstions for the Higher vtedical 
EtaminatJons Su^esuons for the Hifher Si-r 
eical Examinations Suceestions for the Special 
Diploma Eaaninauons Rc(resher Courses Open 
mss for yy omen Hints for writing theses 
Mcdica] Prot^pectus inaus along uiih It t of 
Tutors etc on application to the Pnrcijial 
1” Red Lion Sq London W C 1 (Telephone 
Holbom 6^13 ) 


ST MARY’S HOSPITAL 
MEDICAL SCHOOL, W' 2 

<l MV ERi;m or LONDON ) 

THE MTNTEB SESSION MILL 
BEGIN OV OCTOBER Isl 1938 


The Medical School rroxides Courses in Pre 
limmary Intcrroediate «nd Final Suhiccts, and 
Students can ;om at once after Mainculation 
SITUATION — Between a l-rgc populjiion pro- 
xidmg Cltnical maienal and one of the bc^t 
residential disixicts thus enabling Siudcn.$ to Ii>c 
in close protmit> to iheir work 

NEyy BUILDINGS — The new buildings wht h 
cost £2.0 000 arc now m use 
CLINICAL UMTS IN MEDICINE AND 
SLRGERV — Cen-tn members of the Mcdicrl and 
Surgical Stall dexcic ibeir whole tme to teaching 
and reseaich 

nearly 1 tW BEDS axailaWe for teach ng — 
nddjiional Clini-mJ maicnal being rrt tded bj 
atniiati n m an fnl^tmarx and other fr iitutiin 
ENTRANCE AND RESEARCH SCHOL\R 
SHIPS to the xaloc of H 00 are aw rded ^.nrcally 
APPOINTNfENTS noing in >-aIue cr to £~ C 
■^r annum open to Sitdents after qt-xlficaiion 
Tor further pAttKttltrx and I’uAtrated 
appl to the SJjpol Secretart 

C M WILSON (MCI MD F R,S P Dean 


R ADILV! beam THERAPy RESEARCH 
At the Radium Invt im 
1 Rit. nr H -n?^ Street London W I 

ASSISI VNT MEDICAL OFFICER treAwC-t) 
S- arx Cl 0 pc' ar-um S t r-r th ar~v-~-r~‘rrt 
A-'p catJvP^ t-tinc -r c -^t on% an- cx 
pcrcn'c w h c»rm of i-\ •«*e^ « to b^ «eri 

t-v ihc *<x:*'ciarx R u im Pc m Th'*rar> Re'c,jxh 
rrt 1 cr than Vnn^.ax Jcl h 

It t» ble frr a canJ^jtc lo bed 
and at ih* Ajm t n*e to •^fT> on jvent 

r- 4. a c X t'^e moT ofN h<*rr f'ec 


LMATRSm COLLCGC LONOON 
rAClT-Ti or MEDIC \L SCIFNCLS 


«PEC!iyL ciUT F for Tr”- r* 1 v \ 
FELLOyy-llU LW'MNvTUIN Of niF 
Cor Li I L I r roN 


iHy‘=T''»L 

SLPTEy ac'* n I 

Et_'- „ 

y^ATc^Iy p' -s K 

'in O';. 

pHyMc Ic'd PH I . b *• 

F y 

’r- c - A - 


yN MO n 

*■1 r 

*■ e** — 

H V 
FT'; 


f \\ 


V n 
r~ 


d “V 
•t *-e 


t _ a „ w •> 

et K ■" y - f 

R-i. -f D « ' — V 

oi i*'' eu ,1 

ThCj'cePn r .. 

JPu Hn ! 

dcri r tnt - jr ^ . 

S .. r* (Sw -x.- cx c r r™ 

ber f ^ 

FlII pan Lire r* h n ^ 

Cl C r> K IF 

s. 

L r cfv fr C •**-c L-tCw a i\ll 


L’NlNTRSm COLLEGE HOi5Pir\L 
MEDICAL SCHOOL 

RvoenFFr CHOCK r tiumilim 
nuiOLkr»*nip IN oLitMiroiOf > 

The Ctr*~*jt{cc of INIvtRSIlT CO If r 
HOSPirvL n le a— -ti -s f the R 
CfN-ker Tn eJtm Svh i r^h n n D r—j 
Ih Vhpljr'h r r i ar*' ot ~at 
r' < ( nab L fer a per-x. f tuel cm “ : V 
pert at t'*'e r c uu> h Ss.** 

C nm tree ut iJe of ih Ln ted K r m 
Card '^atcA rntr-t t“ Bnts h tde" I 

t n MediraJ S>.htx' g t-j n fa 

L niter it m the L r ted ki .ed 

AppJ *arK>p> muxt be ub*^ tied no b 1 re 
Ti csda July 1 ih IS b 
Ftr further p-rti ulaT 3r"li to th D «n 

R SLOLEV Sxre af\ 


QOVST\ BOR.OLGH OF SOLTHrCPT 

DEPLTn MEDICAL OPnCER OF HE MTU 
AND SCHOOL MEDICAL OFUCEk 

The Council of the Ctumx B r u h of SuthiAn 
inxttes apcIicatiLn kr the post of Dcpur> Med -al 
0*“ieer of Health and S^-hool Med cal O^’ieer frt m 
gentlemen duK qualified holding a Dp om { 
Public Health or a derrec n State ATcdvne rd 
not oer **0 >can of are 
The salan mTI be at the rate of tt-PO per 
wnnum with two annual incrcmert^ of £* H-x 
and one of ^ to a maximum f per amm 
The appointment will be subject to three momh 
nott c on other dc. The person arromted w tl 
not be allowed to engage m pniaie praoi c 

An -Ilowance of f*0 per annum wi 1 be rnaut 
for the maintcrar c o a moitr car if used in the 
AerviT of the CerponuLn 

The person appo nicd will be rcqnred i pj 
a medical czammati n and ii corm^uic ia t*'c 
Corporation J Superannua ion Rchrm 

Expencr c in the ducnLxi and tre tr'en f 
external exc di ca’«^ and errors if refrj i cn \ ill 
be regarded as an adduipnal q a’ heat n 

Appl canon on the prcv.ri'^ f rm M inah c 
from the Nfed *al Ofl 'tr of Heal h Chi h 

Street Southron i ild be adure*xcd r the 
undersu-sed end xeJ D p itx \ ci_ -al O'*" cr cf 
Health ard cell cred not laier tS n J i jf, 
Canxas mg direct r ind reel wIldNOta fj 
Town Hall R EDGAR PERMNN 

Scuthxft Town Cl rL 

Jun ,9di P S 


iTl Df PLV lOUTlf 

MOLNF COLD OKTHOOAEDIC HOSPITAL 
(Of hop ev Ni-vl on I 0 Fx. 1 

Arr*^ton Sff If' 

ASSISTANT ORTHOPAEDIC SLPCEON vh 
» II XT r ihe aN. e hr^--a 1 c c sc* *' wccU> 
Th*x sci. rt r*ar i" kdc waru w rl n 

C“«crai n- r our r t cr cl - * -r e> Pc 

r-j ra n -.1— P^r a-n-— • 

Ap'' -a'’ tru? b>- Eel ow o* c o tSe P n I 
C ~*cx o S- r or _n> r- -v ^ c-r -- m t t 
whoc-t"" r n c of trtb''~-cd » ” ax 
Th' -’err wi be cct to i*' c r- 

rr — "a r her s— c 

ri,n‘“a r nii. ars m be c'-.a - i. f -m i e 
Lmfex r-ed t a— h.jr s r-j h-- 

wa i-ci- r t li cr iN,- Ju v 1 '' 15 ’* 

1 wD Ha 1 T PflKSON 

Sron cute M i- -a r*-" c 1 ... t. 

r TrcL-ih 



56 


THE BRITISH MEDICAL JOURNAL 


JuL\ 9 (9^S 


jlQ^ANCASHIRE C O U N T i COUNCIL 
PUBLIC \SS!STANCC COMMIT! EC 


LAKE HOSPITAL AND DARNTON HOUSE 
JNSTHUTION 

Ashton under L>ne nenr Manchester 


APPOINTMENT or SENIOR RESIDENT 
MEDICAL OFnCPR 


Sajnr> flOO r>cr annum together with the tisinl 
icsiucmial cmolvtmcms The person appointed will 
be required to nKc iip dut\ on September Isi 1038 
Applications arc insitcd from Jiemtered Afcdical 
Rractiiioncrs for the above appoimmcnt at the 
LaKc Hospital and Darmon House InstUuUon 
Ashton under L>nc comprising "^00 and ^25 beds 
rcspcctivcls The Hospital is rccogniicd as a 
complete Training School for Nurses 
Candidates inust be unmarried Preference will 
be Riven to candidates having previous hospital 
espcrience cspcciaU> m the administration of 
anaesthetics 

The appointment will in the first instance be 
for a period of six months the succossfij] candidate 
being eligible for reappoimmcnt for a further 
period of SIX months at the end of that period 
Forms of application mav be obtained from the 
Counts ^tccUcal Officer of Health Public Assistance 
(.Hospital and Medical) Depnrtiucnt Coiuiti Oi7iec5 
Piesion to whom all applications accompinicd bv 
topics of not more than two recent testimonials 
must be forwarded not later than Sotimlov 
Jills Ksth 1938 

Coiinij Ofiiccs GEORGE ETHERTON 

Preston Clerk of the County Council 

June 24ih 1938 


I ANCASHIRC COUNTS COUNCIL 
PUBLIC ASSISTANCE COMMITTEE 


WHISrON COUNTS HOSPITAL 
Near Prcscoi 


RESIDENT MEDICAL OmCI U 


Applicauois are mtited from Rccistcrcd Medical 
Practitioners for the appointment of Resident 
Medical Officer at the above Institution <500 Beds) 
Candidates must be unmarried 
Preference will be Riven to candidates having 
previous Hospital experience pirticuhrJy in 
Midv<ifcrv 

Sahij at the rate of £350 per annum tosethcr 
With the usual residential emoluments 
The appomtmcni will in the first instance be tor 
a period of six months the successful applicant 
being eligible for reappointment for a further period 
of «ix memUts at the end of that period 
Forms of application may be obtained from the 
Cmatts Medical Offtcet of Htalth Public Assistance 
(Hospital and Medical) Department Count} Ofiices 
Ptifstou (o whom alt application? accompanied 
by copies of noi mote than two recent testimonials 
must be forwarded so as to be received not later 
than Saturday Jiils \6l/i 1938 

County Omecs GEORGE ETHERTON 

Preston Clerk of the County Council 

June 27lh 1938 


ANC^SHIRE C O U N T COUNCIL 

appointment or dental surgeon 


The Lincashirc County Council propose to 
appoint a full time Dental Surgeon and invite 
applications from fully qualified and registered 
Dental Surgeons vvho must not be over 40 years 
of age The duties of the post include the dental 
inspection and treatment of school children work 
under the Maternity and Child Wclfirc Acts and 
such other duties as mav from time to time be 
imposed by the County Council 

The salary will be at the rate of per annum 
nsme subject to satisfactory service by annual 
increments of £2*? to a maximum of £700 per 
annum together with allowances for travelling etc 
The person appointed vviU be required to pass a 
mcdrtil cxamunPori and to contribute towards the 
Council s Super mnuatjon Scheme 

Vpplications must be made upon a form which 
cm be obtained together with further particulars 
from Countv Medical Officer of Health School 
Medic \I and Child Welfare Department County 
Ofiltcs Preston to whom tlic completed form 
should be returned not later than July 25th I93h 
All communications must be endorsed Denial 
Surgeon Canvassing is strictly forbidden and 
will disqualify 

e County Offiecs GCORGl rPHERTON 
^ Pre ton Clerk of the County Council 


Corporation oi Glasgow servicfn 

~UNTOR assistant MEDICAI OFFICER 
(male) wanted for the Hawkhtad Ment il Hospital 
rreshus mental hospital experience unnecessary 
but prefereHec will be given to one who has cn 
gaged in nihofogieal work or has been house 
physttntt ample opportunity afforded for research 
salarv to commence at £300 per annum wuh 
brard lodging and laundry 

Full particulars on application to the MedteaT 
Supennicndcnt Hawkhcad Mental Hospital xio 
Crook<ton Road Glasgow S W 2 


r ANCVSHIRE MENTAL DEFICIENOi 
^ COMMITTEE 


ACTS 


]yjlDDLCSE\ 


C O U N T \ 


COUNCIL 


An ADDlTfONAL ASSIST \NT MEDICAL 
OrnCCR age not to exceed 35 'years is required 
by the above Committee for the purpose of visiting 
and certifying Mental Defectives ihroughoiil the 
County of Lancashire the supervision of Occu 
paiiort^Ctnfres and the carrying out of such other 
duties as the Committee may from time to time 
require 

Salary £600 per annum (with an'' additional £50 
for a Diploma in Psychological Medicine or n 
Degree m Psychological Medicine of tiic London 
University) rising by annual increments of £50 to 
a piaMmum of 1750 per annum 
Tlic appominicm will be subject to three months 
notice on either side 

Form of application and further ptrlicuhR of 
duties etc may be obtained from the under 
signed and applications accompanied bv copies of 
not more than three testimonials must be delivered 
not later than July 23rd J93S 
County Offices CfHORGE ETHERTON 
Preston Clerk of the Committee 


CUURC\ COUNT\ COUNCIL 


PUBLIC ASSISTANCE DEPARTMLNr 


RICHMOND INSTITUTION 
(2S0 Beds) 


APPOINTMENT OF RESIDENT ASSISTANT 
MEDICAL OrnCER 


btivcr Street Edmonton N is 

ASSISTANT MEDIC \L OI FfCER tcqimcd hr 
Casualty and Receiving Room dunes CaiwlJ icv 
must be registered medical pnctitioncrs have held 
posts as House Phvsicnns and House Sutccons and 
with considerable general experience 
Salary £350 pa with hoard lodslng and 
laundry or cash allowance of £100 pa m lic» 
of residential emoluments Appointment n^n 
pensionable but subject to medical cvaminujoa j 
for period of six months vviih possibiluv of ct 
tension for Uirthcr six months and is terminal! 
by one month s notice on either side 
NVhole>tlmc services required under dir«. ft n of 
Medic il Supenmemiem Hours of duty lo im to 
6 pm dally with Saturday afternoons and Snndus 
free 

Application forms not provided Nnplunjpr 
stating age qualifications and experience tocuh r 
with copies of not more than three rcecni 
^monials must he received by the under JcncJ n-'t 
later thaw JuK Huh iw cw\elorc< enJooed 
C M D North Middlesex Uchtionship to 
ariv member or ethcer of the Council mist u 
disclosed in the application and canvism 
direetly or indirectly a disqmlifieailon 
C \S KADCLUIC 7 

Clerk of the Couniy Co»in il 
Middle ex Guildhall 
\\ estnunstcr S W I 
June 20ih I'JJk 


Applications arc invited from registered medical 
practitioners for the appointment of Resident 
Assistant Medical Officer at the Grove Road 
Institution Richmond The Institution is ad 
mlmstcred bv the Public Assistance Commiitcc of 
(he Counctf 

Applicants should have had experience as a 
House Surgeon or Physician The appointment is 
for a period of six months renewable for a further 
period of SIX months and the salary is at the 
rate of £2^0 per annum together with lull 
residential emoluments valued at £125 per annum 
Applications staling qinhlications and experience 
and enclosing copies of not more ilnn three recent 
testimofuals should be endorsed Resident 
Assistant Medical OtRccr and sent to the County 
MtdJtal Officer County Hall Kingston on Thames 
so as to reach him not later than July Hth 1938 
County HvH DUD! EY AUKLAND > 
Kingston on TInmes Clerk of the Council 
June 25th 1938 


gURRLT COUNT\ COUNCIL 
PUBLIC health DCPAKTMCNT 
RCDHILL COUNTY HOSPITAL (300 Beds) 
RESIDENT ASSISTANT MEDICAL OEEICER 


Applications arc Invited from registered Medical 
Pnctwiowcrs lor the appoimntcnt of Resident 
A^siyiant Medical Officer at the Rcdhill County 
Hospital EarlsvvooU Comrnon Rcdhill 
The Medical Officer appointed must have had 
pfCMOUS experience as House Surgeon 

The appomtmcni is for a period of six months 
renewable for a further period of **W months and 
the salary is at the rate of £250 per annum 
together with full residential emoluments valued 
at £125 per annum " , ^ 

AppUciiions stating age- qiniificaticins and 
cxpLiieuec and enclosing copies of not more than 
three recent tcstimoniab should be addressed to 
the Medical Superintendent Rcdhill County Hos 
pital Earlswood Common Redhill so as to be 
received not later than July 13ih 1958 
DUDLEY AUKLAND 

County Hall Clerk of the Council 

Kingston upon Thames 
June 27ih l9aS 


‘OUNT'i BOROUGH 0( READING 


BATELC JTOSPITXL 


appointment or resident assistant 

MEDICAL OFFICER 


Applications ate invited (tom rcgiMcrcd medical 
prietiltoncrs for the appoimnicm of Resident 
Assistant Medical OfficeT (maR) at the above 
Hospital at a salan M £300 per annum wuh 
board residence etc Candidates must be single 
and should not be more than 30 years of age 
The selected candidate will Vic required to Work 
under the direction of the Medical Superintendent 
The appointment (vvhieh will l>c determinable 
by one months notice on cither side) will be for 
a period of one scat and preference will be given 
to candidates who arc reading for higher 
quahneaiions 

Forms of application may be obtained from and 
must be returned duly completed to the under 
signed with copies of ihrte recent icsumonuls not 
later than Tlvwrvday 28ih instant Canvassing 
either directly or indirectly will disqualifv 
Town Hail C S JOHNSON 

Reading Town Ckrk 

JuK 5th lOti 


R 0\AL NZ SOCILTN for the IllXUIJ 
or WOMEN kNO CHILDREN (INC) 
(PLUNKEI SOCinT ) 


appointment or MrDlC\L adviser to 

THE DOMINION COUNCIL OI HIE 
SOCIETV 

The Damintow Council of the Royal K Z Sieim 
for the Health of W omen and Chiklftii (In 1 
(PUmkci Society) invites applications from mem 
ben. of the Rtilish htcdical Association for thf 
appcimimeiu of a Medical Advocr to die Siviciy 
The successful applicant will rtoiurc lo rriJe 
at Dunedin New Zealand to enter Into a contra t 
for a period of five years and to tfciotc hi< iihtk 
lime to the work 

Salary C! 200 per nnnum New Zealand ciirrcn > 
Eutihcr particulars may be obtained from Dr 
K C JrwrsnuKa MD EH CP 5 W impale 
Street Cavendish Square London NV or him 
the Hioft CoMXfisstovcR I OR Nrw Zulasp New 
Zealand House Strand London R C' 

TTic successful appliciinl will be required to taVc 
up dutv early in 1939 

Applications giving full particulars ns to ate 
experience and qualifications logciher with cop'^' 
of recent icsilmonhls will be received not liRt 
ihai) September 30tli 1938 and yhoufd be aiWrcs^ 
to the DOMINJOS PRCSIDINT PlunVct SvMth 
Queens Buildings Princes Street Dunedm New 
Zealand 


QOUNTT BOROUGH OE ROTHLhRl''! 

MCDICAI SERVICES COMMITTEE 

JUNIOR ASSiSrxNT UCSIDCNT MEDICM 
OEEICER 

Applications arc invited for the post of lum'* 
Axsistmr Resident iMcdii il Officer at *1’^. p,., 
Road Hospital Rotherham at a sahry oi 
per annum together with the iisinl 
Hie appointment will be for a period not 
iwcUc months determinable by one nun 
notice on either suit i 

TTic ippomtmcnt is subiccr to ihe rmvision 
the Lotal Government and Other Olheer' '“Jiv 
anmnlion Act 1922 ind the sueccssful canJtu 
will be required to pass a mcdital cxamiiutt 
The person appointed wiU be .h,, q 

under the general direction of the 
SupcnnienJent , _ # r, ih 

forms of ipphcailon nn> b" !, ,f. ^ 

Mcdieal Officer of Hcilth lown Hall J; j 
and must be returned to the ''"dersiKned endin 
with the title of the appointment not n'cr 
noon on Ji/Jy 20ib , pre rOROfa 

Muiueipal Office CHA8 I br » 

Roihcrlnni Tovs n CWh 

J^OTAl BURCH OI KlRKFUnl 

^ Aonhcainns me Invited (or the ^ 

REsmLNI MEDICM OPriCLR 
jro'ipinl KfrPciUt n Ij, J-- 

£300 rcr innum »iili boird Ll, 

Prcarcncc ^'ill bi- R/'C" 

experience or quahfieauons In r 

nppoinimcni Is vublcet to the 
dmons of ictMCc 17, cq "fJ ' 

nnd the ^uccct^fiil cmdidatc "ill be fM 
pi« 1 mcdictl cnmiiniion ^ 

rorm< ot iirp\i>.-i'ion wd fudher r^fi , 
he ohiDincd from the r !►> 

ipphcatiom MtooW be tcturnol not 
3id> loth lOSh , ,, (H3 

' " ‘’■""'"McdKOl Oli cr o' » ' 


JuL^ 9 lyjb 


THE BRITISH MEDICAL JOURNAL 


ROYAL NAVAL 


MEDICAL SEI 



Vacancies e-Mst for Medical Officers in the Royal Nav-y, and applications are invited for cntrv 
in September, 1938 

Candidates belon the age of 28 years are preferred and they must be registered urder the 
Medical Acts No examination m professional subjects will be held but candidates will be 
required to attend for interview by a Selection Board 

Selected candidates will be entered for Service for a period of three years, which if desired is 
usually extended to five years at the discretion of the Admiralty 

At the end of three years service, officers may retire with a gratuity of £400 but those who 
serve for five years will receive £1,000 

At the end of five years’ Short Service, permanent commissions will be given to selected officers 
who wish to make the Naval Medical Service their permanent career Officers transferred to the 
permanent list will receive a gratuity of £1,000 (less Income Tax) 

Full opportunities exist for transfer to the permanent list, and periods of unemploved or half 
pay are v’ery rare The assistance of pnv'ate mcome is not necessary for the purpose of supplementing 
official pay and allowances 

Opportunities are available for officers on the permanent list for post graduate studv to specialise 
to take higher examinations and to obtain further qualifications 

Naval Medical Officers are mcluded in the Scheme for Marriage Allowance under the same 
conditions as for other Naval Officers 


Copies of the regulations for entry and conditions of service, includmg rates of pay allov ances 
and retired pay, may be obtained from the Medical Director General of the Navy, Admiralty S W 1, 
and from the Deans of all Medical Schools 

Applications for entry from intending candidates must be received not later thacr 
31st August, 1938 


/~'ITY AND COUNT! OF NtW CASTLE 
UPON TINE 

APPOINTMENT OF ASSISTANT CHILD 

WELFARE MEDICAL OFFICER (MALE 
OR FEMALE) 

\pplicatiofK arc mMicd Irom dul> registered 
^tcdIcai PractinoncTs for the po5t of Avistani 
Child Welfare Medical OfBcer The person 
appointed ymI) taVc part m the oTdmar> loutme 
work of the child welfare centra but will not 
be required to assist in the working of the ctatcmiiy 
scmccs 

Applicants tnli be required to base held a p<fet 
as House Phssician in a reco^naed teaching 
hcrvpiial (General or Children) and me expert 
ence of methods of medical or pathological research 
IS dcs-rabic The pcs esMon of the Diploma in 
Child Health granted joinil) bs the Roval Collepc 
of Phi-sicians and the Roial College of Surgeons 
will ^ regarded as an additional qualification 
Salary £500 n mg to £"00 per annum b> annual 
mCTcmcnis of £25 

The appointment wMl be subject to the provisiocs 
of the Local Goscmirent and Other Officers 
Sur>cr3nnuation \a 19— and the ^u-xTcssful can 
didatc will be required to pass the necessary 
medical cxaminaiion 

\ppIications on the rre<cribcd form whi h can 
be obtained on application to the Medical Offtce* 
OF Health Health E>cpartment Town Hall 
Newca tte»upon-T>ne 1 mu t be utT tied net 
later than Saturday July 16lh 19 S 


H ull corporation health 
di:p\rtment 

BEVERLEY ROAD INSTITUTION (HOSPITVLl 
( 00 B ds) 

ASSISTANT MEDICAL OFTICER (^\OM^N) 

^ppli attois -v.rc intiicd from umtamed cr 
1 Jowed Women Med cal Practiti ners f r the 
abvtc arpv mrment fra rv.nod of one year 
Sahry £3^0 rv.r nnum to ether waiH board 
t's'dcrKC nnJ laundry 

The Hcwi Hal i equipped with \ ny and Ultra 
% I ’ct Light D partments 

\rp* cation forms etc mar be obta ned from 
and houM be returned duly completed it the 
tirdcrsicncd nyt later than 10 a m on Mcrda 
July ISth 

NICOLAS GEBDIC M D 

Mcdsnl O'^cet cf Health 

Health D'rarfnent 
Cut dhal) Hull 
June :'th 19 


^OUNTY OF SOMERSET 

APPOlNTkfENTS OF MEDIC\L OPHCtR OF 
HEALTH FOR THE URB\N DISTRICTS OF 
FROME AND KE'^'NSHAM ^ND THE 
RURAL DISTRICTS OF FROME 
ANTJ BATH WON ANT> 

ASSISTANT COUNTY MEDICAL OFFICER 


Apoltcaliors arc insited from duly qualned 
Medical Pra“Utiorer» who ate rcgtstcred in the 
Medical Register as holder of diplomas in 
Sanitary Scicrce Public Health or State Med cne 
for the abo'c appcintmeni wh^h it t anierded 
shall be held by the same person 
Th" dulim as A ont County Medxal OfS'pr 
will include s,.hool medical in pcctioo and serural 
dr^exse work 

The officer appo cted will be requ red to dcsote 
his whole time to the dut cs of the abosc 
mentioned appoinlm nu ard wDJ be rotnacd 
from cn''agin'’ m rn'aic practice as a med cal 
practiuoncT He will be required to perfo^ all 
the duties presenbed by sum. c or regulation ^rd 
such other duties a> nt_y fi-cm ti*^ to tr~e b* 
a i ned to him by ihc County Ccaral 

The aggregate ccrarnencinr s_lar> will be fsOO 
rising by annual ir-'cn'cnis of £25 to £900 a year 
TrasclliP** allow-arcc for th» trv- of tbe cr s 
mo*or car wi I be paid in .'^rdar e wy h tb- 
Counts scale ard o^cc ac cir'ncd..i cm ..rd 
cleneal a la— c will be r o ided 

The successful can<Aiw,aie who i-ust pa s S3t.>- 
factonly a medical cxamirit on wd! be reqered 
to reside m o rear th" City of B~ih 

Appli'atiorts atin a e qua ifmitiop dm otr 
rd espener-c mu t be a compar cd tx cop m cf 
not r"c e than three recent testm "—is ..nd m ^st 
be sent to the Clmk of ih- C arts Cojn P C'u-ty 
H n Taunton so n fo reach h m rot la cr th-n 
Jul lS|h 1** n en cl ~es er^orsed 
Medical O-i cr 

Funher pani-mlars and c nd -ps cf w— mnt 
rren may be cbt-in'd from th" O k cf I'-e 
C jnty C unal on re^r of a araned auv. e«sev 
f so scap cm cl 

C-n -3 "s d cctls cr m- rectly w 1 be dccr*c-_ 
a d Aqual ‘icauen 

H NROLD RING O-rk cf t'-e Sc— erset 
Cou- C uncil 

H J NLLARD Omk tn t‘*e Fr — 
Urban D net Ccu** 

W B KENT C— k to th- Frc— c 
Rural D net Cotr*~l 
GEORGE R ASHTON CT— k t t‘- 
Kes-sSam U'N-n D'ntt — C ^ nci 
R H WHITTINGTON Oerk to t^e 
Ba ha on Rural D met Cosis*jl 

Jl~c 19 a 


jgAPP^ URBAN DISTRICT COCNOL. 
ACCIDENT AND SURGICAL HOSPITAL 


Ap’^liiaLoix ,^e n 1 “d for the r<^t of 
RESIDENT SLRCICAU OFnCER to c'mtrcrcc 
duti-^ in Ovpober cent S-bry t'* ra c f £3 > 
per annam n_ "g by two mere— *r j 1.9 per 
arnjn to 4 0 t gCvher with bsm v. id l-iu-r 
tbe -rroT — n to be t-r— n_ cd b* tr - 'm 

nou-c on cnber -de 

Cand dates must not t'* over - ears c a — 
ard mu*st tc capable cf r>erfcr— — p*j r j— val 
operaii m Preference w 1 be r cn to ^ 

ho'd ns b -*'er surmcal qua! ^ mt «-d a** „ 
assry in carryir- co lh“ I ra\ ucrV cf I'-c 
Hosp tal Th“ arroinu~cr i ..beet to th pfo 
Mvom of th Local Cosc-r— e^t ard O**— r O^-cr 
S'^per'ccuacpn Act 19 _ ard th* u! 

eacd date wi I tx. teq,.. cu to pa a _ 
examtnati n 

The u-cesiLl cand dat- » I an u“-er t‘— 
direaicn cf th- Aled cal Su-en c-'dert and the 
Suremm 

Ap"^ caaor Sv-Lr- _c -mi I raru“u_r« w ♦' 
regard to etperer e, wiuh cc-.es cf t*‘ree revert 
tCNDmoouI to be ert to D E I D sir 
Medi'al O^ccr c HcalJi R b Heal h O'*" r» 
Barry Gl_r" so as to rr*ch h — a -r »'■ - 
Jul I6vh 19 

c>5u-cil O'*" cs T D HOWELLS 

Barry C’c^t t«-- Co* - 1 

Ju- Z- h 19 « 


QIT^ OF MANCHpSTTP 

CRLMPSALL HO'??lTAL fl_- Fn.. ) 

Th P-’" Ho h C-- — 1 t — » -s r- t - 

fr— re— te cd r-c^ cal r "UIn-cts f 
f RESIDENT SIRGICAL OPUCER a 
abfTvc 'u-'*u h‘^“ j’ 

Th sa f t a— « rs r x ^ 

I. _< — rs y t a m-T — — 

-s,") ^ ^ fp. > 

n - - - ‘"C't t:» I - M - — r — • 


A— 
r -r' 

ex V.— 

El I 


H 


r"-'bJ h*'r 
-x.r- *• cb-r-m 

1 P'- 

— _ - -d f T* r 

— .J f N- t \ O 


be re e 


bv 


L c* 


pr-v r- -v: 

)u > U h \ 

T-*m H FEW APE'TrK JO t v,U 

A ^ Tr-s-* C — 

J - " ^ 




58 


THE BRITISH MEDICAL JOURNAL 


pOUNTY nOKOUGJ) OP WIIKENHCAD 
dcpauimcnt or the medical 
orncEii or health 


BIRKENHEAD MUNICIPAL HOSPITAL 
(560 Beds 1 


RESIDENT SURGICAL OEriCER 
RESIDENT medical omCER 

Anrdicanon'; arc fn\itcU for the 'thovc posts 
which will fill Meant on October Ht 1938 TIic 
appointmcnis arc tor twelve months 
Candidates nivisi he male unmarried and fully 
civ^iucO rcRistcrcU medicT) prnciiuoncrs 
Tlic duhes punched to die post of Hcsidcnl 
SurRlc'il OfTitcr arc nninfy surpjcil 'ind ob^icJrjcil 
a»d preference will be given lo cindiditcs who 
h'i\c hid previous post criduitc sutricM (including 
opcfTiivc surgcr>) experience ciihcr in tv Mumciml 
or Voluntary Gcm.nl Hospital 
The duties atiachcd lo the post of Hcsidcnt 
Medical Officer arc nn»n)y mcdlcM and preference 
will be given lo candidates who have had previous 
post griduatc medical experience 
Salary CJOO per annum with board residence 
and I umdry 

AppUcaiions must be made on forms to be 
obtained from Or D Morlci Mithicson Medical 
Officer of Ifcalih 9 llamihon Square Birkenhead 
Applications endorsed Ucsldent ^^edlcaI 
Ofliccr to be received by the undersigned not 
later than July 2^th 
Town Hall C W TAMC 

Rirkcuhead Town Cl erk 

M A N C H K S T E n 


C 


I T \ 


Of 


ASSISTANT TUBERCULOSIS OmCER 


•The Public HcvUli Committee fruhes applications 
for the position of Assistant Tuberculosis Oflkcr 
at a commencing salary of C65CI per anmim rising 
b> annual increments of £2S to £750 per annum 
Candidates must be registered Medical Practl 
nontrs having spccid knowledge of Medical and 
Surgical Tuberculosis and should state uhclhtr 
they possess the Diploma of Public Health 

Appheations (no special form is issucdl statmt, 
age qinhhcailons and experience with conics of 
not more linn three recent tcstimom ils and 
endorsed on the envelope Assistant Tuberculosis 
Officer must be addressed to the Medical Officer 
of Health Town Hall Mmehester 2 and not to 
members of the Committee or Council and*muist 
be received by him not later than July 27ih 1938 
Hie gentleman appointed will be under the 
administrative control of the Medical Officer of 
Health and the immediate control of the Senior 
rwbercnlosjs Officer He wiU be reqvuced to devote 
(he whole of his time to the duties of his position 
(o execute the Deed of Service and lo tontributc 
to the Corporation Superannuation I und 
^Canvassing m my form direct or indirect oral 
or written is prohibited 
Town Hall E L NVARBRCCk HOWELL 
Mnnehester 2 Town Cferk 

3olv 4th 1938 


I r Y 


o r 


MANCHESTER 


CRUMPSALL HOSPJTAE (1 543 Beds) 

The Public Health Committee invites applications 
(tom registered medical pracmioners for the post 
of RESIDENT ASSISTANT MEDICAL ORfCCR 
(Grade 2) at the above named hospital v 
i he salary for the appointment is fZ'JO per 
annum with board residence and laundry in 
addition subject to the Manchester Corporation 
conditions of service The duties of the appoint 
ment ate of a surgicU nature and candidates must 
invc had previous experience in surgerv 
The apnomtmcni will be made m the first 
instance for i period of six months rcncvvablc for 
a further six months but not rcncvvablc there iftcr 
EiiU mtornntion and forms Of apphcaticm may 
be obtained from the Medical Olficcr of Health 
Town Hall Manchester 2 and appheations for 
(he post must be received bv him not later than 
July 20tli 1918 

lowii Hall r E WARBRECR HOWELL 
Manchester 2 Town Clerk 

July 2nd 1938 


1 T ^ 


o r 


BIRMINGHAM 


ROMSLC\ HILL SANATORIUM (120 Beds) 


RESIDENT ASSISTANT MEDICAL OmCER 

Applications arc Invited for a Resident Assistant 
Medieil Officer Candidates must be unmarried 
and have held a resident hospital appointment since 
Quahfymg Experience in the diagnosis and treat 
mem of uibCTcvilcv is will be a recommendation 

Tlic appoimmcm will be limited in the first 
Instance lo six months vnd subject to satisfactory 
service may be extended for ^ further six months 
ITic salary will be ai the rate of i24l) per annum 
for the first six months and £27*» per annum for 
the second six months with board and residence 
in caeh case 

^"arms of application miy be obtained from the 
Medical Supcrmiendeni Uomsiey Hill Sanatorium 
Halesowen nvar Bnmlnpham and should be 

returned to him not later than July 23rd invs 
rcturnc F H C WILTSHIRL 

Town Clerk 


'F'" UNIVERSITY 


or LIVERPOOL 

, 'PPliMtions lor Ihc pou ol 

rir n '*'« DEPARTMENT 
or pathology SoIto EGOO nslnj: by luntnl 
incrcnicnis ol £25 to £700 

‘*iR'c 5 of rtic Lecuircr will commence on 
Oclobcr 1^1 1939 The mpoimmcnt is n whole 
lime one antf ihe Lecturer will be icqmfcd lo 
comply with Ihc coniliilons of ilic ) cdcnleil 
Super inmioiion System tor UnivctsiUcs 

Eour typcwritien applitilions lojjcthcr willi ilirec 
rclcrcnces nnil Iil ihc copdiiloie so Ocsirev) topics 
ol tcsiuponisK shotifd bt fofwsrtlcd not htcr linn 
Sihjrds} Scniember ltd )93S to Ihc RtKisimr 
cnqiihies for fiirihcr fnformnion shoiilil be 
sddrcssctl to ihc Gtorac Elolt Professor of 
Pstholofty Ihc Unistrstty of Elscrpool 
, , ^ STANLEY DUMBELL 

July )91S Rcjiistrsr 


gSSEX COUNTY COUNCIL 

SECOND ASSfSTANT MEDICAL OEriCCR 

The County Council of ihc Adnilnlslnlitc 
County of Essex invite appllciilons for the nppomi 
mem of Second Assistant Medical Officer at the 
Black Noticy Sinttorami ncir Bramtree 
This San itonum contains 300 beds for the 
treatment of pulmonary and non pulmonary 
tuberculosis in men women and children vnd 
possesses all modern facilities for diagnosis and 
treatment and a staff of Msnmg spcchfisi^ 

Tile appointment is limited to a period of four 
years The salary will be at the rate of £tR) per 
acinum and vvdl rise siib’cct to satisfactory service 
by annual increments of £25 to £425 per annum 
together with tcsidemnl cmoUmicnis valued at 
£160 per annum Appheanis must have held a 
resident appoininicm m a pcncral liospin! The 
succesy/w) app)/ean( uiB be reau/fcd to pars a 
medical tvammation and will be Mibject to the 
Council s Sick Biy Rules and RcguhHons a copy 
of which Will be forwarded on npphcalinn 
Appheations Mating age oualihcattom and ex 
pcncncc accompanied bv copiv of wot more than 
three recent icstlmonhls (which will i\o\ be re 
turned! should be nddrisscd to me and delivered 
nt the County JJaB Chclmvlori) noi laltr than 
JO am on Tfmrvdi) Julv 2lvt 
Counti Hall t S UOLCROrr 
Chtl/ijvford CRrk of the County Coi/ncO 

Jub 5th /9J5 


<OUNTT mental HOSniTAE 
' WHiniNGIlAM near BRrsTON 


Applications \tc invited for the whole time 
ippoimmcm of SENIOR ASSISTANT MEDICAL 
orriCEU It the above Mental Hospltd The 
salary Is £700 per iimtim An addnumal £50 per 
annum wtll be pdcl for (he possession of i Diploma 
m psychologic li Medicine The scicctcxi candidate 
if single will be featured to live in the Hospiml 
and Witt be provided with (voard lodgings etc 
tor which a charge of £I50 per annum Is made 
U the selected candidate is married he may be 
required to live within icasonibtc distance of the 
Hospital until a bouse or married quarters is av ul 
able Hie appointment will be subject lo the pro- 
MMOns of the Asylums Officers Superannuation 
Act 1909 and the suctcssful candidate will be 
lequircd to pass i medical examination 
Appheations giving full particulars vviih icsii 
monials (copies only) should be forwarded so as 
to rcaefi the Medical Superintendent on or before 
July 20Ui 1938 


>OUNTT 


BOROUGH or MirSTON 


SHAROE GREEN HOSPITAL 
(250 Beds) 


JUNIOR ASSISTANT RESIDENT MEDICAL 
OniCER (FEMALE) 


Appheations arc mined from fully qualified and 
registered practuioncrs for the above appolntnicni 
Silary at the nte of £100 per annum with full 
board and residence The appointnicnl will be for 
a period of six mtuwhs and can be renewed for a 
period not exceeding six months 
Applications Mating age amliOciiions and 
cxper/cncc tpgetber wilh copies of three rtceni 
(eMfmonlalx should reach the Medic il Superin 
tendem not later than first post on July 23rd 1938 

T Jir LIVERPOOL HOSPITAL FOR 

CONSUMPTION AND DISFASHS 
OF THL CHEST 
Mouni ricasani IiverpooJ 


Appheuions arc invited (or a FUl L IIML 
RESIDENT MEDICAL OFFfCtR to the Hospital 
for Consumption and Diseases of the Chest Pre 
slows hospital experience cicsfrahtc Both Medical 
and Swrgvcvl Trcitmcnl of Pulmonary Tuber 
tuJosis are imdenaktn at (his Hospital 
The appoimmcm will be for a period of one 
year Silary £ls0 per anum with board and 
residence 

Applications stating age natfonahiy quahhea 
tions and expcncntc fogcthcf with copies of three 
recent iLstimonnh or names of two local referees 
to be sent to the Secretary not Htcr than July 
20ih t93b 


Jun 9, 1918 


(;^auNTY dorouoh or sr Hci,rN 5 

Ai.S)STANT MEDICAL Ol EtCLR Of HEMTll 
(rcnvalg) 

TuZe\TT\r't 

a nnMimim Of £700 per mnim. Mi! h 

nnnlher A Hi '' ‘'""‘'‘'■"5 "O" lo H'C '« 11 « Ol 

Aiiihotiiy on i tlslni! 5C\tc rccosmtiin 

H Lw "in' mil Arnhem" 

mlixlng Ihc commcncitm 5nhtv ’ 

'O "'5 Ptmilemet 
.1 Oniccts S„pc, 

inmntloii Act 1022 nod to the succctilnl caiUj 
t /1 c pn<,Mn(! the necewiry mcdn.il cy-vmiiraton 
.1 mil he ohtilned hem 

the Mcdicnl Oniccr o! HcNih Tonn Ihl) 5 , 
Hclcn 5 nnd complelcd nppltcillont necompinlnl 
I not more than three rttent tntimonnN 

should reach him not later than July I4jli i 9 js 
Canvassing nicmbcts of the Covm it ot Com 
Puttees of (he Corporuftm wifi he a disqinliiiviilYn 
(own Hall I RANK llAUWVtLL 
St flclcns Medical OOKcc of Ucalih 

June 24tlt 193S 

QLAM013GAN COUNT) COUNCII 

COMMIT rn for"!™, cakt oi the 
MINIAILX DlUCrilM 


APPOINIMCNT or JUNIOR MlDlCM 

orncj R 

At Hciwol Cisilc near Poniyclun 


Applications arc invited for the ipnointmcni f r 
I Period of one year of a Jumor Mcdail Ofli rf 
it Hcnsol Cistlc Certified Institution ntif 1 nty 
chin Glam at a salitv of £150 p(.r annum 
together with emoUimciits coiislMiae of KirJ 
ipariments and huiulry v ilucd for siipcrinnintiox 
purpose It £P0 per annum 
U will be an ailvantav.c If candUhtes hive hiJ 
at least one vein; txptrjtnee m general medwps 
liter qualifying 

The anpolnimcni will be suhlett to the pfovlnm 
of the Asylums mid Certified Itwlfintions (OfTncr) 
Pensions) Act 1915 

Applicitions on Ihc ptcsctibcvl form otnfniK 
from the Medical Supcrinicndcm of Ilctwol Cm’ 
iTe to be icccivcvl by him not later tUan the fioi 
post on Saturday July 16th 1038 
HLNIO ROWLAND 

Clerk of the Ciiinly Cownui 
Gl imorgati Coimly II ill 
Cardiff Jtfly 4(h I9JS 


g O K O u G H or 


\V O U T U I N 0 


DEPUTY MEDICAL OriJCFR Ol lirAUll 


Applications arc Invited for the abaic appofnf 
ment from duly registered medical pncilfioatn 
possessing a diploma In Sanitary Sclcntc 
HcaUli or Stiic Medicine Salary £650 per «nm/n 
rising by anminl Increments of P5 to & maum 'a 
of £700 per annum 

Terms and convlitlons of appointment nnd umu 
of application will be supplied on receipt of a 
stamped ind aildrcsved foolscap envelope 
Applications with not more than three tcceii 
icsiimonials must be received by the undrqi('i‘y 
not later than July i6th I93h 
Town Hall J KLNNLD) AlLf RTON 
Worthing Town Ckti 

June 1938 


PHE RO)AL INI lUMAU) SUNDfRk/tSfi 
(35S Beds ) 

ASSISTANT PAIHOLOOIST 

Apphsatlons arc invited from Rccisteted i’ 
Practitioners for the above post at a coinmrr i t 
salary of £400 per annum Previous /iNM?r» 
experience after graduation fs cssendaf 

Hie successful candidate will woik urucf ' 
dircttlon of the Pathologist and "■bl ^5 
to devote the whole of his lime to the l aK’fJi l 
Appheations staring age and a 

accompanied by copies of testimonials 'ho« 
sent to the undersigned from whom 

n be obtained not liter tbm Jnly ir 
M J IIUNTil) 

House Governor and Scvrcun 


W 


CCT YUiroIK OINIRAI UHSrir'* 

C</rj M Fdmwndr tJJJfiedi) 

IIOUSI I-IIYSICIATT^nml . 

(he Unrec of Ihc hicdic/il })cd> MairsniH 
Cmnli) inti the AiiminHfrit/on >>' Af , 
SN mnn'ln post Sahty iUO PC xnntirt 
Lii i1 cmotiimcrus ^ , h 

Appticinis miisi I c trfB'f'oJ i . 

Appl.olions laimi. lec cspaicncs w ^ ^ 

iiltlv Miih copies of iftrcc rcccni ic'U 
he sent (0 (he hecrenry 
July 4iH I93S 


JUL\ 9 1938 


THH BRITISH ^1ED1C^L JOURNAL 


D urh\m county council and 
CULSTER Lt STREFT URBAN DISTRICT 
COUNCiL 

DISTRICT TUBtRCULOSlS MEDICAL 
OPnCER AND MEDIC SL OmCER 
01 HEALTH (VtALE) 


Aboltcaiions ore inxitcd for ihc abo^c appoim 
mcnis Candidate* mu^t b« rcgi icrcd m the 
Mcdi al RcRistcr as holdinj; a Diflorna in San t3r> 
S icncc Piibh Health or State Medicine artd 
must haic had a satisfactoo ctperien e m the 
dnsnosis and treatment of Tubcrailosis 
TTic sa1ar> will be £'=00 per annum in the pro- 
pottiort of £5"- Us pliable by the County 
Conn il and t-2* *s payable by the Chester Ic 
Sirc\.t Urban Di tnci Coun :1 
The olTii.er appointed must either ha'C held a 
presious appomtment as Tubcrcufosis Medical 
OITiccr With the approsal of the Minister of 
Health or 

(i) base bad at least three years cipenen c 
m thtf rnicii'c of his profession 
(u) hi'C pent in itcncral clmiml \sorV a period 
not Ics than eishteen month of sshich not 
less than ix months ha\c been spent m a 
Hospual as Resident Officer in charsc of 
beds occupied by pcneral medical and 
surgical cases and 

(hi) has-e rcxcised spccnl traminR for a period of 
not less than six months in the diagno i 
and treatment of tuberculosis 
TrascllmR and subsi tence al1o«-sn cs accordins 
to a calc from time to time m for e v.in be paid 
by the County Coun il in respect of the duties of 
Dt met Tubcrculost ^fcJl al Officer and the 
officer sMll subject to the directions of the County 
Medical Officer be under the control of the Central 
Tubctuilosi Medical Oflicer 

It smU be a cindition of the appomimcm that 
if either Post i terminated the other post \ ill be 
•ymomaticnlly x-ueMed 

The appointments ssiff be subject to the approsaf 
of the Minister of Health and the oflicer vnll not 
be perTTUtted to txke part in pnsaic practi c 
The pet an appointed v-ill be required lo hse 
in or near Chester te-^treet 

\pplicauons endoned T Nf 0 and Nf O H 
and accompanied by copies of not more thin 
three recent testimonials mu t be iddrcv ed to 
the County Medic'll Officer Shire Hall Durham 
■snd mu i be reeciscd by him not later than July 
^'rd l9tR 

Shire Hall J K HOPE 

Durhim Clerk of the Couniy Council 

July 4th 193S 


QOLNTi BOROUGH OF CROYDON 

JUNIOR RESIDENT aMISTANT MEDICAL 
OFFICER 


Application ■stc insitcd from resi tered Medical 
Pri tmoners for the pot of Junior Resident 
As Istaot Medical Officer it the Mayday Mo pital 
a Renctal hospital of bed The person 
appomicd will hate charge of medical beds and 
will be required to act as Anaesthetist when 
neves ary The person appointed may al o be 
required m an emcrscncy to ict as A sj tani 
Medical Officer of Hcilth The appointment is 
for a rcriod of iscbc months 
Salary ftoo per annum wnh furnt hed quarters 
and board at the HpspuaJ 
Applications must be mide on form, to bo 
obtained from the Afedical Officer of Health Town 
Hill Croydon and return d to him toccihcr with 
copies of three tcccm testimonials not later than 
II am on Afonday July Ifhh I9 j^ endor ed 
A sistant Afedical Olfi cr 
Town Hall E TABCRNER 

Croy-don Town Clerk 

June ^9th 1939 


\X/ORCESTER COUSTl AND CITA 
W HOSPITAL 

Powick near A\ orecster 


Appli ations arc invited for the pc*t cl ASSIS- 

tas’t aiedical orncER 

Appti ants mvM be male mslc under thirty 
Il c years of age and duly quahticd in medicine 
and surRcry Commen inR salary £^'0 rutne by 
annual in rement of £25 to a maximum salary 
If £4S0 per annum tigether with fum^hed apart 
ment board laundry and attendance A further 
per annum will be paid if the selected candi 
date holds Of obtains a Diploma in T^ycholoci'al 
Afedi me Cspericn e in Ansesthcti's wdl be a 
revvmmendation The appointment is sub Cvt to 
the rro\i I n of the A ylums Offi ers Superanni a 
iim Act jooo 

AppI iticn tatiOR aye and full pafxi'ulafs of 
qvnlili ations and cxpcricr c acccm’'an ed by 
cones of three receTit tcstimor al to be ferwarded 
to the Mcdi-al NipcnnienL-ent net later thin 
Thursday July I t 1919 _ 


H AAlpSTC-AD r C N C R A L HOSPITAL 

lUscrstcs.fc Hill N U 3 


Ar" I ations are nx ted from smrle med al r* n 
f r the foJJ nine fa^ JJOl AE PIIASICJAN 

lb) JIOISL SUKCrON for ix ncnih sa-'am 
Auni t 1 t Saltrr flPO per -sTinuri w h K^rd 
rrsfu n c and laundry 

Aprl "atl n on the rres.nbed f m w h three 
lest monials to be ret rned to the Secretary by 
July Uih 


J^ERTTORDSBIRF COLNTV COITNCJL 
AfATERNITY AND CHILD UELfARE 


C<T^ 


O P S \ I. F O P D 

HOPE H05FnF,U- 


ASSIST \vr MEDICAL OFFICER DF HEALTH 

Applications arc in tied for iljc rest of Meu cal 
OTi cr for Maternity and Chpd Welfare work m 
the Cotmty of Hertford Applicants mc-i be 
recistered Afedical Pra niioncrx ard base h-d 
special expener e in Maternity and Ch?d Welfare 
jnd Antenatal work ard have had at least three 
year experience tn the practice of thar profes ion 
Commencin'* salary COO per -nnum n me by 
annual incrcmcri < of £2* to « max mum of £”0o 
per annum 

The povt i sub cct to the provisions of ih- 
Local Covernmeni and Other Offi ers Superannua 

non Act 19 and the suc^ fU applicant will 

have to pas n medal examination 

The Olficcf appointed shou d possess a car for 
the use of whi h a mileage atlow^cc accord 'i'* 
to the Count} Snjic will be paid 
Pariicula s of experience qualifi ~tnn< and 
cop es of three rcvcm testimonial should be ent 
to the Clerk of the County Coun'nl Clerk of the 
Peace Offit Hertford not later than Afonda^ 
July ISlh 19^9 

ELTON LONGAIORE 

Hertfird Clerk of the County Cov/n<J1 

July 19tS 


' "^s s- ed frr t*“c T rLx 

DENT OfiSrrTRtC OTFrCEP 3 M'-- H-^- 
Sa fo w Ii5 ^ vfv'r a p-- e 

nc' ^ ^^ry t- o pc- r~-x - - 

^ ' rer - r s N lx. -* a"— - 

Ut-d > A d-dat n ' s <;y"t w b'- 
nad from x. ary a-d es --j -- o c of e-v 

ne"i> f f — -ja ^n pi, pAA^es 

The H »Hr ijj CO- j -s I 1 0 be*^ -s- « eq — <rs, 
w th PaihsJ ?)ol LaS-ra -> T Pay r‘<rcT x 
C d prarh a-J a^-rdi fu ( -« f'< 

investig i 

Tbe Re^ i, -t O-* c n O* -r i >n- o' i fe 
Senjc Res Jems, an* w i be rm-v-”- e t ■- w yV 
in ih cbstctriv a ^ evr-jcA, — j t 
C rJ daio nt t have b-u r-tcr rs - era t-caJ 
expener cm r*. a w i- cv-a 

mu t PS's css t*'c M C O C D F'r r 

WT I be r* cn n aru i-acswb a c' ne 

the h he su r'a! s,aa! at r 

Further parnsniars arv - — rr i> 

obtained from ih Al- 
Rc-c'tt R ad SLilf rJ 
relu -ed a mpan cv. b 
three rcvcn tcMi~isr.aN 
July rJ ?n « 

H H 


o"- 




T 'p- - Tc-sn Cl rk 


J^jAAfPSHIRE COUNTY COUNCIL 
assistant counta aiedical officer 


Applications arc invited for the post of \ i tant 
County Afedical Officer Pos CASon of a Diploma 
or Degree »n Public Health is essential and pre 
VI us experience in the " 311010 . bran he of publi 
health work espcaafiy tuberculosis and chool 
medical serxi c is dcsifaMe 

Th*“ snccessfui candidate wall devote a portion of 
hi time to the w fk of Afedical Officer of Health 
of a County Di met The salary will be £'~6'~ „ 
year ri me on approved servi e to a minimum of 
£s00 a year tsubjet tcT deductions for pension) 
m acdiiun to traxellini: expend 
Application with copies of not more than three 
recent testimonials upon a form whi h with the 
conditiop of apnoimrecnt may be obiaiPcd from 
the County Afedica) OTi cr The Castle Win h-ster 
should be ent to him as soon as pcs ible and not 
later than July Uih J9t9 Can a sing 15 prohibned 
The Ca-tlc F \ BARBER 
A\ in hester Clerk of the County Coun il 

July -nd 19 9 


TTIE LIAERPOOL SAN^TORlLAl 
A Oelamcre Forest Frod han 'la AAamn ton 
(l"t Bed for the trcatmcni of patients sufienne 
from pulmonary lubcrculcni ) 


ASSISTANT TO THE MEDICAL 
SLPFRINTENDENT 


Applications arc invited (tom male practitioner 
»uh suitable qualifications for th- abo c named 
appointment Candidate* must be unmarried and 
preferen c wiU be eiven to apnticanis who have 
held resident medial appo ntments since qoalifica 
lion and ht»e had practial mstitotional experience 
in th- treatmem of pulmonary tuberculosi 

Salary will be at the rate of £2_5 per annum 
V ith board quaners and faupdry 

The appointment 1 norrialy tenable for twelve 
months but may be extended 

Particular of duties xnJ full mfcmatisn to 
Rcther With forms of appliation an be obtained 
(r im the Secretary Hospiul for CorNumption 
Mount Pleasant Liverpool 3 Form completed 
with copies of three recent cetimon-af should 
be returned Julv Hih I9t9 to the Secretary 
Ho piul for Consumption Mount P asari LiveX 
pool 3 


jgOROfCH Of B A R K i \ r 

XASIafASr MEDlCxl orriCER 
fA! c tr Fcm-lf) 

App ..jii - are i** -u bef e J si v 

from qualifcd medical p- n t or-rs ». 1 r» c e 
n robU hatih w k ard u r ^ _ r 

in pub' health f r tb n t-q j-p - 

A I tap Alcdcal OT cr < f H h pJ \ 

Swijo* 1 Met. al cr 

SaUrv V. c tTsy 0 p a 

n wan e 

P ft ujr 0 ' d 5tie» ad p" .,1 n f n r-j) 
be lb aired fri m in u--er 1 red 
I wn Hall S A lE\AtP9 

Barkirc T wn Ccr 


M illfr general 

Creep* h Road S E 10 


unsriTAL 


ANAEirnirnsT 


App! cal IS ar nvued fp me p.-Hi v, a m 
tb I t ito attc'v un T> «^jv afteT'trv-ri ft v« 

the < h arc ■w.cv lly c*! tew in th pra c 

v)l n lb It's 

H m TiT um at ibe r?ic f n, ne- per ’• — 
for o attendar* e a wrtk f e- h v. r 

uticrlap c n cut ea w II ’-c t i d 

r u ler pan cular m app at n « be S n-T t r 

App'ioii p tv etb-T w th * -s ( p r 

than three re ent test n u t be «e-t n p 

belcrc Julv 19th I9tv 
July <ih 19 s 


L 


ON DON 


hospital 


£ l 


Aprl a j n arc invited f i*- co«t r 

aifdical I irst assistant and 

REGISTRAR The >rr i-t-'ent is f r 0 - c xe 
tut I renewabe arnualU on arcl a c*j for tw s 
further per xs ct cne year Sal-ry £_r>3 pet 
anni m ravabc by the H'-r I and Alcd 1 
Co cst )oi Uy 

Candiuatcs ri t be fuUy qu_ i d r-ed -al' 
Applicatio-x bouL m c at tb- Hc-pital r— 
later than bv th br i post cn Saturday July h 
Funhc particulars nay be cb ircd frem the 
Heu c Goverror 

ARTHUR G ELLIOTT 

Ho ♦VO Goverr r 


gOL 


INGBROKE HOSPITAL, 
Wardjwonh Corrm n SW IJ 
(135 Beds ) 


HOUSE PlfySICIAN (male ur-mam-d) re 

Quirrd e 

Ttie appoimmeni » for six mopib.. cem-emr- 
n Aueoit lit juts Salary £l 0 per ,.nn.-» w ih 
board res Jen e ard lat.nd'y 
CanJ dares mi*si be (ulh quaJ ed ^nJ rep vtered 
Apnfi aij£>n> surmt ace qualif catio-s *rd ex 
penen c w h cop es of nit r-otc th n three testi 
monial h"»uld be sent lo the urv.er cned i-a or 
before July Itth 19 9 

XA S RANDOLPH BISS 

SccretaD Surermter-ent. 


C ONN At GUT HOSIITAL A\ xLTHAMSIOW 
t I 

<l|X Beds with Fotr Rev^ -t Mcv. cal (3*^ c ) 
CASLAL'n on ICER (r- c) reqv-ifcv. t 
mence dim July iS 

Tbe ar-w ir- nt wil be f rx r-— „•* wt h 

icni-r-rat n at tbe ra c f £IP p-r -n — w h 
N-vsnl m -cnee »'M launv,ry 

Apr ‘v.ai •* ut tc e r -v- t> q.. 1 .. 

t ST and cxperi— c ac-c-'-u- edbve-evo rt 
rw c than ihiec to* n-i v. r-ast b- c 1 ere., to 
tb- urx,ers n-d ret later t a- Juy I th 19 
R H ALTON HARR ISOS 

A« s S-CTctary 


L 


ON DON 


hospital E I 


ArTlimiio-x are inx ted fo- t**c rY--t f 
MEDICAL OUT patients FIRST ASSISTANT 
Cand dates rmr-t b- fully q -a f td ri-'~ -a 'y 
The al ry tf the po* tv '^l 0 e'er a— am 
Ihe d iiev mvolr- a erd-n e n t*" xi-d a! 
Oa pa ent D m.rm r c- every week-day ftcr 

^PP } ppj « th i-st — on— I *•— ad be lert 

10 the Hnose Cove— ^r (tr-^ w en f -rme- r-^ 
i. f t may be cb-a '’-d* - *- v. v 3 r e re- 

T-i.r t art n li^f If b 
“ ARTHUR O rlLJOTT 

l(-^ VC C orm-CY 


E ast HAAf xfE'fOR/AL Hr/srUAf 
Sb ewys- -y Po-J E B dt ) 

Tbe G— m-al Cc—m- — — jra - (>r 

lb pov cf HONORARY CY'NATCOKX’lST 
C-rv .jt-s r~ -t b- Fc ~ I <■ t*- I rv 1 C rt 

cf S r- *• a - 1 Gv x 

- e- at- I t- '-c-j n t'^ 

t-***-r w J* c"-"-* cl — t-v — ''--1 t yb - 
tea b t^- t.->-r x''-d c- c- be — J- y K *• 
CL-..'u- m w b- cx-»*— -u ty — i cct-"-x r- 
jv ^ ^ t-s _-u— — i « t a'sJ ca I -S'" 

f—mben c' the b''-rT3rv mcdiCiJ s ^ 

plcinald plrpy 

Sci^e.. y 




60 


THE BRITISH MEDICAL JOURNAL 


Juu 9, 19IS 


r OUGHBOROUGH AND 
GENERAL HOSIITAL 


DISTRICT 


Applicotions arc invited from dul>^ rcRlsicrcd 
candidates (male and unmirncd) for 
a HOUSE SURGEON salarj £150 per Tnnum 
from Aucust Isi 

a HOUSE PHIiSICIAN sahry £125 per inniim 
from July 1st 

The appointments are for six months and include 
apartments board and laundry The House 

SuTBCon must be an experienced anaesthetist 
All appljcaitons sfaiing aRC etc with copies 
of testimonials to be sent to me at once 
TRANK H TOONE 

9 Leicester Road Secretary 

LouRhborough 


L 


IVERPOOL 


OPFN-AIR HOSPITAL 
CHILDREN 
Lcasowc Cheshire 


TOR 


Applications arc invited for the post of JUNIOR 
RESIDENT MEDICAL OFFICER at the above 
hospital for a period of six months commencing 
Aurusi 1st next Salary at the rate of £200 per 
annum plus board residence and laundry 
The hospital has 240 beds for treatment of 
Surgical Tuberculosis and orthopaedic conditions 
and has one ward for adult patients 

Applications stating ape sex nationalitj quail 
Ocations and experience toRCthcr with copies of 
three recent testimonials to be addressed to the 
ScCRETARy not later than July 16ih next 


ENERAL HOSPITAL NOTTINGHAM 
(189 Beds) 


A REilDENT CASUALTY OTTICCR (Male) 
IS required at the above Institution The appoint 
ment is for six months with "salary at the rate 
of £150 a year with board residence and laundry 
Candidates _ arc desired to send applications 
stafiOR aRC qualifications and experience logethcr 
with copies of testimonials to the undcrsiRncd at 
once 

Duties to commence on July 14ih 1918 
HENRY M STANLEY 

House Governor and Sccrcinry 


UDDERSFIELD -ROYAL INFIRMARY 
(321 Beds) 


MALE HOUSE PHYSICIAN required to com 
mcncc duty on August Sili 1938 
Salary £150 per annum with board residence 
and laundry Appointment for six months subject 
to renewal at the discretion of the Board of 
Management 

Applications with copies of three icccnt testi 
monials to be iddrcsscd to the undersigned mime 
diaicly 

H J JOHNSON 

Gen Supt and See 


B arnwood house hospital for 

MENTAL AND NERVOUS DISORDERS 
Near Gloucester 


Required SECOND ASSISTANT MEDICAL 
OFFIC^ER (male sinslO Commencing salary £500 
per annum with board residence and laundry 
Experience in P'lychoihcrapy a rccoinmcndaiion 
Applicants must possess the D P M Flic hospital 
has Its own non contributory Pensions Scheme 
Applications with copies of three recent test! 
moniais to reach the Medical Superintendent not 
later than July 15lli 1938 


LACKBURN AND EAST LANCASHIRE 
► ROYAL INIIRMARY 


RESIDENT SURGICAL OFFICER (Male) 
required Salary £250 per annum with board 
residence and laundry 

Prcfcrcnec will be Riven to applicants holding 
the rues Diploma 

App}{cauons siaung n’iiiona}it} Qui}}ftcaiions 
and experience toRCihcr with copies of recent 
testimonials to be sent to the undersigned 
Royal Infirmary T DEWHURSl 
Blackburn General Supt and Secretary 


D oncaster rot al infirmary 

(185 Beds) 

(Recognised under the regulations for the D O 
and D L O ) 


HOUSE SURGEON (male) to Eye and Ear Nose 
and Throat Departments required 

Salary at the rate of £150 per annum with 
board residence and laundry 

Applications accompanied by not more than 
three testimonials to be sent to the undersigned 
R LANCASTER 

Secretary Superintendent 


J^URHAM 


COUNTY AND SUNDERLAND 
C\E INFIRMARY 


HOUSE SURGEON required immediately 
Must have Ophthalmic experience Salary £350 
per annum rising by ivso annual increments of £50 
Non resident Must devote whole time to the 
duties of the Institution Applications with copies 
of recent testimonials to be sent to John Buttfr 
HELD Eye Infirmary Stockton Road Sunderland 


Y H n RE T R E A T YORK 

A REGISTERFD MENTAL HOSPITAL 
under the Mnmccmeni of n Committee ot 
the Society of Friends 


A MEDICAL SUPERINTENDENT will shortly 
be required at the above Hospital and applications 
arc invited for the position 
The initial salary will not be less than £! 000 
per annum with a bouse and other emoluments 
valued at £300 p a for Pension purposes 

Facilities will be given if desired for obtaining 
some special experience prior to taking up the 
appointment The doctor appointed will be ex 
pcctcd to work in sympalliy wiih the ideals of the 
Society of Friends 

Applications with not more than three test! 
monials should be sent before August 27th to the 
Chairman of the Committee The Retreat York 


S ALFORD ROYAL HOSPITAL 
(256 Beds) 


I ni, Kuy AL HOSPITAL WOLVCIUIAMPFON 
(Incorporated under Charter) ^ 

HOUSE SURGEON required (General Surterxl 
duties to commence August !«u tiia h 
« m-,m, 300 beds meludcfthl m.'nl 

f"? l’> the siriom rumimL 

Ac'?“'nd'''rnZncd’' 

The ippomlmcni is for six monilis Silm m 

ronm"’" 

rooms and laundry provided 

.h"'"’ '“tmionials lo he 

lorwardcd to the undersigned 
Wolverhampton W H HARITR 

June 27th 1938 House Goxcrncir 

X^EST NORFOLK AND KINGS LINN 
VV GENFRAL HOSPITAL (112 Red.) 

RESIDENT nousr PHTSICIAN 


Applications are invited from duly qualified 
practitioners for the post of RADIOLOGIST (non 
resident) for attendance each morning (Sundays 
excepted) and at such times as may be required 
Sahry £300 per annum Twelve months appoint 
ment renewable Fhe successful candidate will bt 
required to work under the supervision of the 
Honorary Radiologist 

Applications stating age and qualifications 
together with copies of tcsttmonials,and certificate 
of registration should be addressed at once to the 
undersigned from whom all particulars may be 
obtained 

By Order of the Board 

H B SHELSWELL 
General Superintendent and Secretary 
July 2nd 1918 


T he GLOUCESTERSHIRE ROYAL 
INI fRMARY AND EYL JNSTITUTION 
Gloucester 

(232 Beds six Residents ) 


Applications arc invited for the post of RESI 
DENT SURGICAL OI FICCR (male) Salary at 
the rate of £300 per annum with hoard residence 
and laundry Candidates must be fully qualincd 
and unmarried and have heid previous house 
appointments Ilic appointment Is for twelve 

months which nay be extended 
Appiicattons stiting age qii-Jihcations and 

nationality together with not less than three recent 
tcstimoiu Us should be sent to the undersigned r 
The cKcu.d candidate will bt required to enter 
tipon lus duties at once 

r J STMONS 

June 30th *938 Secretary 


T he west Norfolk and kings ltnn 

GENERAL HOSPITAL (112 Beds) 


RESIDENT HOUSE SURGEON 


I he Governing Hoard invite appllcitions for the 
above post The ippomicd applicant will have 
charge of Casualty Department and one Surgical 
Ward Sihiy 1120 per annum Flic appointment 
IS for SIX months m the first instance Trcfcrcncc 
if suitable will he rl'tn to the Resident Jloiisc 
Surgeon when Uit post of Rcvtdciu House Physician 
fills vacant Applications stntink age nationality 
qualifications should tc accompamtd by test! 
monials and icach the undersigned as soon as 
possibJt 

JOSEPH E SEARJFANT FCCS 

House Governor and Secretary 


TROUD GENERAL HOSPITAL 
* Stroud Gios 


RESIDENT MEDICAL OFFICER required 
Candidates must be folly qualified and registered 
Six months appointment duties to commence as 
soon as possible 5i/flry £160 per annum with 
board and laundry 

Applications stating age nallonahty etc to> 
gciher with copies of three recent testimonials to 
be sent to the undersigned from whom further 
paniLolars may be obtained 

C FORD SPENCER Secretary 


TIE H A H T L E r O O L S HOSPITAL 
(95 Beds ) 


Applications arc invited for the position of 
HOUSE SURGEON at a salary of £150 pa plus 
board residence and laundry 

Appointment for six months subitct to renewal 
and dunes to commence July 15th 

Applicaiions to be made to the undermentioned 
NORMAN O DEANS 

Secretary 


j^otherham hospital 

Wanted CASUALTY HOUSE SURGEON 
(male) qualified Salary £150 per annum wiih 
board residence and laundry To have charge of 
Out patients (130 beds ) , , . 

Applications with copies ol recent testimonials 
to be sent to the Secretary G W KonrRTS 
8 Moorgaic Street Rotherham 


Appucanons arc Invited for the above 
iai iry £130 per annum To have charge of M«l( al 
and OphihalmiL beds also to act as Ucsidint 
Anacsthaist 

The post is for six months In the first Invnncc-- 
oiTcrs valuable experience in both Inpatient anJ 
Out patient work 

Applicition With conics of recent tcMimonlaU 
should be sent to the undersigned is earh it 
posvibic 

^ JOSEPH E SEARJCANT FCCS 

House Governor and Sccrciirj 

I^ANCHESTER VTlTfORfA MEMOUIAI 
JEWISH HOSPITAL 
Cbcciham 

(Non Sectarian 102 Deds ) 


Applications arc Invited for the post of 
RESIDENT SURGICAL OFriCCR (male) Sdiry 
£250 per annum including board residence and 
laundry The appoininicni is for iivclvc nionihi 
Applications staling age and qiiahficailonv 
together With copies of three recent tcsiimonlah 
to be forwarded to the undtrsigned not liter than 
July 22nd 1918 

By Order of the Board of Management 
K C HARDING 

Assistant Sccrefarj 


Ro\AL fNriRMAKY siitmnn 
(500 Beds) 


THC 


Applications nre invited for the pou ol 
CLINICAL ASSISTANT to the Ophthiimt 

Department (male or female) The Opluhilmii. 

Dcpirimint contains 68 Beds and an Out 
Paticrti Dcparimtnl which is open daily 
Sahry £100 ptr annum 

The appolnitnenl will be for one year viiM«t 
to two months notice find the oflwct elected will 
be eligible for reappointment 1 clicrs siaimi 
age and giving full qualifications ptcvlMis 
hospital experience etc to be forivarUcd to the 
General Supcnnlcndcnl nnd Secretary immidulch 
June I4tli 1918 

•^^ALSAIL GCNERAI HOSPITAL 

The Committee invite applications from men f’t 
the post of HOUSL SURGEON 

CandidnU-s who must be registered under tre 
McdiL il Act must produtL three recent fiN' 
monilis The appointment will be for , 

Silary al the rate of £1*50 per mnuni The ffospu 
coni uns 14x beds and is equipped m all sr«‘u 
departments , 

Appliciilons to be suit at once to the tmu t 

xlsnul WALTFR rRANCOMllI 

June Sill ms HniAC Oo'Mor_ 

T iic LivcRPooi rvr par and tiiro'T 

INFIRMARY 
MhiIc Sircci Llxcrnool 7 

HOUSE SURGEON (Eir No'C nnd INm" 
wanted to commence duties Aucuu I’t 
Salnry £120 per nnnum widi 

and laundry .u„iiiiv i> 

Appl/cations statins asc and ndlonnnr ^ 
Bcthcr with copies o( ilirec tcccnt 
sliould be sent before July 20th to J f [ j 2 
Esq (Chairma n) 9 Harrington Street Luctroo _ 

T ONGTON HOSPITAL STOKFONTRFNT 
JU (50 Beds ) 

HOUSE SURGION required '■i'’''' 
risiUR to £’0fl after six months wn" 
residence and laundry P'"* .e J ' 

Applications with copies of r^c Chaim 
and statins nationality to "c, 'on Ttm' 
of Directors I oneion Hospital Stoke on 


NCHESTLR ROYAI EM 


IlOtrlFAl 


lOR HOUSI SURGEON 
icr annum with residence ^ f , ' 

i, cations (with copies M n 

:d House Surseon to be adJie 
dcrmeniioncd ^ORTII 

Gen Supt and Secrernr 







JlU 9 ]9j}< 


THn BRITISH MEDICAL JOURNAL 


61 


^^VNCHtiTLR RO% \L lsnRM\R\ 

RF51DEN1 RtCIStRM TO SLRCIC^L 
OUTI'TTIEVr IILPM TMEST 

TTi B urd I tt the Mtt hc«tcr 

RttAl Itthmjih in\ tc sp"' aii ii ( r the ah t. 
trr intncn \ leani t n \i[ t i I t Id 

•\pr I am r^\i N. tcc \ tcJ jnJ h d a Meds 
"^nd Sure Til vuJtr ju *1 nJ haNt h J a h pint 
ap'Vjm'*icrn 

Tbc '\p-N, nrrn^t (r rnPh <rcncwab1». 
f r limhcT pen n. f i n mh ) » p txt n ih 

rT».'j I ns of ipc B>e-ta\N a ic. n t c et SaUn 
fl^i) per annu~i sup p ^rJ ri> u n and al 
Tnvc f r Iiu'nJ'? 

Ar"' 'at! n tati-c acc r b enr t*i 
Chairman f iPc Med il Bxiril net Ui r than 
JtJ\ (Hh lOK 

B> O-Jer 

r J C\BLC 

Gen Si rt arJ Secretary 

JuK rsl lorv 


^/JAVCJlESTtR RO'i \L INFIRMARY 

UOliE SI RGEO\— ALR M. rYN\ECO- 
LOCICM. \ND OPHTHVLMIC 
DtPARTV^eSTS 

The Bi’anl i f Mana^er’crjj rf the Ytar h-^tcr 
Ri nJ Infmary insiie apnJ *311 *'s for th e 

appomtnent v.hi h be-omoi \a ant on \urtist i^ih 
ISts 

Arrheant piip ho d a Medicst nnl Sur? "al 
fjual canon and be recivered 

The ap^ inrment i\ for mt months up 0.1 i \ 
the Bi las»-s to rotr'c « at xhc ta 

of £*0 per annum 'kith board tesK-crce and 
al?cman“c for iatJTTdtr 

Yr” cal OC.V, tanne ape to be <ent to the 
Chatman of the Nfcd^al B ard nit later than 
Wednesdij Juh Pth 19^8 
Bj Ord f 

F J CABLE 

Gen Sufit and Secretary 

July r»d 19 « 


J^ANCHESTER ROY AL INFIRMARY 
HOUSE PHYSICIANS (Four Nacan evi 


The Biard c( vianapcmcnt of the Man he ter 
Rocal Infirmary tnxnic arphcaticn l-v- the jpoic 
'ippoffttr'ent «ht h bectne 'ucant a 1 5cm' 
T»o on Auputt ISih ».nd rwo on Sep emPer 1 th 
19 ' Arplhatiom «i(l be con^dered i< Pc f r 
any of thme pM unte*' tt t pectally tated to 
the contrary 

Ap'^hcarts mu'; hold a ned cal and surgical 
Qualilicatton ard be Tcgi tered 
The appoi’-tn nts are ftr sit months subject to 
the prost'ti.m of the Ote-la'wt as to nonce etc 
Salary at the rate of *0 r-r annum iMth board 
rmiderr^ and allowance for laundry 
Appltcations laiihB ase to be 'cnt to the 
Chatman of the Afed cal Bnard n t later thatj 
WednevSay July h 19 
By Orucr 

r J CABLE 

July "nd 19^^ Gen Supt and S«. retary 


J^ANCHF-STER ROYAL INHRMARY 

HOUSE SURGEON fNeuro Surmca! Dcpanmcotl 
HOUSE SURGEON (Onhopaedte Depanmcntl 


The Board of Management of the Manwhotcr 
Roy'al Infirmary insnle applicatton for the -bo>e 
aDpointmcnis v.h eh beconc s-aeant on Aujni't I th 
19^5 Applicants most be re* sicred and hold 
a Medical and Surg cal Qual fication 
The appointments arc for s < month, ub ect to 
the pro'iMcms of the Bye la s as to nmcc etc 
Salanes at the rate of £.0 per an"um with heard 
rcsjdenee and alio van c for laundry 
Applications stating a e to be cm to the 
Chairman of the Medical Board not later than 
%\ednesdaj JuJj _0ih 19 
B\ Order 
F J CABLE 

July «nd 193S Gen Sort and Secretary 


R OY AL HALIFAX INFIRMARY 

Hospital Rccogniied by the Royal College of 
Surgeoas lEngJaiyd) 

Wanted a THIRD HOUSE SURGFON (male 
unmarried} Candidates must be duly qual fied and 
regi tered The appointment will be for it months 
followed by promouon if sunap t. Salary including 
all scrnccs reqjired in coancxi n nitb Paying 
Patients Ward £1^0 per annum with restden c 
board and I undry The Resident Staff consi t 
of a RcMdcnt Surgical Officer ^nd three House 
Surgeons The Hospital contains Maternity and 
Paying Patient. Blocks Also a Paiholomcal D- 
Kiriment a Urge Eye Ear Nose -^nd Throat 
Deponment Radiological Deparrment and Radium 
Otme 

Paniciilars ot the duties may be oPta ned from 
the undersigned to whom apn icauom stating age 
and nationality together with lestimonial Jiould 
be sent on or before the l9th imtant 

A MIDGLEY 

SccretaD 


lyj WCHf-STER ROYAL INFIRMARY 

HOLSF SwROEONS tFvur Vatin lol 

fhe B a if nf Afaraaemcni of the Man fic'tcr 
P lyil Irfrtrao »n\Uc arp •ation for the abi\c 
app ntm r s \a not on Auvust Uih 1 > 

Api i-y 1 mv t P *d m u a\ and uf 1 al 
Qu^lin all n nJ be rtgt tered 
"^h appimm m ire f r nine tnnih bet 
t the prys nr of the B c Lavsi a ti ni 1 c 
et Silarv 11 the rate of f 0 per annum vijth 
NardrcvJen c and ilowan c for laundry 

Apphcati n tatin'’ ice ti be cm to the 
Chairmin tf th Afed al Biard not later than 
Wcdnc'dij Jtly ihh IQ s 

B Order 

F J CABLE 

Ju'y «nj IQ s G n Supt and Seer t ry 


B erkshire mental hospital 

Wallin f rd 

Ar»' I atj n ate inn ed Irtrt recf lercil m’lJict.l 
practm ner f r the pmt of SECOND ASSISTANT 
MEDICAL OFFICER (male inglcl it the iPoie 
Afental SaUn 0 mine b annual 

in<.rcrient of £*< t> f4<0 per -mum to^lh r 
h furni hed -parttrem board ard taundry 
allied at tno per annum An cdiiionaJ anount 
of t_rt per annum 1 pis ib c tf in po c* ‘on of 
D P M Eipcncr c in the treatment if mental 
di nrueri * ad be a recomiefKfati n The 
appotrir-cm up ea to th- prtMi n f the 
A slum (TVers Superann latton vet 19 <9 
Ar''«'atiir in wfi in it gether ith pics of 
three icstimt nul h ulJ rea h the Medical 
SupennttnJcnt by fir t post fl Thursday Julv -I t 




GEORGES SANAfORrUM 
SAILORS UPHOOK HAVTS 


FOR 


(seamen Hc^ptal Socieivl f r ihe Treatment 
of ifYi^rn •’a’Y and N n Pjfr* o-ry 
Tuberculosts 


ASSISTANT MEOfCAL OFFICER < »n I male 
r fern I » required a fr m Aumi t I t for 11 
rr imh ^alar at the rate f £ pet annam n 
the first in tin c Appi -'ll n wuh c< p c^ of n 
l<> than three testimonial to be cn n ititc 
diatcK to the underimcd 
F A LY ON 

Sc^et ry Scan n Ht pital 
Society Greenwich S E IP 
Gfeynwi h ful 4 h 19 


R oyal lancastfr infirmary 

Lar -ayter 

<140 Bed ) Four Rev dents 

Arrl *311 n arc invited for the po't f HOUSE 
SURCEON Salary £1 0 Per annum with brard 
fcMdcr e an<- laundry The -rpt mmeni i for 
1 1 mcmh 

Apr! tjtion taim age qua fimtion crpcri 
CP c and nationality to-cthcr with opei of three 
recent tcvtimomaU to be «it to the under, m-d 
FRANK A MILNES 

Sure I lemJert Secretary 


R ot NATIO\AL KOSTITTL TOR CO'- 
STMPTION AND DISEASES OF THE 
CFIESI 

Ventn r Isle of Wi hi 

SECOND ASSISTANT RESIDENT MEDICAL 
OFFICER (n !e) urmarried reqi— cd Kr sit 
m mh omr-cr ng Auci.it I th 19 < Sa^ at 
the rate of *_i() per annum wuh board rtsiu,er e 
j art. laundry allo'wan e The ju OMfuI chrd-Jai 
win be c -'b e for pr m(,tiE.n to Fi-^t A osurt 
I Re ucPl Meu cal cf f r a funbet six rror b 
at 3 saJ-r> wt the rate of £-no per 3n”*im » :b 
im Ur e~olum ni* Candii-tes nuat be ful y 
I QJ_l lied in Mediune and Sur ery and prevne 1 
. ctpene-ce m TutcrculT>.i.s nd Ba^crv.fo lual wo k 
wilf be an ad artage 

I Ap*' canons in candidates own banuwnti 1 
. tatjn .»g- Quaf fi-att ins ard e-ipencr c (w b m 
! py of three rcucrt tesuTrcn-al > to be ert lu 

the Af-di al Supcnr enuer P i\al Naticna 
, Help uf for CunsumPUon Vcniricr Isle of 
W igbt not later than Saturday Jiuy _ rd 19 


R oy AL SALOP fNFlRMARY SHREW SBLPY 
( I 0 Beds ) 

Appointment of resident holse 

PHY SICIAN 


Applicati os arc inxited from fully qual led tin 
married men fm the appo ntmen of Rcsx.cni 
House Pftysnan vacini immcdaie/y Saaryiffd 
per annum with Niafd retiden c etc The 
appointment i for tx mun bs sub cct to re 
A-Pb ntnenu 

Resident Staff cimpn cs Pcs dent Surmca! ef 
Rc*idcnt Hou e Phy t tan and i«. RcMucht Hou c 
Surgct-i 

The Resident Hou c Phy laan « Rcsid-nt cr 
to the Af-d ul Ward of the Hcnjntal urdcr the 
d rcciton of three Hinorary Phyx lans 

\pptioucns «ut*n'* c cnal fi atiotis etpen- 
cn e naijiraljiy and a ermpaned by copies of 
three recent tenimonjls to fcc sent to t**e 
undernered forthwith 
Board Room J W NOBLE 

July 4 19^9 Secretary Sj^'cnatender 


pHESTERHELD AND NOPTH DERBY 
^ SHIRE ROYAL HOSPITAL 

(—0 SoTgcal and Medicaf Bed ) 

HOLSE SLRGEOn TO OPHTHALMIC AND 
EAR NOSE AND THROAT DEPARTMENTS 

Apphcaiiony are insi ed from felly qualified ner 
f r the above rest The appci n oee m » for «x 
months frim Julv .0th 19 « 

SaLry at the rate of £M0 per ahrum 
Aprhcation< taring ape to"ether with <.up es 
of ibret recent tevtitnontals bould be serr to 
the unu-r i-med as cen as per Me 

Af H BOONE 

June tsT 19 Supennterdent ard Secretary 


OY AL SALOP INFIRMARY SHREWSBURY 
(I<0 Beds ) 

appointment of RESIDENT HOLSE 
SURGEON 


R oyal northern /sF/RtfARY 

In cfocs (-00 Bed ) 

Appl canons are invited for the po t if HOLSE 
PHY SlCf AN (male) to the Phymran Con ultani 
(Hi hland and I land Scheme) and to the 
Honorary V 1 mn- Phy lao Appli^nts mu t be 
Graduates of a Lnivcnuy and ha e had ix troaih 
H P expcrien c in a large hirdal Tpe 8p»'omt 
mmii vkiU be for six months and i r ncwablc 
^lary £U0 p 3 

Appj call ins »ji*i cop e> of iCMiniini-J bculd 
be sent to Aled cal Superintendent 


D istrict infirmary 

Ashton u*idci Lync (.00 Beds ) 

RESIDENT SURGICAL OfFlCER required 
immediately Six month apmyintrient with 
povibiiny ol ren wil Salary at the r re of £_ro 
per wonun with the u u.1 tcriu nial emolument 
Application »iih testimonial to be mt at 
once to FRANK OLIVER 

General Supi.r»ntcndent and Sc”ctary 


E ssex colnty hospital colchester 

<U4 Beds I 

Wanted urmcdiaicly an ASSIST VNT HOLSE 
SURGEON (mate) Salary £I 0 per annum with 
board washin** and rCi dene M-di-al arc 
Surgical qualif canons r -qu red 

Aopfeat in with three rcce-t loumcoial to 

Secretary 


Appl nations arc minted from fully qualified 
upTiarned rien for the ^o^l of Residcrit Roo5c 
Sur'*-orr .carr trr’-^.aidy Salary £/F(7 per 
annum with beard rcsidenwc etc The .proim 
rr-nt « for ix t-on hi sub ect to rcar''omtmcnt 
Appfrcanon vtati g age qaaJffi'maors cipcn- 
cn t and nat oruljry .ccoripanied by cr*' ey of 
three receri tcMi’Tomai to be sent to ib^ 
imdersign-d immediately 

Board Room J W NOBLE. 

July 4 19 S Secretary Su'^na endear 


R 


W 


OYAL BERKSHIRE HOSPITAL RE-ADING 
f 3S Beds ) 

Apd cation, are mxued for the pit of RESI 
ENT ANAESTHrnST (na/eJ which fan vacate 
i Aum t 6 h 19 S 

The ap^mimcni is for sex norths fn the first 
lancc Ca^!<L.tci must be fully c'Ja’.fied and 
•n tcr-d and have had comiderabfe eipenerct: 
ibe adni nitration of ..naesthctics 
A salary of £—0 PJ with beard tesalence 
id laundry wnll te pa^d 10 a candidate posscss- 
suiiable qual ncations for the pos 
Apclcatorrs. stating age and cipcncncc, w tb 
ef ro more than tiuee recent resomonuJ^ 
be sent to the unders gned ^ rusib e 

Secretary 3 rd Hou c Gov error 


ARRINGTON INFIRMARY AND 
DISPENSARY 


HONORARY DERMATOLOGIST 


JgURTON-ON TRENT CENTRAL JNRRM ARY 
And matrons are muted for the pen lon et 

caslalty officer and holse 

physician S-Iar> at the rate of £1*0 per 
annum with board rcsidctice and laundry 

AppUijtioos giving age qoafficamns and 
nauonaliiy together with copies of tcstimcn al to 
be vent to E VV Thohnixy SeerctaD 


Applications arc muted by the Beard ef 
Afana-’ement for the above posiuon Candidaxe 
who taurt ^ spccializmg m Stan Diseases shoo d 
send in tbeir applicauons to the cndersigred 
giving particulars of expeneoce etc PamcoLn 
of duuci «c will be sen on acplioticn 
By Order 

HENPY L B(YOT 

July Htb 19 S Supennterdent and Secretary 


July 4th 1938 









62 


K 


the BRITISH MEDICAL JOURNAL 


DISTRICT VICTORIA 
HOSPITAL TOI RSHIRE (WEST RIDING) 
(124 Bcdb ) (Two UcMdcnis) 


APPOINTMENT OT RESIDENT MEDICAL 
OrnCERS 


Applications arc invited from Rcftistcrcd Medical 
vnctHioncrs (fcrrnlc) for the following posts 
first Kcsidcnl Medic'll Ofliccr siHry £160 per 
'innum to commence August I5th 193S 
Second Resident Medic'll OfTiccr s'll'iry £120 per 
'innum to commence Scnlcmbcr Isi 1938 
Proof of Tcgisiration to be lurnislicd before 
'ippomimcnt full rcsidcntnl emoluments Term 
siK months rcncw'ib c 

Applic'itions with p'lrticuhrs of age experience 
'ind n'liionaliij together with conics of two recent 
testimonnls to be sent to the undersigned not 
htcr tlnn July 20th 1938 

J VOUNG 

Secretary Superintendent 


jyORTH ST A r ro R DSH I R E RO^AL 


I N r I R M A R V 
Stoke on Trent 


REGIONAL RADIUM CENTRE 


APPOINTMENT Of PH\S1C1ST 


The Committee invite applications for the position 
of T full limc-Physicist to the Radium and Deep 
A Ray Department Applicants must possess the 
Degree of M Sc and have had previous experience 
Salary £3^0 per annum 

Applications to be sent immediately to the 
undersigned giving particulars of qualifications 
experience age etc accompanied by copies of 
three recent testimonials 

W STEVENSON 

July 4th 19 j8 Secretary and House Governor 


G 


RfMSnV AND DISTRICT HOSPITAL 
(164 Beds ) 


HOUSE PHYSICIAN (Male) 


Applications arc invited (or the post of 
House Physician Remuneration £1^0 pcr.annum 
with board residence tie Candidates must be 
fully qualified and registered and previous hospital 
appointment experience is desirable Duties to 
commence Aupusi 1st 1939 llic successful candi 
date will be appointed for six months and may 
apply for re election 

Applications stating age qualifications cxpcri 
cnee together with ihicc recent testimonials to be 
forwarded to the unicrsigned immediately 
H B CO \TES 
Secretary Superintendent 


G 


R!MSB\ 


AND DISTRICT HOSPITAL 
(164 Beds) 


Applications arc invited for the post of 
RESIDENT ORTHOPAEDIC omCCR Salary 
£229 per inmtm with board residence The 
appointment is for ivvchc months subject to 
renewal Duties to commence August Jst 1938 
Candidates must be registered under the Medical 
Acts reside in the Hosnital and have had cxpcri 
cnee in Orthopaedic and fracture work 

Applications with copies of not more than three 
testimonials to the undersigned immediately 
H B COATES 
Secretary Superintendent 


aWINDON AND NORTH WILTS VICTORIA 
> HOSPITAL 


Applications arc invited for the post of HOUSE 
SURGEON male British or Irish unmarried 
Salary £125 per annum with board residence and 
laundrv Appomimcni is for six months in the 
first instance There arc two residents ITic 
hospital IS fully equipped for general v\ork and 
the specialities Private bed no obstetrics 
The post IS suitable for a recent qualified man 
and there is time for reading Applicants must be 
rcustcrcd under the Medical Acts 

Applications stating age and qualifications with 
copies of three recent testimonials to reach the 
undersigned by July 19th 

KENNETH N KNAPP Secretary 

0\AL CORNWALL INFIRMARY TRURO 
(84 Beds) 


R 


HOUSE SURGEON (male) required with ex 
pericncc of Anaesthetics to commence duties on 
August 1st next Salary £170 per annum rooms 
hoard ind washing 

Apply with copies of three recent testimonials 
to the Secretary of whom further particulars may 
be obt lined 

k Truro W E GRENFELL 

p, July 4ih 193$ Hon Secretary 




\DFORD 


CHILDREN S 


HOSPITAL 


HOUSE SURGEON (lady) required immediately 
I uHy qualificJ Salary £lxo with board residence 
ind luindry 

Vpplu-ations with recent lestimoniaU and 
stating age 10 

J W LONGLE\ 

Secretary Superintendent 


’ H E GLOU 

lNriRMAR\ 

C 

(232 Beds Six Residents ) 


JUL^ 9, 19\<! 


\ L 


post ot 

OrriCEU (imic) Sihri the ntc 
pi ini) per annum with boird rcsitlLncc -intl 
laundry 

The appomimcRt is for six months which may 
be extended for similar periods by re election from 
lime to lime 

Applicants must have held a resident appomi 
n^nt and have had experience in fracture work 
Inc clceied cindidaic will aNo be required to 
deputise for the Resident Surgical Officer during 
his absence 

Applications staling age qualifications cxpcri 
cnee and nationality with copies of not less than 
three recent icstimonials should be sent to the 
undersigned 

The elected candidate will be required to enter 
upon his duties nt once 

f J SIMONS 

July fth !93y Secretary 

'yHE PRINCE Of WALFSS HOSPITAL 
Greenbank Road Plymouth 

(formerly South Devon and East Cornwall 
Hospital ) (264 Beds ) 

Applications arc invited for the posts of HOUSE 
PHYSICIAN and HOUSE SURGEON Salary 
£120 per annum with board residence and laundry 
Appointments arc tenable for six months and arc 
subject to renewal Duties to commence 
August 10th 

The Hospital is olTicnlU rccognired for the 
surgical practice required bt.forc admission to tht 
final fellowship Examinations of the Royal College 
of Physicians and Surgeons of England 

Applicants must be registered under the Medical 
Acts and be members of either the Medical 
Defence Union or the London Coumtes Medical 
Protection Society 

Applications staling ape and qualifications with 
copies of three recent testimonnls to reach the 
undersigned by July 22nd 

ARTHUR R Cf\SH 

July 5th 1939 Secretary 

XHE BIRMINGHAM UNITED HOSPITAL 


THE QUPLN S HOSPIIAL BIRMINGHAM 19 


REGISTRAR to the Ear Nose and Throat 
Department required part time nonresident 
The duties \rc In connexion with the In patient 
and Outpatient Departments Hu, ippomtmtnl ix 
for SIX months m the first instance 
Candidates must bt rtpistcrcd medic'll pracli 
tionerb and for preference should hold higher 
degrees 

Salary will be at the rate of £190 per annum 
Appheattons with copies of three testimonnls 
should reach the undersigned not later than first 
post on July IClh 

P CROCKER 

JiiU 9|h 1938 House Governor 


T he king edward vii welsh 

NATIONAL MEMORIAL ASSOCIATION 


Applications arc invited from duly registered 
medical practitioners (male or female) for the post 
of ASSISTANT RESIDENT MEDICAL omCCR 
at the South Wales Sanatorium (296 beds for male 
pulmonary eases) Talgarth Brecs 
Salary £200 per annum plus maintenance 
The appointment is limited to a period of one 
ar 

Applications stating age quahrications cxpcri 
cncc etc together with conics of three recent 
testimonials should reach the undersigned not later 
than Wednesdiy JiiK 20th 1938 

D A POWELL 

Memorial OOiccs Principal Medical 

Wcst4,3ie Street Cardiff Officer 


■’HE BOLTON KG') AL INEIRMARY 


(319 Beds including two Auxiliary Hospitals) 

Applications arc invited from Ladies and Gentle 
men for the post of HOUSE SURGEON 
The duties of the post include car nose and 
throat work and gynaecology 
Salary £190 per annum with board residence 
and laundry 

Applications for the post stating age nationality 
and experience together with topics of testimonnls 
should bt forwarded to the undersigned as soon 

'' H CORLLSS 

Secretary 


■'HE GENERAL HOSPITAL BIRMINGHAM 


R 


OPEN APPOINTMENT 


Applications arc invited for the post of HOUSE 
SURGEON to the Throat and Car Department for 
SIX months from July I9th Salary £70 per annum 
plus board residence and laundrv 

Applicaltonx giving full dciaiN of qualifications 
should reach the undersigned as soon as possible 
A H LC\NE\ 

JIou e Governor 


P'SSrn fSoSWo',;;' 

to'St'ais sr,"™ “"■» 

examination i mcv 

HOUSE SURGEON to the r\r A\ra tad 
NOSE AND THROM DEPARlXtATc 
Ophthalmic and Aural Surgeons ' 

Salary In each ease at the rate ol Hso rcr 
innum will, boird rcMdvncc and laimdri 
Application stating age training anil oualih 
c lions 10 be Iiddrcsscd to Mr Jons Citins 

rresm," 

0\AL VICTORIA INEIRMIR) 
Ncwcistic upon Tjnc (711 Beds) 

Rim2lnI'r'’"*r.rr,',S'r',‘,'-‘' SENIOR 

In the Lines IlospiUl 
(Pi> bed Section of the Rojit Viclorn Infimiirv) 
Cindiditcs must be rcRisIcrcd in Medume snj 
in Surgery Tlic tcmi of appomtmem is lot on 
year beginning August 9th 1938 and is rcnewjbv 
for a further period 

Salary £200 per annum with board and rcsidcn c 
Applications stating age experience and accorr 
panicd by copies of not more than three rixcni 
icslimonials must be received on or before Vonbi 
July 19th 1939 by the undersigned from when 
further particular, may be obtained 

S DUNS! AN 

House Governor and Sctrctjo 
July 2nd 1938 

J^O^AL INriRMXRN Of LDlNnURCH 

Applications nrc invited for appointment as 
CLINICAL ASSISTANT (nonresident) In the Iv 
Depirtmcni for a period of not Icxs than tweve 
months A salary nt the rate of £''00 per annum 
Is attached to the post The candidates must be 
duly qualified and tegMeted The row i a tn<>si 
valuable one for graduates wishing to srcciali 
Jn Di casts of the Lye 
Applications should be sent vvhhnm delay lath 
imdcrsipncd at the Royal Inlirmiiry 
HENK') MAW 

Secretary and Itcasurcr 

rue LAD'^ CHICHESTER HOSPITAL IlOM 
for functional Nervous Diseases 
(60 Beds) 

JUNIOR HOUSE nnsiCKN (ntimanl re 
quifed Six months appoiiumeni at 179 psr annum 
nil found Valuiblc evpcrienec fo Diplmu n 
Psychologic d Medicine Duties to commer 
middle of July 

Applications with icsumonhN to tc sent to P 
Secretary Mr P f Spooner 33 Ucst Stfff* 
Brighton 

July 2iad 1938 . 

ICTORIA HOSrirAL DFAL 
(90 Bedv ) 


V 


Applications arc invited for the post of PL9f 
DENT MEDICAL OEl ICER (male) Umivh nati 
ahly unmarried The appointment to comme f 
immediately for six months Sihry frO pa wi j 
board lodging and laundry Spceial know/curc o 
Anaesihclics is desirable 

Applications stating age and qualificaiioni 

gelhcr with copic of three recent tcstimomjn 
be sent to the Secretary Medical Roard 

Hospital Dell Kent — 

E') MOUTH AND DisrRicr iiosriT'i 
Weymouth 

WinlcB l,.l> Il'ih HOUSE 

(European) Salary £ts0 per annum with 

residence and laundry , , j 

Applications stating age { 

comes of tCNtimonials to be sent to ine 
signed not later than July 

MORRIS I ODOr 

I fono rary ^ 

IlOlill'l 


W 


K ent and canterbur) 

(isj Belli 4 R M o s ) 

HOUSE PlIVSICiAN rcauircJ VI",”’ " i’ 

Sir mon In ippiimimcni re 

191R Silin £1-1 nr 

lienee mil liuniJry < of lein- ' ' 

Applicnions insci!n.f wit i cn" n n " 
slioiilil be leni lo llic 

SimerintentJe nt leer rm 

PRINCESS Alice hoseitm rfjf];'"" 
Jr (\oliinnri Ccncnl Hoipinl ' 

Iwo Hotiic Slirseotii) 

resident house surgeon ,c3 
J„l> ir.h Sihrj flORf j-""™, one tn 
AppIiciPoni ihoulil *7, ‘I"' 'em ,-,iiT ' 
.inJenieneJ "“'i RUSSEL " I 

Juli 1lli 1918 


Jul,^ 9 I9'!S 


the BRITISH MEDICAL JOURNAL 


APPOINTMENTS — Important Notice 

JItdic-\t pnclitioncr^ irt n.qiKbtcd nol lo -ippK fov '\ppointment referred to in the tollov m" 
tnbk without Inruig fir t coiiimunic-Ucd with the Stcrct-in to the Bnli-h Mcdicil X'lsocntjon B M A° 
Hou-e Inu-tock ^qinre \\ C 1 (in the cose ol Scottish nppointiiKiils with the Scottish Secretary 
/, Driiiiishcu^h Gnrdtiis Ldinliurj^h) 


(a) British Islands 


Town or D St i t j 

Town pf Di in f 

Town or D ttri'i 

CONTR\CT PRACTICE 

CONTRxCf in\C1ICB'^Cflntd} 

PUBLIC HEALTH 

j 

ABERnsSMCMFDlCNL MDSOCIET^ 

MIDRHONDDs MEDICSL \ID SOCIErV ; 


(Aifitran/ '/<• caJ OfTcer ) 

j COUNTY OF POXBLRrH 

j (AiUiiant \fedcol Ohee ot Health ) 

BL\EN\\ON MEDJCNL SOTIETY | 

(Chef Me c*.l 0**'crr i 

NtATH AND DisTPicrr 1 

iMrdfuf All Atticijt on ) 


GILFSCH GOCH GLVMORGAN | 

(11 c krrttn % Mr uf \<he nr 1 

orvioRt \ VLLEV rLwioPCvN 1 DISPENSARI APPOINTMENTS 

[ tH intfam Call ery Met al AtJ ^tcieSi ) 

1 

LL55\N\riA CLNDACH SALE, » 

rrN)CP\lG GIAMORCVN j 

HI 0 kn rn J tfr cef St/ r rr ) j 


LIMERICK CITY 

al on, "'‘la^'l/a,l'°^l 1 ,a 1 l</a,a,a,a Cprata,, llmual OFca , I 


(b) Oterseas 

Medical practitioners are lequcstcd not to applj for am ippointnieiit reterred to in the following 
table without haeinq first coniiminicated with the Honorar) iiccrtlar) ot the Division or Branch 
named in the second eohiiiiii oi with the Secrctarv lo the Briti-h Medical Association, B M A House 
Tavistock Square, \V C I 


Tewtt or D stfiT. 

lltn Se of Ol 1' on '( 

rnrjrt, '} ot O iml. 

Kon See of Dnnion 
or Drahch 

Town or Oittncr 

Hon Sec of D >1 co 
or Bran h 

NTETW SOUTH 
WALES 
(AH Fnerdtf 

St'cefy Afseirtt 
rifrii ) 

Th* Vfediml Secretary * 
New S uih Males 1 
Bran h P* Mac 
Quar/c Street Sidney 1 
NSW 1 

1 I c T 0 n I A 

tAII inttiiuie c 
Meleai Pnprn 
ioites ) 

The H<o rary Secretary 
\ ictortan B r a n c h j 
Btitnh Medi a) As <v 
eiation SI e d ic a 1 

Sen. ei> Hall Albert 
St ^st Melbourne 

V laorn 

ITESTERN 
AUSTI5ALIA 
(Centreef find 
Lodte F act cei ) 

The ffon Sec tVesiern 
Austnlun Branch 
Bntub Med cal Axso* 
ciation Shell Hotzte 
*03 St CeoTze s Tet 
race Penh \N extern 
Atntralia 

The Hofl See Gueers , 
land Bear h Dntah 
5 icdic3l Aisooation 

B M K Ucjk.se ^ 1 

NS Ickhan Terrace ^ 
Bfttare B 17 ' 

QUEEN SLA>D 
(fir(ib4*’< Aiteeiaie 
Friendly Seefehei 
insurute ) 


Jiilj 6 193S Bj Order of the Council G C ANDERSON, Secretary 


gRISTOL ROV^ INFIRMARV 

\prt»~aiion« arc tamed for the fo5 Rc^I 

d nt ^tedj“3l Nrpoininettt^ { t the rnontb» 
t rMnemne StncmbcT I't 1935 

Three HOLSE PHYSICIANS (on- cl «ho-i 
al o acts as HoiAC Phyaicwn to the Can ct 
Departnent) 

Four HOUSE SURGEONS and One ASSIS* 
T\N*T HOUSE SURGEON 

One HOUSE SURGEON to the Casualty Depart 
ment 

One HOUSE surgeon to the Ear Nose artd 
Throat D parirrent 

One HOUSE SURGEON to the Fracture Depart 
ratnt 

One SENIOR OBSTETRIC HOUSE SURCEOS 

One )UNlOR OBSTETRIC HOUSE SURGEON 

Salaries at the rate of per annum ctccrt in 
the ca e of the Sencr OMtctnc House Surecon 
who mli rccene n wlari at the rate of £f00 p».r 
annun anj the Senior Casualty House Surzeon 
who Will receisc a salary at the rate o! £I 0 pet 
annum 

Caml dates ssho mist be duly Qualified to setsd 
ta their applicatum on forms to be o’^iain-d from 
the undcTs iT’ed which tnti t be returned on or 
Kfcre July I^th 193 to ether wnh cipies of not 
more than three test monials 

The elected candidJt s mu t become members 
of the Mcdi al Dcfen e Union before talvirtir up 
ihcif appointments 

ELLIS C SMITH *r CIS 
Se-rctary and Hovse Cosernor 


M 


D L A S D H O S P I T A t 

Easy Row Birtntn ham C50 Beds > 


\rnlic3tions are insttecT for the post of HOUSE 
SURGEON Duties to commen e Auznsi 1st 
Salary £ 00 per annum with hoard residcn e and 
launsity ,, 

Arpbcations statine wben at liberty are quail 
fications tOKCther ' ixh copter of recent lesiimonnls 
to be addrestd to the undcrsiened 

OLlve FURNEAUN SeCTctary 


\/TANCMES^n:R NORrilERN HOSrJTM 
Cheetham IliH Road Mat' h'-stcr S 
(General Hospital *^1 1' Beds) 

Ap'ih atiots sre insiied (or the posts of RLSI 
DENT HOUSE PH^SfCI\N and RESIDENT 
HOUSE SURGFON Salary £lon per annum 
with board and residcn « 

The uppoioimenu are (or six month fr<m mid 
Au-u«( 1915 (successful candidates are e!i» ble 
for reappoint rent (or a (unher st months) 

AppI atlons statin ace qualificatjorts ard 
mtionality with copies o( pot less than three recent 
tmiimontsis ho id be ent to Mr JsMfs C 
DssiinA Scemnry 35 Barton Arcade Maoshester 
3 by July Uih 


M wchcsttr northern HOSPIT SU 
Cheeth r» Hill Road Manchester 8 
(Gen ral Hospital— 111 Beds) 

Applications ore mstted for the post of RESI 
DENT SURGIC^L OFI ICtR commer ire salary 
£1^0 per annim with board and rc^idcn c The 
appomtiTcni ts (or twcl'c months from mid \u{rust 
lyts 

\rpIicaiions staim" ace qualiSmtions ard 
nation lily with con-s of not less than three 
recent icstimon als to be ent to the Secreury 
Mr JsMES C DsNirts JC Barton Arcade Man 
Chester ^ not later ihao July Pta 

\71CTORl\ H(TSPITM. BLACKPOOL 

V <182 Beds) 

HOUSE SURGEON (MALE) TO THE SPECf VL 
DEPARTML>FrS 

(Eye Car Nose ard Throat and 0''«t-tfies > 

\ppU-~ations xrc insiicd (or the abosc ppomt 
ment Ihece are four resident ofTl ers 

Nppoimm m is for six months Salary sr the 
rate ol £!“< per annum with board residence 
and laundry 

\rrlvcation with copies of three re cm testt 
monuls sho ild be yent immediately lo the 

General Supeiimerdent 


QITY H0SPIT\L CHESTER 

JUNIOR RESIDENT MEDICAL OFFICfR 
(male) required for the abosc zen rat hcispiul 
Salary will be £1*0 |>CT annum plus full rest- 
central emolument Tb arpot-rmenr wdl be for 
Mt months only and wtJl be terminable at anv 
umc hy one month s nonce on eithe- s de 
Appliotjon sayimz a-e Quali/tcattons and 
prcsious experience lo-cthcr with copies of three 
recent tesumon jls shou d be sent to the Med/cal 
OT er of Health Town Hall CbcMCf by 
NNcdncsday July I3ih 1935 

J H DICKSON 

. Towtj Clerk 


'OSSHAM MEMORIAL HOSPITAU 
' Klnsswood ol 


A T3can-y will appear at the end of July for a 
JUNIOR RESIDENT MEDICAL OFTICER 
Salary £l 0 per annum with board and laundry 
to remain for 5ie months in the fim instance 
Applitams (male) should be British national ty 
fully Qualfcd and rez sicred 

Applicaiionj with cop -s of rcecni testimonial 
to be sent to (he Secretary 


'OSSHAM memorial HOSRITAL 
' Kin"3wood Bristol 


W nied an add iional HONORARY SURGEON 
fi_r ecnerat surai^al work 

\pply with full panirubrs to th- Secretary 


C 


VEPS \H;\ ONSHlKE \ND 

INFIRMXRY BSNGOP 
(A Gercra! Hosp tal ) 


ANGLESEY 


SENIOP HOUSE SURGEON wanted (jralc) 
Salary £1 0 per annum wiih residence hoard and 
laundry Dufies to comircr e Au-ust 1« 

Apoli'm ions sjtin- -ace quahficatioTW and 
nttiofiTlity with two recent testimnni-Is to reach 
the ^rctary rot later than July 13th 

fAppomtmrnrs coni nur(/ an P 67J 















THE BRITISH MEDICAL JOURNAL 


JuL\ 9 19'(S 


TO ADVERTISERS 

The British Medical Journal has 
T larger ciicuhtion than that of 
all other British weekly medical 
periodicals combined 
CIRCULATION OR TinS 
ISSUE— Jl, 000 

TERMS FOR ADVERTISING 

SMALL IMICPAID ADVERTISEMENTS 

The Minimum chaige is 9s, which 
co\cis up to 30 words Extra words 
arc charged 1 s 6d for 5 or less, e y , 
33 words would be charged as for 35 
Name and addicss should be 
included when counting words for 
cost 

If Box Number is used, it Should 
be reckoned as 5 words in the total 
Advertisements, accompanied by 
remittance, should reach this ofTice 
not later than NOON, TUESDAY, 
for insertion in ensuing number 
DISPLAYED ADVERTISEMENTS 
Whole page, £24 and pio rata to 
one eighth page 

Special positions dates and rates on 
application 


T' ’’ DUPLICATING 1 RANSI A 
In Mcdinl «ork 71^11 
MONIALS THESES Uc accuntcly copied in 
^>lc tint commmds nttention — Woburn Duriau 
Dnyton House Gordon Street London W C 1 
(close B M A House) I USton I77S 

'T'TPEWRtTING— SPTCIALISTS IN TTPING 
^ Medical and scicnitric papers lectures 
llRscs nnd book:* Shonhind t> pists nlwnis 
available Proof readme inJeslnc — Maroarpt 
Watson Ltd 16 Palace Chambers llridRe 
Street S \V I WHItcliall IRtS 


ASSISTANCIES 


'V\/'AMCD IMMLDIATELX* INDOOR AND 
rr Outdoor ASSISTANTS tor Poisn and 
Countrj Pricticcs with ind widiout mcw to 
Partnership Good ‘v'tl'incs ofTered SiAtL full 
mrticuhrs —llRiTtsit MrmcAt Buriau 31 Cross 
Street Mmehester 2 

\^ANTCD IMMEDIATcn OUTDOOR 
ASSISTANT for Lisdy worked P-incl md 
P^^^tc Prictfcc near Uirminglnm Dispenser kept 
Salary £450 pa If own car extra £50 allowance 
Usunl bond— Address No 7119 BMA Ifousc 
lavisiock Squart W C 1 


Y^ANTED IMMEDIATELY ASSISTANT 
» » Pant! and prixatc practice In coastal town 
in Dc\on Salarv £100 p a plus £50 car allowance 
— Address No 7131 B M A I Ionic faiJstock 
Square W C 1 


W ANTED IMMEDIATELY ASSISTANT TOR 
nriv itc and panel pntticc Manclustcr 
Salary £100 to £400 per annum iccorduiR to 
cxpcriLnst Ah found car allovsancc cxin Suit 
iKwli qu illllcd min — Address No 7259 BMA 
House TuMstock Square W C 1 


P' SS-S, SS™!. 

'"'"r'', WNMARRirnt assis 

11 tn acrccabic Smith Wal« 

le u'k Pnnciral imine 

ijnn ? "'t'''®"' ‘"'f Prmrdcd Silarj fun n, 

I'lOO (neeordme to cxpcncnect with Iiinmlinl 
“^aplicatlone m AdJiw 
No 7016 B hi A Houec Taaistock Square W C I 


pARTTIME ASSISTANl WANIPD SI 
I INC out M lie or funnlc Rriiiih 1)» 
locum second half Aukint Suit poMRtiJiiau 
—Address No 7117 BMA House Taiiimk 
SqinrL W C I 


pARTTIMr ASSISIANT WANtLD POR 
A- practlec S L Lotidou Suit semi rcihcd or 
postsrnduate —Address No 7278 11 M A Home 
Pavistoek Square W^ C 1 


COUTH HAMPSHIUC— WANTID ASSISlASt 
Lr with early \ic\v Briilsh Chirnmiit house onJ 
sarden aiailahtc Stlnri to be art meed floisl 
liospttile and social nnicnlifcs foe miles sei — 
Address No 7101 II M A House Tauihsl 
Sqii ire W (2 I 


I OCUMS 


W AN 11 D POSITION AS I OCUM ASSIS 
TANISHII or PARTTIMF WORk 
Experienced in panel and prisaic prachtc I tee 
now Will BO anywhere — Phone renii 47'ii 
(London) or address No 7134 11 M A Home 
Tayistock Square WCl 


EVERT ErrORT IS MADE TO ENSURE 
THE ACCURACT OT ADVERTISEMENTS 
APPEARING IN THE JOURNAI NO 
RECOMMENDATION IS IMPLITD DT 
ACCEPIANCE AND THE BRITISH 
MEDICAL ASSOCIATION RESERVFS THE 
RIGHT TO RLEUSE OR INrLRRUPETHE 
INSERTION OF ANT ADVER I ISEMENT 


AdVCRTISI MFNT MANAGER 
British Mtdical Journal 
BMA House, Tnvistock Squ.arc, 
London, W C 1 

Telephone EUSion 2111 


NOT CLASSIFIED 


CIGARS (ENDCUT) ALL HAVANA 

TOBACCO GOOD SMOKES at i low price 
quality fjimrantced Box of ^0 for 25/ post free — 
Sole' Manufacturers J J Freeman ^ Co Ltd 
P iccadilly London W I (GRO 1529) 


“BIZIM” CIGAKETTES 

THESE luxiinous dcliclouhJy satisfying smokes 50s 
or 100 s at 6/3 per 100 58/6 per 1 000 post 

free — Sole Manufacturers J J Freeman ^ Co 
Ltd 90 Piccadilly London \V 1 (GRO 1529 ) 


SOLACE CIRCLES ” TOBACCO 

THE finest combination eser discovered of Choke 
N itural Tobaccos Every pipeful an indcscnbablt 
pleasure 12/6 per 1 lb tin poM free — Sok 
Manufacturers J J Freeman tL Co Ltd 
90 PiLcadilly London W I (GRO 1^29 ) 


A ROAR \ —LEAST KNOWN MOST LOVELY 
hohd i) rciori m Ireland Best free fishins 
rouRh shooting ROlf balhinR an artists paradise 
First class ACCOMMODATION proxidcd by 
doctors widow lew guests taken Vacancies now 
— Address No 700S B M A House Tavistock 
Square W C 1 


F or \ll income ta\ complications 

or diflicultics consult or communicate with 
Mr C C C KJLNFR (late H M Inspector of 
I axes) 7 bt J imcs Street Piccadilly London 
S N\ 1 Telephone W hiichall for appointment 


R lfrycuon and niL ordlring or 

CLYSSrs — Pnciieal work tauRhi tO 
Mcdicil Praetitioncrs b> praeiismR London 
Ophthalmic Siireeon is Ss for 10 lessons 
— \ddrcss No 7116 BMA House 1 im toek 
Sgii tre \\ C I 


W YNT CD EARLY AUlUMN FOR PART 
NCRSIUP country practice 10 miles north 
of London an OUIDOOR ASvSISTANT Mum 

be well qualified and under 35 years of trc 
A ppoinimcnt for six months or by arnnrement 
No Mew to pirincrshlp UnfurnMied flat to let 
Suit married man Must possess own car Salary 
£420 pa including car —Address No 7124 

B M A House Tavistock Square W C 1 


W ANILD ASSISTANT IN FAR NOSL AND 
Throat Practice with view to early succession 
— Address No 7253 BMA House Tavistock 
Square W C 1 


W ANT CD —MALE ASSISTANT INDOOR 
for mixed London practice Silary £350 per 
annum Recently qu ilificd man considered — 
Address No 7113 BMA House lavisloek 
Square W C I 


W ANTED IN COUNTRY JOWN IN MID 
lands male Outdoor ASSISTANT Silary 
£400 to £450 according td experience Car pro 
Mded Ample time for reading — Address No 7121 
BMA Hous- Tivistock Squire W C 1 


W ANTED ASSISTANT IN LEEDS MIXED 
pnciicc Sal iry £350 ill found Applica 
tion to Riynoips and Branson Ltd 13 Brig 
gate Leeds 


W anted outdoor male assistant 

(or pane! and private pnciicc in the Mlu 
lands Salary 1400 per annum Must be rcliiblc 
Car supplied Usual bond —Address No 682S 
I! M A House Tavistock Square W C 2 


W ANTED INDOOR MALF ASSISTANT FOR 
pncticc near Cardiff Silary £360 pa Car 
allowance if required £52 p a State age and other 
particulars to —Address No 7228 BMA House 
2 avistock Square WCl 


F or CARDIFF MIDDLE CLASS PR YCTICF 
Outdoor ASSISTANT wanted ImmcdntcK 
Own car preferred Salary £400 and £50 «. »r allow 
ance Time to read — Address No 727^ U M A 
House I avistock Square YV C 1 


TNDooR Male assistani British 

1 wanted September for Middle class Pnetke 
20 miles lomlon Salary £400 with view Car 
provided —Address No 7118 BMA House 
lavisiock Square W C I 


M ale assis^iant wanild in good 

class Gloucestershire practice from AtiR Isl 
to Jan I St Seven guineas weekly all found 
must have own car car allovsancc — Address No 
721 ' s BMA House TavUiock Square WC 1 


TVTANTrD LOCUM FOR SMAM S IOM>0S 
Tt Practice from July 29lli to Am UUi ILhi 
woiK no mids few visits Posillliiy o( jvm ot 
full lime work later — \dilrcss No 7IL nM\ 
House T uisiock Square WCl 


W ANTFD LOCUM AUGUST Mh TO ’hJ 
for compact pnctice South I ondon Mvn o; 
woman expentneed m general and nanO 
Slate ige Usual terms —Address No 7 
BMA House Tavistock Squire WCl 


W ANIPD INDOOR lOCUM UrOl’IIONf 
semi hoild ly Auguvi Detbyshirt easy ^ 
Dvks Work liRhi 6 ftiimeas plus I guinc-i 
weekly truispori —Address No 7‘’55 DM 4 
House lavisioek Squire WCl 


W ANTLD LOCUM MAN OR \\OM\N 
for Sept 3rd to I8th approx Countb 
South Midlands Car aviiliblc Rcfcnaxcs-- 
Address No 726"' B M A House favuux* 

Square W C I 


W ANILD HOM'IIALITY I OCUM FOR 

self wife and boy for two or three Rery 
between last week July ind hsl week 
Bring own car — Address No TIO’ BMA llou'e 
Tavistoek Square W C 1 


W ANT))) lADV TO ACT AS LOCUM IN 
busy London practice from nkht of J*'' 
5th to night of August 28ih Mum be 
must be able to drive car —Address No 7 
BMA House (avistock Square W C 1 


E VBFHJLNCED J'KACTniONLK 
sold praetke is now free to act as 
at present near Warwick n Sim r 

preferred — Address No fl 5f A 

Tavistock Square W C 1 


■pxI'EltirNCID GP WSNTh I OC UM F 
J-/ OAOLMIN3 hoxpinliu lor 
nrcicrrcd 0»ncir Tree n<ro linii^ljiy 
— Addresx No 7137 B M \ Hoioo Fa'”' 
Square W C 1 ^ 


H oliday locums and , 

Fxrcrlcnccd hd.cx nnd ’Ver- 

Immed dcH or ncxr luiurc ^ i < 

munK.lc vMih-rnr Mrnioi Atixn- 1.1 
Southampton Street Strand vv C _ 

TT I iirr IND Gi 8tr)NfH . 

HP, ti^ln as I OCUM 
Square W C 1 
























Juu 9 t93S 


THE BRITISH MEDICAL JOURNAL 


65 


L ocum ixstss imvld requirld tor ^ 

rtrnxJ of ocTsl wccX ccxrmcnanic Aucmi 
Hh 19*^ The rcmn arrH>tnrcd %in he TefltnretJ 
u rroJc In the B roiich ami 'MtV, under the 
direction if the Med ol OTicef of Health 
^ClomT^x.JU n couM he rro'ided at the In 
fcitK'u Di'ea.en Ho pita) habry 'Ri 11 he at the 
rate of 10 fuineas per week less ccduction for 
hoard and rcsidetKc if rrosulcd Etpenen e in 
treatment of infectious di 'a es and tuher'ul'ms 
dcMrahlc “Apph Nfcd “al OfTieer of Health Towti 
H all East Ham E 6 


L oclm or MORMSG \ND ENEMNG 
SURGERIEIS required hs eldcrU pf~ciitmcr 
'fcho ha recer J> so d hi p tuc — Addres So 
■“llfi DMA House T3>^tOlV. Squire W C I 


L ocum work w vsttd cxperi 

eoced C P Jul) Hjh to ^cr emher 1st 
Ertl shman LondTn Ho*! tal Excellent 
m nials Accustomed to rood-cJivi p ua e prac 
IK.X and indjstnal O' n "ar — Addres So " ^6 
B M A House Tail loiA !x;viafc kV C I 


W OAfAS DOCTOR REQUIRED AS LOCt M 
fnm Aunist 1st lor about six »ctks cnc 
pumca a da\ and irasclhn* aIo*arr^ — Adures 
So "*-9 BM A House Tasixock Square 
M C I 


W OMAN LOCUM WASTED FIRST THREE 
s»eeVs Aurust Hosritaliiy ofTered two 
reopJe hestdes loium Hou c sca front W orL 
1 rht OwTi car desirable ihouth not es cntial 
— Address So ”2 0 B M A House Taxi locV 
Square W C I 


\/OU*sr DOCTOR THREE 1 £,\RS G P 
■I expenen'e viU be free to undetiake LOCUM 
WORK for JuK to October prcferabl) extended 
cnFafernents tn xicinitj of Birmintihara Own car 
Ten nuineas r«r «cel: Excellent references — 
Address So ”IP BM A Hoirse TasnoiK 
Square W C I 


MEDICAL POSTS DISPENSERS 


W'^'^TED immediateli for colstry 

▼ * rracit c 0 nilcs north of London LAD> 
SECRETARY DISPENSER under ^ \cin of 
w c expen shinhand i>p t with cood knowicde 
of d ipcanne Mu t be keen and of pood appear 
an^c Pos cxxiofl of own car and fpndre^^ for 
polf tennis etc will add to the anteni les of the 
job Second di '»cnscr alrcad) emplojcd — Address 
So "U B M A House Tatistock ^uare W C I 


\\/ASTED IMMEDIATELY RADIOGRAPHER 
mate or female for 2 months Salary L5 
per week plus ua'cSlmjt expensed Knowledxc of 
Deep Therapy dcsirab e —Apply to the Koi-sr 
Gosfxvo* ivD StrafTARr Royal \ietona In- 
f mary Scvicastle opotv-Tyne 


\TM^'TED YOUNG QUALIFIED DISPENSER 
» • (Hull) fo two weeks LOCUM Autru t ®ih or 
l^ib ret qu tc full iv^c pcs ib c permsren-y liter 
Send full particulars experience photo — Address 
So "II B 'I A House Tansiixk Square W C I 


W ASTED FOR A FEYV W EEKS JS LOSpOS 
3 medical man to help m DRAWING UP 
A MEDIC \L WORK Must be sery efli^ent 
Eicn pare time considered —Address So 7-‘'7 
B M A House Tavistock Square W C I 


D ispensing career for young ladies 

FULL TRAINING for Apothccari-s Hall 
Ccnifi ate Enrolmetiu every three tnenths — 
VrrU The Pnnapal Central School of Pharmacy 
s Moretoft Street London S W I Telephone 
\ nofia 1641 


D ispenser olalified i6 years ex 

pencnce seeks p» i with Doctor DLcrtnced 
now — Mi M K Farr Bn 'stock Road 

Th mion Heath Surro 


D ispenser hall ouALincATios seeks 

full time po-t Hi piul Sufeeon or Pharmacy 
Quick neat arM a'curaie di pen cr with cck^ 
references Cental doctors work — Addres So 
*101 P A! A Hou c Tail lock Square W C 1 


D octors reouirisc qualified 

D «per erx Nurse D pen cr Secrctarx 
Di pen n or ChiulTeusc D pea cm are in itcd 
to write wire or phone Temple Bar Xiir 

Dfsrrssrr s CitfAt ^ Lind<i> Hoii c 1 1 
Shaftesbury Avenue Lcodcn W C 


CECRETARYSHfP DAILY OR RESIDENT TO 
docto or other professional desired by Oxford 
Grad Capable tcltab e food addre«s — Box 
A R 7II 55 Bryanston Street London W i 


CCCRETAPY DIS'^ENSER REQUIRES POST 
^ with firm of doctors Hall quair-tion 
cxpencnccd eficient and rcliab e Typ")? and 
knowledge o! numin — Address No " 61 B M A 
Hou c Taviitcck Square W C I 


T he royal arnpy medical corps 

ASSOCIATION Ecclestoo Squj.re 

SW J (Telephone Viaoria sufp m 

Qualifed Di pen ers Bookkeepers Lab r.»t ry 
As tanis Sanitary As rsiants Male N r es 
Mental ard Special Treaim-rt Ordcrlie? Denial 
Clerk Orderlies Porters Carcukers ci w th>ut 
charge to prospective employers 


P^RTSEKSHIPS 


\X/ANrED BY CaMB graduate AGED-? 
Yt PARTNERSHIP m teiicr-tU.is Practice 
South of England preferably m Home County 
Cros- im. mic not Jess than i! 00 Two yean 
postgraduate Hospital experience in London — 
Address. So /lO^ B M A House Tavtsfock 
Square W C 1 


^iiiiiiiiiiiiiimimimiiiiiiiiiiiiiiiii^ 

S "The Names and Addresses of ^ 
ZSi Advertisers UAmg S; 

I BOX NUMBERS | 

g are held b\ us m strict con S 
«— fidenceand mav noibedisclosed 5 
S Applications should be S 
S separatelv enclosed and cicarlv 

addressed S 

S Address No S 

S B \S A House 5 

S Ttmsfock Square H Cl S 

M All comrruntcations are foru-arded SS 
US to advcTtrsers under pl^m cover !S 

^IllllitllillllllilllllllllllilllllililliiP 


F ULLTPIE LADY PATHOLOGIST RE 
Quired British nationality lor pri ate practice 
in West End W me for further details to — 
Address No "US BMA House Tavistock 
Square W C 1 


PXPERIENCED LADY DISPENSER SECRE 
' TARY required end of /ul> London N W 
Apply statinp ape and experience (with tcsii- 
T^onuls) — Address No "I— B At A Hou^e 
Tavisioik Square W C I 


W ANTED PARTNER AFTER PRELIM 
ir-iD As 1 lant hip for suburban praci e 
Midi nd -tty Third to half h-rc in KO 
rra-iice at two years pur base Prospea at ra 
It c Should be British wctl-qualifed and 
energetic — Addros No TL5" BMA Hoirse 
TavKtoefc Square W C I 


\/TEDICAL PARTNER MALE PROTESTA.NT 
TYi- wanted for P jmhrn* Glat'ow Practice 
Shire over £l liV) per annim Good pro*pea< 
Apply with full paniculars to CtAWTOio Heiiov 
i*co C Htxov Solicittrs -5" West Gecrgc Street, 
Glasgow 


M r^ OR MR CP WANTED TO JOIN 
L/ three cJiers in larpu better-class practice 
in delightful Afidland town SHARE tl I 0 at 
two years purchase r ms to equality Modern 
hoine at low rental Mu t have wide hoipital 
experience Hospital faetl ties available —Address 
So BMA Hou c Tavistock Square W C 1 


P ARTNERSHIP EXCHANGE SOUTH COAST 
fc»0rt eO milm London — HALF SHARE of 
£-.-00 Ea ily worked Ex h-p-e with Larjrcr 
Panncmbip anywhere Beautiful rrodem house 
and carden best louslity good svhoo alt 
ports — Audres No *3 BMA Hou e 

Tavi tock Square W C 1 


S HAPE value £1 ooo-n -OO IN HRCT’ 

class country p^ciice in West Wales near 
sea coast Welsh or Scotch preferred Price J4 
years purchase — Address So 6K10 B M-A. 
House Tavistock Square. W C J 


S OUTH MIDLANDS— THIRD SHARE OF 
£1 ■'CO m Rrowins town pracpcc — Addtcm 
No 72'"6 BMA House Tavutock Square W C 1 


\X/ANTED PART TIME SECRETARY RE 
*Y CEPTIONIST W cst End pnciicc After 
noon work References — Addres No ”1 0 
BMA House Favnocfc Square W C 1 


E xperienced lady secretary seeks 

pot wjih doitor Well edoaicd imual 
qualification fimilianty medical terms accus- 
tomed usin itmiaiive quick versatile thorough 
dme any car di engaged no* — Address No 7-60 
B AI A Houve Tavtiock Squ-rc W C 1 


PKACnCES 


A lady dispenser bookkeeper sup 

plied immediately on request qualified 
and with pramcal experience in private praatcc 
and di<pensaD work al o trained in Bactenologicsl 
Laboratories of the LONDON COLLEGE OF 
PHAPALACY FOR WOMEN Preparations for 
Examinations — Write wire or phone fBays- 
watcr 0969) Secretary 7 _W estbournc Park 
Road W.2 


A COURSE OF TRAINING IN DISPENSING v 
and Phanuacy is given at GORDON HALL 
SCHOOL OF PHARMACY and Secretary Dis- 
ren ers can be supp ted to Doctors Se<; ions 
January April and September — Apply Pnn iral 
School tjf Pharmacy Dray ion House Gordon 
Street W C 1 Phone Euiton 3930 


B ritish colow — assistant required 

a soon as possible Commencing salary £ 00 
r a increasing by £0 pa Conti ct years 
Passage paid Applicant mtrvt be of German o 
Austrian nationality holding Briti h quaUhcalion 
not over 38 years of ag- and preferably unmarried 
— Apply BgtTisii Meoicai Blriau Ta i totk 

Hou'c South Tavistock Square W C I 


L ady doctor wasted for private 

Menial Home near London Salary £300 
Expenen e cssemul — Address No “135 BMA 
Hou e Tavistock Square W C 1 




family socia ly inclined par 
tially cnppled left wmt through illness desires 
u tabic EMPLOY MENT bu loes or professional 
— Address No "{»’2 BMA Hou c Ta istock 
Square W C I 


OSTGRADUATE DOCTOR ^’ND^, 

ofTered conven ent FURNISHED HOUSE in 
TURN for LIGHT DUTIES Near London and 
3l Hosp taf or would sell pr-cticc Premium 

0 Address No 71 »0 BMA House Tav lock 

.-.r.. \\ r t 


P RACnnONER AGE '0 AT PRESENT 
having o n p'^cocc w^ms LIGHTER WORK 
in or near coontrv North or South W est rte 
ferred N midwifery Active and can work 
Write — Address No 71— B M-A House Tavi- 
10^ Square VV C 1 


V^ANTED PRACTICE OR PARTNERSHIP 
W £l.-00 upward surg’cal cope desirable- 
South Coa t Nonb or Central Wales Border 
Coumie' Cumberland cr Lake District preferred — 
Address No "-5* B vf A House Tavwtock 
^uare W C I 


\TirANTED IMMEDIATELY IN SOUTHERN 
W kf dfand or Home Counties unopposed 
counto PRACTICE £I 000-£1_00 Panel and 
good house and garden essential — Address No 
“0^7 B Vf A House Tavistock Square W C 1 


W ANTED TO PURCHASE IN LONDON S E. 

dMnct sm„I PPACTICE with Panel — 
Address No "J1-. B-M A Hou<e Tavistock 
Square W C J 


C OMPAfTT PRACTICE OF KCO IN NORTH 
London wiih-^scopc easbf run expenses low 
AI o niDe^CKrred house and garden in good repair 
m pleasant road accessible to all pans Sun young 
jyractnioncf or <emi-rctircd Pnee £2.000 includ 
in'* drugs instruments furniture ard fxtures. 
Mongage arranged — Address No 7106 BMA 
Hou'C Tuvi lock Square W C 1 




































66 


A DJSPOS \L -COUNTHV 

Vi ® 'y EnsWnd pcnsini! 

^ P'^ncI 635 Choice of Iwo 
excellent modernized houses to let chzrniine 
xilnge nnd district Introduetion ns required 
Price prnctice £2 000 —Address No 7271 B M A 
House TaxistoeK Sqinrc WCl 


170(1 SzVLE ON RETIRAL OLD ESTA15 
^ hshcd const PRACTICE with retention of 
pinci 'vna 'ippoinimenis unopposed \ciy dcsinblc 
district in V\ csi of ScoiHnd stmll but capable of 
dc\ciopmcni nuRlu specially sun semi retired 
prattiiiortcr — Apply Powsir Aiton and Co 
S ohenon* 190 West George Street Ghsgov. 


POU SALC ATTRACTIVC PRACTICE IN 
Midland suburb Avcr'igc receipts list three 
years £3 000 pmd 1 850 increasing stcidily 
EvccJlcnt house specnlly bmli scpiritc profcssioml 
rooms fne bedrooms double gingc Also brincb 
surgery Introduction i^ required Price for 
practice £G 000 —Address No 7258 R M A 
House rivisiock Squ \re WCl 


poll SALE PRACIJCE S LANCASHIRE 
■*- town Receipts iNcnge £3 000 panel 
loprox 1 800 Good house tvith surgerj also 
bunch surj,cr> let or sell Prcmuim for practice 
1 years purchase — Address No 72^4 IJ M A 
House Tavistock Square WCl 


L ondon l 8 —old established prac 

TICE averaging £500 panel 7^0 Premium 
£850 Also corner bousi. with garden near surgery 
for sale Excellent scope muncrous L C C flats — 
Address No 7268 B M A House Tavistock 
Square W C 1 


L ondon s w — ron sale lock up 

SURGERY panel 150 Premium £120 for 
quick sale — Address No 72*'6 fl M A House 
JaMsiock Square WCl 


L ,IVERPQ0L — OLD ESTABLISHED PRIVATE 
and panel PRACflCC for disposal Working 
and middle class Panel approximated 1 100 units 
increasing Approximate gross income around 
£900 per annum Low expenses Good scope 
House on lease Disposing owing to ill health — 
Address No 7129 BMA House Tavistock 
Square W C I 


VTUCLEUS — RAPIDLT GROWING RCS( 
La dcntial district coast town Lancs Small 
panel suitable stmi retirement or aciwc young man 
or woman work up Good house rent Threx. 
golf courses near Leaving due lU re \Ub Premium 
wry moderate —Address No 7269 BMA VIousc 
Tawstock Square WCl 


TVTUCLEUS IN BOURNEMOUTH TOR SALE 
Moderate pintl Capable of cxpan^iion SuU 
able small house to rent Central^ situated — 
Address No 7274 BMA House 7 iviMock 
Square W C 1 


O I D ESTABLISHED PRACTICE NORTH 
Manchester averaging £1 300 Panel 1 450 
Considerable increase possible b> bnneb in ad 
lommg suburb Good lotaiion available Good 
house four bedrooms two rtccpiion attie garage 
excellent professional rooms with separate 
entrance Vendor accepting full time appointment 
House and Practiee priced low Sale urgent — 
Addrc^s No 7104 BMA House EivistocK 
Square WCl 


S USSC\— COUNTRl PR aCIlCF AVERAGE 
over £t 000 increasing Panel 1 200 House 
to rent ibO Good neighbourhood and schools 
Premium two fifths share (wuh increase later) two 
Stars purchase — Address No 7K6 BMA 

House Tavistock Square WCl 


W OMAN DOCTORS NUCLEUS CENTRAL 
Middlesex for sale £a70lasticir including 
nos pmcl and PMS Scope Small house and 
eirOcn for sale or would be let One >eat^ 
pvirchasc — \ddrc No 6S24 BMA House 
1 ivi toek Sqii irt WCl 


W UHIN E\S\ DISTANCE OT LONDON 
smdl NUCLEUS with scope together 
with \er\ aitraciivc house Residential area 
Coiiake Hospital House and Nucleus £2^00 — 
\ddrev No 7111 BMA House Tasistoek 
Square W C ! 


W OM\N DOCTOR WISHLS SMALL 
PRACTICE or NUCLEUS with scope 
preferabl) London S coast or coimir> acecs vHc 
from London Panel anJ Using accommotlaiion 
on rental csscninl —Address No 711*. BMA 
House Tavistoek Square W C 1 


THE BRITISH MEDICAL JOURNAL 


Juu 9 Uis 


HOCJSE 8 , CONSULTING ROOMS 

ESTADLISHCD 1860 

BEDFORD & CO. 

iiinoors Auctioneers and JEsinIr Aircitls 
10 WIGMORC STREET 
CAVENDJSH SQUARE %V 1 

Specialists in Professionil Houses, 
■'"d Consulting Rooms 
in Sized xnd Ic'iding Alcdicil Positions 

Telephone Laneham 3927 and 3928 

COMMANDING POSITION ADJACENT TO 
'Vest Kensington Station in modern bloci. 
of (IMS— SELT CONTAINED SUITE on Ground 
and First floor front door opens on /o 
thorouphfire Constant hoi wafer central heating 
decaraiions to choice — Apply Jojinstov Zsan^ 

^ George Street W 1 or Tlie Lctimg 

H. '1^'* Kensington Court North End Road 
W 14 rulham 427? 


^ Wl-AN EXCELLENT 
consol I ING ROOM in one of the finest 
house*! in the street available five sessions per 
"‘^ck Rent £125 pa inclusive — Address No 
6356 BMA House Tavistock Square W C I 


TXrNTAL SURGCR\ TO LET OVER 
Doctor X Surgery main road Elephant and 
Castle Established ten years — Address No 7107 
B A House lavisiock Square \V C 1 


ESTABLISHED 1845 

ELLIOTT, SON & BOYTON 

(H C Rowe FSI) 

VERB ST , CAVENDISH SQUARE, W 1 
Zsute Agents AnUtaneers and Surioon 
xrc lltcaiEST LOCAL AGENTS for HOUSES md 
consulting rooms in the Harley Wimpolc 
Quecn Anne and other streets m the Cavendish 
Square district VaUialions for nil purposes 

Telephone 3204 Mav pair 


E minently sun ABLE as nursing home 

OR SIMILAR INSTITUTION —Tor Sale 
Xrechold A siihstomnlly bw)h Residence 
pleasantly situated in n tonvcnicni position near 
Lpping Forevt 3 reception rooms and iocgn 
excellent domestic ofTices 7 bed and dressing rooms 
2 bathrooms all eompames services ccntnl 
healing attractive garden with tennis court ind 
garage at rear frontage to two roads Moderate 
price — rurtlicf particulars from Curtis and 
Hlnson 5 Mount Street W 1 Tel No 
Grosvenor 3i3i 


H ARLC\ STREFT— exceptionally LARGE 
conxufting room m one of the finest houses m 
the Mrcct rent £2‘*0 p a Another on xccond floor 
(lifi) It tl^O pa To Mcvx and for all pariiciilirx 
— \ddrcsx No 7110 BMA House favisioek 
Square YV C I 


F or sale one or riir finest houses 

m the Hatley Street dixinct Income from 
lettings of tonsuliing rooms over £J ODD p a Execl 
lent rcMdentul nnd consuUing room iceommod luon 
avadible for purchaser long lease for sale at low 
price — -Address No 7)09 BMA House Twistoel 
Square W C I 

F or sale or lease— non or s com 

modious house 147 Nitborough Road 
leiccsfer £1 000 or £125 pa rent —Address No 
703b BMA House I ivistock Square W' C 1 


HARLEY STREET 

AND MEDICAL DISTRICT 

Tor all tvpcs of available accommod ilion 

BERTRAM & CD. 

59, Connaught Street, W2 Padduigton 1042 3 


H arley street and district— a num 

her of excellent CONSUI TING ROOMS ire 
avail vbic (or full and part time use at moderate 
tents Pariiculirs on apphcailon — Et roop and 
Co 10 Henrietta Place Cavendish Sqviarc 
YV I Lang 2601 

H arley street— large consulting 

ROOM beautifully decorated will be con 
\cricd into suite to rcquircmcntx all amenities 
and services Also furnished trcaimcni rooms 
available —Address No 704Y B M A House 
iaviMock Square YY C 1 


NC'VION court LEINS! ER SQUM t M ' 


O'" HAVING 1(1 riRI D 

I mnlr x "o" ™ icr hi’ 

lOUSE The house iv modern and suimM m 
charming rcsidcmnl district on the LanLiS.rJ 
coast A suitable oculfst would soon tceover ihr 

BMA House IxxislocL Sqinre WCl 

pORTHCAUE — EICHriELD HOIM 

HOI A n't cmr'vz.J^ BcnchiM 1 Rll 

RLSIDENCI: ciclichifiilli sillialnl ilitcvilz 
Common inJ 

Roy at Golf Course Accommod uion Spacnn 
Hall two front Reception Rooms Kiithr/i 7uJ 
usual olnces seven Bedrooms Bathroom an I 
Lavatory Central heating (clecjrjc) large Cnruc 

FRiniOlD 

J LOT Ob LAND adioming 40 ft by I 0 fi lull 
iarticularj, from Sole Agents Drinr Sos isu 
(F A I PA) Lvfatc OlTiccv PortKjHl 
(Tel 78) and 119 St Mary Street CirdT 
(Ul 3470) 


pARK LANE— ADYFiniSI R YVISIITS 70 
■*- meet consiifiant whh view to LFTTINO 
ROOM Use of waftinR and hdicv room 
also small \ rivs £1^5 pn References —AilJrcw 
No 70H B Y( A House Tavistock Square WCl 


P ART TIMF use 
and LIVING 
Harky Street PIc 
7139 BMA House 


vicntTiser t'HoM 
Si 


Q UFEN ANNE STREET —ONLY HO PA 
secures exception illy fine CONSULTING 
ROOM for use when requited with lucndan c anJ 
all services Residential accommodulon avjiliMe 
—Address No 6355 BMA lloibc Tavnicxi 
Squire YV C 1 


ctreatham hill -modern CORNFR 

HOUSE in central posfiiim m good rcsIJenml 
divinct near station 5 bed bath recep hmk 
hall In excellent repair expensively fitted B 
tached parage also built m garapt siilnWc I't 
conversion into surgery rrke £' IDO ffichnlJ-* 
Apply Good MIX 4 High Road Sireallnm 


BY ORDER or THE rUBIlC TRUSTET 

T O BE SOLD BY A U C f I 0 N h) 
ARTHUR LAYYSON X MASKlLL \ M 
at their 

Estate Sak Rooms 12 New Street YctV 
on IHURSOAY JULY Urit 193^ 
nt 7 p m sub tci to condition of xak to be ii 
produced ind rt id 

LOT 1 

TREEMOLD DWELLING HOUSr x\«\i 5 Nil' 
entrance to surgery and waiting room 
1 East Mount Road York 
ocCupymn I tommindinp position In a promiwm 
central position for many ytirs In the wuipjii 
of n Member ot the Medical I'toR 

For further Information apply to the Yin.inr 
as above or to Messrs JouNSTOsr 
U'vikiK Solicitors 6 YYcckUay Crovs Nofim ' 


MISCET I ANEOTJS SAU S ftf 

INCOME TAX 


■VOlm Imr.lrti I" (tl'R Ell 111' < 
/ii\ ‘'prctWtfn ro rfi<* 

HAKn\ iV iiAuny 

I’y LinxciuY I VM iondoy 

Irlc|h<>nc H«ll i»rn tb * 

H ntc for fret cop) of Adtlcc on IrtCf tne ^ 


(on 


P ( 


D UNLOPILLO MATTRESS 
unii cd cost £7 Invi 

■ A.i'irzv.v at 


v:> (> ft iL 

. .ost £7 KK Jrive 

carriaec paid — Address No 7I0S U ' 

’^iM lock Square YV C I 


D 

£1 


CLAGr D8 88 3) IITRT ^0' 1*^ 

SALOON by Eironl IiM rr> / '’/N , 

son Doctor ouncr will coniiilcf ' l, 
»n one third oramal cost — Adarevr 
M A House lavisiock Square ^ ' 


troR SME— luii triai srT 
Jf v\ainiii ease (Curry and f / >- 

trial (rmve etc Vovki- Ta’ 

AUdrew No 700"* BMA I 
Square YV C 1 














IliL hmiisH Ml UICAI JOURNAL 


C7 


Jii\ in'<: 


! fiQ P O R I! A £ 

l» Ml MIU I.S of Ilir 
MI I)I( « I’HOI I '«slON 
ntnms oi pjsnNcnoN f r ciniumis 
( ni‘'CKjvtt\\nsr iwu s-nm i cu 
J vU n • 1 rv1 t c *1 » X. 3* f 1 I 

n !f <*3 F 1"^ 0 3 V» f i n I c 

xir r'ci'-'irn 
n >• Nil n ir- r' c! *--v 
1>c n ^ P' -3 ^1 Ivr^rcr-r 's c 

^ tx." 14 Ix'v't \V c't ! '■■J C;^ cr«- 1 irr' 
I a a; f 4 . -n-xiI 

\ll llViJjroM Pro* il fi -r*- tlVM> 
iiMsiun IN i\ni\ I'.^i’Niui njTMi-. 
'•r/</ir ofUh 

MOIT N M**! <in I! k p trr > X-l 4 


iJrtf^l V.*^| •twain \rt U*» I I Nilk w \lt a 

Miun 1 vNo TLon^mi tihu mj!** ts r 

TV'e II I ** it f#*r I rvfr^l n 1 «' Il in» 

I 111 Ni I '»! ITx iw m r from £l <»* 

<>\ n m vfx ^ ^ r •“ 

UINMll vlits ^ fn ft 

plivs. -I IT> frwm no lO 

ILlv JUin V| ITS from It t 

TUP 11)1 \P '‘ull fwr C uwtr^ art I S|*t»rtl«f r 
« oul vniii ntniM pnnntis from xr r 
inpiNr iiMiiTs xn r 

niniNp poops „ X3 n 

COST! Mis \ lONr rOlTs „ tt 

i^soi irnrn appr rn ntion 


** / J r •• 4^1 r-r». "w mrn »« » hi 

hole fa 1 ac •» I'* f'. I* //« / « e 

c t*-r ct ef 1 f' t 1 om ilirm rt * 

jnr-j hs t Norn '^r^rci P^i Cttt c-d P o h “ 
CSir-«\.) SI N VIA Mn iRCrS 
rNTTTRNs po<rr PRrr 


Pcffcct P Gujr n ccw f'wn ^ **"■ < ^ I rra -fc 
rs~>t I “r-i cf I atierTt C r-e** x 
t It r» lo I^n lew raw of ati f f I an r ■! 

Sf«rrlal 1 alir n Sioul 1 tVirw l»r rat *i»«l Prrfmt 
f II ns Onlhm wppli 1 afl r «>itlie«ii tmlns w 


HiRR\' HALL, LTD. 


Ci rm -f 1) fcv»o, JtArrr 1!» I 
** Till ** Coat Urorrltr^, llaliit awl C<» •« »»• 
~ Sporl ii tv 

m oNionpsT^Ti I 111 airir fnr,n.C2 

Tfif 

CERrani-.-^ 4V.v trd 4-*^ V AriOtaMC 

M kr' of I i^cM Ow tt p-^-k ic Cl -f 

•rvj Hinurc C" I c -so r-stlr"cr 

lllsliw 1 As «! 12 < oM M H 1 

I t o or 40 r r* 


Avrotymirs 


R 


O^AL LONDON OnmiALMlC HOSinM 
IVltv**^d<54 Pie HfwriisT) 

City Read E C I 

HONORARY ASilSTANT SLPCEONS OAVO) 


Ar" 'cati'*m axe inMtcd to f 1 t»o >ac3mes rn 
the HONOPARI SLKGICAL STA1 P at the -be e 
Ho»ri^3i 

Carujdates r-i- t be I cf of the Ri tal Cof ere 
f Si.r*wrrt of C"f jnJ 

Cantti f*T n no rem tied Cand dates ire 
hme'cf requeved to end cor *s of ibetr arr i 
otjo’' aivw imti's rul K the 'fcmbc' o the 
Coirn let of Man-'cmeni anJ the artins Mex..,,al 
and Sj'ncal talf whest rvnrv a"d adi.tes cs can 
lx ob ai-ev on a r~' teat on to i^c SecTctaf> 

Arr xaiisn i-tine a-'- wnh coHes of te^n 
rnonuli mir^t be rccci cd p< t later th_n Ju1> l^th 
i;v 

AKTHOR I M TARRANT 

Sccrciar> 


E velina hospital tor sick children 

SouJ'wa^tk, S E 1 

Arr call rs a e niitcd fo the po t of HOL SE 
SI RGEON (m- ) for t r'cntfn Iront Au mt 1 ih 
(fint mo r'onth in the Ca3ualt> DerTrtnc’'t) 
Saian a: the rate of 11 0 per annum uih be rd 
-nd rcMdcn c 

ArP’tcatJ n wuh copirs of three re- ert loti- 
men— K should Tx *<ni to the under in d not 
1 icr than Crst pest on July I^'th 

W H SfDNTLL 

Hou e OoNcrnor 


H ospital tor troi ical diseases 
Gl don Strcti V\ C I iSc men iRsfual 
Society ) 


HOUSE nnSIClAN (male) rcQuifcd (or \x 
trerthi frem Ansit't iM I9iS Salary £l 0 per 
rrirn with board rc< dence and laundry 
\rr catiors utth ct p m of three ie<timonlaly 
to be sent in on or bef ire Jul 16ih to the 

under cned „ 

D A C PRICE Sx-TCtary 
Ho r'tal lor Tropical Duca es 
Oc u n Sweet k'- C I 
June 2Jilh 1938 


\,HClDklV lIDSrit M um ClHinULN 
’ 1 II Ml II Ocl ei S k\ 1 

Cim Red ) 


The C tm lice I M n ement imiie arrh a 

t n I r the pt t 1 1 

tiiHtnsi imsiriNN 

• b> HtH sr SI 1 (»lON 

b ih \ ar \ur lit 1 ts ph^ arPt h men 
te 1 r \ IT n h S3!3 »ic< t the fate <1 Xli-o 
|xf rn m w th bXjru I wJc re *irj 3 I me 
i » t am* ALT A on K I K (n n ro dent) 

I r a pet ixl f three r* n h< Dji cy i com 
rrc*"c on \ur r*! 1 i l**iv 
H I > am 1 3 1 10 p m d dv tin lidinc 
S.»»ri.3y) N't! t rwc of i iO jKt arriim 
V ih 1 1 h 

Card daipi ate eyxvxtcd t attend t Si b-C Mn 
wcT f f nn inter w and h i!d end ibeir 
rr ati n aiv! c - en o three tC'i m njl t3 
the N'V’rtiry o t 3 tt than f pi p«»«t on Wcdpc^ 
U13 ih inh I tan 

I) SI JOHN RAMFORD 

Secretary 


R 


<)IA( lONDON OlltniALMlC HOSPITAL 
(Sf(V)Ki tn 1>S lAr HOSllIAL) 

Cty Road I C 1 


Ap" at n are in3 ted f f Ih pint o! Ol T 
I MljNI OPIICIR to attend ot» Tue^lay* and 
f f -»y* tm rr r > ea f> week Cand Jatr' rtu t he 
ter cfcd Med af Pr»nii oert 

S.Ur at ih taic tf fK^") per annum The 
tljt pit em O'* rr nit tv app n cd for a pen xl 
< *>c tnr and wi)J he eJ r bV t r rcappo nimeni 

C pten rerx t r\ can be Mamed n 
aprl t n 

'r ‘nat 'n w th tntifnon a tat np are nd 
i, ilf ai n f rcibff wuh ph/not aph n r*} be 
re cued by the tind^r'irn-d n t later than f nt 
po't <n VVrdncvlas July Pih lO'K 

AIM Farr ANT Vccteiary 


r ONDON JEWISH HOSPITAL 
Stepney Ctcer E 1 
ICcncral H al— 109 P ui ) 


The C 1 rwd of SJanafement -re ab j to opr nt 
-r HftNORAin SVSfSTkSf SIRrif»\ t> the 
I 3f Nine and Tbf ti Dcrufirrent CanJwWc* 
who **-"jd be Ee » ol ibe Roi I C i' re » 
s irr"<'* o^ tn rj F I nb itfh o* Jrr nj or 
Ma pm < f Streerr of a Tint: \ Lr en n ib «j 
tend twer y fou eop r* <f ibrr sr''loli(n w ih 
CTc«r thtce fcecn tmt m n i v the Sc tc*aty 
rf the Hmpta! It xn wN'tn patti ul n if ihe 
< ** e mar cbained on c before J«l» *-Pd 
19»« 


Q 


LECN MARA'^S HOSPITAL EOR THE EAST 
I>D 

Stratf td E I' 


An tn cniinn n o hems onoctiakcn in ca^e^ of 
Ch cnic Rheumatic Drvc3Mr> at the aNtc llmpinl 
and a CLINICAL ASSIST AN E h reCu red I r 
the mvi rufr<*'e of a me the Phj nan in 
cbaisecIvM wcik 

AticndanvC at the H'»'rul on either Si md?' or 
TAiuTNcay alicrn-K n w tequ red (torn - r m 

ArnfcztipfT< Co he ent r« the urxIcrMrred 4. 
early 3 p.*\ iHe 

RAniAEL JACKSON Slaiir 

Swetaty 


J^OA AL 


NATION AL orthopaedic 
HOSIITAL 


\ppl at n re in led for the f'l HOLSE 
Si RCLON <i»o Male tinmarri^) at ihu Hen- 
r'tal s ccunff* hr*f» h at IfrocM y Hill Stannere 
SI ddle>c* 8 Bed <160 cam cf yurciuil tuber 
cu C3jyl 

Salary £l 0 per -nnjr* wiih bcurd quarters 'ind 
Jjundrr The apptintmentf ar for U rarn bs 
Dui m to contmence one on Aucust l*t and one 
on SepternKT 1st Appl atlons v-iih cop m of 
tc'trmcnials shou d be sent to the Se'reiary ■'34 
Ctcm f onland Street London W I not Utcr thin 
July IJih 


W 


1ST LONDON HOSPITAL 
Hammer mith W 6 ( ’9 B ds ) 

There i a \ in 3 for the newt <rcatcd po« of 
IH)NOK\R\ IHASICIAN for FNicbolo-icai 
Med n Cirdidatc^ who may be rrm ir 
wemt n hon'd be Members or Fclli'js w( the 
R 1 3l C 1 epc f I h\ 1 un London ard he d 
hire h 1 omc emnen c in Child INychairy \ 
D rl m in P\ch ' I \!cdi me 1 dciirab'c 
If e land Jaic app inicd 3 ti d be cvpcctcd 1 ) 
im-cftaKc at le st on Out patient S's on per 
week apj 1 h teaching as mt be rcqi ircd by 
the Med al S h*.ol The aprointmcnt d vs n t 
irrs with it the charpi, f any Hovpital beds 
\ppK3ti rts 3c mp pted by copes of tewr- 
n n al mu t tea h me n t later than Fhur day 
Ate t th Cand dates mu t -ticnd a meet n? f 
ihc ^^rdfe3I C uncil it 4 ?f) p m cn E iday 
Auea I <th and pn r to that oaic call up’^n and 
end t p cs of ihcir application ard tesiimonji 
to c h member thcrct f The rru t not can a 
member of the H ard but nercrt'’c/e»s mu i end 
c< r cs of ihcir applican n and icstinontals ii cj h 
member thereof ird if v r n*‘cd be in ancrxfarKe 
at a meet nc of the Board at ^ p m on Tumday 
Aufint 9rh when the appomtfren wiJf be midc 
H A MADGE Secretary 


W 


ESI END HOSPITAI I OR NER 
Disr ASES 

INIATILNT DEPAFTSIENT 
Clouvnlcr Cate Resents Park N A\ 


TTie Ctvnm ttec c Manaeemcnt intites applica 
in f r t*'e pr t of RESIDENT HOI SE 
IHASICIAN (male) Duties to commence Sep- 
tember i t |9ts Sahry at the rate of £I < per 
apnum with beurd rrndmve and laundry 

I reference will be riten to cancui-tes who haic 
held a res dent appvinment m a ccr ral benp laJ 
Appl uijins with co'^'cs 3f three recent testi 
rri( n 3t nu3l be rccct cd bs the undersirned trot 
Ijicr ibin Afopda' Julv I h I93S 

J r AACIENHALL 
Secretary and Hou<c Goernor 
“1 AAclbeck Street U I 


W EST END HOSPITAL EOR NERAOLS 
DISEASES 

Out Patient Drpinmept 
•1 AVelbcck Street H 1 

The Ccwnniftee cl Manatem ni iptiics immMoie 
app 'atio- for TNAO HONORARY CLINICAL 
ASSISTANTS *of the Ch M G» *dnnee Dcrariment 
Cardidatm are reque^ ed to obtain funher p-ir 
t u! m a< t( Hint t r*c< etc from the 1 nder 
ifneO to horn appl "sti n with cop ev t ml 
more than three re ent lestimon x't ho i J be 
pcr-icd n t laier than Mi^dav July Hih 

J P AAETENHALL 
Secretary and Htuic Gotern r 


T he roaal Waterloo hospital for 

CHILDRLN AND AAOMCN 
Uaterfcxj Road SC. I 

HONOR ART ASSISTANT PHNSICIAN 

There ii a tacancj for an Hon A«i<rant 
Phy van at the aboie Hospital The candidate 
hi uld be a EclJow or Member of the Royal CoBclc 
of rh3''iciarrs and a craduatc cf a Uniiersity 
revocn/ed by the General Afedical Council He 
houM oho ha\c special knowicdcc of ihc di ea es 
tf children 

Appl aliens accimpaned by three tcstimonal 
hould be c"t to the underpinned from whom 
further pnni iilan can be o^ramed not later than 
July 18th I H TEASDALE Secretary 


K 


ING EDWARD MEMORIAL HOSPITAL, 
Elaline (145 Beds ) 

CASLALTT OmCER AND DEPbTT 
ILSIDCNT MEDICAL OmCER (male) req t red 
IT m nihs appointment with pexs b liiy f re 
Ic II n fnr a further period Salary £ — 5 per 
nnum with u uuf re^dential cm lumenu 
Appicainns tatm- aftc caper ence and qu. U- 
cati n tpfftbcr with copes of two recent 
rMmonul should be ent to the undcrsicocd 

nmed icly ^ ^ MICkCLW RIGHT 


T he LONDON CHEST HOSI’ITAE 
A 1 lorta Pirk F 2 

<n Tr m -nd Kail C mind c Heath 
L nd N C Railway ) 

A sa-ancy for 1 IKTLSE PHASICIAN (rralc) 
Will cccu sn Septembe t t Six monibs appoint 
mtnt Salary at the rate of £J00 per annum 
Btard rc' Jenct anJ Iturdfj proMdcil 

Applicaw n \ ih con es of three tcstimon ils 
hould be cm 10 the u'yder'iy.ncd on or before 
AAcdnc<di> Aumist rd 

THOMAS BROAA^ 

Secretary 




E OULEN S HOSPITAL FOR CHILDRE.N 
HaeVn y Road E.2. 

A Temperan Vacancy has occurred in the 
DEPARTAIEST OF PSYCHOLOGICAL MEDl 
CINE Applicaticns arc lavitcd and Jiould be 
sent with comes of teccni tcntmonials to the 
under icned as soon as possible Sa months 
appointment Attcndan c tvso half-days tseekly 
HcnoTanvim of on* cumea per csdon Caiidi 
dai*s muw be medically qualilicd 

CHARLES H BESSELL 
June -1st 1948 Secret ry 


June -1st 1948 







THE BRITISH MEDICAL JOURNAL 


6S 


■pjCVONSHIRE R O > A L HOSPITAL 
Buxion Dcrb>shjrc (^00 Beds) 

(A N'ltion'il Hospjlal for Uheumatism and 
A^hed Diseases ) 


House PHYSICIAN fmilc) S^Ja^> £no rising 
to £175 after three months service (ant) prospects 
of promotion to RcMdcnt Medical Ofticcr) \sith 
boird residence and laundry 

Candidates must be fuU> qualified and rcgisttrcd 
The appointment is for a minimum period of 
Six moniJis and maj be extended for a further 
Period of SIX months 

Applications endorsed Medical Appoinimcni 
Slating age experience and qualifiLaiions Togevhtr 
With copies of three recent tcsiimontals must be 
forwarded without dchy to the undersigned from 
whom any further particulars may be obtained 
Considerable orthopaedic experience is avail 
able and the appointments offer special facilmcs 
for a gcnifcman preparing a ihcsii, or wishing to 
undertake special work as the Hospital contains 
3)1 the necessary Jaboratory and other facilities 
for research 

Canvassing will disqualify 
By Order of the Committee of ManaBcmcnt 
A PRESTON TURNER 
General Superintendent and Sttrclary 


W ArrORD AND district peace 

MEMORIAL H0SP1T\L 
(144 Beds) 


Applications arc invited for ihc following posts 
for a period ot six months commencing 
August iM 1938 
HOUSE SURGEON (female) 

HOUSE PHYSICIAN (female) 

Salary al the rate of £150 per annum wiiJi board 
md laundry 

Applications stating age naiionalitv and quali 
ficaiions together with three testimonials to be 
forwarded to the undersigned forthwith 

T H rLLTCHER Sccrctarv 


UTE HOSPITAL LUTON 


H9USr SURGEON (male) wanted to commence 
duties on July ht or ns soon after as possible 
Salary £150 per annum with board residence and 
I tundry 

Applications stating age nationality and cxpcrl 
cnee together with copies of not more than three 
recent testimonials should be sent immediately to 
the Secretary of the Medical Advisory Committee 
at the Hospital 

R E LINGARD 

Secret iry Bute Hospital 


THE DOCTOR IN PRACTICE OR 
ABOUT TO ENTER THERIN SHOULD 
BE ADEQUATELY PROTECTED BY 
INSURANCE IN RESPECT OF 

HIS LIFE 
HIS HEALTH 
HIS HOME 
HIS PRACTICE 

AND 

HIS CAR 

q 

FOR ALL THESE 
CONSULT 

The 

Medical Insurance Agency 

h> Cu vrantec) 

OniTISH MCOtCAL ASSOCIATlOfI HOUSE 
TAVISTOCK SQUARE, >/ C 1 

□ 

WE CAN ALSO ARRANGE 
ADDITIONAJ. CAPITAL FOR THE 
PURCHASE OF A PRACTICE OR 
PARTNERSHIP 

Sfaf» nr\.t hirtliJar 

tcfitn tmttns 


JCLA » |<) ? 


THE MEDICAL AGENCY, Ltd 

DUDLEY HOUSE 8 I> S 8 , SOUTH XMI’TOA ST STD AM) « c-> 

Telf^phonrs—Tcmpie Bar 1034 1054 r , *. . 

EMibhvhcd in I59t by J \ Rnsp 


LONDON S W 12 — Old established middle class 
Rcs^cniul locality Lart.e house spLndid 
garden Receipts approx £1 500 Select panel 
nearly 420 Fec> 1 6 up Premium H ytirs 
purchase or near offtr 

LONDON SE (10 niins Charing Cross) — \Sork 
ing class G P Mam 
thoroughfare House to 
rent , Receipts £700 
Panel rtearh 900 Pre 
mium 2 vears purchase 
or near ofTcr 
HERTS (norder) -Middle-class PR \CT1CE 
Residential locality Corncrhousc cardt-n t-attuc 
Receipts niarl> £1 700 Panel met' 300 Tcct 3/6 
up Premium 2 > cars purchtsc or near olTer 
SURREY — Mixed G P Rcsidcmnl l£)ca\u> Small 
iiousc to rent Receipts approx £I 250 Panel 


r OCUMS AND ASSISTANTS 
ALWAYS AV AII ABLE 


•'00 Pn-miimi £1 SOO 

Croxdanl-MidJiL-chst PR u 
IH-L Residential Isxalii) Me 'un s > 
ruiial Rcsiipis n jfU Ji (ivi 

LONDON S NS IS MiiUlk and 

_ class G P Well p 

latcsl lovalitx X 
fronted ptcmisis R c 
approx £000 I ard < u 
— ) ! r e ni I u m I j scats 

LONDON N r— Middle eh 's' C. P Re , s 
approx £2 SQO Panel I 200 Prcmiuai s 1 1 
purcinsc or near ofEr 

LONDON Ell — Mixed CJ P Corner housed re 
RccLiplx £700 rmi-l 620 frviniuin tl ') 
inclusive Scope for Eye work 


MANY OTLXERS FOR SAIa,E DETAU S ON KEQUrST 


EsTAtLlSIlEO I86S 

PEACOCK & HADLEY, Ltd , 

arEDICAL TBANSFEB AGENCY, 
67 68,ClnndosSt Bedford St Slnnd,W' C 2 

THr^rams Herbaria Lcsqiiarc London 
Tet^phonr Tetupif Bar 5564 
LOCUM TENENS and ASSISlANfS supplied 
fret of charge to principals 


FOn BISPOSAL 

I LARGE MIDLAND TOWN (Suburb) —PRAC 
IICE held 16 years by \endor Hccelpiv aver 
age nearly £800 p a good panel Atuactuc 
house on rental Premium about £1 500 


EsTvunsiirn 1S77 

LEE & MARTIN, LTD, 

The Blrinlnp;hnm Medical Agency 
71, TEMPLE BmMIN(,I|\M 

Telegrams Tf1erf< i 

Locum Birmingham 5963 Midi mJ lUi-i 


TRANsrnn or puaciicis and 
rAKTNFRsinrs aruyngid 

MAMMUM I EE £50 if cxtluMVcly 
entrusted to us 

ACCOUNTS JN\FSTlCATrn AM) /S(DUf 
TAX nauRS^ rhrPAKFn 
RELIABLE AND rmCllM LOCDyfS SU 
PLllD AT SHORT NOTICL also AVSlSISSiS 


2 NEAR rULHAM S W — Well established 
mixed-class PRACTICE Receipts last ycir over 
£900 panel nearly 500 increasing Nice house 
on rental Pfemium £1 250 

3 GLAMORGAN COAST— HALT SHARE of 
old established PRACflCC Receipts average 
over £3 000 p a Large panel Very fine hou c 
with good grounds for xak Premium for share 
2 years purchisc payable pan by jnsialmcnls 

4 KENT — Developing part Very promising 
NUCLEUS Rccevpls last 5 months flW 
Panel 140 increasing Fine corner house easy 
terms of mortgage Prcmumi for Practice £275 
hxcellent opporiuniiy Greii scope 

5 A number of small PRACTICES at low pre 
mums Excellent opporiwnitKS for pracimoners 

Kins lo get V practice with scope 

C NEAR VKJTORIA S W' — W'clJ cMablisbcd 
mlxed>class PRACTICE Receipts last yea 
nearly tiOOO fair increasing pmcl Nice flat 
on rental Premium £850 pay ibic £600 down 

7 near HOLBORN XV C — Well established 
PRACTICC Receipts average £1000 pa 
pan*-! I 104 Splendid surgery accommodation 
only Long introduction if desired Pnmium 
£2 000 

S ESSEX— DEATH VACANCY Did established 
PRACTICE held 30 years by late vendor Re 
ccipts £l 000 pa pane! 900 \cr> nice house 
for salt Premium 2 years purchase 

9 wanted in LONDON OR PROMNClS 
PRNCIlCnS with idcomc> £500 to £2 000 pa 
Xfany purthasers waiting and quick fran iction^ 
for immediate cash 

No charge matte to piirchafers or for mqiufiri 


THE WESTERN 
MEDICAL AGENCY 

Dr K H Dcvsctt and Dr W J PAtvstoxE who 
give personal attention to every client 

22 Cl VRL STKELT, BRISTOL 1 
Tries Medm Bmiol 7rl Urtstol 
V, BEDFORD ST, STRAND, W C2 
Trt Trmp’r Bar 25)2 


iSii 

1 COVERS FOR BINDING 

' I 3rd II o' t>- BRITISH 'ILWCVL 

I jni PNXL lo 111" 3rd rtc'i ux jear c n 
K had r I c 2v t*J or r*^ free 2^ lOJ c- b 
Ofd-rs with a-'rorrac rc^ittar e vhoiU b- 
aJ-rcN -d to 

f THEMNNACrr 

} PliTtsH '!fPir*L Jr »>vl 

, BM V lIoLsr Ia isir^A. S<x.»»r 

j wet 

i * ~ 



n ANTED TO rUICIIASr 


1 BIRMINGHAM (or within 50 miles ih tc f 
Good Mixed PU'ACTICI wiib a fjnef if f * 
over and receipts of from fMoaftb' 
URGENH Y RLOUIKI D CSrilAL ASM! 
ABLE 

2 REOUIRED — Good tnulivh Sum h ir 
Irish LOCUMS at once Also YSSISTtSlH 
Good posts to olTcf ImmcdiitcJ) with or •i*' 
out view 

TOR D/SPOSH 

1 GLOUrcSTCRSlimi — NNellcIsWiUtdr' ' 

and «orkinRc1a« PU\Cncr Rct-cipi >’ 
£1 2'0 r a Pincl I "'00 Saopc la m ' ‘ 
and good house 

2 STAriJt— Hipidli iniieaMns mitnl Tmi 
and I tnci I RACTICF Rcccmn L" 1 
£1 O'O I nnci 1 "'ll) rxcclicnl hm:« » 
xcmccx PIcannt locaiily 

3 MIDLAND';— nnnmWp unh ' 

Sion in well established lar Nose an! »'■ ^ 
I’RACTICI Rccciplx at £I r> ' 
Appoinimcnlx pi £k50 pa In otr t * 
haxc r R CS and xpccialin cxpctlrn t »' 
lent house to rent 

4 VOHkS — Old c nWishcd tnitcd ' , 

Panel PRACTICE Receipt' iJ'i 
Panel 1 T4 Good hoii'C "hkh mar t-c t 

5 LONDON —Old cst'Mi'lted mned IP'' ‘‘ 
Panel PRACriCr receipt' il t'5 P a " 
966 Ample XLOPc ind aoeod hou'C 

6 LANCS —Old c'taWi'hcd middle an' » 

claw PRACIICL UccctPl' fl ’ 
malcly I’lncl I 'flO Good p™ e 


FINANCIAL ASSISFANCr a/lptJed '<> a 
apph ants for the piirchaic of r/aci) es ^ 
hips on very rcisonablc terms luM 

npph lU 'in . . r , 

RFlIABir AND rl lien NT I "f ’ 
SUl PLIED at SIIORTEAE NOIU 


Telerhiine IVclhe V. * 
rncsrjmt AxxixtH'io It'a” 

NURSES 

IVIALE OR FEMALE 

rRAINFD NURSfSj"^,! 
MFNTAl MLDICM 

AND rr VI R CSSI-S^ ^ 

\i/rsri rm !r the • f 

lot uttfrt caPi ^ 

Tlir NLR‘'I 1 

-"-'’;6,v,rrWNr^ 




Jin >3 


THI BRITISH MCDICAI JOURNAL 


69 


UeiTISlfi MEDICAL BUBEISAin 

(The Scholastic, Clerical and Medical Association Ltd.) 

iFOUNDED 1880) 

NORTHERN RRAMCIffi 

33, cnoss SX., MAIVCUESTER, 2. 

— . . /Manchester • BlackfrUrs 392S Tel^enat 

iei-n-VsTwa iManchester • Rusholme 2549 (Nish CcUt) “Locum, Manchester” 

Branch Offices a! Leeds and Belfast 



OILSIURF TOWN fn-ar MincHe^trT -DI VTI! \ \< ANO — O 

1 r-iie;5 Pj'>el Fixe PRXCIICI. Ca%h fccr last ear 

raT<!2,l' r xceJ e^t i5c*a..hexl he l«n o«n pr unu I ^ rreep ‘ f’ 

'•t'rcfx- ^ nal ri>.'>'*'v. x Ivicnant *qaincf\. 

»*x3 p-* v-en I c* wle at \Atuitjcm Premium— Pra best r — No IMA 
Nt_AR MANOIESTXR ~Wc l-cvafc sSrJ m«d - anj be* er » rkin Vass 
PR \CnCL ir r '-^jrban d net n r^xic'' bands IS sears A erj'x 

cash r«* - s c T* pA Panel I ‘rt) Cfvxl v. p^ C hxJ o rrer h ov. 

2 recep » • ■* bcdroc'*"t Pro^'esstnnal rrx ••'v, parade arj p^rue* aU » llrareh 
Su'"^ r e*~ ses. Uxh r“a' be rtp rd on leave Prer-ut)— I f veafs purcAave 
—So nw 

LlNCOUNSlIirir.— Nm c d<'taH ibed PRACTICr n peavjrt coonjr> 
icwT Cash rrce la> \tar C2,4 | Pa <1 aK » I C tta e H n*» tal 

GcvkI hou'e * bedfoc-n** i-ra I pa i.— para-* etc Pre'r un>— pramce — 
£* 1*0 for Cwici. lale— So U3. 

NORTH ELAST COA^TT— ^ J^^tab Ned mived Panel and Private PR AC* 
TICE. Ca\h fee* * s last ear £2.1(0 Panel 2-^ Vrp< mjmer * and C! iM 
(trarv'*- «b el apn ounuieh £-M pj Gexxj houne 2 rcveptior ' bev, ot m 
P^L est *-aI ps ar- ard »’na!t pard'O. PrKe 1*00 Premutm — 

2 ear% pt. ebave cf near o ’cf — N< |ff> 

NLAR AfANCHLSTTf R — \e*% oM-« ablrdi* I 
r-ivi<.e ^rd work rp^la\^ PRACTlcr in 
r*" npe-oji to«-n Aerj sui .b e f r Uo fn*rd< 
n pjnn*'^’’ * cr r*-> be run b ere man and 
ar Aw.- a* C-a** recc * > U« sc-t C^J.O 
pj «*I roo Nj-e nc«de*n home . frcepti n 
4 bedroo-m ic'rara c Pr '«h )nal nta, pjra-e 
a-w I rp* pa ue- To i-'* at valuatmn Pre 
rr un — b*a r"’er— -No J137 

SOITH AORKSHIRF Wei! e5taMi^hed 

rr i!u/C endbeft*f t»orij"p-ca fPRACT/CT on 
■3visk ns tf tpxn Scope for irercasc a\ d 
dc\elc-'ir- Cash rrce "ts last star £1471 
IjnclIOJO Etcere*f hoL-e (bJi 3 'cars apt) 

2 reception 3 b*droo-*s parape parwcn 3 Pro 
*c' nalrotr'sfsc-arajccrtrance) Pr>i..e£|400 
Prttnium — 1* v-earx pu-chaie ct rear v"ef — No Ul2 
AOITII COAST — PARTNERSHIP (a*tcf pTliminrv Assistanshrp) m old 
e« abhvh-d p-iod mis.«.-c ass IRACTICF m pleasant Seaport town Astra*e 
cash recti-ts last 2 se..rs £3 lOlpJ Parsel 1 “00 and appointments l«50pa 
Stcpe fr>r ^.r-ai ir^errase Suhj*' c a commoda nn for in^-t 'nmx man Salary 
as As istant £4^pa Pre— lum— ore half or one third share — 2 jears 

piircb-sc — No liny 

NEAR LEEDS — OM-e<i-bloVd rmdd’e and \*orking-cIass PR \CTI( I 
Cash receipts avtra— £!.*00pa Pane! 900 IjiccIIeni detached ho 
2 rcccp'ion ■* bedr/v ms r/o*’es'ior3l rooms (ve-araic ertrsnee) paivpe aid 
pardca. Price £l f*00 Mortga c can be jnan-cd Ircmium — PraciK. — > 

1} sc-Ts pur hast oi T)*aT oCer — N«> 11 ^* 

Ai ANCH1.STER ■ — Weil<stabi h*d mived Pane! and Private PRACTICE m 
plutsa-t suburban dutrxn ad actnt to new Hous ry, Estate C*is.h re-e pi\ 
apo mriatJ £I |00 Pare) about 1 000 Evcelicnt modern house 2 rrcep 
ii n -» bedrooms, para e and rice trarden For sale or mav be rented I remium 
— 11 je-rs purchase — No IIM 

DERBYSHIRE. — Ofd-establisbed f PACTICE capab c of ermt ncrcisc Cash 
receipts bs >c3r £740 (mcreasms) Panel 862 Excel ent home 2 rc'em >n 
4 tedrc'O’TS, 3 Profess or 1 rooms fscparaie entrarce) garape end good garden 
Premium— Praaice ami house £I C/V— No 989 

NORTHWEST LANCS — Old-esiabhshcd mixed Panel and I nvate PRAC 
nCE jn large town Cash receipts last >e3r £I 102 Panel over 1 000 Go d 
boL^ p e3sant!> situated 2 reception 5 bedrooms garage and sm-ll garden 
Premium — Praci*ce — 1) vears purchase — No /lO* 

MANCHESTER — \ery old-established mi ed Panel and Pri "ate PRACTTIf L 
Cash fcceips la t >ear £I 519 Panel I 3Sl> Scope Good hvuse 2 rc epti n 
4 bedrooms gara-e and gard n Rent £90 p a I remium— 1 » stars pure) a>e 
(to ircluJe debts brin^ine in £6 per week) Urgent sale o me to illness f 

Vendor— So 1134 _ 

SHROPSHIRE. — Old-established unopposed Country PRACTICE. Cj n 
rece -ts last year £6‘'8 Panel 450 Modem hous- 2 reception 5 bedroom^ 
3 Profes-ional rooms gara-e and large garden Ei-ctrve Ugni. Rem £S0 p .r 
Premn.ni — b«^ o^er — No I0V6 

YORKSHIRE (W R ) -Old-established mi cd Panel and Private PRACHCE 
jn better wor) mi -class and rural district Cash recsipts last year £1 166 «^nel 
I 3M Svope Good bouse 2 reception 3 bedr.xmis maids r>om 3 Pro- 


— ^V\^TI:D — 
ASSISTANTS and LOCUMS 

lor Iiiinicrii tic I nenLcntcnl^ 


Apply utfh fall pariuular\ toutoxi a<Jilr<\s 


fov rul r X ms (veparaic entrance) garden with tennis c lurt Rent £45 p a 
( a rer cd Ircmium— I J years p» rclia e — N 1122. 

Nb.AK MANriH>TrR — f VRTNrRSHir m oM-estaMis*'cd mi ed-cla s 
Pr3Cth.*e wtr to rcvent death of senuir partner Average cash receipts 
£^*•46 pJ tir\.reav m ) Panel 2 Svvpe for ip^n’case Good boose to 

ten 2 recepti in. < * bcdriHvmv 3 Pr '’ess octal rxini gara-c ard smal garden 

1 rem un— s ne half Sjrt—I| sears pur haw— No 1114 

NORTH l-ANCS— YORKSHIRI BORDER —O d<s:ab unopposed Country 
PKACTICl in p c e-t barus 20 can Cash rc^ipts £l 0^ pj Pare and 
a*Tnirtments appr v nj civ £4 0 p a Wellbu'i h u«e vsith ample 
aeommocati n cemral bcatipg e e-trx. lii-ht parage and garuen of 2 a re.. 
R<*t £“Vpa Prcnijm— £1 *0) Vendor rctirm- — No MI9 
hCOTt-ANI) — M cd Ijpel ar 1 Pn ate PR ACTICF n nanufactunng liwo 
eat if bvitlard Cah receipts arpn v r ately £1.2*0rA Pare! 1^.0 
Ivcelert b xive rrcep n •* bejr > 011 x 5 Profes.s oral room gara-e and 
garden for safe frtmum— If years purchase or near offer part by 

ttrar-en'crt — N IM* 

OtESHIRI-— O 1< t M vhed rrneJ Panel and Private PR VCTICE in plea —nt 
Cc*i nt > t wn Average cash receipts £ 2? p a Panel I.**)^ Attr- ii c 

hvtre 3 rt ept' n ' bedrxms parage arJ large par Jen with tennis c arts 
Premium— If xears pur have —No lUO 
MIDLAND HLALTH RE-SORT -PARTNER 
SHIP in vc’y Qid-cvtab' vbed m <L and better 
worlin <lj s 1 racti e Cash receipts la i ear 
£- 00 I irel I .00 Excel ent bouse * ith jnple 
a T n m 'daft r gara e ard parJen Premium 
—one lulf share — 2 vears purchase —N 11.4 
MIDLANDS — Vcr> olc-cstablished PR \C*TIEE 
in p easant Counin- distna rear lar** 1 wn. 
Cash rcce pu last year £2 845 Ap-vnr ments 
about C^Opa arJ Pare! / 60r) ^epe t cr/- 
lert detached house V reception 7 bcdi > ms 
) Professional rot ms, garage jrd large garden 
Prcri um — 2 vears purchav. — No 

NEAR MANC HFiTTFR — P \ RTNERSK1P 

in serv old-esrablished middfe ard beiicr 
wotkirs-cia s PRACTICL WITH SUCCESSION m one or two years. 
Ca h receipt' C^6C0 pj Par*I 1 4*0 Good Svtpc Su table accomn-toali n 
available I rcliminary A vistaniship if desired Premium — 2 3th sbare — 

2 sea s purchase — No ijOi 

1 |A J HPOOL — Steadil ircreaving mixcd-cJa s F RACTICE m suburbs Cash 
receipts last year £7*S Panel 6*0 Excellert uei-ched hou e 2 rcvepii n 6 
bedrooms garaie and parden Prrrr um — Practore — best offer — Nj 10)6. 
INLAND SI A — Ircreasing mxrd Pare an) Private PRACTICE Cash 
receipts la t vear £<00 Panel 200 G x>d flat to rent ..r £*0 p a Premium — 
bc-t « fTtr — No 10*“ 

MANCHLSTb R— Vlixcd Panel and Private PRACTICE, Cash receipts lt«i 
Cwf £# 0 Ijnel I 2 ' Good ho ise 3 bcdrxms 2 li ir* rov ms . Pr>- 
fes tonal roern. small gard n Rent £63 p a (irr-luJing rates) J rcmiom— 
£1 **o rto ircludc drugs and dispen ary furniture) — No 1 127 
l_ANO> TOWN — Verv t Id-esiabl s^'cd m \ed Panel and Pr -ate PK \CTICE. 
Cash reccip s last year £1 172 Parcl 1 >25 Svope Good house 2 rcotp 
t« m -.bedrooms 3 Ir fess nal rooms (separate erJtrarwx) Prem um — Pr3ct« 
— I* years pur base — N 1131 

NORTH MIDI ANDS — O d-estabhshed tr sed Panel and Pn ate PRAC 
TICE in Coantrv distr t near large town A crage^h receipts it 06 
Panel 9“0 and transferable appointments £200 pj Exceffent ceta ned 

2 reception 6 bedrooms, Protesxiinal rooms garase and 1 rgc garden rncr 
£1,2 0 Premium — H years purchase — No 1117 

NORTH STAFFS —Verv old-established better working and m ddte-cla.s 
practice Cash receipts last vear £2,431 Panel ! 2-5 Scope as di tncl 
dc el ping Escelfeni h uve - reception 4 bedrooms maid 5 ro m scpjrafe 
surgerv prem ses, garaee and garden For sale Freehold Premium — Practice 
— If sears purchase or near offer — No 1120 

MANCIIFSTFR — Old-established PRACTICE in irdu mal dtsina Cash 
Tcot pts last year £1 230 including Vaccination appoinimem £125 pa. Panel 
f 1*0 Scope Gold house 2 reception 3 bedrooms and j Profe^toru) 
rooms, garage Rent £70 p a Premium — £1400 to include book d bts 
(£)00 t.400j surgery fittings and drugs — No 1133 

MIDLANDS — In reasing midd’e and working-class PRACTICE in large 
town Cash receipts last year £1 0*0 Panel over ! .00 Scope Excellent 
modern houe 2 reception 4 bednoms, garace and large garden For sale 
Freehold Premium — Practice — £2,0(X) — ^No 1123 


All commun.c.tion. lo be eddre.sed to the Branch Manajer BRITISH MEDICAI, BUREAU 33 CROSS STREET MANCHESTER 2. 









70 


THE BRITISH MEDICAL JOURNAL 


Jin^ 



Tele Address 

Triform, Wesfcent — London 


(rOUNDEO 

TAVISTOCK HOUSE SOUTH 
TAVISTOCK SQUMtE, C 1 


To 1 o[(}ioir riistonj''’" 


The Assocntion Ins long been fTounbh known to the members of the McdIc^! Profescion ^s i thoronDhi. 
triistworth> and successful agenct ^r the transaction of ciert description of Medical Scholastic md Acer, misn v 
business, and the BRITISH MEDICAL ASSOCIATION has escrv confidence m recomniendinq its niLnilars 
to consult The Managei in all transactions requiring the scrticcs of a Medical Agent 

Member- of the British Medical Associntion mat take ndsunlagc of a reduccil si ale of d iiirgcs api.lii d.i, 


REDUCTION IN TEES 

In cases where the Buieau arc sole Agents the commission in 
lespcct of any sale of goodwill, book debts fuimtuic, dings 
fittings and othei effects (excluding sales of anj freoboUi oi lease 
hold propel ty oi of piactices, effects etc, outside Great Biitain) 
IS limited to a maximum fee of Fifty Pounds 

FULL TERMS ON ATPI rCATION 


Practices and Partnerships for Disposal 


Full Particulars sent frii 


1 S COAST HEALTH RESORT — Non dispens 
mg PRACTICE £1250 pa No panel but ample scop.. 
Commodious house for sale Premium £2,500 

2 DEATH VACANCY— ESSEX SUBURB — 
Receipts astrigc £939 pa Pmcl 7D Well sitiutccl house 
for sale Scope 

3 N WALES — Populai seaside icsort Coed chss 
chiefly non dispensing PRACTICE i\ci aging £870 pi 
No pincl £xctlltntl> sitintcd del iclied residence for silc 
Good scope Prcnmim two jears piirchise 

4 LONDON E — Cash and panel PRACTICE 
avenging £2 800 p i Pmcl 4 800 House (5 bedrooms) 
Rent £|s() pa Scope Premium two and a hall jcais 
purthise to include drugs etc 

5 W MIDLANDS— PARTNERSHIP in Practice 
avenging £6 000 pa m market town Pmcl 3 500 One 
sixth shire at first at two >cais purchase Incoming pirlncr 
should be aged 28/30 and ibic to do general stirgerj ind 
minor E N iiid 7 work Hospital Prclimmai) Assist mlship 

6 N MIDLANDS —PRACTICE in residential 
district near progressive town Receipts 1937 £770 Panel 
about 100 Choice of two houses foi sale Good scope 
Prcnmim £1 000 

7 S or ENGLAND —Well established SANA- 
TORIUM for the open iir treatment Receipts at prcs-nt 
at rate of about £3 000 p a Premium £1 000 to include 
furniture etc 

8 MIDLANDS’ — Middle and upper class non- 
dispensmg PRACT ICC iboiit £l 200 pa m prosperous town 
No panel House could be obtained Moderate premium 

9 LONDON, SE— PRACTICE averaging £800 
pa 111 populous suburb Pine! SOO Dct itlied double Ironled 
(louse Price of Icisehold £1 250 Scope Premium £1 750 

10 FRENCH RIVIERA— Old-eslabhshcd PRAC- 
T ICr M D essential Vendor at present in England 

11 S COAST — Bettcr-cliss non dispensing PRAC- 
TICE in fnoiirile w itering place Receipts £2 455 pa 
including generil stirgcrv ind eir nose and iliroal work 
Lxeclient nonbiscment house Purehiser should hold 
1 RCS Hospitil ind chance of appomlmcnt Premium 
one and three quirtcr scars putshase 

12 SW ENGLAND— Countrv PRACTICE over 
£1 -lUO m bcii ' part Pmcl about 1 KX) Exceptionalls 
mcc niodcrn house si . "^ng m ovsn gtoimds for sale Hunting 
md slioolim Scope Premium two \e irs piirchi e 

n EkSJERN COUNTIES— THIRD PARTNER 
rcuii.rLd m PriLtiec £5 200 pa m mirket town within 
'W miles of London Pmcl ostr 4 000 House to rent 
Oiu li.ih or one fourth stnre tvso sens purchase 

14 C [ STR \L LONDON PRACTICE —Belter chss 

Pin It .onifortiMc a\est Ind fanub Pit Larger lixk up 
brine'. It) nunuiee dtstanl Bolh in^re -mg I vuel 1 
Rcceip pit sear £| 6')' (I'erice £I 41411 2 sear- pur h isc 

15 SI CONST — PNRTNERSHIP in Pricticc 

iveraeiri^ £- ttxi p j i^i crowing re-o I Paaet 1 '•0 Good 

lie'U-v - Kdre.oa e) to rent One fifth 'hue at lust i! two 
Nt. IT'S pur*.h 1 t 

If. MIDDl IJsEX — partnership in Prictice 

cner £4 iCrti ,a ere* iia^ town P irel 2 1 Modern d tie*i-d 


pa - . 

raoni) g ing- -nd po xl p irt'-a 'liinvi 
Pn c £ 1 -fXl fr c' dill Pr-mi in lao ec II P 


tl 

(S t 


J I 


house for sale or lent One fourth share it fust at iwu mil 
i qu liter VC us piiithasc Prclimmirj Assist uilsliip 

17 Constilling Eir, Nose uul Tliroot PRALlLr 
III mdiislrnl citv Receipts ivenge £1 350 p i (in iildilinii 
appointments worth ibmit £850 pi) Ccntrall) siiuitel 
house to rent Puiehiser shoiiUI hold f RCS uul liiu 
specialist expel icncc Premium iwo )eirs puielnsc 

18 KENT — PRACTICE m developing tlivlrtei 
12 miles from London Receipts past }cir ovei t50p pm ( 
ibout 465 House (3 bedrooms) to lent Ample sci>r 
Premium £750 to include drugs cit 

19 BIRMINGHAM —Medical Woman s PRACTiC I 
iveragmg £1 269 p i Pmcl ncar)> 400 Good house wiili 
garige ind gaiden Price £500 Icisehold Scope Piiniiuni 
one and Uiiee quarter jcirs piircli isc 

20 S AFRICA— PARTNERSHIP in litcrahve 

Practice m Natal Share woilh ihnui£1 800 pa aloncjeirs 
purchisc Applicant should be tompcieni surgeon iru) pic 
Icrabl) an E R C S 

21 WEST END, near Lords Cnckci GreumeJ- 

PRACTICE avenging about £1 900 pa m ule \1 iisulcninl 
pul Pmcl ibout 1 “^00 ujth prosptcis of Kooil innu 
WvU bmlt dctichcd double fronted house j-iri|,c jrU 

nice >izcd girdcn Good introduction Primium 

22 MIDLANDS— PARTNERSHIP in mixed Pne 

lice, £4,800 pa m prosperous town Pmcl mer 3 
Modern hbour saving house to rent f^rcmium one 
shire £3 *>00 \o inchidc drugs etc Uospild , 

23 S W OF ENGLAND —PARTNERSHIP m mix-d 

country lown Pricticc over £6 400 Panel 4 500 Sliirri'i’in 
£1200 at two jeirs purchase Preliminary Assislant'lup 

24 W MIDLANDS— PARTNERSHIP in non do^ 

p^nsing Practice about £3 750 pa in I'cjuiifull) '0''/ 
Lounu town Pme\lS00 UoubC to rent One fourtn 'ni ^ 
al lust at two >eirs purchase Aged about 30 willi I we 
preferred Prelmiin iry Assisi inlsliip , , 

25 MIDDLESEX— PAR rNCRSHfP m 

incrc'ismp town Pr iciicc ibout £-000 pi , i » 

Home lo rent Prcnmim one Inlf slnre i\^o pU' 
Appheint should be Cnplish or Scottish ^r-i^r .r 

26 SURREY— Mcdicaf Womans rRACThi i 

oullying suburb IP district Receipt- list ye it £3 0 '' 

for -ale or rent Scope Premium one veu s pur-uiw ^ 

27 S Al RICA— Medical Wont in holcling DO ix 

reiiuired m Or'illnlmic Pricticc Ixpericn-ti! )a , 

worl ind not oe cr 40 preferred SHARI ibout £l u i 
ifter ASSISI AM SHIP , , 

2b SUSSEX— P\RTNERSHfP in goal cb 'is U 

l»ct ncirlv £1000 in ficounic nnAct to u ? 

I 200 Jfot/sc lo rent Slur of £I OO-T it h’-o 'cus r 
Prcim\m''rv Assisimc Inp 

29 S COAST— PNRTNERSHIP m Prie!i-_ , , 

£t 000 pi f 1 SL Ad re or I Pmcl jhuut 2 OVi ^ ^ ^ ,/ 

^ou c h s! oins) for stIc or rent JVen um o'" 

£ oyt rxv-x.^ If ho n t d ind s ont. f(ir sur ?> 

30 MIDLANDS— Coiimrv PR \CTlCl o - 
in I uitne di frivt f*irc! ^*0 Good i‘- 



Jl’M 0 1*1 S 


Tiin nRiTi<;M mi dicai journal 


WAVS'’' pttlital ^art 

(Til. Vd oi V'.TIt ( I I KK M V^linUAI A^SOOATION I Tl) ) ^ 
cFi « V m I U 


Trlr Vdtlrr^K 

Trlfortn CNirmt— -l^mdon 


‘.(lOIV'^TIt ( I I Kl( M VAlinUAI A^SOOATION I Tl) ) 
ir< I V in 1 i( 

J VMSIOCK HOLS! ^OLrlI 
4indon IVMMOfk syUVUt V\ C.1 '''''' 


Toirphono FuMon 

I IW j 


1 rirtlr#^ and 1 nrtntr^lilpN for l>ivposnl («onllniJrd) 


31 N 12 LNOl \ND — P \R1 \CRSHIP in non p incl 

Pn-tK-x: doiiv bou 1( IVX1 in one of lU thef town 
Hone a>aibblc One M\ih ‘ire at tuo ^C 1 r^ purvluAc 
r finer be ^iirfj'^illv nwlincd 

'2 LONDON Sr 1 — PR \mCL •'hem il IM>p'i 

in populous ill tri 1 P rel I '^(K) Cot-cf \ ausc Rent 
£10n pa ^opc Prenium tuo >cnis pur^f a c 

3.' LONDON N W — Mcdic^il Wonnn < PRACTICC 

oxer £’‘00 pj^ in i. our) dtsirici P^rcj 7i(» fj.m c lor 
v~r or rent Premium Acars pu%l n^c AppLAintment 
u inh £2*0 pj ■'ddilmal poAsjb‘\ tnn^fcrib’e 

34 S COAST HCAITH RESORT — PARTNER 

SHIP m Pr^atcc aSnut £1 <00 pji land oNcr I tOO 
{ bedrooms) parnpe and pardon to rml I renjium iwo 
lifthv hue £1 2f0 to include drup\ etc 

3n N or ENGL \ND INI AND SPA —PARTNER 

SHIP m Practice about £1 <XX) pj Panel 1 200 I xccllent 
boJAC 1^ bedroonn etc > for sale Scope Premium ore half 
sh.ue £1 <00 

'6 S COAST — PARTNERSHIP in non-dispt.nstnj. 

PractJcC c%er£<f <'0 p^ m hcnllh rr'orr Panel about f-(Xr 
Share uorih about 1*00 at tuo >ears purchnve further 
share in luo scars 

^7 S OF ENGLAND— CaMh worked PRACTICF 
about £I COO pai in Cathedral sits (dub uonh about £1f(l 
*.nd panel I Of<) House (C b^J nnd dre np rooms! for xalc 
Premium H sears pur».lu*ie or sers rear « ‘Ter 

35 WTiST END or LONDON —Good chss non 
dopenunc PRACTICf about £1 l<0 No f* nel Larpc 
house to rent Premium lensc and pracitce £^ (sHi 

39 BUCKS — PR \CTICE in gro'Mng town Rectip s 

la t STar £«J-t P^rd aK ui House for vik \ScJl 

ct,uipped bo pital I renuum £1 <(V) 

-0 LONDON W6 — Non-<lispcn<ing PRACTICL 

£I OCKl pj P’casjni suburb No panel Ih u ar (< bedr soms) 
e.arapc ard garden Prenium house and practice £2 *(K! 

41 ESSEN — Countrv PRACTICE tbenn £700 p i 
I *-rcl ».bojj •«<0 \ ers pood hou ^ (< bedroom ) ^irapc and 
p rden Pent £f < pa i tm urn £1 0*0 

42 LONDON S W-^Mcdicil Woman < PR ACTICC 
ibout £9fi0 p^ in outbinp suburb ' o p nel Suitab'c 
nccomrrodatron is iilib’e Premium £9<0 

43SURREA —Medical Womans PRACTICE aboui 

£<00 m dcsclopmp district No panel Rent of bnu c ilOO 
p^ Scope Premwm £^00 


44 SM\I1 R\DI0100IC\L PRACTICE in 

pfosincu! lossn Good oproriurily lor >ounc. ib c mm 
I ro pcct of bo pti! anpoinlmcnt later Premium Ll KiO to 
i’'d»dc imsl'Tn pTmt (\aluc iboul £1 IfX)! 

45 PARTNERSHIP in increasing Ear Nose and 

lliroit I r ctiwc tn provincin! loun P irtr cr mu i *’o d f RCS 

•,6 MIDDLEMEN— rOURTH PARTNER required 

m Pricucc oscr £7 bOO pa m residcniial di trici on the 
Ih rues I tncl r.fi0 Hou c (< bedrooms) to rent Scope 
Premium ( ‘‘0 bs share £1 100 

47 LONDON N W —PARTNERSHIP in PriciiCL 

avenj 0 ). iNiut £<-(*0 land about 6 (VX) Maisonette 

(2 bedrooms etc ) to rent One fifth share at hrst at two 
)cars puTcha c 

tS N E COAST — Middle and belier working class 

PRACTICC over £I 1<0 pa in seaport town No panel 
Private residence for s le Premium £7<0 to include furnish 
inc' etc of consuItinL rooms 

49 LONDON W 9 — PRACTICE doing between 

£9()0^£9<0 pa m rcsidcniul di tnci Panel about 60 but 
p'cnis of scope Rent of maisonette (•* bedrooms) £200 
I remmm £1 OOt) or offer 

50 S W ALES — Chtcflv non dispensing PRACTICE 
1* 0 pal in seaside town Panel ‘'<0 Centnllv situated 
house Pnee £I 2<0 Good scope Premium £1 4<0 

51 LONDON N W 4 — Middle-class PRACTICE 
about £<fO p^a in developing part larcl tOO Hou e (a 
bedrooms) for sale or rent Scope Premium £1 250 

52 LONDON SW 16— Medical Womans PRAC 
IKE over £lf>''>0 p^i Pare! hD S m*dctachcd hou c 
Price £9<0 frcehoUl b o*' Prem um £1 <00 

53 HOME rOLNT^ - EOURTH PARTNER 

required m Practice in ).rowinp tov'n Ian 1 M)0i> Incomm^ 
partner mu t b* cnerpciiw Oj-cd ^bout aO (ntarned preferred) 
with a leaninc touarJ m'*di me Iniln! hare about £!^<0 
pai Premium t”* 000 Prehm n ir> A sistantship 

54 SW or ENGLAND — Non dispensing PRAC 

Tier averaging £16 6 pj m ftvountc watering place 
Smill pincl S mi detached hou'C for sale or rent Good 
hospiijJ Premium £2 <00 

^5 CORNWALL— PRACTICE averaging £655 in 
mrket town on West coa t Panel -00 Mouse (S bedroom ) 
l^aragc and garden for 'silc or rent Scope Premium one 
ansi a quarter venrs purchi c (half down) 

COi ONIES — Number of Colonial PRACTICES 

Incomes range from about £7<n pa upssard% 


Purchasor<i can raise additional capil*i.I for the purchn«;c of approved practice's or share-' 
Particulars as 111 be forwarded on application 

All communications to be addressed to The 'Manager 


W SCOTTISH BRANCH, 21 

roit nisrosAi. 

A SCOTLAND —Old established Cil> PRAC 
TICL Reccip •> approximatelv £2 4(X) Panel 2 <00 Hou c 
price £900 P cniium two vear^ purchase or ncir ofTcr 
B YORKSHIRE— Countrv PRACTICE Receipts 
£1 200 Panel <00 excellent house with garage Price £I 200 
freehold Premium one and three quarter >cars purchise 
C E OF SCOTLAND — Manufacturing town Re- 
ceipts about £1 2<0 Panel 1 2<0 Attractive house price £l 500 
Premium one and three quarter vears purchase or near ofTcr 

D EDINBURGH.— DEATH VACANCA —PRAC- 
TICE averaging £635 Ample scope for private and panel 
Exceffent houM: for safe An> reasonable offer 
E E OF SCOTLAND— Country town Receipts 
Iasi icar £685 (appointments £tl2 PancI 5f<) 


hous^witligrragband^rdcn Price £14<0 Premium £1000 I able house to rent Keasonable otter cons.aerca 
For further details appl> The Manager 21 AUa Street Edinburgh 
Terms on which the business of the Branch is transacted will be submitted on application to the Branch 
Manager to v.hom all communications should be addressed 

reliable LOCG^IS and ASSISTANTS are URGENTLY REQUIRED b^ ALL OFFICES of the BUREAU 


Alva Street, Edinburgh, 2 Ej^u’th'''m'> 

F EDINBURGH —Lad> DoLtor s PRACTICE 
Receipts !a*>t vear £690 Panel 390 Suitable house for sale 
or might let Premium one and a half years purchive 
G N OF SCOTLAND— Counlr\ PRACTICE 

Long esi iblj^hcd Rcccipls app OT.matcIv £ 1 000 Panel 2/5 
H WALES —PARTNERSHIP in country town 
Rccopts £1200 Panel o^er 1000 Suable hou^c Pnee 
£800 One half share at one vears purchase 
I EDINBURGH —PRACTICE doing £450 House 
mu« be bought Premium pncuce and house £1 6S0 
K EDINBURGH — PRACTICE aseraging £1022 
Panel 80< Price of house £1 <00 might let on lease Premium 
one and three quarter vears purchase or near offer 
L EDINBURGH— PRACTICE about £400 Smt 
able house to rent Reasonable offer considered 


72 


THE BRITISH MEDICAL JOURNAL 


Jun 0 (9,\ 


Bovril Medical Agency, Ltd 

4LDINE HOUSE, . * 

^ 10 13 BEDFORD STREET, STKA^D, LONDON W C ■> 

Telegrams BOVlVIEmCAL, I.ESQUAKE, LONDON Trfoahone t, 

Chairmnn and Managing Director, Dr J FIELD HAIL ^ nni>l 

1 Dirt payable on the sale of an\ Practice or PartnersUin m Groat RrWnm niurt ^ i . 


rur„U.rer.rstrnn{ei^s-^^i.oi;i.l^^ Samar'S 


JO 


11 


12 


n 


16 


12 


Accoimhncy -ind leg^I services furnished b\ the Agency where desired, it modente inclusive cinree. 
No charge is made to Principals for the introduction of Locum Tenens or Assistants 


hih 

nijf 

oil api>11( iiuni 


SURREY -^WcUHTSlablished increTsmg PRACTICE siiiutcd m <lc\cIoping 
reaicicnini drstnet Gross cash receipts for last 12 months ahotit £900 
including panel ol about 500 Srmll compact freehold house Price £S50 
pirt on morti^age or would rent at £S5pa Premium £1 500 Ample scope 
for encrgeiic worker * 

rfsidentkl district within w miles or 

LONDON -^Recently esnbhshcd upper nnd middle class PRACTICE 
£700 p a uith defcmtc scope for increise Selected panel 
ol f2 * ecs 5/ upwards Prominent corner house with 2 reception 5 bed 
rooms Sepante entnnee to ProfcssiomI rooms Well laid out girdcn 
Ercchold for snle subsnninl pirt on mortgaLt Good sport Tnd schools 
I tffcnascr should be about *10 and cspcricnctU 

SURREY— PARTNERSHIP— ONE HALF SHARE in developing middle 
and better working class Practice in favourite resideniid hospilal lown 
Gross cash receipts for 1 ist 12 months £1 860 Pine! of 500 Lou expenses 
Well built house with 2 rvccption 4 bedrooms etc Rent£l00pa Ingomi, 
partner should be experienced a^ed 25-40 and iblc to do some surger> 
Premium M >cars purchase for quick sale 

WITHIN 6 MILES WEST Ob CHARING CROSS— Vers sound old esiab 
lished PRACTICE m good residemnl district producing* over 400 p a 
Panel of 2 230 Very nice house in prominent position with all modern 
conveniences on rental DtRnnc scope for incrcas- Suitable for two friends 
m partnership 

NOREOLk —COUNTRY DISTRICT WITHIN 6 MILES OF GOOD 
TOWN — Old established mixed class PRACTICE producing apprq>imatcl> 
£I 800 p a including panel of about f 400 and 2 appointments worth £:160 p a 
lees from 3^6 Detached house in own grounds with ample accommodation 
Rent £150 pa Premium £3 000 

LONDON S W— W'lTHIN EASY REACH OF CITY AND W'ESTFND — 
Well established chieflj middle and better class PRACTICE with surgical 
scope producing ifaout£l 450pa Selected panel of 45 Tecs 5 and 7/6 
Good stzed hrst floor flat with ill con\enienccs Purchaser should be able to 
do surgeo nndFRCS would be idi antai.cou5 

LONDON \\ C — W'cK established PRACTICE producing ncarl) £l 500 p \ 
tncludmg panel of I 660 Suitable accommodation available and surveo 
premises used as lock up on rental Premium 2 xcarv purchase 
LONDON— WESTERN DISfRICT— Old established non dispensing non 
pintl PRACTICE producing about £800 p n Capable ol cxpmsion 
especially if panel work undertaken Well situated corner house on mam 
ro td w iih ample accommodation Premium 1 vear s purchase Practice would 
be sold tpari from house if wished 

SOUTH WALES — Old established nninlv contract PRACTICE producing 
last year £2 200 of which £2 050 is from contract work and panel Suitable 
house available Future '■ • •''Icnl as new works 

have rccentlv been creetc 
LADY DOCTOR S PR 
PRACTICE producing, I 
panel Tees 5 upuards 
Suitable house asadablc 
cash for quid sale 

KENT COAST— FWOURITE SEASIDE RESORT— Old cstibhshcd 
middle cl iss PRACTICE producing about £670 p a Small pane! 200 
patients Verv good house in best end of the town with ample accommoda 
tion freehold nailable Prcmuim £1 200 Eminentiv suitable for retired 
arm> ofliccr wishinj, to augnienl pension of there n scope for younger man 
SUSSC\— fANOURITC COAST TOW N —Old established PRACTICE 
prodiiLtni, about £S00 p a including panel which brings in about £l50pa 
Good house on two floors 2 reception 4 bedrooms etc rrcchold for safe 
Premium 2 vears purchne with income Luiranieed for first year 
SOUTH CO VST SEAPORT— PARTNERSHIP— ONE THIRD SHARE 
available m old cst iblnhcd and ripidly increasing Practice which last year 
produced approximalclv £3 '^85 including a panel of over I 600 patients 
lurchiser van vhoosc lin own residence Practice is conducted from central 
surgery and the expenses arc not hiy-h 

LAD\ DOCTORS PRACTICfS —Several available full details on 
application 

NORTH VNTS — VSSISTVNTSHIP with view to Partnership m an old 
established country Practice with good future prospects Initial salary 
£500 p a iiivludmg car illow ince the assis ant to live out full details on 
applivalion 

MIDLANUb — FWOVJRITC COUNTY TOWN - SURGICAL 
Ot’LMNC, — A QUVRTFR SHARF (ifier prcliniinarv nvsmaniship of 
3 (Iioniliv) IS oltcrciJ in otd-csiahlishcd in^rcasinj, Praclicc froduvini, aprjovi 
nutciv £1000 pa land of about 2 SCO Ont appominient worth about 
£125 pa Fees' to 0 No dispensing Sunabic house svnh tarden 
and taravc Rent £f ' p a Premium 2 'cars purchase pan by arrancement 
lnt.t ini, partner should be under W espcricn ed and able to do some >uri,cr> 
SOUTH Ol LNGLAND — tOVST TOWN — PARTNFRSHIP— A HAI I 
SHVRL in 1 .' d mived dis (’tactic- e mblished over 100 veirs averacme 
apprOMmjtelv £ OvXI p a with substanll il panel Aproinimcnls worth 
ab utbRiOpa Suntbichov. ecntental„t£l00p a 1 remium 2 vears pii shave 
MIDDLtbtN -PVRTNFRSHIO — ONL H VLF SH VRl m insteasin^ 

I ra ti e pr dusin,. approsiinatclv £2 N’O p a P^rel of 600 and incrcttini, 

II VC VV Ih . revepti n vbsdivn cs Re £100 p a Premium 2 years 
p If liasc 

tt)MH)N SI O d vstjblid ed chicPy n iJd wtbsv I R VCTICf pf'* 

J rliMl-m nh^tl2''4pi Pardcl62'' buitabic houvc on rental 

IfemtJTi cjr> p rtha r ne-f c 7*^ 

I \13V hot H)f s rRVCTlt! MIDDI I SL\ — Chiefi worMna'Uavs 
I R Vt I U I CN A*' N evt to vevrs an J pri.di>.ins < 'cr £VL)ripa 

I '* k I V* jp’' m pT'Tis Ol r fi ak u f.'Dpa n t irwlLL-vd in 
fPL- -■ S i ^ L e %Mih . rc cpii fi •• be 'r; i Lcjv ^ 11 f r vi’-“ 
f »* L. J fc" I r-r- isj 11 P >e iri pi r h u-* \ env. ■»r irg 


s - Old established 

about £400 from 
Miduiferv usually 5 guineas about I2 20cascspa 
Prcmiuln 1* ycirs purchisc or would like £2 000 


21 SOUTH AFRICV -PARTNERSHIP -Good sufLkal open.n Ik t 

rcccip/s about £- 000 pa « ith ample scope for exp insion with aivi of \\\ m'' 
partner ruil details on application 

22 HCST OF FNGLVND— ATTRACTIVE RLSIDLNTIAL TORY -V , 

sound non panel PRACTICE established nbout 41) scirs vven,, r, 
cash receipts for hst 3 years oscr £2 000 pa Tees 3 6 to 1 yn C il ^ 
ntrt on miKitacc in cvccllent position 3 reception 5 bedrooms ei Ire 
hold for sale Prenuurn 2 ye tn> purchase 

23 FAVOURITE SOUTH COAST TOW N — Old estaW.shcJ clueOv 1-t 
class PRACTICE pro Jucinc for hsl VC u o\i.r tJ lOO ! inch I 4^0 Iv? 
dclachcd house with 2 reception 6 bedrooms Well stocked i.atdct\ \i- 
hold for sale Premium 2 vears purchase 

24 HANTS —COUNTRY PRACTICE WITHIN I VSY Rl VCil 01 

LONDON — Good mivcd-clasx IRACIICI prodiiviiu i i u 

£2 500 p a including panel of I 335 Suitabk house with inipleatvomn 'j 
turn garden gxragc Can be leased Premium 2 yc its purtluic 

25 WEST Ol FNGLAND COAST— VrR\ \TTK\CTIM niSTRlCT- 
ONC THIRD SHARE (with increase later) in good mixed Prauti e pr x ), 
£3 300 p a Panci of about I 400 Small modern dcuLhel k » f w *1 
garden Rent £80 pa including rates and garage Oo< d sKial and i, \ 
ins facihiics Premium £2 2D0 

26 N\V LONDON —Old established PR \CTICC avcriLing mips h ’ 
of approximately 1 070 Fees 3/6 to 21/ Very nav hou« vudi in 
iccommodaiion Frceliold for salt IVenuum 2 year* piirthiie 

27 SOUTH WELSH COAST— PARTNI RSHJP —ONI HAII SIMM n 
old established nxuklle and working class Practice produtini, owr £! DXip j 
Ptnel of 2 300 Good house with implc actommodation Lir; pt’ 
Freehold for safe Premium £3 500 pirl by arnnevnient 

25 NORTH tNTS—OM esfjhhshed mixed class I'HACTICl i’ 

£1 000 pa PincloflOOO lees 3 '6 to 10 6 Dtfachtd hi u e i iia i ’ 
garden Freehold for safe or might rent Premium £1 5IX> 

29 kSSLX— ATTRACTIVE COUNTRN DISTRICT -PAinNl HMIU - 
ONE HALF SHARE of old*estiblij.hed mixedcliss Iritiv /•fJ-.' 
approximately £ I 200 p a with ti'oU scope Pincl brinv.x imbnii l vtpi 
Good house with 4 bedrooms etc Rem £50 pa Verv rcasi rnbk pr 

for quick sale 

30 SOUTH CORNISH COAST— Old established PRACTiCrptodi la i 
£900 pa including panel of 342 lees 2^6 to 42/ Good horn mihJ 

r t T/’h -jJp I annum £1500 ,.r/Yi 

31 ^ STIAL TOWN WITHIN 30 M1U5 0‘ 

N ONL FOURTH SHMH fwiitv i f 

good m»xcd>claxx Praciitc pro In i’ > 

. painimtius worth over ^ 

partner must be experienced m sua.crv and prcfcrabl/ hoU *«' 
Preliminary jssistantship if wished I rcmium 2 vearx purchjve 

32 LONDON \V9— Chicfiy bclier-claxsPRACllCl avcrawtnkGOOiiIl'’^ 

pa in residential district Pincl (recently started) about hut very % j 
scope Inclusive rent of maisonette £200 p a Premium £l OoO i r r it i 
Vendor specializing 

SOUTH MIDLANDS— PARTNERSHIP— A MALI SHARI 
established good class countrv Practice in bcaulirul 
receipts approximately £3 000pa includmi. panel of nbout rV^^r 
house with garden and garage I rcchold for sale Very ga'J r 

shooting and other sport Premium 2 ycaix purcluse ...crtor 

SOUTHWEST ENGLAND -I AVOURITI S^VSIDF HISORT-^ 
established non dispensing I RACTICF ivenging for Uvi 3 years l r 
Selected panel of 400 Good house with ample accommoJJiioa jijrv 
Runtc Freehold £1 700 or nu(.hi rent nvivnY -O 

COUNTY TOWN WITHIN I'O MILES NORTH Ol LOMIOY i 
esiJblished better class PRACTICE produeme fur last 12 , 
Panel recently started of 45 Coyntt lusus vvith 2 reveriuin 5 ^ " , 

j, 3 rdcn garage Freehold for sale Spor of all kinds Ooxu 
hospital being enlugcd prospea of vacancy within year ‘r s 

■*6 SURI^L’V —Old established mixed-class f R VCTICf “ 

within easy reach of London Average gross cash rcccjrts ‘ j 

Panel and cUibx brmv in aboui fhJiU p a Cfio»vc oi tj 
P remium 2 scars purchase u„».*i a * ^ 

37 WEST COAST -Old-esnbhshed P^^'^CTICF m j 

resort Receipts for list 12 mvmths nearly £1 900 iJneJ aad 
worth about £50-1 pa Well budt hnuxe with ample ac*- 
hold £1 too lremium_£3 30I^ VuiVuuTl^ T' 


tv 


34 


35 


I 


I 


38 


41 


Thi i 3 t \ It i 
fi»r tlxt 


. m sd< 'irmnsrontonl’s for sprpi si fscilltl*** on \fr> . . 
sti\ inti. of irt of tht iircniitini for ni> suit shir* prsetke or pnrln* rMtip 


MIDDLESEX — RIMRSIDf ... 

rilTH SH VKf (with increase bfer) m scry iourd 
increasing 1 ractivC produ-'inv, f f U't *2 mo'uM 
Panel of 0^ \pp untmenis \ c rth about £./d p a *■> ‘ 

I rcmium 2 years purchase invffK* 

MIDL \NDb — Old exTabIjshed iinonposcd inurcjsi » * ^ 
far last 12 ms ntl s £740 f areJ r I Very m -r dcu b d 
4 bedrvoms etc vo d j ifdca f n e frcch dJ £! 

Prcmii m M >cari purchase .m ♦ j r 

SCOTLVM) — UNIM RSITV J 7" ^ ^ n a ' 
PRVCIICL prodiring fo Um 12 nonths ov r Iz/JpA 
from r«inci '•n 1 abot i i7l> from anp j''irren s 
non r> hedroorrs cit J recholJ J ar xj^ or mt 

I \s7 vNc nv-viTuvCTivi 
PR VOICE jvcri in- past 2 years y 
£<00 fn m pi-cl 1 MS G >d hm S- ' 

mod rn c ^rve- er cs -i dc" jara - I re J t r vi 
1 1’"'”! im £I 7(*a »<- 7ir i r 

STMIS-IVRGI town— f w, ' 

lav I 2 rr''"hsn'c -iiXi farlrfa itl ifra- f 
fi n 4 liet* >1 p i c par J n p ^ - i ‘ 

par hjsc t r rea o ’‘c 

f-»3otinl.ln inrnis t.. ”7 of ’• ' 


Sd jb I 
, K J' > 
DiSrOCi - 



li n o I" s 


Tiir HRinsif MrnicvL journ\l 


PERCEYAL TURNER LTD. 

MEDICAL AGENCY 

Ebt iblishcd 60 Years 

25. MVIDEN L\NE, STRAND, LONDON W.C 2 

(HlllMI <11 IIIIIKlnl) 'Til IT) 

rWfCfnni //"•fllf/O l<>M>0\ T,I,/>h„n,i 11 Mi’ll 1,41, 9011 ( I l,n <) 


I^( ! I ''li I fOUU/^Js/OA } OH <OI I 1CI "SO 0'S Sill 01 VHUTKl OR SIl (HL 

I \( n I oi iioisi PROPUin no nir j unison ippik tnoy 

1 orr^t Ti M N«: \^n X'—i-'T wt*; 1 1 omiti n wniioi t 1 1 1 to I’KiNcirMs i nxcTio-^ iNxrsTiGxTrn 
\'-‘'i''T\\ci \HK\vrin in mikomo c x--! < xccointxncx vnd li.gvj ‘jekxicis 
iKOxinm xxiirN unu iMO 


PIUCTICES .S. PARTNERSHIPS TOR DISPOSAL 


1 SOI TH co\br— o 


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cvxi^ I •' c ru “k i-v 

COlNn lONNS » 
c f X CN n I" I S 1 
t < pJ c r "■ *- 

^N.•^ 

nL\ON ~ 1. '• 1. 

- J r a \rr' ”"fr 

r -v- -.1 

rjr-*rT«i-\i p*— i 

riKv isGHW vr\R 
ro'Xu •pc rJfcl nc f 
2’s- r ra - ale at £ 

J| \S7S 

N flop-. r yx. f 


fl 1 ! r 3 f* re I i 

N c y *Td n <■ -pea ~i 
X -t r~ rM I t **> * fw* 

1 l» - - — I \K1NIJ S\np XM\1 
Nvii ft I O TJ > i ircni 

cr 1 I JNC I R t S CE c t f 


it 

-We 


rf £ I U'll pa 
P« rirf~ •" £1 
rjfx.cn ary! y r »< 


n *r* n r nd uo t*> 

0 tie rt flee J 
f r yx c t Hi r: 


I rjr~ 
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■^an I r' •'ic-r* rr-n ^ 
CONTIMMAL IKVCTICl 
vki "v. Nt D ex c* lal 
^OPKtHIPr DMTS— Pc I fu c 
Pi l—rr-* Kx. -c trt - r xl 
n.tj c h! e r ret •> 

sfkp MCinviv sw j — l xv.ir 
0 t'yv. -• •>€ S”**' e ffr o *al 

} Cl h"'*". Icc'Mcr P/c^ I 


•c*! b bcx! rear! t p a in re c 

NT U.CXC •xrc -fCT Cl 'np cl h rvc c fucn 
I rf I j I'O r • ricr* m £1 

a c'aec 'I p i P rel 1 f » Ap^y m— e<* 

•c r r e ar c t re «f* P- 


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t J-oxtab *'cxi crare f| Ay 
iKi r a Sl re-.. <-i p t - 
^ p P cr* in £l i 
N i ipa mten p •'cl 
~n kJ t n on rent 1 -t < pa 
rth 


c t I'xm nj p- c 

-c area Ch 


MlnDLFSFA bl nLKn — r SPINI bSMiP Hal 

J c prx- CT e a^ : f C» o P a f - I ( o 

b e Prem n ^ear pu t <* 

S IDL\SDS —<' i*c»l M re r •“ixiiari \ wr "pt ic 

tir r £t II p a ra"cl "'O -n “tfrert £I01 pa Pf p m 

2 )ea p r ha e H <• i rcrer n. ( bcy» hkt c-ara e eT> 

crtrancc fru^ rafwcn nrarc j''<J <yib -nn f f ole r r* fhi let 
CLiLOr Of- D —SeifW £ C<i r - ta i <.< cJi •y rt rtyi set pp »r m 
inf r.-ncl c - n C nn. t h i sc in cfy<l pinui n nn fen al at £ o p a 
UJSDOS \A Od-enta*' bet- arer re pa p net » »ih 

rr*dd c and t«cncT cast Si*e bci. c txi h a'np c lixtn- accommi'i-.ii o 

H prtfet ioP.»I cn tease Prem u*** I tei.r p rcha e 

LONDON N r — rARTNrRStnr natt th re siith earl) ices n 'I 4 0 
p-a Panel iiX) anpte score Conpjci bnu"*c on rent at i4< pa Pxc 
p*iMn 2 >car ptirch- c 

LONDON N I-.—O er £ on pa Ircreat nj and scope Panel ' 0 rers 
^ to to < CcnxcPicni h use in ctccHcPt pm Uen to l-t Iremium - 
>cars p'jfchate 

SCOTLAND <N > — Coiirtry o»cr £1^00 pi^ in lud rf panel of fifV) 
pa \i H A to £5 t \ erdor rciirirt Good house tor sale r rental 
Prernn-n IJ >ear purchase of ofTer 

KENT coast town — PvKTNrRSMIP one third tr half share re- 
cppu pa Panel o ef -.000 Good hi use on rental at £b' pa 

Prer* un ■* tears par h_se 

MIDDLtSFA SLDLPn— £10 0 pj panel Hxi P M3 f |00 pa 
dc ctop rs res c n I I -irca Compact m yJern hoi c farden and cararc 
for sale at £I Ht cr n rht le* I remium >cars pjrchj t 
L-.d> Doacr PRACTICE Lenoor S \S ^ — Lo^K op £4«A pa land 
<Xj Good riofc*. lofxal accornmodatiop in rcrtal at £^o pa Premium 
It >ears p ireh-se 

L 2 d> Doctor s PP ACTICE L nd sn LI. — £1 *»O 0 CI 00 p a Panel 0 
mixed sxorkire rJ m dd e d ts W ell-eqi »'’ned Ixin aril profet icnal 

— ccommod-iion i n lea c at £ o p a Prem i m It tears pun ha e 
LONDON W I — A cr ic about f O') p a Select pincl of yiHt Cisod 
cepe \endir c xcs nJ> pan i me Njcc hoi c cn mam ro d for sale 
or re-ial prerr .m _ >cars pinh tc_ 

NLCLELS N I_ — Dcidop ntr rcsiucrjul area abcut f OO p a Pinel lf« 
s cpc Nt c double fr nted hou c for sslc tr In f rcmi im t" *> 
lAMAiCA pW I — Abcut pa increasinr and scope f »r * ne with 

urjt j 1 expcncrcc Larpc house 1’ acres On rental Di tn t res dcnttal 
-Id rood licach 

JAVIAICA BW I —PARTNERSHIP half h re Tier f m ntSs \ i tant 
h p In omc £ 1 X 00 pa Surpical cspencrxcc an id antacc Choi e of 
bouse Iremiim . ^c-rs purch c 

Northern tow N — Old-c*tab' shed m ddle*cla s n n rm I norwli pens 
inp a cr_KC £l P a jiood scope be\tcr-da PP SCIICL Nice hou c 
2 rcccptien 4 bedrooms and attics sarape etc To be od for XI .Wi 
frcmium £. CKV) 

KENT unde’’ 20 miles from London- — Countr> PP ACEICE aNJut f^tiO 
pi Panel a"5 easilj worked scope Nkc hou e ard eartlen for .ile 
cr let Premium £" 0 or near cfTcr 

CROTDON— Sm-U incrcas njt PRACTICE m ihi kb poruiitcd area 
£f«0 pa Irereasinjt panel of hIX) Compact house on m tn road lo be 
let at £104 pa Premium Co 0 or near olTef 

LONDON ElO— O cr £4 0 p a Panel 6“0 cocsl cope Thtekb popu 
latcd dt trie! Nice house ample accommodation pardert and ^arape 
Lease 90 >c rs at rera>mcni of £<_ pa Premium £<>00 or near offer 


SI HRM SLBtKP Nl M lONDON— t 
cc r rx*nr i*'ifb n w lb t p j P 

m >x. rn t T4T h t e ss tS r c* oral r 
1‘tcm I m tl o T cl cr 


f rd T aty- f ra c Rent 


' lt»NI)ON U -f)Nf IMIRD SMAKE ax ! be in t \P 

r a d C P Pra t e Re c pH axcr t ropj DA1RE pref 1 1 

' ItlNlKJN At near Mj •* c Sr h — Bcitef-x. r '•-c pe” nr r ** r cl 
IRaOKI O ..-est a cr fc £1 f/ r a PrcmiLn tl (,i r rear " 

N e b » e “ th m-xte a 'm~ vlai n f r c 
I S Ak RlC A "e r r I r m —() J-est a cr c 1 t r a ex e**! onji 

S-. '•e N;re r y -'cd b i c sx ih pr c nil c m— d ii *• ers i s 

unricT ct Err ale at ' pan can rem n Prjnium (c Pr i c 

tH VI 

!>1 S ON NtCiLlS— AKit f4(Vi p a nil (, pT-’el r t 

«n Jtarcxj N choc •. firm n tr nd " >0 < be- rex n t, 

on rctsHi ^ r> a Prem m I o to in U de h t f”’y etw 
t lONDON Wft— Olu-esjK bed m ddie af*)! be icf-s . rcr r r PR \C 
nn a cracn^ £*^0 N e res uen at dnir t Deta h u b le . 
revert n < beer y m i nl P* es r u tir" arJ wain r — den 

and carae f r t t Prern um fir Pra ti c kl <''S 

4 lONDON S 's IS— Wcli-est M bed mere nr m r wc resid " I rca 

aN i 0 St rres t I re 4H> ivi Cl b ^ Pi p "v- Anr c It •.nd 

pr fc 1 nat Ct mm y..t tm n rental .1 C"* pi Pfcm cm ^1 hi near 

< '*cf 

’ I ONOr>N S r 1 —Tj d-e t n JJl- and bet cr c a s n ce resident I aryl 
mere n lyal at present £" £ 1 pa Panel 3 o EK a bed h i e 

fevepii-m rfy m < bed: ym c n uitir re m ct for ale *> r tr let 
at r a Prem m t sears p jrcb 

1 SOLDI W xirs -PAPINM SHIP ball hare ea de town rece r v 

ft ru__ r rcl ■* i» Arpe niren ^erttr r rtner re* rir N e hy. e 

fimnc'ea I re er* n < bedfH ms u i a! c"* es . a res of rarden terns 
c ifi c mr* el f r s^ie ir rents Prc'n m for b If hare ) r» 
p r bj e 

1 HANTS— C mir^ PR VCTfCr a cr fee abciT £400 pa Pan t I « ore 

Nice bouse jcvcrti n 4 bex-rvm* in {tin ait n r>m and dy 

pensao ’ acre of rarden rarare Tc sale or let at £* pa Pfe*~ium 
£ 00 

IS SLRPt^ D rules from T xwn — semiKOuntry receipts ■•I'O p ncl 0 

nice ho I e - rccepi m rsem 4 bedroom usual ofTces c n ult nr rfy m 

wattinc room t acre of irarden rarar to be let or so d Premium for 
Pram e £400 

19 LONDflN SE6 — Eat in rca nt ce\el pur-, area niv. prrdu injr ab iii 
C" 0 p a panel f*0 increa inr Ample ace mmodati n on rental t 0 

pa Brarxh urtCD to Ihtcklv populated pan Premum £1 DO 1 tdi. 

drurs book deb and fitunrs 

40 NOTES — PARENERSMIP share produ inr f 00 pa to ccmmen c in 
rural Practi c m xcd with panel of 900 and aprsyr mem Cb rmirp 
crt»nir> urr nind nrs p cc ccmpact hiuse on rental Premum . >c rs 
puicha c Sod I d> rmitioner 

41 CLAAfOKGAN — Sm II incrca me I R ACT ICE rear Card IT about £ (X) 

pi irrcwinc panel o cr 0 Ni c hou c with pro ev on-l accorTr-ocat on 

rood rarden To be i d fxr £| <it rremium f r Pracl c I >c->r s 

rof base 

4 r3Sr-\ COAST resort— ophthalmic practice illbralth rca n 

f r vile U pa ex cnent ope N c bou c m local H_rlcs St 

on rental £10' pa Premium f r Pract e £'(0 

41 MIDDLESIN SUBURB —PARENl PSHIP half hare in Lt ir.r as p- 
PRACTICE m dexefop ne suburb Receipt tf f-<Vi pa ir rca m. at r »e 
of £ 00 Pi Panel iXi SiitxMe hoas<, a a hbl fir sale cr rent 
Premium 2 >ctr p rcha c 

44 LINCS COASr lOW K — W clI-cstabliNh d iscru.- ci 40) pi parel 
I 30 p a Larre cmi-s-ci ched ho se - mtos from ea -. revert cn o bev 
ro m u o I OfTces jrden and jtaracc for .Ic at £1 0 Pr n urn 

fer Practi c £ 4<0 -.-f • j 

4' lONDON W — Old-CNtabl hcxl nn panel m sed PRACTICE A ndcr 

ret rinr As X 00 p i Apr mtmert C '0 p a Mu-w fer> ' to o rP' 
Corner re den c - con ultmjr room 3 reception and ( bedrooms t ub c 
caracc Le chold 3f sears to run Premi m - ears purchase 

46 S E COAST — Old-esijbl hed n cc era t tnvxn eood v.ore m sed ith 

m ddtc atxl better cla Net income £f00 pa Panel -00 svope Ni-e 

house for safe modern red 6 bedtoems 4 acre xth E3n*’C Prvm um 

4 " DE^TSHIRC— Ofdesrabli hed unoppo ed me country Recarts 
LI 090 p a panel <^66 Nppt X iX) p a Good detached hou c retepn n 
nd 6 bedrooms con ultine and sxaitin room and di pensars G rtf n of 
t a's’c ssiih tenn s court and paraec Freehold £1 '00 Premium for Pr c- 
tice It >car3 purchase 

48 CORNWALL — Ofd-csfabli hed unopposed counrrj PRACTICE .tcrape 
£911 pa last sear £I OU Panel OO Excellent house 4 rcwepti n 2 
mall ' bedrooms etc surgery sxaitins room diNpcnsaD Rent i^o pa 
Premium 2 jears purcha e 


tr^AI OTHERS ISOT ADVERTISED 


XX AN TED ^Tiirchastrs nailing for PRACTICES rn all 

parts Incomes from £750 upwards 


ASSISTANTS ANTJ LOCUM TFNTNS XX ANTED —Man j 
XACANCI^ in Toun and Countia ' List on application 



74 


THE BRrrrSH \rEDlCAL JOURNAL 


Tlu ^ 1 ') N 


INDEX TO ADVERTISEMENTS 


PUBLISHERS 


Chcmists—ro/fr/nMi / 


Bale Sons 5. Curnow Ltd / 

6 

Saccharine Corpn Ltd 

44 

British iMedicaf Assn Cu\er m ' 

1 s 

S P Charges Co 

47 

Cassell &. Co Ltd 

9 

Simpkin A L ^Co Ltd 

48 

Churchill J fLA Ltd 

4S 

ThacLra> Chas F Ltd 

28 

Hcincimnn \Vni Ltd 

7 , 

Wander A Ltd 

26 

Leu IS H K & Co , Ltd 

10 

Warner M' R A. Co Ltd Supf 

1 tv 

LiMiitstonc E & S 

5 

Wright La>mm A (Jmnc\ Ltd 

0 

Murny John 

8 

NN'cth John A Bro Ltd 

IS 

Oxford Uni\crsit> Press 

4 



Practitioner The 

Saunders W B L Co Ltd 

n 

3 

FOODS, nC\€R\GES 


Stitionert Office U M 

8 

Bt-max Salts Ltd 

IS 

U ruht John t Sons Ltd 

6 

Bengtr s Food Ltd 

*9 



Boru icL Geo A Sonx Ltd 

13 



Gasmer Win A Son Ltd 

-i*) 

ASSURANCE & INSURANCE 

Im^ram A Rosie Ltd 

42 

London &. Coimttes Med Prot 

1 

Libbs McKedl A Lihbs Lid 

41 

Soc Ltd Supp 

1 1 

1 -Nestle s Milk Products Ltd Supp ii 

Medical insunnet A^encs 

68 

Peek Frcari A Co / td 

42 



Runeri-Co Ltd 

40 



Schweppes Ltd 

28 

BANKS <S. riNANCC 


Sumner sT'phooTci Ltd 

4A 

llntixh Medical rinaiKt Ltd 

as 

\ altntinc s Meat JtliLc Co 

44 

CHEiMISTS 


MOTORS & ACCESSORIES 

Aluzimc Products 

48 

U ikefitid C C kCo Ltd 


Armour ^Co Ltd 

34 



Bell & Crovden 


NXME PLATES, etc 


Boutalls -Ltd « 

2:: 

Hall r n LCo 

4s 

British ALaloids Ltd 

25 1 

Herd S J i.A 

49 

British Drug Houses Ltd 17 21,23 I 

Osborne L A Co Ltd 

48 

Burroughs Wellcome A Co 

37 

Willie Broiire Co 

4\ 


C>ba Ltd 

Den\cf ChenucTl NJft Co 


Supp 


PRINTING, TIPE^^R^ERS, 
c(c 

Tavlor sT>pcs\riitr}» 4*? 


TAILORING & CIOTHING, 
etc 


Biber Ch is H 

46 

ClmrLh&Co Lid 

48 

Cl trk A Co 

41 

Dcirntf PabricCo 

10 

Dinvic A Marsh ill Ltd 

Supp III 

H irdx s 

s 




SURGICAL APPARATUS 


Duncan Flockhart&Co 
UiLill) A Co Lid 

20 

17 1 

Allen A Hanbur>i Ltd 

Cover IV 

Evans Sons Lecher S. Webb 

1 

Bade! W H Son Ltd 

47 

Lid 

29 j 

Curtis H E A Son Ltd 

47 

FLtlowsMcd Mfi, Co Ltd 

^42 

HmgerACo Ltd 

12 

Gcdcon Richtcr Labs 

16 

Hawkslej A Sons Ltd 

n 

Genitosan Ltd 

36 

Milliard 

49 

Glaxo Laborafonej: Ltd 

19 

Leslies Lid 

46 

kavlene Ltd 

24 

London Hospu ij C ileut 

49 

M iw S Son A Sons Ltd 

24 

Mifhkin A Lawltv 

4i> 

NKnIcj A Janies Ltd 

as 

^ Rohmson A Sons Ltd 

74 

Milton Proprietarv Ltd 

40 

Rousscll X Livl 

48 

Napp H R Ltd 

IS 

Salmon Od> Ltd 


Op[>snhctnier Son A Co Ltd 

16 

Sail S. Son Lid 

Cover II 

Oxo Ltd 

20 

Short A Mason Ltd 

47 

Rck.kui A Sons Lid 

23 

Spencer Corsets Ltd 

|4 

Robin-'on A Son Ltd 

74 

ThcrmcLJ I td 

46 


TOBACCO tA CfCAKCnrs 
WiJK sCi| sfTnCfi.Tref(tS 10 


VUAVS & ELECTRO 
MEDICAI 

Gvncnl RtcIioIock tl Ltd Stipp iii 
Gov.thnds Ltd 14 

Ilford Ltd n 

rtloSuottCo Ltd 14 

\jcior\ R*)' Corporilion Ltd 41 


HOMES iS. INSTITUTIONS 

PtCts 49 ^0 M 


5P\S. HI \JTH RISORIS 

& mnuos 

C7«.«.hiK'o\ jV,ia < 

Ihrr'Life < 

KinmelHall 

Pistanx Sp I ^ 

RocVsidt Hsdro <\ 

'?inedle\ s H\dro < 


MEDIC \l SCHOOr^, 

tutors & 1 1 CTl Ul )!S 

PlLCS <t 


HOUSE AGEMS 

1 


66 


HOSPITALS A Cl IMCS 

Londort Clinic 
New Lodfc.c ClmiL 


SAN ATORIA 

Cotiwi Id Sinaionuni 
PendvflfVrt Mill Sunaionunt 
Tor «a Ot.c SinJtoriuni 


NURSING, clt 

I'l L 


TRANSi CR AGI MS 

Tlovril MciliLil \ccnc> ltd 
TlntisJ) \Ic Ja d Diift HI ( > 
Let L Mirfin Ltd 
Mcdit i| Ai.cnc> Ltd 
PcTtotL ^ Ihdlc' I Id 
PtrcivTl Turner 1 td 
\Nef|trivNfcditiI \».ert' 


CONTRACT PRVaiCI 

I )i;c * 

HOSPII U A'ACANLIIS f!f 

rn,es <C n ^ 

60 6 I (' 6 > <■' >< I' 


Cl \ssirn D 

AD^ ERTJSIMLNTS- 
(W mied A 4 innt) 


rjuci 


M »' 


GI NLRAI 

Hnu'h Motor Itoat ’'•L ^ 

ltd 

Clijrtcrc IStK. i fMi'-i f 
I rant^l ind 

I urnilurc L I int \it C 
T I td 


For use in (he treatment oj the 
CIlCSl and jLllHigS 
and siirgicaL uses generally . . . 





mum tmue 

rrcDTP^Dr 

*;ot r i ropRiLTORs 4 . \i.\NLr actlwrs fobinsos '< *:ons ltd or cHrsTrprirTD 4 if? old st 10 n 


M ide c\^ctI> itcordiu" to ili» 
WiriLtion of Its iin tutor, llic Ute 
S luipson Gmigic, 1 HSl Lon 
suiting Snrgooii to tlie O'"’’ '' “ 
Mo'pit il, liirnmiginin Cotiii'o fd 
of gntlccotton t\ool tio!*' d 
in ili-orlirnf gniirc 

Ottnirn^iU tn p rrr qttnhlK^fr^ ^ 


I'lb 4-cd hv I! c Pror i-to's the Briti ') MeJ cjl As cvuimn Ta\i (Ott Square t oodon U C f arj pnnietl bv I 'rVi'*!'- 
Lmi -J Las lUrdnsS IkcsS LondoT CC4 Ptn cj n C cal B na o t utered a Lliv alN-sYos l>- 




ARCfflVES OF 
DISEASE IN CHILDHOOD 

JUNE 1938 

CONTENTS 

Intracnnni Hncmorrlngc in the Ncw-bom B\ \V S Craig, M D , T R C P Ed 
Nitamin C C\cretion in Children, with Particular Reference to Rheumatic 
Fcicr B\ J D Keith, M D and Cich-n M Hickmans, Ph D , M Sc. 
Otitis Mcdn and Mastoiditis in Infanci B> Grace McConkej, MB. B Ch , 
B A O D C H , and Eduard C Ross Couper, M B , Ch B , E R F P S 
Radiologs in the Diagnosis of Hijiertrophic Piloric Stenosis B\ Leonard 
Findlas, D Sc , MD, FRCP 

The Blood Phosphorus in Cgi^ptian Infants B\ I A Sahri, M R C P , 
D T M and H , and M A Ahboud, M R C P , D C H 
Osteopetrosis Bj A M Nussci, MD, MR CP 

The Coolci Sindromc in an English Child Bj E G L Bjmatcrs, M B , 
B S M R C P 


Case Report Case of Diabetes Mcliitus in a Young Infant Bj John 
Deiinc M B , Ch B 

PDBI ISHLD QUxVRTCRL'i 

1 early sttb^cnoltan ( t numhers), 25/- To tucuihcr^, 20/ 

Siiiele i\ unifier, 7/0 

Issued bj the British Medical Association. Tasistock Square, London, WC 1 


“Thu cookery book is based on the latest scientific standards 
Medical practitioners can pailiculaily recommend it to those 
of their patients who have to get a full pennyworth of food 
value fioni every penny of then outlay 

THE DOCTORS^ 
COOKERY BOOK 

21 Menus and 82 Recipes for Family Meals 

21 PAGES OF PHOTOGRAPHS 


PUBLISHED BY THE BRITISH MEDICAL ASSOCIATION 
Ohtatrablefrcm aUbcokstUers ents Smth sheokstalls and Co^native Societies 

All trjuirtes lo ihe B I A Tavtstoch Sq^arCt London WCi 




rv 


THE BRITISIf MEDICAL JOURNAL 





In order to obtain uni- 
formity of calibre and 
complete roundness of 
strand along its entire 
length, A & H Catgut 
IS polished by automatic 
machinery 

Hand polishing of indi- 
vidual strands fails to 
obtain this desirable 
precision and uniformity 
in the production of 
surgical catgut strands 

One of the modern 
advantages incorpor- 
ated in the production 
of A & H Catgut. 

The entire product 
manufactured 
in England 

A ilcicnptnc booklet \ull 
be ic/ir an application 



Precision Automatic Polishing, in one operation, 
of twelve catgut strands, each 10 feet in length 




AZOULE BRAND Manufacturing Licence No 6B 


ALLEN & HANBURYS LTD., LONDON, E.2 

Manufacturers of Surpical Instruments and Appliances Sterilized Surgical Sutures, 
jiianujaeiurer J ^ Furniture and Electro- \tcdical Apparatus 


Showrooms' 48 WIGMORE STREET, W. 1 




BRITISH 

MEDICAL JOURNAL 

JOURNAL OF THE 



ASSOCIATION 


SATURDAY JULY 16 1938 


PRINCIPAL CONTENTS 


Cerebral Integration of 


Leading Articles 

p 128 

Ocular MoA’-ements 

P 107 

00 

H 

f 

Correspondence 

Chrome Mastitis and Breast 


Cancer 

”3 

Surgery in General Practice 



Fracture of the Humerus 

134 

Uterine Bleeding treated 



with Progesterone 

ii6 

Birmingham Hospitals Centre 

138 

Brodie’s Abscess and its 
Differential Diagnosis 

1 19 

Epidemiology Section 

158 

Reviews 

125 

Parasitic Foetus Successfully 


Removed by Operation 

123 

Photogravure Plate at Middle Opening 


WITH SUPPLEMENT AND EPITOME 


LONDON 

BRITISH MEDICAL ASSOCIATION 

TAXOSTOCk SQUARE 


No 404^ \\FCkL\ PRICE4/3 


Copyright 


REGISTERED AS A NEWSPAPER 




THE BRITISH MEDICAL JOURNAL 


Jcci ir. 


BRITISH HEDICAL ASSOCIATION 
EXHIBITION, PLYMOUTH 


An 

InyitattO)! 


.iilll 


O: 

£e 


AOMINlSTKtTiVf 

OFFlCtS 


^ ^ & Co 

ED 


3 □ D rj 


REGISTRATIONS 

and 

'tickets counters 


\ 1 s 1 1 ( 3 1 s a 1 e 
Jj u ] 1 u VI u h A \\ 


invitee! to 

] ! ( () 111 < <S. 

S t 1 Ji d No 


inspect 

L o L \ h 


t li t 
I 1 ) I t 


41 


y a □ c~ 

. 



r 

1 

entrance 





I. f 



— 

_ 


‘TABLOID’ 

SULPHONAMIDE-P 

0‘5 gramme 


(sulphanilamide) 


I iu '<^lul^^(ul I) II ti I II kIi for 01 1 1 in 

lienioJMK str< ))toi 'II I il ml' 1 luiii' h-' 

\iliiil>!e .uiiun 1- lint IiigtH to tin 
r qiidili NNUU \eluili the liruc' i' ilirtiotil 
lhlou,^ll01lt f'l< ll-'-'lK ' lll'l lllll'i' ol 
tin lio'h 


! ! t< I t-> in m I rl I il in jiui tin r il 

-ijini ( 11)11 nil i)in„i)i III I il iJi'i tirin ir\ 

Ir « I ^ /> t "// J iiitiilioii' Mn i) ti' li 
Ho In 1,11111111111 il Hill 1 1 rt tin oiliiv 
llllt i1 Kill' 


7 


7 '// 0 ; ti! L ft 

' TABLOID • SULPHONAMlDE-P 

0 5 Gramme I’* 1 'i'" ' I ^ 

or Inn j>n im In 4 • 

/ / / / f i ft * ** 


'll P n) I n ft ! H I 'll Ol t! f //It 

WELLCOME SULPHONAMIDF-P 

iJf rrlf nt J"' r itiitin s 19 
n alts f tn 1 s 6 


BURROUGHS Wellcome & Co. London 


v' 

* I r t if h ('Iff 1 1 

N^\^ YORK MONTREAL S D -J F Y CaR«^ TOV fi mil* 

H .r ii ■ Il f ! ■ ■ H I 


/.A (-CO f,> , ' Iiuiiiiun, SNOW Hl^L BuijloInGS EC t 

lO HENRIETTA PLACE CAVENDISH SoU^rr ./I 

0 O ^ 


JO 



TABLE OF CONTENTS 


VDDRESSrs \ND P\IURS 

Cerebral Integration of tlic Octilir 
Movements Cio^dos Hou'iis 
v* D„ F R c r I p_s 107 

Oironic Mastitis nnd Breast Cancir 
\ Tamih Iliston of I im Cases 
W Swirsos Hssdlfv ms ri csll' 

Dvsfimctional I tcrinc B'tcdins 
treated «itli Progesterone 1 N 
MsccRrct-R VI D r R rd tI6 

Brcdics MFsecssand its DiITercntial 
Diasnosib J\ ns I Bfsilsioid 
M D SI R c r 119 

Parasitic Foetus SucccssfiilU 
Removed bv Operation 'Iv< 
GrxtvRERC tPWtd 123 


SL'RGICVL SIRIIS 
Fractures of Shaft and Subcapital 
Rcsion of the Humerus 1 P 
McMurras sich^FRC^cd 134 


CLINICAL MEMORANDA 

Recurrent Cerebral Thrombosis 
■wath Recovers G Luwruas 
Dsmcs siRcs lrcp 124 

Orthoptic Cure of an External 
Squint of 3a Degrees in a 3\oman 
of Thirrv 3\ H DU Prl sin 124 


REVIEWS 

Dietetic Malnutrition in the Tropics I2S 


Tumours in the Neck 12S 

Nuintion and Dieletics in Brief I2S 
Therapeutics of Anlimonv 126 

Gnnker s Neurologv 126 

Practical Anatomv 126 

Notes on Books 126 


GENERAL ARTICLES AND 


NE^\S 

Tlic Birmingham Hospitals Centre 

Roval Opening Ccremonv 13S 

National Food Policv 139 

Nova ct Vetera 

Surgical Forceps down the Ages 137 
Medicsl Rfsearcii Colscil I4I 

A Medico Lecsl Isstitete 142 

Mstermty snd Child Welfare 
COSF fRENCE 142 

Preparations AND API LivxcLs 127 

Medical Notes in Parliament ISa 

Umaepsitics AND Colleges 160 

Medicai Nias 161 


LEVDING \R1ICILS 
Clinic-il Science 12n 

A Pioneer Hospit tis Centre 129 

Phns for PlAnioulli 127 


AN NOT VI IONS 

Slrcplo O'cu Cirricr Problem PO 

Pcsklivm HliIiIi Lxrcrimeni 1 '1 

far \ in s C nccr 1 I 

Svmpioms of Cardiat Siindsiill P2 

Mc„surinc Lmoiion 1 a2 

ImmtintA non ic insi PolionvAcliiis I 1 

\ Setback to Medico Iceal Science P' 
The Half vearlA Indexes Ij 


SUPPLCMENT 

Medical Practice in Germanv 

Bv KxRLllvtDtNI AMP MD 


TIic Mental Treatment Vet 
(Section 1) 

Bv I_ H Wootton Ml) and 
Lolis Minsm aid 


Untsipiovmlt IsNVRAMi rot 
Doctors Faipiovces 
TTblic Health None 
iNstRANCr Mldical SuAicr 
CoRprsi oNDENcr 
PoSTCR-ADL ATF Ni \A S 
Meftincs or Dixinions 
Association Notices \acancies 
and Appointments Dnrx 


LOCAL NEWS 

EnC I AND AND W'aI t3 

Associaiion of Special Hospinls 146 
West London ^lcdIco-chIru^glcal 


Sociciv 146 

Treloar Cripples Hospital 146 

Irfi and — 

Medical Research Council 146 

Rojal MalcmitA Hospital Belfast 146 
Scotland — 

St AndrevA s \mbulance Asso 
ciation 147 

Cremnlion in Scotland 147 

Roval Blind Asvium 147 

Princess Margaret Ro e Hospiial 147 
I7ccrcascd Mortality in Fife 147 


EPIDEMIOLOGY SECTION 

Tvbie or Infectiols Diseases and 
Vital Statistics 158 

Epidemiological Notes 159 


CORRESPONDENCE 

Medical Relict in Ch na H 
Gopdon Tiioaiicin id I4g 

Anti vcncrril Mev tire Do olvn 
Whiti aid 1,3 

Ischio pubic O leo^hondriti 
H \ 1 r AIPBANI r p r e 1 4S 

Ri me Inc dcnce ot PsacIio onijlic 
nine S \ E C AKV I R M D 
W S Hafi r M p c N 1,9 

Lneon ciou Mind and Medical 
Practice R M I ad,ll mp I sd 

Mentil \ltcr c^rc Rfcinild 
W orn! Mil PO 

Trcalmcni of Ibici moa a H H 
Biovan tpcs IsO 

Pvittaco IS J P Hamincc aid lal 

Treatment of PhcLnta Praevia 
S K K.riNAP J E Gienf-n 
MR and 0 Li DVT) ai b lal 

Sm ill pox and CompulsorA \ c 
cmation C K Millard aid PI 

P oriasis Wm Gilfili an mb 1s2 

Complications of Gold Theraps 
GtR-ALDSLOT SID J B BINNETT 

MB P2 

QiiinsA Pcrilon illar Ab ces H M 
DENHD! SI AoiNC SIR IS2 

ThcbinaIMB B S Lend Sir F 
GRAHASI I ITTLt MP AID P3 

The \fcclici I Directors 7919 

J AND A Chlrchill I td P^ 


REPORTS or SOCIETIES 

Roval Midico Psvchological 


Association 143 


OBITUVRY 

Harrs Campbell aid frcp Ia3 

Charlton Hall Bch 154 

H Ottndge Reik md 154 

J Anthonv MeVea sib 15, 

A E W Hird sircs , 155 


THE SER\ ICES 

48th and 6Ist (S M ) Divisions 
RAMC 160 

Deaths in the Service, 160 


LETTERS AND ANSWERS 


Cockroaches 161 

Mosquito Bites 161 

Income Tax I6I 

Nasal Sinusitis in Childhood 162 

Appendicitis and a Meat Diet 162 

Medical Tour to Soviet Russia 162 


Collection of Old Medical Books 162 


A KFY TO CURRENT MEDICAL LITERATURE will be found at the end of the JOURNAL 




THE BRITISH MEDICAL JOURNAL 








Jin 16 IQJ'! 


THE BRITISH MEDICAL JOURNAL 


-ill- 


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NLNDlf^ rOLK JLsT I bBLISHfO \\ ilh 5 I Pp xu 


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CHRONIC RHEUMATIC DISEASES 

Bcmi: the Pourlh Annu-\! Report of the British Committee on Chronic Rheumatic Diseases appointed by the 
Ro\al ColIei:c of Ph>sicians Ed ted b> C W BUCKLE’i MD FRCP 

NUMBEIT ONE With 8 Flit Rt i M S\a 12% 6d n t pc t=»-, fd 


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NUMBER TWO Rni! Svo 

NUMBER THREE, Ro\aI 6io 

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THE MANAGEMENT OF SOME MAJOR MEDICAL DISORDERS 
tiiTiftf hrn rit^nrn iko»i t /;/ hi iti n ^ttnitii joi it\ ti 
\OLLMl ONT W h lUu r no- IVr \ bxn 6t Cd nrt p^j In e (JUST PUBUSHEO ) 

Uisensrs of the Rrspern orj Tract ** \cute Specific Foers Cnrclio V iscular Diseases 

\OLL\E TWO Vih IMu tion Den v b lOs fd n-t pot e bd (RE\D\ NEXT WEEK) 

Diseases ef the N rvous System Diseases of the Oi rslive System Some Diseases of the Blood 

r I rumatic Dl cases Metabolic Diseasis Diseases of the Kidney 

7 tvn \ ' m a H Jul \ ' - t n 1 t^ I j 1 a a I a iff th i! r t iie of n i *ne 

- Ti I \f {_! t jt T T frjf J r ) 

RECENTLY PUBLISHED 

A TEXT-BOOK OF X-RAY DIAGNOSIS 

Ba BRITISH AUTHORS 

Edited bx S COCHRA^E SHANKS iMD .M R C P PETER KERLEV MD MRCP D \l R E and 

E \S TWINING \l R C S MR CP D M R E. 

^ OLU^tE t Pp xii — 5*^0 Wit a Illustrations Crown 4to SOs net 

\ OL.UME FI Pp XI — 4So. With 307 Illustrations Crown 4to 42s net 

Jr /« /-.\J/rT//» Til IT III njLt It titifiT Till nir M/r t ioliui ii 

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rjcrf- 1 in in ti e ett arc cl arJ> a 1 ^ tf re c I" r o rr f a f i ai ct -i ’ >n T^i< r j rr e \im it carli rccr iu ron 

a a da c ~ — I %^c»T 

JUST PUBLISHED With M Plat includim. ’4 Fi ute De^r^ 8vo 7s 6d n t p^slnec 6 

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With 2 Coloured Plates and P2 Plustrrttcn n the Text Royal Rso ]2s 6d net postage 6d 

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B> D B BLACKXOCK M D Edm D P H Lond DTM Liverpool Professor of Tropical Hygiene in the 
Liverpool School of Tropical Medicine etc and T SOUTHWELL D Sc PhD Walter Mjeri Lecturer m 
Parasitologj Liverpool School of Tropical Medicine 
TIi 1. 1*1 clearJj wnttn an 1 w 11 illi rat 1 Je cnjtmnv of nclUo I of iha no iv v 1 d are 'iinckly 1 arni anj ea ih 

carrmi Cut general excellence a 1 1 rcl al i}ft> —1 %sc T (/ rtr t /m r c ci t r { cJitijt j 

NEW (NINTH) EDITION Thoroui.M> Rcvi ed and Enlarged 
With 4 Plates and 208 oiler IIIj trations Pp *tv — 9/5 b^ins x Sims 30s net po taj* 7d (abroad Is 3d) 

PRACTICAL BACTERIOLOGY, H/EMATOLOGY 
AND ANIMAL PARASITOLOGY 

By £ R. STITT, M D Sc D LL.D Rear Admiral %IedicaI Corps and Surgeon General US Navy retired etc 
PAUL W CLOUGH M D Chi»*f of Diagnostic Clinic Johns Hop! ins Hospital etc and MILDRED C 
CLOUGH M D formerly Frllou in Bacteriology and Instructor in Medicine Johns Hopkins University 
^ ha incr a>el m ire an I one ma> trilj > in u lulne — ^Tr i-tcvL Dt tv r I llftis 

Ccmf-lcti Calahgtu^ on r^quc^l 

LONDON H K LEWIS & Co Lid, 136. GOWER STREET, WC 1 


JULY 18-22 


STAND No. 9 

H K LEWIS & Co Ltd, 136, GOWER STREET, LONDON, WC 1 


development of 


THE BRITISH MEDICAL JOURNAL 


16 19 


HEARING AIDS 


We Multitone Electric Co , Ltd , do not believe ourselves to be the laruest Deif Aid minufKtnr r 

work'* TZ\ “■» !=»<!, and have led for SaTvlt 

k of the Valve Amplifier Hearing Aid As invAriahW happens in ,t new field such is this 

^‘ive from time to time endeavoured to copy our inrcnlions and ihc 
follovving fist of some of our principal developments and patents will show the impro^enienis n), 1), 
we have ourselves introduced, and may clear up misunderstanding 

tone control 

Developed and patented the TONE CONTROL TRANSFORMER The only priciicabk 
tone control then avaihble for Deaf Aids Used at the time by practically ail Dc il Aid 
manufacturers under licence ^ BRITISH PATENT No tS!,540 

1933 CLASS INSTALLATIONS FOR DEAF SCHOOLS AND 

RADIO FOR THE DEAF 

" De\eIopcd and patented the DEAF AID RADIO SET, which provided deaf people nith 
radio programmes as well as speech amplification This was supplied lo a hrge niimlx,r 
of Deaf Schools all over the world, including all the London Count} Council spccnl 
schools BRITISH PATLNT No 416,436 

1934 VNMASKED HEARING 

Developed and patented a system of oveicoming the masking of high notes by low and 
middle notes in Deaf Aid amplifiers b\ employing a pur of tclcplioncs in one ol which the 
intensity of low' and middle notes is greativ reduced Thus, since the lower and middle notes 
lieard in one car cannot mask the high notes heard m the other a high order of 
intelligibility is obtained c\cn at \cry high \olumc levels The same elTcct cannot l,e 
obtained by using only one telephone This system, which is piotectcd by Bntisli Letters 
rucnt No 434,294, has since 1934 been desciibed bv us and has come to be gcncnlly 
known by the Medical Profession ind deaf people as UNMASKED HEARING 

CRYSTAL MICROPHONE IN PORTABLE DEAF AIDS 

Wc believe that our Portable Type P, fiist shown at the Radio Evhibition 1934, w is 
the first commercial Deaf Aid to cmplov a crvstal miciophonc 

1935 POCKET VALVE DEAF AID 

Introduced what wc believe lo be the first POCKET VALVE 'AID oficred to the deif 

1936 THE REACTOR DEAF AID 

Produced miniature 3-\ al\c crystal microphone Deaf Aid Entirely dry battery operated wd 
employing ncgiiivc rciction for tone and volume control BRITISH PATENT No 476,877 

ATJTOMA itfcv.vOLUME CONTROL 

Introduced Automatic Volume C<fmrol in Dcif Aids 

1937 THE 3^ST POCKET MULTITONE 

Produced i 3-Valvc Crvstal microphone Deaf Aid for Ihc pocket believed to be the first 
of us tv pc 

TELESONIC SYSTEM FOR THEATRES AND CINEMAS 

Developed a form of inductive pick-up for iliciirts and einenias which wc gave the nime of 
TELESONIC SYSTEM According to this svstem the Detf Aid receives the recorded 
sound in the c ise of cinemas or the sounds on the stage in the case of theatres not through 
the microphone but tliroueh a pick-up coil which is energized bv conductors disposed iboul 
the uiditorium Thus the deal person cm hevr from any seat m my part of the houst 
without att icliins the instrument to am fivecl point and without being disturbed by the usii il 
uiduonum noise's Some cinemas and theatres have alreulv been fitted up bv us and ih. 
svstem IS being nken up bv the Guimont group ofcinemis Negotniions wuli other 
croups arc m proercss P ilcnt h is been applied for , ,, 

Since our first insnlhiion mimcrous attempts have been midc lo devise or m irket simdir 
svstems with which we irc in no way concerned 

1938 Dcvelopnierts during the cuireni vear will be devit with in our next 'dvertiseiiunt 

MULTITONE ELECTRIC CO., LTD. 

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123 l!!u incInJin? 13 I ht" J 

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Srcot d L*t on 340 Illustration 3* 

EDEN & LOCKYERS 
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104 



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ILLINGWORTH &. DICKS 
TEXTBOOK OF SURGICAL 
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v e I (7*/ ) f) / / II n "3 I III! fit ic I 


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V I li r< a 1 M I Text fiK«re -I 


SHELDONS DISEASES OF 
INFANC1 AND CHILDHOOD 

c~r (Sr rf) // t Ttxt iirf< 

n-'d 13 I late 1 

S1DNE1 SMITH’S FORENSIC 

^lEDICINE A Textbook for Students 
and practitioners 

S-r (S-f/i r' e |60 Illitntton* 


DARLINGS SURGICAL NURSING 
AND AFTER TREATMENT 

I ( S rth) r* t n nil tratif 


GIBBERD S SHORT TEXTBOOK 
OF MIDVSIFERY 
I “ ll’ii nt n 1 


MICKS ESSENTIALS OF 
MATERIA MEDICA PHARMA 
COLOG\ AND THERAPEUTICS 

Nr-t (5* f i» Til r 1 '1 

PINE^ & WVARDS CLINICAL 
ATLAS OF BLOOD DISEASES 
<f trtn / ft r 4 I ate^ (3'< 

t o’o I c*l I 1 cl 

MACNERS TEXTBOOK OF 
HEMATOLOGY 

2'> lUu ir-t rn (inch Jm 3 tolojtcl 
I ate 1 1'' 

GOULDENS REFRACTION OF 
THE EYE Includin'; Elementary 
Physioloflcal Optics 
\<~t (Vf if) BJ ton 1 1 IIlu tratioi 
1_ M 

DUKE ELDERS PRACTICE OF 
REFRACTION 

%<*•! (Tf I a Hu ration 

I » (-ii 

HADFIELD & GARRODS RECENT 
ADVANCES IN PATHOLOGY 

Sr I (Tfi rj) £J fi n 6 111 i ra ion 

1 

WHITBY S MEDICAL 
BACTERIOLOGY 

CDescrtptive ond Applied) 

ru (f/iirf) BJtticn Hlu tration 

JI CJ 

GILLS SEASONAL PERIODICITY 
OF MALARIA and the Mechanism of 

the Epidemic Wave*- 

lllu tration^ 10 

HAWK &. BERGEIM S PRACTICAL 
PHYSIOLOGICAL CHEMISTRY 

S ea (BIc rnf/i) Ed tton ' Coloured 
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GLOUCESTER PLACE, LONDON 


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SHAW S TEXTBOOK OF 
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S CO f I i I 4 ( lourc { 1 1 

\ 1 ext f tir IS 

EDEN &. HOLLANDS MANUAL 
OF OBSTETRICS 

/i; il t Hi t R 1 I) LSKOLLN 
IIOI I \M) MU I R L s 1 I ( M 
12 I Iitc (3 Colo re 1 1 ml T i 

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WHITBY & BRITTONS 
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Srr nJ r I li n 1 I it ( I ol t re I 
til) r xt h Lr .J 

CLARKS APPLIED 
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CUSHNYS TEXTBOOK OF 
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Bio rrt/i BJttiot Pe\ cd 1 > C \\ 
LDAILM**- M L» anj T (I W 

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J i/lli Bdtfi'^n 1“ Jlhi t ation -I 

WINTON & BAYUSS HUMAN 
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JOHNSTONS SYNOPSIS OF 
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NEAME & VVILUAMSON NOBLES 
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PRESSURE - HEAT - LIGHT 

The Pa\nc\ has for some time succcssfulK promoted mote 
rapid reconstruction of gangrenous tissue indolent ulcer etc 
It comprises a motable pressure mechanism and a boot of 
Pjrc\ Glass Controlled pressure and suction and artihcml 
hjperthermia may thus be gi\cn concurrcntlj to stimulate 
blood floss and local metabolism 


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A Hrge number of pipers line been published m different 
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there IS no norfv dealing mth the subject as a iihofe, and it 
IS iMth tlic intention of filling this gip that this work has 
been written 

Pp XII “ 336 229 Illustrations 

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Pp I III — 366 113 Illustrations 

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EASY STARTING -In the 
V/olseley 14 56 h p 3 thermo 
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system does ovoy with 
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pulling A 12 volt electric 
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ROOMINESS -Quick and 
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fresh air renewal every 60 secs 
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' mil SUITS lull-si/c m tlie dail^ 

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He IS aigning along lunltli lines, 
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clean and olniatcs some ol the 
disoidcis of the hod) 

Mi Tlicrm would be dihglitid to 
know he had doctors hi hind him 
in pimeiplc 

of the Daily Bath 


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INSURANCE 

FOR 

NATIONAL HEALTH 
PRACTITIONERS 

The Insurance Acts Committee of the British Medical Association 
after protracted negotiation secured for all Insurance Practitioners 
an opportunity of entering a 

Pension and Insurance Scheme providing 

(a) Pension at age 65 

(b) Disablement Income 

(c) Family Protection 

at extraordinarily low rates which are available only until 

September, 1942 

Policies effected prior to that date will not be affected by 
any alteration made thereafter 

The scheme was made available also to members of the Association 
not engaged in National Health Insurance practice 

These policies arc issued through the Medical Insurance Agency 
of B M A House Tavistock Square acting as agents of the Insurance 
Offices which adopted the scheme for the collection and receipt 
of quarterly premiums 

All other insurances Motor Household Educational Life and 
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In this as in all else 

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a laUon It keep^ iiidefinitel) 

le-tcd and ippio\ed b\ i lending London 
llo'pitnl Prc-^ciibe it for nn\ cindition in winch 
knioii juice iiid bnrk} water are allowed 


" VAIPLI ■;u\t willi 1 !c I'uri, ibo useful lo 1 let ' ith 
I HI ) liat elnet-. mil ‘•jcJrrom niiii- irmn n I o do i 
11 t il Write 10 KiMtr iV Co ltd Mtdic I 
Dept n I f till I N IS 

2-11 hottU al nil Iciulinj f Iiriintt< (tiiil craters 


liL\ ir, pi V 


EVIDENCE 






Wr 


Iv--V 'fi 




% 


r5i { 






-iiV t-T'* 


. This 
sandal 
sole 
was cut 
away 
from 
a worn 
and 

discarded 
CLARKS 
sandal. 

I 

IT SHOWS the imprint of 

the child’s foot, and demonstrates how 
faithfully a Clarks shoe is planned to fol 
low the natural foot outline Although 
the sandals have been well worn, 
notice that the toes have not reached 
the end of the shoe, , because Claris 
shoes allow exf/a looni for toes iogro>' 

SHOES AND SANDALS 
safe for growing feet! 

HhiMrau (! ft t (It t ontf i amt t>f ft it ’ ^ ^ 

^tipfhtt* on fiijuc'st sipfiT 





JlLI 16 I*) 


THE BRIT[SH MEDICAL JOURNAL 


13 


OXYGEN AND NITROUS 


an important announcement 



to physicians, anaesthetists and hospital authorities . . . 


O WING to the increasing demand for its Medical Gas Products, especially 
Ovjgcn and Nitrous Oxide, The British Owgen Company Ltd has 
estabhshed a Medical Section which will control the distnbuuon of Gases 
and Apparatus and the installation of Pipe Line Equipment throughout 
the Umted Rmgdom 


PPl^CC Accordins; to the consumption of the user and the 
sizcofc>lmdcrs p ices base been established which 
are uniform throughout the countrj Th'*se pnees in nearlj all 
cases represent a considerable 3Mng to Hospitals Thc> are th- 
same whether the Companj s O' pris^tel) o smed c>linders are 
used Further sa\ mg can be cff'-ctcd b> the use of larger c>hndcrs 
Gas*s will be *oId bj the cslmd-r and not b> the cubic 

cylinders being standardised — the ^nailer 

and odd capacity cjhndcrs are being 
wiihdrasn and I-rge numbers of new ao too and 

150 cu ft Qhnders are being put into arculation All arc being 
treated in enamel fimsh and fitted with new easj worlcing 
Chromium Plated Vahes The larger sizes for O'^gen Tent 
and Pipe Line use arc fitted with self supporting ring bases 


NO HIRE CHARGES 

Will be made on Medical 
Gas Cslindcr Man) thousands of new c>hndcrs arc nced'*d 
to marc this important mnosation possible and the co opcrationof 
customers is requested m the matter of the speed) return of emptier 


DELIVERY SERVICE 


Our fleet of sam. has been 
considerabh augm-^med so 
th,-t almost csers town in the Kmgd'^m is covered b) a Regular 
Guaranteed Deliver) \ll gases arc Delivered Free moreover 
jntermedute rvquircnents b) Rail or Gamer arc also (subject to 
certain conditions) delivered free Hospitals v hich alread) deal 
direct vvith the Companv v ill receive automaticallv the benents ot 
then^w condiiion'i as from isi Jul) 193S Others arc invatcd to 
write for particulars 


Allow the Medical Section to supply all your gas r equir ements — 

OXYGEN OXYGEN -f-CO> CO, NITROUS OXIDE 

GAUGES REGULATORS FLOW METERS cic 

Gas- Air /Gas-Oxygen Analgesia s. an/Esthesia Apparatus 
Pipe Line Installations 


THE MEDICAL SECTION 

THE BRITISH OXYGEN CONPANY LTD. 


Telephone 

ARNOLD 123^ (10 lines) 


V/EMBLEY, MIDDLESEX 


Telegrams 

OXTGEN WEMBLEY 


14 


THE BRITISH MEDICAL JOURNAL 



ROBUVAL 

ELIXIR STRONTII BROiMID el VALERIAN INODORAT 

PALATABLE yet possessing aP the CALMATIVE properties of 
VALERIAN and BROMIDE FREE FROM BARBITURATES 

A HIGHLY EFFECTIVE SEDATIVE 

For Prescribing - . . - 8 oz 3/6 

For Dispensing - 40 oz 10/6 net, 80 oz 20/- net 

IRI-IL BOTTLE LITERATURE & FORMULA from 

ROBERTS & CO., 75 , New Bond Sheet," LONDON, W 1 

/ hunt U O /«tr 4i~‘3 



THE WORLD RENOWNED 


ThisNatui al AlkalmeMinei al 
Watei may be piesciibetj 
with absolute confidence 
with legaid to its puiity 
and natuial condition It is 
bottled at the Spiings undei 
the most caieful supei vision, 
and to ensuie fiesh supplies 
IS impoited with legulai 
fi equency 


NATURAL VICHY SALT 
Drmking and Bnths 


for 





NATURAL MINERAL WAJLR 


The VICHY WATERS, 
being almost devoid of Sul- 
phates, aie most agiccablc 
to the taste, and aie daily 
lelied upon by Physicians 
the woild ovei in the ti cat- 
men t of Gout and Rheu- 
matism and foi Affections 
of the Livei, Stomach, etc 

VICHY DIGESTIVE PASTILLES 
prepared with Nnurnl Vich) StU 


CAUTION —Each bollle from the STATE SPRINGS bears a neck label with the word 

INGRAM & ROYLE, 

Binror WInrf, 45, Belvedere Roid, London, S E 1 And H LiNrrpool »nd DrUtol 

fret t W ibe MaUi tl //i/riuin 


VICHY ETAT" and the name of the SOLE AEEH7S 

Ltd. 



Modern Iron Therapy 


Iron Jclloids la in ckuint md rclnbk 
nums of idmmiMLnng ihe proiocarbomlc 
of iron The prcpiriiion Ii i> none of ihc 
of Pil Blind Thi. iron content 
rinninN Iresh ind unoxidizcd indi-finilch md 


injury to In.Ih ly avoided 
The Jclloids ire hichl> UTccliyc in the treat 
nient of ichlorlndric imemi i md indstd in 
ill the sinipk in icmi is fn nhieh nnssnc iron 
Ihc ip\ IS indicled 


Iron Jelloids 


1 oil ■'Is sordi illv in iitd lo ipp!\ lor v-tmp'es lor lIitis I lest 

//< /ri> y /'<! ' C< n r >' /n' X/ >r^t ^ tirfiii 11 < ffivd //< '■'i 





Jui^ IC I'l'iS 


THL BRITISH MCDICAl JOURN \l. 




LACTAGOL (rtlo-lmr Cnlnnm Plto«pliorii*) 

Iiclp'; lo conipciisnlc for llie co i>innl 
<Iniii In llic foctiis upon tlir rc=cr\os of 
tlip cvpcriniit niollicr 
It IS T Milmhlo rolionnt (liiniic coimics 
ccnre follow ins pnrtnriiioii uni e\trls 
n clrfiinli s^I^ 1 ^l^sosnlc nrlioii on tlic 
In^nlnnr^ sHml' of tin nnr'ins niollirr 
Spccinniis forclininl IrnI free on nppli 
rntion I^nrlosol 1 id iMitclnni Snr^o^ 



'pfe? 

2 


ibsfe lU fISB 


Sinusitis in 
Older Children 



Tnfcriions in older cliildren i\itli Hr^Cr «iniisC5 
nnd rrlatn cK snnlkr o^tn mpiirc spcini treat 
roent in addition to the remoa al of constitutional 
disorders 

The most approaed treatment eonsi-ts of the me 
of suction, remoaal of adenoid*, and nasal t im 
pons of 10 per cent solution of Vrgarol — the 
standard in mucous membrane inflammations for 
mana jears 

ArgaTol Las pcftiliarla 'cdatiac, inflammation- 
allajing qualities, and it« clinical successes of 30 
acars’ duration maa he ca'ila accounted for ha 
pertinent chemical facts 

The a era great diircrcnccs hctaiccn ArgaTol and 
other silaer salts in sdscr ion and in hjdrogcn 
ion concentration (or alkahnita) no doubt haac 



much to do aiith the irritation noted ha doctors 
aihcn allegcdlj cqiiiaalent mild sja cr protems ore 
substituted The plf and p Vg of \rgaTOl are 
espccialla regulated for treatment of delicate 
mucous membrane' Insure the results jon 
expect — specify ‘ARCiROL” 


Sole Distnlmtors 

FASSETT & JOHXSOItf, LTD., 

86,. Clerkenwell Road, London, E.C.l. 

TnElu; IS OVE AND ONLl ONE ••ARCIROL,- MADE OSLa Bl, a. a BARNES COMTINI SOLE 3IAKERS OF ARCiHOL AND OV OrEBBPt 


^AR4RT from its low 
slarcli content, HO\^S 
is practically free from 
indigestible cellulose 

GmMiM 

25Zadded wheat-germ 

^TZi/A In VITAMIN'S' 


Best Bakers 
Bake it 



Macclesfield 





16 


THE BRITISH MEDICAL JOURNAL 


Jiu 16 


IT ISN'T JUST "GOOD-FOR-rOU 


' Pineapple Tnice as \on can sec from the anaKsis below i« a \ aluable addition 

to am,bod% ^ dut It i- a good source of ^ltl^lIns V B and C and natural fruit 
siigirs It procides mineral -alts C ilciiiiii Ovidi 022 % Alairnc-inin Oxide OIO^q 
Copper 0002"o Man_ane-c IHIOI^o ind Iron 0005°o Dole Pineapple Juice In- an 
alkaline rcailion in the hod\ which tnid- to offset the ellccl- of acid producin_ food- 
II ha- been accepted h^ the Vinencan Medic il k— ocntion Committee on food- md i- 
m cop-lant ii-e in niant \niern m Ilo-pilal- md Aiir-iii!: Ilome- 

Bnt it IS equally important tint tin- \ahiahle fresh fruit drink i- more than accept ihle 
to patient- especialh children with oh-tiuate appetite- or fickle la-tc- It- fre-h I m_a 
0 leonr, not like the sjnipi liquid ton expect to find with tinned piiicaqiple i- refre-hme 
tliir-t epicnclimg and memoritmg It is not ofli ii _e on come arroc^ a drink that ton rim 
recommend tilth titch ‘Hire 1 notclcdgc that \aiiT adttre icill he foUoued 


M 11 liirc 
V It 

FmI (rllicr xtr*irl) 
r r (riM (N 6 -,5) 
< rti(l« filtrc 



TYPICAL ANALYSIS OF DOLE PINEAPPLE JUICE 


o t 
o 1 
« 1 
41 02 


rtirir »ci 1 t> <> 'j 

llrAlticin^ Uf.ar« n in •‘M 

'Ujrnr 12 t 

Carhnii •Ir-'ttr nUirr than 

(liA ! n'rrrnrr) O 30 


★ 

h •? i’in <1 / } Jut 
rin <1 / Irci tucQf 

NrnfU 2 000 dneu r« ha\e rtcci Ih 
i inrappic Jitice If \tu u 

fiftll !»<• ptt'isH'tl ! •rntl \oM on** 


★ ★ 
ij finti'* I /> nn fir matt r 


xnniplr tin of I) tc' 
xoitr Ifllrrtira I »»*• 



It l>t US to AOU f IJ If *» I 
w Itcii tt I' tin c ’ n 
Dolt J I li 


DOLE 


PINEAPPLE JUICE Fiom Hmmii 

3 K HUSBAND & CO LTD 10 EASTCHEAP LONDON - C J 


BAUMOL TOILET SOAP 

A pure super-fatted soap introduced to the 
public more than half a century ago 
Recommended by the medical profession 

BAUMOL BATH SOAP 



A super-fotted hard soap specially milled and 
perfumed for use in the bath 


Particulars 

on 

application 


BAUMOL MEDICATED SOAPS 

A full range of medicated soaps Invaluable 
m dermatological practice 


DUNCAN, FLOCKHART & CO. 

EDINBURGH .mfl LONDON 

10A--I08, HOLYROOD ROAD, 8 155, 


FARRINGDON road, EC 



Ji'u If I'>1S 


Tlir. BRITISH MEDICAL JOURNAL 



ACETYLCHOLINE B.D.H 


Substitution thcrapj is the rational form of treatment in endocrine 
disorders when immediate results must be obtained This is so also 
in such conditions as parah tic ileus^ Ra\ naud’s disease, embohsm of 
the retinal arter\, ambhopias and post-operame abdominal distension 
In all these conditions Acet\ Icholinc BDH continues to be used 
Mith success 

Acet} Icholinc BDH is a stable sterilised solution of acetjlcholine 
bromide issued in solution containing o i grm in each i c c in 
ampoules of ’ c c , i c c and 2 c c 

Sample on n-j ast 

THE BRITISH DRUG HOUSES LTD LONDON' N i 
Tel'phonj CIc'Kcnv^tll 3333 Telegram Tttradome Telex Lo 3 Jo 3 


A NEW TECHNIQUE FOR THE INFUSION 

BLOOD AND SALINE 

The infusing of citrated blood and saline by 
means of the new Baxter Indirect Blood Trans- 

fusion Apparatus, coupled v/ith a Baxter " Vaco- ' ' /' " T 

liter” of Saline Solution, is the latest contribution 

on the part of Baxter to Intravenous Therapy j 

Over 400 Hospitals in England have standardised i w 

on Baxter’s Intravenous Solutions in “ Vacoliters ” j 

and we are glad to present this further evidence | '~f~ 

of the efforts of the Baxter Laboratories to | J 

improve and simplify Hospital methods i / 

We shall be pleased to send on^ request further . ^ 

details regarding the Baxter Blood and Saline ' 

Infusion Technique and welcome the opportunity to \ ' 

show you how simply and effectively it operates 1 

JOHN BELL & CROYDEN ! J: 

Wigmore Street, London, W 1 j s 

DAY AND NIGHT SERVICE > ij s 

Sole DiJnhiilors in Crcal Bnlam for Baxter Loboialones Lid | Jj 

24 Conti ay Road A' 15 ! ^ ' ' 


18 


THE BRITISH MEDICAL JOURNAL 


Jdu tfi 1 ') <: 



FORMULA 

Thyminlc Acid 010 

Hexnmctlivlenctc triminc 
Anhj draincth\ Icnccitntc 0 oO 
Ilcxamctliylcnc rctraimno 2 50 
Piperarmc Tirtntc 0 25 

lltlilum Ciriionito 1 00 

Sodium Benzoate 1 00 

BBcrvcsccnt Bo«e ad 100 


DIRECTIONS 

One teaspoonful to be taken 
morning and night in a 
tumblerful of water 



m addition to being u solvent and eliminator ol 
pathological Uric Acid, is a powerful urinary antiseptic. 


Normally there exists m the body a certain quantity of uric acd which 
assists general metabolism, and after it has played its part is eliminated together 
with the normal thyminic acid of the organism When however, uric acid 
IS present m excess, the body needs additional thyminic acid to supplement the 
resultant deficit of this normal solvent of uric acid 



by Its thyminic acid content, supplies the agent 
necessary to dissolve excessive uric acid 


The next step is the elimination of this thyminic uric acid which, being 
in excess of normal, necessitates treatment by an agent capable of enhancing 
elimination 



by Its content of hexamethylenetetramine and lysidin, 
stimulates the organism to eliminate the pathological 
uric acid already dissolved by Its thyminic acid content. 


Somp/es end literature on request 


CONTINENTAL LABORATORIES LTD 



30 MARSH AM STREET, LONDON, S W I 


PROTAMINE INSUIIN 

(wiih Zinc) SUSPENSION. .BOOTS 

The fall m blood sugar after injection of Prota- 
mine Insulin (tMth Zinc) Suspension is 
giadnal, and the Insulin carbolic drate metabolism 
reproduces closely the continuous secretion 
of Insulin as it takes place m the normal person 



N\ illi *.111 ill «Io«c*> (uiiilcr 30 iinHs) llie rii-k of 
In pophe iciui I I- le-i limn snlli Imiilin nni! 
I’rol inline Iii-ulin (vitli /Dine) Smpcn-ion is 
|) irliriil iris snlinililc for ii-c in „encr il prirliti 
bnipplicil III rubber nppcii anils ni ibe fo!Io«m„ 
slrcn,.,tlis 


to iiiiif* III 

ISO iinitf pi 


r c c 

ore M il 
10 c t anil 
r e r 

5 I I ani 


(200 iiinl') - 
(400 mill') 

( 100 mill') - 


2 , I 
1 '6 

I r> 


RELATIVE HYPOGLYCAEMiC EFFECT OF 

PROTAMINE INSULIN 

(WITH ZINC) SUSPENSION BOOTS=«dlllSUllfl 


BLOOD 5U0AR CURVES 


1 W 




a 



s 

1 

P 

m 

■ 

■ 

■ 

1 

bi 

■ 

i 


M 

m 


s 

s 

g 




I 

■ 


■ 







luaCH omaiR 




lltoful at fir cur\rt from n mnri ^5 yr^fl / * 

t In uim th^ frrnnl 
Jn i/in (i lib /inr) — Uoitt* Tb/* */' f 

tamr on loth ofcuiioni //rif J i 


Firll of the irnirornl of 

McHitu** mi!!i I’minniinc (villi 

Sii'*pen'‘mn tre ut <Hir liool f'TT 

of vim It vill hr •'ont <»rt rMpir*! to f 



J 


j 



JlU Ifi I01S 


THE BRITISH MEDICAL JOURNAL 


19 


HEPATEX WITH IRON 



A POWERFUL STIMULANT OF THE 
BLOOD REGENERATING ORGANS 
Of distinctive service in — ’ 

The anasmia of pregnancy 
Stubborn secondary ansmias 
Anasmia resultant upon haemorrhage 

In the maintenance treatment of Pernicious An$mia Hepatex with Iron 
affords helpful support during trying seasons of the year 


POsf Oiu or t 1 f,r dit\ i an pK lit tl t iiinjoril\ of ca\ts 


Hepatex with Iron a combination of Hepatex Liver Extract with a readily assimilable form 
of iron IS issued in 2-oz bottles 8/6 each 


Evans Sons Lescher & Webb Ltd. 

Manufacturers of Fine Chemical Pharmaceutical £ Biological Products 

LIVERPOOL AND LONDON 


MERSALYL B.D.H. 


It jrct on of 

The use of mercurial diuretics has 
become an established routine in 
ordinary clmical practice The su- 
penoritj of the sodium salt of salics I- 
(/-hy droxy mercuric- /S-methow propy 1) 
amide-O-accucaad o\er other diuretics 
is offiaally recognised, and this sub- 
stance has been included in the B P 
Addendum under the name ‘Mersaltl’ 
and as ‘ Injection ofMersahl ’ 
Alersalyl is indicated in \arioos 
oedematous conditions, particularK 


Morsa \ ' B P 

those associated 
dysfunction 


with cardiac 


It will be found m most cases that 
premcdication with digitalis consider- 
ably enhances the effect of mersalyl 

Mcrsalyl BDH is aiailable m a 
stenle buffered solution m ampoules 
of I cc and 2 cc , it is supphed 
also m suppositories for adjuiant 
treatment or for administration (follow - 
mg a single injection) m mild cases 


Literature on request 

THE BRITISH DRUG HOUSES LTD 

Telephone Clerkenwell 3COO Telegrams 


LONDON 

Tetradoms, Tele'?, London 


N I 


Mr3lfS/4a 


the BRITISH MEDICAL lOURN \L 


Jim K' EL'; 


.ivocr-' 










r?l t 






In aikemic conditions of 
nidetei mmate o) igni 

LivSgcn contains an abundance of supple- 
mentary principles essential for the conttol of 

” .mJ ^.s d=.ly t ”! r, d 

bv a marked increase m the number ot red 
Wood corpuscles , the lassitude, inert, a and 
Ick of zeS associated with antemia are over- 
come and w.d. renewed appeme and remrn 
Tnormal d-gemve proeesses Je ^ 

livogen 

Snm^'k on request 

the BRITISH DRUG HOUSES LTD 
LONDON N I 

Telephone aerken.cllBOCO Tcle.rnms Te.r.dome Tele. 1 on Jon 

Lfin/b 60 


S 1 1 “ © p t o c I d ® 

(p am,notenaen«a/p/.on<m..de f ™ns) 

1 «, * 1 . 


TherapeutienMnd^^^^^^^^^ 

Gonorrh oeal tract 

Therapeuticnl Scnrbunni 

""" kLtff VVonnds nnd Burns 

pis. SenrHUnM Rh.n.fs Wlr.t.ow 

Chronic Ulcor-ition Celluhti* 



''~:.‘'l'rnnnh.-a o -rrs’d mscJ;^ 


<25 0 25 Krml/3 « 5 prm !/« 

,„bc,.Usof^2^5^0 25. 

250 


Folcird Powders 


'o^^ cicrs •> »R 

,nbo«son 2 0 25 prm 2 /^ 


For external use ^ 

er; M,,p,oc,ae in solution .0 
Confiins 5 < -tr 0 

,_d.n 2nr ColHpsible TuBe, 3 ^ 

1 lb Tin’ 


P renp.K n, -'^o- ' 

„.ed in 2 or coiiiP’iMei^^^-j::: 


■ ,0.1 . -11 b”- ^tipn-n » TZTTc^y institute B> . — 

- v/ebb ltd. 

,*b.,c «QNS LESCHER & 

gVANS SONS j- 



Jlu I(V I‘)’s 


THE BRITISH MEDICAL JOURNAL 


21 



IN PREGNANCY 

T he phvsiological drain of calcium phosphorus \namins 
and other important food elements calls for replacement 
during pregnancy Composed of milk eggs and malt 
‘Oialtine’ supplies these essentials in a delightful form 
which does not osertax the unstable maternal digestion 
A cup of ‘Ovaltine’ on arising during the early months, 
IS often effectne in controlling sickness and has a food 
xalue greater than three eggs 

IN LACTATION 

To maintain lactation to the eighth month is an deal not 
often realized under modern conditions of life Ample 
esidence is available to shoss that ‘Osaltine’ has a definite 
action in increasing the flow and enriching the quality of 
the milk It has, moreover a beneficial effect on the health 
of mother and child The flavour is So agreeable that it can 
be taken for prolonged periods without any distaste arising 

A hberal supply for clinical seiul free on request 

A WANDER, Ltd, 184, Queen’s Gate, SW 7 

Laboratories and ^^orks KINGS LANGLEY HERTS 




/ rv miEr 

A dri f ed 
rhrs ctan ei 
ytemphjt 


m 



27 


THE BRITISH MEDICAL JOURNAL 


Jin Ifi IP 



Vi%W Oiir stand at the UIIITI.SII 
MEDICAL A.S$0€IAT10N 
EXIIIRITIOJV. PLYMOETII. 
JULY mth in 22nd. 




I 


KAYLEINE 

(Kn>knc Brand of Colloidal 
Kaolin ) 

KAYLEiAE-Ol 

(Kajlenc Brand of Colloidal 
Kaolin with highh vtscoub liquid 
paraffin ) 

AIAGSOnilEiVT 

(The oiiginai and “itiiuhid hniui 
of Svnthclic Ihdiatcd M iq 
ntbiiini Tiisilicatc) 


Sainplts and hh>atH>t. oblainabh ftom ibc io/c mannfaclia trs — 

KAYLENE, LTD., Sole Distributors ADSORBENTS, LTD, WATERLOO RD., LONDON, N W 2 


lilrflianc GLAdsloitc 1071/2/3 


Tihgrniin Am hiilol, Gold Ion' 


KOROMEX METHOD 

riie 

Korome\ Occlusive Diaphragm is made 
in a range of sizes to fit each indnidual 
patient, pure laicx rubber pessaries 
Light and comfortable, practically jnfelt 
Two-year durability guaranteed Prac- 
liiicners and birth control clinics, for 
more ceiliin protection, piefer to use the 
perfect filling Koroinex Diaphragm with 

KOROMEX VAGINAL JELLY 

Stainless and prolonged cffcctne 
spcimicide The carefully gauged ms- 
cosiiy of Korome\ Jelly affords the all- 
important mechanical block No tcMcit) 
01 irritation makes the diaphragms 


The Highest Record of PROVEN 
SUCCESS in Contraceptives 

A Evidence of the high degree of efficacy of the Koromc’: 
Method IS based upon the experience of 234 clinics— 
140 hospitals — over 50,000 physicians. 



THE KOROMEX METHOD 
KOROMEX DIAPHRAGM •{• KOROMEX JELLY 


cv-ier to insert 

ld\i'-c the Koromcv Method Your 
patient uiJ! be grateful 

1 sample of Koromcv Jella avill , 

be cent on application to mcdic-'i pr-’cti’ioners abo a O The Koromex Diaphragm appears on the , 

1 I T . .1 rai r- 1 . i, t f„. „ Control Associations approved list with seven s' , 

boc-kki the Pin sicinn s Guide on the technique of htlmg proUucts, inctuding Condoms, Sheaths. JcILei* 

wt. Occhnne Korotne\ Diaphragm No charge Write to Suppositories Price list and samples cn rcr.jsst 


EN7IF LIMITED, CONTRACEPTIVE SPECIALISTS, LONG'S COURT, ST. MARTIN'S STREET, LOHOOH- ViC J 

Sole agents in Great Brit <a in for HoI/and-Rantos Co iievi X® 


I n c 


1/ *iut rr/ nitf ri rt trirt^ rt "nJrrly tfti Pnnti/ /fi/frrU rly ^ftfhral fifiU/ttn f t^ntrnf t ptn* 
f'rurftt « kinitl% ii* JT # ghatl In supfity littrf nitftiJfiTi 

t Ttii nrrrns* that fisttirt tunts nrt #/>r r#o//v s» ri| 


Tin 16 


TnE BUITI'^w ''EDfCAL JOURN'L 


CRUNCHY FOODS AND THE 
HEALTH OF CHILDREN 


The inclusion in c\cr\ child s diet of a quantity of hard, dr\ food 
IS regarded as essential mam practitioners Such food compels 
thorough mastication , the regular exercise this gues to the )aus 
IS bche\ed to assist their correct dcnclopmcnt, thus preventing many 
possible troubles to the teeth in later life 

The importance of instilling the habit of thorough mastication is 
fiiither stressed because of us value to digestion, to which the 
practice of sw'alloumg insulhciently chewed masses of food is 
considered extremely harmful 

Many phjsicians therefore recommend that growing children 
should eat crisp Ryvita with their meals Free samples of Rvvita 
for distribution to patients will gladly be supplied on request 


'THE RYVITA COMPANY LIMITED 
g 6 - g 8 SOUTH HARK ST LONDON S L i 

Bakcrtci in Birmingham 


4^ 



c 


24 


PROMOTES METABOLISM 

To ensure a well balanced metabolism 
the tissues need more than heat and 
energy Organic elements and inorganic 
salts must be furnished in proper propor 
tion in order that the electric magnetic 
and chemical forces 


Prnle„lonal snmpirs and 
hleralure gladly , ,cnl on 
reouesi 


the BRITISH MEDICAL JOURNAL 


Juu lb 19 ^ 



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THE BRITISH MEDICAL JOURNAL 


Rn ](, )o 


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Ifi 


THE BRITISH MEDICAL JOURNAL 


31 



A POWERFUL URINARY 
ANTISEPTIC 



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A C OW 8c GATE I 




Moisture 

Fat 

Protein 

Lactose 

Mineral 

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Lactic acid 

Calorific 
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pH value 


0/ 

/o 

87 8 

O' 

lO 

24 

/O 

89 2 

O' 

'0 

3 1 

0 

'0 

90 4 

32 

'5 5 

1 7 

07 

0 1 

3 1 

28 3 

32 

33 0 

33 

44 

41 0 

45 

49 5 

49 

07 

65 

07 

74 

07 

08 

63 

07 

63 

06 

100 0 

100 0 

100 0 

100 0 

,100 0 

18 1 

129 

i 

14 3 

104 

104 

46 


4 6 


46 


r-j I 


PRODUCT 





BRITISH MEDICAL JOURNAL 

LO^DO^ S\TURDV\ JUL\ 16 1938 


THE CEREBRAL INTEGRATION OF THE OCULAR MOVEMENTS* 

B\ 

GORDO> flOLMIS. MD.I RCP.FRS 

rin^iciivi tL< Chanm, Crow Hoti'iial ami to tin \aiitmal Hoipiial for Ser\oii\ Diseases Queen Square 


It IS cusloniars among ns to commcmoralc great men 
from lime to time bj a lecture or discourse relating to 
their worlv or to some subject in which lhc> ssere inter 
csted To-da> «e meet to pas a tribute to the memors 
oC Victor Horstei almost on the tvsents second anniset 
sars of his death in the sersice of his counirs sshile 
strising for those ideals which characterized his life — the 
relief of suffering and the defence of Iiberl> 

Horsles s name is indelibls inscribed on the records of 
human achiesemcnt His ssork as a phssiologist is in 
corporaled in the heritage of our knossledge and he ssill 
eser be remenTbered as a pioneer in the surgers of the 
nersous ssstem which since his das has grossn as onls 
his faith 'could ha v foreseen But great though his 
achiescments ssere tn the realm of science it is his per- 
sonalit) which keeps his memors most sisidls alise to 
those of us who had the prisilege and good fortune to 
ssork ssiih him We recall his amazing cnergs his 
enthusiasm for knowledge the help he gase so liberalls 
to sounger colleagues his kindness and generosils and his 
unsssersing desotion to the welfare of his fellosss 1 
accept gratefulls this opportunit) to add m> contribution 
to Viis memorj 

The subject of this lecture is one to sshich Horsles s 
insestigations contributed materiallj some of his earliest 
ssork defined accuratel) an area of the cortex bv stimula 
tion of sshich ocular mosements could be obtained later 
he described the anatomical paths connecting the xisual 
cortex with the oculomotor apparatus in the midbrain 
and his latest experiments on the cerebellum svhich im 
fortiinatelj base neser been published in full dealt ssith 
the mosements and postures of the ejes which can be 
elicited on electrical stimulation of this organ or result 
from lesions of it 

There are seseral categories of ocular mosements In 
the first place sve can mose our eses b} an act of volition 
but fesv of their ordinarv mosements arc in this sense 
soluntarj or the result of a conscious effort An> pen 
pheral stimulus a^ mosement a flash of light or a sound 
may deviate our eyes insoluntarilj tossards its source 
sshile accurate vision demands accommodation and fusion 
svhich IS effected by so arranging the visual axes that the 
images of the object at svhich sve look fall on corre 
spending parts of the tsvo retinae Finally there are the 
compensatory or adjusting mosements by which the eyes 
' are kept directed on an object when either it or our 
I heads move The upper part of the brain stem contains 

’ The Viaor Horstcy htemoriat Leetore dcliscred at UniverMlv 
College Hospital Medical School on July 12 1918 


a complicated mechanism bs svhich all these types of 
mostment are cffecli.d and co-ordinaltd here we are not 
concerned ssiih this mechanism but ssith the more highly 
csolsed nersous Centres at the behest of sshich it acts 

All our mosements those of our eyes as well as ot 
our limbs and trunk are directls or indirectly initiated 
guided and controlled bs afferent impulses and in the 
case of the eyes the most important impulses are those of 
retinal and fabsrinthine origin The ssork of Magnus in 
particular has shown hosv the labsrinths either alone or 
in conjunction ssith proprioceptive impulses from the 
muscles of the neck ensure the correct postural adjust 
ments of the eves to changes of the head in space but 
in the higher animals retinal impulses suffice for the 
normal control of the movements and postures of the 
eyes even where the labsrinths or the fibres conducting 
from them are destroyed 

Differences in Organization of 3 ision between Man 
and Animals 

Experiments on animals base contributed much of what 
we know of the phssiology of ocular movements but all 
conclusions from such experiments are not applicable to 
man owing to essential differences m the organization of 
vision In the first place each human retina contains an 
area of highly developed scnsitisits at the fosea sshich is 
cmplosed cxclusiscis for distinct vision and many ot our 
ocular movements are directed to allow a distinct image 
of the object sshich interests us to fall on this part or 
keep It there in lower animals sshich do not possess 
differentiated foseae such movements are naturalls not 
fulls represented Binocular vision is also more accurately 
organized in man Further though in the phylogenetic 
scale Vision is the first function to acquire cortical repre 
sentation the visual cortex is more highls elaborated in 
the primates and in man complex associational areas 
svhich play a part in the movements of the eses develop 
around it The differences in the organization of cortical 
vision in various animals are obvious from the effects of 
destruction ot the occipital lobes All observers agree that 
in man no perception of 'ight or reaction to retinal 
impulses except contraction of the pupils can be obtained_ 
when the occipital lobes are destroyed In monkess 
closure of the lids occurs on sudden illuramation 
(Kluver) dogs can in addition react to differences in 
intensity of illumination (Marquis) rodents may recog- 
nize the position and distance of objects and even avoid 
obstacles (Lashley) while birds from which the forebrain 
has been removed may react even more normalls to retinal 

4045 


fill Hi 

Mlnicn 1 , 


108 July 16, J938 CEREBRAL INTEGRATION 


stimuli During ascent in the aninnl scale there has 
been, therefore, a gradual transference of MSion trom 
lower to higher levels of the nervous system, till m man 
It IS exclusively a function of the cortex 
Parallel with this movement of vision corticalwards there 
IS a similar ‘ encephalization, or transference towards the 
forebram, of the seat of reactions which may be excited 
by retinal stimuli till in man no movements in response 
to light are obtainable without participation of the xisiial 
cortex It IS therefore on the study of clinical matcrnl 
that we must mainly rely in any attempt to understand 
the physiology of the ocular morements m man But 
the methods should be the same as those of the experi- 
mental physiologist — to study the simplei components 
of a complicated function by isolating each of them and 
then attempting to integrate the separate parts into a 
normally functioning whole \Vc must, however remember 
that symptoms of dissociation of the ocular mosements 
cannot be simply interpreted as toss of function of the 
injured part they arc usually the response of the organism 
to the abnormal situation produced by the lesion and 
include, as Hughlmgs Jackson repeatedly insisted mani- 
festations of'disordcred activity of undamaged structures 


OF OCULAR MOVEMENTS 


impressions excited bv the stimulus md tint thne x u 
the frontal oculomotor centres but Mimk sluuvul' if. 
they could be still esoked after he had isphicvt 
occipit il lobe from the rest of the cortex h\ i (i 
incision That there is an apparatus m the cccipuil m' 
from which ocular movements can be excited dirceils 
made more probable by the demonstration b\ tlcevor arj 
Horsley of fibres passing from here to the anterior qimfn 
geminal bodies in the neighbourhood of the oeiitompia 
nuclei About the same time Probst dcserihcd ifn- 
cortico tcctal fibres in the cit According to later imhe.s 
as Minkowski, Bicmond, and Poljick they tikconemm 
the cortex around not within, the area striata Tlo 
descend through the occipital lobe medial to the ope 
radiations, ind pass through the puhmir and the inamr 
br ichium to reach the tectum of the midbrain 
There arc therefore two w'idcly scpiratcd corticil ana 
concerned m mosements of the ejes and each has ns on- 
projection Irict to the oculomotor mceliinism in the hr n 
stem A study of the eflecis of their injury ordestrulira 
throws light on their functions and on the pirt each taVc' 
in the normal organization of the oculir mosements 


Cortical Areas Concerned in Eje Mosemcnls 

In both man and lower animals movements of the exes 
can be obtained by stimulation of certain parts of the 
cerebral cortex One of these which was originally 
described by Hitzig and Fcirier but was more accurately 
localized by Bcevor and Horsley in the ape lies in the 
trontal lobe scpiratcd by incxcitable cortex from the 
motor centres of the precentral gvrus Cushing Foerster, 
Pcnficid and Boldrcy and others have demonstrated it in 
man The function of this oculogyric centre has natur- 
ally been compircd to that of the precentral motor area, 
but Sherrington has shown that in the chimpanzee there 
arc such m \rked differences m the nature of its responses 
IhU It IS ncccssirj to put it into a sepiruc physiological 
category It is interesting that Beexor and Horsley m 
contristing the responses from this frontal irea in the 
orang-outang with those they obserxed in the bonnet 
monkcj, recognized these same features— i slouaicss m 
dcxclopment md m execution of the moxements of the 
exes The projection fibres from this Irontil centre piss 
through the anterior portion ol the intern il c ipsulc then 
probablx enter the cerebral peduncle ind turn dorsahv irds 
into the tegmentum 

The fact th U destruction of this trontal centre does not 
produce i persisting palsy of an> of the ocular moxe- 
ments li is r used doubt on its sigmfic incc U m ix be that, 
IS Wermcke suggested all ocular moxements irc repre- 
sented in both front il lobes ind conseciucntlx as in other 
bil Iter ills inncrx ited movements the clfects of x one- 
sided lesion maj be compensitcd bv the unafTected side 
Permanent xotunlirx pa|s\ in min his however been 
dcseiib.d Vsx Tilling Lutz ind others as a result of 
bihteri! frontal lesions but Ferricr and Turner observed 
no piralvsis ifter remov il ot both front il lobes in the 
monktv 

Osular nuntnient can be ibo obtained bv electric il 
siumiluion ot the visual cortex on the inner ispccts of the 
oeeipit il lobes This Ovulomo’or are i vv is first described 
bv Sehiefei met t Uer sttiilied b\ Miink and others in- 
etuetine I e’erster in ni in Xteording to some it is the 
eo lex ininudMielv irotincl the visuil Tea r uher thin the 
<are I srisii whieh is extiiib'e but trom our point of 
vie' dll' m liters It "as n itiirallv sti 5 ,pested th it 

1110 1 ms elieilcii trom n ire elu,. to svii'jeetive visiivl 


Effecl of Disturbances of Trontal Centres 


Disturbances 'of the (unctions of ilic front i! emuo 
produce the more obvious symptoms These iisii illv to .’i 
from involvement of the frontal pi ejection fibres in if 
intern il capsule or in the neighbourhood of the intiriu 
pirt of the midbrain nthcr than of the cortex and mi! ' 
icspcct they ire comparable to the loss ol volimlarj ro' i 
in the muselcs of the lips, longue, pahfle, mil Iutv 
which chariclerizcs pseudo bulbir palsy 

The most sinking fc ittircs of a tvpical case ts tlic mibilii t 
the piticni to move Ins eves to commiml or wlitn ordeteJ " 
look at an object in one or possibh in mj dircsiion I or ina ^ t 
on command to turn Ins exes to the right or to look at an ' 
in the righi half of the field of vision no deviation of the t < 
occurs iliouth the effort at movement is olnioii'K i-tcii P 
iiicmpi IS often accompanied bv expressions of tloifcw r 
p ilient on being iskcd to look to the right first inrrcd 
head in lint direction tlicn jerked it ihout and raoed n 1'^ 
the pillow flexed his bodv forward ind rotated tt to 
tdvanced and flexed his arms clenched Ins fingers and cii' ' 
ind protested he tould not do it in ex implc of d c i 
trophic rx iction winch Goldstein Ins describ'd i o 
wilh f iilurc lo cirrx out a lask owing to ' "fcl'wi k 
Tven when the licad is iclivelv turned m the dc'itcd dll'" 
the eves oUen fill to move with it 


Tins condition at first sight shows all the apf'*'*' 
of loss or piriljsis of the moaxmcnl but lint ihivi'i^’" 
present becomes obvious when the subject is 
follow with his eves a slowlj moving object tb n f 
sided the rate ol movement is uniform and nnt t'’'’ 

1 full ringe of deviation m^iv be obi nned h 
ihe displ icement of the object he itfempts to fo!l‘"V 
rapid or irregnl ir the eyes most through onlj 
xnglc and quickls slide back to their poMlum 
tV'hen the pitient looks it i slowly roiihfi’ ‘ 
vhich lines or figures arc tiispliycd the cyts ^ 

- . . . _ u.t I - 1 


• ^1.^. f fl r* flfTII 




nvstagmus seen in norm il persons docs not tft ^ 
miv also fill to converge on i ncif object r' ' ^ 
so when a distant object is slowly ipproieheinu ^ 
\\c therefore find tint (hough solunia’'v ■ u 
produce movement the eyes folios a n o i'’ F 
ini iges of whicfi f ill on (he foveae 
Th- mnii-ncc of fovei) imp ibes on ttc c> - 
tf esc inovemcniS is obvioui hut tmpit! cs a 



Jl'L\ 16 I91S 


CEREBRAL INTCOR V^ION OE OCULAR MOVEMENTS 


"ntE BffTbH trjCT 

MEDtC^.1. JoCFSXL 


ilnlc neighbourhood of IIil nncuht nnj be <.frecii\i, loo 
II there ire two nnrks on i sheet of piper the pitient 
ni3\ bw umbic to turn his e\es from one to the other but 
he cm otten do so when the nnrks ire joined b\ n line 
his cves then as it were creep along the line from one point 
to the ne\t the movement being evciled bv i series of 
impulses coming Irom the coniines of the foveae Simibrlv 
the cves cm irivel along i scries ot closeh arranged dots 
the retinal imace of each succeeding dot being an adequate 
stimulus \ttenipts to read reVeal the same f icts the 
cves travel slowlv from letter to letter but if there is loo 
Wide a spiCe between the words the itlempt rnav fad At 
the end of the line he is un ible to bring his eves leftwards 
to the beginning of the nest line but frequentlv piiients 
surmount this dilTicultv In moving i finger slowlv along 
the line as thev read and bv it le id the cves back to the 
start of the nest line 

'lovemcnl of the cves cm be elicited even more e isilv 
bv cither active or passive movement of the head if for 
instance the subject is unable to look up or to the right 
his eves mav deviate upwards when his head is bent 
forwards snd to the right when his head is rotated to the 
left his ejes move simult ineouslv with his head and 
through an equal angle but in the opposite direction 
This compensalorj deviation has been bv several authors 
attributed to adjusting reflexes of labvrinthine origin but 
though this ma> be their nature in animals under certain 
experimental conditions vve shall later see reasons whv it 
Is not the explanation Biel'chovvskv who originallv re 
garded it as a lab)rinthine reaction later stated that this 
holds onlv if the movement of the head is quick and 
abrupt Labvrinthmc reflexes mav howeve' plav a part 
for in some of these pathological cases a compensators 
deviation of the e^cs occurs even when the lids arc closed 
and all retinal stimuli thus excluded and in a patient 
with complete cortical blindness whom I examined the 
eves moved to the left when the head was passivel> 
rotated to the right and vice versa On the other hand 
in two patients who were deaf and in whom no vestibular 
reactions could be excited 1 found that the cves moved 
with the head when the lids were closed as both retinal 
and vestibular impulses could be excluded the probable 
explanation is that the tone of the ocular muscles 
dependent on their own proprioceptive impulses kept the 
eves in their nomal relations to the orbits 

When the eves are deviated from their normal central 
position either bj following a slovvlj moving object or bv 
rotation of the head the patient mav be unable to move 
them back or he may^xperience much difficultv in doing 
so particularly if the eyes remain fixed on the original 
point this IS one of the arguments against compensatory 
deviation being essentiallv of labvrinthine origin for the 
stimulus which excites the labyrinths is movement and 
reflexes dependent on them cease rapidly at the end of 
the movement 

Further investigation of these symptoms helps us to 
understand their nature All observers have been struck 
by the fact that the paresis is variable under certain 
conditions no voluntary movement can be observed under 
others the eyes can move through a modified range at 
least Though in a typical case deviation of the eyes to 
either side on command or towards an object is impos 
sible the eyes move simultaneously with his head but 
in the opposite direction when his head is rotated If 
however the lids were closed or if the experiment is 
carried out in a dark room or if a screen is held imme 
diately in front of the eyes so near to them that no point 
can be accurately fixed this compensatory deviation docs 


not occur There must iherctore be a visual factor con 
ccrncd m the phenomenon and this factor seems to be 
fixation— that is the tendency to keep the images of the 
object It which the subject looks on the toveae either 
bv maintaining the postures of the eves or bv moving 
them 

The fixation Factor 

Anoilur senes of tests emphasizes even more strongly 
how important this factor is It in a normal person one 
car IS irrigiied bv cold water nystagmus is evoked ihe 
slow phase being towards the ear which is irrigated the 
sinie effeet IS obtained by passing a galvanic current 
through the two ears or bv rotating ihc person In many 
of thes. pathological cases however no nystagmus 
develops but the eyes become sironglv and persistemlv 
deviated in the direction towards which the slow phase ot 
the nvseagmus should occur — that is towards the irrigated 
car or towards the anode of the galvanic current This 
deviation is frequentlv so strong that it is uncomfortable 
or distressing to the patient It varies however iiifder 
dtITe ent conditions ot examination In one pitiem who 
lacked almost all voluntarv movements ot the eyes it was 
generallv very pronounced but on other occasions it could 
not b- elicited Further examination showed that its 
appearance was influenced mamlv bv ihe patients visual 
interest in his surroundings for when his eves were not 
fixed on an object or vvhen his lids were closed or his 
eyes screened a stron^ deviation could alwavs be obtained 
but vvhen his cves were fixed on anv point as on the exes 
of the observer who sat in front of him even the 
strongest vestibular stimulation often failed to produce 
any deviation Fixation which was the only variable 
factor in these experiments is therefore capable of inhibit 
mg the powerful reflex deviations which in its absence can 
be obtained bv stimulation of the labyrinth 

Fixation mav influence even volitional movements for 
patients in whom the degree of palsy is not great can often 
move their cves on command or look towards an object 
when accurate fixation is made impossible by placing 
convex lenses or a screen in front of the eyes In seve'ely 
affected cases the range of movement possible under 
these conditions is usually small and the movements 
which obviously need great effort are jerks and discon 
linuous but in milder cases an approximatelv normal 
degree of deviation may be observed 

In attempting to follow a moving object the accuracy 
of fixation also plavs a large part success is possible only 
when the subjects eves are accurately directed on the 
object before it moves and if its movement is so rapid 
or so irregular that fixation is for a moment broken — 
that IS if Its images no longer fall on or in the imme- 
diate proximity of the foveae — the eyes cease to follow 
It and recede towards their position of rest 

These observations explain a cunoiis paradox which 
has often been observed in these patients Though they 
fail to move their eves in one or in all directions on 
command and to turn them towards an object the eyes 
may at times move about in a more or less normal 
manner Tiling in the first recorded case of this type 
found that though there was apparent paralysis of xerlicai 
deviations and of movement to the right the eves some- 
times moved involuntarily in these directions m Bristow s 
case recorded a few vears later the eves moved mde 
pendentlv ""of her will though there was no power of 
voluntary movement in a similar case Roux reported that 
nothing in the hospital ward escaped the patient and 
one of my own cases was regarded by the nursing 



110 July 16, 1938 


CEREBRAL INTEGRATION OF QCDLAR AIOVEMENTS 


attendants as “hysterical, as they obser%cd that his e\es 
frequently moved about as he lay m bed but failed to 
do so while being tested Such spontaneous nlo^enlents 
arc most often seen when the patient is dro\ssy or half 
awake, or when he is in a state of emotional excitement , 
for instance, one man who was unable to mo\e his eyes 
voluntarily became excited while being prepared for 
vestibular tests, and his eyes rolled about in all directions 

It was also repeatedly found that when these patients 
tried to look towards an object they employed \arious 
devices by which to interrupt the fixation of the point on 
which their eyes were directed some blinked or closed 
their eyes momentarily, or jerked their heads abruptly , 
one man occasionally brought his hands before his eyes 
It is therefore obvious that fixation of the e^es on an 
object tends to impede voluntary ociilai movements and 
can even inhibit the powerful reflex reactions excited by 
labyrinthine stimuli It is now necessary to consider the 
nature of normal fixation 

Tlic Nature of Normal Tixation 

Fixation means the maintenance of postures of the exes 
by tonic contraction of the ocular muscles so that the 
retinal images of the object which is fixed fall on the two 
foveae These postures can be kept up with remarkable 
accuracy for long periods It is true that fixation in this 
sense is only relative, for the lines of xision constantly 
oscillate through small angles about the point fixed and 
consequently the images move oxer the foxeae this axoids 
sensory adaptation and the appearance of after-images 
xvhich xvould interfere xvith the acuity of vision But 
fixation does not imply only immobility of the globes in 
relation to the orbits, for we can fix moving objects and 
keep our eyes on a point when our heads arc in motion 
this requires constant adjustment of the eves by con- 
tractions and relaxations of their muscles, for the slightest 
displacement of the head necessitates a compensatory 
dex nation of the ejes in the opposite direction, so accurate 
and immediate that the foveal images remain relatixclj 
stationary By voluntary effort alone this accurate adjust- 
ment of the eyes would certainly not be possible and the 
observations referred to above show that fixation may 
persist when volitional movement is defective Fixation 
must therefore be regarded as in part at least a reflex act 
But fixation, as all the other visual reflexes requires per- 
ception— that IS tne intervention of consciousness— ind in 
this respect the fixation reflex differs from those reactions 
in which onlv the lower levels of the nervous sjstem arc 
concerned, to which the term ‘reflex is usually applied 

Normallj', fix ition is under the control of volition for 
we can move our eves from object to object as vve will, 
but when voluntarv movement is defective the fix iiion 
icflex becomes so dominant that the eves max remain 
mchored to an object and can move from it onlv when the 
reflex is broken bv interruption of the retinil impulses It 
Is for this purpose th it persons affected with this condition 
blink jerk their head or pi ice a hind between their eves 
ind the object vvhich fixes gaze ^\e cm sp^ak of the 
p iihological condition as spismodic fixation It w is 
first observed ind cirefullv described bx Gowers in 1879 

Spasinodie and Reflex I ixation 

Spisioodie fix ‘lion IS eompiriblc lo the sp istie paresis 
\ tiieh lesulls troai lesions of the cortico sp n >1 Ir els in 
this eorulitioa ihert is is in the eves i defect ot xoliirt'rv 
pe'.vcr but movement is also interfered wnh by increased 


tone of the muscles due to uninhibited reflexes initiUui f, 
proprioceptive impulses from the muscles thcnisehcN i^i 
It disappears when the muscles arc deafferemed 
exaggerated lone of the ocular muscles on the other bird 
is dependent on retinal impulses acting on a eo ti, ! 
mechanism no longer under control , when thew in 
pulses are interrupted tone decreases the power o' 
Voluntarv movement improves ind the responses to oif t 
stimuli either voluntary or hbxrinihmc, ire no loner 
impeded 

It IS impulses of toxeal origin which determine rePex 
fixation On the other hand the chief function o! iK 
peripheral parts of the retinae is when an image exutev 
them to bring about such movements of the exes ilni |X 
images fill on the foxeae James his aptly said ihit i'- 
periphery of the retina acts as a sentinel which crieso i 

Who goes there’ and if necessary calls up the nioie 
accurate vision of the foxeae Owing lo the ineriinpr 
'sensitixily ot the retina as the toxca is approiehcd iv- 
tendency ot pcriphcril retinal stimuli to delermint fixtina 
IS grciter the more closelx to it the imiges fill I im m 
adult life these fixating moxements arc lirgelv reflix j 
flash of light or a sudden moxement in the ptriphay C 
our fields of vision attracts oiir gaze whether uc nuh ii 
or not This reflex xvhich determines the fixation of exiri 
foveal images is the means by which patients siif[crin» 
from paralxsis of voluntarv moxement cm rent fplknv 
a line with their exes, or count a row of dots cicli ux 
cceding letter, dot or segment of a line tends to exuv 
a moxement, and if the impulse which initiates it con' < 
from near the fovea it mav be intense enough to intamr' 
the strong fixation reflex which tends to impede il) iL 
other visual oculomotor reflexes as it does voliiniin 
movement of the eyes 

A special feiture of these reflexes is that they imp!' 
in iddition lo conscious perception, interest and iiiiniic' 
It IS only the object vvhich occupies itleniion tint ewi' ' 
the fix ition reflex , only the succeeding word or dot wtixi 
interests the patient that draws his eyes towards it cr'i 
the gesture in xvhich he recognizes a threat or dm 
xvhich makes him blink and turn his eyes iway 

Other svmptoms which some of these palienis p c^r 
throw further light on the nature ot this condition F' 
instance, one man who ilso suffered from severe P'civo 
bulbar palsy vv is unable to separ.ilc his lips, open 1 ' 
mouth, or perform the movements of chewing on o' 
mand but when bre id was placetl m his mouth ' 
misticatcd it , he could not protrude his tongue bill wh ^ 
siigir wns placed on his lips he licked it In these rc'f 
he was simply a reflex machine If shown iprvU’ ^ 
food he merely smiled but if the food vv is broiighi *'o' 
towards his lips his mouth opened at once .and b'’ F. ‘ 
to champ his jaws as if chewing but this occiirrei i^ 
when food in which he was inicrcsicd wis aprrp'’eli e 
his lips He therefore possessed anotlicr visuil rd ' 
that IS, a compile itcd purposive action indcp.nee" ' 
volition — vvhich was excited by rclin il imprcsvio, - 
which entailed not merely perception of in obi'e ' 
ilso recognition of its nature and of its spiinl f'l' 
to himself ^ 

The inatomicil lesions responsible for He ci ' 
chnractcrized by loss or diminution of ibe p 
voluntarv movement msoci iled with ‘ 

fix lion reflex miv be siiiiited in vinous P'' 
brain In i few of the recorded cas^s there v e'c b 
injuries ot the front il ceulomotor centres ili ’ > 
but more commonlv the p ojcctun tifc' fn ^ 
centres Were involved in the intern il c ip uF t 



Jit\ 16 I'^^S 


CERLBRAl INTEGRATION OF OCULAR MOVEMENTS 


T»{i. BurroH 
Medical Joltn^l 


in 


It It i< an imi-ri-^ting fact tint as m the ctsc ol the 
supranuclear palsies of the facial and bulbar muscles these 
pirals-ses of the solunlarj ocular mosements arc more 
commonh dm. to alTcctions ol the projection tracts from 
th^ cortev than of the cortc\ itsell In some cases the 
discise ssas lamilial and progressive probablv a primarj 
degeneration of these fibres fvon Pallatlu Ballet 
Canlonnet and Taciiet) 

Effects of Interference nilh the N isual UeBcees 

On turning from this condition charaetcri/ed b> loss of 
vohintarv movement and exaggeration of the fixation 
reflex to a studv of the cfTcets of direct interference with 
the visual reflexes vve encounter considerable diflicultics 
for all these rcllcxcs use the same afferent paths as vision 
and probablv arc mediated through the same cortex as ih it 
bv which visual impressions are perceived Consequcntlj 
lesions of their afferent fibres or of the cortical reflex 
centres cause at the same time loss of vision and m 
absence ot vision these reflexes cannot be studied Since 
however the cortico tcctal fibres which constitute the 
efferent limb of the reflex arc run a dorsal course through 
the piilvinar thev maj be involved bv lesions which spare 
the optic radiations as well as the descending fibres from 
the frontal oculomotor centre Bilateral injurj of these 
cortico tcctal fibres is ver) rare and as part of each fovea 
from which the more important visual reflexes arc excited 
IS represented in both hemispheres of the brain unilateral 
lesions do not produce striking effects 

UTicn vve wish to see an object distinctlv we usuall> 
adjust or move our heads so that our eyes in their position 
of rest are directed on it this posture of the eyes demands 
little if any effort and voluntarv action alone may suffice 
to keep It up ft IS often bv rotating our heads too that 
we follow a moving point or a senes of closely spaced 
objects as in reading The fixation reflex is therefore 
not essential and its absence causes no pronounced dis- 
turbance But when the eyes arc turned widely from the 
middle line the maintenance of the new position demands 
considerable effort and tt tires rapidlv even when supple 
mented by a normal fixation reflex but as long as the 
deviation is kept up fixation is accurate If however the 
reflex is defective fixation cannot be maintained accurately 
bv voluntary effort alone though the ocular movements 
are unimpaired This disturbance is most commonly seen 
on deviation of the eyes to one side ^\^le^ the patient 
IS asked to look at an object to this side he moves his 
eyes promptly towards it but he fails to keep them 
directed steadily on it they quickly recede towards their 
position of rest and are brought back by a senes of jerks 
which arc obviously voluntary In following a moving 
object, especially if the rate of movement is not uniform 
or if his head moves while he attempts to fix a stationary 
point, the difficulty in keeping up fixation is even more 
pronounced the necessary ocular movements arc possible 
but the reflex maintenance of the position obtained is 
deficient This failure to fix accurately is generally more 
pronounced the further the object to be fixed is from the 
middle line, in other words it is roughly proportional to 
the muscular effort which the deviation requires 
When this disturbance is bilateral the symptoms arc 
more striking The patient complains of inability to sec 
distinctly or to focus properlv When his head is not 
steady as when he walks or rides in a carriage the 
difficulty in obtaining clear vision of any object is even 
greater That it is not merely due to diplopia or failure 
I of fusion of the retinal images is evident as it persists 
when one eye is closed Orzechovvski has given an excel- 


lent description of this condition in two patients their 
eyes oscillated about the object they tried to fix they 
were unable to seize or hold objects with their 
eyes cspeciallv on deviation to one side in reading they 
failed to follow accurately letters or lines moving objects 
could not be accurately followed bv the eyes and when 
walking or in motion thev were unable to recognize 
or distinguish objects by vision Erb and others have 
observed similar cases 

Here there is no question of ocular palsv or ot 
nvstagmus from which the condition differs in its mam 
festations and in the disturbances it produces vision is 
normal or at least adequate scotomata are not present and 
there IS no defect in visual orientation — to anv of which 
inabilitv to fix accurately may be due There is conse 
quently a state characterized by a failure of fixation 
though the muscular apparatus of the eyes and its central 
innervation is intact it is essentially an mabilitv to keep 
the eyes steadilv in a position to which thev have been 
brought bv voluntary contraction of their muscles 

It is well known that when hemianopia js present the 
patient often fads to keep his eyes accurately on a point 
to the hemianopic side even when they are directed 
towards it This had been usuallv attributed to the lov> 
of vision but as his gaze may remain fixed on a point 
directlv in front of him — that is when his eves are in their 
position of rest — it is obvious that this cannot be the onlv 
cause Further this failure to fix may be present even 
when there is some degree of macular sparing The more 
probable explanation is that the voluntary movement i> 
not supported by the fixation reflex which is normallv 
mediated by the damaged or isolated visual cortex 
Inadequate fusion or defective accommodation may be 
partly responsible for the disturbances of vision of which 
these patients complain One of my patients said he 
could not fix his eves steadily and that thev tended to 
roll about another that she could not focus and that 
on attempting to read the letters ran into one another 
In neither of these cases could diplopia be demonstrated 
yet both read more easily with one eye closed the fusion 
reflex bv which the coalescence of the two images is 
effected in binocular vision was evidently at fault 
Biclschowskv has also described loss of fusion in a case 
with lesions m each occipital lobe 
We have seen that when the fixation reflex is not under 
the control of other cerebral mechanisms there is a ten- 
dency to exaggeration of its function with the result that 
the eves cannot easily be diverted from the object on 
which they are directed In these cases on the other 
hand the fixation reflex is defective and post mortem 
evidence goes to show that this defect is due to inter- 
ruption of the cortico lectal fibres which form the efferent 
limb of the reflex arc In my own cases which were 
verified the disease involved the dorsal portion of the 
thalamus including the pulvinar 
These two series of observations are complementary 
The most striking feature in the one series was loss of 
deficiency of voluntary movement associated with a ten 
dency to persisting fixation of the eyes on a point in 
central vision from which they could not be easily 
diverted by will or even by the intervention of other 
reflexes unless central retinal impulses were suppressed 
In the other series the subject was unable to keep up 
fixation accurately particularly when he or the object 
to be fixed was m motion, and in some cases fusion and 
accommodation were probably disturbed too 
These observations, have emphasized the reflex nature 
of fixation, but there can be no doubt that under normal 



112 JUL\ 16, I93S CEREBRAL INTEGRATION 


conditions fixation is partly voluntary The fixation reflex, 
however, supplements and steadies the voluntary effort 
but It IS, on the other hand, under the control of volition 
On the normal co ordination of these two functions the 
accuritc and purposeful use of central vision depends 

The Brain and Oculomoior Actisitics 

We can now consider what parts of the brain arc con- 
cerned in these oculomotor activities and then discuss how 
in normal life they work together 

All evidence at our disposal indicates that the frontal 
oculomotor centre is concerned in those movements and 
reactions of the eyes which we may call voluntary 
Through it we can by an effort of will look or turn our 
eyes in any direction and converge them on a near object 
By It, too, we can keep our eyes directed on any object 
that interests us, though this is largely a function of the 
occipital cortex 

The functions of the occipital centre arc more 
numerous Fusion — that is the reactions necessary to 
unify the separate impression Irom the two ruinac — and 
iccommodation depend on it The movements of the 
c>cs to an object outside central vision, in so far as it 
IS involuntary, is also excited through the occipital cortex 
by extrafoveal impulses And finally the maintenance of 
fixation on a point, whether it is at rest or in movement, 
IS determined by a cortical reffex mechanism in the 
occipital lobes 

The abrupt turning of our eyes to an unexpected sound 
oi towards a peripheral stimulus is a more comphcitcd 
reaction which implies spatial loc ihzation , the eridcncc 
as to the oculomotor centre through which these move- 
ments arc effected is incomplete, but the frontal cortex 
IS probably concerned in them, for whit we know of 
Its organization indicates that no part ol the cortex is 
desoted cxclusivelj to socitlcd voluntary activity In 
other reactions, as blinking and ivcrsion of (he eyes 
Irom threatening gestures and in ocular movements which 
imply judgment ol the nature of the stimulus md of its 
position in space, more extensive ircis ot the cortex arc 
involved The reaction to thrcits can for instance, 
ibolished by smill lesions of the puietil lobe, and the 
experiments of Radcmakcr ind Geldcrblom show th it in 
the c it the associated closure ot the lids tiepends on the 
initgiilv of the sensorimotor cortex The movements of 
our eves m icsponse to hbvnnthine and other proprio- 
eeptivc impulses is effected bv subcoriie il mechanisms ihc 
lorebnin is not concerned in them 

rbc integration or h irmon ous working ol the different 
puts eonctrned in otuhr movements and postures is to 
sv'tiie extent revelled b) the disintegr itions ot Ihes^ func- 
tions winch We hive studied md these serve ilso to 
illusir ite other letivuies ot the eortev 

In the eveiliition ol the brun vision is the first sense 
oinn to obt itn i present ition in ibc eortex oi the tore- 
Irvin Even in bird-, tibies curving retinal impulses 
Kiel) whit Is regirded as the origin il neopalhum il is 
onh liter in evolution ih U other sense orgms ill iin 
einiie il eonnexions md it is still liter tint so c died 
moti’i eentres ipp. ir XSith vision too, loeihzition 
m i!u euitex re lelicd its lenve tor cverv pom' ol the 
ae 111 le IS represented rigidlv in u ih^n the br iin it 
■ v ms sp^ leleologie llK eleelded tbit swell i riLid 
* ut It. o S ti Isvii iWe to Us tlirther deVelopni.nt nd 
I't p el! IIH e pl's’ic O e mi/ tion tor its 1 iter e ohetl 
ik u'» s It |s Cl 'iskkju.n U noi surpri'ine ih u coriieil 

1 I le elio S in. ! lo e lligli! o e mi/ed md pv'sibls 
i 111 ed on eiiiip\rp'in th in ellur eereb d etivities 


or OCULAR MOVEMENTS 


Even m birds the original visual cortex is Lonm^iuln s 
the roof of the midbram bj effcrinr fibres— the tr.u 
occipito mescnccphabcus of K tppcrs-wlueh ire prcbab'i 
the homologiie of the cortico tect.al fibres ot mmimiX 
and by means of these the cortex ma\ be able to infli u, 
rcvctions, including ocular movements and postnus ^ 
response to retinal stimuli As the cortex hiume 
mam, and finally the exclusive organ for Msml 
tion the primary visual reactions— as rellev direetwn el 
the eyes to light, accommod ition, lusion when himxu’jr 
vision was icquired, and fixation— were transferred to k 
till in man they can be evoked through it onij Th r vi 
step in development was the appearance ot isscx.iiinpil 
areas around the visud cortex which enable it lose 
operate with other sense impressions and lo cliboru 
further the faculties of spitial perception disenmnuiion 
and recognition At this stage in evolution eontuT a 
visual reactions by higher ccrcbrd functions— is vo 
sciousncss, utention, and discrimination— hceame mu 
sary, and the newer cortex of the frontal lobe w n givn 
this task Now that the exploration of sp ice b> tin no 
and the direction of gizc towirds in) object of infui i 
no longer depended wholly on visual impression, remiun 
to vision were no longer confined by the falild) oi i 
reffex there was now ,v mechanism b) wliieh bctnvn' 
and reactions lo environment could be grcatl) evlmdaf 
This IS the prim iry signihtance of the tlevclopnwnt o( 3 
frontal oculomotor centic 


But in order that a highly evolved funetion n 
idcqualely serve its purpose it is cssentnl thil it i 
control subordinate mechanisms, so the front il un' 
became not merely m organ from which otuhr mo 
ments could be evoked, it acquired itso the poi'U >' 
inhibiting inappropriate and undesirable atlivilits of i' 
occipital lobes The importance m ordiniry lift of '* 
faculty of inhibition is demonstrated b> the cxietti i 
ol the fixation rtflex when the voliinlir) motor ctiiire 
tilt front il lobes ire out of itlion , the t)cs ilitn b o'" 
fixed on an object to ibc exclusion ol the rist o' <' 
environment 


Conclusion 

\Vc can therefore eonelude tint in iiormil lom’'' 
there IS in iccuntelj vvijiisted cooper ition htUui'' 
pirls ol tile cortex concerned in ocul ir niuu i 
Through llic occipital tenires some visiiil rtlltso i' 
moiLiiunls which luin our tjts low irds objttts i' 
field of vision other rcfltXts delcrniint bv hi » ' 
vccommod Ition the tcciinie ptrecpiion md il'- 
tion of binociil ir mi igts others Itep iht e)ss fn 
inv point which cliims iitention or tvcile-. mtin i < 
front I etnlres m ike possible the turnim; of j in 
desired direction md the explor ition ol sp st * ' 
ilso keep under control or inhibit reffexis flu' 
ippropn lie to our tondiiei oi our re itlions to I 
iround us 


The Coflee. o, PfissiLiirs of Pin! idelpbu I - 
Xlv rent i Prirc lo Di Haliird 1 opt of tic f 
In lilijit for Mtdie il Kc tifth Pfinttloa X J (c I 
recent rc t refits on the itliolo,. ril cr 
infliicn/ Ihc pri/c v is csi ih!is(;e<l h d '■ ’ 

1 r irci eo I'e Cos 1 Xi irer i of i i roa f’o'‘n 
el It fthov tlic { oU'ft of Pb s .1 r, to ' 

siiniidi bv lb- College of Ph lei s or <• ki 
ilic dt ih ot It,'- itsiao Jut I- ly'"' !<’ '* ^ 

be-I irtrrorid o' tirpuHis’cd fs i' if'' 
r likirc whieh n ) be I'ccrci' i o t‘i r ! tf ^ f i ^ 



Jun tC< 


Tre Bmthk 

MiI>rC4L J-JCTIS^L 


113 


CHRONIC MASTITIS AND BREAST CANCER 


CHRONIC M\STITIS AND BREAST CANCER 
\ r\Min iiisToin or rni sisters 

v\ 

S\MrSON HANOI LI, M S IRCS 

Cf>/ iii/n/ii, SiirQeon to the \iitlillc5cx Hospital 
(\\ mi Sri cuL I’l ml 

Tins historj of a tamiK of five sisters pursued bj breast 
cancer cosers a period of about nineteen jears during 
which with regrettable gaps hesitations and relusils of 
adsicc I base b.en jointlj responsible with their own 
doctors for their defence against the famih foe it is 
known that Ihcir mother died at the age ol 69 of cancer 
of the liver and her mother at the age of 37 of abdominal 
cancer probable gastric since it wns attended bj persistent 
vomiting 

In advising this famdv I have b.en guided b> the follow 
in^ convictions 

till Chronic mastitis is a prccanccroiis condition 
(11 Chronic mastitis is often amenable to deep v rav treat 
ment viithout operation and consequcntlv deep t rav or taduim 
I'catmcnt mav be an efleclivc prophvlactic acainst cancer 
<<r> The prolcclron afforded bi r rai s is neither absolule nor 
permanent, and cases so treated should cone cverv ilirec or 
SIS months for rc-esammation 

Id) Cases of chronic mastitis in immediate dancer of cancer 
present recognizable clinical pcculianties and should gencrallv 
be treated bv masiectomv 

Irl B'cast cancer should be treated bv radical operation 
vvitn simultaneous radium lo the internal mammarv glands 
and subsequent modente prophvlactic eradiation Escep 
tionallv Kevness radium method mav be preferable 

Five Separate breast cancers in the familv hive been 
treated b> radical operation — four bv mvself and one bj 
Mr Turner Warwick and in addition two simple mas 
tectomies have been done — one for incipient cancer the 
other for precancerous mastitis In the result two of 
the sisters have died of breast cancer and three are vvell 
at the time of writing The two sisters who died sur- 
vived operation eleven and nine )cars rcspectivclv These 
results in the face of intense predisposition to the disease 
in a bilateral form offer encouragement to mv belief that 
routine mastectomy for chronic mastitis — a polic> cquallj 
distasteful to patient and surgeon — can be safelj rejected 
in favour of x rav treatment followed bv periodic exam 
inalion with mastecIom> in reserve if danger signals show 
themselves 

If I have described these cases at length it is parllj 
because close personal observation of such a group over 
such a long period is perhaps unique but mainij because 
in these histones the whole important question of the pre 
vention of breast cancer is involved To avoid a running 
commentar> upon the case histones I here submit some 
general remarks upon the nature and treatment of chronic 
piastitis 

Oinical Characters of Chronic Mastitis 
It IS rare for the induration of chronic mastitis to affect 
the whole breast The upper and outer quadrant of the 
breast is the seat of election as for carcinoma and the 
fact emphasizes the genetic link between the two con- 
ditions The indurations of chronic mastitis affect the 
breast b> lobes and consequentlv like the lobes them 
selves thej are sector-shaped broader or narrower 
according to the number of adjacent lobes affected, often 
multiple in the same breast and sometimes symmetrical 
in the two breasts 

For their appreciation a special technique of examina 
tion IS necessary, resembling that of a cat treading its 


bed preparatory to lying down A displacement of the 
swelling upon the pectoral produced by alternate pressure 
of the two hands lightly laid upon the skin enables its 
outline and character to be accurately determined as it 
slips to and fro under the fingers Except in the cvstic 
form ot mastitis it is not a defined lump but a fine's 
granular induration None of the signs of contraction 
or adhesion is present The glands if enlarged are soft 
and often tender 

Chronic Mastitis — a Prccanccrous Condition 
It IS impossible within the scope of this paper lo marshal 
the evidence that chronic mastitis tends to end m carci 
noma In mv book (Handles 1931) I believe I have 
proved that chronic mastitis and eventually carcinoma 
arise within local areas of lymph block in particular lobes 
of the breast The lymphatic block results from Ivmph 
angitic surface infections often unnoticed ot the mam 
ducts near the nipple A state of papillomatous hyper- 
trophy within the smalle- ducts is seen in the later stages 
of chrome mastitis as Lenthal Cheatle showed and this 
IS the immediate precursor of carcinoma All the stages 
of the process from simple Ivmph stasis through chronic 
mastitis to early carcinoma can often be demonstrated in 
the same breast 

Hormones and Ch'onic Mastitis 
Normal physiology — the rapid development ot the 
breasts at puberty and the recurrent monthly congestion 
and tenderness of the breasts just before each menstrual 
period — demonstrates the important influence upon he 
breast of the ovarian hormones Lewis and Geschicl ter 
(1934) showed that the injection of oestrm into the breasts 
of male monkeys produced a feminine tvpe of breast, 
a condition of gynaecomastia Lacassagne (Cheatle I93s) 
experimenting on young male mice found that a course of 
ocstrin inj.ctions produced in some weeks a cystic mastitis 
terminating in carcinoma Cramer and Homing (19 ’6) 
showed that heavy doses of oestrm produce degeneration 
of the adrenals together with an initial stimulation 
followed bv subsequent destruction of the anterior 
pituitary^ Quite recently they have found that these 
changes in the anterior pituitary produced by oestrm 
can be kept in check if the thvro’ropic hormone of the 
anterior pituitary is injected in suitable doses They 
funher find that the administration of this thvrotropic 
hormone to females of a strain of mice in which half the 
females die of spontaneous mammary carcinoma affords 
apparently complete protection against the disease 
(Cramer and Horning I93S) The therapeutic hint ot 
this striking piece of work is obvious but it will lake 
some years to lest the suggestion it contains The Ivmph 
stasis theory of chronic mastitis and cancer to which I 
have referred is perfectly consistent with the view that 
hormones play an essential pan in the causation of these 
diseases It is obvious that local areas of lymph obstrue 
tion must necessarily be areas where the hormone supply 
IS defective for the regular flow of the tissue fluid through 
these areas is more or less arrested Hormones mav fail 
to reach such areas or may accumulate m them to excess 
Lymph stasis supplies the localizing factor which deter- 
mines the site where the cancer anses 

Treatment of Chronic Mastitis 
It has been fashionable of late years to treat chronic 
mastitis empincally by oestrm The expenmental evidence 
just detailed would seem to show that the treatment is 
irrational and possibly dangerous I have recently seen 
a case of cystic mastitis in which the patient herself 
was convinced that her breast trouble dated from a course 



114 Jun 16 1918 CHRONIC MAST n IS AND URCASr CANCCR 


Tilt Rmimi 
Rlimrii. loijsAi 


of OLSirin injections Whether treitment uith intciior 
pituil ir\ th\rotiopic hormone will succeed in preventing 
hum in cineei is .v question jet to be decided It m ly 
prose difficult is in the cise of tubeieulm to get the 
remedj to the letu il se it ol the diseise Me intime we 
lu\e It our disposal i method of prosed s due 

\ ItSS I HI SISII M 

In 1910 1 idsoe.ited the X r IS treitment ol chrome 
mastitis and eser since in hundreds ol eiscs I hise ad- 
siscd Its use instcid of mistcetoms, svith good results 
Pun promptls disippeirs ind in i few weeks obstmite 
mistitic mduritions often compictels s inish I he proof 
tint bv this treitment m in> brcist e meets base been 
presented is nituriil> sets jilifiicult but the esidenee 
which I reseisc lor molhei piper, ruses i prtsumplion 
tint such IS the truth 

Danger Sigiuls in Chronic Mastitis 

The chxraelers ot chrome mvstitis m sonng ssomen 
hise just been described As the e nicer igc ipproiches 
the elise ise mis show one or moic ol the Uxllowing 
dinger sign ils all ol them dependent upon the lormition 
of idscntuious fibrous tissue in the iffecicd lobe or lobes 
These signs cinnot here be described in del id Thes 
irc 

Mi'll I eiisstrs 

1 Retr iclion of one or more of the duct oriliees upon 
the nipple ssithout retraction of the nipple itself 

2 Serous or blood st.iincd disch trge Irom the nipple 

3 Desiition of the i\is of the nipple 

4 nics ition of the nipple 

5 Appcirancc upon the nipple of white or blick dots 
from svhich plugs of degenente epithelium can sometimes 
he squeezed 

6 n ittening of the nipple 

7 Retraction of the nipple 

tlRfAST CIMNGI S 

1 Appear incc of multiple hard clistic or fluctuant 
lumps in the mastitic area (cystic mastitis) 

2 The presence near the nipple in the mistitic ircx of 

r idiating tortuous cords svhich ire thickened main 
ducts ' 

3 Adhesion of^’the breast to the skin or the pectoral 
fascia IS rarely se'en except in fullv dcs'clopcd circinoma 

I Case Histones 


The case histories, subsequently to be given in detail, 
are siimmarizell in the following table 


] 

1 

Dtvc \ 
of 

Birth 

Brc-ist 

Left Breast 

Result 

SiMcr A 

1871 

Mass Tppeared m 
1930 just before 
deith (Second 
pnmary circi 
noma) 

Primary carcinoma 
1919 (Radical 
mastectomy) 

Died 19^0 avith 
signs of pNloric 
obstruction 
due to a pn 
mnry gastric 
growth or to 
secondary ab 
ci o ni 1 n a 1 
masses 

Sister B 

1875 

Prinnry CTremomn 
J925 (Radinl 

mastectomy) 

Primary carcinoma 
1937 (Radical 

i mastectomy) 

Alne and well 

1 19-^8 

^Sister C 

1879 

Proliferative mas 
tills and incipient 
carcinoma 1933 
(Simple masiec 
lomy) 

Mastilic induration 
1930 (Surface 

radium treat 

ment) 

ProlifcraliNe mas 
litis J930 (Sim 
pie mastectomy) 

Ali>c and well 
1938 

D 

1885 

Mastitic induration 
1929 (\ray 

treatment) 

AliNc ami well 
w ith normal 
breasts 1938 

Slater E 

1886 

1 

I 

1 Second primary 

1 carcinoma 1927 

1 (Radical 

I tomy) 

1 

Primary carcinoma 
1923 (Radical 

1 mastectomy) 

Died in 1932 of 
recurrence in 
supi acla\ icwlat 
glands ster- 
num and spine 


sisnn s TORN 1871 VNMsnmiD 
In 1919 1 openled upon this patient for a circnonn m 
the lower outer quadrant of the left breast fhe crowih h a 
been present since 1918 w is 2J inches m diuneter, anil ins 
idhercni to skin and muscle llioiigh clinicalK the asilhn 
glands were not enl irgcd Microscopicil section showed a 
rcgiilir spheroid d cell circinoma with considerable tubule 
formation but the isillirs glands were free from growth 


She rem lined m good hcilth until 1929 when she began 
to suffer from irilinlis of the spme and hip Rndiognphs 
showed no cMdcncc of sctondirj bone deposits In Noicmber 
of ilic simc xcir I igain saw her she was then suffenne 
from i neoplasm of (lie stomach with pxioric obsiniciion 
Her condition was hopcle'-s and did not admit of radiogr ph\ 
of the slom ich II w is impossible to sax whether the 
neoplasm w is prinnrx or second irx She died in Janinn, 
1910 litr doctor Dr A M Harlow reported that a few' 
weeks bclorc death a lump (i a second primarx carcinoma) 
ippc ircd in the right breast 


On the whole it ippears likclx since her mother posMblj 
imf tier grindmolbcr prob iWx died of gislric carcinoim Ihil 
ticaih w IS due to a prim irx neoplasm of the stomach 


SISIIR II, HORN 187S , MjXRRILD 
I he piiicnt XX is first seen in 1920 She had had an abwe s 
in the left bre ist iftcr a miscarriage ind a narrow teiior 
sh ipcd mistiuc indiiruion containing two small nodulo 
ilioiight to be exsis xx is found aboxc and internal to the 
nipple fhe left nipple xx is cicx ilcd hut in xicw of ihe 
lustorx of ib'Ccss the importance of this sign was minimized 
The right breast was normal I isked to sec her in six weeks 
time but It xxas not until 192"' lint she agtin appeared wiih 
atxpied circmonn of the right breast Vague mduralion 
could be felt m the left brcist at the site of the exsis but it 
XX IS otherwise normal A right radical mastcctomx xxas done 
and microscopical cxanunaiion of the specimen showed a 
circinoma with no inxolxcmcnt of the axillarx glands 

In 1927 she xxas well but i thickened duct could he fella 
short distance aboxc the left nipple Deep \ nx and surhcc 
radium treitment xxas gixcn during 1927 and 1928 Jn I9'0 
a prceaiiiion irx left mastcctomx xxas adxised but the paiieni 
declined operation and anotiicr course of deep x ni treat 
ment xxas gixcn In 1934 thickened ducts had again appeared, 
and operation xxas urged but without success 

In 1937, fixe xcirs after the last x nj treatment, a hard 
lump adherent to the skin appeared in the upper and outer 
quadrant of the left breast just outside an area of i ra' 
tcl ingicctasis present aboxc the nipple since 1931 Mr Turner 
Warwick performed a radical mastcctomx and pathological 
examination showed a cclliihr spheroidal cell carcinoma 
without axilhrx gland inxasion The patient made a good 
rccoxcry from the operation and is at present well It 
interesting tint the carcinoma appeared outside the am o 
telangiectasis I base nexcr seen a carcinoma dexclop beneai 
such an arci but 1 can recollect at least one other ci'c m 
which a carcinoma appeared just bexond the margin 

The history ol this cisc shows that the proicciion 
agiinsl carcinoma afforded by \ rays is not absolute m 
permanent Jt also emphasizes Ihe need for three moni ' 
or six-monthly re examinations of the abnormal hnas 
and for repeating the x-ray course at least every two 
three years It is to be noted that the breast " 
watched and treated for fourteen years before its 
was urged, and that frank carcinomi did 
until three years later This is prima facie evidence 
It IS possible fo distinguish the onset of Ihe danger 
stage of chronic mastitis 

SISTER C , BORN 1 879 , married 

In 1927 this patient xvas sent to me by Dr Barlow 
in ind under the left breast She had cardiac 
irregiihritv following influenza, xvith a bruit oxer 
sternum, and xvas subject to indigestion All lemai g 
had been extracted a year before 



Jl'l\ 16 I93S 


CHRONIC MASTITIS AND BREAST CANCER 


The Bumsn 
Medical Jocrnu. 


115 


On cv^mmition ncaIot vlnped nnsiuic induniion \''is 
found in the upper quidnni of ihc left brcist In it near 
llic nipple could be fell tortuous thickened ducts The left 
nipple NNtis bii^her linn the ripht Tnd pointed fonvirds md 
oulNsnrds while the nuhl pointed nornnll\ — Ihil is forwirds 
outwards and downs'^rds 0\Mnc to ihcvc si^ns I regarded 
the brcisi a"; a dantsCrous one but in njcw of the cardiac 
condition tr<. itment was advised in preference to 

nnstectomv \ month htcr the Icfi brcisl appeared almost 
normal except that some lhu.kcned ducts persisted abose the 
left nipple On this occasion some thickened ducts were fell 
above the nipple of the other frighi) breast In June 1928 
both breasts were much improved In Mav 19 0 there w is a 
shuht duct ihickcmnv. above the left nipple and further \ rav 
ircaimcnt was given to both breasts bv Dr Russcjl Rcvnolds 
The left nipple was still raised and deviated 

In September 19 o following a blow on the left breast a 
mall lump a quarter of an inch m diameter and adherent 
10 the skm was found m the left upper and outer quadranl 
1 diagnosed carcinoma The patholocist reported that the 
lump was a cast and that the breast onlv showed chronic 
mastitis A simple masteciomv vvas done Re-ex imtnation 
of the slide has com meed me that the duct cpiihcl/um uas m 
a prccanccrous condition 

In March 19 3 a masimc swelling containing thickened 
tortuous ducts appeared above the right nipple and I urged 
3 simple masteciomv with removal of the glands This was 
done The breast showed advanced fibrosis with microevstic 
distension of the smaller ducts and proliferation of their 
epithelium At ccnain points the breast showed diffuse 
papillomatosis of the duels sidl innocent (Plate Fig 1) At 
one point there was seen a duel distended bv epithelium ssith 
definite infiltration of the surroundinc tissues — an incipient 
carcinoma (Fig. 2) Glands were not infected Subscqucntls 
a course of x ravs was given 

This case confirms the e\idcncc of the preceding one as 
to (1) the controlling power of irradiation m chronic 
mastitis (2) the need for periodic examinations in such 
cases (3) the xaluc of the danger signals which hcrild 
approaching malignanc) 

SISTER D BORN ISS^ MARRIED WITH TWO CHILORCV 

The patient first presented herself in 1929 because of dis 
comfort and pain m the left breast of twelve months duration 
Examination showed a slight mastuic thickening in the upper 
inner quadranl of the left breast which vms lender There 
were no other signs in either breast The induration dis 
appeared after a short course of r rav thcrapi 

In 19^0 an indurated area was noted in region of the 
axillarv tail of the right breast but this abo subsided under 
surface radium treatment The breasts were normal when the 
patient was last seen in October 1937 

SISTER E BOR.SJ 1886 MSRRIED 

This patient was operated upon bv me at the Middlesex 
Hospital in December 1923 for an advanced carcinoma of 
the left breast when aged 37 Radium tubes were introduced 
in the upper intercostal spaces and a patch of radio dermatitis 
developed a month later o\cr the inner end of the third space 
She does not appear to base been seen again until Sep 
tember 1927 At this time two patches of radio dermatitis 
were present at the inner ends of the third and fifth left spaces 
In the right breast m the upper and outer quadrant was a 
defined granular sector shaped thickening an area of chronic 
mastitis The nght nipple seemed less prominent than normal 
and was fiame-shaped in contour in the plane of the skin 
with the point directed towards the masutic thickening There 
was no definite adhesion to the skin but a ver> faml depres 
Sion appeared over the induration when the breast was dis- 
placed I advised removal of the right breast but as an 
alternative owing to the reluctance of her relatives offered 
t ra> treatment with reexamination in two months The- 
axillar) glands were not enlarged There was no recurrence 


on the left Mdc I wrote to her medical adviser Dr Barlow 

There seems to be some danger that this patch wiH develop 
into a carcinoma and removal of the right breast would be 
a wise precaution since the second breast m a patient who 
has had carcinom.i is four times as hkcl> to develop cara 
noma as the breast of a normal woman 

Bv October 1927 after one dose of deep r ravs which 
gave her acute pain m the breast and made her ill for some 
dTvs the patient had made up her mind to undergo operation 
A faint but unmistakable skin dimple could now be elicited 
over a small lump beneath the edge of the right great pectoral 
at the pcriphcrv of the breast The masutic swelling had 
become less definite probably as the result of the t rav do^e 
The flame shape of the nipple was still evident A diacnoMs 
of second primarv carcinoma was made and immediate 
radical operation w is urged and performed Histological 
examination showed a spheroidal cell carcinoma without in- 
vasion of Ivmph glands considered to be a second primarv 
carcinoma 

In June 1928 she was free from recurrence though suffer- 
ing from inginal attacks but she then CNcaped from obscrva 
non In Mav 19^0 I was informed that she was having 
adium treatment for enfarced glands in the neck A sternal 
recurrence was subscqucntlv treated bv buried radium In 
1932 spinal secondarv deposits appeared and she died in 
193-U after being bedridden for two >cars 

In the historv of this case the rcgreiiablv long intervals 
between examinations arc to he speciall) noted 

Commenfarj 

The historj of this unfortunate familj recalls the high 
incidence of breast cancer found in certain inbred labora 
lor> strains of mice Dr \\ E Gve (1936-7) makes 
some intcrcsiing observations on these strains He sa>s 

inbred strains of mice are verv useful in some branches 
of experimental cancer research The discovers of the car 
cinogcnic propertv of oesirone was made with such a strain 
and the analvsis of the chain of events which ends m 
malicnancv of the breast is simplified bv the use of pure 
strains of hich and lower cancer incidence But as Dr 
Cmmcr has pointed out inbred mice are not normal animals 
^and in high cancer lines the clinical picture of cancer is 
distorted bv the predominating influence of one aeiiologiral 
factor — inherited susccpubifitv in a particular organ — to such 
an extent as to minimize the importance of other factors. 
Conclusions drawn from observations on such strains cannot 
therefore he applied without reserve to cancer of normal 
mixed stocks In high cancer strains for example multiple 
tumours of the breast arc of frequent occurrence whereas in 
mixed stocks single tumours are the rule If a cancer m a 
high strain is excised surgicalh the animal though cured of 
this particular tumour is liable to develop a second or a third 
independent growth in another part of the same breast or in 
the breast of the opposite side The inherited predisposition 
to cancer of the breast is not affected bv the removal of the 
first tumour and surgical treatment in these exaggerated 
artificial circumstances is ineffectual and appears to be 
irrational In mice of mixed strains surgical removal of a 
tumour IS not followed b> the appearance of fresh independent 
new growths if local recurrence takes place it is due to 
incomplete removal of the primarv tumour The differences 
between cancer in pure line strains and in mixed stocks ma> 
have their counterpart exhibited less stnkingl} m fjuman 
surgery 

How far are these conclusions supported for human 
carcinoma bj the facts I have related*^ The fact that 
three of the five sisters are still living free from pain and 
from signs of recurrence partly as the result of radical 
mastectomies for developed cancer partl> as the result 
of simple mastectomies for threatening precancerous con 
dilions shows that in the human race (which fortunately 
has onI> two breasts) surgical treatment ma\ be worth 



116 Jun 16 1918 CHRONIC MASTITIS 

N\hi!c ho\%e\ti strong the constiliiiion tl predisposition to 
breast cancer Though I believe radiUion to be a 
valuable proph^l itiic, it cannot in ill ciscs be an cflicicnl 
substitute for surgery indeed ilic impermanence of the 
protection it tlTords is manifest in the case records 
Dr G>cs btitcmcnt that ’ m mice of mixed strims 
surgicil removal of t tumour is not followed by the 
appcirincc of fresh mdepcndcni nevs growths is far from 
being ipplicabic m the ordmirv ease of hum in breast 
cmccr with no spccnlly strong familv history My 
experience is that 1 see m mere ising number of eases of 
second primarv c ircmoma of the opposite breast f hope 
to dimmish ihit number in fuinrc In idvismg routine 
post opcritive irradution of the remaining brcist and by 
even more c ireful following up of eases 


Sumniarv 

Tins paper records the historj of five sisicrs descendants 
of i cmceroiis mother ind grandmother who have been 
under mv obscrv ition for nineteen veirs There is 
evidence ihu three of them hise sufTcred from double 
pnmarv circinomi of the breast One sister was treated 
b^ irr idiaiion for biliteral chronic m isiitis, which has’not 
lecurrcd The remaining sister w is treated for chronic 
mistitis In irridiation, u firsi vsiih success but after three 
>eirs 1 left simple m isicctonn seemed ncccssirv and 
three vears 1 iter a right simple mastectomy The right 
bre ist sho>scd an incipient circinomi The dinger 
signiis vshich herald the onset of carcinoma in such eases 
are described md it is held to be possible to distinguish 
between cases of chronic mastitis which mas safeh be 
treated b> irradiation and cases in the prccinccrous stage 
needing mistcctomv Two of the sisters in\c died of 
breast cancer surviving operation eleven and nine ycirs 
respectively and three remain well five radicil mastec- 
tomies and two simple ones have been done 

Ri rmtsers 

Chcatic, Sir G tenth it (IWS) Bat J Surj; 22 710 
Cramer, W and Horning E S ()93()) Lnncci 1 747 

(1937) J Path Pact 44 633 

(1938) Lnneet 1 71 

Gye, W L (1936-7) Imperial Cancer Research rund Report p 18 
Handley W Sampson (1910) Praettt/oner 84 463 

(1931) Genesis of Coiiccr H K Lewis London 

Lewis D and GeschicKicr, C T (1934) Ann Siirg 100 779 


Dr Henry Herd, school medical officer for Manchester, 
in his annua! report for 1937 records the transfer to his 
department of a child guidance clinic which was formerly 
run on voluntary lines The present tendency to make 
use of the school clinics for early consultation, in prefer- 
ence to awaiting the next routine visit of the medical 
officers IS shown by the rising ratio of special ’ to 
“routine inspections During the year under review 
some 33 000 routine inspections were undertaken, as com- 
pared with nearly 49 000 special inspections The niun- 
lional grading required by the Board of Education was 
continued during the year An analysis of the very 
different findings of a group of officers confronted with 
L the same batch of children, the grading being based on 
ij^eneral observation only bears out Dr Herd s view that 
Whe economic test which reveals that a child can, or 
^cannot be receiving an adequate diet on the income avail- 
able for feeding him, is still the only reliable and 
practicable method capable of application on a large scale 
to the assessment of nutrition The scope of this report 
IS as Wide as ever, and it includes a paper on the physical 
fitness of schoolboys, with special reference to nutrition 
and the mechanism of heredity 


AND BREAST CANCER 


Tnt British 


DYSrUNCTIONAL UTERINE BLEEDING 
TREATED WITH PROGESTERONE* 


BY 


1 . N. MACGRCGOR, M D , F R C S.Cd , M C 0 G. 

G\n<tc<olaf.tst Deaconess Hospiiat Lt/iiifiiirj;/i Late T,m 
III Chiiiciil GsnaccohgS Rosa! liiftrinars Edinhirfh 
Cnitiion Research Scholar 

(Wmi Srrcivi Pute) 

Although tow irds the end of last centurv it was sugges ti 
th.it irrcgiilir uterine bleeding was associated' wsth 
ibnornnl ovxri in function it is only within coraparaiivdv 
recent times that this has been confirmed h) scieniiii,, 
d ita The dv sfunctional nature of irregular uiermt bkedmg 
vv IS disclosed when the endomttnai structure and hormese 
findings in such eases vvere correlated with the endomclmi 
changes ind hormone concentrations occurring cvilicalK 
during the normal menstrual process It is knoiui thi! 
mcnsiriia! rhythm is founded on the harmonious me 
tction of the gonadotropic hormone of the amen, 
pitiiii iry and the oestrogenic and luteal hormones of liit 
mines Seven} faciors however particularly disfuncuor 
of one or more of the other glands m the endocrine dia’a 
ind nbnorm il nervous stimuli, may affect this intim’ ' 
relationship 

The present communic ition records a studv of thirl*".! 
eases of irrtgul ir ulenne bleeding that vvas es«t.ntia!!s 
associitcd with <a disturbance of the piiiiitarv mams 
mech inism 

Typos of Bleeding 

Two types of Weeding only arc considered—nam h, 
ovular and ‘ anovular 

Oiiifiir BIciilinii — Bv this term is implied b'e'dir 
which mav occur at or near the time of ovulation aba* 
the middle of the cvcle This phenomenon, which b’^ 
been noted bv manv observers (Hartman 1932 Ha a 
1934) IS probablv due to a disturbance of the hormca’' 
equilibrium at the time of ovulation In such cases it « 
presumed that between the time of rupture of the Graafi a 
follicle and the formation of the corpus iuteiim thw^ 
i transient lowering of the blood concentration of 
Consequent on the fall of blood oeslrm there is diminwW 
endometrial stimulation, which is snfhcient to 
partial disintegration of the endometrium with bkedir 
When the corpus luteum is mobilized, however, the cMi'’ 
mclnal stimulation is restored and the haemorrn’'' 
subsides 

Anmulor Bletiliiig — ^As distinct from anovular 
stiiiaiiwi this term is synonymous with that of nKin 
patlu i haemorrhagica The pathological findings in 
condition are cystic degeneration of the Graafian loiii'-'^ 
with no recent or forming corpus luteum in the own 
mvohyperplasia of the uterus and marked proliferate 
of the endometrium with cvstic dilatation of thtl^f*- 
(Plate Figs 1 and 5) The cells lining the s'an® 
cubical, with centrally placed nuclei , no glycogen is 0 ‘ 
in the cells (Figs 2 and 6) This characteristic 
logic.il picture may result from (nl an upset in ^ 
pitmtary-ovanan mechanism or (h) a local pelviv 
interfering with the normal process of ovulation 


Mechanism of Bleeding , 

Ovular bleeding, it has been suggested, is 
with a towering of the blood concentration ^ 

Report to the Therap^lic Gjnmo’r' 


‘A 

Research Coimcit From Dr Douglas M'licr s onspiijl G 
3finic, Royal Infirmarj' Edinburgh, the T^eaconc s 
iiirgli ami the Jnstitute of Animal Genetics, Edine ^ 



Jn,^ 16 19'lS 


PROGESTERONE IN UTERINE BLEEDING 


The Bsmsn 

^lEDICAL JOLR>At 


117 


till. tiniL of o'lihlion mil il is probiblc ihii i simihr 
fnv-lor opcnlcs in nictropilhia IniniorrlnRiCT Clinicillv 
and cvpirmiLnlnlH ii Ins besn ikmonsiriled lint cndo 
niLirial stinnihtion cm b^ nninl iinid for long periods 
proMdtd an adi.qviatc mionnl of oestrogenic hormone is 
administered The withdriual of the hormone howescr 
IS followed b% endometrial dismtegrttion In metropathii 
hacmorrhagica therefore there must be some factor which 
inmates a lowering of blood oesirin 

I ha\e seieral times confirmed he obsenalion mide 
b\ mans inscstigators that the large follicular cssis found 
in the osaries in cases of metropathia luemorrhagica 
contain a fluid sshich has oestrogenic properties There 
arc therefore in these cases depots of oestrin in the osaries 
sshich suppls a continuous amount to the general circii 
lation and thus endometrial stimulation is sustained 
Gradual intracsstic tension hovseser mas cause cither 
atrophic changes in the secreting cells or compression of 
the blood scssels Whateser the cause the direct result 
IS a reduction of the hormone passing into Ihe general 
circulation Although it ssas shossn bs Corner (1927) and 
Hartman (19'2) and subscqucntls confirmed bs others 
that ocsttan ssnhdrassal causes uterine bleeding it ssas not 
until Markee s (19'6) csperim.nts on monkess were carried 
out that the mechanism of this phenomenon ssas demon 
strated He shossed that diminution in the blood concen 
tration of oestrin causes sasoeonsiriction of the cndo 
metrial capillaries Consequent on this sascular spasm 
the nutrition of the highls proliferated glandular structure 
is impaired Partial necrosis results with consequent 
shedding of the endometrium 

Diagnosis 

The historj obtained in cases of anosular bleeding is 
characteristic There is usuallj a period of si\ to ten 
sseeks amcnorrhoea followed b> prolonged bleeding of 
from four to eight sseeks duration In cases of osuhr 
bleeding there is a hislors of frequent loss which in some 
cases occurs rcgularh csers fourteen d3>s It is some 
limes neecssarj to remose endometrium on scscral occa 
sions in order to distinguish between the osular and true 
menstrual bleeding AilhoUj,h a diagnosis of these con 
ditions mas made on clinical csidcnce this should be 
confirmed bs histological examination of the endometrium 
In the earls sears of reproduclise life a thorough exam 
ination of the genital tract including measurement of the 
length of the utero-cers ical canal and microscopical exam 
ination of the endometrium furnishes information which 
IS of saiue in determining the form of thcrapj most hkel> 
to be beneficial This examination including in particular 
biopsj, is essential near the menopause as the possibilit> 
of carcinoma being the cause of Ihe bleeding must 3lsva>s 
be excluded 

Treatment 

Progesterone svis the form of iherap> used in the 
present investigation Initiall} 1 to 2 mg svere giscn 
daily or esery second day, but sshen more abundant 
supplies became asailable 5 mg were gisen daily In 
osular bleeding the treatment was gisen isso or three 
dass before the expected anomalous bleeding Ihe aim 
being to maintain endometrial stimulation during 
Ihe time of osulation and thus tide oser the period 
sshen the blood oestrin ssas lowered The administration 
of oestrin at this time bs presenting a diminution of 
blood ocstnn, produces the same effect As is known 
howeser oestrin at a certain concentration inhibits the 
anterior pituitary and accordingly it is possible that this 


form of therapy may by influencing the pituitary stimulus, 
dehy or inhibit osiihtion Theoretically therefore the 
former method of treatment is preferable 
In metropathia hacmcrrhagica progesterone may be 
gistn at any phase During the bleeding stage 5 mg were 
adminislLrcd daily until the bleeding ssas controlled 
During the amcnorrhocic phase 5 mg ssere gisen daily 
the total dosage amounting to 25 to 30 mg Though 
ocstrm therapi mas by sustaining endometrial stimula 
lion control the haemorrhage in these cases the effect is 
only a temporary one Indeed oestrin ssould only aggra- 
sale the condition and its ssnhdrassal ssould be follossed 
bs still more haemorrhage Accordingly this form of 
therapy is definitely conlramdicalcd 

Data and Rcsulfs 

Thirteen patients svere treated with progesterone hse 
were cases of osular bleeding and seven of anosular 
bleeding sshilsl one case, though treated ssnh progesterone 
ssas found to come under another category 
Oiiilnr Bkerlinq — As the result of treatment three 
patients have had regular menstruation for the list 
eighteen to twenls two months One patient studied oser 
a period of eighteen months had three regular periods after 
cessation of therapy She then became pregnant but 
aborted at the end of the second month of gestation 
(Chart I) The other patient though not completely well 

~ T=| til jp It ir i 

■ I II ■ III 

• r ^ uxf wU* Air 

^ If “ iM It a a u I riii 11 ‘ 

II ■ 1 1 1 

.A c fc** 

■ I 1 1 I I 

Tet ip- ka7 

I !■ I r 

^ sec Sr-t ^ Oe* acsT 

CiliRT t — Case 4 aged 30 Mcnarchc al 12 Menstruation 
regular 7-S/2b until the age of 25 Since then menstruation 
tias been irregular 7 2If 17 21 Biopsy curettage earned out on 
two occasions indicated Ihat osailanon was occumng but was 
associated with bleeding The chart indicates the cfTcct of 
Ireaimcnt Doses of progestenDne were giien on the following 
days 1936 Apnl 7 8 9 10 IS IS 21 and 25 t mg Apnl 
27 and 28 2 mg May 24 27 and 31 and June 3 I- 17 and 

21 and August 10 and 13 I me August 30 and September 
i and 4 5 mg September 20 23 27 and 30 and October 19 

22 26 and 28 and November 8 I mg November IS IS 22 
25 and 29 and December 2 and 6 2 mg 

has now only a brownish discharge whereas formerly 
she had frank haemorrhage for a few dass between es-ery 
two periods 

Anomlar Bleeding — In four cases of anovular bleeding 
menstruation became normal in duration and periodicity 
In two cases however there has recentls been a recurrence 
of the irregularity This has been attributed by one 
patient to a nervous turn following the sudden death 



ns JuL\ !6, 193S 


PROGCSTCRONn IN UTERINE BLEEDING 


TiirllRmsii 

MtDICAt Jow<4t 



I 

P^se«lla I > ‘ ’ I 

. _ ► j. — ^ ers. •- ‘—f-J- ' 

1^1 1 I 1 » S SJTM ■ ( -< t ^ r~ -U 

I I I ' I 1 It t / I 

CiURT II — Ctsc 6 ^pcd 31 2 pin \Kn$truuion 

4 7/2I-2Sili> lApc since the mcmalic at (lie ipe of U tilt 
December, 19''^, sslicn period hsied from December "i 1935 
to Januar> 1 1936 After an intcrt il of four weeks, WeedmR 
begin igiin in the beginning of rcbrinr> and lasted until 
March 23, 1936 when a diagnostic curd tape was earned out 
nisa! metabolic rUc + 7 per cent Dloodstigir tolcnnce 
88 mg per 100 c cm after “iO pm plucosc, 100 119, 99 90 
and 90 mg per 100 cem The diagnosis of metropathia 
liaemorrhagica was connrmcd be Instolopical esammilion of 
the endometrium Doses of progesterone were given on the 
following da>s 1936, hfas 10 II, 12, 13, and M 2 mg, 
Ma> 31 1 mg , June 3 7 and 29 and luK 1, 2 mg August 
3, 9, 12 15 17, 19, 22 and 24 I mg , 1937, August 8, 2 mg , 
August 9 I mg 


Of .t near relative while in ihc oihcr casc,thc paiiem 
Mislainecl .1 shock on falling olT a bus (Charts 1! and 111) 
in ihc tcmaming three eases the iilcrinc endometrium ivjs 
c\.amint.t) histologically before and after treatment and 
It IS of inlcrest to note that as a result of the treatment 
the hvpcrplastic endometrium has been changed into a 
pseudo secretory ph ise in two of the cases (Figs 3, 4 , ^ 
.ind S) These cases have onlj recently been under’treat’ 
mcnl and two have had two normal periods, whilst ik 
third h IS h td one normal period 

On the other hand, the following ease illustrates ik 
vvasicftil aspect of the indiscriminate use of endocrine 
liter ipj for irregular uterine bleeding 

( iiu iS — ((uspiticnf aged 13 was first seen on August P, 
1936 Mcnsiniition slartcd in Eebruarv 1936 and her periods 
Were is follows the first period lasted five davs, the second 
period five weeks later lasted seven days the next period, 
one month later lasted a similar time the period in Mav 
listed seven divs two periods in June lasted seven days, a 
period started on Jtilv 4 1936 and continued until the palienl 
w IS seen on August 12 Thvroid thcrapv had no effect on 
the blecdinL. Between August 12 and 17 the palienl had 
to mg of progestin Bleeding stopped oiv August 28, but re 
St irted on September 3 and lasted nine days, it was again 
present from September 24 to October 3 and came on once 
more on October 12 Between October 19 and 26 the patient 
h id 3S mg of progestin which did not control the bleedine 
rximin.aiion under anaesthesia on October 31 showed that 
the uterus u IS small the utcro cervical canal measuring onli 
two inches Thereafter she was put on progvnon B olcosom 
forte (ocstridiol benzoate) ind after a total dosage of 45 me. 
mcnsiniaiion came at regular intervals for five days and has 
continued to do so 

I have indic.aled 'hat the progesterone treatment m this 
case vv is indiscriminate If the patient had been cvamineii 
mill illv under anaesthesia and the hypoplasia of the ulem 
dctLctcd progesterone would not have been given, as d 
would hwc had no cfTect on an endometrium which had 
not been siiflicienlly primed with oestrogenic hormonv 

Discussion 

The histological appearances of the endometrium befcK 
,ind ificr the administration of progesterone are sigiufi 
1 cant, in that they demonstrate clvad) 



1 Xw 


till in 

, July AOS s«j>t ' Oct ' Buv 


Dae W57 


ihis hormone on 


the 


Chart III —Case 7 aged 31, 1 pan Mcnarchc at age of 12 Pciiods were 
regular 4/28 until birth of child two years ago Menstruation recommenced 
three months after the birth and was regular 4/28 until Apiil, 1936 The diag 
nosis of metropathia haemoirhagica was confirmed by histological examination 
of the endometrium removed on April 30 1936 Doses of piogesicronc were 
given on the following days 1936 November 26 and 30 and December 2 6, 
and 9, 1 mg , December 13, 15, 17, and 20, 2 mg , 1937, rcbiuary 21, 24, and 
27, 2 mg rcbrii iry 28 ind March I and 2 5 mg 


the effect of -- 

'endometrium If this were the onl) 
action produced, however, I"'* 
therapy vvould be of little 
as Its effect vvould be merely a loca 
and temporary one 1 have shown 
that progesterone therapy, lO 
eases of metropathia haemorrhig^^j 
was followed by a normal menstrin 
rhythm This result, it is presumw. 
has been due to a re establishmen 
a normal hormonal balance 
rationale of this form of therap) 
possibly as follows the prog«te^ 
brings about an increased ehniin 
of oestnn by urinary 
converts it into less physiologic") 
active fractions (Smith, Smith, 
Pincus, 1938) This exults m 

lowering of the blood concentration 


oestnn to within normal , 

inhibition o' 


limits 
n el 
aicd 


following upon this, that 
the pituitary which has been 

with a high concentration ol 

is removed The piftntacy c 
act at a normal level 


Jin 16 IQ'S 


prooestcrone: in uterine bleedinq 


r>.n.ti\ \lion ot o\ in in fuiKtion rcslon.^ tin. noriml 
hormoinl bihin.e i conimuition of which clfLCts the 
rctiihr niLiislrinl rh\ ihni 

Compirati\i.U few fixoiiriblc refills will lollow the 
tndiNCriniinilc use of progesleronc thcripe bm in cnees 
where lie cmplovnient nppenrs to indiciletl b\ the hislo 
logical elnicliirc ot the enilomctrnim cncoiinging results 
can be obtained Although ridiiini Iheraps is sticcessfuf 
in the 'reatruent of metropathia haemorrhagiea occurring 
at or near the menopause a wider use of progesterone 
se.nis to be indieatcd as a more rational form of treat- 
ment 

Summan 

1 Two tspes ot irregular uterine bleeding are described 

2 The mechanism of bleeding in meiropaihn haemor- 
rhagiea is discussed 

' The results ot treatment with progesterone are gisen 
and the effeet of this form of theraps on the uterine 
endometrium is illustrated b\ photomicrognphs 

-t The rationale of progesterone thcrip) in irregular 
uterine bleeding is discussed 

1 wash to express nn indebtedness and thanks to Dr Douglas 
Miller for the pnsitege of in'csiigaling and irealing eases 
uncer his care and to Professor F A E Crew for the facilities 
afforded me in his department 

The preparation of proccsteronc used in this investigation 
was progestin orcanon and I am grateful lo the maniifaclurcrs 
(Messrs Organon Laboratories) who supplied it lo me through 
the Therapeutic Trials Committee 

Rrmucccs 

Corner G (IQ27) J Amer tied Aft 89 IS3^ 

Haia A M (19)4) Quart J evp Phtjtol 24 lOI 
Hartman C G (19)3) Carnegie Insi Wash Pub! So 413 
Coatr toEmbrso! So 1)4 
Marke" J E et nl (1936) Ant Rrc 64 ;)! 

Smith G van S Smith O W and PinsU G (19 9l Airier / 
Phfsteil 121 9S 


BRODirS ABSCESS AND ITS DIEFER- 
ENTUL DIAGNOSIS* 

n\ 

JAMES r BRMLSrORD, M D . Ph D M R C P 

Coiisidliuf! Radiologist Cm oj Dirmmsham Hospitals 
(With SprcisL PLsrt) 

In the collected works of Sir Benjamin Collins Brodie 
published in 1S65 will be found a paper on Chronic 
Abscess of the Tibia which was presented to the 
students of St George s Hospital Jn this paper he 
pointed out that an abscess maj occur in the interior 
ot an> bone m the bodj but according lo his experience 
vxe meet vxiih it more frequentl) m the tibia than in an> 
athcr bone He gixes a brief account of eight cases 
All the patients except one were males between the ages 
of 13 and 34 jears The abscess was m the upper third ot 
Jie tibia m four and m the lower third m four The 
linica! histones indicated that the lesion had existed for 
oeriods ranging from five to eighteen jears The account 
af his first case is as follows 

Some Earlv Cases 

It was as long since as the jeat 1824 that I was con 
ulted bv a joung man 24 vears of age under the following 
ircumstances There was a considerable enlargement of 
he lower end of the tibia but the ankle joint permitted of 
verv motion and was apparenllj normal The s)^in was 
bin t ense and closelv adherent lo the penosteum There 

* Paper read at tlie Annual Meeimg of the British Association 
f Radiologists at Belfast May 13 1938 


TiiEBirrm IJG 

XltDICVL lot. R-NVL 


wxs constxnt pain in tin. part gcncrallv of a moderate char 
acler but cverv now and then it became cxcriiciaUng keeping 
the patient ivvakc at night and confining him to the hou e 
for mans successive da^s It made his life miserable and 
his nervous svstem irrilahle one effect of which was that 
It spoiled his temper and thus produced another set of 
svmploms in addition to those which vverc the direct con 
kcqucnce of the local maladv The disease had been going 
on for twelve vears Me had consulled manv surgeons 
rcspccling It and had used a great vanetj of remedies but 
had never derived benefit from anv thing that was done 
Instead of gelling beller he cverv vear became so much 
worse I tried some remedies without anv advantage and 
at last recommended that he should lose the limb Mr 
Travers saw the palicm with me and agreed with this opinion 
An pmation was performed and the amputated Iibia is now 
on the table 3 ou will sec how much the lower end of it 
IS enlarged and that the surface ol it presents marks of great 
xascniarilv The bone m the preparation is divided longi 
(iidinallv and just above the articulating surface there is a 
caviiv as large as a chestnut This caviiv was filled with 
dark-coloured pus The inner surface of it is smooth The 
bone surrounding it is harder than natural On observing 
these appcaranecs I could not help saving that if vve had 
known the real nature of the disease the limb might have 
been saved 

In another paper he tells us that the patient died 
a few davs ifier the operation The other seven patients 
he treated b\ trephining the bone al the site of the point 
of maximum tenderness and the release of pus relieved 
the svmptoms and led to rapid cure 

In addition lo the signs and svmptoms recorded m the 
account of the first case the following are recorded in 
the other histones 

The pain mav be of moderate character with penodic 
exacerbations of cxcniciating almost intolerable pain and 
periods of perhaps several months of freedom from all 
svmploms The adjacent joint mav exhibit periodic effusions 
after exercise which arc absorbed with rest One patient 
had liibcrcles in the lungs and vomicae dead bone in the 
ribs and other complications In one case a sinus com 
municalcd with the knee joint The new periosteal bone is 
softer than normal 

Such IS the account that Brodic gave to a condition 
vshich he recognized as a distinct cntit> The accuraev 
of his observations and the value of the method of treat- 
ment which he devised Were such that though thousands 
of such cases have been treated b\ hundreds of different 
surgeons since his lime little if anj addition has been 
contributed to the clinical picture 

MTiat Constitutes a Oiromc Abscess') 

Brodies clinical work was unaided or as some would 
express It unhampered bj bacleriologv or radiology It 
IS therefore impossible lo define accuratelv in the present 
terms of bactenoiogy or radiology the nature of the lesion 
which he described Though in theJight of our present 
knowledge most of his eight cases appear lo be of a 
slaphxiococcal nature the history of at least one of them 
suggests the possibility of a tuberculous infection Con- 
sequently though we may reasonably refer lo any chronic 
abscess of bone as a Brodies abscess it would be prefer 
able from llie point of treatment to confine the term 
lo abscesses that are due to the staphylococcus These 
constitute all but a relatixelx small minority that are 
attributable lo the tubercle bacillus, typhoid bacillus 
pneumococcus streptococcus etc We are also faced with 
the question of what constitutes a chronic abscess') 
Brodie stated that the duration of symptoms in his eight 
patients varied from five lo eighteen years Today, with 
the ready accessibility of the harmless and painless radio- 



J20 JluL\ 16, 1918 


BRODIES ABSCESS 


gi iphic c\ainin ition such lesions may he detected \ery 
enly in the course of the disense, md vs hit might in 
Urociic s day invc been allowed to progress for some 
veirs before siirgici! intervention vvis niidc is now 
cvp-vbic of detection mid treitmcnt within n month or 
so cif ns onset For tlie purpose of this paper 1 have 
cvinilncd the old ridiographs and cisc histones, nntl 
made recent cimicn! and ridiographic cx.sminalioti, of as 
manj as were available of the si\tv-two cases of chronic 
bone abscess which have been submitted to me from 
time to time during the past fifteen scars The results 
ire shown in the following table 

T«W< \tiiiimanztnii tin Maw rtaiurtv of 62 Cnwv of 
ClirotiH /t/ivcivv of lloni 1-12 iiuih \ 20 ft mates) 


Apt PCftOti a( >\hich Atlv:c4^ found 


^ car\ 

1 5 

MO 1 

11 IS 1 

i6-:o 

21 W 

31 40 

40+ 

Number ufca^cs 

(, 

5 ' 

19 ] 

i< 

10 

5 


Duralion of i 

^vmrionual nmeradirv-' j 
Fwr^»c cutfencr %'a5 
cMainckt i ' 

1 

lu 

|f niiJjs 

to 

1 

\o 

5 ^f5 

1 

J j 

1 to 
U}f3 

1 ! 

1 vr 
to 
eO}n 

t mth 

1 

|10,M 

i 


Sne of Ttimary Hone I ecus 


Tibia ] 

1 ^ 

Femur 

Inumenis 

t 

^ l/fna 

1 Radius 

1 

j fihuU 

1 

linger end 

lUrr^Jtrd Mid third 

29 

9 

2 1 

i 

« 

7 1 

1 ^ i 

2 

1 


Smg!e focus in bone 45 casts Muldrle bone foci, 17 catet 


Analvsis of the Cases 

Anahsing this table, we see that the lesion occurred 
twice as often m the nltie as in the female The 
"majority — thu is, forty-four — occurred in the age period 
of 11 to 30 >tars The younger the patient the shorter 
was the duration of symptoms though m a few isolated 
cises, even in adult life, a brtcl hisiorv onlv was obtain- 
able Jn those eases with v long historv, starting m 
some instances in the eirly years of life the symptoms 
hid been intermittent , ait icks of pain and swelling were 
followed b\ long periods during winch there was ilniosl 
complete freedom from symptoms and it is probably 
due to this that the lesion was not submitted to radio- 
graphic examination Of the six children under the 
age of 5 who developed signs and symptoms severe and 
protracted enough to c uisc the doctor to seek radio- 
graphic examination the lesion in five of them appeared 
to be due to secondary tuberculous infection 

Jn some cases radiographic evidence of a septic focus 
in bone was obtained within a month of the patient 
complaining of symptoms, but since we are unable to 
fi\ the date of invasion of the site by infective organisnas 
from the patients story we obviously canuot, in the 
majority of cases, say how long such a lesion has been 
present The intelligence of patients, their reaction to 
pam and discomfort, and their resistance to infection 
vary considerably, and so does the virulence of the in- 
vading organisms The physical signs also do not 
materially aid us in our estimation, for even m acute 
osteomyelitis swelling of the affected hmb and redness of 
its skin are relatively late signs In the ease of the 
chronic lesion these signs appear intermittently, and 
though (here may be long interv'als during vvhich little 
an be detected, these intervals tend to dimmish as (he 
signs become more prominent and intensiv'C 

Upwards of a third of the total number of abscesses 
were found in the lower end of the tibia This is in 
opposition to the findings recorded by other workers m 


TntpRtxisn 

hltPlCAL 


icute osteomyelitis of childhood, when the upper end , 
tlic iioi I w IS more often involved Extept )n a \t] 
few instances the primary lesion was seen to be m il 
nictapliysc d extremity of the dnphysis, and by ihe a 
of serial radiographs it was observed that the li 5 ,c 
extended from this sue towards the medulla and rare 
perforated the epiphyseal joint cartilage In ibo' 
instances m vvhich the latter occurred the tubercle bacilli 
was found to be Ihe infecting organism 

In the majority of cases the periosteum did not sho 
any evidence of reaction, but when the abscess was larj 
and involved the whole cxicnl of the diaphyseal cxiremn 
periosteal new bone was evident This distribution an 
suggestion of spread of infection is m opposition to Hi 
views put forward by Starr with regard to acute oslw 
mvelitis He produced evidence to show that the mfectioi 
pisses from the mclaphysis to the periosteum, strippia 
the latter from the bone by the formation of a sul 
periosteal abscess and subsequently infecting the meduii 
X la the Hnvcrsnn cannls In these eases of chronic bon 
abscess I am unable to obtain any radiographic evadenc 
of infection of the bone xia this route In neatly oai 
third of the eases the patients either exhibited evidcno 
of previous septic bone foci or subsequently developti 
such lesions while oihcrs gave a history of tonsito 
pnciimonn, empyema, etc The duration of the lesion it 
most cases was so long that the early events in its hatoil 
were not well remembered, but in no fewer than cicbl 
instinccs there was definite evidence of severe mjurj to 
the part preceding the development of symptoms Insom 
eases the symptoms and signs produced by Ihe iraniM 
passed imperceptibly into the symptoms and signs v'buh 
iiaVL bLComc associated with the bone abscess 


Many of the patients gave a history of having iirf 
scirlct fever, measles, and other exanthemata, and in soir< 
cases the lesion in Ihe bone developed during or shonl' 
after the infectious illness In two evses a history o 
typhoid fever was obtained, and the organism 'ut 
recovered from the abscess As in acute osteomychtis ik 
infecting organism found in the majority of the eases w' 
the Slaplivlococuis (iiiruts 


Pbjsical Signs and Symptoms 
The chronic abscess has an insidious onset, qui'* 
distinct from acute osleonvyclitis, in vvhich (bt- stnlio 
clinical features arc the sudden onset of sevw or 
cxchiciatmg pam and the development of a 
exquisite tenderness over the primary focus— whiw 
piticnt guards with fear— associated with rigors, ' 
fever, and rapid pulse, followed by (he signs of a ss 
toxaemia, dchnum, and coma The patient 
of recurrent attacks of pam which have 
creased in seventy The pain is often of a . j 
burning character, giving the impression of ^ J 
expansion of the bone from some 
ind at times it may be almost intolerable ^ 

eomplained that it was worse during the day 
were walking about, but that it became I,, 

md at mght In these cases the affeemd hmb^ 
Dccame somewhat swollen, the skin reddenc , 
ivas evidence of oedema of the soft ^ 

effected bone during the day, vvhich subsided 
aight In others the pam appeared to be * jr 
lone being experienced during the day u 
he evening Attacks of pam of a usurer 

asting three or four days were followed m 
ay months of freedom In most cases t e 
aess on pressure over the abscess fliiciwt'-'’ 

rliases the patient may show n hot, red, ic > 



Ju-I If. I^'.S 


BRODIES ABSCL-SS 


lire B'lrTisrr 
^^EPtCAl. JOCENIL 


swelling with SOUK oedenn of the ilTeCled limb The 
ndjic..nt joint H such pins.s sometimes b^enme swollen 
ind showed si^ns ol elTusion into the joint In t few 
enses snpcrticnl nbscesscs developed nnd dischuged md 
somciimcs dehnite thickening of the ilTccted segment of 
bone could be observed 

Rndiognphic Signs 
vn TE osnovm tins 

Rndiographic evidence of nente osiconnchtis for the 
purpose of diagnosis does not evist Bv the time the bone 
show's changes detectable bv radiographs the shaft will 
have been denuded "of periosteum and sequestra have 
formed From radiographic examination of septie fingers 
in vshich the date of onset can he more accuratclv iixcd 
1 have dctcmiincd that changes mav bv. found in the 
affeeted bones vvithin 
ten davs The earliest 
sign IS localized osteo 
porosis W hen the 
focus IS situated in 
the medulla absorp 
tion of the cancellous 
■.Iruclure mav be 
videtit In less acute 
csions no apparent 
hange ma> be sc^n 
or one or two 
nonths though there 
aiaj be highlv sug 
estive clinical signs 
md svmptoms In a 
latienl aged '^2 who 
lad complained of 
>ain m his leg for 
•ne month radio 
raphs revealed a wcll- 
efined area of can 
ellous destruction in 
le medulla of the 
bia at the junction 
f the middle and 
pper thirds with 
imc increased den- 
■* t> of the surround 
g cortex 

bLB SCUTE OSTEOMVELITIS 

In subacute osteomjcliiis phvsical signs and sjmptoms 
ecede the development of radiographic signs by a week 
more Thus in a girl (D V) aged 10 years radio- 
aphs taken one week after the onset of pronounced 
ivsical signs and symptoms showed a small ill defined 
ea of osteoporosis at the lower metaphvseal extremity 
the tibial diaphysis but a month later radiographs 
sealed irregular osteolysis of the whole of the lower 
rd of the tibial diaphysis including its compact cortex 
d an accretion of new periosteal bone which in places 
o exhibited calcium deficiency It was impossible to 
fine the boundaries of the infected bone Further radio- 
iphs after another month showed that calcium had 
en deposited and there was now increased definition m 
affected zone evidence of consolidation and localiza 
n of the process and more regular ossification of the 
w periosteal bone No evidence of sequestra formation 
uld be found 

CHRONIC BONE ABSCESS 

The chronic bone abscess at the diaphyseal extremity 
the patient whose epiphysis has not vet fused is revealed 


on the radiograph bv an area ot cancellous destruction 
extending fiom the epiphyseal growth cartilage towards 
the medulla Its boundaries are not sharply defined but 
they are perhaps rendered more apparent because the 
adjacent bone has an increased densitv Frequently the 
lesion is spalul He in form and even with five years 
history may be less than a quarter of an inch m thickness 
but extending an inch or more from the epiphyseal line 
towards the medulla The more acute the abscess the 
larger the cavity formed and the less defined arc its 
boundaries and the gre iter the probabililv of nevv 
periosteal bone accretions As the lesion increases with 
age ns boundary wall tends to bvcome more sharply 
defined and sclerosed In one patient aged 21 who gave 
a history of a lesion of seventeen years duration the 
radiograph showed an abscess with a sharply defined 

regular wall which 
was little more than 
a quarter ot an ineh 
in diameter extending 
from the subarticular 
surface of the tibia 
for one and a half 
inches towards the 
medulla (See Fig 3 
Special Plate t In 
patients above 20 
years of age who 
give a history sug 
gesting the beginning 
of an abscess about 
the age of 14 the 
radiographs may show 
the abscess to be 
about an inch above 
the ossified epiphy 
seal growth cartilage 
It IS rare for th. 
growth cartilage to 
be penetrated bv 
staphylococcal mfec 
tion and the epi 
physis eroded con 
sequcnlly though the 
joint may exhibit 
periodic effusion t is 
rare for it to be infected by extension but after the 
epiphvsis has fused the lesion may be extended into the 
epiphvseal area and even pfect the joint No evfflence 
of accretion of new periosteal bone may be found even 
after the abscess has existed many years thus in one 
of seventeen years duration no thickening was apparent 
and consequently no swelling was detectable on clinical 
examination However in those cases m which the abscess 
has involved most of the diaphyseal extremity an accre 
tion of new periosteal bone will be shown No sequestrum 
IS to be observed within the abscess caviiv except m those 
cases that have been subjected to surgical intervention 
as the abscess extends bv the gradual absorption of the 
adjacent bone 

Much less common than the abscess m the metaphyseal 
region is the abscess in the middle third of the shaft of 
a long bone and beneath the periosteum 

MEDLLLVRY ABSCESSES 

An abscess in the medulla of the middle third of the 
shaft of a long bone is recognized from its radiographic 
appearances The shaft in the area shows a spindle- 
shaped expansion or thickening In the middle of the 


LCGLi>DS rOU lUDIOGRAIMIS IN SFECIVL PL-VTC 

Fig I — RiJiograpIi of G J x xouih aecd |s showing subacute 
abwes-. in lower erd of diaphsiiis of libia Duration of wmptoms two 
monlhs Noic iliNJcIincd area of central can..slIoos dcslru lion with 
increased dcnsiis of ihe adjaccnl bone and accretions of new psriosleal 
bone A radiopraph talcn six years after evacuation of abscess shosved 
linear outline of cavitv in lower third of diaphv is but no evidence of 
reaction in ihc adjacent bone or pcnosicum Clinieallv cured 

Fic Z — Radiosraph of Mr D E aged 21 showing chronic absecss 
in lower third of tibia three-quarters of an mdi above Imc of cpiphvscal 
growth cartibgc Note marhed increase in densitv of surrounding bone 
Duration of ssmp'oms five vears 

Fig V — Radiograph of Mr S B aged 21 showing chronic abscess in 
lower end of iibia which has extended to subarticular bone ihc epiphyseal 
growth cartilage having disappsaircd Duration of intcmaittcnt svtnptoms 
seventeen sears So c svellKiefined outline of sclerosed wall ol abscess 
and absen-e of jacnosieal reaction 

Figs 4 and 5 — Antcro-posierior and lateral radiographs of Miss E M 
aged 14 showing chrome abscess m lower end of tibial diaphysis 
Duration of svmptoms five vears Note wtiWefined wall of abscess 

Fig 6 — Radiograph of Miss E M ten scars after biopss which 
failed to reveal abscess Compare with Figs 4 and v Sole drill holt 
in bone (made ten scars prcsious to this radiograph being taken) is 
avs-av from site of abscess but resolution of Ihc infected area has largely 
cccurrcd 

Fig 7 — Radiograph of D C aged showing absecs insolvmg the 
epiphysis Duration of ssmp oms one month Tuberculous 

Fig S — Radiograph of P P aged 6 showing tuberculous abscess 
which has involved the cptphvsis Duration of svmploms several months 
Tuberculous 

Fig 9— Radiograph of Mi s E H aged 2-. showing chrome absecss 
in femoral shaft Duration of ssmplom fourlecn months History of 
typhoid fever Typhoid bacillus removed from pus 



i2: jvL\ 16, ms 


BRODIES ABSCESS 


cxpindul SLgmcni \ wcllilciincd roiindccl or ovoid irci 
of cuklIIous dLstruction~thc ibsccss c.iMly—js seen 
This arn is surroundsd by i thick wall of dense compici 
bone, which appurs to oblitcntc the medullary easily 
abosc and below ilic ibsctss ewity Surrounding the 
thickened abscess will csidenec of nelnitv is indicated 
b\ the thin regular lajcr of new bone lb it is being 
iidilcel bene ith the periosteum Tollowing successful 
surgical craciiilion of the ibscess easily the bone assumes 
its norm il comp ict ind c inccllous proportions, the 
reactnc periosteal bone being ibsorbed 

IIHIOSIMI UlSCI SSI s 

When the lesion dcstlops is a localircd abscess there is 
present bencalh the periosteum a locilired fusiform 
thickening of the bone winch is due to the lajing down of 
addiiionnl subperiosteal compact bone in the thickest 
p irt of which a well defined rounded abscess easily will 
be seen 


Tifri)«rrtsn 

MeDICM 


Sr ' “> 

• Whit ire the circumstances that would lead vou (« 
suspect the existence of abscess in the tibia? The inLer 1 
\\ hen the tibn is cnhrgcci from a deposit of bone cxtcrnaiK 
lien there is cxccssnc pun, such is mij be supposed t„ 
depend on cMrcmc tension, ihe pam being aggmaled 
mien ds md these ssmpioms continue md become <iill 
furlhcr atgrasiicd. nol jicldinfi to medicines or other Ireat 
ment tint mi> be Ind recourse to, then }oii miy reasomU, 
suspect Ihe existence of abscess in the centre of the bone' 

The clinical history will indicate the age of the lesion 
and the cMslcncc of any previous seaiic focus or mfecuon 
likely to be associated xxilh bone abscess Such inforira 
tion IS mvalinblc m view of the fact that lesions of a 
xv/dcly different significance produce radiographic appear 
anccs which arc rather alike Such lesions are tuber 
culous abscess, gumma, simple bone cyst, sarcoma, and 
cndotlichoma 


Rndiognpbic I ocalizntion of the Vhsecss 

In these dijs when lesions of bone can be accurately 
locali7cd bv ridiograpbv this should be done before any 
surgical interxcntion tikes pi ice , for, as already indicated, 
the abscess is usually but i narrow trick ihui m<ay easily 
tscMpe the surgeon s weapons and thus permit the record- 
ing of one more radiogriphic fail icx Two ridiographs 
(Figs 4 ind 5, Special Plate) revcil such in ibscess xvhich 
eluded the surgeons scirch II is interesting, for it shows 
that while the ihsccss w is not discoxcrcd bx the trephine, 
the lesion rcsolxed, though the scar of the trephine hole 
has persisted for oxer ten years ffig 6, Special Plate) 
Localirilion of the lesion followed by the marking of the 
skin indicating its site, would enable the surgeon infallibly 
to expose the lesion in Ihe minimum of time 

Results of Surgerx on Radiographic Appearances 

Serial radiographs of the bone from which an abscess 
has been evacuated show that the cavity may persist for 
many years One, two, or three years afterwards the 
walls of the cavity arc not sharply defined and present 
a radiographic picture which has been mistaken for that 
of an active abscess And ns it is not uncommon for a 
patient to have occasional bouts of pain or discomfort, 
xvnh undue redness of the arei over the site of the old 
ibscess, particularly if he has an injury to the part, it 
IS imperative that this possibility be realized, otherwise an 
actix’ct abscess may be di ignoscd and a useless operation 
be performed At this operation no abscess xviU be 
found, and histological examination of material remox'ed 
will indicate the reaction of trauma A few days' rest 
results in disappearance of these clinical signs though 
the radiographic appearance lemains While little radio- 
graphic evidence of the abscess site may be found after 
two or three years, in some cases even after Ixvcnty years 
the walls of the cavity made by the surgeon may be 
observed Such old scars in bone arc clearly defined with 
linear contours, and present no evidence of reaction in the 
surrounding bone After the effective evacuation of an 
abscess xvhich was associated with definite accretions of 
new periosteal bone the latter is soon absorbed, and in 
a few months no trace of it can be found This is an 
additional feature useful in the recognition of the evacuated 
^abscess ' 

Differential Diagnosis 

■TThere is pel haps no lesion in which the clinical history 
the patient is more helpful in diagnosis than the Brodie 
'abscess, and in introducing the question of differential 


nmcRcuLoos abscess 

In this senes of eases five of the six children under tk 
age of 5 years who presented a lesion of the bone <o 
intractable that radiographic mxcstigation was soiflil 
h id i tuberculous abscess xvhich xvas associated with some 
typical lesion in another part of the body The tubv 
culoiis abscess docs present certain features xvhich assi'l 
m identification Mention has been made of the hctlliat 
the tuberculous process docs not appear to be check! 
bv the growth cartilage at Ihe melaphysis and prexenttJ 
from invading the cpiphvsis, as is the usual feature of ih' 
staphylococcal abscess (Plate, Figs 7 and 8) The eatl) 
tubcrcuhns bone abscess is a regular rounded cxcavilicn 
xvith clearly defined walls, for the effect of the organism 
IS the solution of the bone against xvhich it comes into 
contact xvilhout any apparent reaction, such as osteo- 
porosis or osteosclerosis in the adjacent healthy bony wall 
After an interval of some months general decalcificalioi 
of the involved bone occurs, and then an illdeftnd 
sequestrum of somewhat greater density than (he nemii 
bounng bone may be recognized 


GUMMA 

Gumma of the bone is usually identified by the niassiM 
reaction it produces in the adjacent bone This findw 
should indicate Ihe need for obtaining the Wassermann 
reaction Evidence of other syphilitic lesions nnj ^ 
forthcoming 

SIMPLI BONE CiSTS 

TJic commonest sites for such lesions arc in the ncitli 
faourhood of (he great trochanter of (be femur ana I ^ 
middle third of the shaft of the humerus and the lowtt 
third of (he radial diaphysis In these sites the bom 
expanded The expanded area is ovoid, cyst like, an 
devoid of cancellous trabeculae Its boundary is 
thin xvail of bone, which appears to be yielding to 
pressure of its contents There is usually no evidence 
new periosteal bone , m fact, the thin bony xvall may ew 
appear to have been completely absorbed in one in 
Spontaneous fiacture through such a cyst is often 'hee 
which leads to radiography and to the discovery o 
lesion 


OSTrOCEASTOMA ^ 

n the early stages of its development 
sent a radiographic appearance xvhich rather resen 
chronic abscess The discovery of such •» <‘3 
stage xvould be accidental for the signs and sy P 
negligible, radiography of a bone folloxving if 
ig the usual means of recognition The chmcal h 
therefore be a most essential factor m identifi««n 


Jl'L\ 16 19->h 


BRODIES ABSCESS 


The Britub ] T3 
RUDrCAL JOLR,*’U- " 


SRrCOVtE 

Then. IS 1 l\ pc ol sTrCctni \ sshicli snrts in the mediilb 
b\ dcstroMiig Tcijaccni bone and producing "in ibscos 
like ciMtt that nni or Pin not hise mciisc changes m 
the adjacent bons wnll Us boundaries are not clearh 
detincd as in the case of the simple bone c\st It mas 
lead tel speintancoiis fracture anei subsequent radiographic 
appearances ma> gne the suspicion of a sequestrum 
I'lifiin the abscess like caiiti The short hislor> ind the 
paucits of clinical signs and ssniploms associated with 
the radiographic features should arouse suspicions of the 
grasitv of the lesion further radiographs after i week or 
so nia\ reveal conclusive evidence ot us nature Otten the 
bone in the region of the fracture will now show perioneal 
spieular formation 

rsnoiiiriivi viicroviv 

Endothelial mjeloma of the bone occurs at about the 
same age periods as vve find with chronic bone abscess 
Like bone abscess it mav be associated with lesions m 
other parts of the skeleton It otten shows intermittencv 
ol svmptoms The clinical features however do not 
reveal the chronicitv of the bone abscess the progress 
at the lesion IS more rapid Tile radiographic features 
which bear some resemblance to those of chronic bone 
sepsis I have dealt with elsewhere Otten a marked 
response to r radiation therapv is seen in endothelioma 
and this is of diagnostic significance Serial radtographie 
stiidv of the lesion will usuallv suflice for identification 

BiHLiocmrHi 

Brill ford dimes F (t9tS) The RaJaltut < f Ih n s an I J ntt 
dnd ed J and A Churcliiil London 

not-) Bnl J Ra.hal NS 10 171 

(t^t*! Prac rui Sac Stef 30 7Sl 


PAR4SITIC FOETLS SUCCFSSFULU 
REMOVED BY OPERATION* 

BV 

MAV GUCCVDCRG F U C S Ld 

Scalar Siirficort Johiniiit shitr^ Harpaat 
fWiTii SprcivL PevTtl 

A mate child born on Apiil 6 1937 was admitted to the 
Transvaal Memorial Hospital for Children under m> care 
on April 36 He was born normallv in a right occipito 
anterior position there being no diflicullv with the labour 
in spite of the child being the mother s first The period 
of gestation was normal 

On examination an incomplete') svmmetrical conjoined 
twin was found attached to the epigastric area of the host 
bv a flesh) pedicle and consisted of a right arm an 
abdomen lower limbs pienis and scrotum Tlie lower 
limbs were kept m a frog position astride the abdomen 
of the host the penis and scrotum being opposite the 
host s umbilieus (Figs A and B) On palpation a bonv 
pelvis and saerum could be made out but no vertebral 
column or ribs A rounded firm mass could be fell in the 
abdomen of the parasite and there was an imperforate 
anal dimple a heart beat eould not be felt or heard and 
no movements were observed the parasite appearing 
oevoid of sensation Both the host and the parasite 
passed urine at different times The host except (or the 
ittachment of the parasite was normal 
Birium was given to the child b) mouth and was 
observed under an r rav screen It vvas found to pass 
through the stomach a nd small and large bowels ot the 

Shown at the March mceiing of the Southern Transvaal 
Branch of the Medical Association of South Africa IB M A) 


host but not in the parasite suggesting that even if 
there Were bowv.1 m the parasite there was no cortvmunica 
tion between the two 

f our cubic Centimetres of uroseicctan B were later 
injeeted into I vein and radiographs were taken at frequent 
inters ils for an hour The dve vvas easil) visible m the 
parasite reveilmg a normallv functioning kidne) but it 




lllu tralionv showine Ih* relative positions of ho t and 
para lie (Redrawn from phoioeraphs bv AUdrev 3 


A > 


was poor!) shown in the host owing to there being a Jarge 
quaniilv ol intestinal gas but the sccrctorv s) stems were 
present and the d)e collected m the bladders of host and 
parasite 

The host during the following two months was growing 
normallv while the parasile remained stalionarx the ratio 
of host to parasite having risen from approximate!) 2-V 
to I It birth to 4 to 1 on June 1^ The child continued 
making this progress till August 2^ vxhen surgical removal 
ot the parasite w is decided upon 


Tte Operation 

bndcr general anaesthesia an incision was made round 
the parasite through skin and subcutaneous tissue and it 
was then noticed that the peritoneal cavities of the host 
and oarasile were continuous A loop of blind ending 
bowel trom the parasite la) free m the hosts part of the 
periloni-al cavitv and a fibrous cord apparently a urachus 
joined both bladders The hosts abdominal cavit) con 
tamed Its normal viscera but in the parasites peritoneal 
cavitv there was onlv a horse shoe kidnev with two 
ureters entering a bladder 

The peritoneum vvas cut close to the parasite leaving 
enough tor the hosts abdominal cavil) the blind loop 
of bowel was returned to the parasite and the fibrous 
cord joining the two bladders vvas ligatured and cut near 
to the host s bladder The host s abdomen was then 
closvd m lasers The wound healed b) first intention 
and the child was discharged from hospital on October 2 
1937 The parasite is shown in Fig 1 of the Plate 

On Februarv 2 193S the child was again seen being 
then in perfect health He had put on weight and there 
was no sign of ventral hernia having developed at the site 
_ of operation (Plate Fig 2J 



CLINICAL MEMORANDA 


124 JUL\ 16, 1938 


Clinical Memoranda 


Recurrent Cerebral Tlirombosis »ith 
Recovery 

The c.l^L of certbra! tlirombosis ol which 1 gi\t sonic 
tLt.iiIs strikes me is being rather iiniisii il, if only because 
the patient has made such a complete rccoicrj after etch 
attack, and this in spite of her age and the alarming 
character at tiic time of some of her symptoms 

CAsr Rccord 

\ hds ai.ed 69 bccinic \cr\ dcprcs<;ed in Echrinrs 1916 
and strange in her ni inner following an accident to tier 
daughter wlicrcbs the latter lost m c\c Her rclitiscs stated 
that she hid become \crs confused ind no longer took ans 
inicrest in ciiher her personal cleanliness or her clothes whereas 
before she had aliiais been most particular in this respect At 
the same time her speech bccinic indistinct and there was 
considerable musculir weakness so that she could hardh 
walk Her pubc was slow (601 and soft and her blood 
pressure 120/60 The heart sounds were municd The pupils 
were small and contracted and barcK reacted to light the 
knee jerks could not be elicited There were no other ph\ steal 
signs ,and the Wassermann reaction w.as negatue Complete 
rceosers followed within a month 

After a period of perfect health i similar attack occurred 
in \f u of I9t7 hut was marked b\ periods of conn altitr- 
nating with spells of motor activits when the arms were siowh 
ind mcchanicalK raised and dropped, to gisc rise later to 
considerable general restlessness Insomnia w is a feature of 
this attack Complete rceosers followed within a month 
On December 23, 1937, she igiin became strange in her 
manner her expression was sicint and she had diflicults in 
recognizing those around her Bs December 27 she had lapsed 
into a deep coma A catheter specimen of urine showed 
albumin + and sugar nil There ssas incontinence of urine 
and faeces The arms sscrc flaccid but not compictels para 
Issed By the csening of December 28 as her condition 
shossed no improscmcnt I gasc a hspodcrinic injection of 
digitahne gram 1/100 with slrschnine gram 1/60, this ssas 
followed bs a marked improscmcnt within half an hour so 
ihat she opened her escs and responded to questions ssith a 
considerable degree of intelligence These injections were 
continued thrice daily for the next tsso davs bs the end of 
sshich time the patient ssas talking and answering questions 
almost normally 

Unfortunatcls' a profuse and foul diarrhoea nosv set in and 
ripidly dehydrated the patient, the escs became sunken the 
face thin, and what ssas more alarming she rapidly became 
stuporous and sank in a heap off her pillosss, and presented 
all the signs of rapidly approaching death Added to this a 
gangrenous patch 2 in long by 1 in ssade had developed at 
the upper end of the natal cleft Kayicne in one drachm 
doses in a little svater or milk svas tried and retained This 
svas increased to a dessertspoonful esery three or four hours 
on the following day, and met sSith a quick response The 
stools lost their frequency and their abnormal character and 
the patient started to take her food once again and shoiv esery 
sign of a return to health 

The sloughing tissue on the buttock svas irrigated with 
eusol three times daily and soon separated leaving a deep but 
-althy looking wound, which gradually but completely 
iiulaled up with the aid of lotio rubra 
The patient h is now made a complete recosery 

SUMMARV 

An elderly lady with a somewhat low blood pressure and 
slow pulse develops cerebral thiombosis as the result of 
severe mental trauma Symptoms suggest a (esion of the 
frontal lobes m the first attack as evidenced by a change 
m character and behaxiour This postulates a thrombosis 


TiicEriTisH 
XltDiCAL lomAAl 


of the anterior cerebral artery The second attack was 
marked m nnly by motor activity the up and down mo\c 
ments of the irms ind the genera! restlessness suggest 
lesions It sites different from the first attack, and in the 
nrn supplied by die middle ccrebni aricrv The third 
Itl ick more serious than the first two, suggests a more 
eomplclc thrombosis of the middle cerebral artery as 
shown bv the fiaccidily of the arms ind (he loss of control 
of the sphincters 

The use of (he old ind well tried drugs digitalmc and 
strychnine based on the pathology of the condition, was 
imply justified bv the astonishing response The value 
of knlcnc in acute infective conditions of the bowel is 
also Well worthy of mention 

G Llewellyn Davies, 

London S \V 6 M R C S L R C P 


Orthoptic Cure of an External Squint of 
35 Degrees in a Woman of Thirty 

I think tl) It an iccoiint of the cure of this case should 
conxmcc sceptics that there must be something in 
orthoptics ind perhaps ilso raise hope in the hearts of 
adult squinters who would gi\c much to have a pair ol 
straight c\cs, like the majority of their fellow beings 
This worn in had had i bad squint in her left eve from 
caih childhood hut there were points in her favour (1) il was 
an extern il squint, (2) she was a woman and had therefore 
a stronger desire to be cured than most men have — her mirror 
w IS her const mt ills The vision in the right eye, with 
-os 

-VO as i^s 

correction was 6/9, and m the left eve, with 

-05 

-2S ai 50 


corieclion w is 6/6, but of course onlv the right eve was 
being used 

The angle of the squint was 3S degrees and when iisine a 
scjaaralor with a com in front of the good eve she could jnd 
sec .a bright light held m front of the other bin not a non 
luminous object such as a piece of while paper — lint is vision 
was entirely uniocular 


She came to see me twice a week and practised at home 
about three quarters of an houi dailv with grcU legiihrilv 
Within ten weeks the eves were straight but onlv while she 
remembered ’ In four months the acquirement of siercoscopic 
vision and the great increase in l)ni,hliic<is consequent on the 
use of both eves had made temper irv relapses into uniocular 
vision so distasteful that no further exercises were needed to 
keep hci eves straight 

The stages of her training weie as follows (1) The acquits 
ment of vision with both eves simullaneoiislv This was done 
with Remv s separator and Cantonnet s mirror stereoscope 

(2) The transition from simultaneous vision to binociiht 
vision — when foi the first time in her life while using bnm 
eves, she saw an object in space as one This vns achieved 
by means of exercises with Cantonnet s stereoscope the large 
diploscope, and the smill diploscope, together with Javals 
grid for reading 

(3) Lastly, stereoscopic vision had to be acquired For llus 
purpose she went through a course of Swan Cole orlhogranis, 
using the ordinary Holmes stereoscope The whole mining 
was completed by a study of anaglyphs by Dr kfargare 
Dobson 

The enormous supenoiity of this oithoplic cure over i 
surgical cuie, if indeed such had been possible, is obvious 
when one remembers that a surgical cure would hive 
been merely cosmetic The originally deviated eye 
have remained a non-seeing eye, and the gieal 
xfaining i pair of straight eyes—ntmciy, slereosc p 
zision — would hive been absent 
Tisbury, Wilts W H Du Pri , M B , B S Lond 



Ji n 16 19^'? 


RE\ lEW'I 


The Bfms;? 
'(epical JOLltNU. 


12^ 


Reviews 


DILTmC MALNUTRITION IN THL TROPICS 

Tn^pcitl \titniipt ttrtil B\ I NicholN 

M D (Pp 16^ fihlci 2 plaic'^ '!\ M net 1 I ondon 

lUilIicn. Tindill and Co\ IP?*? 

In his prslicc to -I TriitU^i of / ooih piiblislKd in 1704 
Lcinis Ltnisrl rLnnrl,s lint St'i-ral Authors ln\w Irtalcd 
ol this Subjcsl but some ol them base bsLii so I iri,t. and 
proh\ ih It there is no Reader though neser so niiieh bent 
upon It but must be dashed m eonsiderinj, onH the leni,lb 
ol the Work Others have handled it unh so mueh biren 
ness and bresits that sou cm scarce meet ssiih halt the 
Things there sshich ought to be in The same might be 
sa d ol a numb.r of authors who base treated ol this sub|eet 
within reeent sears but not of Dr 1 ueius Nichotts sshose 
reCentls published book Tropuot fyutnitoii tiiul 
g'sts a clear concise and pnclical aecount ol the relilion 
ol foods to health and disease in the Tropia It is meant 
primanis for medical praclition rs who work imoitg the 
masses in these regions but those ssorking cKesshere will 
tind It worth their sshile lo studs il for experience gained 
in the Tropics of disease due lo diet irs defieiencie- pns 
sides much that is instructise for doctors elsewhere Of 
th- elesen chapters m the book six are desoted to an 
up to date account of the essential constituents ot food 
— cjrbohsdrates fats proteins minerals sitamins 

roughage — and the cnergs salue ol foods In regard 
to protein requirements it is pointed out Ihit sshile there 
IS a general acceptance among the nutrilionisls of Etirttpe 
and America that the d uls protein alloss ince should be 
100 grammes this allowance is too high for tropical con 
ditions The aulhor is in agreement with Askrosd th it 
6s grammes is stifhcienl for men and '1 tor ssomen 
additional allossances being made for growing children 
and lactating ssomen The weight of tat in the diet should 
be about the same as the sseight of proteins Three 
chapters on dietars sursess analsses of foodstulTs and the 
prescribing of diets ssill be found most useful 

Tlie chief interest of the book lies in the account it 
gises of the ssmploms and signs of dietars deficiencies In 
addition lo the extreme conditions such as beriberi scurss 
pellagra and keratomalacia sshich arise from sarious food 
deficiencies the studs of the less cogent results of 
dietar) deficiencies has brought to light the presaknee of 
mans signs sjmptoms stunted gross ih and other effects 
These are dr> and staring hair phrs noderma pellagra 
like eruptions scrotal dermatitis petechial haemorrhages 
oedema stomatitis sore tongue marginal stomatitis 
oesophagitis spongs gums Bitot s spots night blindness 
xerophthalmia dental decas malocclusion and irregular! 
ties of the teeth signs of rickets neuritis pareses anaemias 
lowered resistance to infection particular!) of the lungs 
and intestines, and poor growth and condition of the bods 
No doubt future study ssill reseal others For if Foods 
contribute so necessariH to the presersalion of Lite and 
Health they also produce the greatest part of the Dis 
tempers to which we are subject and so the know 
ledge we ought to be most desirous of should be that of 
Foods fLemert 1704) Dr Nichollss book presides 
this knowledge shossing svhy it is that foods coniribiile so 
necessanls to health and boss it is that improperls con 
stituted food produces many distempers His object — 
lo gise as shortly as possible the general principles of 
niilrilion and dietetics and to collect under one coscr ihe 
salient points of this information — has been ssell 


achiesed If there be a fault lo find m the book it 
IS in ns title Tropical Niilnlion Can nutrition a 
fiinclion of the bods be spoken of as tropical per 
laming to char icterislic of or peculiar to the Tropics'* 

TUMOURS IN THE NECK 

VnreiK/f of the Doetues of the Seek Bi 

A'ihur L Herirler MD iPp 23" 206 figures 2Is nett 
Philadelphia London New Aork Montreal J B 

1 ippineotl Compam I93S 

The tumours which appear in the neck form a group ot 
eonsiderable surgieal interest coiermg a \er\ wide range 
ot pathologs There is indeed no region in which the 
appearance of a lumoiir is more eommon or in which ils 
diagnosis max be more difhcull The present xolume 
dealing IS It does with both ihc surgical and pathological 
characters ot this group of tumours will be of interest to 
medical praclilioners in mans fields 

The first chiplers are dexoted to Hodgkin s disease and 
th,. Ixmpho-areomas and an account is gixen from the 
surgical standpoint of Ihc xarious news xxhich pathologists 
haxe taken of these conditions This is folloxxed bx a 
discussion on the rare primarx tumours of the neck and 
of thxroglossal ind branchiogenetic cysts A description 
of the b.nign tumours of the neck folloxxs Diseases ot 
the salixarx glands are treated in some detail and the 
xolunie concludes xxiih a description of the secondary 
tumours and intectious conditions arising in the neck 
The whole xohime is beautifullx illustrated both bx 
photographs of ixpical cases and bx microscopical sections 
The descriptions gixen arc brief and to the point and xxhile 
no attempt is made to go into elaborate pathological 
details the accounts gixen are sufficient tor practical 
purposes The xofiime is indeed csscntiallx practical and 
will xxell repax Ihc stiidx both of the student and of the 
surgeon xxho has to deal with these conditions 

NUTRITION AND DIETETICS IN BRIEF 

FihuI III (/ FI wica! Ftit as Bx Professor E AA H 
Criiiel. bank MD D Se MRCP (Pp 148 15 tables 

2 figures s net posiace sj j Edinburgh E and S 
Lixing tone 1938 

Under the title of Fuoi/ tintl P/i\ytial Fitness the Regius 
Professor of Phxsiologx at Aberdeen has made axailable 
in the form of a short monograph a series of public 
lectures which he had delivered under the John Farquhir 
Thomson Bequest The book is a xerx good attempt lo 
make axailable to the general public the results of research 
in nutrition and the elements of sane dietetics In his 
introduction Sir John Orr says that information of 
oraciieal importance has been collected and presented m 
lucid and interesting language xxhich can be understood 
bv he general public and this is a xery fair commenlarx 
The interest of the public is growing steadily m the subject 
of nutrition in relation to health and disease and to 
eeonomic policy This book will be of great service to 
those engaged in social services and to householders who 
wish to 'make the best outlav of their budget on diet 
The general principles of the energy needs of the body 
and the value of the different foodstuffs for energy pro 
duction and the sources of minerals and vitamins are 
verv carefullv dealt with 

In Ihe last few chapters Professor Cruickshank deals 
with subjects which are a good deal in the public eye 
at present — namelv the relation of dental canes lo de 
fective diet and the effect of adequate nutrition on 
phxsique and muscular development In a somewhat 
trench int chapter on vegetarianism he exposes the fallacies 



126 Juiv 16 193S 


KLVICW9 


of \ irioiis iiiodLrn diet fads These dislorlions of liiith 
line undoubtedly iriscn to Till the \.\cuum created by 
the het that the public ire mere ismgly iwarc of the 
importance of diet m relation to health, and yet the 
iveragc doctor is either un iblc or unwilling to transl itc 
physiologic il principles into simple languige which the 
hv public cm undcrslind Professor Cruicksh ml s book 
will go a long way to filling this s icuum by reasoned 
facts and it would be a grcit id\ ml igc if the book w-ere 
read not onlv by the lay public but also by the mcdieil 
profession 


Tut Ruhnn 


pa ioni/cd less on its indiMduil merits ihan on ihc 
extent to which the autho. ,s known personally or by 
repute to ll.osc who happen to want a comprehensne 
m.inual of neurology at the moment The nrescni 
volume will therefore ippcal to the Chicago medical 
schools ind those other schools which ire under the 
mnuence of that import mt centre of learning but we see 
no piriiciihr rcison to commend it to British readers to 
any greater extent than several other works of a sinulnr 
n itiire 

PRACTICAL ANATOMY 


1HLRAPIU1ICS or ANTIMONY 

III till t lit ruin iitK% Ilf Aiiliiiioin Its Professor 
Dr Phil Nit Hans Schmidt mil Dr Med j' M Peter 
M'llh a preface In Philip MinsonBihr CMC DSO 
MD I RCP (Pp 2^7 lOdiurams RM |R bound’ 
iM 19 50) I eip/ig Geori rhicmc I93R 

This IS an IZnglish version of Lrtuhnnu iiiul rorlMliiiiiL 
tht Inliiiionllttrapii bv Professor Hans Schmidt and 
Dr r Nf Peter which w is published eirlv last yeir 
Jn our review of the Cicrman volume (Uninli Midual 
Journal 1937 2 66) we mentioned the remarkable r ipidity 
ol the adv mcc in the import ince of the mtimonv com- 
pounds m the trcitnienl of tropical discises An English 
edition IS therefore verv welcome moreover, the authors 
have revised and cxpiiuled the origin d nntcnal md 
hive incorporated the literature up to the end of 1937 
Thej hive also iddcd an luihor index vvhich is i very 
vduabic addition Dr Philip Manson Bahr his con- 
tributed a pref ICC, in which he reviews the extiaordmirv 
career of antimonj as a thcrapeiilic igcnt Je/cbel used 
It to darken her cvehrows P.iracelsus boomed it as i 
pinicea and the Universitv of Pans solemnly banned it 
and all its users In the first h ilf of Ihc nineteenth century 
It was the chief basis of the orthodox method of * heroic ” 
Ircaimenl, while by the end of die ninclccnlh cenlurv it 
bid almost ceased to be used finally in the twentieth 
century it has made i sensational come-back, and orgmic 
aniimonials arc steadily incrcismg in import mcc m chemo- 
ihenpy 


GRINKCR’S NEUROLOGY 

A'fino/ogv Bv Roy R Gnnkcr M D Second edition 
(Pp 999 406 figures 38s) London Baillicrc, Tindall 

and Cox 1937 

The second edition of this work appcirs wiihm fom 
years and without any outstanding eh mge m its scope, 
except that the descriptions of new developments, such 
IS the increased knovvledgc of the physiology and pharni€i- 
cology of the aufonorn*,' nervous system and advances m 
diagnostic methods suci^^;,hc electro cnccph ilogram and 
improved enccphalograp ,'Von ^ necessitated the shorten 
mg or omission of certau'' j\tions m the first edition if the 
aim of the author to kec)-. me work within the covcis ot 
one volume was to be maintained In spite ot this 
hudablc aim the work is large and heavy, extending to 
-nearly 1,000 pages, which only goes to show whu a 
omplicated subject neurology has become 
The scope of the book is along the lines ol the modem 
ysiematic textbook, the arrangement being largely on 
pathological lines and covering the field of organic 
neurology reason ibly completely It is well illustrated, 
with a useful bibliography at the end of each section 
A good many textbooks of this kind arc being published 
novvidays vvhich cover much the same gioiind in much 
the same way, and it is a little doubtful how far their 
multiplication is worth while Probably each is 


Miiiiiiiil of rrailiitil Aiuitonn \ oliiiin I Upper Lmih 
lout I I mill anil AMomcn I'olii/iii II Tlinrin Ikml 
mill i\’iik Cnilnil t\’cnoit\ 'iMiem L\c anil Fiii Bi 
J I rncsi tnrer D Sc TRCS ami Reginald H 
Robbins M A M D (Pp sifj qnil pp 4'i6 281 figures 
iml 290 figures lOs r,tl each volume) 1 omlon 
Bullierc T md dl and Gov 1937 

Ihc Miiiiiial of I’laiiuiil Aiiiiloiiiy by Trazer and Robbinj 
of St Mirvs Hospit il, London, is something more than 
i guide to dissection and region il anatomy since the 
det iilcd description of the structure of the idiilt subjcci is 
explained md supplemented by references to develop 
mental uiatomy These not onlv tdd interest to the 
inatomical I icts but throw i cic ir light on many dcinils 
of in itomy which would otherwise be obscure Due 
ittcniion h is ilso been paid to the medical ind surgical 
aspects of .m iiomy ind we may specially mention m this 
respect the descriptions of the thoracic ind abdominal 
regions 

The book IS in two volumes, but it is not burdened 
with 100 much dcliil, the full description of special 
structures such as the eye or car being left for sttidv in 
the lirger systematic tre Rises on anatomv The nomen 
claturc employed is the ‘Birminghim Revision,’ ami 
e ich volume his i scparitc index md glossary The 
manuil is on the whole well ilhisliated, miny of tlie 
figures having been reproduced from standard works such 
as Hiischlicid md Levcilld , others aie new or have already 
ippcarcd in Frazer’s Manual of Linbnology or in 
Buell m m s Analonn , all ot these hive the unmistakable 
stamp ot origin iliiy, md though some are schcmaiic 
others .ire drawn from actual specimens and serve to 
illiistritc pirticular points, such is the rclition of articular 
c irlil.igcs pads of f it or svnovial pouches to the ligaments 
of a joint The book, which is the work of two cxpcri 
cnccd an itomisls, is admirably id iptcd to meet the require 
ment of both junioi md advanced medical students, not 
only With icgard to the anatomic il information vvliieh it 
coni uns but ilso is a training of the faculties of observa 
tion and dissection and as an ud to the passing o 
cxaniin itions 


Notes on Books 

The first gioup ol ai tides on Ihc Nf magenient 
Major Medical Disorders contributed to these com 
,vert republished in M irch, 1936, as Volume 1 ol ro 
nenl in Ccncial Piatlnt This collection 
hseasLS of the respiratory system, iculc specific ic 
ind caidiovasculai diseases In reviewing it Dr 
Hutchison said that ” the articles arc so .I,- 

node of picsentment that they might all hive 

vork of one author, whilst the therapeutic inslrucfion 

•iven m them arc clear and definite, and ‘ . 

ml confused, as he so often is in books 
jy the mention of lists of remedies which arc 
aicccssful ’ ” The book was reprinted in 't*-' ; . „ 
md now a second edition, revised by n, g.a 

s juiblishcd by Messrs H K Lewis and Co at 


Jim IC IOIS 


127 


NOTCS ON BOOKS TuEBumm 

MEDtcAL Joe PS It 


Tor 1 ilion ind niori. HiwK^ Prmtual Pli\uo 

C/teinntn In'; Iillii m oiitsi indini, work and 
succlssiee editions reaching now to the eKsenth (J ind A 
Chiirehill ’is) hue kept well abreast of the \er\ rapid 
deselopmcnts of the subject In his great undertaking 
Professor PittLti Hwsk has ot recent jears enlisted the 
help of more colhborators and three other well known 
names now appear on the title page and \ inous eon 
tribiitons ha\e lent their expert knowledge and adxice in 
dilTereOt parts Tlie book is and alwaxs has Iscen the 
complete laboratorx guide stocked with methods so care 
ftilh Selected that the> mix be relied upon xxith absolute 
confidence In places a point of detail max be licking 
but onlx xxhere the original Iitcriture is quoted for fuller 
reference 

The monograph bx Dr Crtcii A Htior on Dit 
iorii/iot/ncr Krui k/ieir (Berlin R Sehoetz, RM 3) other 
xxise known as mxalgia icute cpidemica of Sxlxest consists 
of a critical rexicxx of the literature including the articles 
xxhich haxe appeared in the British \ftiliciil Journal bx 
Pickles (1933 2 gI7) Carter (1933 2 S6) Jai (1934 1 
79) Buchanan (1934 1 1201 and SeOtt (1936 2 699) The 
clinical aspects actiologx cpidemiologx and distribution 


of the Bornholm disease in Gernianj and other countries 
are discussed at length and the author comes to the 
following conclusions This disease represents one of the 
mjsterious short lixed tebrile maladies of temperate zones 
on xvliich new light max be shed by further epidemio- 
logical ind parasitological inxestigations as has recentlx 
been exemplified by tularaemia Japanese rixer fexer 
Wcils disease and tropical and subtropical typhus ft is 
probable that the Bornholm disease is caused by some 
kind of lixing xiriis xxhich is kept m an animal reserxoir 
and transmitted by blood sucking insects at definite 
seasons ol the xear The question further arises as to the 
existence of endemic epidemic or pandemic diseases xxhich 
are transmitted not bx a specific agent but by telluric 
and cosmic influences xxhich so affect man animals or 
plants that ihex dexelop a disease just as if thex had been 
attacked by a fixing xirus The author suggests that the 
Bornholm disease max be an example of this kind 

The Inlerntiiionalc Zeiisihrifi fur Pnclioanohse and the 
journal lmat,o the official organ of the International 
Psychoanaixtic Societx both edited by Professor Freud 
haxe Ceased publication The International Journal of 
fiuliMiluat Pi\rlu>los\ will also cease publication 


Preparations and Appliances 


TRIPOD FOR ^E^TRICULO^.RVPl^C ACPDILS 
Dr \ Opil\ (I ondon \\ I) untCN 

It often difficult to keep <itcnd\ the \cntnculocnphic 
needle ditrtnct the repented nspinttons of ccfthrospfnni fimd 


ciilir caMl\ It consl^ts of a tripod which is slipped over the 
needle ns soon as the ccr «’rospinal fiuid begins to flow The 
pointed ends of the slighllv ciined legs of the tripod bur> 
Ihcmvehes rn the diplou of the trephine opening while the 



A N enlficulogniphic needle 17 cm long once in the correct posiiion in the brain ii »s fixed b> means of the 
tripod (B) whcih is made to slip over the needle a a a” Short blades for grippmi* ihc needle b Movable nng 
When It moves upwards in the direction of the arrow the legs id d d") of the tripod spread out and the pomiv 
(c c c“) bury themselves in the diplo- of the trephine opening Simuliani.ou>l> the bladc,s ta a a ) are brought 
closer together and grip the needle which is thus immobilized The set strew (/) prevents the nng from sliding alter 
It has been brought into the correct position The needle (A) is then connected to a svrmge b) means of a short 
rubber tube which is slipped over the free end of the needle (Actual size) 


and injections of air in ventnculographv Even a slight shifting 
of the point of the needle ma> stop the flow of the fluid The 
device depicted above helps to stead j the needle and to keep it 
in the correct position after it has penetrated into the \emn 


blades at the opposite end of the legs gnp the needle flrmlv 
and thus prevent it from being pushed in or out during the 
subsequent manipulation The tripod is manufactured bv 
Messrs Lewis Brov *68 High Street Mar>lebone V» I 



CLINICAL SCICNCC 


128 Joi\ Ifi 10^8 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDAY JULY 16 1938 


CLINICAL SCICNCC 

To all uho were privileged to enjoy Victor 
Horsley s friendship, and especially (hose who were 
so fortunate as to work with him as collaborators 
or disciples and were thus able to savour the 
scicntilic genius as well as the courageous and 
lovable personality of this great Cnglishman, the 
very title “ Victor Horsley Memorial Lecture” will 
bring a flood of happy recollections — perhaps most 
of all to those who were with him in that last and 
noblest chapter of his life written in Egypt and 
Mesopotamia and conccined with greater things 
than science We do well to commemorate such 
men primarily that we may not cease to learn from 
them those lessons of moral courage intellectual 
integrity, and scientific imagination that their lives 
show forth but also and particularly in this 
instance and at this time because Horsley cxcmpli- 
hed that successful combination of clinician and 
<;cicntific mvcstigatoi the very possibility of winch 
has recently been challenged by a distingtiislied 
laboratory scientist So wide was the range of 
Horsley s scientific interests that in a single lecture 
but one aspect of it can be adequately consideicd 
and Dr Goidon Holmes has chosen his contri- 
butions to the pliysiology of ocular movements as 
the theme of the present lectuie He has developed 
this m a manner reminiscent of Hoisley s owm 
method, foi he has piesentcd a body of precise 
observations and lias proceeded to piovide an 
analysis of them on physiological principles 
The cerebral integiation of the oculai movements 
IS a peculiaily complex pioblem m the physiology 
of movement, and this perhaps because of the abun- 
dance of facts of obseivation rathei than fiom any 
lack of them In some ways it may at first sight 
seem that these movements aie a law unto them- 
selves Then coitical lepresentation in the fiontal 
obe is anatomically sepaiated fiom that of other 
movements, and the ocular responses to electucal 
stimulation of this repiesentation differ qualitatively 
m some respects fiom the more familiar motor 
lesponses to stimulation of the so called “ excitable 
motor cortvX ” Again, m many widespread dis- 


Medical Jolrn^L 


orders of movement and of posture from brain 
lesions eye movements alone escape disturbance 
as, for example, m chorea double athetosis and 
pandysis agitans, to cite but the most famlmr 
To Hughlings Jackson we owe certain illuminatmir 
generalizations as to the modes of dissolution of 
function in disease of the central nervous system, 
and in the light of his conception of loss and release 
of function the phenomena of cerebral paralysis 
have been analysed on lines that are familiar to 
students of neurology 

Jackson himself made many studies of disorders 
of ocular movement, but these disorders have 
never been brought fully within the scope of 
the principles w-hich he show-ed to govern the 
evolution and form of disorders of movements 
other than those of the eyes It is the merit 
of Dr Gordon Holmes’s lecture that he has 
so brought them, and has demonstrated that a 
careful study of disorders of ocular movements 
from ceicbral lesions reveals those same phenomena 
of loss and of release of function with w'hicli we 
arc familiar in respect of other movements Thus 
the cx.iggeration of the fixation reflex winch may 


be found in association with certain forms of loss 
of voluntary deviation of the eyes is seen to be a 
release phenomenon comparable with the livpcr 
(onus and other increased postural reflex reactions 
that arc so prominent a feature of what we call 
spastic paralysis Conversely, there arc described 
the disordeis of voluntary movement and posture 
of the eyes that result from a defect of the fixation 
leflex, and this leflex itself is also subjected to 
close physiological analysis In a word Dr 
Holmes s studies have brought one more group of 
clinically observed disorders of function xvithin the 
scope of those geneializations that have alread\ 
proved so fruitful in neurology and while thus 
making these additions to our knowledge, he has 
also integiated them with the general body of 
neurological theory This is the true scientific 
method, and that it can still be pin sued by simpk 
clinical observation must be a chcenng sign lo 
those w'ho believe tliat this method has yet a nth 
haivest to give to medical science and that it has 
not yet yielded pnde of place to the experimental 
method These studies also teach us that whateier 
help we may leceive in the advancement of medica 
science fiom the labouis of the experimental 
physiologist it must always be the clinician who 
places the coping-stones upon these labours by 
detei mining" then application as only he can to 
the human subject 

The English school of neuiology has a grea 
tiadition and w'e may learn from the studies whici 
form the subject of tins lecture that this tradition 


js still alive and honoured 



3ul\ 16 


A PIONEER HOSPITALS CENTRE 


The Biotisr 
^fXDICAL JotTSAl 


129 


V PIO^CCR HOSPITALS CENTRE 

Al picc P’S we publish in account of the Binning 
Inm Ho'ipitak Centre and the Medic il School 
Buildings of the Uni\crsit\ of Birniinghini opened 
on Thiirsd i\ b\ the Duke of Gloucester icting in 
pi ice of the King who was preicnted b) indisposi 
tion from fulfilling the engagement This ceremony 
IS in outstanding event not onK in the annals of 
a citv famous for its progressive spirit ind local 
pride but also in tht historj of voluntary hospital 
planning in this counlr) The Hospitils Centre 
— which means a hospiial or group of hospitils 
linked structurallv and in i working irrangcmcnt 
with the Medicil Tacultv of the Universitj — is well 
understood m the United States but the Birnimg 
him ichievcmcnt is a pioneer one m Greit 
Bntiin The new buildings are a first instilment 
providing some 500 beds the completed hospit il 
IS planned to iccommodate 740 It embodies the 
latest ideas and experience in design planning ind 
administration The beds are to be orginizcd in 
units of sixtv each unit being complete in itself 
The first instalment of patients is deferred until 
the autumn To provide a complete organization 
working at full capacity "will take some time cs- 
pecialh in a hospital of modern design including 
all the many departments supplying the needs of a 
medical school 

Full) to understand the idea behind the scheme 
for the Hospitals Centre it is necessary to go back 
a little Soon after the war it became apparent 
that there was an increasing deficiency of hospital 
beds in Birmingham having in view its growing 
population and perhaps its increasing ' hospital 
consciousness The two large general yoluntary 
hospitals — the General founded in 1766 and 
Queen’s in 1840 both of them teaching hospitals — 
began to consider the question of extension on 
their existing in town sites The General with its 
Jaffay branch has 536 beds and Queen s 324 
The Hospitals Centre scheme was made possible 
by the amalgamation of these two hospitals for 
working purposes, under the name of the Burning 
ham United Hospital of which Lord Austin is 
chairman A joint committee was formed in 
eluding representatives of both institutions and the 
ambitious plan of a Hospitals Centre right outside 
the city was determined As soon as the full com 
plement of the 740 bed hospital is complete 
Queen s will close down Another ruling con 
sideration which has led to the establishment of the 
Hospitals Centre is the need for closer co 
ordination with the Medical Faculty of the Uni 
versity Hitherto the Medical Faculty (with those 
of Arts and Law) has been housed in the buildings 
of Mason s College in the centre of the city It 


Ins been unable to follow the other faculties out 
to Edgbaston so long as the two teaching hospitals 
remained on their present sites As the Prince 
of Wales said when he laid the foundation stone 
of the hospital and cut the first sod of the medical 
school buildings in 1934 A working partnership 
between the hospital and the Medical Faculty of 
the Universitv is novv universally recognized as the 
most effective service that can be rendered to those 
in need of circ and treatment 
The most urgent need was for general medical 
and surgical beds but it is expected that in due 
course the v irious special hospitals — of which 
there ire nine in Birmingham — novv located in 
the centre of the city will migrate to the new site 
This must be in cich case a rather complicated 
business in view of the disposal of properties but 
the special hospitals arc ilready associated with 
the scheme and thev will have the opportunitv of 
working out with the Executive Board plans for 
their own development on the site while still pre 
serving their identity In years to come there may 
be in the city onlv casualty clearing stations and 
with an adequate ambulance seryice all in patient 
and out patient provision will be concentrated at 
Edgbaston The site which the Birmingham 
Hospitals Centre owes to the munificence of the 
Cadbury s is of 150 acres of which 100 acres are 
scheduled for hospital purposes and 50 for open 
space This IS considered adequate for all hospital 
developments for at least half a century to come 


PLANS FOR PLYMOUTH 

Publication of this number of the British Medical 
Journal coincides with the opening of the business 
and political part of the 106ch Annual Meeting of 
the British Medical Association, and in our next 
Supplement we expect to giye a full report of the 
first two days proceedings in the Representative 
Body The Association has met only once before 
at Plymouth sixty seven years ago The meeting 
of 1871 in the Three Towns” (Devonport Stone- 
house Plymouth) was regarded as one of the most 
enjoyable ever held and if the elaborate plans 
sketched in last week s Supplement are carried 
through in the traditional Plymouth way the same 
will be said of the meeting of 1938 No member of 
the British Medical Association has to be reminded 
that at Plymouth he treads histone soil It is 
moreover a locality which combines the charm 
of seascape and landscape with the varied 
animation of a great port and arsenal Indeed 
the programme of entertainments and relaxations 
in a beautiful setting is so full that there may be 
risk of pleasure standing in the way of duty 



no Jun If), 


PL^N5 1 OR PLYMOVril 


The seventeen Scientific Sections have arranged 
a good and many-sided programme foi WedfTcs- 
day Thursday, and Fiiday Tliicc combined 
sessions Will be held one to discuss sciatica 
another the prevention of piicipcral sepsis iind 
another iheinniiloid arthritis Tjic main subjects 
taken by the Section of Medicine arc toxic infective 
jaundice anxiety states and oiganothciapy , and 
by Surgery, the ticatmcnl of acute appendicitis, 
cancer of the breast and the septic hand The 
Section of Obstetrics, when meeting alone will 
discuss occipito posterior positions .ind their com- 
plications , Orthopaedies, fractures involving (he 
knee-joint Neurology .ind Psj'chological Medicine, 
vertigo and the differentiation of states of depres- 
sion Ophthalmology has what may be called a 
joint topic — coopcialion between ophthalmologist 
and physician in eases of visual loss , and Medical 
Sociology, not to be outdone, makes co operation 
m public health administration its chief item The 
Section of Public Health will discuss the future 
dexelopmcnt of the hospital system Physical 
Medicine (meeting at Torquay on Friday), the basis 
of national fitness , and the Services Section the 
evacuation and treatment of gas casualties while 
Physiology stoops to conquer the practising doctor 
with a session devoted to light in relation to 
climate and health Pharmacology will debate the 
dosage of anaesthetics, the teaching of anac«tncsia 
and ovarian therapy Pathology has chosen the 
aetiology of rheumatism and rheumatoid arthritis 
for discussion , Tuberculosis, the prevention of the 
disease with winch it is concerned, and skiagraphy 
of the chest , Radiology v rays in the elucidation 
of haemoptysis, and the treatment of uterine 
haemorrhage — iw'o matters of interest to other 
specialties The programme for Diseases of 
Childien includes a debate on the modern failure 
of breast feeding, and another on empyema m caily 
childhood , and on Us second day a Iccluic m 
memory of the Jale Editor of this Joiinuih on Some 
Nutritional Problems of Childhood will be given 
before that Section by Piofessor L G Parsons, to 
whom the Dawson Williams Piize has lately been 
aw'arded Beyond these larger items m the 
Sectional plans for next week there arc many 
independent papers coveiing a wide field of 
practice and research, all of them listed m the pio- 
gramme published on July 9 It is to be hoped 
that the audiences in the Sections will be woithy 
of the fare provided 

In 1871 it was held to be a matter for seiious 
nsideration by members “ whether it will not be 
sirable to subdue the otherwise naturally growing 
endency to allow the holiday-niaking to overude 
the seventiftc and xrorking objects of these annual 
meetings” Never befoie so the argument ran. 


Tut Bmiisii 

MtOICAL JOLUMI 


had the British Medical Association coveicd so 
Jdigc a giotmd of public usefulness or influenced so 
strongly public opinion “ The annual meetings 
offer (he finest professional platform which ctish 
for the propagation of opinions m the profession 
the public.t(ion of researches, and (he enunciation 
of facts The natural course of events would 
be therefore, that these meetings should continue 
to attract papers of more and more value , and it 
was the operation of this opinion, and the grut 
increase m the scientific prestige of the Associafion, 
w'bich necessitated recently the formation of a 
mulliphcity of Sections The reaction from the 
years of sectional activity to those of continuous 
pleasure making requires to be checked” The 
visitors to Plymouth in 1871 had earned these 
prim words of rebuke by their neglect of w-ork 
for play Some such warning may be needed 
even m 1938 


TJir STRIVTOCOCCVS CARRIER PROBLDf 

The new chcmotheiapy lias so changed the outlook in 
the problem of puerperal sepsis that its other aspicts 
.ire apt to be forgotten It is indeed interesting to spccu 
late on the direction which propliylnctic efforts might 
ha\c taken during the past three years had so slrikingl) 
successful a treatment not monopolized attention The 
chief achance preceding this had been to identify the 
source of puerperal infection ns usually the nose of 
throat of a contact with the case, and measures for 
detecting such earners were coming to be regarded as 
an obligation on those responsible for the conduct o( 
midwifery, at least in institutions Where do we stand 
now in tins mailer ^ It has been emphasized repeatedly 
that the possession of a powerful therapeutic weapon 
in sulph.mihmidc is no cvciisc for relaxing precautions 
oi for ncskcling olbci forms of irentmelit It must 
neierthclcss mflucncc a decision when the proper course 
of action is really in doubt, or when extreme measures 
m detecting and excluding earners arc impracticabk 
Strictly speaking the w'holc personnel of a midwifery 
unit should be sw'abbed on entry and at intervals there 
after, and earners of haemolvtic streptococci proved to 
be of Group A should be excluded until free The 
iigid application of this rule would ovenv'heJm evisimg 
bactciiological laboratories w'lth an exceedingly tedious 
type of woik and probably demand the establishment 
of others, and at the same time it would sometimes dis 
organize clinical work by requiring the banishment of 
essential personnel Nor will these extreme measures 
necessarily succeed for a member of the staff ntny 
acquire a streptococcal infection at any time, and an 
active tonsillitis or sinusitis is a far grcA.tcr danger than 
the quiescent earner Any efficient vprccautionar^ 
system will include prompt attention to any^cutr '■ 
of the upper air passages wiiethor by way ol ^ 
from dutv or of bacteriological investigation | ‘ 
tion IS w'hether this form of precaution wly»cs> 
also mvwWe We elwwcal tccognitron of tf 
infection of the upper air passages and itsf 



JUL\ 16 19*^^ 


STREPTOCOCCUS CARRIER PROBLENf 


TirtBiuTOH 
MiorcAL JouwtU. 


131 


in\(.stigiiion IS not pn.feriblc to n s\stcm of unnLp;il 
This iltitudi. w is supported in our corre 
spondcncc columns sonic time ngo nnd it is hsoured b\ 
Lucs M Brsec nnd Phsllis Tcssslcs ' who report in 
dctiil nn extensile studs of the enrrier condition in 
connexion ssith i sniill outbrexk of puerperal sepsis 
in Austr lia This inscstigntion ssas soniessfnt Inm 
p^red bs the lack of ficihties for the serological fsping 
of streptococci ind in attempt to classify them bs 
determining their susccptibilits to different strains of 
bactenophage did not proside a s,itisf iclors substitute 
for this nie'hod Ncserthcless the results indicate 
cWarls that sshcreas m the presence of spreading strepto 
coccal infc^iion persons ssith a normal upper respiratorj 
tract mas become earners for a short penod onls those 
ssath chnicalls detectable abnormalities in this region 
tend to remain carriers irrespectise of their ensironment 
The conclusion drassn is that a clinical examination of 
the nose and throat should precede the studs of mid 
ssifcr) this IS a common sense attitude sshich has much 
to commend it 


THT PECKH\M HEVLTH E\PER1ME>T 

An interesting meeting ssas held at Clothssorkers Hall 
in the Cits of London on Juls 6 for the purpose of 
discussing the rcccntls issued intenm report of the ssork 
of the Peckham Health Centre This report entitled 
Biologists in Search of Material ssas rcsicssed in these 
pages on June 18 (p 1312) Sir Wsndham Decdes 
ssho opened the discussion said that fise or six \cars 
ago the starting of such an enterpnse as the Peckham 
Health Centre might ssell base been thought impossible 
but despite difficulties and prejudices Alpine if not 
Himalajan Dr Scott Williamson and Dr Innes Pearsc 
the seeking biologists had surmounted them all 
Too man) expenracnis ssere undertaken bs people ssho 
had a perfectls clear idea of sshal thes ss anted but did 
not alloss the data — the material — to base enough to 
sas in the matter On the other hand the Peckham 
expenmenlers had no preconceiscd ideas thes ssere 
content to assait sshateser results the interaction of the 
matenal and the ensironment ssas capable of bnnging 
about The pohes of ssaitandsee in this connexion 
ai least ssas not ssnhoul its adsantages A great deal 
of monej ssas sometimes spent in social ssork but the 
people for sshom the social sersices ssere designed ssere 
forgotten or at least not studied Great changes in 
social ensironment had talen place ssithin the expen 
ence of the present generation Man had been taken 
largel> from the sillage or small tossn into a sast societj 
m svhich the indisidual ssas lost and fesv people had 
gisen scientific consideration to the sociological con 
sequences of such change One sentence in the interim 
report had struck him People tell us that there is no 
real neighbourliness We base discos ered that the 
siQiJonditions suitable for neighbourlmess are not there 
Ho r>, e suitability or otherssise of the ensironment of the 
made all the difference betsveen happy and 
trated lises Dr Scott Williamson said_ that the 
Qt e significance of the interim report lay m the ssord 
p'j P' dnogical ’ Sir Ws ndham Deedes had extolled the 

Sfeit J Austral 1938 25 i 639 


courage of the expenmenters but courage and faith and 
biologs all ssent together The most appalling fact to 
bv deduced from the report ssas svhat could onls be 
desenbed as the dcsitahzation of the people The 
Centre ssas dealing ssith a represeniatise cross-section 
of the communiis not poserts stneken relatiselj ssell 
housed mans of the people in safe emplosment and 
set in spite of the fact that sanous diagnosable maladies 
had been dealt ssith and maladjustments corrected there 
had been no great rebound to health The desitahza 
tion ssas present in sanous degrees mans of the people 
enjosed a sense of ssell being (sshat our resiesser called 
ssell Seeming 1 but the population ssas rather a sur- 
sising than a lising one This ssas due to the hentage 
of ensironmental conditions m the hses of the voung 
people Later ssork at the Centre subsequent to the 
period cos ered bs the report had brought out the help 
ful fact that notssithstanding a people relatiselv desital- 
izcd the children bs the application of appropnaie 
scjenlihc measures could attain normal phs siological 
standards This ms a great encouragement to go 
further and discover a scientific approach to the sanous 
problems bs ssatching boss men and ssomen under 
conditions of rclatise freedom behased and reacted to 
the facts presented to them in the simplest possible ssa) 
The experiment therefore had much further ground ‘o 
cover One lesson for our profession ssas ssell put by 
Dr Scott Williamson Medical practice of the future 
he said ssill have to take into account the fact that 
patients are not onls sick persons but units in some 
form of social machiner> and the approach to the 
people IS not best made through the contacts rendered 
ncccssars bs sickness but through communits centres 
or some such form of organization In repls to a ques- 
tion he promised to offer some guidance to social 
workers and local authorities on the method of organ- 
izing in their respective localities such centres free 
from officialdom as Peckham 


TAR-MRUS CA^CER 

Reference has been made several times reccntls in this 
Journal to the hspothesis that all malignant tumours 
are initiated and maintained in actisits bs a living 
virus In order to explain the undoubted carcinogenic 
action of mans chemical imtants tn accordance with 
this hspothesis it is necessars to suppose that chemical 
action of this kind only serves to render cells susceptible 
to the virus One of the leading advocates of this siesv 
Peylon Rous briefls announced two sears ago the 
startling results of an expenment which at first sight 
appear strongly to support it The Shape papilloma 
IS an innocent tumour infectious and unquestionably 
due to a virus svhich occurs naturally in the skin of 
wild rabbits in some parts of Amenca It is transmissible 
to domestic rabbits and in them sometimes undergoes 
malignant change especialls in response to trauma 
the virus however becomes irrecoverable after malig- 
nancy is established Rous injected a suspension of 
this papilloma virus intrasenousls in rabbits whose ears 
had been tarred The tar used seo .rarely caused 
malignant change even after prolonged application the 
only result being the formaPon of indolent papillomas 



J32 JuL\ 16 19^5 


MEASURING EMOTION 


On the other hand, about three weeks, after the mtra- 
^cnous injection of papilloma virus the tarred cars 
suddenly assumed great piolifcrativc activity and 
multiple cancers appeared on them and grew rapidly 
Apparently two stimuli, each incapable in itself of 
causing malignant change, had co-operated to achieve 
this result with astonishing rapidity Peyton Rons and 
J G Kidd' ha\c now at Jong last published a full 
description of this phenomenon Allhougli this docs 
not detract from its significance it is now made clear 
that the cITccl is by no means a constant one an 
exceptionally acli\c \irus suspension prefcnibly ob- 
tained from a natural growth in a wild rabbit, appears 
to be necessary to secure it Tins paper also records 
in minute detail the effects of varying the technique in 
a number of wavs and in so far as tlicsc other results 
can be interpreted ihev point to the conclusion that 
malignant change occurs only when active virus in- 
jected intravenously becomes “ localized ” in a pre- 
viously tarred area C H Andrewes and liis colleagues^ 
Iiavc to some extent confirmed Rous’s observation, 
using not papilloma virus but that of the Shopc fibroma 
a similar but different innocent tumour of rabbits It 
will be interesting to see where this method of experi- 
ment ultimatclv leads It should not be difficult so to 
adapt it as possibly to gam csidcncc of the presence 
of a virus in purely malignant mammalian tumours 
Any such results would be of cnormouslv greater 
significance than those hitherto obtained 


SYMPTOMS or CARDIAC STANDSTILL 

Some patients xvith heart-block h we spectacular attacks 
m which there is loss of consciousness and convulsions, 
associated with extreme bradycardia or cessation of 
the heart beat This syndrome the Stokes-Adams 
attack. IS also associated, though more rarely with 
other disturbances of the cardiac mechanism that slow 
the circulation almost to a standstill In the attack 
as usually described convulsions and apnoca take' place 
while the heart beat is very slow or arrested but P 
Formijne’’ describes five patients with apnoca or con- 
vulsions which occuircd after more or less normal 
cardiac activity had been resumed Three had heart- 
block, one a syncopal attack of emotional^ origin, and 
one attacks of ventricular fibrillation or flutter In two 
of these cases graphic records of the heart beat and of 
respiration dining the attacks show that apnoca began 
at an mteival of a few seconds after the return of the 
heart beat , convulsions or localized clonic movements 
were observed aftei about the. same interval in three 
of the patients Cerebral anoxaemia, which is held 
responsible for the convulsions and apnoea accompany- 
ing cardiac standstill, will not account for these events 
as observed by Formijne, and he suggests that they arc 
to the action on the brain of hyperventilated blood 
, le latter contains a high concentration of oxygen and 
a low concentration of carbon dioxide, and results from 
the continuation of respiration while the circulation is 

‘ / e\p Med 1938 67, 399 
^Lancet 1937,2,893 
V ^ Anicr Ucait J I9'^8 15, 129 


Tiic British 

■ ^ICAL )Qln\Kl 

arrested In cxpccimcnts on narcotized dogs it 
also demonstrated that apnoea and dome contract, o‘ns 
followed asystole when this was of 15 to 35 seconds’ 
duration , analysis of blood taken from the carotid 
aitcry immediately after the return of the heart beat 
showed a reduced CO. content, and the blood was 
redder than normal arterial blood The apnoca could 
be prevented by the inhalation of 5 per cent CO in 
oxygen during the period of asystole The respirator^' 
effects arc believed to be due largely to chemical action 
on the respiratory centre, but some of the results indi 
cated that the carotid sinus may also play a part 
Immediate treatment is rarely possible for a patient 
in a Stokes-Adams allack, but in the light of Forniijne’s 
work oxygen and CO- might be given with a view to 
preventing convulsions 


MEASURING EMOTION 


In this country and in the USA a wide interest is 
taken in the measurement of mental altitudes and 
emotional trails, not only on account of the importance 
of these assessments in social, educational, and medical 
questions but also on account of their uses in industry 
In spite of this there has existed hitherto no collected 
account of the literature on this wide subject To 
help to fill this gap Dr P E Vernon has undertaken a 
descriptive survey of experimental work which has bctn 
earned out on the measurement of emotioml 
characteristics His survey w'hich Ins been issued by 
the Industrial Health Research Board of the Medical . 
Research Council,' is icstiictcd to an account of types 
of verbal behaviour which are susceptible to quantila 
live treatment The techniques which have been 
invented for collecting groups of opinions arc fully 
described and adroitly criticized by Dr Vernon In 
discussing the procedure of rating he points out that 
in relation to the marking of examination questions 
both the average mark and the dispersion of marks 
given by each examiner arc liable to scandalous varia 
tions which could be and should be adjusted When 
due care is exercised in technique of experiments 
striking results arc sometimes obtained It is pos 
sible to measure the relative effects of various types 
of propaganda by examining people before and after 
they have been subjected to the influence of a cine 
malograph film Of the specific tests quoted, one of 
the most ingenious is Watson’s test of fair-mindedness 
The person under examination is presented with a stale 
ment, such as “ all most, many, few, no Roman Catho 
lies are superstitious ” The subject w'ho encircles 
eithei “ all ” or “ no ” is deemed to show prejudice m 
his response There are also ways of detecting pm 
judice in the examiner If, for instance a rater regar s 
a subject as highly aitistic he will tend to allribuw 
all the other traits commonly associated with 
artistic temperament to this subject if the rater t un 
the subject melancholy he will fail to notice siici o 
his characteristics as do not fit in with the prcconcei^ 


‘The Assissincitl of Ps)choloi;tcal Quahhes />! 

, P E Vernon, PI, D Med Res Coiinc industr Him 
I Rep No 83 London H M Stationery OHicc 


I 



Jli.\ 16 lOlS 


IMMUNIZVTION AGAINST POLIOMYELITIS 


over '^iniplifii.d notion Tins pln-nonKnon known is 
the halo elTcet usuillv due to the raters general 
liking or disliking for the subiect is almost unavoidable 
It gives rise to suspieiouslv high correlations between 
pairs of traits in the estiniition of eh meter rollow- 
ing the lines onginallv laid down bv Spearman in the 
analvsis of special mental abilities manv investigators 
have attempted to analvse the results of questionaries 
self ratings ard vocational tests in terms of specific 
factors Tor example the degae of extroversion and 
introversion n a given subject has been thought to be 
separable into five component factors — nameh socia 
bilitv emotional matuntv masculmitv freedom from 
cam and intellectual interest Dr Vernon points out 
that It IS now gcncrallv admitted that an infinite number 
of factonzatiops of the same set of variables is possible 
but he expresses the hope that factorisation mav vet 
help us to make predictions with a maximum degree 
of cfliciencv Not all who read the sunev mav be as 
sanguine as this Dr Vernon however is to be con 
gratulated upon a painstaking and cxtremelj lueid 
summarv of existing knowledge in this verv obscure but 
fascinating field 


iyiyiunization against poliomy cutis 

Constant attempts are being made in the United States 
to devise a means of protecting against poliomvelitis 
It will be remembered that one of these — the injection 
of a living and supposedly attenuated virus vaccine — 
led to disastrous results the active virus having un 
doubledlv caused attacks of the disease some of which 
were fatal More rcccntiv attention has been concen 
trated on rendenng the nasal mucosa impermeable to 
the virus bv repeated spraving with astringents a 
labonous proceeding which if earned out with per- 
sistence can scarcclv be supposed to leave the nose 
quite as it found it A new possibihtv which will not 
however be translated to the clinical field without much 
courage and care is foreshadowed m cxpenmental 
results reported bv S D Kramer L H Grossman and 
G C Parker ‘ These indicate for the first time that 
U IS possible to immunize monlevs bj the nasal route 
Natural infection bv this route in man is usuallv over 
come without involvement of the nervous svstem and 
It IS thus that the majontv of adults have acquired 
immunit> The monkej reacts dilferentlv to the intra- 
nasal instillation of virus which cither produces polio- 
mjehtis or leaves the animal as susceptible as before 
What the present expenments show is that if the virus 
r introduced into the nose of monkevs after the 
repeated instillation of pituitnn and adrephine (a mix- 
ture of adrenaline and ephednne sulphate) the disease 
fails to'develop and a resistance to infection is usually 
produced indicated both by negative results from in 
stilling virus alone at a later stage and by the demon- 
stration of protective antibody in the animals serum 
some animals also became resistant to intracerebral 
inoculation It is not clear why these drugs were 
chosen or how thev act their antiseptic power is shght 
and the fact that the action is local is indicated by 
failure of protection when they are injected elsewhere 


TnrBMTjsn 1‘2‘3 
^t£otCAI. Journal 

Thev elicit a cellular response in the mucosa in which 
eosinophils are prominent The practical outcome of 
these observations remains for the present quite un 
certain but thev at least suggest that there is no need 
for a defeatist attitude in this difficult field 


1 SETBACK TO 5IEDICO LEGAL SCIENCE 

In April 1935 the then Home Secretarv Sir John 
Gilmour appointed an Advison Committee on the 
Scientific Investigation of Cnmt Its members were 
Lord Trtnchard (chairman) Lord Atkin (vice chairman) 
Lord Dawson of Penn Sir Russell Scott the late Sir 
Edwin Dcllcr Sir Bernard Spilsburv Sir Frank Smith 
Sir Robert Robertson Mr Hugh Lett Sir Fredenck 
Menzies and Sir Arthur MacNaltv TIus expert com 
mitttc unanimously reported in Julv 1936 m favour of 
the cslablishmcnt in the near future of a Medico legal 
Institute ' It declared that the scheme set out in the 
report was long overdue and should be pressed forward 
as a matter of public importance Remforang this view 
the Senate of the Universitv of London gave unqualified 
approval to the general pnnciple of creating a central 
institute for forensic medicine in the metropolis and 
associating it with a universitv chair The scheme pro- 
vided for ihn-e separate but interrelated branches of 
activitv — teaching routine work and research Such 
a national institute organicallv linked with the Faculty 
of Medicine of the Dniversitv on the academic side and 
associated with the Metropolitan Police College labora- 
torv at Hendon m its dav to dav work would as a 
matter of course become a centre for research in the 
medico legal sphere to which problems would be re- 
ferred bv outside bodies Two vears have passed but 
nothing has been done Worse than that the Govern- 
ment pressed for a sign of its intentions now announces 
that It cannot at the moment consider a scheme which 
however admirable it may be would involve a not in 
considerable capital outlav The polite correspond- 
ence between Lord Trenchard pleading on behalf of the 
non official members of his committee and Sir Samuel 
Hoare the Home Secretan is reproduced at page 142 
There is hardiv a capital in Europe that does not possess 
a medico legal institute but England is still too poor 
and must await better tunes or persuade a “pubhe- 
spinted benefactor ’ to put up the money 


THE HALF-YEARLY INDEXES 

The usual half-vearlv indexes to the Journal and to the 
SuppleniLitl and Epitome have been prepared and will 
be ready shortly they will however not be issued with 
all copies of the Journal but onlv to those leaders who 
ask for them Anv member or subsenber who wishes 
to have one or all of the indexes can obtain what he 
wants post free by sending a postcard notifying his 
desire to the Finance Department Bntish Medical Asso- 
aauon House Tavistock Square YS C I Those wishing 
to receive the indexes regularly as published should 
intimate this 


’/ exp'Med I93S 67 529 


Bntish Medical lottrnal August ] 1936 p 229 


134 Jui-v 16, 1918 


FRACTURES OF IIUMLRUS 


TiitBRnisii 
MlDJCAt JoCRML 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

This /y one of a senes of articles contnbuted by mvitatio'i 


FRACTURES OF THE SHAFT AND 
SUBCAPITAL REGION OF THE 
HUMERUS 

n\ 

T P. ISlclMUIlRAY, ]S1 1} , M Cli , F.R C.S U. 

Anv of the three types of Molcnce— direct, indirect or 
muscular niav c itisc i fracture of the humerus it any 
Ie\el Thus n direct blow on the arm mij be followed 
by a fracture it the site ol injur\, or i fracture at iny 
le\cl ma% follow a fill upon the outstretehed hind Or, 
again, a fracture may result from excessive nniseuhr 
strain, as in the teir fricturc of the great tuberosity, in 
which this portion of the bone is pulled iway from the 
he id of the humerus As i rule fractures towards cither 
end of the shaft arc caused bv indirect xiolcncc, whereas 
those occurring towards the middle of the bone ma> be 
cither of the direct or indirect t>pc 

Fractures of the upper pirt of the shift ire cl issificd 
into two main groups (1) fricturcs of the anatomic il 
neck, m which the lesion lies extern il to the articular 
surface of the he id, usu illy p issing through the substance 
of the tuberosities (2) fricturcs of the surgical neck in 
wliieh the fracture line is pi iced below the Je\cl of the 
tuberosities 

FRkCTURL 01 \NATOMICAL NLCK 
This type of fracture is seen usually in the elderly 
patient as a result of indirect Molcncc following a fall on 
the hand Tlie fragments arc gener illy impacted, although 
non-impactcd fractures are also seen 

Signs of the Impacted Fracture 

In this, the more common type of fracture of the 
anatomical neck, the presence of impaction between the 
fragments may Icid to great difliculty in diagnosis without 
the help of a good \-ray photogiaph Following a fall 
on fhc outstretched hand the patient complains of some 
pain and tenderness in the region of the shoulder, with 
slight swelling in the injured arei ind a restricted langc 
of voluntary movements On passive rotation of the arm 
the shaft and head of the humerus move in one unbroken 
mass On such clinical evidence a mistaken diagnosis 
of bruising of the shoulder may be given, and the patient 
be advised to massage the shoulder and to use the arm 
freely in order to prevent the formation of adhesions 
Such a course of treatment, although based on a wrong 
diagnosis, is often successful, and the presence ot the 
fracture may not be appreciated unless an a ray examina- 
tion IS carried out at a later date This fortunate result 
can only occur if the impaction remains firm, but if during 
the massage and active movements disimpaction occurs, 
then all the usual signs of Iracture become apparent 

Treatment of the Impacted Tjpe 

As the patients are elderly disimpaction of the fracture 
correction of any deformity should be avoided, unless 
re is such severe malunion that the subsequent move- 
ents of the joint would be gravely restricted As a rule 
the extent of the impaction is not equal over the whole 
line of the fracture, being deeper on the inner than on the 
outer aspect It follows that some degree of deformity 


IS present in ilmost every instance, but not to such a 
degree as to c.iusc iny serious limitation of the ranse of 
movement in the joint 

Treitmcnt therefore should consist in the protection 
of the impiction until union is complete, when nny 
restriction cm be diminished by active use of the joint, 
assisted by gentle pissive. stretching A firm triangular 
sling IS applied to the limb, supporting the elbow and 
preventing the constant strain of gravity, which might 
cause disimpaction, the hand and wrist being left free for 
ictivc movements As an additional safeguard, when the 
pilicnt IS nervous the arm may be bandaged to the chest 
bv i hinder, after a firm pad of wool or felt is placed 
in the ixill i Fix ition is maintained for two weeks, after 
which the patient is advised to use the arm and is 
encouraged bj gentle massage of the whole of the shoulder 
girdle 

Signs of the Unimpactcd Fracture 

The signs present in a case of this type of fracture of 
the neck of the humerus are very simil ir to those of dis 
placement of the upper epiphysis In each the shaft of 
the humerus is displaced forwards and upwards in front 
of the small fragment, which can be felt under the tip of 
the icromion process In each the arm is slightly shorter 
than the norma! when mcisurcd from the acromion 
process to the external condyle, while the elbow on the 
iffCctcd side IS carried behind the mid plane of the bodj 

Treatment 

The treatment is biscd on the impossibility ot con 
trolling the small upper fragment, which, because of its 
muscle attaenments, is rotated outwards and upwards As 
a result of this rotation the rough upper end of the lower 




Jiu 16 S 


FRVCTURns or HUMERUS 


Tite BamsH 

MiDJCAi. JOEf XA.L 


135 


lion 01 llic lo\\cr lriuiii.nl bndcr imcslhi-sn llic arm 
IS piilli.d oiinnrd Ironi the sidi. inlo n position of nbduc 
lion nnd i.\ii,rml rotilion when locking of the fragmenls 
can be fell The fVni is iheii nniniaiiied in ihis correcled 
position for two weeks until consohdition of the fracture 
ins begun when gentle moienients nn\ be started and 
the position of adduction gradiiilb assumed Sonic little 
dilliculti is met with in after treatment which maj be 
prolonged 

rKkCTLiRCOr \^\TO^IICAl MCK3\1TH 

DiShockTioN or nr\r) 

\ rare but csccedingU troublesome complication of 
fracture of the anatomical neck of the humerus occurs 
when the upper capital fragment is dislocated from its 
position m the glenoid cantv (Tig 1) 

Clinical Signs 

With such an estcnsise injuia there is great swelling 
pam ccchsmosis, and tenderness round the region of the 
joint while the patient supports the injured limb with the 
other hand \ ra\ photographs will demonstrate the lesion 
and indicate the new site of the Jicad of the humerus 

Treatment 

Owing to the presence of a fracture through the neck 
of the humerus it is evident that reduction of the dis 
located head into the glenoid cavitj cannot be accom 
phshed b\ anv of the ordinar) methods of rotation or bv 
cvlension of the limb Its replacement however is pos 
sible bv open operation — an cvtreniclv difhcull procedure 
— or more simplj bj extension of the limb in the vertical 
direction 

Reduction In Manipulation — Under full anaesthesia 
extension is applied to the limb in an almost vertical 
direction above the head Slow stcadj traction in this 
direction is continued until the dislocated upper fragment 
slips back into the glenoid cavitv Occasionallv during 
the extension of the arm assistance to the replacement 
can be given bv the fingers which press the held gcntl) 
into position through the skin of the axilla For success 
of the manauvre reduction must be attempted within one 
week of the injurj If a greater interval has elapsed 
reduction bj this method is difficult or impossible After 
reduction the fracture is treated as alrcadv described 
The two raw surfaces arc interlocked so that the limb 
mav be brought dowai to a position of 50 degrees abduc 
tion at which redisplaccment is improbable Later the 
range of movements is restored bv active use 

OLD FRACTURE DISLOCXTION 

WTien the displacement has been present for months or 
jears the head of the humerus is usuallj united firml> 
to the side of the shaft The arm is held avva) from the 
side and movements between the humerus and the scapula 
are lost Reduction of the displacement is then impos 
sible and the onl> indications for active treatment are the 
presence of signs of pressure on the nerves or vessels of 
the axilla or limitation of movement of the joint 

Treatment 

W'hen the signs of pressure on the axillarj contents are 
slight considerable improvement often follows a gentle 
manipulation of the shoulder under anaesthesia If how- 
ever the signs of pressure are outstanding features such 
treatment is useless or even dangerous and relief js onij 
possible by removal of the head of the humerus 


The operation is a very extensive and difficult one with 
till, possibihtv of injury to adherent vessels or nerves but 
if carried out slowlv and carefully the result is satisfactorv 
After removal of the head of the humerus the stability of 
the shoulder is dofimtelv diminished Passive movements 
arc free but stable active movements are negligible The 
operation docs however succeed in its object of relieving 
the pain or swelling of which the patient complained and 
to that extent it is advisable 

FR XCTURE or SURGIC XL NECK 

\ fracture of the shaft of the bone occurring in the 
iipp-r sixth and below the epiphvseal line is described as 
a fracture of the surgical neck It mav follow on direct 
or indirect violence and unlike fracture of the anatomical 
neck usuallv occurs in vigorous adult life and is not as 
a rule impacted 

Clinical Signs 

In addition to the usual signs of fracture such as pain 
swUhng ecchvmosis and spasm of muscle the upper end 
of the shaft can be felt King in front of the head forming 
a mass on the anterior aspect of the joint which rotates 
at the line of fracture without movement of the head 

Treatment 

If dispIacLment of the fragments is not present treat- 
ment should consist in fixation For this purpose the 
wrist IS slung from the neck by a halter the elbow being 
flexed to right angles the weight of the forearm acting as 
a steady extending force on the atm Lateral movements 
of the fractured surfaces are prevented by the use of 
three moulded metal splints which enclose the shoulder 
and arm down to but not including the elbow joint This 
protection is maintained for six weeks when the splints 
mav be removed movements being restored bv voluntary 
effort the range increasing wijh the diminution of tender- 
ness in the fracture 

WTicn displacement is present reduction under full 
anaesthesia is simple bv the application of steadv traction 
to the limb in slight abduction Locking of the fragments 
can b^ appreciated and redisplacement is unlikclv as the 
fractured surfaces arc usuallv more or less transverse at 
this level When the reduction is satisfactory the arm can 
gcnerallv be adducted without risk of redisplacement 
fixation with three metal splints forming an adequate pro 
lection and preventing anv recurrence of deformitv 

FR XCTURE OF GREXT TUBEROSITX 

Owing to ns protected position under the muscular mass 
of the shoulder joint fracture of the great tuberosity 
IS not as a rule caus-d bv direct injuries to this region 
but follows ovcraction of the abductor and rotator 
muscles which arc inserted here The fracture is usually 
present as a single lesion but it may be accompanied by 
dislocation of the head of the humerus 

Signs 

The diagnosis rests on the radiographic appearance 
and in the absence of a dislocation little can be elicited 
clinically beyond the presence of swelling and tenderness 
under the acromion with pain on passive movements of 
the arm WTien dislocation is also present this lesion 
may overshadow the comparatively small fracture and 
considerable disability results from the treatment of the 
injury as a simple dislocation without recognizing the 
existence of the bony lesion 



Juu 16, 1938 


FRACTURES OF HUMERUS 


Trcitmcnt 

As It IS impossible to control the detached fragment 
and bring it into apposition with the body of the humerus. 
It IS ncccss iry thit the rough stirfict of the humerus 
should be brought into contact with the broken tuberosity 
This IS easily done by abduction and external rotation of 
the arm to an ingle of SO degrees In this position 
replacement is complete md if it is maintained for three 
weeks xoluntary mox’cmcnts can be instituted md the 
norma! range of moxement restored 

FRACTURE WITH DISLOCATION 

Here the head of the humerus lies in the subcoracoid 
region from which it can be replaced in the glenoid 
cavitx by rotation or by slow steady traetion If the 
dislocation were the sole lesion after-treatment would 
consist in the fixation of the arm to the side until the torn 
capsule had healed 

Rest in adduction which would be ideal in the treat- 
ment of a simple dislocation of the shoulder, produces 


TiiEBnmsit 

— ^^CD ICAL Jouv^i, 

of greater xvcight than this is not only inadvisable but m 
some eases positively dangerous Non union is report d 
as a common sequel of fracture of the shaft of ih 
humerus by the same surgeons who adxocate sirono 
extension as the mc’ins of reducing the displacement ° 


Treatment 

The weight of the forearm is used by slinging the wnst 
from the neck by means of a halter, the elbow bving 
kept at a right angle By this simple means the full 
length of the arm is obtained, but only if the hienl 
movements of the rough bony ends arc prevented In 
most fractures of the humerus the line of fracture is not 
transverse, so that locking of the fragments is not iisuallj 
possible There must therefore be a continuation of the 
action of the weight of the forearm if full length is to be 
maintained 

The diagram (Fig 2) shows the simplest and most 
cfiicient method of producing both of these actions on the 
fraelured bone The wrist is slung by a halter from Ibe 
neck, while the broken humerus is protected by Ihree 




Fig 2 — Front ind back views of splinting for friclurcd shaft of the Immcrus 


a wide separation of the detached tuberosity It is there- 
fore necessary to rest the arm on a frame m a position ol 
50 degrees abduction for at least two weeks, when the 
angle of abduction can be increased to 75 degrees, at 
which the arm is maintained for a further period of txvo 
weeks before the resumption of voluntary movements 

FRACTURES OF SHAFT OF HUMERUS 
In considering the treatment of fractures of the shaft 
ot the humerus, whether transverse, oblique, or spiral, one 
IS apt to think of fractures of the femur In each there 
IS a single bone, a fracture of which leads to shortening 
of the hmb with overlapping of the two fragments 
Although (he conditions are similar up to this point, the 
analogy cannot be followed any further In fractures of 
the femur the shortening is maintained by the protective 
spasm of muscles which are powerful enough to support 
ody weight, whereas m the case of a fractured humerus 
the resistance to reduction is much less 
In fractures of the humerus extension with weights, 
pulleys, or elastic is never necessary Full length of the 
arm and correct alignment can be obtained by using the 
weight of the forearm as an extending force The use 


metal splints, surrounding the hmb from the top of lb 
shoulder to the level of the epicondyles In folloi'iij" 
such a method no (riangiil ir shng is used, as tins "ou 
support and lift up the elbow-joint, thus destrojing ' 
extending force of gravity In the ease of a man * 
shirt must not be tucked into the top of the P^*'**’ ^ 
arrangement which is similar in action to the use o 
triangiihr shng The patient is encouraged to stan P 
or sit upright xvithout any support under the elbow, 
at night correction is continued by propping him up m 
semi-erect position _ . 

If straight splints are used for the lateral ? 

the bone, union xvith deformity will almost . 
result The reason for this is clear a . 

applied on the outer aspect of the arm touches t c 
of the shoulder-joint and the external condyle o 
humerus, leaving the middle of the bone (,( 

unless this be pulled towards the splint into a po 
deformity If, however, mouldable metal * Ijon 
these can be twisted on their long axis so that ’ > 
top of the acromion, on the outer aspect of tn 
joint, and towards the back of the bone at its 1 ^ 

The small splints used on the inner and anierioi 




Jin 16 


I U \t IMvI S OI IIUMI lUIS 


la ,i\tn » Miiiil II twist so til It tils I'oiK IS siippoitiil iii 
Its wliolc eotirsi. imi its noini il iluniiisiit rctiiiuil 
Tiiitnisrit IS contimisil in tins w n lor si\ wnks wlun 
ns 1 nik till, splints ni i\ Ik rsiiioviil mil tin, pilnnt 
snsoiirnti.'i.l to tisi. tin. innlorsniill nliM iiioMiiiints tin 
slm^ iisuilh h-iiig ritiinid is i snppoit foi inollni thin 
or tour wsiks Conipkii. loiisolnl itioii ol tin Inmnriis 
IS to hi cNpestal in nine or tin wnks nul i hill i iii|i of 
nioiimmt \ir\ soon iflir tins On ision ill\ thiii is 
soiiii nstriction of inosiiinnt in tin slioiiliki i loiulilion 
whiih nns iit|iiiri i lOiirst of plijsiollnr ip> 

coMPuemoNs OI iKvriiitin iuimi ihk 

Non Union 

The ociurnnci of non imion follonnii i fi nliiu of 
the humerus cm he ittnhiitiil to ms of tin usnil i uisis 
such IS Mint ol fivUion of lln frnlnrtil hone w ml of 
apposition or the prcsmci of pitholoi ical cluniis in lln 
bone but in nnn> insi imcs non union is ilirull) elm to 
an error in treatment 

Tlicri ire two common i iiisis of non union nhiili iiri 
not siifinnnth recogninil (H the ssnlcspitid nnios il of 
partialis detached friennnls of bom in i compound fin 
lure 12 } the tppltctlton of cxcrunc tr tclioti to lltc frac 
lured bone prodininp sside sipartlion belssccn tin 
fractured surfaces 

Trintmcnt — ^The Ircalminl of non union ikpinds lirjilj 
on the length of lime lint has clipstd sinct the occur 
rcncc of the fracture When this period docs not rseted 
fisc months union frcqucnll> follosss ihc use of cfficniit 
treatment as for a recent fr icliire reinforced b> the 
slimulition of passisc scnoiis congestion al Ihc silt of 
fracture The mclhod is simple a linn rubber hind is 
placed round the arm next the slm iliosc Ihc site of 
fracture before the sphnis .arc ipplicd mil cicli div this 
band is lightened for three periods of h ilf in hour sviihoiil 
interfering ssilh Ihc flsition of the splints "flic conjcsiion 
must be of such i degree dial the li ind become ssvollen 
and bluish but not piinfiil This mellind is coniiniicd for 
at least three monllis before dccidinf ssheilicr union svdl 
occur or not If hosvcvcr more dim sis morilli li iVc 
elapsed bone grafhng holds out the only hope of union 
and should be earned out sviihoiil del ly 

None Insolicmcnf 

Any of the nerves in the arm may he involved it the 
time of the fracture or it i lalcr dilc cilticr ihroiifli 
injury by the rough bone ends or dirou;li cornpre<’sion in 
callus or scar lissuc The musculo spin! nerve on icconni ~j 
of Its position close to the bone is involved more often 
than cither the mcdi in or the ulmr nerve 

5 /ij/ir — When Ihc function of die mu ciilri'pinl nerve 
IS lost all the muscles on the extensor isptcl of the fore irro 
lose their power of volunliry conlriclion wilh or williour 
paralysis of all or part of the tricep , ictording lo du 
site of the lesion 

Treatment — When the clinicil cxaminaiion indic iie 
that such an injury is pro ent Ihc panly ed mu i le- nui I 
be protected from ovcrslrctching by pi icing the h md md 
fingers on a long curved splint the wri I being hefri in 
dorsiflexion with Ihc met icarpo pli d mge d md inler 
phalangeal joints in slight flexion 6»cndi- rm if* i 
given 10 these protected muscles Ihc progre* of di> nerve 
injury being gauged by rcpcitcd elcclricd ex irnination of 
the paralysed mu'clcs If from such cxmiinilion it i 
evident that the nerve is torn an opcruion for m rvc 
suture or nerve freeing should be carried out without 
delay Very occasionally when there h g been wide prcid 


skstiiKtii'n ol luiM lissiii IIS III II siK'U' ( oiiipiuiiid liiu 
lull It milt bi Imptiisilih l(> pi i loilii ii lalliliu loi v iiiiliiii' 
Ilf lilt ihsidid mill iiiiil iiiipioii Mil Ml III dll' liiiiilliiii ol 
till Itimliimt oiih hi' possihli by Inmspl.uilliig llii liiidoiis 
111 somi ol Mil llisoi mu ills ol lln loli.uiii lo llie 
doisum so dull liny ml ii ixliu'ois iitlliii lliitii llesoii 
III till iiiisl mill llu) us 


Nova c( Vetera 


SUIlfKAI I OIK I I'k DOWN Mil Afd “ 

tin /ti%f(f\ {/ till limfx /In /nuxtfintt n f '• tin i*i >i> 
Hit In Inlti n unit t hr i / lln 1 1 m f \ ft n I n In ii n / tun i 
u t! r I /(*tf nt l>in (U jlli « * iiiitio oy I) Mil ti i \\/ VMIm Imi 
Nfollrr ( tifhh titrM (Ip ttl hiutf A (hr(MMt(*t( i) 

I il>l( ''O iirl > i r (i(l( n 1|iiim| Im< v Vlilff rd ( m| 

I cvMi lint MiihL i 1 iOt 100 


t)r Villulm Molli I ( liiisli list u siy>- llutl hi Ittvt iili (I It 
pur of loiiip wlitii III Will lilt iiKKliiitl pliyililiili III 
lliniiuirl. Ill l'>l| f iiiio ilv III! hiiii 10 iiii|iiiii iiilo 
llu hisloiy of loiiip mill Id i iiio'l in iijdi In llioiii'ld 
dull iiiir only ii li w vmiiliit liivi slig ilioii "oi ii 
should hrro /os roo/dr roo/ Ik /ms srror /roviZ/rr/ fat 
.mil re III tiiuih lo |>riiihiii ilili bool on IfiUr liisloiy mid 
tiohilion 

flu riiiill of ho iiu|iiirli ' Ims hii ii l(> chow dull font f c 
tvcri III or long hi Ion ihr iiivi nlioii of <■( ic ois, mill 
Hill llu y mi loiinil in I | y|>l mut Vli soj'Ohiioui iihoiil 
■0(1(1 IK Ihr ddliiiul lyp s i vidvrd win imiloyiil 
for tpildioii foi llu nioov.d of fi.nigii hoihu-, and for 
lie ding with the tniofy v/kis of the oil liifo(s lliiii In 
common u'l flu ((nliiion fonifi win- u ul idilr I y 
till II md iiomiii formifij n (mil of Ihilr Itnlil silc 
I viiyonr in iik lo Imvr i ilili <1 cm h li crl ft f (lit ft Kill I 
li.isc hrtn mmy wht> jinftrtrtl lt> (hut tiiil Ihtlt hilts 
Wiili I piif tif Intern r ilhrr dim I' shivrtl I'llh a flltd 
Of hfiui/f r i/tir Iwn ilillrrrnl (yjt vrtr th vt It (oti 
dll ( ypriol mtl ihr Myirtni m d oiil i ihtui iiiil yt itv 
tiler i)f f hn tin ro ihiids Ituy vutr ool liiioi'o lo iht 
Ifypiiins hill yen lilrr ihr 'vlyti n it iti lyfr foiititl ds 
wty It! Iidy Old ‘ t oidin ivi i I hods lt> iht i/t tb t.f 
Dr } k Milrit dir ciof k d in Inniirnl t.f fitrrir end 
Rotor or f otly v/rll bntiwti Dr f hn ftt. rn hu ttti 
ciillrd liK hotiV Old i ,d.lr it. thoit frtoi f find t/itu 
imlion dill 1 pof of 1 roror ftttrf. it. Ih f t.f olugrti 
Mu euro ic morr hkriy ft hivr I fro u i tl ftt tfriwOig Ihr 
slump of Irrlh Ihifi i ff.ililit.ti ItKtrf m wi cliirtf 
by fJr Milnr 


‘iiffiid ft.ttrf h wr nt.l ufidrrjtr.r .o./ god (hm,' 
diiririf (he 1 1 I 'llVi yr oc (l.rutli If Wi i frog lifn 
hrfnn Ihr I I oir wrrr fidfrd it. it.if.rt vriu t.f vf.itf. 
oiiteridly ir.rrrird ihrii ftifiKii fforr ft w. h fif' t 
cfill t. fore Ihry i rrr frt.iithtl i ith i not or dof fr. Irr< f. 


dicro dr. kI o.tl rmkr (hir.. sdf itih. rn.f V/h r. f>r 
6 hn frr. rn i/i ir. ffiflmd hr vi .ird ff.r lUlljJl 
Mu riini Old du V/rlltr.n. Mrdu d fr. lifofr (/I Jyj 
twrnly for r.f foorf iii Ih. f rOi h Mn f nil/ I i 4 ‘t ootl 
hr diiolf Ihil '( VI nlr n o. icK(tfKjW III /"“ I " ‘ 
ifu ir lie foi i.r.i* n i rn hr did ni i Ihi 
rxoufh in ilir hi on il ttfl tlkh if ''j',,,' 
rnrr.t o the f r v d f t Ih f ' t f ' ofk' ' h ". I IM 
firld wl.rrr hr i/t old 11 mt til/ haW u ' u vl , 

Neilhrr hi f.r rr id Ihr I dr Mi All Oi f 
on Ihr d. vrltfOirt.l tf ll.r fo 'in' 

Ko hrfU f60i Old 'i o.ri V'rli « 

du f ritnfi Mriliffil fr iirn/il tu l'>r (I 

I er. r... r.l.r I. il dl t f M llu Cl V/g’' 


riir hr ol I VK y II ' I III i i 
eclifii of r.u du d hi ir.iy fhti 
1 chroiiOhigu' il III!.' II..' ml 
dillrn ol lyj i from ( i I'lii I 
kiblio; I iphy, old iiUhir 0| 



13S Juu 16 193S BIRMINGHAM HOSPITALS CENTRE OPENING CEREMONY 


THE BIRl\HNGHAi\I HOSPITALS CENTRE 

ROYAL OPENING CERrSIONV 

Tl)c opening of ihc Birminglum Hospitils, CliUic nncl 
ihc Mctiicnl School Buildings of the Uniscrsity by the 
Duke of Gloucester on July 14 sets the seil upon n 
greii enterprise which was first mooted eighteen \cirs 
igo 

The new buildings nt Edglnston two miles Irom the 
centre of the city on open ground 500 lect .ibose sen 
level and just to the north-west of the Unnersits, make 
an inspiring group c\en now, although the scheme is far 
from complete Nothing has been spent in useless adorn- 
ment but the scry simplicity of the trcitmcnt ind the 
harmonious massing of the several buddings give it all 
the needful dignity The three mun structures — the hos- 
pital Itself the nurses home to the north and the medical 
school buddings to the south — fit m perfectly with one 
another so that 
the eye is satisfied 
from every aspect 
All the buddings 
arc in a yellowish- 
grey stone, dis- 
appointing at first 
glance when com 
pared with the 
wirm red of the 
University a few 
hundred > ards 
aw ay, and yet 
not iinplcasing On 






r r*r 

V > ~ 


Side View of Hospital nnd Nur'^cs Home 


JJLil IJJJJfJIV; V^l> three sides of the hospital stone 

balconies have been constructed on every floor of 
the medical and surgical wangs for the outdoor treat- 
ment of as m my patients as possible, and these give a 
decorative relief to the pliin wall surf tees 


The 

'lEOlCAl. 

the clock tower, which serves the utilitarian , 

witcr storage The medical wmg to the ca^srofrt' 
block IS also complete, as is the surgical block to thJi ! 
with the cNccplion of one of the forward projut o . 
There remain to be added, on the west side, a™ 
department and vv ,rd and the large out paUents’ to!? 
ment, and, on the cast, a paying patients’ block of IM 
beds ilso to piojcct from the centre of the biii!din> 
son hwai^ds the chapel Opposite the principal cnlranu 
to the hospital (north), on the other side of th“ fine 
roadwaj, is the nurses’ home a large seven stoned 
slrucUirc which when complete will have on Ihecntsid 
of n a smaller night wing and on the other a horn,, for 
the hospital anaids A dispensary is at present beracbmlt 
as a link between the surgical wing and the outmM 
department 

The New Medical School 

To the south of the hospital, at a lower elevation 
Separated by a wide and pleasant court and garden sp’a 

which will b. Usd 

for convaleseeal 
patients, are !>■ 
iMedicnl Schco' 
Buildings Th < 
are onh two, Ci 
in some pain 
three, stones n 
height, so that the 
do not rob tl 
hospital of am 
sunshine But ih 
main front’ \ 


« iTir,, 

"I rei lYii 


- Li v< .^*1,1 v. 1 , 

V. fn j,,,„ . 


j ' *«t «r>,ii 1 1 1 j 
' " > < Huw Kl 

1' < T • " 

t »i I n 


»r i#v r I - ^ 

I I, I 




^ » Lrnmmm • ^ •'* 


evtends for a full 600 feet On cither side of theentrancv 
block IS a square of buildings surrounding an open aninl 
court If tliese school buildings stood by ihentselies ik i 
would be regarded as a triumph of architecliire , (hij sr 
dwarfed however, by the great mass of the ho'p!’. 


icorilivu fv;i[v;i lU iiiv: (Jitiii uy ui tiiv itv'i > ' 

Evidently Ihc scheme owes something in its aichi- behind them On one side are located the analonij Jiil 

Icctiiral conception to the Medic il Centre of New York phvsiology departments and on the other those of bachw 

City in which many hospitals and schools are asso- logy and pathology, and the museum and library overlwv 

ented , but there the emphasis is on the perpendicular the road leading to the University- Three wellequippJ 


i !ik 





* 1 


-I 1-- 

S'lil.ljl ijSil 


11 


1 — j 

‘S SIB 9 










IP G I S G 1 





Metlital School South Frontage with Hospital Clock Tower bc>ond 


line, whereas at Birmingham it is on the horizontal The 
hospital building is of seven and eight stones, as compared 
with the twenty-two stories of the Presbyterian Hospital, 
the original unit of the New York Centre The architects, 
who submitted the winning design in open competition, 
are Messrs Lanchester and Lodge of Bedford Square, 
London Mr H V Lanchester is the dcsignei ^of the 
Univeisity of Leeds, the Cardift municipal buildings, and 
the leconstruction of St Bartholomews 
The First Instalment 

The buildings which have been opened this week arc 
a hrst instalment Much remains to be added before 
the Centre corresponds fully vvilh the aichitects’ oiiginal 
plan The new hospital at present will provide just over 
500 beds, whereas the completed hospitil is planned to 
accommodate 740 The buildings so fai finished and 
opened include the cential administrative block, with 
olfices, stoies, -and laigc central kitchens, dominated by 


Rcluie theatres have been provided, t]- 

laboratories for each of the foui principal seen ,, 
building was still in the workmens hands on me 
of oui visit, but it was evident that teachers an 
will enjoy every accommodation and faciiitl 
ways and corridors connect the medical school 
hospital 

Internal Hospital Arrangements ^ 

The 500-bed hospital now opened 
the bed accommodation will be incrLased to i ^ 
again, is nevertheless complete with 
ancillary services It embodies the latest ide • 
ence in design, planning, and admmistratio , 

arc to be organized in units of, will h 
complete in itself Of the sixty beds, ^ 
men and thirty lor women each thirty "'ll , 1 ,^ 
of one ward ot sixteen beds two of four J- , ^^||| p 
of two beds The largest ward in the h P 





.lUlA 16, 10)8 

T N MACGREGOR SI* UNCTIONAL UTl- RIM. 



tjo I — (050 (I ape<t JI ifrninhc nt 10 ifcn<<ruAf/on 1/2^ 
reKulnr for four \c'\rM Slticr then j^orlrvl^ hA%o heen trrcKulflr >n<lo 
mctrltini l>cfore jirouc^tcrone thempj (Mnkniflcntlon x ) 



I ui 3 — Case 0 Endometrium after 25 m^ progesterone (Mag 
idhtation \ 50 ) 


The IJRiTfflH 
MFDlCtL JOCKMI 

bleeding treated MTIH I’ROGESTERONE 



F 10 2 — ( a. e 0 I ndonjetrhim before progesterone therapy (ifspil 

nraliou X ’CO) 



niflcntlon x 260 ) 










lun i« i9js 


Ml 


Till ItKIimil 

oicii. 


W !3AMPi>ON HANDI F\ 


C'llUOMC NfASlim \Nn Bin AST CANCI K a I AMIIA HIbTOm 



j]n I _sMfr I niutit lirca«l lll(ru*<i liiimcant imiiKIo 
I lf tho duct' Mnunlfliatlon v IdO (Ihoto ti) lliaiid 
Milton lii'lllutc 1 



I in 2 — ^I^tc^ I Uli,lit tircnst , Ini,ltdctit carflnotna IWct 
dl'ttndpd li> I jiillirlliini liiltltrntloii licMi'idni' Maulflcitloii 
X .0(1 (I’lioto 1)1 Dhiid Mittoii Iiiatitiilc ) 


MAX GREENBERG PARA&ITIC I OETU& MICCESM REMOVED OPERATION 



Fio 1 — Parasite aftir rtinoiftl 




Jui\ 16 191'! BIRMINGHAM HOSPITAl S CENTRE OPENING CEREMONY ,;g 


ln\i. mori. linn si\lci.n beds Tlicri. \mII be si\ ptnenl 
openling lliLiIri-s — one on the floor of tncli of the 
siirgicnl units — ns well is dtpTrlnunts for nnssngc md 
rsnudnl (.scrtises r ri\s ind ridiuni Llsctrotlitrapj 
IndroilKrapv ind other sp^tul purposes The b^ds is 
far as possible are b^inq arr->ugcd parallel to the windows 
instead ot in the usual right angle position and the heads 
of the beds ire agiinst partition screens projecting into 
the ward some eight leet from the mil It is intended 
that each member ot the senior si ilT shill be issigned one 
of the units of si\t> bed- with accessors sereices clinical 
laboralcre record room and so torih When the com 
plelcd hospital IS funclionine of the 740 beds 240 will 
be medical, 200 surgical 60 childrens 60 gynaecological 
and obstetric 60 special (tar nose and throat ophthilmic 
derm itologieal) and 20 casualty In addition there yeill 
be the 100 beds in the paving patients bloek still to be 
Cl nstructed Tiflv of these bids vvill be in single rooms 
This block will be so related to the hospital that all 
essential services mav be obtained with the least incon 
venience to the patients 

Tile nurses home when the night wing is added will 
accommodate a60 nurses giving cich of them a separate 
bedroom Tticrc will be separate bedrooms also in the 
maids home for 100 maids Part of the nurses home will 
be a training school with lecture theatre and demonstra 
tion rooms 

It should be added that it is expected that it will be 
October or November before the Centre opens for the 
first instalment of patients The Birmingham United 
Hospital (the General Hospital and Queen s) is under 
taking without avoidable dclav the rcsponsibilitv for the 
new buildings and sen ice but the speed is neccssarili 
regulated bs'rale of recruitment of nursing and domestic 
staff To provide an cntirclv new and complete organiza 
lien to full eapacitv will take some lime csjacciallv in a 
hospital of such modern design and containing all the 
numerous departments connected with the special needs 
of a medical school 

The Finance of the Sclieme 

On the financial side (he Centre, being a unified institu 
tion not one hospital appealing against others with com 
peting claims has been fortunate in enlisting the cnthii 
siastic support of the whole comnuinitv The civic 
authorities headed b} successive Lord Mavors since the 
appeal began in 1930 have been particular!) co operative 
The cost of the scheme with the 740 bed hospital is one and 
a quarter millions one million of which rcpres_cnts the cost 
of the present first instalment That million to within 
the last £30 000 has been secured A few da)s before the 
opening the Lord Mavor received a letter from an 
anonvanous well wisher promising £10 000 to cover certain 
additional items of expenditure if the outstanding £30 000 
were forthcoming Thanks largely to the efforts of the 
secretarj of the Centre Captain J E Stone vyhose 
writings on hospital administration are well known in the 
hospital world the appeal expenses represent just under 
1 per cent One sixth of the amount of the appeal fund 
IS credited to the University for the building of the school 
the maintenance of which is the University s responsibility 
no part of the expenditure falling upon the hospital 
authorities WTien the Univcrsfx, a few days before the 
opening marked the occasion bv conferring certain 
honorary degrees, it was mentioned that Lord Nuffield 
who received the degree of Doctor of Law had been the 
chief contributor and next to him the largest single 
subscriber had been Mr Harrv Vincent a Birmingham 
business man for eight years the honorary treasurer of 
the appeal and one of the hardest workers on its behalf 
The words of Dr Robert Hutchison President of the 
Royal College of Physicians of London (who with Sir 
- Cmhberl Wallace President of the Royal College of 
Surgeons of England and Sir Edyvard Mellanbv Secretary 
of the Medical Research Council, also received honorary 
degrees), on the same occasion may be quoted 


It (llic idea of forming the Hospitals Centre] was an idea 
of great imagimtion carried out with all the praclicahu one 
expects m Birmmchim and I am sure it vsil! not fail not 
only to facilitate the treatment of the sick but also to imp ovc 
the Icacliine of the student and extend the facilities for 
research It cannot fail to enhance still further the already 
Inch reputation of Birmincham as a teaching centre Tho e 
yyho practise in Ihc metropolis yyiih its yyoefully scattereo 
medical resources yicyy not only yyiih satisfaction but yyith a 
considerable degree of ensy Birmingham s Hospitals Centre 
I bclicyc that the example you haye set here to medieinc m 
Ihc concentration of medical resources in one quarter cannot 
fail to be yyideh folloyyed in other cities 

Opening by flic Duke of Gloucester 

Till, arrangements for the royal opening on Thursday 
of this Week had to be revised owing to the illness of the 
king in whose place Ihc Duke of Gloucester accom 
panied by the Duchess performed the ceremony The 
spaciousness of the setting permitted b 000 people to be 
present It was arranged (hat Ihc Duke and Duchess 

driving from New Street station should spend 

exactly one hour at the Centre first entering the Nurses 
Home where certain presentations were to be made by Sir 
Charles Grant Robertson chairman ot the Executive 
Board of the Centre and Vice Chancellor ot the Univer 
silv The list of presentations here included members and 
oflicials of the Board rcpresenlalives of the architects 
engineers coniraclors and works staff the house governor 
and matron and members of the honorary medteal staff 
of Birmingham United Hospital After the presentation 
of an address bv the Lord Mayor Their Roval Highnesses 
proceeded to the main door of the administrative 
block opened with a kev presented lo the Duke by 
the architect and then passing through the vestibule 
visited one of the large general wards of sixteen beds 
and an operating theatre The further programme m 
eluded an inspection of the buildings of the Medical 
School where the Chancellor of the University Viscount 
Cecil of Chclwood presented the Dean of the Faculty 
(Dr Stanley Barnes), the professors and other officers 

IThc phoiographv icproduccd arc by H J Whitlock and Sons 
Ltd Btrminchim I 


NATION/U. FOOD POLICY 

W'lllim recent weeks two documents have been published 
which bring into jiromincnce the imjyeratiye need for a 
national food policy planned not only lo safeguard the 
health ot every citizen in times of peace but his existence 
m times of war The first is a Report on Niilriiion ' 
issued bv the British Association for Labour Legislation 
It IS an effort to carry out the instructions of the 
Assembly of the League of Nations and the International 
Labour Organization to the various nations of the world 
to study the problem m- their own country It sets out 
clearly and concisely the relevant facts in regard to this 
problem as it exists in Great Britain An outstanding 
feature of the report and one that lends to it a high 
value IS Ihc emphasis laid on the relation of British agn 
culture to national health a relationship which is we 
consider fundamental to the whole health question 

The Second document is a special report entitled 
Towards a National Food Policy issued by the Com 
mittee against Malnutrition and recommended to public 
attention bv a number of authorities on the subject of nutn 
lion It emphasizes the need for adjustment of national 
economy towards the provision of an a dequate guaranteed 

Obtainable from the Hon Sccrctao St Marv s Mansions 
Paddinclon \\ 2 (Pp US price Is 6<1') 

Bulletin No 27 Jul> 1933 19 l EagiC Street Holbom 

London \V C I 



140 July 16, 1938 


NATIONAL FOOD POLICY 


Tiic URmsii 
^lEDrCAL JoUPNAl, 


diet to ^ll sections of the coninuinity It touches upon the 
rnnge of possible mcisures that might be taken to this end , 
incisures which the public — medic il scientific and lay 
alike IS invited to evaminc ind discuss The pioblcm is 
^ 1 national one upon which the public is i nholc must 
make up its mind 

The relevant facts ind suggestions, as set out in These 
documents, may be summinzcd under the following 
holdings in order, is w'c think of importince food 
production food distribution cheapening of bisic food- 
stuffs, the raising of incomes in certain classes of the 
community and palliatncs 

National Food Production* 

The work of the scientific mscstigators of nutrition on 
the one hand and of public heilth ofliccrs on the other, 
has demonstrated that there csists among our population 
a large amount of indifferent health Or actuil disease and 
of predisposition to infection due to dietetic malnutrition , 
defects that cm be obviated by the generd adoption of 
a more balanced dietary which will include an increased 
consumption of materials — particularly fresh \cgetablcs 
and dairy produce — which are normall) products of our 
own agriculture Of these materials our own agriculture 
docs not produce nearly enough for national needs 
although our conditions of soil and climate are pirticularly 
suited to their production This of itself suggests that 
some selection cm be exercised in the national interest as 
to the crops that should be grown md the stock to be 
kept, proxidcd always that the farmers arc assured of an 
adequate return for their products 

Secondly, agriculture has become an assisted industry , 
the aid from the State in the wav of duties subsidies or 
other relief has been reckoned to be in the order of 
£40,000,000 It IS then not unreasonable that the State 
should direct the incidence of this assistance so as to 
ensure the production of the matcfials essential to national 
welfare At present it does not do so Owing to the 
operation of subsidies much of the best land in England 
IS being cropped with wheat and sugar beet, though it is 
so eminently suited to the growth of vegetables Wheat 
and sugar are among the cheapest products in the world s 
market, the easiest to transport and store Neither the 
everyday need for them nor the threat of war justifies the 
expenditure of such vast sums m substdizing their home 
production As it is the nation consumes vastly more 
sugar than it needs If war emergency arises we are still 
under the necessity of importing the bulk of our food, and 
economy of shipping tonnage becomes the determining 
factor m what we can afford to import Wheat and sugar 
are of all foodstuffs the most concentrated and come fiom 
the Americas across the one sea that is likely to be open 
War emergency should be met in another fashion that 
of bringing into cultivation a great deal of the now 
neglected and unimproved grassland of England It would 
therefore be sound national policy to transfer the subsidies 
now being accorded to the growth of wheat and sugar to 
jjther branches of our agriculture, such as milk vegetables, 
and meat 

Thirdly, the agriculture of this country is not flexible 
ugh Flexibility of farming demands the ability not 
y to produce a particular commodity of a particular 

ality at a given time, but also the ability at all times 
o utilize to the maximum of advantage, and with the 
minimum of waste, the urine and faeces of the grazing 

* Much of the subject njatter undci this heading is in the 
Iinguagc of the Report on Nutrition b> the British Association for 
Libour Legislation 


animal for the m iinlenance of soil fertility with the least 
possible risk of disease to (he stock concerned Our 
arable arc i— and that is our only flexible area-contribuies 
but 21 6 per cent to our land surface , rough and hill 
grazing th in which nothing could be less flexible coniri 
butes 32 I per cent , and permanent grass, but little more 
flexible than hill grazing, contributes as much as 31 per 
cent The black patch— .and it is the largest patch— is our 
huge are.a in permanent grass, and in easily improvable 
rough and hill grazing no Ic^v than sixteen million arm 
in England and Wales The cultivation of fruit, vegetables, 
and ccrcils is denied to a huge acreage of the counlrj’ 
Perm inent grass and rough grazings flow like a sea right 
up to the very doors of our highly populated industrial 
centres These great centres of population of necessitj 
obtain their \cgctables from considerable distances .and 
hence the populace never, or hardly ever, eat vegetables 
that arc fresh in the true meaning of the word Further, 
the fertility of this huge acreage cannot be properly 
maintained , nor can the health of the grazing animals 
Permanent grass lias a short growing season and therefore, 
a short carotenc-giving season The health of animals is 
probably, to a very real extent, a function of the length 
of the effeclnc onidoor grazing season 

In an emergency the prime need is calories and the 
greatest possible production of energy-providing food 
stuffs This necessity makes peremptory demands for a 
system of farming which is flexible It is only by a mass 
attack on our permanent pastures that we can adequately 
safeguard our supplies of health-giving foods and hope to 
meet an emergency in respect of calories If the country 
IS so minded it can without further ado enormously 
increase the gross output of its food supplies add almost 
immeasurably to the health units contained m such output 
and permanently benefit British agriculture Moreoicr, 
(his greater production meets another national require 
ment in that it involves a high rate of employment on the 
land The first essential, then, in any prudent natioinl 
food policy IS to adapt our agriculture to ’national needs 
These needs are clear their satisfaction is imperative, the 
neglect to satisfy them is the extremity of'folly 


Food Distribution 

The protective foods the population needs are such as 
can be produced here to the permanent advantage of 
British agriculture But for large sections of the popula 
tion their cost is prohibitive It is not the cost of their 
production but that of their distribution that stands in the 
way of cheapness to the consumer L‘ The whole of our 
system of trading in these perishable goods — commission 
agents, salesmen, wholesale merchants, and retail traders— 
is out of date and is paying extravagantly for services 
rendered Much of it has giovvn up to accommodite 

the laziness, lack of forethought and real economy in the 
people themselves , there are no ‘ robbers of the poor 
to be denounced for the. expensivencss from which the 
‘ pool suffer ’ ’ A complete census of distribution is an 
essential preliminary to a thorough rationalization of I n- 
distributive trade The Committee against Malnutrition 
suggests that basic food should be taken deliberately on o 
the noimal field of supply and demand, since fo™ “ 
primary necessity and must be guaranteed , 

ail Basic food should be marketed through pu 
concerns boards should be established to handle iv 
whole distribution of food from the point of ^ 

or import to the home of the consumer, the " 

under the control of a Food Minister or of some - 

Ministry such as the Board of Trade The sys 



Jiu 16 ]9\S 


NATIONAL FOOD POLICY 


TirtBumsH 

'ItOICAL JoLJLV^t 


141 


d-nlnlizcd \\hoIcs,>lc distribulion presents great oppor 
tunilies ol eeonomic organization but if am preference 
IS to be grinted to such a s\ stent in Icgishtion adequate 
assurances sliould be obtained that these opportunities will 
be taken Space does not permit turther reference to this 
matter, the iirgencs of which is self csidcnt 

Cheapening of Protcctiic Foods 

Measures to this end are concerned mainb with lowering 
the cost of distribution of protectixc foodstuffs and with 
increasing the demand for them Demand is largel> a 
question of education and of income The problem of 
nutrition is fundamentallv one of poserts thouch ignor 
ance indilTerence and thriftlessncss arc not unconnected 
with It To solve it vve must banish povertv and ignor 
ance Large numbers of our people have not the means 
wherewith to purchase food that will satisfv their phjsio 
logical needs For these the raising of incomes becomes 
a question demanding close consideration 

The Raising of Incomes 

A rise in the level of working-class incomes is almost 
invariablv accompanied bv a wider cvpcnditure on the 
necessarv protective foods But it does not of course, 
follow that the whole of the margin is expended on food 
stuffs The Report on Nutrition (British Association for 
Labour Legislation) affirms that the standard of national 
nutrition could be raised bv raising incomes lowering 
the prices of foodstuffs or reducing the fixed and prior 
charges on the familj purse such as rent rates, and insur- 
ance premiums The possibilitv of introducing a svstem 
of familv allowances and of securing wider adoption of 
one or other of the various rent rebate schemes should 
m the opinion of the authors of this report be invest! 
gated The Committee against Malnutrition on the other 
hand comes to the conclusions that an attempt to ensure 
adequate nutrition through raising incomes can at best 
only have partial and indirect results A scheme of 
familv endowments onlv affects one section of the popula 
tion A rise in other working-class incomes affects or is 
held to affect, the course of cmplovment it is also con 
sidered frequentiv to influence the prices of food and 
other necessities by leading to a price rise that effectively 
swallows up the benefits from higher incomes Thus in 
any case it would be necessary for the price system to be 
manipulated bv Government intervention if any advances 
in average working-class incomes are to be of benefit to 
the consumer 

Palliatives 

The present method m this and other countries of 
dealing directly with the problem of nutrition is that of 
providing free or cheap milk and other foodstuffs to the 
necessitous in certain sections of the community The 
method is a negative one it serves to treat or forestall in 
some measure the worst degrees of malnutrition as we 
experience them it does not envisage a situation wherein 
malnutrition is practically impossible In the second 
place and associated with the first consideration the 
schemes have been and still are administered m the spirit 
of the old Poor Law with the accompaniment of inspec 
tors income tests and so forth Thirdly only certain 
sections of the community — for example school children 
and expectant and nursing mothers — are contemplated by 
the schemes and of necessity there must be numerous gaps 
and omissions Even at the best the schemes frequently 
work in a sporadic manner usually ceasing during the 


school holidays and at periods when the mother is unabk 
to visit a clinic Meanwhile no consideration is talen of 
the fact that the organism requires an adequate diet all 
through Its life and not merely at certain periods and 
during Certain critical phases There is reason to doubt 
loo whether the provision of milk however desirable 
solves the whole complex problem of individual mal 
nourishment in some circumstances of dietary deficiencv 
the consumption of extra milk may be of little use 
Finally it has been demonstrated that the provision of 
milk and other foodstuffs to the necessitous is a burden 
to local authorities in special areas of the country and 
mav tempt them to provide meals of no great physiological 
value m the effort to conserve funds the responsibility 
should evidently be assumed bv the nation as a whole and 
not left to the whim or the resources of local authorities 
— as It now in fact is Such are the views of the Com 
mittce against Malnutrition and vve agree with them The 
committee suggests that there should be provided at the 
cost of the State to all elementary school children without 
discrimination a well balanced ample and sociable midday 
meal served m comfortably equipped centres open to 
supervision by the parents But valuable as this scheme 
would be for the school children it still leaves us with 
a selected group of the total population Probably any 
idea of a wider extension of communal feeding would be 
quite alien to conditions in Britain to-dav and it seems 
doubtful whether the country would at present consider the 
large annual outlav needed to maintain even the scheme 
for elememarv school children 

V Mnnv sided Problem 

In concluding this necessarily brief summary of the 
facts and suggestions set out in the two documents vve are , 
reminded of a recommendation made m the final report 
of the Mixed Committee of the League of Nations on the 
R-elation of Nutrition to Health Agriculture and Economic 
Policy (Geneva August 14 1937) which appears to have an 
important bearing on the subject under review 

A mlionaf nutnlion policv requires the guidance of some 
central authority with special responsibilitv in order to utilize 
to the best advantage the teachings of science interpret them 
in the light of national conditions and suggest means for 
their practical application In making this suggestion vve were 
especially influenced bv the manv sidcdness of the problems 
of nutnlion and bv the necessity for co ordmating economic 
and social action with new physiological teachings VVe are 
now more than ever convinced of the necessity for bringing 
together scientists economists agneultural experts consumers 
representatives teachers and administrators in National 
Nutnlion Committees It is our firm conviction that 
through National Committees adequately representative of 
the vanous elements that go to constitute this complex problem 
the most useful progress can be made 


MEDICAL RESEARCH COUNCIL TRAVELLING 
FELLOM SHIPS IN TUBERCULOSIS 

The Medical Research Council announces that it has awarded 
Doroihv Temple Crqss Research Fellowships to the following 
candidates who intend to study problems of tuberculosis at 
centres in the United States dunng the academic year I93S-9 
Nexulle Christopher Osw ald MB BChir MRCP 
John Frederic Paterson MB MRCP 
Kenneth Murrav Allan Perrv MD BChir MRCP 
John OvENgTONE Westvvater MD M R CJ* 



142 JuL\ 16 1938 


A MEDICO LEGAL INSTITUTE 


The BRrrmc 

AUDJCAL JoURS^L 


A MEDICO-LEGAL INSTITUTE 

GOVERNMENT AID W ITHHELD 

The following corrcsponcicncL Ins pissed between Lord 
Frenchaid clnirman of the Adnsory Commillcc on the 
Scientific Inscstigition of Crime, and Sir Samuel Hoare 
the Home Secretary regarding the question of the 
cst ihlishmcnt of a mcdico-lcgal institute in accordance 
with the recommend itions mule b> the Commillcc in 
Its report of June 1936' 

Letter from Lord Trcnclurd to Home Secretary 

‘I am writing as chairman, on behdf of the non oflici d 
members of tlie Adnsors Committee on the Scientific Inscsti 
gallon of Crime— namch Lord Atkin Lord Dawson Sir 
Bernard Spilsburv Sir Robert Robertson Mr Hugh 1 ett 
Sir rrcderick Mcnzies and ms self — with regard to our future 
course of action You will recollect that the Committee was 
set up by Sir John Gilmour is Home Secretary on April 9 
19t‘i, and tint we submitted an interim report on June 24 
1936, which was published on Jul\ 2'' This report therefore 
IS nearly two sears old and we hisc been scrioiish exercised 
as to what our future iction should be 
“ NVe understand from sou that though sou sselcome the 
principle of the est ihlishmcnt of an institution for medico 
Icgil research sou find that ossing to present das ssorld con 
ditions It is impossible for the Gosernment to gtsc ans 
financial assistance at this time towards its cst iblishmcnt 
We feel that there ssould be no difficults in the maintenance 
of such an institution but that there would be great diffieutts in 
finincing the ncccssars cipitil expenditure for the jiurchasc 
' of a site the erection of a budding and the equipment of such 
an institution ssithout adequate Gosernment support We 
fully accept sour opinion bosses or that ossing to the financial 
situation at the present time it is impossible for the Gosern 
ment to gisc that support sshich we consider ncccssars 

We cannot conceal our disappointment at this decision 
for as SVC pointed out in our report the projected institute 
IS a matter of pressing public importance There ts hardls 
a capital in Europe that does not possess such an institution 
and we had hoped that the time had come sshen this countrs 
might cease to deserse the- reproach of lagging behind the 
greater part of the cisilized world in organizing research and 
instruction in a subject of such greit public importance 
But faced ssith the impossibility of tarrsing this greit and 
important ssork to a satisfactors conclusion ssithout Gosern- 
ment support for the initial expenditure and sensible of the 
importance of seeing that all the ssork and research into 
this question sshich is embodied in our interim report 
should not be lost we feel that the Committee should be 
adjourned swe the It svoiild then be possible foi x’ou to 
reconstitute it at any time that you consider suitable We 
believe that this svould be the best course to pursue as it would 
be most unfortunate if the ssork that has been done so far 
svere to be completely svasted 

Of course if anv public spirited benefactor came forssard 
and offered to finance the capital expenditure or to gise a 
large sum tosvards it it STsiild then be possible for you to 
reconstitute the Committee and carry on the ssoik xxhich we 
hope we have been of some use in fuithering 

'We svould lemind you that when- the report svas published 
It aroused much public interest in the Press and inquiiics 
have since been made as to the progiess of this work There 
fore sve ask you to agree to the publication of this letter 
in the Press ' 

The Home Secretary’s Reply 

I have received your letter of June 24, conveying the 
suggestion of the non official members of the Advisors Com- 
mittee on the Scientific Investigation of Crime that the Com 
mittee should be adjourned si/ie the m view of the decision 
of the Government that they are unable in the existing financial 

‘ British Medical Journal August 1, 19S6, p 229 


situition to provide the necessary funds for the esiabhshment 

lull 1 Committee rcrom 

mended in ihcir report of two yens ago ( have discussed 

this projec with the members of the committee and omelf 
on more than one Decision and I do not need to reiter^ 
mv person il svmpathv with the object you have in vm, 
3ou wil apprcciitc however that the demands made iipon 
the Excimqucr in the present abnormal situation are such 
tluil the Government cannot at the moment consider a schenK 
which however admirable it may be would invohe a noi 
inconsiderable capital outlay Unless therefore the necessary 
funds can be provided from some other source there is 
cicarlv no immediate prospect of (he scheme maturing and 
I cm only express the gratitude of (he Government to the 
menihers of the Committee for the valuable work they have 
done in preparing (he way for the further consideration of this 
project when financial circumstances permit 1 am m entire 
igrccnient with your view that the Committee should remain 
in being and I welcome therefore your suggestion that ii 
should be adjourned rinc die m order that it may he re 
constituted when circumstances permit 

! have of course no objection to the publication of this 
correspondence ’ 


MATERNITY AND CHILD WELFARE 
CONFERENCE 


A n ilion il conference on maternity and child iiclfaa 
was held ,al Bristol from July 5 to 7 under the presidency 
ol Mr R H Blrnais Parliamentary Secretary to the 
Ministry of Health It had been organized on behalf of 
the N ition il Council of Child Wcllare and various of 
Us constituent bodies by the Nation il Association of 
M itcrnity ind Child Welfare Centres and for the Pa 
vcntion of Infant Mortality in co operation with the 
maternity and child vvelfarc group of the Society of 
Medic il Officers of Health and was associated with a 
clinic il course for medical pr ictitioncrs which was con 
ducted on July 3- ind 4 After the opening speech by 
the Lord Miyoi of Bristol Mi Bernnys delivered his 
presidentnl address on the psychology 'of pregnancy m 
conjunction with the tailing birth rite, in which he said 
that (lie matcinal mortility rile last year had been 3!! 
the lowest for the ccntuiy but there had been no 
appreciable decline in the dcith rate of infants unda 
lour weeks old A discussion followed in which Dr 
Eleanok Joven Partridge dealt with the tcndenci of 
advancing civilizition to diminish procreation partly for 
economic icasons but also because of the existence of 
what she teniKd ‘sex-starved spinsters Professor 
Drew' Smvthe had pieviously stressed the importance ot 
the economic factor but Dr Paitridgc insisted on u'v 
part plax'ed by' an attitude of fear of sex inbicd in young 
girls by mistaken behaviour of their paienis J” * ^ 
naildei eases ol this predisposition education could ellee 
much good but in the more severe cases psy diologici 
ticatment was essential In the evening of the first oi) 
theic was a icception by the chairman and members 
the Bristol Health CommiUcc at the Clifton Zoologies 
Guldens 

Physical Fihiess in Children 


Mr R C Elmslie F R C S , opened a discussion on 
lysicai fitness in young childien by reading a 
islural defects in this class of the community nc 
ifincd a "^defective posture ’ as one which vvas 
icessitated by or adapted to what was being done 
e moment and gave ilJustrativ'e examples A 
isture further interfered with normal 
! considered a defect it must be habitual * . P ‘ 
laxed attitudes were not always harmful ,incl 

It be too tight, particularly across (he '^besf and^ronn^ 
B shoulder-joints Shoes for children 
ift to bend undet then weight Postural defects snoi 


Jn.\ 16 19'S 


M XTERNITI AND CHILD WELFARE CONFERENCE 


TittBumur 
Medical Joltlsal 


143 


Fl tri. iti.J In triMirinc full mobililN nnd bv simple 
cvcrencs for this -riHi lor control of bnhncc nnd position 
ind b\ other simple msuh initil nielhods rceonimcnded 
b\ the medic il pri«.tilii,nLr Mr Elmslie idded thnt during 
his lifetime he Ind seen n greit diminution in the number 
ind sc\erit\ ef posniril defects resulting from improve 
nient in hvgiene in clothing ind in phvsicnl education 
In voting children minor onhopiedie defects were most 
likelv to be encountered immcdntelv ifter birth when 
the child b>gin to sit ind stind ind with the stirting of 
school ittcndince Mr Jons Bvsiovv I'RCS dcilt in 
sonu detail with the treitment of minor orthopicdie 
defects 

Co-opcntion between Orpinized Bodies 

This session of the conference wis opened bv Dr 
F J Povsios who spoke on the need for closer co 
operation between the school mcdie'al ind matermlv ind 
child Welfare services and the need for inertiscd 
provision of convilcscent residential accommodation for 
children under school ige He wis followed bv Dr 
■\ S M Mvccreoor medicil offiecr of health for 
Glasgow who insisted that the child vvclfire service and 
the school medical service could ind should function 
most harmomouslv under public health idminisiration, 
the two services having now been amalgamated in most 
parts of Scotland and Ihcre being from the point of view 
of the Department of Health for Scotland no real 
break in the child s development mcdicillv between the 
ages of 1 and 14 The two services further came 
into close practical contact in the joint use of remedial 
clinics medical inspection of the pre school child and 
the nurserv school Dr Maegregor gave details of what 
was being done m Glasgow mentioning the training 
course for teachers and explaining whv he thought that 
on practical grounds it would be 'better to issociale the 
ntir'en school vnth the child welfare service rither thin 
with the school medical service He was followed h> 
Professor R H Pxrrv medical officer of health for 
Bristol who said that coordination of the two services 
was far from being general in the counirv gcncrallv at 
present Details were given of the methods of obtaining 
closer co-operation in Bristol and the creation of the first 
health centre in the Shirchampton (Portwav) district of 
the citj m 1935 

Dr Wilfred Pearson sponsored the claim of the pre 
school child to further consideration b> the public and 
the provision of better convalescence facilities for 
children of that age m conjunction with belter supervision 
in the home and adequate medical attention when 
required Periodic home visiting should be svstcmalic 
while dav nurseries and nurserv schools should be 
multiplied Dr R CoveSvhtii asked for the provision 
of emergency homes for infants and toddlers m cases of 
parental illness or domestic crisis He paid a warm 
tribute to the supplying of such dav nurseries bv the 
National Societv and he enumerated the tvpes of children 
which might be expected to benefit from an extension of 
such facilities Care must be taken to avoid institu 
lionalization and it was necessary to provide a background 
which would give a sense of seciiritv and develop self 
reliance and initiative rather than dependence If tem- 

porary shelters were going to be provided bv the 
Government as part of the Air Raids Precaution scheme 
some might be used from the start as emergency holiday 
homes until the more urgent need arose Under careful 
supervision the supply of adequate ventilation balancing 
of diet and the supplv of suitable clothing there would 
be an improved environment with a minimal risk of cross 
infection The most satisfactory size for such homes 
would appear to be a nursery school of about fifty 
children presided over by a matron with nursing and 
nurserv school qualifications, and assisted bv a nursery 
school teacher, four staff nurses, and about fifteen 
probationers 


Parental Considerations 

Opening a discussion on the parents of the future 
Miss Marv Mvcsl'Lvv considered a wide range of possible 
questions which were posed by children and adolescents 
and discussed how ihcv shou'd be dealt with She thought 
that fir too little was being done to use the different ages 
of children to prepare them for their own eventual 
maturity and possible parenthood This paper led up 
naUirallv to the subject of sex teaching in girls clubs and 
Miss Violft Svvaislvnd indicated various practical points 
which aros^ while Dr G DC M Rudolf in a paper on 
seX teaching in boys clubs said that parents should be 
nude to realize that knowledge of sex did not imply 
licence but rather that the sexual and acquisitive instincts 
could be turned to other than the direct uses of them 
Children should be taught that pre marital inlimacv 
caused psvchological harm and tended to lead to unhappv 
marriages while restraint before marriage led to more 
ctspect and happiness after the wedding dav Dr 
Edward Griffith read a paper on individual preparation 
for marriage 


Reports of Societies 


RO’i \L MEDICO PSYCHOLOGICAL 
\SS0aAT10N 
knnnal Meeting in Yorkshire 

The ninctv seventh annual mcLling of the Royal Mcdico- 
Psvchological Association was held at IlkIcy from July 6 
to 8 under the presidenev of Dr John R Gh-xiour 
medical supcrintcndunt of Scalebor Park institution (West 
Riding County Council) The meeting was attended by 
Several psychiatrists from abroad who brought greetings 
from their respective associations Dr R Gjessing ot 
Oslo Dr Noel Peron of Pans Dr M Sake! formerly of 
Vienna and now of New Y ork, and Dr J H Pameijer of 
The Hague 

TIic Private Patient and Some Changes 

In hiS presidential address Dr GilxioL'r discussed some 
of the changes which had taken place cspeciallv with 
regard to private patients during his more than thirtv 
years experience of Scalebor Park — the only local 
authoritv hospital solelv for private patients he believed 
m the country The most noteworthy change he said 
had been in the incidence of general paralysis For many 
vears this incidence was high now it was very low 
Alcoholism had been almost negligible among his patients 
Formcriv it was accepted as inevitable that tuberculosis 
would break out m anv mental hospital but it was now 
manv vears since a case had arisen in a patient at Scalebcr 
or a member of the staff Influenza was still a potent 
cause of mental trouble Many of the cases were of what 
he called the August holiday type the initial attack 
of influenza took place m the winter or early spring fol 
lowed bv listlessncss inability to concentrate headaches 
and increasing depression and after the August holiday 
had faded a number of patients sought the refuge of the 
institution A social change which Towered the numbers 
who could be discharged as relieved was the duninishing 
familv which meant that often there was no disengaged 
relative to look afler the patient 

The greatest social change Dr Gilmour continued was 
the vastiv increased public interest m psychological 
matters since the war accompanied by a decline in the 
observance of all forms of religion Thirty years ago the 
reply to the question as to a patients religion was given 
unhesitatingly and without apology now the question had 
to be directed to his reactions to the cinema or recreation 
centre 


144 


Juu 16, 193S ROYAL MEDICO PSYCHOLOGICAL AS,SOCIATION MEETING 


>o''«Scr tcnci ition nc no loiie'er looking otHw.ircls 
lor inctr s'\iV'\tion but \rc dn\cn deep inlo ihcjr inmost 
con<;ciousncss for a solution of their problems inci finihng 
ificrc uiut does not gtsc (hem peicc thc> fly to the 
psschologisi Man lus turned to bis own siibicctnc 

processes and in> m il ulaptation of these leads to > feeling 
ot Illness and that illness being psychic, must be treated 
psychologically * 

Plnsio-padiology of Sclii/ophrciin 

Two of the three scientific sessions were dcyolcd to 
schizophrenia, its pathology and treatment, tnd seven 
papers yv6rc contributed on cbnvulsivc shock therapy A 
cincmatogr iph film illustrating insulin ind cardiizol 
treatments was shown by Dr G VV B James It showed 
a normal morning of insiihn treatment m one patient from 
injection to interruption the various manifestations of 
hypoglycaemia, and (a colour film p irtly m slow motion) 
the epileptiform con\utsions induced by cardia/ol Dr 
J H Quastcl and Dr W T Wales read a paper on 
faulty detoxication in schizophrenia They had used the 
hippunc acid excretion lest m sixly-seven cases of mental 
disorder, eighteen of which were classed as catatonics All 
the catatonic patients studied, svithout exception, showed 
a diminished ability to excrete htppunc acid at a normal 
rate The authors inferred that i metabolic disturb incc 
of the li\cr affecting benzoic acid detoxication may be a 
characteristic feature of catatonic patients Dr R 
Gjcssing of Oslo gave the results of a study of thirty-three 
patients including twenty -four periodic catatonics The in- 
vestigation consisted of kmctic regisirttton of a number of 
reprcscntatisc physiological functions daily or several times 
a week oyer a period of four to six months During the 
stupor-free and non-cxctled phases there yvas a gradual 
accumulation of nitrogen in the body yyhich reached the 
threshold characteristic for each ease When (his level 
h id been reached there yvas a sudden change tn the vegc- 
tatiyc (one the excess nitrogen yvas excreted and the 
patient entered the active phase of stupor or excitement 
as the case might be 

Professor F L Golla, speaking on this last yvork said 
that his feeling yvas that here yvas offered a definite treat-, 
meni based on somatic pathology for a certain — possibly 
very limited — class of patient At the s imc lime he thought 
It yvould be the most unhappy thing if it yvcrc supposed 
that in order to improve the mental state of the patient 
It yvas only necessary to use the proper hormone for an 
endocrine gland yvhich yvas functioning improperly 
Dr P K McGowan also uttered some cautions sug- 
gesting that Dr Gjessing’s work might not have the 
pathological significance he was inclined to attach to it 
and that there yvas a physiological cxpl ination of some 
at least of the results he had been able to obtain 

Convulsion Therapy 

The first of several papers on shock thetapy was by 
Dr Manfred "SAkEL, yvho described what he called his 
“ pharmacological shock treatment ' The overdosage of 
insulin manifested itself in two mam groups first, m (he 
form of the so called “ wet shock ” with coma and profuse 
perspiration, and, secondly, in the form of an epileptic 
seizure, frequently without perspiration — the so called 
“ dry shock ” As these two mam groups could not be 
directed by insulin alone, he initiated the dry shock — if it 
did not occur spontaneously — by injecting cardiazol in 
the second or third hour after insulin, and thus provoking 
convulsions Dr Sake! presented a statistical record of 
1,500 treated cases from New York State Medteal 
Service The number of recoveries yvas given as 192 
280 were said to be much improved, and 357 improved 
The ratio of improvement yvas definitely less with the 
duiation of the disease , nevertheless, m cases of six years’ 
or greater duration there had been recoveries and im- 
provements Dr Sake! s statistics were criticized by some 
members because they had been compiled by a profes- 
sional statistician, not a medical man One speaker. 


TiieVitnan 

MtDlCAL 


Dr H G/I-LICS declared that professionallv comnitfui 
lies were a I.ttfc worse than useless 
senes of insuhn treated eases it requited im 
juplmg to prove fl) that insulin yvas a complete me t 
schizophrenia and (2) that it was of no usVat T £ 
honest impression was yvorth more than reams o stLstfes 
md hts impression w.s that insulin and card.azo! did 
some way aid m the production of remissions 

Cook discussed the range of mental teacta 
states influcnctd by cardiazol convulsions Convulsion 
treatment, he said, did not pick out particular menial 
diseases or individual symptoms Its cllecls depended less 
upon the type of morbid reaction than upon its duration 
and depth md upon (he degree of dissociation of per 
sonality Dr L W Russell pointed out that the com 
bmed insulin cardiazol therapy enabled the fits to be 
controlled “ The too placid patient gels bis fit and ik 
patient who is prone to fits has luminal to stop them, and 
has the fils as they are indicated by the use of cardiazol' 
In the “ruv ’ cardiazol treatment the failure of the in 
jection to produce a fit yvas often folloyved by agilalion 
^and nervous upset, but with the combined therapy the 
faded fit yvas less common because the patient yvas more 
prone 16 the fit, and also less upsetting because it nas 
produced in a state yvhich yvas so near to unconsciousness 
that It yvas completely forgotten Lately he had thoiiEht 
that subconvulsivc doses of cardiazol yvere oC great 
benefit They seemed to have a better effect m the 
stuporous eases than the full fit dose Patients often ted 
a pithctic terror of the cardiazol injection, but insulin 
predisposed to the fit and also gave a complete .imncsia 
besides having its own therapeutic effect 

Psychological Aspects of Shock Treatment 

A study of the behaviour of patients under insuhn yvi4 
presented by Dr Edivard Larein Patients yvho recoycred 
yvith insight he said, yvere iblc to describe their fcelingy 
yvJidst (hey had been in the schizophrenic slate Thej 
agreed that the predominant feature yvas lack of intui-st 
in persons and things He gave a description of a method 
of quickening external interest during treatment With 
the treatment properly earned out the patient Inniself 
began to make efforts (o reach out to reality and graduillj 
to get ,iyv,ay from the childish plane Dr Larkin added 
thil observition of the behaviour of the nurses id 
ministering this technique indicated a possible neuro 
pathology ol schizophrenia yvhich, if true, established pari 
of the rationale of insulin and cardiazol treatments 
Dr A DiCk ind Dr W McAdam presented obsena 
tions on four cases of cardiac complication in cardnwl 
treitment — auricular fibi illation in three, and the onset ol 
heart-block immediately follpyving a convulsion w 
another Dr L A Finiefs discussed the dangers ana 
emergencies of insulin therapy ^ these included prcmalure 
incidence of coma, circulatory and respiratory complin 
tions, convulsions, delayed return to consciousness, a 
toxic reactions and after-effects 
The use of a new convulsant drug, triazol , 

treatment of schizophrenic and other mental states v 
described by Dr A Wale and Dr W MaVER 
Its advantages yvere given as smaller dosage, Icsseneu 
less unpleasantness to the patient, and the possiomiy 
intramuscular administration Certain variations o 
treatment were noyv being tiicd out, including t 
duction of prolonged “ tyvdight ” states withou 
vulsions the induction of multiple convulsions, an 
administration of convulsant doses with inhibition 
fit by amyl nitrite 

Precautions and Qualifications 

Dr Isabel Wilson of the Board of Control 
a point which had emerged from the „nf. 3 nt 

value of standardization of technique .....am or 

that those who were going to work with m 



JL’I.\ 10 


RO>Al TvICDICO PS'iCHOt OGICAL ASSOCIATION MEETING 


Tue BfimsH 
Medicai. Jocr-sal 


145 


ordnzol or in\ of tlie'n. drugs should kno" the orthodox 
methods before thes begsn Another point of great 
importnncc to beir in mind \s"is tint there was hirdle a 
worker m this field who did not also rel\ on psschological 
methods of some kind It was out of the question to 
treat these pttients with a meehtnical substanec and ex- 
pect that to work the whole miracle As for the dangers 
of the treatment e\er\one was agreed that the more 
experienced the worker the less w is the dinger Sir 
LsLRCNCt: Brock chairman of the Boird of Control 
mentioned that the Board was shorlU publishing i report 
b\ Dr Isabel Wilson and Dr Rees Tliomas on treatment 
with cardiazol as obserxed b\ them during > recent \isit 
made at the request of the Board to Budapest, Vienna 
and Frankfort 

Dr H Pull SR Streckcr said that it \sould be unfor- 
tunate it the idea became prevalent that mental disease 
could be cured bv a few convulsions or comas This 
occasionallv did occur but certainlv not as a general rule 
The verv advantages of cardiazol ireatipent ccnstitiited 
a danger — nameh that the public or even the profession 
might come to believe that anv case wlialevcr ns ivpc 
or duration could be cured While admiring Dr James s 
cinematograph film he thought those who had seen the 
actual treatment with insulin and cardiazol would agree 
that It vvas not quite so drastic is the film m ide it appear 
Dr J H PAXttiJttR Inspector of Mental Hospitals 
Holland said that in the mental clinics of the four 
universities in his countrv about 700 patients had been 
treated bv insulin and I 200 bv cardiazol Individual 
cases did completelv recover and in others there was sur- 
prising improvement But among the 700 cases subjected 
to insulin treatment there had been stx deaths and four 
deaths among the 1 200 subjected to cardiazol He had 
also known fifteen cases of fractures occurring during 
cardiazol treatment Dr A A W' PetrIT described the 
apprehensions of the patients subjected to cardiazol — a 
real point against the method Some of the patients had 
described it to him as worse than death 

Genclical Problems in Mental Dcficicncv 

The final session of the meeting was devoted to the 
subject of mental deficicnev and two papers were con 
tributed from the Roval Eastern Counties Institution 
Colchester Dr L S Pevrose in a paper on genetic 
problems said that rare dominant Mcnddian characters 
might be the chief causes of mental defect in cases of 
Huntington s chorea epiloia neurofibromatosis and 
some tjpes of oxvcephalj Dominance in man vvas very 
often incomplete however, and the expression of dominant 
genetic factors was variable The genetic factors 
responsible for some relativel) mild tvpts of mental defect 
appeared to be incompletelv dominant In some families 
the mating of two cases of mild defect produced offspring 
with severe defect Again in a number of Ivpes of con 
genital defect though there might be a genetic background 
environment was much more significant than hercdils 
Congenital s>phihs encephalitis and cerebral trauma 
from the medical point of view were simple environ 
mental causes of mental impairment When the ongm 
had to be sought for in the prenatal period the effects 
of environment and heredity were less easy to separate 
The maternal age at the birth of the child was aetio 
logicalK important in mongolism and also but to a lesser 
degree in anencephaly, hvdrocephaly and spina bifida 
Dr T A Musro presented a paper on consanguinity 
and mental disorder A survey of a large group of mental 
hospital patients showed that the incidence of con 
sanguineous parentage vvas higher among psychotic 
patients than among persons suffering from general bodily 
diseases A comparison of 132 psychotic patients of con 
sanguineous parentage with a similar group of unrelated 
parentage showed a higher incidence of schizophrenia in 
the consanguineous group Differences also appeared 
amongst the relatives of the patients m the two groups; 


those in the consanguineous group showing a higher 
incidence of neurosis and psvchopalhic personality Dr 
Munro exhibited the following table showing the parental 
consanguinity rale among patients in the Cardiff Mental 
Hospital and in the Cardiff Roval Infirmary respectivelv 



No of 
Patterns 

Percentage 

1 Parents 

iCk nsark.utr.ccusj 

Percentage 
j Parents 

1 Fjfsi Cousirs 

Menial Hwpita! 




Prcvrri patienij 

* j 

- <S 

I 2 

Fofirer pattern* | 

1 ^6 

i 

- 

R >al Infirmary 

J 7.J 1 

osi ; 

0 46 


Tlic ncirer in blood to the patient the greater the chance 
of menial disorder Among patients who had blood- 
related parents he had found several instances of strange 
and rather alvpical psychoses 

Dr J A fRv/rR Roberts drew aileniion to the people 
who exceeded the intelligence quotient average by the same 
imounl as idiots and imbeciles foreshortened it — persons 
with intelligence quotients oi l^O or thereabouts on the 
Bind scale as compared with the 40 of the teeble minded 
He was not sure whether the child with an extremelv high 
intelligence quotient — a colleague had come upon a ten 
vear boy whose quotient was just over 170 — was not as 
abnormal sociallv as the imbecile Dr E O Levvts 
said that it was a matter of pride that in this countrv there 
were two centres at which this kind of research vvas 
organized and carried on in a systematic wav — namelv, 
the Royal Eastern Counties Institution and Stoke Park 
Colony The vounger generation of investigators like Dr 
Penrose worked on meagre data as compared with the long 
gcnelical tables of Karl Pearson and Goddard but the 
meagreness of the data was a merit because it showed 
that they were far more critical of their data than the 
older workers 

At the annual dinner of the Association Sir James 
Bvillif Vice Chancellor of Leeds University in proposing 
the principal toast urged the need for more training m 
psychology for medical students He believed that 90 
per cent of the students passing into the professton had 
had no proper or systematic training in general psychology 
at all It was not enough to study the abnormal A 
training in normal psychology was as necessary as in 
normal physiology He looked forward to the time — not 
distant he hoped in the case of Leeds — when every hos 
pilal attached to a medical school would have among its 
posts one dealing with mental aberration m its earliest 
stages 


R Laportc and R Grimal (C JJ Soc Biol Pans I9tS 
128 42) have found difficulty in cultivating tubercle bacilli 
from material which has taken some days to reach the labora 
lory and which has arrived in a state of putrefaction With such 
material the ordinary sulphuric acid technique cannot be 
relied upon for the destruction ol conlaminaimg organisms 
Expenments have shown that a saiisfaclorv way of preventing 
baclcnal growth in post mortem and other material is to 
place the tissue m 5 to 10 times its volume of a 10 per cent,- 
solution of sodium carbonate This solution has some destruc 
live action on the tubercle bacillus but not verv much more 
lhan Ringer Locke solution Material that has been soaked m 
It for some time becomes soft and can be ground up verv 
readily with sand in a mortar Once a homogeneous sus 
pension has been obtained the carbonate is neutralized with 
hvdrochloric acid using litmus as an indicator The suspension 
can then be diluted with distilled water and inoculated 
directly on to tubes of egg medium Only if the tissue is 
badly contaminated before being placed in the carbonate 
solution IS It necessary to treat it wtth sulphuric acid before 
cultivation 



UG July 16, 193S 


ENGLAND AND WALES 


* TraBxmsn 
Meojcal lovxsu 


Local News 


ENGLAND AND WALES 

An Assocntion of Special Hospitals 

A coofcrencc of delegates from si\ty-lhrcc London 
special Viospn \ls was Vicld al die Ron \\ Wcstnimstcv Opli 
thalmic Hospital on July 5 for the purpose of founding 
an Assocntion of Special Hospinis Lord Mersey, chair- 
man of (he Royn/ Wcstminsfer Ophthalmic Hospital, 
presided Mr J P Wctcnhall, house governor of the 
West End Hospitil for NerNous Diseases, proposed that 
the Association of Spcci \l Hospit \\s be founded He sard 
that he had discussed with the \icc chairman of his own 
hospital fourteen jears igo the possibilit) of forming such 
an assocntion but the matter was not then earned further 
The public ition of the Sankey Report last year had 
brought the matter to the front agun After a preliminary 
conference held at Moorficlds Eye Hospital last October 
an atl hot committee was formed, md as a rcsnlt ol its 
deliberations the present meeting was being held Sir 
Kenneth Wigram, chairman of the Cancer Hospital, 
seconded the resolution, which wis earned unanimously 
A constitution proposed by Mr Wentworth Stanley and 
seconded by Sir Mortimer Mirgesson was earned, and 
the association elected the following oflicers president 
Sir Kenneth Wigram honorary treasurer, the Earl of 
Dudley (chairman of the Bromplon Hospital) , honorary 
chairman, Mr Wentworth Stanley (vice chairman of the 
City of London Maicrnuy Hospital) , and honorary secre- 
tary, Mr J P Wctcnhall A council was elected con- 
sisting of two representatives of each of eight classified 
groups of special hospitals — women s children’s, oph- 
thalmic, nervous diseases, car, nose, and throat, chest and 
heart — with representatives from unclassified special hos- 
pitals including genUo-unnary, cancer, and “long-stay” 
hospitals 

West London Medico-clnrurgical Society 

The president, Mr D G Rice 0\ley, took the chair 
at this society s annual dinner held on July 6 at the 
Trocadero Restaurant Viscount Dawson of Penn pre- 
sented the society s Triennial Medal to Professor 
E C Dodds, who, he said, brought to his searchings 
after knowledge a Promethean fire and an untiring 
energy His work on the purification of insulin had 
reduced its price considerably and brought about a great 
benefit to the community His greatest work, however, 
was on the sex hormones That very year he had pro- 
- duced a synthetic male hormone which outstripped 
anything Nature could produce Professor Dodds, in 
thanking Lord Dawson and the Society, pleaded with his 
clinical colleagues to give research workers the greatest 
possible freedom The generosity of the staff of the 
Middlesex Hospital in allowing him to wander into any 
branch of chemistry he chose had made possible the 
bieaktng of one of the strongest Continental patent rings 
in this particular group of substances Proposing the 
health of the society. Lord Macmillan said that, like 
all good things it had grown up spontaneously and was 
the ideal club for a profession like that of medicine 
They were entering on a romantic age of medicine, full 
of the stirring of adventure The president, in reply, 
^sketched the activities of the society, and Mr Alex Roche 
"proposed the health of the guests, who included Dr 
Robeit Hutchison, Sir Farquhar Buzzard, Sir William 
Willcox, and the presidents of many medical societies 
Replies were made by Dr Robert Hutchison, Sir Henry 
Gauvain, and Mr J E H Roberts Dr Hutchison 
claimed the West London medal for heroism in the 
discharge of medical duties, on the ground of the large 


number of banquets he had to face as Prcsiri, m .i, 
Rojal College of Physicians He rd^d ^ *0 \u 'n 

Trefoav Cripples' Hospital, Alton 

On July 6 over 150 members of the medical profession 
of Hampshire accepted the inMtation of the trusiets 
of the Lord Mayor Trdoar Cripples HospiiM, Alton 
to meet Lord Hordcr and to witness a number of spxiai’ 
demonstrations by the resident and honorary medical suff 
Lord Horder, m his iddress, contrasted the treatment o( 
the crippled child thirty vears ago when the hospital 
was founded with the treatment nosv gnen at the TkIms 
H ospital The advance made, he said had been hredi 
due to the work of Sir Henry Gain am and his staff 
They had done a great deal of the field work m that 
sphere of medicine and had settled the principles on 
which flic treatment of the crippled child was foundui 
The scope of the work had been widened until il cm 
braced anv and every crippling condition He had 
w'atchcd It grow, and he warmly congratulated Sir Hcnn 
Gauiain on the success he hid achieved and the sub- 
stantial contribution he had made to medical scienu 
During the afternoon interesting cases were demonstrated 
by HAT Fairfaank Sir Henrj Gatnain, Pro 
fessor Hey Groi’cs Dr C E M Jones, Mr T Ponifret 
Kilncr, Mr H H Langston Dr R L Volliim and Sir 
William Willcox The hospital, the rebuilding of whxh 
has just been completed, and the New Treatment Centre 
which embodies ill the most up-to date modem applnncis 
and mpro\cmcnts, proMded a >er> interesting illmeon 
for the visitors 


IRELAND 


Medical Research Council of Ireland 

The Medical Research Council of Ireland Im made tL 
folloivmg awards Dr Patrick J H Clarke Wwk tinx 
gnnl lor six months training m jinemle rheumatism w 
be taken at various centres m London to be followed ht 
•i six-months survey of the disease as it occurs in DuWra 
and district Dr E S Duthie Grant-in aid for one ji-at 
to enable him to employ technic il assistance in connewn 
With an investigation of (n) chentotaMS in leucocjles and 
(6) enzyme content of lymphocytes, the work to be carriw 
out in the Sir William Dunn School of Pathology Utinu 
sity of Oxford Dr D M Mitchell Grant in aid fe 
expenses in connexion with an investigation of the 
of deficient diets upon the central nervous sisiem ana 
penphcral nerves, the work to be carried out in the Sclioal 
of Pathologj^ Trinity College, Dublin Professor H r 
Moore Grant-in-aid for anatomical and pathological 
technical assistance in connevion with an mvesugatioa o 
bundle branch block the work to be earned out m w 
Anatomy Department University College, Dublin b) 

E Keenan and in (he Mater Misencordno Hospi'a, 
Dublin, by Dr W R O Farrell 


Rojal Matemitj Hospital, Belfast 

The new wing to the Royal Maternity Hospital 
vhich has been named Johnstone House after Sir Xo 
ohnslone, was opened on June 2S by Lady .j, 

t contains twelve beds in single rooms and one 
hree single-bed cubicles , two theatres, with a 
oom , a separate nursery with an annexe for mciiin 
nd a milk room besides other service rooms P ^ 
yards are intended for patients who are able to n 
ull cost of' maintenance and medical treatnicnl, 
ubicles for patients of limited means, the ‘Charge 
mgle room being higher than that for a , pi 

lobert Johnstone who attended the iJr 

he importance of safe maternity It was the out) 



Jt’n IG 19 'S 


SCOTI AND 


piiMn. iml ot lIiL Go\i.riinKnt hi. -.iid to <,cl thnt motliLrs 
wtri. 'TIl whiti. t-i'int, hi Ih lo Ihtir children >nd tint lht.\ 
\\i.ri. restored sife to their fuiiilies ifterwirds It \\ is 
not eApcetexI th It Johnstone House nhhoiich a piling 
hliscli ssoiild bring in in\ enormous income Subscribers 
would hue to eontimic their lo\ il support of the 
institution 


SCOTLAND 


Si \ndrcn s \mbjl incc Nssocnlion 

At the recent ininnl nicelinp in Olisgow ol St 
Andrew s Anibii! inec Assocntion it w>s snted thnt during 
the past scar -tvodJ cills had been made for the sersicc 
of ambuhnee wagons and that the total number of 
p-iticnts con\c\cd since the formition of the association 
was SIS '72 In Glasgow alone during the \cir the 
ambulance w igons had turned out on an aserage (ifl\ 
seacn times dailv The icrophnc ambulance sen ice insti 
tilted in 19s' continued to grow and sesentj four patients 
had been carried b\ this means during the past \ear The 
association had now eights nine motor ambulance ssagons 
of which sesentcen were in Glasgow and the remainder 
throughout Scotland 

Cremation in Scotland 

At a eonlerence on June 29 ot the N ilional Association 
of Cenietcrs and Crematorium Superintendents and the 
Federation of Cremation Authorities in Edinburgh Dr 
\\ G Clark medical officer of health for Edinburgh 
speaking on cremation from the standpoint of the public 
health official said that legislation threw upon the medical 
profession the responsibilits of ensuring that m the dis- 
posal of the dead there should not be danger lo other 
persons A badli situated cemclers might be a danger to 
the health of the nation although a modern cemeters 
properlv constituted was not so As a public health 
official howeser, he believed that cremation was the 
hvgienic method for disposal of the dead Dr Douglas 
J A Kerr medical referee lo the Edinburgh Corporation 
read a paper on the Cremation Act and Regulations and 
said that at the present time control of cremation m 
Scotland was exercised b\ the Secrclarv of Slate through 
the Department of Health The ultimate aim should be 
to make cremation as convenient and economical as earth 
burial this could onlv be done if crematoria were at 
hand m everv district With regard to the medical certifi- 
cate he thought that a change was necessarv The first 
medical certificate was of course essential but the word- 
ing required to be adjusted The certificate began 

Having attended the deceased before death and this 
was construed bv some medical men to mean weeks, 
months or even jears rurther the provision for crema- 
tion during epidemics should be extended to cover deaths 
in air raids 


Roval Blind Asvium 

At the annual meeting of the Edinburgh Roval Blind 
Asvium and School on Julj 6 the question was raised of 
unemploveo persons who received training at community 
centres in the city in work usually done bv blind persons 
and, bv undercutting restricted the markets for the goods 
produced by blind workers It vvas considered by one 
member of the board that the problem of blind workers 
could only be solved if institutions providing for them 
were taken over bv the State The Roval Blind Asvium 
could not even afford to tram all those who applied, 
some persons had been waiting six years to begin training 
Professor James Drever of the chair of psychology in 
Edinburgh University, said that the compulsorv education 
of blind children dated in Scotland from 1890 but until 
the Act of 1936 came into force the education provided 
was elementary and the period of compulsory education 


The British 
Medical Jolhsal 


147 


extended from 5 lo 16 vears Many children how 
ever who to dav would be recognized as educationallv 
blind had been denied a satisfactory education because 
school boards did not send them lo a blind school unless 
thev vvtrc obviously blind in the popular meaning ot the 
term Tlie 1936 Act now required the provision of ediica 
tional ficililics from 3 to IS years During the past 
twentv vears blindness hid been greatlv reduced because 
the public health authorities had successfullv tackled 
blindness of the newlv born to dav only one child was 
blinded from this cause as compared with ten twentv 
vears ago About two third:, of all blind children at the 
present lime vyere blind from causes outside medical aid 
and as a result they must make provision in their school 
for between 120 and 130 blind children 


Princess Margaret Rose Hospital 

A new Nufiicld Ward at the Princess Margaret Rose 
Hospital for Crippled Children Edinburgh named in 
icknowledgmcnt of a donation of tb 000 from Lord 
Nuffield towards the cost of the extension of the hospital 
vvas opened on Julv 4 by Mr John Colville Secretarv of 
State for Scotland Mr Colville said that since Sir Robert 
Jones became a pioneer ol modern orthopaedic surgerv 
in England manv thousands of children had been made 
whole and straight vvhile many others had had their 
handicap in life reduced Orthopaedic surgery was not 
a simple process and treatment was prolonged sometimes 
to vears it required therefore many kinds of skill and 
infinite patience There were no reliable figures as vet on 
which 10 estimate the number of persons in the coiimrv 
children and adults who were crippled in one wav or 
another but these would be available when the survey 
of cripples m Scotland which was being earned out by the 
Central Council for the Care of Cripples was completed 
The Earl of Home president of the hospital, pres ded at 
the annual general meeting of subscribers and Harriet 
Ladv Findlay in submitting the annual report said that 
the work of this hospital was growing every week Co- 
operation between the hospital and the local authorities 
in the south eastern area of Scotland was increasing and 
It vvas hoped soon to have the full number of clinics 
required for after care of patients treated m the hospital 
The finances of the institution were satisfactorv but 
further funds vvere needed lo p''Ovide an adequate endow 
ment and for additional buildings Mr W A Cochrane 
said that during the past vear there had been 232 ad 
missions and the hospital through outside clinics vvas 

now caring for the large total of aearlv 1 000 cases 

Patients were now being admitted m the earlv stages so 
that treatment could often be carried out in clinics for 
one child who needed to be admitted to hospital ten con’d 
be dealt with outside as out patients with great saving m 
cost and m suffering 

Decreased Mortalitv in Fife 

Dr G Pratt Yule who is retiring after twenty six vears 
as medical officer of health in Fife in a valedictory address 
rccentlv lo the Counlv Council Public Health Committee 
said that one of the most important features in the countv 
vvas the fall m the infantile mortality rate In the period 
1892-1906 the rate vvas 108 per I 000 births but during 
the following fifteen vears the rate fell to 97 and after 
1922 there was a further fall to 79 Health visitors had 
had much to do with this result by teaching mothers 
how children should be fed and clothed Fife had been 
one of the first counties in Scotland to introduce health 
visitors When he qualified scarlet fever vvas a virulent 
disease and during the period 1912-21 the vearlv scarlet 
fever death rate vvas 79 per I 000, but between 1927 and 
1936 It dropped to 65 In the former period there were 
twenty three deaths from typhoid fever, but durtng the last 
SIX years there had been only six deaths from this disease 
Similarly the deaths from measles bad fallen from 161 lo 
64 while those from whooping cough had fallen from 
260 to 113 



148 Juu 16, 1938 


CORRCSPONDCNCC 


MewcAL Jotxsa 


Correspondence 


Medical Relief in China 

Sir, — In .i recent issue of the Bitti'ih MliIuuI Jouiiuil 
jou very kindly inserted an ippcal for help to keep the 
Biitish hospitals in China supplied with necessary drugs 
and instruments during this time of stress and strain due 
to the SinoJvpancsc conflict The apped which is a 
special section of the Lord Mayor s Fund for the Relief 
ot Distress in Chini bore the signatures of a number 
ot those whose names ire well known in the medical 
world and a copy w is sent by post to members of the 
profession in Engl ind Wales Scotland, ind Irclind — 
appro\im itcly 40 000 in number 1 am glid to siy lint 
the list IS too long for me to ask you to publish the 
names and amounts of those who base so far sent in 
their contributions 

Up to to days ditc 871 subscriptions base been reccised 
imounting to £1 ‘'40 7s lOd and although each one his 
been acknowledged with an oflicial receipt, 1 wish through 
your columns to thank those who base responded ind 
It the same time to remind others who ha\c not yet 
sent in their donitions that for this special purpose 
£6 000 IS needed and we do hope th it this amount may 
be forthcoming 

If there is one thing more than another which stands 
out in this welter of hum in sufTcring in Chini it is the 
waj in which complete cooper ition has been ichicvcd 
in the matter of medical relief No barrier^ of race or 
religion has been allowed to st md m the wiy, md the 
business man the consular oflici il md the mission iiics 
of ill denominations have co operated in trying to bring 
relief to those m distress Cheques md postil orders 
should be sent to me at 121, Westbourne Terr ice London, 
W 2 — I am, etc , 

H Gordon Thompson 

Julv 11 Executwc Secretary and 1 rcasurtr. 

Lord Ma)ors riind 


Anti->cncreal Measures 

Sir — D r Robeit Forgan (Jounial June 25, p 1389) 
seems to think he can easily make hay of the Ministry 
ol Health Report on Anti-venereal Measures m Scandi- 
navia by quoting a few ill digested figures He speaks 
of the decline of syphilis m England and Wales fiom 
1922 to 1936 as being onlv from 25,000 to 18 000 as 
compared with that m Denmark from 2 400 to a thud 
ol that number This latter he calls a drop ot 300 per 
cent — a new method of reckoning' I prefer the ordinary 
method, by which a reduction of 100 per cent means a 
drop to zero Thus a drop from 2,400 to 800 is a 
I eduction of 66 per cenl But the figures of the two 
countries are not comparable, since the English numbcis 
(25,000 and 18,000) are cases of syphilis at all stages 
(See pp 237 and 238 of the Ministry of Health Report 
foi 1936) What we need foi comparison is the number 
of flesh cases of syphilis for each year , and this we have 
(m the same report) for the years 1931 to 1936 Now 
these figures show a decline m fresh cases of syphilis from 
9 104 m 1931 to 5,675 in 1936— a reduction of no less than 
38 per cent m six years From the earlier figures given 
in the 1936 report it is certain that a further considerable 
I eduction of fresh cases had gone on during the decade 
19Ty to 1931, so that the total reduction ot fiesh cases 
between 1922 and 1936 cannot be less than 50 per cent 


This reduction indeed is not so erent ne ihii „i j , 

„„d Swdto Cbom S 

tfvely bill the dilTercnce ,s nol shnling Incidenlalii 
Dr Lomholt questions the reliability of the Dinish 
figuics If my contention is right Dr Forgan is nol a 
little wrong ' 

In my cisc at the present time, Holland w-hichhasnot 
idoptcd compulsorv measures had according to this report 
a syphilitic incidence ol 106 per 10,000 population 
m the yeir 1935, which is midway between the corn 
spondmg figures foi Dsnmark and for Sweden But 
the Ministry ol Hcilths Report is not concerned onh 
with statistics the pitlalls of which are known to cwry 
statistici m The conditions of each country, cxiirin! 
' and intern il, the character of the peoples, the density 
of their population the nature of their industries, form 
1 bickgroiind which must be taken into consideration 
before ipplymg to one country a system which may be 
suitable for another The Commissioners have candidh 
suted that m Dcnmaik and Sweden the compulsory 
system works without much hardship on or conccalnii.nt 
by patients this being due to the social outlook of tin. 
people and the influence of the medical profession In 
Holl md where the population density is 667 to tk 
sqiiiic mile (is compircd with Denmark, 224, and Sivedui 
39 5) we should expect the incidence of syphilis to b 
higher than in either Denmark or Sweden, and m Griaf 
Britain at least as high as in Holland The figures givin 
per 10000 population aie Denmark, 2 1 (minimum 16) 
Sweden 0 67 Norwiy I 5 , Holland, 1 06 , England amt 
Wiles I 7 md Scotland I 8 

I know th It in this country there arc many laynun 
md clinicians too, who in justifiable anxiety to git rid 
of xcncreal diseases xvish to fly to compulsory methods 
The wisdom of such a course must be determined nol h) 
slitistics alone but by reflection on the character and 
outlook ot the populace 1 for one am convinced that 
here the cflect of compulsory notification would, on ik 
xvholc, be detrimental From the report it is clear thatth 
Scandinavian administrators say that legal compulsion is 
seldom employed though they think it is useful to hold 
in reserve In spile of il, however, gonorrhoea, which is 
cqii illy under compulsory laxx's, is not markedly decreasing 
m Scandinavian countries any more than in Great Britain 
— 1 am etc 

Dumbirlon Juty 6 DOUGLAS WHITE MB 


Iscliio-pubic Osteochondritis 

Sir — Being convinced that cnl irgemcnt of the iscliw 
pubic junction, with or without some definite irrcgulariti 
in density ol the bone was not nearly as rare as Mr 
G D F McF idden m his report of a case published in 
Xhc. Jounial of June 18 (p 1309) suggests, i limited si ire 
has' been m ide m my personal records with results tba 
seem to be of some interest 

Batches of consecutive films showing the pelvis 
hood were examined for this lesion In 200 cases sul cn 
fiom various affections of the hip twenty five showed 
ment of the junction in one or more of their films to f 
a few del Ills The first HO cases of congenital ‘’■'‘''’‘^1; ,, 
of the hip provided eleven with the lesion on one or , 
sides of the pelvis Both uni and bi lateral lesions occi 
with cithei iini or bi lateral dislocations There sec 
be no connexion between the appearance of the 
manipulative reduction of the dislocation since in " 
ossification of the rami at the time of the roduclion 
[iHle advanced and the lesion was only found r 
eight years liter In one Case the lesion was pres 
ihe reduction 


JuL^ 16 I'll*: 


CORRESPONDENCE 


Of ihirtv M\ lon'ci-iilivc of p cmlo co\Tlt,n icn 

'‘lia'vctl Ihc i‘-tliio piibit Icvion on one or bolh Mdc*: In 

three of the'^e the levton r\t*- iinil'itcr'tl nnd on the opposite 
'tile to the (.hnnue- in the fcniornl held In the rentnining 
'exen e oex the lexion «ts bihtcml in onh one of thc‘C were 
the ehnnuex in the fcmonl hend il o liliteril In thirtx odd 
lives of snrioiis tvpes iniindmp tiiberniloiis nnd other infei 
lions of the hip four were found vhowinj. the lesion in 
two It was unilaleril and in two bifiteral Two of these four 
n es suffered from tubcrculou disease of the hip joint In 
none of these twents fisc cases were ssmptoms noted directing 
mention to the isehio pubic junction Were such ssmptoms 
pre ent at ans time thes were either oserlooVed or mis 
interpreted In most of the cases the abnormilils as seen in 
the films consisted onis of enlargement of the junction in 
a few there was irrcgulariis in densits of the bone in iddi 
non In the majorits of the cases films tifcn at a later date 
were asailabic for ccaminalion in each such c" c the rami 
had fused and presented a normal appearance 

These cases it sccms o me sugccsi that enlargement of 
the ischio pubic junction ssith or without some irreguhrils 
in densits mas occur as i desclopmcntal pcculiarits desoid 
ol ans clinical significarce \ns inference sshich might 
be drassn Irom the higher percentage ot lesions found in 
the pseudo-cONalgia group — a small group from sshich to 
driss conclusions — seems to be ncgitised bs the fact that 
the numbers found in the other groups sserc tar from 
be ng negligible 

\s to the cases ssith ssmptoms sshich appear to be due 
to the changes at the ischio ptihic junction it was suggested 
m ns sears ago bs ms colleague Mr George %\augh sshen 
showing me films of a case with definite ssmptoms that 
the pathologs ssas nothing more than neglected trauma 
Ms smill experience of similar cises — the notes of three 
such are before me as I write — strongls supports this 
suggestion Complcie rest for no more thin a fess ssecks 
permanentls relics cs the patient of >11 ssmptoms films 
taken later show complete disappearance of the lesion 
There remains the question sshether pathological changes 
wcrihs of the title osteochondritis cser occur at the 
ischio pubic junction Personalis 1 doubt it it ssc lake 
as our tvpe p eiido-coxalgia in sshich be it remembered 
the changes progress markedls to' s.seril months before 
helling Sets in and ultimitels restores a normal densits 
if not a norm. 1 shape to the femoral head Though I 
cannot agree ssith all the opinions expressed in hts letter, 
I strongls support Mr G Edgar Church in his protest 
against the indiseriminate use ot the term osteo 
chondritis for csers case m sshich irregularits in dcnsilj 
and shape of an epiphssis or other fragment of bone 
fo'miag in cartilage is no, readils aitribuiablc to a definite 
ciiise In ms opinion a largv p opariion of the reported 
Cases base little or nothing in common ssith that interesting 
condition of the hip sshich I hise suggested should be 
taken as the tspe and sshich passes under so mans names 
,.niong sshich pseudo coxalg a has the idsaniagc of 
committing one to no pathologs — I im etc 

London \S I June 11 HAT Fmrrsnk 

Rising Incidence of Psschosomatic Illness 

Sir — D r James L Hallidas in his interesting article 
(Jniirnu! Juls 2 p 111 appears pizzled bs the rising 
me dence of disorders ot psschological origin 1 submit 
hut much ot this increase is apparent rather than real 
Wnen I ssas phssician to the Birmingham Nerse Hospital 
b.fore the ssar I could not help being impressed bs the 
large number of out patients attending there ssho had 
b»dn turned assas from other hospitals because no 
organic basis for their complaints could be discose'ed 


The BiirruR 
Muhcai. Joctlnal 


149 


fn those dass sshich seem so long ago the psychological 
factor in disease was pooh poohed and such patients 
drifted iboul until thes found a doctor ssho realized that 
dyspepsia ind other disabilities could be caused bs 
ideas as readils as by physical or chemical irritants 
Disturbances arising from the phssical concomitants of 
emotions sscre but little understood and a sufferer from 
them ssas disdained as a malade iinagmaire and a 
niiieancc This had a deterring effect Nosv such dis 
orders arc beginning to be gcneralls appreciated esen 
classified and tabulated and to this extent their increase 
IS onls apparent 

There is hosseser another important factor — sshat the 
Germans call the Kninkheusgeninn Since psychogenic 
illnesees hast become not onls recognized but ressarded 
a person ssho suffers from the phssical changes associ->ted 
ssith anxicts and other emotions instead of being lurnud 
sssas IS noss gisen elaborate treatments ceriihcates of 
unfitness tor ssorl and perhaps a holidas at a con 
salescent home Thus he lacks incentise to adjust himself 
to or osercome a trouble from sshich he indirectls 
profits Phssical treatment alone tends hut to fix the 
ssmptoms During the ssar in the special neurolo^, eal 
hospitals (I speak cspecialls for Maghull) while hostilities 
continued pssehoncurotic soldiers ssere difficult to cure 
Being in hospital and out of danger satisfied their 
unconscious longings After the armistice ho'seser most 
ol them got ssell ssith surprising rapidiis thanks not 
to them nor to their phssicians but to the fact that the 
cause of their fears had ce-ssed to operate and earls dis 
charge offered adsantages Then follossed the Ministrs 
of Pensions clinics on sshich I al'o sersed and there 
again I met with the Krimkluil^giwinn factor — the larger 
the pension the more difficult the treatment 1 do not 
refer to conscious malingering though this also existed 
but to the unconscious clinging to a ssmpiom for its 
secondars saluc Noss that n mans forms a comparable 
rcssard is easils obtained we must expect a real increase 
m the numb.r and duration of psschosomatic 
illnesses — 1 am etc 

Caldceoic Julv s A E CxRSER 


Sir — T he present ssidening interest in the psschogenic 
aspect of illness ssill be rcinlorccd bs the opportune 
surscs contributed bs Dr J L Hallidas to the Journcl 
of Juls 2 (p 111 It is becoming increasingls csident that 
in a large number of cases ot functional nersous dis- 
ordc' there is an initial failure on the part of the 
mdisidual concerned to adapt and adjust himself to his 
easironment The underlsing psschological conflict tends 
to4esolse Itself along the l-miliar lines of either mental 
or phssical disabilils the particular sariets ot sshich 
appears to be conditioned bs the personalits make up 
of the patient in each case In this connexion tsso 
famong seseral) important factors appear ssorths ot atten- 
tion — n «mels (o) the indisiduals posser of inhibiting his 
ossn instinctise fears etc and (b) the trend of his imagin 
alise actisities — that is sshether in a constructise or 
destruens e direction For bresils this mas be represented 

diagrammaticalls thus 


X lO H II 
irtf'" ated 
P s 


lr>h>b)Uorv ct e’k lEncu nal 
/ restrairt 

Well-conir led 

cor iruai e j-Pianred 
imacirjition J acti\ tv 


( Sos-ces 
r ..dapt.. cn 


Inmt 
L r tchl 

N U CfMl IC 

r tcnal I 


1 In«ffet.ti%e irbibi j 
I lion f fe-r eic J 

Unconm^led . 

I dcstrucu\c 
\ imagination j 


Hcichtened cnotio^al’ 
tension or sorre 
t«rr,cs (n the ca-C 
of repression for 
CA«imple h steria) 
rparert ou naru 
indirercoce j 


Ir-dcquare 
adaptatior 
pence ps chn- 
neurolic ».nd 
psAChc»oru ic 
il ness 



150 Juu 16 1938 


CORRESPONDENCE 


Power of ad iptalion is the keynote Where (he normal 
stable individual would skilfully tack or tike m sad to 
meet hfes sudden squalls, the “neuropath’ imbued as 
he often is from the start with a spirit of congenital 
defeatism tends to heel over ind capsize The remedy 
lies to hand and involves (I) systematic inculcation of 
sound psychological principles during every students 
hospital training and (2) earlier detection of and psycho- 
therapeutic assistince for, the unstable -type of individual 
who would otherwise drift into psychoncurotic or psycho 
somatic illness — 1 am etc , 


Tnc BRnmi 
MtOlCAL JOLKNU 


Bo’^combe, }i\\y 4 


W V Harke 


The Unconscious Mind and Medical Practice 

Sir — T he art of psychothciapy, like the art ot other 
branches of medical practice can only be learned through 
ns evcrcise The textbooks which Dr G Waugh Scott 
{Journal July 2 p 39> his read should have given him 
an insight into the general principles of analytical 
psychology Every case however, is a separate problem, 
and in the nature of things it is impossible to provide 
him with a \adc tutciim in which he has only to refer 
to the index to find a specified treatment for each 
symptom Take the two eases v.hich he brings forward 
IS illustrations both the man and the woman arc 
punishing themselves by inflicting on themselves the 
thing they fcir most, the thing most damaging to their 
rcspectnc egos To clear up the condition one would 
hue to discover the source of the childish iinintegralcd 
guilt which they are thus expiating and investigite the 
current mental conflicts which have revived the latent 
ones 

My ads ice to Dr Waugh Scott is to begin (he msesli- 
gation boldly on the general lines which he has learned, 
leaving the particular symptoms to take care of (hem- 
selves He will soon find that he is acciimiilaling a 
wealth of material which will point the svay to a cure 
Solvitiu ambtilando ' — I am etc 
Birmingliam, July 4 Macdonalo Ladlll 

Men'al After-care 

Sir — May I be permitted to lav before readers of the 
Journal a brief account of the aims and activities of the 
Mental After-Care Association the nature of whose work 
IS inclined, unfortunately, to be known only to a limited 
public specially interested in mental or nervous illness 
We feel that if a greater knowledge and insight were given 
as to the valuable assistance rendered through this associa- 
tion to patients leaving mental hospitals the sympathy of 
a very much larger public would be obtained 
The stormy progress of the mental hospital towards 
honourable recognition is becoming increasingly well 
known, and it was in 1879 that this association, was 
founded with a view to helping patients leaving mental 
hospitals to readjust themselves to a great extent before 
they were expected to face the difficulties of normal life, 
from which many may be cut off for a period of years 
Out convalescent homes enable those patients to spend a 
few weeks in an atmosphere less disciplined than that of 
hospital routine, and at the same time not so completely 
lacking in supervision as is expected when they leave to 
,take up work in the ordinary way 

Unfortunately, it is still true that the layman is inclined 
to distrust the man or woman who has been in a mental 
hospital no matter what the cause may have been , and 
m tins respect we have thiough our employment buieao 
been able to assist pitient and employer alike by placing 


the patient in suitable work and by interviewing ihe nro 
spcclivc employer who then feels that he cm apply i^s 
If he is dissatisfied, while each patient who passes throuch 
our hands knows he or she can look to us for a mm 
(hctic reception should occasion arise Our most recent 
addition has been the inauguration of a summer holidry 
to suitable patients still under treatment in hospital and 
the experiment has bcen-^vell justified This summer we 
hope to give two weeks’ holiday to over one thoimnd 
patients from various mental hospitals 
As your readers will readily understand, all this entails 
a great deal of expense, and if our high standard of 
efficiency is to be maintained we must look to our lery 
many good friends to assist us Even the smallest amount 
will be most gratefully received — I am, etc, 

RroiNALD Worth 
C lnirmm Mental After care Associilion 
Room tS4, Grind Buildings, 

Trafalgar Square, \V C 2 

Treatment of Pneumonia 

Sir — To quote from your leading article of June 23 
(p 1371) “ If chemotherapy can equal or even approach 
serum therapy in efficacy serum will stand little chana 
of more extended trial Certainly the results oblauiid 
recently by Dr Telling and Dr Oliver {Lancet 1938, 1, 
1391) and m a hundred consecutive cases by Dr Evans 
and Dr Gaisford (ibid , 1938, 2, 14) indicate a delimte 
superiority over scrum treatment The difficulties of 
treatment by specific sera are obvious Sera have been 
used with success in America against many different types of 
pneumococci but only Types I and If antisera have bein 
much used in this country If serum treatment is adopted 
typing IS essential, but m many cases sputum is not 
obtainable early enough Surely it should be possibk 
to obtain the specific organisms directly from the pneii 
monic lung by aspiration with an exploring syrinci 
Serum treatment has other disadvantages — for example 
the possibility of anaphylactic reactions occurring The 
effects upon the pneumococci of the chemotherapeutic 
agent and of a type-specific serum are essentially similar 
The specific serum combines with the capsule, upon which 
the virulence and type specificity depend, detoxicating the 
organism and making it vulnerable to phagocytosis 
T693 also has a definite action on the capsule In cither 
case the pneumococci Jose their virulence and are reidil) 
destroyed by leucocytes 

Professor Fleming {Journal July 2, p 37) recommends 
that specific immune serum should be used together with 
(he chemical agent, because he found that human bloo 
with the addition of T693 and immune serum could dea 
with a much larger infection than the same blood con 
taming cither T693 or immune serum only Cannot Ine 
same effect as that achieved by a combination of serum 
and T693 be obtained by giving a larger dosage of the 
chemical agent‘s T693 accordfng to Whitby, has a grea 
advantage over sulphanihmide in being relatively n®” 
toxic, although active, in small doses 
Evans and Gaisford m a few cases gave as muc 
9 grammes in the first twenty four hours with 
effect There were no toxic symptoms with the excep i 
of cyanosis — in about a quarter of the intensively R®® 
cases — which disappeared when the drug was with rai 
If It IS possible to increase the amount of the ' 
the infection is especially severe without detrimcn 
patient, surely there can be no necessity to soppe 
Its action with serum 

ft IS upon the efficiency of the 
leucocytes that recovery from pneumonia u 



TlO 16 !<)''! 


CORRESPON’DENCE 


depends It llu\ till neither serum nor cheniothcnpj 
c'n si\e the pitieni s life The onset of i,rTnuIoc\topenn 
during the course of nemc pneiimonn is of fifil sicnifi 
cinee and e\cn Icueopenn is ot serious import J B G 
Muir {Journal \pril '0 p 942) records i case of pneumo 
eiseeil peritonitis in a child iged 10 in which the Icuco 
c\te eoiinl fell npidU to 2 700 per c mm but treatment 
with pentose nucleotide riised the count to 27 000 per 
emm in a few dies ind the piticnt cecntiialle recoeered 
in spite ot the complication ot double lobar pneumonia 
E'en eehen Icucocetosis remains at a considerable height 
the bac.cncidal power of the blood m i\ be defic ent 
Lcucocetcs from different individuals espccialle those 
suffering from acute infections mae ears considerable in 
phagocetic actieite In such cases the addition of fresh 
hunun blocd from a suitable donor cspecrlle if of high 
leucocetic ictieite mae turn the scale in the patients 
favour The Icucoevtic content of the donors blood mae 
be increased be a previous inicclion of sodium nuclein itc 
and the Icucoceies nonspecific phagocetic aclieiie m tv 
be enhanced be the intravenous injection of a sm dl 
amount of staphe lococcal vaccine a fcee hours before the 
biood IS withdrawn or it mae even be added to the blood 
after eeithdrawdl Frequent blood counts with differential 
Icucocete counts during the course of the illness arc a 
use ul guide to trc'^tmcnt — I am etc 
SVcilhm- Jute s HfRBERtH BROVS-N 

PsiKacosis 

Sir — In the Journal of April 2 fp 737) there appeared 
a leading article cn psittacosis in which it was stated that 
a carrier state is readilv set up in budgerigirJ and that 
It IS trom sueh apparcntle hcallhe carriers that mane ot 
the human cases have arisen during the last few ecars 

In October 1937 1 attended a female patient aged ^6 who 
died from an atepical bronchopneumonia on the eighteenth 
dae of her illness Her temperature fell to subnormal on the 
eiemh dae and for the ensuing eleven davs remained sub 
normal During this period her respirations varied from '2 
to tS a, minute and her pube rate remained con'tamle at 
120 a irnnute On the dae of her death her pube rate fell 
to 72 

It IS interesting to note that her husband bred biidg 
erigars and at times the patient had attended to them 
The birds were fept in somewhat close pro\imit> to the 
kitchen E\amination of the birds failed to reveal ane 
sign of psittacosis Nevertheless I am of the opinion that 
her death was due to psittacosis In Australia and New 
Zealand the budgerigar has become a favourite household 
pet Some fond -owners kiss their budgerigars goodnight 
with a regulariti calculated to arouse the jealouse of a 
perhaps somewhat neglected child' Let us hope we shall 
not hear in the future of what mav be termed a budgerigar 
complex' In all seriousness I believe that unrecognized 
cases of psittacosis have probable occurred in Australia 
and New Zealand Might it not be as well to record all 
cases of severe pneumonia m which the patient has been 
in contact with sick or apparently healihe budgerigars’ — 
I am etc 

Auckland June 1 ^ FLeSTlNGS 

Treatment of Placenta Praeeia 

Sir — In the case described be Dr H Gordon Oliver 
(Mae 14 p 1071) Willetts forceps applied to the scalp 
With slight traction might have been a suitable form of 
treatment Dr Olive' seems to have been particiilarlv 
luckv vviih his case With a low placental implantation 


TuEEvmnr let 
VllCICAL 


the cerviv is like wet blotting paper and attempts at 
minual dilatation are often likclj to cause serious trauma 
ind h lemorrh igc The prolonged manipulation is abo 
liktlv to incrcisi. the risk of sepsis Delivers of a full 
term bahv (S) lb in this case) through an os seven eigh hs 
dihted carries the risk of damage to the cervical suppons 
with possibilities ol gvnaecological complications 

\nolher point that needs comment is ihe fact that Dr 
Oliver administered prontosil after the case actuallv 
showed signs of sepsis this should have been given as a 
prophvlactic from the start with such evtensive manipula 
tion carried out near the site of placsnlal implantation 
If vaginil cvaminaiion is carried out with due attention 
to asepsis using gloves and a mask this will not be anv 
•■crious conlraindic men to a section Cases of m-rginal 
placentas rarelv assume a serious stale and can usuallv 
wait and all cases of uterine haemorrhage during the last 
lew months ol pregnanev unless too far awav ought to 
be Iranslerred to a hospital after an injection ot morphine 
without a vaginal examinalion unless one is fuliv equipped 
and prepared lo deal wiih a case on the spot The slight 
lo s ih It the palicm mav have in transit can be easilv 
made good hv a transfusion at an institution — 1 am etc 

D riAi HoArinl Suagei Palani S K kELkvR 

Kcitah Xlaliva June 22 

Sir — Wt. vvould like to thank Protessor F J Browne 
lOr his helpful crilicism {Journal Julv 2 p 3Sj We 
cvnnot help being surprised however when we read his 
qiitrv Do the writers rsallv believe that packing Ihe 
vagina controls haemorrhage trom placenta praevia it 
the membranes ^re unruptured’ \\e would respecifuih 
urge Professor Browne to reread our pape- and in 
parltcular the section headed Principles and Practical 
Aspects of the Treatment m paragraph 3 of which we 
wrote When cither marginal or lateral placenta praevia 
was diagnosed Ihe membranes were artificiallv ruptured 
vshethcr the patient vs as m labour or not and as much 
liquor as possible was allowed to escape This usualK 
led to salisfacior> descent of the presenting part and 
pacling the vagina was emploved onlv if bleeding was 
proluse or continuous Again in paragraph 6 fi) we 
wrote While packing of Ihe vagina in conjunction with 
artificial ruplure of the membranes is a recognized 
slimuUis to ulerine contraction wu have not found that 
undulv rapid dcliverv resulted 
Onlv m cases of central placenta praevia was plugging 
ever emploved before Ihe membranes had either ruptured 
spontaneouslv or been ruptured artificiallv We vvould 
not attempt lo defend plugging per se but onlv as an 
integral part of the routine to be adopted under the 
circumstances described and vvould stress the fact that 
It should alwajb be performed under stnetiv aseptic 
conditions preferablv m hospital \Ae hope that these 
quotations explain the principle emplojed which was 
to effect haemostasis bv compressing the placenta between 
Ihe foetal head above and Ihe plugging befow — Me 
are etc 

Samanian Free Hospital for Women ^ ^ GlESEN 

London iS NV I Julv 9 O LlOTO 

Small-pov and Compulson Vaecinafion 

Sir — A statement is made bj Dr A L Craddock in his 
letter on diphtheria prophylaxis (Journal Julv 2 p 42) 
which reallv cannot be allowed to pass unchallenged 
After referring to the entire freedom of this countrv from 
fatal small pox in 1937, he goes on to sav There can be 
little reasonable doubt that Ihe remarkable position in 



CORRESPO>^DENCE 


Tiic British 

'ICDICU JOURSU 


152 Juu 16 1918 


respect of smalI-po\ is due higely to compulsory vaccina- 
tion If Dr Craddock redly believes this 1 can Only 
suppose that he is entirely out of touch with current views 
among those most tamiliai with the questions of the 
aetiology and prophylaxis of small-pox I wonder if he 
knows that resolutions in fas our' of the abolition of 
compulsory vaccmttton have been passed by both the 
Association of County Medical Oniccrs of Health and the 
Society of Medical Oflicers of Health , md docs he realize 
that the disappearance of fatal small-po\ in this country 
has largely coincided with i continuous decline in com- 
pulsory eximinitionv Also is he aw tie that localities 
which liase taken the lead in the abandonment of com- 
pulsorx viccmation hive shown just as great a icduction 
m small pox mortdity as the rest ol the countiy? In the 
city of Lcicestei where compulsory viccmation was aban- 
doned over fifty years igo and where for many ycais 
the proportion^ of mf mis \ icemated has been less than 
1 per cent there hive been only two deaths Irom small- 
pox in the list Ihirly-thiee y'cars — I am etc, 

Leicester July S C KlLLICk MiLLSRD 


X Psoriasis 

Sir — I read with mlcrusi Dr John T Ingrams exed- 
Icnl irticlc on psori ISIS (/ourmi/ April 23 p SSI) Lha\e 
been using ultra-Molct ndiuion m combmition with 
various unguents m tlie treatment of psoriasis for the past 
two years, and m many eases have found it very satis- 
factory In treating some of my fellow practitioners I 
hive tried out, successively sihcyhc acid, mcicurials, 
cignohn and t ir preparations in ointment or paint form 
together with 'the ultra-violet light 1 found that the 
far preparations were the most effective ind for cleanliness 
a paint with an acetone and benzol base was preferred 
Many patients with psoriasis state that they arc free from 
this condition in the bathing season, and usually give the 
credit to the sea and water Many are so sensitive about 
their eruption, however, that they will not appeal m a 
bathing suit 

I agree with Dr Ingram that a small ultra-violet limp 
in the patient s home would be most valuable to prevent 
recurrences, but 1 do not agree with his method of giving 
a small daily dose I consider that most of the benefit 
IS derived from some degree of erythema , most aieas 
require only a very mild reaction, but resistant areas, like 
the knees and elbows, need a brisk reaction I have h id 
several patients come to me from the northern Australian 
sheep stations, where it is very hot and very sunny From 
constant exposure (working with their sleeves rolled up) 
their forearms, hands, faces, and necks have been very' 
deeply tanned, but these tanned areas have been just as 
much affected by the psoriasis as the covered areas In 
treating these patients moderate exposure to ultra-violet 
light and the application of an ointment will clear up the 
coveted paits, but on the exposed areas a heavy dosage 
ot ultra-violet rays is necessary Does it not seem rational 
to suppose that with frequent applications (he skin will 
tease to react to modeiate doses and the psoriasis will 
^tiirn, as on the exposed parts of the patients I have 
mentioned, and is it not also likely to increase the risk 
of keratosis developing laler't 1 have advised the smallest 
amount of exposure necessary to clear up the attack, and 
hive found little, if any, increase of dosage necessaiy for 
the lecui rentes — I am, etc, 

Wm Gilfillan, 

Atlcfiide, M ly Clinical Assistant, Sl.in Depiitmcnt, 

Ailehiile Ho^piul 


Complications of Gold Therapy 

SiR-l im ghd to see that Dr H Warren Croiw 
(Joiinidl July 2 p qq) has become a conveil to cold 
Ihciapy and I feel he deserves our congratulitions on 
his results m th it he has never had a toxic reaction m his 
senes This experience I am sure must be unique Hi 
slates that ‘ gold is given in minimum doses at as lone 
an interval as possible depending on the tendency of iht 
symptoms to recur My own experience is lint 
those cases which liave done best in the end have had a 
recurrence of symptoms during treatment Having tried 
gold in the very small doses prescribed by Dr Crowi 
1 am not surprised that thcie is no reaction, but on tlk 
other hand 1 have failed also to secure beneficial cITut , 
no complication is likely to arise after the administration 
of one hundredth of the initial dose 

I do not agree th it " the kind of gold salt used dois 
not ippcir to make very much difference Tins again 
IS contrary to the experience of most workers I havi 
scLia marked dilfercnccs with the various salts used which 
IS not unexpected, considering their diffcrint chcniica) 
cli iraclcnslics During the past year however using 
nco solganol which is a calcium-gold keratin prtparalian 
It has been found that reactions have been much kss 
m irked and the progress much quicker than with other 
prep ir itions In only one case so treated has thae bun 
my skin re iction 

It must be very diflicult of couisc to assess liKnptiilic 
cnecis vvlien two sepaiatc treatments based on cntialj 
difleicnt conceptions of therapy ate being used sinitil 
taiicously — I am etc , 

London, SV I, July S GCRALD SuOT 


Sir — D r Warren Crowe is to be congratulated upon 
the satisfactory results he obtains with ‘ gold injection) 
and particularly upon the absence of “ any toxic rcictton 
of anv kind whitever 

Auro intoxication is nevertheless i problem which 
confionts most othci woikers in this particiilir field A 
considerable amount of cxpeiiment investigatioft ind 
inquiry has been earned out it the Royal National Ho> 
pital toi Rheumatic Diseases Bath to find i method of 
predicting those cases which may suffer from mtovicalion 
by ‘ gold, but so far without result The gn mg ef 
small doses docs not ensuie the absence of reaciion 
added to which the icaction may be delayed for some 
weeks after the last injection A hospital patient lO 
mine developed uiro-intoxication with skin lesions afw 
a total of 0 17 gramme divided in five doses at wedl) 
intervals — I am etc 


Bath July 4 


John B BrNNcrr 


Quinsy -Peritonsillar Abscess 

Sir — H aving lead the coi resporidcncc on “Qumsj- 
Pciitonsillai Abscess and noted (hat it is often foim 
difficult to evacuate the pus efTecluiIIy may 1 (allhons' 
not a surgeon) ventuie to describe a method which lo"^ 
fiequently lound to be very effective 

When the abscess is behind the tonsil and cannot 
opened properly and the neck is swollen \ 

I make a small incision (under local anaesthetic) )i' 
behind the sterno mastoid about the level of the cbm 
cut Ihiough fascia then take sinus forceps an i 
the closed point passing it behind the ^'^rno nns 
(posteromedial) and forward Ihcn driw 'be 
foivvaid so that the point moves in a curve o 
nitdnlly, and up 'ind then farther up 'ind 



3t’L\ 16 19 


CORRESPONDENCE 


The BuTtsH |^3 
\!£DJC-*1. JotRNAt 


III! lilt- poinl IS nlmosl behind the tonsil Th^n open the 
forceps nnd pus pours oiil insert j,lo'e dnin 
One Ins to go sIowK nnd gentle •■nci feel the eeie Me 
first pntient colhpscd moment inle nnd reeoeered 
(probible pressure on i sempithetic gmghon') Hnc the 
ne-h ecre slightle fleecd in the process— I nm etc 

H M DCMlOLei ^OL■^G 

Ldmburth Jute F M A \1 B Ch B 


The Final M B B S Lend 

Sir — " ion eecre gotsd enough to gi'c hespitahte in eour 
columns m the carle part ot this ec^r to i discussion of 
certain suggestions for a mcisurc ol co openticn "ith the 
Conjoint Board of the Roeal Colleges m the final 
esamueafiott for the MB B S of London Umecrsiie The 
Senate eecre mtornied in a memorandum (dilcd Januare 
1 1 19^7) presented be the then % lee Chancellor to the 

Board of the Facihe of Medicine ot f enden Lmsersne 
and ihcreatier communic'tcd to the Senate that ol the 
medical students rcceieing their educition in London onle 
17 p“r cent obtained a degre- ind it was upon this m- 
fcrmation subseijuen’ie proecd to be erroneous that *n- 
Senate in Mae 1917 -uthorized the Board of the F tculie 
of Medicine to discuss eeilh rep cscniatiecs of the Roeal 
College of Phesici^ns and the Roeal College of Surgeons 
me problem sub-rmted to the Senate be the Court— nanicle 
the small number cl students in Medical Schools eeho I ihc 
a Degree of the L’niec sue of London 

■\ctmg upon this authorization delegates appointed be 
the Faculte Board from us men membership conferred 
eeith delegates from the Roeal Colleges The result ot 
this conference as it affected the Roeal Colleges "as sub 
muted to the Comma of the Roeal College ot Phesicians 
cn Mae 12 !9iS m the folio eing terms After gteine 
long and serious constoer ilion to the mailer the Dele 
gates (of the leeo Roeal Colleges) came to the conelu 
s cn that fhe p\'’n of i common cNaneination presents so 
mane di/hcultics as to be impracticable nor <to t/ie\ think 
ihiti It nou!tl hi m tin btst intcrens of nuihcol Kliicotn'ii 
III Lonilon [The italics are mine — E G L ] Thee there 
fore recommend the Roeal Colleges not to agree to it 
The recommendation eeas then and there adopted eeiihout 
modification and eeithout ane dissentient eoicc bj iht 
Fhesicians and a fen dies la'er be the Surgeons 
This decision ot the Roeal Colleges evas reported to a 
meeting of the Board of the Tactilie of Medicine on 
Jiile 7 191S, and the Board had ofaeiouslj no allernaliec 
bm to acquiesce in it 

Thus ends the third efiort m forte eea.s to establish a 
common standard of esaminaiion m the final meoical 
eeaminalions of the Conjoint Board and the Unieersiie 
The first sustained dnee m this direction eeas made during 
the sitting of the Gresham Commission m 1894 ft ee->s 
the eeidence gieen to that Commission be that eeteran 
and doughte fighter Sir William Colhns that was chiefle 
responsible for the rejection of the proposal be the Com- 
mission and graduates in medicine of London Umeersiij 
owe him special gratitude The second effort eeas niade 
m 1912 during the sitting of the Haldane Commission 
and eeas U was thought killed bj the masterlj statement 
- contained in the report published in 1913 demonstrating 
eere conclusieelj that the suggested co operation eeoiild 
not be m the true interests of medical education thus 
anticipating the eerdict now recorded be the Roeal 
Colleges themselees which eee mae hope wilt finally dis- 
courage an> further attempt of tins nature 


At Its meeting m Mae 193“ the Senate upon the motion 
of the Eeteinal Council took the step of appointing a 
‘ctond Committee ot us oeen bode to consider 

li 1 how t ir the problem ment oned m Ihc \ ice 
Chireellor< Memorandum of Januari II 19’“ can be <ohcd 
eeiihin ihc Statutte and 

Ih) the M ui'lital purport of tbe diffieulte 
nd thit this Commiiiee report lo the Senate through the 
Aeadcmic and Eelcmal Councifi 

Lpon the adeicc of the Vice Chancellor no meeting of 
this commiliet. his eet b^en called as it was considered 
ad'isibk to leeail the omcome of the conference beteeecn 
the Board ot the F iculte of Medicine and the Roeal 
Colleges Noee that this Conference has come lo the 
decision recorded aboec the wae is open to meesligatc 
the red position of the problem the seriousness of eehich 
es IS imdoubtedle ceaggerated in the memorandum of 
J iniiare 1 1 Professor Greenwood has eontributcd to the 
medical press certain statistics eshich eeould indicate that 
'0 lo 6t> per Cent eeould be an approeimation to the per 
cent ig- ol London Lnieersite students in medical schools 
who f'kc Inc fin’’! medical degree of the Lnieersite These 
figures though sul! unsatisfactore arc not nearle so 
csLmitoiis as the \ ice Ch inc^llor s Memorandum sug 
ges'ed ard modifications entirch within the power o£ ih^ 
Lnieersite to ni ikc such as more frequent e\ iminations 
new idjiistmcnts of the curriculum etc m le bring about 
the further improecmcnl anticipated and hoped for be the 
Court during the ncel quinquennium — 1 am etc 

Hone of Comnen 3iil\ 10 F Oftetleei LiTTLE 

The Medical Dirccton 1939 

Sir. — T o miiniain he accurace of our annud eolumc 
we rele upon tni return ot ou' schedule eehich has been 
posted to e eh member of the medie i! profession Should 
ihc sened ile haec been lost c mislaid we eeill gladu 
loneard duplicate upon request Tbe full nimes of th; 
doctc shcui’d be sent for idcntifica ion — We arc etc 
} ssD ^ C tie Rc HILL Lro 

i<4 Gtouit let rises Ppnmsn 
bqtL rc W I JuU n 


Obituary 


H-kRRf CAMPBEIL MD FRCP 

Cor uJimg Phssi ran Wcei End Hcapiial for Neraou 
Di ca o London 

Dr Harre Campbell who died on iule 8 eeas the ‘i\ih 
son of Hugh Campbell of Ewcland Hall M irgaretiing 
Essex ind was cducaled at Carshalton House and in 
Germ..ne at Neueeied am Rhein -nd then entered St 
Bartholomew s Hospital eehere he eeas prominent in eeork 
and plae captaining the Rugbe W of ISSI eefiich even 
the inter hospitals cop In the same eear he qualified 
MRCS and graduated MB BSLcnd in I9S2 
proceeding to the \f D in ISS^ He was elected socn 
aftereeards to the staff of the North West London Hospital 
as assistant phesician and pathologist and retired as full 
phesician m 1919 In IS96 he was elected a Felloes of 
the Roeal College of Fhes'cians of London and joined 
the eisiting staff ot the W'est End Hospital for Nereous 
Diseases to eehich he eeas phesician for mane sears and 
finalK consulting phesican 

J-ancct Julj J) 19 j7 



1^4 JUL\ 16, 1938 


OBITUARY 


Outside the practice of medicine Di Cimpbell had 
many intellectual interests He was a Fellow of the 
Anthropological Society and n former President of the 
Society for the Study of Inebriety He hid a clear and 
agreeable literary style, and his writings covered a wide 
range of subjects the physiology of eyesight , flushing and 
morbid blushing , differences in the nervous organization 
of men and women respirator) exercises in the treatment 
of disease man s mental evolution past and future , and 
the principles of dietetics He publishe'd in 1SS9 a philo- 
sophical essay on The Causation of Disease and in 1924 
r iiiuianicntal Principles in Treatment and a number of 
other books stand to his credit He also edited the fifth 
edition of Auh to Patholog\ ind was for fifteen years 
editor of the Mechcal Press and Circular Everything he 
wrote bore the stamp of a thoughtful, inquiring and 
critical mind 

Dr Harry Campbell joined the British Medical Asso- 
cntion forty-fjvc years ago He was vice president of the 
Section of Neurology and Psychiatry at the Annual 
Meeting at Newcastle upon Tyme in 1921, and mcc- 
presidcnt of the Section of Medical Sociology at the 
Annual Meeting in Dublin in 1933 From time to time 
throughout his career he contributed to the columns of 
the British Mtdital Journal, and a short letter pleading 
foi a precise definition of the term “ unconscious,” written 


TiirBurnsn 

Jotiwa 

Hall as a friend, a physician and a sportsman and m 
none was he lacking m enthusiasm and thorouchmss 
Perhaps his most striking characteristic was his abilitv 

Ills M'" '« '"tej 

friend of all the enemy of none Norwich has lost a 
grwt character ind humanitarian, whose place will h? 
diflicult to fill The sympathy of his colleagLs staff and 
patients goes to his widow who m the past was such a 
help and inspiration to her husband 

Dr Htnry Ottridge Reik who died on June 2 was otic 
of the three delegates to the centenary celebrations of the 
British Medicaf Association in 1932 from the American 
Medical Association Born in Baltimore Maryland m 
1S6S, he graduated from Maryland College of Pharmaci 
in 1888 and M D m 1891 from the Maryland UnntrMti 
School of Medicine He was in general medical praciiu 
from 1891 to 1894, and after postgraduate counes in 
Johns Hopkins University and in Glasgow and London 
including work at Moorfields Eye Hospital he returned 
lo Bahimore to specialize m diseases of the eye and car 
He held the post of professor of 'ophthalmologi and 
otology in the Johns Hopkins Medical School from IS96 
lo 1912, and was a founder of the Baltimore Eyt Ear 
and Throat Hospital He was general secretary of the 
International Otological Congress from 1909 to 1921 
During the war he served in the United Slates army iiilh 
the ranks of captain, mayor, and lieutenant colonel from 
1917 to 1919 and was promoted colonel in the USA 


only a few days before his death appeared m our last 
issue • 

Dr^C O Hiwlhornc writes 

To not a few of (he seniors among us the death of 
H irry Campbell means the close of a rare friendship and 
the revival of many memories He had a place of his 
own and it was a place in the affection is well as in 
the regard and admiration of his fellows His store of 
knowledge was vast and varied, the fruit of wide reading 
and careful observation , and the material supplied by 
the one as by the other was analysed and arranged by 
a highly critical and reflective mind His numerous 


Reserie Corps in 1923 An injury to his right hand 
prevented his return lo surgical practice, and lit was 
appointed secretary of the New York Academi of 
Medicine committee on postgraduate medical courses from 
J9I9 lo 1920 , in the latter year he was appointed editor m 
chief of international medical and surgical surieys and 
four years later he became executive secret iry of (he 
Medical Society of New Jersey and editor of its Joiiriml 
He was the author of Siirgiial Pnthohgs and Tnatimniol 
Diseases of the Cat and Diseases of the tar Nost mJ 
1 III oat and books on the conservation of the special 
senses and the national parks of America He was a 
member of the American Ophlhalmological Otological 
and Laryngological Societies 


writings carry the mark of these processes and provoke 
thought well as supply it Medicine was for Campbell 
a department of natural history, and he cultivated all the 
avenues, remembering always that in the care of the 
patient is the true opportunity of the physician Generally, 
though he delighted in teaching, he was more effective 
with the written than with the spoken word, for gentle- 
ness and persuasiveness rather than emphasis marked his 
method, and the unqualified proposition was hardly 
within his vocabulary With the pen he was a literary 
artist, insistent on precision both in definition and m 
argument and not a^few of his contributions have left 
do impress both on medical and on philosophic thought 
Best of all he was a gentle, unselfish, and sensitive soul, 
with no thought of envy and no ungenerous word And 
It is the memory ot these things that will abide with those 
who knew him long and loved him well 

We have received the following tubule to the late Dr 
Charlton Hall from Drs Constance D Roberts, W E 
Rutledge, and Ian D Dickson At this late period we 
feel It IS not out of place to record a note ot apprecia- 
tion of the privilege of having known Charlton Hall It 
IS doubtful if any member ot the medical profession in 
the district was more popular, not only among his 
colleagues, but in the hospital over which he presided 
As superintendent ot the City of Norwich Mental Hos- 
pital It was his constant wish to make the patients feel 
that they were members of one large family being cared 
foi as sick-minded rather than surrounded by asylum 
walls and in this he succeeded We have known Dr 


Dr James Antiiont McVea died on June 6 at ha 
residence in Netherton Ayrshire Alter early cdiicalion 
at Ayr Academy he went lo Glasgow University, anere 
he graduated M B Ch B in 1903 He was subst,qiicnlli 
for a time assistant to Dr James McGill of Colyfon 
and then practised for some years with his 
Janet McVea, in Lvdenburg South Africa In 1914 n? 
obtained a commission m the Navy and was surgeon la 
It until the end of the war, after which, in 19-0, » 
rejoined his sister, who was then in practice m A'r 
He became a member of the British Medical Associalio 
in the same year Dr McVea was very skilful in n 
building of model ships, and exhibited one vessel ol 
Armada period in the Empire Exhibition at Btlhnouslo . 
It IS now m the Palace of Engineering He "'“S 
member of the Ayr Amateur Photographic Sociciy, 
keen shot and angler, and had a wide circle of protessi 
and lay ft tends He is surviv'cd by his mother anu si *■ 


Di Alired Ernest Wilson Hird a 
af Birmingham City Council, died recently at hi 
n Hagley Road and a memoir . 

Biimini’liam Post of June 28 The son ot i 
aiactitioner, Dr Hird was born at Edinburgh in ' 
He was educated at Cambridge and Birniin^am ^ 
aties, and after qualifying MRCS, LRCP i 
aecame house-surgeon at the Birmingham Gc 
>ital under Sir Gilbert Barling Fro™, 
vas house-surgeon to the gynaccologiea depar 
vas awarded the senior gynaecologic li Pn^n ^ 
iL was appointed a junior medicaf officer 
lam Education Committee and was ''siimg^ 
lasualty officer to the General Hospital from iJ 



Juu 16 i93S 


OBITU \R\ 


THcB^msw 1^5 
MtD C O. lot RNAL 


H<- \ps mobilized on Aiiguil 2 1914 and ■iei%ed m na\al 
ho<;pinl “ihips and null hospmls until Fcbrinn 1919 
He Mas mentioned lor aatuible senices rendered during 
these \ears and received the RN VR Oflicers Decora- 
tion Dr Hird was promoted surgeon commander 
RNVR in 1925 and surgeon captain m 1933 the \ear 
m which he retired Immediateh after the war he was 
appointed one of the assistant visiting anaesthetists to 
Queen s Hospital, Birmingham 

Dr GtoRCiC A.MHONa Zullui superintendent of the 
State Asvlum at Peoria Illinois (189h-19351 and one of 
■Xmcrica s leading alienists died of heart disease on 
June 29 at the age of 79 

Known as the Fither of French Dermatologj Dr 
Jc-SN Dvrier ot the Saint Louis Hospital m Pans has 
just died at a ripe old age and after retirement from 
medical practice Though his birthplace vvas Geneva 
h- spent most of his life in 1 ranee where he acquired 
manv honours including membership of the French 
Academj of Medicine His best-known work was his 
Pacts dc Dermatoloqte Behind a rather cold exterior 
he hid a warm heart and a great capacitv for enthusiasm 
and kindlv feeling particularlv for his juniors As a 
histologist and dermatologist he made important contri- 
butions to the pathologv of svphilis cancer and tuber 
culosis and his name is parlicularlj associated with the 
condition of keratosis follicularts Dr Daricr, who was 
82 also had the distinction of being an Honorarv Fellow 
of the Roval Society of Medicine 

The death is announced of Dr Gvbriee Pouchet 
professor of pharmacologv and materia mcdica since 1892 
at the Pans Facultj of Medicine Vice president of 
the Consul Stipirieiir d Hss'cnt. (fe France and member 
since 189S of the Academj of Medicine he made 
important contributions to tovicologj and forensic 
medicine and shortly before his death at the age of 87 
he was still phjsicallj and mentallj alert 

Dr Sigurd Hvgen professor of ophthalmolog> at the 
Universitj of Oslo, died on Nfav 12 of a hypernephroma 
discovered bj accident last September when he under- 
went a radiological evamination for pain in one shoulder 
Among his most important works was a study of the post- 
operative serous detachment of the choroid and an 
experimental investigation of the secretion and rcgencra 
tion of the aqueous humour 

The following well known foreign medical men have 
reccntlj died Dr John Jacob Abel emeritus professor 
of pharmacology at Johns Hopkins Umvcrsitj School of 
Medicine Baltimore founder and editor from 1909 to 
1932 of the Journal of Pharmacolog\ and Experimental 
Therapemics and president of the American Association for 
the Advancement of Science m 1932 on Mav 26 agvd 81 
Dr Allen Blcknfr Kvnvvcl professor of surgerj at the 
Isorlh Western Universitv Medical School Chicago, 
editor of Surgerx Gxnecoiogy and Obstetrics and author 
of a well known book on infections of ihe band aged 65 
Professor Wilhelm Knoebeelmachfr an eminent 
paediatrist of Vienna, aged 72 , and Dr Luis T vvhm pro 
fessor of orthopaedic surgery ai the Buenos Aires Faciili} 
of Medicine, aged 56 


On the site where she worked for eighteen vears (1907- 
25) at Salisbury Street Lisson Grove a memorial has been 
established to Dr Christine Murrell It consists of a 
Medical Unit attached to the new Portman Day Nurserv 
of the St Marjlebone Health Socielv opened this week 
bv Viscount Stonehaven The memonal is a tnbute to 
Dr Murrells pioneer medical work in connexion with 
infant welfare 


Medical Notes in Parliament 


Progress of Bills 

The Mental Dcficicncv Bill passed through Ihe committee 
tage in die House of Lords on Julv 7 wiihout discussion ot 
amendment 

In the House of Lords on Julv 12 the Green Belt tLondor 
and Home Cotmies) Bill wa read a second time The Rego 
Iration of Stillbirths iSco landl Bill passed through Committee 
The Protection of Animals iNo 2) Bill was abo read a 
second time in die House of Commons on Julv 5 The 
following das the House agreed to ihe amendments made hv 
the House of Lords in Ihe Children and 5 oung Persons Bill 
The Rating and Valuation I \ir R iid Works) Bill which was 
introduced bv Dr Elliot on Julv 7 cvempis from rating 
struelurcs and siructural allcralions made by was of precaution 
against ait raid damage The Bill is a complement to the 
prosision in ihe Finance Bill wherebs such works arc being 
cvcmpicd from habilils lo income lav Mr Colsille presented 
a Seoiiish Bill for the same purpose as Dr Elliots 
The Commons agreed on Juls 7 to the Lords amendment 
m the Baking Indusirs iHours of Work) Bill 

In the House of Commons on Juls 12 Ihe committee <tace 
of the Finansc Bill ssas concluded The Milk (Evtcnsion and 
Amendment) Bill and the Food and Drugs Bill passed through 
committee 

The Disorcc and Nulliis of Marriage iScoiIand) Bill ssas 
liken on Report bs the House of Commons on Juls 12 
Debate arose on an amendment bs Miss Horsbrugh lo delete 
lunacy for five vears from the grounds of divorce The 
amendment was defeated bv I<S to 31 \ subsequent proposal 

vvas to delete Nullity of Marriage from the title of the Bill 

Ordiazol in Treaftncnl of Schizophrenia 

On Julv 5 Mr Sorensen asked ihc Minister of Health 
whether his aticntion had been drawn to the cure of schizo 
phrema bv cardiazol injections and whether this cure was 
beinc applied in all public menial hospitals Mr Bcpnavs 
< aid this treatment had already been investigated bv two 
medical commissioners of Ihc Board of Control and their 
report svas in prcparalion The treaimenl which was <li 
m Ihc developmental stage was beinc applied in a consider 
able number of public mental hospitals but information was 
not available on ihc number o*^ cases cured thereby 

Interdepartmental Committee on Aborlioa 

Dr Elliot lold Sir ^rno!d Wi!<on on Julv 7 that Ihc inter 
departmental committee on abortion under Ihc chairmanship 
of Mr Norman Birkeit K C reccnilv complcied the hearing 
of esidcnce Thev were encaged in considenng the evidence 
and hoped lo he m a position lo present a report before the 
^ end of Ihc year It would be premature to decide al present 
that the evidence should he published vsuh the report 

Refugee Doctors and Dentists 

Sir SvMLEL Hovre rephing on Julv 7 to Sir Philip Dawson 
said that as regards doctors dentists and ocuhsis admitted 
into the United kingdom from Germany and Austria no 
separate figures vserc available for the vear 1937 Since 19^3 
the number of refugee doctors (including oculists) and dentists 
coming from Germany who had been given permission to 
practise their profession after admission to the British Medical 
and Dental Registers vsas 185 and nmetv three respectively 

Expert Advice in Forensic Medicine 

Sir SvviLEL Hovre m an answer to Mr Dobbie on Juh 7 
said the services of iwo analvsts appointed bv and receiving 
retaining fees from the Home Office were available to the 
police and coroners if ihcv had occasion to consult them In 


15f> JUL\ 16, 193S 


MEDICAL NOTES IN PARLIAMENT 


such esses ihcs sscrc rcmiincnled sn ^ccord's^lcc sssth i scilc 
of fees approved bv the Trcasiirj In addition forensic 
science hbor-vloncs had been esUbhshed sn London and 
certain other centses wnh whole time scientific staff 
remunerated b> salary In other ciscs the police could seek 
ijic 'jssj'ii'incc of oilier cvper(s, who would be rcmimcritcd 
oi fee In c\cr\ ease Ihc function of the expert wis to gi\c 
an opinion ns a scientist on the material submitted to him 
and he did so on his own rcsponsibihlj The rcsponsibihtj 
for the prosecution rested with the Director of Public 
Prosecutions or with the police 

Holidajs Hitli Paj 

The HoIida)s with Pa> Bill introduced b\ Mr Ernest 
Brown was down for second reading on Jtih 14 This Bill 
empowers Trade Boirds Agncviluiral Wages Committees both 
in England and Wales and Scotland ind the Road Haiiiigc 
Central Wages Boaid (to be set up under the Bill at present 
before Parliament! to direct tint an> workers whose wages 
Ihes regulate shall be granted holidays The duration of 
holidays is to be related to the period of emplo>ment yyith an 
cmplovcr In the ease of Trade Boards and Agricultural 
Wages Committees holidays so granted cannot exceed a 
maximum of seven dass in the year, and in the case of 
Agricultural Wages Committees there is a restriction that onlj 
three of these da>s can he required to be taken consecutively 
Otherwise the times periods and circiimsl inccs in yyhich holi 
days shall be alloyvcd arc (eft for settlement faj the vyage 
regulating authority 

raniih Allonanccs in the House of Lords 

The Bishop or Winchcstlr moved in the House of Lords 
- on July 7 that a committee be appointed to report on pro 
posals for a national policv of family allowances He said 
that a number of children were deprived of many necessities 
of life To the employed labourer with a familv there should 
be extended the policy already in operation for the un- 
employed man who y\as gnen an additional allowance for 
cyery child that he bad 

Lord Astor said the last report of the Chief Medical 
Officer of the Board of Education on the health of the school 
child emphasized the fact that there was a problem of mal 
nutrition Lord Templemore said that m the mcw of the 
Government there were at least fiye lines of approach to this 
subject These yvere a general increase of vv igcs, the grant 
of family alloyvances bv emplovers to those workpeople who 
had large families, the formation of' pooled funds for the 
same purpose m the different industries, the creation of a 
National Family Allowances Fund out of the contributions of 
'employers workpeople, and the Exchequer, and finallv the 
direct provision of family allowances out of the Exchequer 
Opinion was not yet fully formed and the Government did 
not think the stage had been reached when it would be useful 
to set up a formal body to examine the subject 

The Bishop of Winchester withdrew his motion 

Research into Poultry Diseases 

In the House of Commons on July 1 1 Mr W S Morrison 
explained the Governments policy with regard to eggs ind 
poultry He said the Government accepted the view of the 
Poultry Technical Committee that one of the vital factors 
affecting the prosperity of the industry m Great Britain was 
the high incidence of mortality in poultry flocks The Govern 
Xyent were impressed bv the Committees views on the 
^jeent nature of the disease problem in the industry Thev 
■refore proposed that a Poultry Commission for Great 
yfftain should be set up with the responsibility of conducting 

stock-improvement scheme on voluntary lines and with 
power to contiol the distribution of breeding stock The 
Government vvas also prepared to facilitate the establishment 
, of a research station for lire investigation of the major disease 
pioblems of the industry and to give sv mpathetic consideration 
to a scheme which the Commission would be asked to prepare 
for the establishment of a progeny-testing station with a view 


Thc Bumsu 
MtDJCXL loUXSkL 


to the production of the highest quality foundation stock TIa 
proposal for a poultry research station was alreX Je 
consider ition by the Agricultural Research Conned Leash 

!mroduced"“ 


Living Conditions m Mercantile Marine Service 

The vote for Mercantile Marine services was debated by tin. 
House of Commons on July 8 Mr Greenwood moved lo 
reduce it He sud that despite improvements made diirmc 
the last few years conditions for life and service m the mcr 
canlilc marine were unsatisfactory, particularly in Hit coastal 
SCI vice 

Mr OvyiN Evans kaid it was a common practice of British 
shipowners to instruct that their ships were not to be heated 
when in port In some ships there was no hot water and no 
running water for anybody Sailors quarters and bed linen 
should be kept clean bv someone whose job on board ship 
that was and not by the sailors themselves Commanoer 
rELTcUER said that thc medical ofiiccr of the port of Hall 
reported that in the majority of the ships cntcnni, Hull the 
crew accommodation was in the opinion of a sanitarun 
quite unsmted for human habitation Lady Astor stated 
that this medical officers survey had extended over 1 801 ships 
half of them British The new regulations did not affect thv 
old ships in many of which thc conditions of the crews 
quarters was far worse than any conditions in thc slums of 
London Good shipowners said that when conditions were 
improved thc crews responded m a remarkable wav Com 
mander Mausdln said the medical ofTicer of the port of Man 
Chester reported striking advances during 1937 m the Ingicne 
and amenities of crew spaces 

Mr Oliver Stvnllv said no attempt had been made dtirine 
the debate to criticize the instructions issued with regard lo 
new ships His inspectors were instructed last autumn lo male 
every effort when they noticed thc need and possibility of 
alteration in an old ship to get it made by co operation with 
the shipowner As a result substantial improyemcnts had 
been made in a numhei of ships He rccenctl moniWv 
reports on this work 

The motion to reduce the Vote w is defeated 


Drug Traffic in China 

On July 11 Mr Buteer told Mr McEntee tint he cmiid 
not say whether there had been an increase in the sale of 
dangerous drugs in the International Settlement at Shancini 
Of the opiuna seized during 1917 consignments came from 
both North and South Chmt, while thc heroin was Ihoiighl 
to have come mainly from the North Replying to Mr 
Banfield Mr Beitler said that during 1937, 25> persons "vre 
arrested bv thc police force of the International Sculemeni it 
Shanghai for being concerned m the sale of opium w 
narcotic drugs Of these !44 were Chinese 97 Koreans 
Japanese and 1 Latvian On the same day Sir Ernlvt 
Graham-Little asked whether the British Gosemment woi’ 
obtain an official report from British representatives in Man 
chukuo as to the extent to which traffic m narcotics via 
being stimulated and whether there was any record at v 
Chinese and Manchukuo ports of-the quantity and 
dangerous drugs imported as well as any indication of 
source of origin 

Mr Butler said he would consider the suggestion of a 
report The quantity and value of opium imporicd in 
Manchukuo as well as thc countries of origin were P"*' ''' 
in the annual Customs reports No similar figurcv ' 
available in thc case of Chinn 


SiUcosis in Lancashire and Cheshire 

r Samuel Hoare replying to Mr Gordon 
n said the Silicosis Medical Board granted f 
es in 1937 to workmen last employed in eoM n , 
lashire and Cheshire 4 in 1936 3 in 193 > 

1933 The inclusion of mines elsewhere thin 



Juu 16 I9\S MEDICAL NOTES 


V.ilc<i wn*; not i.omcniphlcd t; pnrt of the in\c<tip3tion into 
lone condition's intone coil miner', at present hemg cirncd 
out bt the Committee of the Medical Rcecircli Council their 
rrethod in thii initincc beinc to mihe an inlcnsoc <uud\ in i 
"selected locihtt nthcr thin a general siinec The Mine of 
the findings honexcr nould not he restricted to the simple 
irci from which the ctidence wis drawn 

Mr MsKsHW-L iched whether m \icw of the great difliai!t\ 
in establichinc claims under the Silicosis Regiilitions csrecialh 
in the grinding trades the Home Secretin would gi'c an 
undertilcing to bnng in carli legislation to remeds these grave 
difticulties. Sir SwarL Hovrc said that question did not 
arise 

Mr GRE-vren. asked the Home Sccretarv to consider making 
a submission to the Medical Board for a revision of the 
diagnosis because there was failure to obtain an award in a 
large number of cases of persons who died from this disease 
Sir Samuel Hoarc said that that also was a more general 
question than that on the order paper but he would take into 
account what Mr Grenfell had said 

Matermtv and Child Mclfarc Climes 

On Julv II Mr ^cuvsn asked how mans local authoniics 
established clinics according to the permission given to them 
under Circular 1621 and whether anv steps were taken or 
contemplated to increase the number Dr Elliot said that 
of (he 365 welfare authonlies in England to which this 
orcular wns addressed, 347 had ante nalil clinics and twelve 
others had arrangements for antenatal supervision bv means 
of a domieiliarv general practitioner service \uthonties 
having post natal clinics or speaal arrangements for post 
natal cases to attend at ante natal clinics numbered 236 
133 authonties had special ante natal consultilive clinics and 
139 had special gv naecological clinics His Dvpartment had 
followed up the circular bv correspondence with the local 
authonlies of areas in which according to his information 
the existing provision needed to be supplemented 

Adiiimisireiion of Analgesics h\ \fidiiiier — Dr Elliot 
told Dr Summerskill on June 23 that in the information vvhich 
he would ask from local authonties for this vears Annual 
Return would be the number of local authorities who had 
arranged for the midwives in their cmplov to have special 
instruction in order that thev might unaided give their patients 
analgesia He would also a<k how manv local authorities 
availed themselves of the powers conferred upon them to 
provide the necessarv apparatus for their midwives m order 
that analgesia mav be available for women at their confine 
menis 

Frematiire Death Registration — Colonel Blrtov asked vvhal 
were the circumstances under which a certain Mrs Manha 
Brabben obtained a certificate of the death of Mr James 
Alfred Douthitt of Hamilton Street Camden Town registered 
his death and caused arrangements to be made for his funeral 
when m fact he was still alive Dr Elliot replied on Jul> 1 
that Mrs Brabben Mr Doutbitt s landladv seeing Mr DouthiU 
King motionless came to the mistaken conclusion that he was 
dead In this belief she informed Mr Douthitt s mcdicil 
attendant, who being acquainted with Mr Douthitt s medical 
condition issued a certificate of cause of death Mrs Brabben 
then look steps for the registration of the death and since 
she was a fullj qualified informant m her capacit} as the 
occupier of the house in which to her knowl^ge Ihe death 
took-place the registrar dul> registered the death upon her 
information Mr Doulhill proved to be ahve on Mrs 
Brabben s return home 

If omen Medical Inspectors for Insured Persons — Mr 
Gr.vh.vm White asked on Julj 7 how manv women medical 
officers were available in the north western divisional area 
when women members of approved socielies were obliged to 
submit themselves under the rules of their societies Dr 
Elliot said there was one woman medical officer available 
in the north vvesiern divisional area for the examination of 
cases 


IN P<\RL1 \MENT 


Mr White isscried that on one recent occasion it w^s 
impossible to secure the attendance of a woman medical 
ofliccr while Mrs Tvtt and Ladv Astop sucgesicd that the 
difficult) arose bcciiisc medical women had to give up their 
posts on marrngc Dr Eiliot said that in fact there were 
onls MX demands from the north west arci to sec a woman 
medical inspector 

Natrttiottal State of School Children — School medical 
oflicers annual reports for all ireas in England and Wales 
include sntistics of the isscssment of the nutrition of children 
examined it routine medicil inspcciion during the sear 1'>'7 
In 260 out of the 315 areas some children arc shown to be 
suffcrinc from bid nutrition but in minv cases the number is 
xerx small often onls one or two out of several thousand 
children cximincd and the total number of such children 
represents 0 6 per cent of the number examined In addition 
107 per cent arc shown to have shghtlv subnormal nuintion 
These figures sserc gisen bv Mr Kenneth Lindsav on JuK 7 

Supph of Gas Respirators — Mr Llovt) repiving to Mr 
Perkins on Julv 12 said he was aware that gas respirators 
Were being offered for sale but no such respirator had 
been approved bv the Home Office unless it bore the Home 
Office ccrlificition mirk It was the Governments pohev to 
suppiv respirators for the whole of the civilian popuhtion free 
of chirge 

\otes III Brief 

The Minister of Health anticipates that it will be possible 
to publish his report which relates to Ihe financial vear ended 
March 31 193$ m about four weeks Asked to arrange for 
earlier publication Dr Elliot points out that the report ts 
based to a hrge extent on statistical information which his 
to be obtained from locil authorities and an3l}5Cd m the 
Department 

Mr Wedderburn staled on June 20 that m Scotland there 
"ere two deaths from the effects of vaccination m 1927 one 
in 1928 one in 1930 and one in 1931 Two deaths from 
small pox occurred in 1930 No deaths from either cause 
occurred m Scoilind between 1931 and 1936 the htesi vear 
for which figures were asiilable 
A member of the staff of the Medical Research Council is 
givinc his whole time to the invcstigition of infinti’e 
raralvsis and cognate diseases 

Colonel CoKillr hopes to male a statement before Ihe end 
of the session on the Governments intentions with regard to 
the recommendations of the Oilmour Committee on the 
rcorganiiation of Scottish offices 
The number of patients who on Apnl I 19 g were 
receiving treatment m residential institutions under Ihe schemes 
of local authorities in Enghnd and W'alos for the instiiulional 
treatment of tubcrnilosis was 27 968 The number of persons 
who had been awaiting such treatment for more than ten davs 
was 1 798 

The full cost of the Joint Council of Midvvifcrv nutrition 
scheme for expectant mothers from Januarx 1937 to March 
31 1938 has been met from the amount of £8 Xfio grimed 
b\ the Commissioner for the Special Areas Before Jamnrv 
1937, the cost was defraved out of soluntarv contributions 
Of 257 cases of tuberculosis notified in single apartment 
houses in Glasgow during 1937 190 were m overcrowded 

houses 

The average per capita consumption of liquid milk in Great 
Bnlam dunng the vear ended Mav 31 1936 the latest period 
In respect of which adequate information is available is csti 
mated to have been two-fifths of a pint dailv 

Mr W S Morrisos slates that dunng the penod of three 
months following the date on which Part I\ of the Agriculture 
Act 1937 came into operation— -namelv, Apnl 1 1938 — pav 
meniE totalling £4 085 were made out of the Diseases of Animals 
Account to cattle owners m respect of assistance under the 
tuberculosis (attested herds) schemes towards Ihe cost of tuber 
culm tests with a view to eradiciting tuberculosis from Ihe 
herds concerned 


158 Juu 16, 1938 


EPIDEMIOLOGY SECTION 


TuEBsmsH 

'ItDlCAl JOIRMI 


INFECTIOUS DISEASES AND VITAL STATISTICS 


Wc print below a sumnnry of Infectious Diseases and Vital Statistics in the British Isles during the sseek ended July 2 IMS 

Figures Notifiibic Disciscs for the week 'ind those for the corrcspondinn week hst \eir for mi Enoianri a w i 

9 Karfforto and (administrative county) (c) Scotland (d) Eire (e) Northern Irehnd Meiin v flues 

.r, ‘’"Z "/ Dint/is iccordiil iimkr each iii/lcIioiis dneme are for (a) The 126 creat towns fiaa m lori 

in England and W-des (including London) (b) London (administrative county) (c) The 16 principal towns m Scotlai^ "VdiTh n 

principal louns in Eire (e) The 10 principal (owns (9 in 1937) in Northern Irc/and ‘owns m Scotland (d) The 13 

A dash — denotes no cases a bl ink space denotes disease not notifiable or no return available ' 


Disease 


Cerebrospinal fever 
Deaths 


Diphtheria 

Deaths 


Dy'senteiy 

Deaths 


Encephalitis lethargica, acute 
Deaths 


Enteric (typhoid and paratyphoid) fever 
Deaths 


Erysipelas 

Deaths 


Infective enteritis or diarrhoea under 2 years 
Deaths 


Measles 

Deaths 


Ophth ilmia neonatorum 
Deaths 


Pneumonia, infiucnrall 
Deaths (from influenza) 


Pneumonia, primary 
Deaths 


Polio encephalitis, acute 
Deaths 


Poliomyelitis, acute 
Deaths 


Puerperal fever 
Deaths 


Puerperal pyrevia 
Deaths 


Relapsing fever 
Deaths 


Scarlet fever 
Deaths 

I 


Small-pox 

Deaths 


Typhus fever 
Deaths 


Whooping cough 

Deaths _______________ 

Deaths (0-1 year) 

. Infant mortality rate (per 1,000 live births) 

eaths (excluding stillbirths) 

nnual death rate (per 1,000 persons living) 

ive births 

Annual rate per I 000 persons living 
Stillbirths 

Rate per 1,000 total births (including stillborn) 


(b) (c) 


____ t!»37(Co >,»pond,„s'V„K) 

(d) I (e) (a) 1 (b) 1 (c) 1 (d) 1 (e) ‘ 



3,926 739 521 

9 6 9 4 10 6 

6,884 1 313 979 
169 167 199 


* After Oclobcr I 1937 puerperal fever pas made notifiable only m the 
administrative county of London 
t Deaths from puerperal sepsis 


30 14 288 43 7l 19 14 

49 36 

167 150 3,986 732 561 144 121 

11 3 13 3 99 92 115 98 116 

338 5,665 l”324 893 333 205* 

22 9 23 0 16 5 16 7 18 3 22 7 19 6 


t Includes primary form m ficures for Tnehud and Wales, London ( 
county) and Northern Ireland 











































































































Jm 16 ir>s 


EPIDCNUOLOGY SECTION 


The Barron KQ 
Medicax JoviusiL 


EPIDE:\rrOLOGICAL NOTES* 

Cnicric Feicr 

Dunne lh<. week under rcMCw 26 ca<es of enteric fetcr were 
notified in EnUand and Walcc compared with 20 in the 
prcMOUs week of Ihcec ^ (0) were in I ondon — 2 each in 
Baitereca and St Maialebonc and 1 in St Pancrae Jn 
Scotland 3 caeca of taphoid fever were recorded — I each in 
Glaegow Greenock and Paielcv 

Diphtherii and Scarlet Fever 

■Nolificatione of diphtheria in Enpland and Wilee fell from 
°S9 to 9-<3 in the week under review and in London from 
146 to 140 There was al <0 a m'vrked drop in the notifica 
tions for Scotland — 176 aa againei 191 — and for Northern 
Ireland a ahght dccrea«c — 21 as against 22 but in Eire there 
was a rise from 41 to 44 Deaths from diphtheria in the 126 
Great Towns of England and Wales remained at 22 while in 
London thev fell from 4 to 2 Of the 22 deaths recorded in 
the 126 Great Towns 2 each occurred in Chester (0) Liverpool 
(2) Manchester (I) Newport (01 There were ' deaths from 
diphtheria in the 16 pnncipal towns of Scotland during the 
week under review — 3 (4) in Glasgow and I each in Dundee 
101 and Aberdeen (0) There was a decrease in the number 
of notifications of scarlet fever in England and Wales during 
the week — 1 641 as against I 766 — and in London where |62 
cases were recorded compared with 171 in the previous week 
In England and Wales the figures were shghtlv in excess of 
the median value for the last nine vears but m London thev 
were considcrahlv less There were two deaths from scarlet 
fever in the 126 Great Towns of Encland and Wales diinnc 
the week under review compared wuh 3 in the previous 
week of these 1 (II occurred in I ondon Notifications m 
Scotland rose from 356 to 361 with I death and in Eire from 
79 to SS but in Northern Ireland thev remained at 78 

Pnman and Influenzal Pneumonia 

Notifications of pnman and influenzal pneumonia m 
England and Wales fell from 76S to 622 during the week 
under review and in London from 76 to 46 the figure for 
England and Wales is well above the median value for the 
last nine sears while that for London is below it There 
were 17 deaths from influenza in the 126 Great Towns of 
England and Wales compared with 20 in Ihc previous week 
in London the number of deaths from influenza rose from 
2 to 3 In the 3\est Riding (Aorks) 82 (1031 cases were 
notified of which 20 (a3) were in Sheffield 2-* <25) in ihc 
Administrative Countv 14 (20) m Leeds In Warwickshire 
36 (49) cases were notified of which 26 (24) were in Birmmg 
ham and 6 (10) m the Administrative Countv Of the US 
(146) cases reported in Lancashire 40 (37) occurred in Liver 
pool 18 (37) in Alanchester 21 (25) m the Administrative 
Countv Of the 17 deaths from influenza recorded in the 126 
Great Towns of England and Wales dunng the week 4 ( 2 ) 
were in London and 2 each in Portsmouth (0) and Cardiff (0) 
_Jn Scotland 178 cases of primarj pneumonia were notified 
compared with 192 in the previous week while there were 
12 cases of influenzal pneumonia — compared with 5 in the 
previous week — with no deaths In Eire there were 9 (II) 
cases of pnmarv pneumonia and 6 (7) deaths 4 (6) of which 
were in'Dubfin There were 13 (14) deaths from pneumonia 
m the ten principal towns of Northern Ireland during the 
p week 9 (11) in Belfast 3 (0) in Londonderrv and 1 (I) in 
Larne 

Measles and Whooping-cough 

In the 126 Great Towns there vvere 8 deaths from measles 
during the week under review compared with 10 m the 
previous week of these 3 (I) occurred m London 2 (0) in 
Newcastle upon Tvne and 1 each m Barnslej (1) Sunderland 
(0) Stoke on Trent (0) Dunng the week 348 cases vve re 

* ^etpt where otherwise mentioned ficures in paicnlhi es refer 
Vo vhc week pTCctding the one under review 


reported from the LCC cicmcntarv schools compared with 
422 in the previous week The average dailv admissions to 
the LCC fever hospitals vvere IS Ihc same as last week 
and the number of cases of measles under treatment m these 
hospitals on Fridav Julv 1 was 724 compared with S60 on 
June 24 On Ihc sam" dav there were under treatment in the 
T CC fever hospitals 9 IS (940) caves of diphlhena 682 (761) 
cases of scarlet fever 262 (264) cases of whooping-cough 
Notifications for Ihc week ended Julv 2 in the eleven metro 
polilan boroiichs in which measles is notifiable were 164 ( 241) 
distribulcd as follows Battersea IS ('41 Bermondsev 6 (11) 
Finsburv 8 (16) Fulham fO (27) Greenwich 64 (47) Hamp 
stead 6(11) Lambeth 17 (46) St Pancras |6 ( 33 ) Shoreditch 
6(6) Southwark 10(13) Sicpnev 5 (8) In Scotland II3 cases 
of measles vvere notified compared with 174 m the previous 
week Ihc figures for Kirkcaldv were 35 (19) for Glasgow 
( 7) and Falkirk (28) 17 each for Dundee 13 (22) for l-anark 
Counts 9 (21) and for Edmburch 7 (8) During the week 
there were 3 deaths from measles in the 16 principal towns of 
Scotland — 1 each in Glasgow Edinburgh and Dundee In 
Eire there was I death from mca Ics occurring in Dublin 
and none in Northern Ireland Of the 6 cases of measles 
reported in Northern Ireland 6 were in %\arrenpomt and 1 m 
Livnaskea 

In Encland and \SaIcs there were 13 (18) deaths from 
whooping cough dutini the week of which 3 <21 occurred in 
London In Scotland 97 cases of vv hooping cough were noti 
fied comparer! wiih 123 in the previous week while there were 
3 deaths — 2 (0) in Kilmarnock and I (11 in Glasgow In 
Northern Ireland 13 (22) cases of whooping-cough were 
recorded with 1 death 

Cholera 

During Ihc week ended Julv 2 301 cases of cholera were 
reported at Shanghai and 25 ca cs with 14 deaths m Hong 
Kong In the same week in Burma 8 cases with 6 deaths 
were notified in (2alcutla 41 cases with 18 deaths m Bombav 
(Pfcsidcncv) 63 cases unh 27 deaths m Delhi 3 cases with I 
death In the Central Provinces I 034 cases with SOS deaths 
were reported dunng the week under review m the North 
Mevt Frontier Province 149 cases with 73 deaths in Madras 
(presidenev) 287 cases with III deaths m the Punjab 112 cases 
with 64 deaths in Smd 16 cases wuh II deaths and m the 
United Proiinces 7 cases wath 2 deaths in Allahabad and 3 
ca cs vsith 2 deaths in Cawnporc In 1 rench Indo-China 
during the same week 117 cases of cholera were notified m 
Annam 177 in Tonkmg and 3 in Hanoi 

Plague 

During Ihc week ended Julv 2 17 cases of plague with 10 
deaths were reported tn Burma In Briii'h India in the 'amc 
week 6 cases with 4 deaths were notified in Bombav (Piesi- 
denev) and 2 cases with I death in Madras (Presidcnc>) 

Small pox 

During ihe week ended Jul> 2 there vvas I case each ol 
small pox reported in Shanghai and Hong Kong In Ihc same 
week in Burma 8 cases vvere notified m British India 22 cases 
with 9 dealhs vvere reported in Calcutta 172 ca«es with 29 
deaths in Bombav (Presidenev) 37 cases with 9 deaths in Ihe 
Central Provinces 36 cases with 12 deaths m Madras (Presi 
denev) 28 cases veith 10 deaths in the North West Frontier 
Province 62 cases with 9 deaths in Smd In the same week 
in French Indo China ihcre were 23 cases of small pox in 
Tonkmg During the week ended June 25 225 cases were 
reported m the USA 

Tvphus 

During the week ended Julv 2 in Egvpt I case of Ijphus was 
reported in Alexandna 2 cases m Cairo and 65 cases in the 
Provinces In the previous week 71 cases with 6 deaths were 
notified in hforocco mamlv distributed as follows Chaoun 
n cases 3 deaths Marrakesh 13 eases, Dukkala 8 cases 
Casablanca 7 cases I death 5 each in Fez (1 death) Rabat 
and Oued Zem Jn the same week m Tunisia 76 cases of 


160 JuL-i 16 1938 


UNIVERSITIES AND COLLEGES 


TiiEBxrrrm 
Medical Soitsxi 


t\pluis were recoiclccl nininly dislribulcd is follows Suk-cl 
Alba 14 cases Southern 'Icrntoncs and Susa J2 each, and 
4 each at Lc kef, Mcd)C7-cI Bab and Tebursuk During the 
week ended June IS in Algeria 70 cases were notified distri- 
buted b> departments as follows Constantine 54 Southern 
Tenitones 10, Algiers 6 In Poland during the same week 
44 cases with 2 deaths sscre reported, mainly distributed by 
departments as follows 7 cases each in Lwow and 
Nowogrodek \Volh>nia 6 cases, Wiino 5 cases, and 3 each 
in Cracow and Polesia In the USA during the week ended 
June II there were 34 cases of typhus Georgia 16 Alabama 
7, Florida 5, Texas 3 and I each in Connecticut, Louisiana, 
and Marjland 


Universities and Colleges 


UNIVERSITY OF BRISTOL 

The Beaserbrook Ecllowship has been awarded to Beryl D 
Corner, M D 


UNIVERSITY OF LIVERPOOL 

On July 5 the Council of the Uniscrsity reappointed Pro 
fessor \V H Wood M D Dean of the Faculty of Medicine 

UNIVERSITY OF MANCHESTER 

The following candidates ha%c satisfied the examiners at the 
examinations indicated 

MD — 'Mary A C Cowell T F Dascy, A Hirris, R L 
Holt (gold medal), N F kirkman B Portnoy, E N Rowlands, 
' B Sindlcr G G E Smyth 

Finm-MB.ChB — N Altlnm, J N Appleton, T E Barlow, 
J E Coates A E Dasid, TBS Dick A M Dickson E I 
Firth, ‘ G Garmany, Edith A Grccnhalgli Kathleen M Henderson, 
* A G Htpplcston, ■’ Barbara M Jcsscl F A Langley, N Levy, 
L Linnell D Longbottom, Constance M F Lyth, J C Mcllor, 
’ A Morgan Jones, S Mottershcad T H Norton J F Rickards, 
J k Rowson, * E Saunsbury, W \V Wilson Frances T Wnght 
Purl I (forensic Medicine and Ifigicnc and Prcicninc Medicine) ' 
A P Bates, D Bolchoier, Irene M Bower J B Brownlie, Frances 
M Bullougli R Cocker, G R Crawshaw Olive I Elkin, Barbara 
H Eiddian, Mary Flcurt, R T Grime Joan H dsttad, P Hnslam, 
J E Horrocks, Hannah Horton W L R kenyon, J Latham, 
Joyce Leach, A D Leigh, R A Martin, A P Massie, Asa Mills, 
M D Milne, M J Paisonagc J R Platt T H Rcdfcrn J C A 
Renshaw, E Ridchalgh G G Robertson B Roditi, E S Rogers, 
M S Rowley, L D Rutter, J E Schofield F W Taylor G K 
Tulton, G H Whittle A F Williams R M Winston, E J Yates 
(Palholog) nnd Bacicrioloi;)) Peggy Anderson, G T Ashley J G 
Atherton T G Barlow, E F Burndred J H Giflord E Lee, 
D Livshin A S Ogden Barbara M Statham, W P Sweetnam 
(Phai inacologi) Hilaiy J Crewe ACC Dasey, J D Johnson, 
F 1' Jones F R L Makin, Catherine E D Nash, J C Seddon, 
G K Spiuell, D H M Titcombe H Walmslcy 
Diplomv in Psychological Medicine — Pan 11 Muriel Hughes, 

1 Sutton Pan / I Sutton 

Diploma in Public Health — Pari 77 S K AppletOT, J L 
Armour J C Biundrct Edna Circmtt C L Elder R S Hynd, 
P A Jennings A I Ross G N M Wishart Part / S K 
Appleton R Bennett J C Biundret Edna Circuitt, H D B 
North G R Walker, R C Webster H C Williamson 

t With commendation ’ Second class honours ’ Distinction 
in Medicine * Distinction m Surgery ‘ Distinction in Hygiene 
and Preventive Medicine 

UNIVERSITY OF SHEFFIELD 

At a meeting of the University Council, held on July 8, ,pr 
J R Grimoldby was appointed demonstrator in anatomy 


Ma^oiiald, J Macdonald Rowla McGowan, J McIntosh R r 
McKenzie, Zina E MonenetT Dorothy I Mortimer i fi xE *- 
r Murray. P B Nicol, R E M Pmerson PhX l 
A W Ralfan, A G Reid, S McR S Men Y 
Ritchie G T Robertson Edith Scott H 'G Skinner A S Swr, ^ 
J H Stewart W J Tivcndale, J R Tocher J Walsnn*n"e 

M Williams ° 

^ ^ Davidson Isabella M O Allan J R Rnn 

G G Dickie, W J Godden, M H Webster 

* With second class honours f Passed Final Medical Proks 
siona! Exnmination with distinction i With credit 


ROYAL COLLEGE OF SURGEONS OF ENGLAND 
election to the Conned 

Four Fellows were elected on July "7 into the Council to fill 
the vacancies caused by the retirement in rotation of Mr 
Victor Uonney Mr R C Elmshe, and Sir William Gidine 
Ball and by the resignation of Mr C H Fagge The result 
of the poll was as follows 


Rcginild CiiEVNE Elmslie (St Bartholomew s) 66’ 
William Francis Victor Bovnev (Middlesex) 6SS 

Sir William Girling Ball (St Bartholomews) 657 
Lionel Edward Close Norbury (Royal Free) 502 
Vincent Zachary Cope (St Mary s) 4!0 

Robert Joseph Willan (Newcastle upon Tyne) 395 
Robert Davies Colley (Guy s) , 356 

Sir Lancelot Edward Barnnglon Ward (Great 
Ormond Street) 349 

Julian Taylor (University College Hospital) 297 

Waller Goldie Howarth (St Thomas s) 217 


In all I 358 Fellows voted , in addition Icn voles were 
found to be invalid Mr Bonney Mr Elmshe, and Sir 
William Girling Ball are all elected for, the full penod of 
eight vears and Mr Norbury acts as siibslitiite memher for 
Mr Fagge until July, 1945 


COMBINED HOSPITALS UNIVERSITY ENTRANCE 
SCHOLARSHIPS 

The following awards have been made 
St BariliohincH s Hospital Medical College D S Cadmao 
St Johns College, Cambridge (Scholarship), J N Milncs Si 
John s College Cambridge (Exhibition) 

Gii) s Hospital Medical School N Gillnnti Downing CnlMf 
Cambndge (Scholarship) H E S Marshall, Donning Coiust 
Cambridge (Exhibition) 

Si Thomas 5 Hospital Medical School J R Tiller WoreoWr 
College Oxford (Scholarship) L H H May, Trimly Colltst 
Cambridge (Exhibition) 


The Services 


48th AND 61st (SM) DIVISIONS RAMC 
Colonel Rali n A BiioDCRick A D M S , 48th (South MidbnJ) 
Division RAMC TA wntes I am very 
promote a reunion of all old comrades of the above R A 
units who served in these Divisions during the great mr 
would suggest that a reunion dinner be held m Birimnf 
m the late autumn of this year under the auspices oi 
Birmingham Branch of the' RAMC Association, an 
that you wall publish (his letter so that •J’® 'hn art 
►^oiir re'tders may be c'\iled to the project YViIi aii 
nterested and served m the corps during th-d P'" “ j 
aiumcate with Lieutenant Stanford, RAMC.TA a 
Icid Hall, Acock’s Green, Birmingham, 277 

Surgeon Commander S H Facey, 
ivvarded a Greenwich Hospital pension of i5U a > ^ 

vacancy caused bv the death of Surgeon Captain b 
Mance. KBE, CB. RN (ret) 


' UNIVERSITY OF ABERDEEN 
The following medical degrees and diplomas were conferred 
at a graduation ceremony on July 6 

M D — ^R G A McLaren „ „ . . 

MB, Ch B — *J Booth *t J S McConnachic, G S Anderson, 
Mary Andeison, Joyce D Bailey Thomson V A Cran, K S 
Crawford, Williamina H Cruickshank T Duncan W Y Fettes, 
J Fiddes D L Fletcher, M Franklin R G Fullerton, J M 
Geddie, C W Gordon, G F Hamilton E I Harper, A B 
Hairmgton Mabel A Henderson, G A Hendry, Jean E W 
Inglis f McD Kerr, W Lamb, J Leask, R N Lees L C Liddell, 
H J Lillie C J Livingstone W Lumsden D R Macaulay, 
A F MacBean, Dorothea F MacBean, J R McBoyle, A W 6 


DEATHS IN THE SERVICES 
Major Thomas Herbert Dicrson R A M C (wt 
'angier, Morocco on June 17, aged 54 
)eeember-7, 1883,. ,yeV"S«t,^aon^oyhe^^l^lj^ 

adiialfil 'IB 
r and a”', 

,d d 
n«' 


scember--7, 1883, the youngest son oi uw " 

C Dickson of Argvle Place Church, \|B 

ducated at Edinburgh University, where ,j • 

:h B in 1906 After filling the posts of ^ aad ' 

ledical officers at the North Riding no'pu 

inior house surgeon at the Royal Sea Baimag . 


inior house surgeon at the Vjcdicil Ccrp* ’ 

dargate he entered the Royal Army 
eutenant on July 31 1909 became major m I9.i, 

July 31, 1929 


Juu 16 1938 


MEDICAL NEWS 


The 

'llOtCJO, lOLJLSkt 


161 


Medical News Letters, Notes, and Answers 


Mr H L Eason PnncipM of the Unnersnv of London 
h'ts been elected an Hononn Master of the Bench of the 
Inner Tempic 

On the afternoon of Tite<di\ Jtih 26 Dr \N alter EIlio? 
Minister of Health wxW open the nc\^ Counts Infirmars ai 
Louth the ctTcmonv tcinc presided over b\ Lord Hcncacc 
chairman of the Lmdsex Counts Council 
An International Plastic Surger) Congress will be held at 
the SarfaUi Insijlulc in Milan on September 25 26 and 27 
Surgeons and specialists from England Germanv Trance 
Scandinavia Holland and North \mcrica have announced 
their intention of attending the meeting. One of the pnn 
cipal subjects to be discussed is the eradication of malignant 
facial grovxihs 

The tucnlx fifth French Congress of Medicine will be held 
at ^!arsclIlcs under the presidcncx of Professor Olmcr from 
September 26 to 28 when the following subjects will be di\ 
cus<ed icterogenic spirochactosis hvpochloracmn and the 
present treatment of avitaminosis in the adult Further m 
formation can be obtained from the general sccrctarx 
Professor Roger 66 Boulevard Notre Dame Marseilles 
The fifth congress of the Latin Medical Press will be held 
at Lisbon from September 29 to October 2 under the prc<i 
denev of Professor Revnaldo dos Santos The subjects for 
discussion will be medical bibhographv and the copvnght of 
articles Further information can be obtained from the 
general scerctarj Professor Armando Narciso Rcstauradorcs 
A$ Lisbon 


All communications in regard to editorial business should be 
addressed to Tin EDITOR British Mfdical Jourval BMA 
Holsi Tsvisrock Solarc C I 
ORIGINAL ARTICLES and LFTTERS forwarded for publication 
flic understood lo be offered to the British Medical Jourtsal alone 
unless the comrarv be stvied CorrcNpondenis who wash noire 
to be taken of their communications should authenticate them 
vMth their names not nctcssanb (or publiuatton 
Authors desiring RFPRINTS of their articles published m !h'‘ 
British Med'ca! Jiuirnal must commum''alc with the Sccrctao 
BMA House Tavistock Square C I on receipt of proofs 
Authors ocracas should indicate on MSS if repnnl?> arc 
required as proofs arc not sent abroad 
All communiuitjons with reference to AD\ ERTISFMFNTS should 
be addressed to the Advertisement M-nager Orders for copies 
of the JouTftcl and communications with reference lo subsenp- 
tions should be addressed to the Sccrciarv B A Hou e 
Tavisio^.k Square \S C 1 

The TfiiPiiovc Nlaidfr of the Bntt'h Medical Association and 
the Bnitsh Medtciil Jourrtnl is LUSTON 2111 
The TitrcR-sPHic ApORrs^^cs arc 
LOnOR OF THE DRITISII Mi DKAL JOIR^AL Attn-'otiy 
H eshent Lot don 

SCCRLIARN Mednrera It esuent London 
The address of the B M A S-ottrsh OHn-C is 7 Drumsheugh 
Gardens Tdinburgh (tc/egrams Associate rdinburch te’e 
phone 24161 Edinburgh) and of the Oflitc of the Insh Tree 
State Medical Union (IMA and BMA) 18 kildarc Street 
Dublin (telegrams BuciUtis Dublin telephone 62^^0 Dublin) 


QUERIES AND ANSWERS 

Cockroaches 


The third mternalional congress for microbio1og\ will be 
held m Ne« ^ork from September 2 to 9 1939 

The mUoduaon address before (he Middlesex Hospital 
Medical School will be gisen on Tuesdas Juls 26, at 3 pm 
at the Queens Hall Langham Place bi Mr Warssick 
James F R C S dental surgeon to the hospital and the pnies 
gamed during the academic sear svill be disiribuled b\ Sir 
Edward Meserstein 

The Child Guidance Council iNSoburn House Upper Woburn 
Place \\ C) has assarded Fellowships in Psschiatrs to Allan G 
Cnsp M D Kenneth Sodds MB D P \f and Rosalind 
Vachcr MB D P bf The fellowships arc of the saSuc of 
£300 and are tenable for a jear from October for half time 
ssork at the London Child Guidance Clime 1 Canonburv 
Place Islington N 

The Ministn of Healih has sanctioned a loan of £253 000 
for the first instalment of Southend s municipal hospital 
extension 


F P" has asked us for the name of the senders of a 
prepanlion called zonol used for the extermination of 
cockroaches (blackbeclles) It can be obtained from ans 
branch of Messrs Boots Uc take this opportunils of 
referring E P (and others similarls afflicted) to the 
pamphlet entitled Tht CoclroaU ll\ I tje Union and 
Hok lo Deal hiiIi Ii b) Frederick Lamp MA B Sc 
published in 1921 in the Fconomic Senes (No 12) bs the 
British Museum (Natural Hislors) Cromssell Road London 
SW7 3I fid per cops (postage Id) 

Mosquito Bites 

B B L ss rites from Scotland in answer to B S s 
inquiry (Mas 28 p 1192) I hase found fisgo — a 
Dubarrs preparation — unequalled Its onlj disadvantage is 
that It does not keep well as it is liable to shrink sshen it 
has been Is mg a long time m a chemists shop Oil of 
lascndcr, 1 found oiirocicd mosquitos 

Income Tav 


The King has appointed Dr Christopher James Wilson to 
be an unofficial member of ihe Legislatisc Council of ihc 
Colons of Kenja 


A sanitars code regulation prohibiting the imporwtion 
breeding and sale of birds of the psiltacine or parrot famils 
went into effect m New York State on June 1 and a similai 
regulation for New York Cilv on Juli I 


An instimtc for the studs of influenza and ns causes and 
treatment has recenlls been established in Budapest 

The foundation stone of an institute for hsgienc social 
Brus'sclT P^'fio'bS' has reccntlj been laid at 


The Mimstcr of Pensions has arranged at the request of the 
Minister of Health to lend to the Mmistn of Health the 
Mrsices of Dr J H Hebb CB CBE KHP Director 
General of Medical Services in the Minisirs of Pensions Dr 
Hebb while seconded lo the Mmistrs of Health ssill be the 
Principal Medical Officer responsible for adsismg on all 
' rnedieal questions relating to the emergenc> hospital and 
medical services for which the Mmisir> have taken over 
responsibilitv from Ihe Air Raid Precautions Department 


Pro/essional Use of Cars 

"^XPAXTR has for mans vears used two cars in bis practice 
The local inspector of taxes has now objected lo an allow- 
ance for more than one car and even then claims to deduct 
10 per cent of the expense of one car as representing 
private use 

Me cannot see the grounds for the inspectors con 
(cntion The question is one of fact If Taxpaver uses 
two cars professionallv he is entitled to the running costs 
depreciation obsolescence etc of both less a reasonable 
percentage to cover the ratio of private use of both cars 
If he were liable to assessment under Schedule E the 
position might be different because the inspector could then 
contend that the use of two cars was not necessarv But 
as regards an assessment under Schedule D that cniicism is 
nol appropnale The inspector seems to us to be no more 
entuled to object to the expense of two cars than he would 
be entitled to saj that a tradesman is emplovjnn loo jnanv 
assistants and that he wiU onlv allow the vvaces of half 
of them ® 


Expenditure on Apparows and Books 

^ ^ spent an abnormal amount rcccntlv on apparatus 
w It advisable to claim ''depreciation on such equipment'^ 
Jhc inspector of taxes has informed him that no allowance 



162 JuL\ 16, 1938 


LETTERS, NOTES, AND ANSWERS 


IS due for additions to the nicdicil library 
periodicals or renewals Is this so’ 


ns distinct from 


, The depreciation allowance is for “plant and 
machincn and surgical instruments fall under the category 
01 tools rather than plant Consequently depreciation 
on comparitiveh small and portable apparatus cannot 
legally be claimed but as the \anous instruments etc 
become worn out or arc discarded as obsolete and renewed’ 
the cost of replacement can be claimed as a professional 
expense The same principle applies to books Where a 
textbook becomes out of dale and is replaced by a later 
book on the same subject the cost can be deducted for 
income tax purposes 


LETTERS, NOTES, ETC 

Nasal Sinusitis in Childhood 

Mr J Bernstiln (Luerpool) writes Mas 1 be allowed to 
reply to various points in Mr Frank Cokes letter tn the 
/oiiriiiif of June 11 (p 128*;) In my opinion there is a 
definite condition m which there is thickening of the mucosa 
of the sinuses with the presence of mucoid huid and this is 
due to the allergic state The mucosa oS the nasal sinuses 
IS continuous with that of the nose and participates in 
similar infections and conditions Whs therefore, should 
the allergic phenomenon which admittedly lakes place in the 
nose not extend to the sinuses’ For mv osvn part, I find 
that group testing will give me almost as much information 
as individual testing and without putting the patient to the 
inconvenience of a number of sittings I have also found, 
and I think that ni ms others are in agreement (hat a par- 
ticular protein mas oltcn give a ncgaiise skin reaction and 
yet be allergic to the patient That is the reason why I 
eliminate, at the beginning the proteins which I base found 
to be the most common olTcndcrs As the patient improves 
he IS gradually restored to a normal diet by the method of 
trial and error As to vaccines and infection I think that 
often the organisms found are merels the result of the pre- 
disposing allergic condition and not the cause Because of 
the unhealthy condition of the mucosa the organisms are not 
destroyed but proliferate Vaccines may help but m my 
opinion they do not attack the fundamental cause and I 
think that is the only point of diffcrehcc between Mr Coke 
and myself 

Appendicitis and Heavy Meat Diet 

Mr Morton Whites (London) writes Dr A Forbes Brown s 
experiences described in the Journal of June 25 (p 1390) 
regarding appendicitis in Uganda coincide with my own when 
I was Assistant Colonial Surgeon in the Falkland Islands 
and, later, surgeon and radiologist to Mackenzie Hospital 
British Guiana Falkland Islanders arc mostly Scotsmen and 
Englishmen, and are compelled owing to the lack of fresh 
vegetables to live on large quantities of meat, mostly million 
Out of every 100 operations among the inhabitants in 
1925 80 were performed for appendicitis The British 
Guiana native population in the Bush seventy-five miles up 
the Demerara River, are almost entirely free from appendi- 
citis In 1926 out of 1,000 operations there was only one 
case of this condition, and the patient died from malaria 
on the day 1 had prepared lo operate on him A post 
mortem examination revealed an acute gangrenous appendix, 
apart from his acute malarial cachexia The patient had 
been a meat-eater while working for Europeans These 
two experiences m totally different climates and under 
different dietetic conditions would strongly suggest that 
appendicitis owes its origin to a heavy meat diet 

Medical Tour to Soviet Russia 

Messrs David Band Norman M Dorr W T Munro H M 
Traquair and Noel E Waterfieed write We would draw 
! your readers attention to the medical tour to the 
USSR recently advertised in your columns by the 
Society for Cultural Relations (98 Gower Street W C I) 
Our visit to the USSR last September was arranged 
by the SCR and we were thus enabled to make 
contacts with medical men and to visit medical insti 
lutes which we would otherwise have missed The travel- 
ling arrangements made for us were excellent Everything 
worked smoothly, and we had no difficulties with regard 


T!iEB«m«[ 

MiCIJICAI, JoiMSa 


Lhc accommodation was comforhWf 
guides were very friendlv 

and obliging We felt that the trip had been scr 
worth while from the point of view of nainint 

STsSi "■'JT"™ r'S 

I I ree’rd the trip also as a vers nlcisam 

'V” London by sea o' 
bemg^rorn^faT^ overland on September’s the cosi 

A Doctor’s Collection of Old Medical Books 

On July 18 Messrs Sotheby of Bond Street are selling tbeboof 
collection formed by Dr Cuthbert F Selous of Tunbndte 
Wells vs Inch includes a good many old medical books some 
of them exceedingly rare Alexis of Piedmonts Secrcii 
containing excellent ruiiLdics against ilners diseases black 
letter, translated by W Wardc and published by K Hall 
1562 IS m three parts bound together in one volume 
apparently the other known copy which is m the Bniwb 
Museum has two parts only There are also catalogued 
two^other editions of this book 1580 and 1595 both of them 
also m black letter Barrough s Method of Flnsiek Ibi-t 
IS the sixth edition of that iiork which evidently was 
popular Sir R Blackmores Treatise of Consiinijiiioii! 
1724, and J J Berlii s Treasury of Drugs unlock d 1690 
precede a copy of Sir William Osier’s Inciiiialnila Mcitica 
Then SVC come to Boerbaaves Method of Stiidsini; Pliysid 
1715 J Parsons s JCnqiiirv into the Nature of Hermephro- 
elites 1741 , Andrew Boordes Breuiary of Heallhe 1552, ami 
G Bakers The Nessc Jeuell of Health 1576 which art 
followed by a long string of the works of that prolifii 
author and earnest researcher Robert Bovle Most of these 
are not medical, but there arc a few which are m this 
category — for example, Mcinons for the Natural History of 
Humane Blood 1684, The Hecoiwileablcness of ipicifd 
Medicines to the Corpuscular Hspothesis 1685, Meihciiu 
Hsdrosiatica 1690, and Medicinal Espiriiiients 1692 and 
1693-4 T Brights Treatise of Melanchoh 1586 Vtsit 
Meciiiii or Companion for a CInrurgioii by T Btusa 
1652 R BunwoTth s Physical Discourse exhihiliiu: the Oiri 
of Diseases by Signature 1656 are followed by a texibool 
on the cure and prevention of the Plague I6J6, and hi 
T Cogan s Hmen of Health 1612 Culpeper is well repn 
sented by' a senes of books, of which need be quoted oah 
hts Directory jot Midunes 1651 Sir Thos ElyotsCahri 
of Helth corrected 1541, unfortunatelv is not quite perfect, 
but a later edition, 1576 is hitherto unrecorded “fd 
well be unique Only two other copies ate known ffriiah 
Museum and Cambridge University) of O G’lbelkowrs 
Boock of Plnsicke niiclyc tionslated out of Loo duche et 
A M Done, laack Caen, 1599 and C Gesners htui 
Jewell of Health 1576, if not quite so rare is at an) rate 
uncommon Another quaint title is that of G O'"'™ , * 
Diiectioii for the Health of Magistrates and /WwN’" 
Englished by T Newton, 1574 Balneology is the siiSjo 
of several treatises including T Guidott s Discourse / 
Bathe and the Hot fValeis theie 1676, Lordeas Disrflii 
of Natnrall Bathes and Mincrall Waters J633 To® 
Scarborough Span SpagvticaUv Anatomized 1670 wu" 
Seal borough Spaw 1 667 , and T Venner s 1 la rec 
sitam Longam nhcieimto is annexed Baths of name 
also Treatise concerning Tobacco 1638 * j n, 

editions of T Willis s Cerebri Analoine 1664 uno 
Amina Bnitoniin 1672 as well as others by that 


a copy of William Harveys Dc Generatione 


published at Amsterdam in 1651 the same year as 
edition Langhams Caiden of Health is . 

first edition of 1579 and by a later one 16V 
interesting old book is the New Clysters in Ph) ^ 
coseied by curing of Cesers and Agnes U"' 9 ^ 

Jesnites Powder translated by Dr Belon 1681 i” 
many other medical books in this collection as 
a large amount of general literature and in a **”'‘, 1 , 4,58 
tion for disposal in the same sale are a fevv more 
another edition of Willis’s Dc Amina Briiioriim 
Cerebrum et Nersosiim Genus afficiiinl ‘’xphru' s ^i 
Theiapetas insliliiit Amsterdam 1674, ’od 
the 1692 edition of R Boyles Medicinal Fxpenm 

A little book by Miss J Halford entitled fJuu 

tant and N in sing Mothers is published by me t ^ I, 
tion Society 29 Gordon Square, VI C l *?“’ „'ovc fa!<£ 
opens with a senes of cautions calculated ‘J* 
impressions as to the diet under such cond 
are followed by numerous practical hints 


( 


V 



XUDfCAl. JOl.*lLN*L ^ 

KEY TO CURRENT MEDICAL LITERATURE 

GENERAL JOURNALS 


Deutsche Mcdizimsche Wochcn^chnft 

rertn ul €4 t 19^^ 

af-i ■V’iowc^\ 

Nexv Trtatr'cm fm O ita. Cr^-rri- ^ ^rVal us >sR»i ParVir run Marttev i 
X on — G Thrcjrrfx » 

Kcrurk* in S>cal<x Bu farun Co e o' CMt n *. rnt^err En erha i» — 

H D s itzJcbcn 

Ju uiVL>a1 a Neil S'Nisn l>ti JunVrrarn 

Chnwal tsreuen rs mji** a No '“** t' 

\ nterrurer Mamtjsrc in noc-u’an n R«^> u »n S^r**!* ~N -Gui 
\ nual \cu i) of Nonad n A u M nor — S JmaV 
rraiiKal SfrSca'j'e of Tniin^onA* orTh'*f3--C r»n>hcl 

O utviijorul 7^»c”r) n Curame jn uruuo"i m BerJj —1 Pjo nr 
H sh Ci'urt Mccjcc“lcsa! Jodfnrris jn -^racv*! arJ 7fcr*t>r 

Aril 5fiJsm<i;\Rc— The Ann spaimodn. n.tion of jtictm 
dal (Schcrmfcl has been tested on the rabbit s •.mall mtcvtinev 
It 15 chimed for this drag that it possesses remarkable inti 
spasmodic properties ssith sen loss toaicits Its technical as 
distinct from its trade name is tri ;i butsl acetamide 

Flocaihtion Reaction —thii test the technique of sshich 
IS desenbed in detail was applied to ’9S non ssphilitic 
patients and 111 ssphilitic patients The reaction was negatise 
m all the non ssphilitic cases In 107 of the ssphilitic cases 
the reaction tallied ssith the Was'crmann and Meinicke U 
reactions In isso cases it tallied onis ssith the Memicke 11 
reaction Thus there ssefe onls tsso cases in sshich the 
reaction described bi Guo "as negatise in the presence of 
ssphihs 

Indian Aledical Gazette 

Cat una scI J3 Srnl is S 

P/C ent ptiition of Or uw smcli^c Hatu «n InJia — R N O *ro 
C S Chofra 

Ifx.H.rnve of RhcumaiK. Infciion Indci — % 'laocjJ k -r*} H i»oft 
SuSmtarcoM Nodule of Rheonv.*'*'^ “■f' Gorerkcri 
B-ncrurh-xc Treaimenr of Djato err m Pru-afe Tauenf — Nf OC nn < 

Herres 2o*ier Therapeutic Etpenmentt « ih Tt ue Lj'wte—P M fJrst^rc 
and L Ghosh 
Re icnaf llci — \ Kaikinu 

Tfeaiment of Sp encncjtaly by Mdk Jn eetiorn —C Pa o ha and C Chrfn 
M tdifed Technique for Phreric E»u)iKn — R \fi»afuihao 
T>phDd Feici prc'^niinc Lr«ual featL/ei — P K*ram handjm ir<J C M cr 
ISo-do-nalijraam Tumour of Resion — M Kir 

CaMi of Jcjanal DnenicuJosn — \ Nath 
Ca c of Brea t Cap"cr »n a Male --“A Oe> 

Ca ific Can er in Girl cf 19 — A Ch-ncra De 
CoTd tuned Refines— S Bhaua 

RhetiiuaUc Infection — ^cufc and flagratillv acki^c phavci 
of the di’icase are conspicuoush rare in India The upe 
ii«uall\ «ccn 15 a mild and chronic form ^Mih vague pains m 
joints and tendons Valvular disease of the heart of rheum 
«»uc origin «eems fairlv common when compared wah ihc 
r^ntv'^of other manifesianons of rheumatism pericardial 
involvement is rare The association of infected tonsils vMih 
valvular disease is too common to be ignored as an actio 
logical factor 

Herpes Zoster — Fortv cases of this disease have been 
treated with hvpodermic injections of tissue hsatc prepared 
from the herpetic vesicles there has been uniform success 
in relieving pain and lowenng the duration of the di ease 
The preparation of the tissue Ivsate is simple and si would 
be possible to prepare it on a commercial scale 

Splcnomegah — The results of the treatment of a series of 
100 patients suffering from splenomcgalv not due to ^ala azar 
' With injections of skimmed sterilized milk are recorded 
There v\as a marked reduction in the size of the spleen m 
«vppTO\vTOa\e\\ ptr ccwk c? \tv\iti 

muscular injection gave belter results than intraculaneous 
^ injection. 


Journal of the kmcnean \tedical Association 

ChH.ays M.I 110 7 193S 

ErUxTin t anJ trUcfiurUrc arU Trca^r-cri of the ticcn rat Ct Jl. — 

S Ki r»e 

M.jjuycfrc/it rf Sept r.*fjepr t»irS Oritrt MfU J - J H Vfjt^cU 
Sw ro-* ac TubCT-*uci< — f ThenpA* r 

S{i1pha*»i ar* »Jc in Trf tr'c"! rl G p nboeal Nul o*'3Sipi5« — S HcPhaP 
M Schn<K.cr Vt R itt ar<l R D H<rti d 
Catb« n Dou’rh dc P 'A'>n ne S » Ca « — S T" Ct ruy ard M Trurrper 
Tfrjtrrcn « f LnJuLn. feter »ifh Sulpbarifar? d" — R Srern arj K Bale 
Noi«e TPcci*. n ttun n Ecinr --C V! Cofd E Tea? ard V\ VVihefidfc 

Klinischc \\ ochcnschnft 

BcrLi Id 1* '1 T 

P i 4 l NciitiljJli A i( Natural \a icr Siii-u ana —E "tic 
N o- rcaif rPrals nf Male Tralicular UinnorcA — " H AcilardO lirrrca 
rreat .A SurrartA-jIt fl P/r natd Hal AdAii iraiun I Small D.ao I 
I I ular H< more — Vf Dime 

No* MffhxJ f'T Oja tan c arJ Ouaniifa ii<: Deterr ru: or of Corpu Lufoim 
Hnrr* rc J J Dj>icne i. Wit 

And Ciacr d SWi- and Am E trial pirlcnirA I —A AlarrU r,ni and 
V» \tiu VnreVil 

IrPucncc ft AlarTA Rea t on and Hr- am AC TRerari on "alee Alcrat I m 
i-i Renal 11 Seljc 

Inn. CP e tf Sf/KhuTC Surrufati'n on Acetj tholi-e Cor err f Ncr\ \n 
SiAiem Neutraluala a of lE a SuE-ua c Ef Dual — J fee er H 

K *ar 2 >k and Z LeJuv Lachomc? 

B Trctiu e and P >•»! Su-ar Su-dics i'n Rabbits »Jih Crficd P forr ty 

C ardi — E- > Jn apd A n > orantJ 

Rc »cn from EmbpJtvn of Abcon -ul -kma — -F Grant 
R«u.ul'<r.d( fhelial S>Me*T and Iron VfCTabo'pn~<» Barkan 
Coftuii cm xr\crp P8 Withdrawal of R»»hi Prsctr»e vfcdfctrjp —fl Mu’ cf 
SAebr’ic^ 

4ail Co\er of 5im — Meaeurcmcnls of the fH of ihe ‘km 
of differen! pans of ihe bod\ rcAealed that the skin is 

co'cred "ith an acid later formed b\ sweat the acid reaction 
pro cncs the skin against bacterial infection But in come 
parts of the bods Ihe reaction is neutral or esen illahne 
This IS the ca'c m the asillae gtniio-craral and anal regions 
interdigilal spaces of the feet and some parts of the sole 
Ihe'c parts are liable to bacterial of mtcolic infection 

Lancet 

Lt-r,don 1 'll •'34 'ti) " 

S»ri «1 Trraimtni of Dctscbncni of ReXfi"-* '“■t Coc MjnhjTl 
Dm ard Inerral Trwrmcrr m Skin D ea cs — F F Hcfl c 
^nrTM.a Neriosa wtrh Spccu.1 Refcrc'v.c lo Carbob)df3jc VfeuKh rr — 
C V\ 

rctipbcTal Neufim ceiated wnh PyJerj * and \ ftarr n B DcfiCf<n«.> 

L r L. Laurert and H VI S ncU«r 
Tjtairrcm of Bubo *rh SuJphanilamidc — ^ ttui hsen 
IhrcnrorhJC Pjlonc Sienon? in One of Laimufar Tw:r' — W ShcK n 

Dctnthnl Henna — \fier desenbing the modificafions which 
have followed Gonms cmplovmcni of cauterization Cole 
Marshall stales that he prefers dialhcrmv coagulation com 
bincd With clectroJvsis for drainage The technique is given 
in detail Two ivpical cases arc reported the tears and the 
post operative vears being illustrated 

Anorexta Ser\osa — A severe case is described in a girl 
aged 12 the carbohvdrate metabolism was investigated in 
detail Dietetic treatment was effectively supplemented bv 
liver iherapv The view of a pituitary causation is not 
favoured a psvchogcnic abstinence is thought to be follov^cd 
bv phvsiologtcal impairment of glucose tolerance a falling 
ahmentarv hvpoghcaemia and impaired gaslnc tonicitv 

Medical Journal of \ustraha 

Svdnej Tcl 1 Apnl .3 1938 

Bob A. HcaUh Ltsiitaucn s tioluuon m SouJh Aasfralia — A R Sk.uihwood 
Concoctioo of Spinu ftem Tip*< of Galen onwards — E F Garxrell 
Ind canons for Blood Tran fusion — I 1 vVAjod 

Ob".eT anom on Morfcidit) m Tropical and Sutiropical Queensland — ■V H 
Baldwm 

JndKatjODS for Jnicrfcrencc durmr jUbouT--A M Wilson 


162 A 



IS JuL\ 14 I9'!S 


KEY TO CURRENT MEDICAL LITERATURE 


THCBRmw 

^ItDlCAV lOlAsvt 


, Mcdi7mischo KhniK 

Dcriii »(jl 34 Mny 6 |»n 
Otilis Lvkrin — H Lodii.ll 

Tu Intirtci Ihrctttyh Acciiii.nt — KricP'niinn 
Mi.nomii>,)| Gcniiil AHiciimn ~\V lliiiiliin 
ll\Lkichc in rcnnU>— \V W Urntr 

Tit imam o( Piarpt il Infti-tions anti Inir i\i.iiniK \iiinnl Cirbon— U 4 nhler, 
Pr ciicil Hints on Diphihcn-i — k brnctz 

‘Ircitnisnt of Polsoihicmit ssith Din Poor in Allnimin — I I isiti 
Tntonalric rsiinntion of bucnr in lllootl Scrum Cttchtospin it I liiid mil 
Urine m Gcncnl Prict si. — J VV Wirtz md H Ktsllc 
KcsORniiinn of Mnlingsrcrs — P Rcckich 

Cnisition inU Dneno IS of Cirdnc Infirstion — 1 A M Kimbsri 


Nordisk Mcdicinsk Tidskrift 

Stockholm \oi 15 Maj 7 

Cmctinant it fiacstictions of hffcci of VUn shon Wascs on Btissl \oo. 

K KnUnT SPccinc^tccirfCsl 

Vinmiii SiiPPli of NonscBian Ship Wintstins in Grccnlnnd-\ h. 1,1,1 
md H \V Rmniascn iiiuiij 

Ampoiils «ilh Silver Silt Solutions for Cccd< Prophilim — 11 \\nH 


Policlinico 

Rome vol 45 Mas 2 193$ (Sez fiat) 


Pi>l\cMhiuiiiia — niCTns of 1 ditt pnclicTlh devoid of 
TninnI Tlbunun it rts possible to reduce ihc red blood 
corpuscles in the different t\pes of pohcithTcmia h3 one to 
Ivto nuliions during the first week of trentment After not 
n ore than two and a half months the red cel! count came 
down to five millions The haemoglobin decreased to 100 to 
110 per cent much more slowh The gcncril condition of 
tin. patients remained excellent but the spleen was still 
enlarged and the blood pressure md Icucocitic count were 
iinchmged A return to a normal diet gise rise to pol\c\ 
Ihitmii again but U was possible to keep the condition within 
bounds b\ means of a parlialh rcstnclcd diet 


Sanirisancc ot Uskii s Reaction and lot prandial Blood Smiao-judv 11 
Tufmonarj Tuhcfculosts —A Rv>bmo 
•Stilphmihmtdc Treatment of Scute and Chronic Gononhota w Milo- 
\ Tommasj 

Glucose Content of Cerebrospinal riiiid in Insulin Shock Thcram ot S-huv 
phrenii — M richer 

Siilphnnilamitlc in Acute mu! Chrome CoDorrhoeu- 
Tommasi had good results in fifis three acute and tliirh diroms 
cases lasage being sometimes undertaken tts well In fise d 
fifts three acute cases slrcptosil was not lolcrated in Si£ 
others and in four of the thirti chronic cases it nas meffcciitc 
The importance of abstention Irom administration of olb r 
drugs al the same time is stressed 


Medi7inische Welt 

Ucrltfi \-ol 12 ^!a^ 7 191'^ 

7nnimmt?<?ri Phrmosi \ Sffthmer 

Dutino i> of Dtsc'l^^.^ of \nt\cs in AUoloCLnts — L Ihl/cr an4.H \ oci 

PuholOB^ PhiMolo^s inU Ih<.r«p> ot HcndTchc — K WtiJner 
^cu\t Diphlhcrn Immumzahon — C Ufditnnn nnd L Bitter 
NfthRnani Dinhthcm — /V So’^smk'i Laehnnnn 
Ootlor and f-fcrhaftvl — V' Lcnr 

Nc^eliiivc Dj^turbance^ treated wiih Uranl Skhlmham. 


IVJunchcncr Mcdizinisclic Wochcnsclinft 

Munich >oI S5 May 0 \<*n 

German or iewi%h rswhothtnpj — Kv Htnntmtnn 
HcaltnR In Kjckcia — E Thomas 
fnfani TccdinB — E Mutifcr 

\\ ntkd Human hfiJK NS'astcd Naiioml Health — L Nk lUhcr 

PccUissis and Bronchtits treated VM(h Volatile Oil Pertut int.ousl> — A Erkcir* 

Calcium Treatment of Trichinosis — C Soscmckr 

Electrodes in Short \sa>c Thcraps — E SthlicphaKc 

Ornamraiion of Medical Mainttnantc Bureau — \N Micmlsu 


Nature 

London sol 141 Mas 7 19 < 

Ethical Dkclaraiion for the Times — ^L L Whstc 
More Discoveries of Ainiialopithecu \ — B Broom 

Colorimetric Estimation of Nicotinic Acid m roadstufTs — kf Swnmmaihsn 
Ltleci of 9iiccinic Acid on Ucspiraiion of Normal Human Min^clc mil Various 
Myopathies — T J St irc E S Gordon and M J M»s>i-r 
and Cocarbo’i>lasc — Ochoa 

Ab orpfion of Growih promoting Substances b) CuttiiiRs — 1 H Jackson 


New England Journal of Medicine 

Bosion vol 218 Mav s 19 s 

♦Siilplnmhmidc in Treatment ot Acute Gonococcal Urciliriiis — W XV Spmk 
and E A Gallon 

Ccrcbnl Asphyxia during Nitrous Oxide and Oxiscn Xn icMlicvn — J D 
Sicvvart 

Imincduie Flan Grafts following Trauma— H T Dav 

f’rt tress m Stiidv of Cardiovrsciilir Disease in 1916 —S McGinn 

Siilphaiulwiiule in Gonococcal Uiclliiins~0( twent> fwo 
men with gonorrhoei freifed with 4 giammes of sulphTnil- 
Tmide dailx for from ten to txvenix da>s elexen xxere decKied 
cured in from four to seven weeks Sludves of the blood 
indicTted that the drug does not affect the gonococcal com 
plement fixation test or serological tests for sxphilis Sul- 
phanihniide increased the bTClericidal powers of the palients 
blood against two strains of gonococci Ibis incicase xsxs 
noted onl\ xxhile the drug xvas being administered 
162 B 


Presse Medicale 

Pans vol 45 Mi> 4 

HiPcfcrciiinaemia — L CormU D Olmcr I Diinin and J Naguc 
Ian Naictl b> S>mpaihcuc m Tnumi of Picc and 1 raciurcs ot J»>v-bk'n*v- 
M Dcchsumt 

Lvpcnmcntit H>pcnhi.rmn — M Bunicin 

PnrK vol 46 M^v? 19J^ 

•Slow Conunuous Jninvenou Insuhn in Dnbehes— A Bvudoum J It'v 
md t Arc'nd 

Infl <mm ttor> Rcaciionv m Pulmoinrj Tubci‘cu)o >s — H Btodi 'ind tt M'lh'l 
•Nitamm C Cxchingi. between Mother md Toeiuv— NS Nmckr ivJ 
J Hubseher 

Insnlitt — ^The authors give an account of it'W 
experiences in treating diabetes v-ith conitmtous ' 

insuhn Tnd claim to h'txe obtained satishctor} results espw 
lo severe or complicated cases (comt, operiBon 
lion) Their results would 'xlso appe'tr to lend support to 
the Mew tint m some cases at least dnbetes is due to 3 
pUinglandui'ir ^nd not mereiv to t pancreatic deficicncj 

For tat Vilaimn C— After an elaborate expcnmentil 
of the xitamm C exchange between mother and focfiR 
authors come to the conclusion that the latter behaves I'l 
parasite nnd draws from the mother the amount of xuamin 
ncccssaix for its requirements This of course enlub ' 
possibilitj of vitamin C dcficiencx in piegnant and niiW'’ 
xvomen Moreover the milk of cows and goats contains nwu 
less xitamm C than lumim mtik (stnee these ammab c 
build up this xitamm sjntheticdlx) so that neither i' 
salisfrtclorj substitute for human milk as regards the viianii 
content Lemon orange or grapefruit juice or sjn i ^ 
xitamm C should therefore be gixcn to make up ihedclicic 

Schwcizcrische Mcdizimschc Wochenschnfl 

Basle vol 6 S Ma> 7 ' 93 S 

Spontaneous rraclurc in CirciunscnlKil Tuhcrculoso of Ulna— C 
•Anauimical and Chnital reiuirc-s of Porked Clavislc and Cu 
Anicul'ilion — C Hcnschcn 

Jnflummilory Cn'Unc GnnwJomi — O Mcn).»'« and B Ghclcw 
Hi>vionaiholoR> of Avihcni i — L LttiicUc 

To; Aid ClaMclc anti Coraco ilaMcidar Articc^^ 

Hcnschcn describes two cases of true <roraco dav ici ^ ^ 
lation discoxered accidentallx and discusses (he I’ it^ 
and ontogenetic origins of such i condition He 
pathological changes which are conceixablc or 
recorded both m the tiue irlicnlalion and ,v 

mentous articulation with bursa formation 
coracoid process and the clixicle 



Jlu 16 I9^S 


KE^ TO CURREVT MEDICAL LITERATURE 


19 

^!£DICAt 


SOCHCC 

Ne« Ti Mk f 'tJx 6 

Iiv.UAn»x Hunun B (u)Km — Uuabeih L HJJcn 
F)c\tT rhMfiJx tf Imwnnt *icrv)m — A Ti ciun and t N Kabai 
Atfionnim for Ifuman Enihi v)i« »n Tjrc \J\ AnD 
M FinUnd and t C Curncn 

TTtr-i»aXMn Futc !> STt nsnt — 5> W fci ^ 

FaHiffc ot AUfilU to rvocm Hxctp rthac*- J»*»oe«c)H<r D ca c — K Nmuh 


South \frican Medical Journal 

C»r<i<"»o 12 ® 

MfdKil i<r>Hr — 1. Wafnrr 

%r3rs Aro — N Dninci Surrton 

Life In uraocc »M »hc Mcdk-al Cxsmincr— ^ MiaIkaS htUttt 

f»c Aruc- 3 iu f I 1 Ra> Treatment and rjramJd n CvnFincd 

C. D BnnV 


Ueesknlt Tor Lacgcr 

Cirfnharrn 'xJ ICO 'laj ^ ^ 

>\c'i.nc<s of LaKur rair<— P Kuhn?! 

^ud« in rncua't'Tia Vfufcld x Capx^ e Rcjt.tivn (t* F Txrr DtHf 
mination — N 1 Npi m and B \anT<-n 
FiU ihrto Cars mih Tramttrj ('x(v>j-«roi.ifA) rlrd W* errunn Kahn 
Rcactn 'tx —P Krat and A Lx'rf'Cf** 

Ar<rnH.n of ^>Mnd{ 

Cx'5 in Viceroy treated » ih Ciinn ami Ax*.prt v ^cid — S T> r* oi and 
C E. Zatlio 

Piuumoiiia — The^e studies conducted at the State Serum 
institute tn Corenhagen and the Sundhv Hospital concern the 
sputa of 336 patients sufTcnnc from acute diseases of the 
lungs The direct microscopic Itpe deicrmimtion of pnciimo 
COCCI with the aid of Neufetds capsule reaction tsas found 
to he sers reliable and useful piriii.iilarh in cases with 
rusti sputum when the upe could usualli he determined in 


fuc to fifteen minutes This procedure is Ihcrcfore of impor 
nnee ns simplifting the technique of the serum ireniment ot 
croupous pneumonn 

Micncr Khnischc Mochenschnft 
\icnra »»} 51 May ^ )9j8 

Hxrx |1)C<>cni Shixli — BpJ* KVk 

IwridiHi r> Ctmmiin lation rn \fal»rul Treatment of lOd Paratxticx — 
C Lnecnh and C Pal va 

f(fIft.uUr If ftnnnc Tfcatmcrt of Puerrerjf fndcfrcirmt »if/i Hjrcrihcfma — 
C Cpselhatt 

IretfAdt D>ct »« a Sfvr»vjr> Meaxure in the Treatment of Cancer— -R lUicr 
Ia racutaneou Eiam rOfion of Alkali Rrxeoe —R ' Lcxrc7>mlii and C F t»k 
Bf»«xl ni*ea»ec and the E)e— W Kfcif'ic 

l!<» dx Ocathemy ard Sht n »axe Therapy djfTcr frem tthcr f'my cf Heal 
rheiary'’-—J K«.»*rv.hik 

Wiener Mcdizinischc Wochcnschnft 

^ Vienna >cl S8 Ma> 7 193K 

r ehi afa n i Dipf ihcru anJ St- Jet Fexer in Tt«n ard Country — J S'C#? 
Naxal BleexJ Off and Infernal Med cine —F Frc^el 
tir^t rd Rav Therapy In Skin Drtcaxcx m Ccrcral Pracii -^ — J Kcnrad 
Ihtiap cl Co** nhoca i*x Fmalcx — H Hp-SiaiitT 

Diphiliena imd Siorlet PeMr — In diphtheria the isolation 
of patients and earners is recommended as sscll is the 
increased application of actise immuniMtion In scarlet feser 
isolation for not less than six iseehs in cases free from 
complications residence in decontamination 'sards for the 
s. me period before going home and the isolation of contacts 
arc important Actise imnsuniiation ssith a consbmed sacane 
of Scarlatinal streptococci and scarlatinal toxoid has not set 
been introduced as a routine practice The prophs lactic use 
of passise immunization bs means of serum in diphtheria and 
scarlet feser should be re cr>cd for special indisidual ca cs 
or for children s dcparlmcms and ssards 


SPECIAL JOURNALS 


Acfa Pathologtca ct Mtcrobiologica Scandinasica 

Cc'^fihapcn xcl 15 la 19*® 

Pc uliar Tjpe cl H cno i is P aJ i cd t Sfa fii/c<‘i<cus ci» r«i — T P I tn 
Sidicx tn F n« Struaurc cf Lfcfinc Rood c( 'fa-’scui Mrrko — 

H OkVeR 3rd E T Ers * 

Funher Sluder on a Tracn Mytlo-x- Lci kevs n \Nhi€ 'lie II — 

H C Ra kN cl en a-'d R R-xk Niclvrn 
Tuh-rco' 'sn In A\ ' rj Litnph G ards — S Her z 
Siudies in S a-hjlccccci \I \\ha» Poe do St rh 'xcwcus Ly m p ir t 
Rahhiis Rood Corpjx*. « ard its Vnib-l tn f y n S aph lAcvnii 
Infccti-v* n Hurran B I’-jis '’ — j Firxrrjar 
Vfvcrhx. cpy cf Ncc*x-l Thxtoid GUnds I Thyi d n the — > Kx-x.h 

Stuph'ilococii — Throughout recent Mudiev ot active mimU' 
nization with staphxlococcus toxoid treMmcnt has been con 
iroHed Trd ns efFeci esiimaied bv the iitraiion of *inti 
hTcniohsm in the patients blood the red celK U'ed m such 
tests being rabbits Forssman prolexfs MrongU agninM the 
V hdiu ot this method the onU recommendation for which 
1 *^ the fact that the susceplibittlv of rabbits cells to Ivsin is 
^ more constant than that foimd m other speeies He not onU 
fnd-> that the htic capaciu of staphvlococciis cultures for 
rabbit and human red cells does not correspond but claims 
•to have proved that the ]\ sms acting on them are different sub 
siaocvb This a'-sertion is based on experiments showmg that 
large amounts of Usin for rabbits cells mav be formed in a 
LtUurc containing onlv a minimal amount of Usin for 
nuntan celk and on the results of fixation tests m which 
the human Us\n vva'^ absorbed leaving the rabbik Ksvn The 
*.nul\sm for rabbits cells must therefore be considered an 
antibodv unrelated to immunitv in the hum'‘n being and 
It »s not surpnsing that as numerous clinical observations have 
shown It can be developed rn large amount v.ithokn corre 
spending clinical improvement Foreman concludes bv 
^'»nc in making this anti h m content the ba<is 


of »n csiimjiion of the thcnpcuiic value of sen intended 
for human ihcrapv wc hivc in nn opinion gone astrav 
and the sooner wc gel HcK to the proper path the better 

Acta TobcrculosT Scandinavtca 

C\r<r)3tm Ml fx Pax I J9IS 

Few Cx cx «.f S credit <.f Lo^r cr Brorchi m Pu n*p*x ry Tube 'u' "rx — E 
*x-m> cr 

Vf \ at Ts 1*110 T-bcr vil'*' i hi Txxo r^crui Fc rsi D uk-t — 

C llcmbc*R 

P u X Fx ucn C X. rtcatal \\ircxvx,px — H Vtyh t 

Mass liiststi iitions in \onwn — In one disiriel the xiishor 
succttdcd in cxamminc xbout 60 per cem of 6 0-> inhxhinnis 
In each indisidual x full medical and personal hivlors ssxs 
obl^ined and x lubcreulin lest cxrried out In those c-'cs 
xhossing a ro'Uisc tuberculin reaction the blood sedimentation 
rxte ssxs determined and the chest screened I dms were tahen 
onJs of those m sshom the last examination mdicxtcd some 
thing xbfiormtl or m those other" isc suspect In ihe cecnd 
district the procedure ssxs different The indisiduals 
"ere first screened If xns abnormalits ssas detected or the 
histors was unsaXisfxctorx the sedimentation rate ssas deter 
mined x phssical examination earned out and "hen neces 
sars a film taken Of ' 400 inhabitants about aO per cent 
submitted to the screening Lsing the first procedure the 
author ssas able to inscstigate fulls about -,00 persons a week 
In the second dislnct he ssas able to screen about I 000 people 
a sseek Of the ‘■'60 persons insesligated 1_2 per cem "ere 
found to suffer from tuberculosis hitherto undetected, requinng 
actise treatment 

PUural ddhestons —In this inseslication the radiolocicxl 
pleural appearances "ere anals'ed m relation to Ihe possibilits 

162 c 


KEY TO CURRENT MEDICAL LITERATURE 


20 JuL\ 16 . 1938 


of indueing i pncuniotlionN In thiitv four pnlienls hkIi a 
prcMous plcurisj induction ^^^s successful m i fciv cises 
onl\ In thiru-one pilicnis \Mth an oblifcnled coslo phrenic 
sinus (whether or not previous pleurisv ms known) and in 
sixteen showing a distinct pleunl line a satisfactorv pnetimo 
thorax was never obtained In cightv patients with one to 
three single pleural spikes at the apex induction of a pneumo- 
thorax Was ncarh alw ivs possible adhesions corresponding 
to these spikes being gencrallj divisible but adhesions were 
often present in other situations in addition The results in 
this group were far better than in a group of 107 patients 
showing no signs of pleural involvement but with diseased 
parts of the lung extending to the chest wall In fiftv patients 
with no signs of pleural involvement and no extension of 
disease to the chest wall a pneumothorax was obtained in 
everv case 


American Joiinnl of Cancer 

L^ncisicr li.nn5>Jvann voJ 52 Apn} ^ 

Ccmpirttnc Stciaj of Rctlucinit Suhstinct (so-callcd GUiiaihionO of Ulood iti 
Nnnif MiIiRnint and Ntm mTlitmni Conditions —Arnold C Oxter 
bcrR Robert J Coffo J Arnold Uirccn and Claude r Diron 
SiiiUics on EKchTnBc of loias^uim bcusccn Tumour Oil nnd Mtdium —Arthur 
Lisnitzki 

rpidtrmojd Cirtjnoma in OsicomjcJms Cisc Report— J H it irrison 
•Sircoma Development in Mice Imccted with Hormones or Hormone hkc 
- Subst inccs — XL L Burns V SuniicfT and Ceo Bocb 

frinspbritablc Uterine Rat Sircomi of lOO per cent Transmivsibiliiy — 
Joseph A Polln 

Sircoma tormiifon in AmotoRous Gnft of MammTri Tissue — Albert fischcr 
Respiratory Ouoiicnis of Normal nnd t.cu\icmic Mouse Lymphnul Tissue — 
Jouph \ ictof nnd James S Potter 

Abihtv of Tumour Tissue to Oxiditc 1 au> Audi in Mtrp — Cnnco Gisrann 
•Comparsilve Effect of 200 k\ \ Kays nnd Gamma Kays on Puptc of 
DromptiRn melanpuaUcr 1 Dciermimtion of Equiv ilcm Hoentcen 
\aluc for Gamma Rtj^ It Summation Dtpenments with \ Hays 
and Giimma Kays — ) H Nfullcr 

Sarcoitw follo^Mn^ Hormone fiijiciioiis — Sarcomata were 
found in ten out of 247 mice injected repcatcdlv with various 
hormone preparations eight of the mice had oestrogenic 
hormones one hid lutein and proluton and one liver extract 
All the tumours save one were at or near the sites of the injec- 
tions The authors arc uncertam whether mechanical injury 
or a more specific chemical effect was responsible They con- 
trast the sarcoma-producing action with the specific effects 
of the oestrogenic hormones on the breast and genital tract 
and' with the action of the carcinogenic hvdrocarbons and 
discuss various degrees of spccificitv in carcinogenic processes 


Tilt Bhituh 

" M IDICaL JotTLSvl 

stalling point in each and was the death of a belovd 
relative in one case and the marriage of a brother m ifo 
second In each instance there was a loss of alleciinr 
attention and both children also had witnessed ,h ^1 
interest given to a friend who had trouble with her eT 
Recovery m each case was rapid One was admitted to tlo> 
pital where the change from home together with encourace 
mcrlT effected a cure in two weeks The second case vn, 
cured almost at once in the course of a visit to the phwicnn 


A7(fis/cv /’ro/i/iylnvis— The globulins were removed from 
adult serum and prepared in a volume of one sixth to on. 
tenth of the original volume of the serum The use of the 
scrum in preventing measles in those susceptible has Ken 
most Micccssful and has the advantige that the amount in 
jeeted IS small The serum can be prepared in anj well 
equipped hospital laboratory and there is less danger ol 
infecting a child with syphilis or tuberculosis There arc fe« 
reactions and the results are good The serum keeps nell 
Without loss of potency 


Amcriettt Journal of Oplitfialmology 

St Louis Missouri vol 21 April I93S 

•Birth iniuncs of Cornea — K I Hoi'll 

Problem of Ocular 1 ubcrculosis —A C Woods 

Lcbtr s Disease • — / E R'nf ind H L Bur 

riickcr Penmciry — L L Mayer and I C Sherman 

Tvscmial CardioMscuhr Hypcricnsion — P T Tookc md J V \ Nicloll 

Microsurgery jn Simple Gl luconn — O Barkin 

Tnchoma in American Ssmoa — r Harbcrt 

Cyst of Posionor Chamber —E F Krus 

Gonorrhoeal Ophihilmia ■— J C Gt«Rcr and R W Burlingvinc 

rroph> lactic for Ophthalmia Neonatorum — C Rambo 

Transparent ExophilnJmometcr — W H Luedde 

Si/t/i htiunes — ^Tliese injuries are caused bj forccp» and 
also by natural delivery, especially where there is sernt 
deformity of the pelvic cavity The resulting lesions include 
ghssy rods of Descemet s membrane, ghssy membranes in iK 
anterior chamber, and mflammitorv slrmds on the posicrini 
aspect of the cornea Several cases are described in detail 
Because left occipito anterior presentations arc commonest iK 
left eye is most often injured 


American Journal of Roentgenology and Radium Therap) 

Sprinsncld Illinois vol 33 Annl I9JS 


Eflcct of A Ra\s and Gamma Ra\s on Diosophda Piipiu — 
Drosophila pupae were used as test objects in the determina- 
tion of an equivalent roentgen value for gamma rays No 
difference was found between the actions of 200 kV v rays 
and gamma ravs on the pupae and the summation of the 
effects of the two radiations was complete The incomplete 
summation of effects on the skin ervthema threshold is 
attributed to a qualitative dependence of the skin ervthema 
upon the wave length of the radiation It seems that theie are 
differences in the therapeutic actions of 200 kV \ ravs super- 
voltage x raxs and gamma radiations which are not satis- 
factorilv accounted for bv phvsical and geometrical factors 
of dosage distubution 


American Journal of Diseases of Children 

Chicsgo vol 55 April 191s ^ 

Acute Laryngo incheobronehiiiv —J Brenncimnn VX M Clifioii A rnnl. 

and P Holingcr r 

Tonic NccK Reflexes in Children in Prognosis— R L Bjers 
•Hysicrieal Blindness m Children Two Cases — E VVroIfe and G S Lacliman 
Niitniional Heart Disease in Ch Idrcn — 3 I XX'anng 
ongeniial Heart Disease Clinical and Post moticm Siudv ot lOS Cases — 
S Gibson and W M Clifton 

T^^hylaMs against Measles with Globulin Fraction of Immune Human Adult 
^l^crum — S Karelliz 

pl^lobm Differences m Healthy While and NcRro InfaniN— B Munday 
^ M L Shepherd L 'Emerson M Hamil M W' Poole I G ^!^cl 
and T E Kaiford 

H\sieiical Blindness —Two cases are leported and both had 
manv features in common An emotional upset was the 

162 D 


Fhc Laminognph and ns VanaUons — J kicffcc 
Body icciion RoeniRcnoRraphy wnh Laminognph — S Moore 
V^cnificular Changes caused by Proved Tumours of Dram R 5 Stjne 
T i Schulze 

RoentBLn Suidy of Skull m Epilepsy — H Chor and E t Barih 
hlistorjcal I^LVicvv of Rocnificn Studies of Gallbladder and Newer ccit 
of Diagnostic Criteria — L J Fnedmah and P S rnedman 
\gucous Preparations to Supplani Oil n RocniBcnography ~H 
Bcmgn Bone Lesions showing Spmdic-ccll Invasion of J T MiirpfiT 

[iocniRcn Therapy of Infections of Nasal Accessory Sinuses— T N 
^Roentgeo Therapy jn Angina Pectoris —M G Wasch'and S G ^ 
Dostrc Chan for Inicrstmal Kodlum Element Needles— L A Pomeroy 
i-fcahng of Gastric Ulcer with Persistence of Niche— A S Unucr ana 
Poppcl 

Joeck s Sarcoid —r J Eichcniaub and I L Sandler 
liialitacive ChanRes tn I ormed Elements of Blood 

itndntion— K Kornblum V Boerner xml S G a, 

S flcrcnccs m Relative Action ot Nciitfonv xml Rocnigcn Rayv 
Relxied Tissues— R E Zirklc and 1 Lamnc 
iccondxry Radniion Inicnsiiy as x rnnevton ot Cctuln Ccomciri 

— H E Scemann „ T..hi- II- 

ipxthl Disiribiiuon ot Rxdixtion Irom a Siinctvohagc Rocnigea 

k C CotoKxn B Cxsscn xnd H S Hlydcn » 

TomoQiaphs —The hmmognph tomognph or 
, device for the radiogriphic presentHion of „ n 

lodv IS described and its principle cxphincu ' , „ ii,. 
if the various motions on Ihe resulting radiographs an 
xposure time are discussed Circular and ^ 

le advocated for the elimination of troublesome »P 
hadows and a special type of spiral molion 
hat purpose is described A method for ^ 31,0 

adiographic sections and a system of P ? ^oeiv 

iscHssed The importance of the method m di c 
\ therapy is stressed 



Jtu 16 t9iS Kb'l TO CURRENT MEDICAL LITER \TURE 


•tHKHrt riitKris — Si\U five pi(icnt\ with jntim ^Cl.torl^ not 
TcUc\ctl b\ ordimrv mediinl ircunicnl had > n' trcaimcnl 
applied 10 the ccr\ieo-tiorvnI and adjaicnt paravertebral 
region 69 per cent were improved iv 'hown hv rediiuion 
in the number veveritv and duration of the altacVe The 
theorv of the action of the i ravs le dieciieecd The tCMiUe 
are more favourable in anpiovpavtic ca'cv than in tho c with 
advanced arlerioccIerOMs or coronarv thrombevis 


Vmcrtcan Review of Tuberculosis 

Bah m rc a I 37 

rLmiifui Tc<t m O cn«v PuJrr D’*ta c — B U rc^MXt \ B 

Thvnptifi L G Glh-im n 
Tutcni >• f G i*^A ird Oc^V. — O G MjMm and S 
Hx nNw-' A ( ru’tr nan \rtcri — J F T u ni K Chirr 
Tt hcrctilc^*s i( Cen 'al Ljrnr^ v.xJcv~-P C Thctir'cn 
B ’jicral rhrer rent IrcTirh^n in Fu’m nar^ ruN-rtoJ'^* — R ' C ben 

-ni O I UucT 

D reten « m Tuher*u c< n m tr inl — C C Diucr 

TnPutmt tf ‘^nn’ tbi on tipcr rrcrial Tihercn -'n—X C Liii ^ 

S R Guha T>uiuriha 

Furciioi al Tist — Thic tc«t depende on the fact that in the 
healthv person the level of owgen intafe returns to a rcvtinc 
level vviihm ci\ minute' of the completion of moderate c\c 
ci'c The evcc's owgen need in thw period per vquarc metre 
of the bodv curface ic comparable in different per on The 
authors describe the use and results of the test in 'ilico w and 
in emphv etna and in the came conditions complicated be 
cardiovascular disease 

Till ruiihiis L\mph \oilcs — A senes of a(XX3 succes ive 
patients attending the tuberculosis dispensarv at the Henrc 
Phipps Institute dunng the vears 19 a to 19 s7 was studied to 
determine the incidence of tiibcrculo'is of penphent Ivmph 
nodes Results were compared vvith the records of ) 000 
successive patients attending the same clinic m the vear l^O? 
The incidence of both active and obsolete tuberculosis was 
apprOMmaielv the same in both cries The author therefore 
concludes that a lapse of thirtv vears has app^rcntlv not 
changed the relationship between glandular and pulmonurv 
tuberculosis 


Annales d Auatonue Pathologiquc 

Pars \cJ 75 ArrH IS f 

Chant, Epithc a! Ncrhruji and Bcncc lores Pr icjpuna ~-P XuiJlcLr-cf 
xic't'd Aiukmta o{ Scailct hc'cr •- oruted »uh 1,1 ertu'c Ant ru n 
Cfidrch with hpccul Referen-x to Legions cf senruA 5 err — 
\ AnthelcvT S F„s e and T r'<nafi>-C<'ni'an Jti 
C t \ l Intcrpa^ X1r'i'Cu5 of Krce — 1. M-aband ..nd H L Gmbcft 
L rnrhan-A of P»!cn Part of Stem ch — C RohJi h 
Fum TA Tubr'cu oms of G an« Pen s CTuhc cl'cjs Cha^Tcl— *1 Brunat 
' o •'hi.’cfu.rfl Studies of Hjpefcf i JnfUmrt*Don in XlL-s-fc Airopfuc if>*n 
IrucuMt) Rcl t on to Panjcipaiicn il Nenous 5) ifn m A Jc tiv 
Reatjons — i XI LasossV) ard D XXs ori>e» 

^rtirp/ogv o/ ot/Zfrgv — The authors rendered leg muscles 
in rabbits atrophic bv one of two methods — section of the 
nerve or section of the tendons The animals were then 
sensitized to horse scrum and given an injection of the serum 
into the atrophic muscle A\hen alrophv had been produced 
bv section of the nerve the usual allergic inffammatorv 
response failed to occur whereas in muscles of which onK 
the tendons had been severed tt developed as in normal 
mu cle These observations are said to support the belief 
that the nervous svslem takes part in the allergic reaction 
thev are also used tn an argument dealing with the nature of 
muscular atrophv and a supposed misconception of its mode 
of causation m nerve lesions 


Annales de Medccine 

P,rK sci «3 Spol l*Uf 

Acnen { Rrrc^itd InAuJm In coionT cn Siruciiirc *.iid Fon ^»cn ct l.*»ryfth<n 
T *Auc — F Aubenm A Licc«l< -nd R SjDc 
lAA-trtwStn e c-t C»r uUmn >n PcfJrhtrs > idrt> »rd Sr^co— M B eij 
srd I? Kchfer 


Inf jcr c if Co ajcral Ctfcufati n in C- « cf CirrhcHK rn B-IiiKc cf OJikc-c 
A mr'cnu and Amiro-a iJa m Fenrheral Bfoed after Injccn n of the c 
SvibAtaottA — R XfiMcns 

Sv’cT A tf Puirriurj Aftcr> 1 t itman n cf B cod Ga « m Lure D^ea cs 
— A 0< avVl 

Ri pit till fiisiilm In/u lions — Repented insulin injections in 
five dogs ciiiscd in increase in the insulin content of the 
pmsreis nd of the dog per kg to a degree higher than that 
loiind in a normil dog but lower thin that of fasting 
inimils The gliicO'C tolcnncc curves obtained after injcc 
non show that for chmcil purposes it is neither possible nor 
neccssarv complctch md constintli to suppress slight periods 
of hvpcrglvciemu It nichl It is sufficient to regulate the 
insulin do>->gc ncir to i point ipprovimiiing to that of full 
regiil ition 


Annals of Tropical Medicine and Parasitologj 

Livcrr^'<?l 33 AfrJl f 1**’* 

Tic^i-'crt < XI u,f i Studi cf Tbcrajxuti'A and Prcrh^’Jxt f Vfa^iria tr 
AAribtiw Orurv < cerp’U cd with 0>i ’’c — Lcanic rf Nan Heshh 

<• r r T-i n 

Xftc h Pi t f* rcTjfc tf>»T d-n- It n Thr b- k- widi Spccul Rcfcrtr<.c 

f Tran i n o* Or fuvrrcc * fit/ui Lcuc*.art — E G 
n EiA ' 1 ,^'* S mu’d c 11 — E G C bbom 
I V. I Xtf n rf Habtc* X irts n a Xamrre Bat — J L P wan 
Pf cvTi n fiT Rotf< c' P dirn n Tft'*cs— D B 

Aat» r\ n Kc r ratcTr Mcubcli n if XfaJaria P^ratHc^ ard Tnrarc- 
_s Pi Vafil Cbri loph n and J D Fuller 
b De trrkf rf l3n>r» LbC'*' <H>t n LpiaVc Tni'anrHcnn iFrirarc 
i *"a hocc ;rnjri and 'fab'U Par'll ica tf/crier^w^ Ar<?*«frs T — • 
S Riciard Chm cnXcr» and J D Fu't n 
5t t r» in Oir** hcTa-> W M Acme- cf Lruec*.ne D arr d c in Xf.»’am ■— 
F Gi r Hush** E X! Ltjnc and XX XerXe 

Risptrciorx Mtiahohsin oj Mnitjrm Porasitts cnl Tr^fmto 
5r»w —Normal or 'irscnic rcxiqanl stramx of trxpanO«omc< 
in the presence of pluco<e take up large quantihes of oxxgcn 
Exen in the presence of glucose the process bccomcN gndualU 
inhibited bx a reduction in pH xxhile depnxed of gluco'^e 
irxpanoxomes rapidK die Oxxgen uptake bx rmhna p'ira<itc 
‘ubAtance continues sieidj|\ for lone penod^ exen tn the 
ahvcnce of glucose Jn 'i medium containing malana par'ixite 
«tib<txncc there is considerable consumption of owgcn an 
pproximatelx cqiMl output ot carbon dioxide hicmogJobm is 
ultcred non protein nitrogen is increased there ix no acid 
torm^'Hon comparable to that produced bx trxpanoxomex and 
there IX no detectable increase m ammonia the xerum appears 
to plax Imic part m providing the requircmenix of oxxgcn 
uptake and the parasite can rcadilx take oxxgen from the 
ovxhacmogtobm of the cell 

£/7m of Dn/cs — Certain drugs cauxe inhibition of the 
oxxgcn uptikc m both trxpanoxomex and malana paraxitcs 
The effect is to some degree paraUef to therapeutic effect and 
max be rcliHcd to it oxxgcn uptake cxtimauonx might conxti 
tutc a dclicHc means of xtudxmg m ufro the Jcihal action of 
drugx 

L nPfcatc Dinniultm — bndccanc 3 13 diamidmc nn expen 
mental irxp nocidal substance the formula of which differs 
cmirch from that of anx known anti malarial drug was found 
to h'*xc a xerx definite but temponrx action in induced benign 
tertian and quartan malarn 


Archil fur Kindcrhcilkunde 

Siuuran >cl 113 An*' t** 

ACir^wnc Siibcuwnca Nconaicrum — R 2cHer 

•.nC Pathoscn«is ct Adipo-necro^n Siibcuunca Nconairnim — 
O Grutr 

Acme MwJd c c-r Diacsac in Children — J Schcidetcr 
Xcfir Ccrteni in Ccrebroipioal Flu d ol Oi d wiih Special Rctc'Cn e ic 
Inbutn^e of GI>coKtj Ferments —B RitneJe 
Vcw Ccoir'tuuonA lo Jhfaniilc Acrcdmia — E Xfayerhofer and B Dr*«ri« 

■iciite Onus Media — Scheidelers paper underlines three 
faeiors <1) the heredtiarv factor is at least as important as 
the anatomical m the production of the condition 12) m 
twffuetizal otitis u is of importance for prognosis and treitment 
to djstinguoh between pnman otius tn which the infection 

K2 E 



21 Juu If, 


KEY TO CURRENT MEDICAL LITERATURE 


Nvfi.ch (nfcction takes place through the Eustacimn tube (1) 

...X 5 ssrr ■' ■" 


MtDJCAL JOIRV^J 


Intimal haemorrh igc was also sometimes fn.ir,,! ,i . 
of thrombosis some other factor must u 

and tt ts suggested that tins m? 


Archucs of Oto\ar%ngo!oR\ 

ChicnRo \ol 27 April 


1 jLu! PtKj o[ Otme Otiftm — A H Ptrski 

Ilevdopmsm Of Otis C.p,.,ls IV fo^nl. Po„ nmiirim-T II llao 
Vavommor lUimius and Mind rondKiona ircaud imiI, Sodium Morrliinic 
Palunmirj lUpoti— 1 t I Mint 
'Coniimiousl, Open Cionilinn luPe — G E ynmMpsli 
Inn imm nor, Urondnil Inmours One Ca c end Ucmos of Lilcr duti, — B S 
rpIliV S Cohen and A M Gna st 
LBeeiv of DcuRs on him Vascnliris— VV I' Coull 

OdTirential Diaqno is ol Bacari d Meninsltis ot Aurd iiid Nisil Oticm — 
lea nsKin 

Nisd lonlration Hisioloersal and Clinaal rialinilon — <\ U Hollcnder and 
“s D Tibricanl 


*tliretl Iniplaniation of tree Ncf\c Grafts beivseen ratul Miiscidttiife and 
riciit Trmil, nrsi Cise rtporud — L I Cirdwill 
Closure of Ptrsisieni Posi-optranu Masioid listuli h, Jnibmiantoiis K-dunsii 
lated I lap —I A Copps ind G L MtCormnV 
Eiisril Pressure Sptml tor Nose — V 11 Kajinhin 

1 111 treiilosis of Upper Itespiraior, tract Summutics ot Eitctaiorc of Pist 
Tss o V c irs — G It VV ood 


Ofrff / ffsfrfc/tffffi Tti/ii — The continuouslv open Eiisi,ichian 
tube although a rare condition is a verv dcrinile chniLal 
ciititv not often desenhed in textbooks It occurs in 
cniaci ucd patients ind is then due to the absorption of i 
pad of fat normallv surrounding the cartilaginous end of the 
Uibe (Rczold) Shinibaugh has found that other factors mu 
enter into the ictiologv of the condition — for example scar 
contnction m Roscnnnillcr s fossa after the removal of 
adenoids or after irradiation of the nasopharvnx for carci 
noma The treatment consists tn the msufllation of a ponder 
composed of 1 part of sahevhe acid and 4 parts of bone 
void into the Eustachian tube 

rnc S’ene Grafts — ^The removal of a parotid tumour 
nceessttated the cutting of (he facial nerve trunk and of all 
the peripheral branches leaving a gap of 6 cm The trunk 
and branches were marked with black silk Three davs later 
the wound was reopened and free nerve grafts taken from (he 
lateral cutaneous nerve of the thigh and the anterior 
cutaneous branches of the femoral nerve were transplanted 
between the freshened edge of the stump of the facial nciVw 
and the peripheral twigs Si\ months later there was still 
complete facial parahsis hut twelve months afST the opera- 
tion the paralvsis had completely rccoveied except in the 
forehead area 


Archives of Pathology 

ChiCTSO vol 25 Apr,! 19VS 

Cardiac Coniusion Espcnuiciilal and Patbolosical Stud, — A tt Moriir and 
I P Atkins 

Tspins ot Blood and Seiniml Siam, by Absorption Ttsl — K C Eindd 
*Capi[lary Rupture wiih Iniimal HacruorrbaRc as Causrttic racior m Coronary 
Tbrombosis — J C Ptterson 

EfYcct of Certain Arscmics on Liter — ^VV C X'on Glahn E ft Elinn and 
VV^ F Kcim jun 

Erteci of 1 2 s 6-Dibcnzmihricenc an Spindle cell Sartoma at Hal — 

F A MeJunkin and W W'olavKa 

r lie of Etyihtocvics and Granulocytes m Spleen following tnieclion inio Blood 
Stream — H wahrle 

H cniocbromaiosis with Primary Caremoma ot Liver — C H Btnfotd H L 
Lawrence and ff L VV'olienwcber 
Pritparv EndoiVichom i of Spleen — S B Billet 

Role pt Vitamin B in Resistance — D Petia 

'’misnfion of Coronaty Thrombosis — The immediate cause 
thrombosis in atheromatous coronary vessels is unsettled 
ateison presents evidence that its cause is often the rupture 
of the intima of capillaries derived from the lumen, owing 
presiimabl5 to softening bv atheroma of the supporting 
stioma and to a high pressure in the capillaries Intimal 
haemorrhage was demonstrable histologicailv in thirty two 
out of thirty-seven thrombosed coronary arteries, and reasons 
aie given foi regarding this haemorrhage as the pnmarv event 
and ' responsible for the subsequent change in the lumen 
162 F 


Atisfrahan and New Zealand Journal of Surgery 

Sjdnc, \ol 7 Jamnfj lyts 


•fbduid Cus in, oiling Dome ot Liver— L Biinicii 
li Inin, 13 —A V Me h in 

Cspcrimcnnl Obicriniions on fncrciscd fntncnnhl Prcmire— R 
Siirginl rrcainiini ot Dciachment ol Rctin, — VV H Robenmn 
Ifcrnii and us Opcruoc Trntmcni — Ij Omek 


D 11 nth, 


H\diitul C\U<i — A review of the complications assomlu! 
with old standing hvdatid infection of the liver The meiboil, 
of surgical treatment are contrasted 


British Journal of Anaesthesia 

Minshcstcr ,ol tS April Ills 

Osuh on the Table Vddress to Sindenls — C Edinrds 
Ncnihiit il-tlilornl N ircosis m ChiWbirih — r H Malhnson 
•rtirtc Oisiiiibing Cases ot Spinal An lesilicsia administered aceonlim il 
Dlicrinkton Wilson Technique — C VI H van dcr Posi 
Carbonired Tiber Inr Anaesihean — K E Madan 

Cllitr(iif,toii 11'ilsoii TcdiitKiiie — ^The use of percunc, ) in 
I W bv the Fthennglon Wilson method was folloiioJ m 
three eases by serious collapse two of the patients died Tns 
operations were Caesarean sections with one death the thin) 
was for ectopic gestation The author questions the saltii o! 
the method and the acciiracv of the figures for the spcifi 
gras 111 of the cerebrospinal fluid and for the dilTusipn taR, 
of injected fluids on which it is based 


British Journal of Ophthalmology 

London \ol 12 April ISIS 

•\ attic of Orthoptic training — Frank W' Law 
♦Sodium and Mereiin V ipoiir Lamp, m Ophilialmoloei — V J Batob" 
Histolog, ot Bowmans Membrane in Glaucoma — Graeme Taibcil 
Esfoliaiion ol Lens Capsaile in Glaucoma — Alcvander Oatinw 

OithpptiL Tiaimiig — ^The assessment ot the value of ttib 
treatment depends upon the definition ot a cute Tlit 
author considers that in ^ome cases a good cosmetic reuilt i' 
suflicient some patients onl) require a moderate decree of 
fusion and to aim at a good stcreopsis is to aim too hu-h 
Jvidged on this standard one third of ninetv one unsclcticil 
cases were cured without orthoptic tninmg Further onhopu 
training, succeeded m curing less than half the cases Th 
greatest disappointment occurred in cases of abnormal rciim' 
coirespondence where onl) three out of fourteen cases ueR 
cured bv orthoptic training It is suggested that more squieh 
than IS generallj supposed can be cured bv glasses vvitli or 
without occlusion Onl> cases in which this treatment M' 
failed should be referred for orthoptic training when a furlncr 
selection bearing in mind the end result desired is 
The results of orthoptic training have prevtoiish 
described too optimisticall) in the medical press 

Soiliiim anil htcrciiis I'apaar Lamps — Lamps smlahle for 
use with a reflecting ophthalmoscope are non availawe a 
show up the finest details m the retinal vascular sjstem 
mercur) vapour light emphasizes the surface relieves o 
retina while these are eliminated b\ the sodium light " 
gives a clearer view of changes in the choroid and the top 
lavers of the retina 


British Journal of Radiology 

London 'o\ 11 


‘d \ rLKPAncy — C Rohin \\ (Iliams 

piodol m Localujiiion of Spmaf Tvimours'-H M l,»i- 

'unficr Ofistrvation on Multdocuhr C)*^pc Di>c 

W A Jonct , ,, , _ 

bM.rv-ii,ns on Cases ot Sunnrcml Tiimour -M " j„j II '< 

oage Svstem tor tnistsimal Radium Thcrap, I -R 
Firksr 



Jin 16 10^': 


1 \ Kat' n Triranc me — iTif L Haller i ci-(cr 
M aifl f Rad um tni ttr ^(ea uri ic D»'<aEc ami Ifannrt Itcaimcpia — 

I C Cnmmcn 

Fiiniihiil Miihili cltlfir C^^tH iit tht Jrri(5"Thc ion 

dmon dcunbcd is one of miilliplc dcniiscroiii CMti oiciirring 
ihroiighout boih ihc upper nnd loner jms ind setom 
p inicd b\ n chronic hiperpbin of Ihc lubninvilhn limph 
ghnds It iiMialli bciomcs appircnt lomrd« Ihe end of the 
aciond tear of life The piper la illuatntcd b\ r^’diogripha 
rOd photocnphi of 'eicnl members of one fimih 

British Journal of Suneen 

Brpiol \t,l **5 

r'oit vi ..r<J Dc»c?trr^eni f Surr'.a'al Iwrirrm^ — C J S Th 
Fdira ^ 1 * tf RjddcT a*rxJ Nairi I -xi -ii} tcUie of Anic*thc»j —I K 

Ferttn^n aru K N'aiV-i"^ 

C-fii-ocna i'njfl In c'Jir I i-i. C 

r rrh-a'vcc >a'wicil ''nh H'rcfif rf'’n imJ Ocfi Pa-atr —Xf C Oct re 
Cht n l,'*nrX ■'Cv.cr'3 E D Telford ^rid H T S r'non 
P ocaijons and Fmt.re'd 'cvratio**' of rcl\i<— XX Jcf^ 
farhc’ciT of S oj c N-icule c TFsti J Cand— A M ro%sX 
cc C-^ or XcNural Di><n«.uU— R O XXard 
Or<~ti r ..nd Otruraro fo Otfi Pa urc —R R ftiico'i-d 
Clirtval C jr c and pji*> r> of B rm ard S^alc under xtxJeff* Treatm<rt — 

XV C 'V“ o" A R Xfa rTtfOT ard CPS e»aa 
0*fr»xL fena of Vti -^E H A rak«.dS L Paler 
Cj"*od Anninsn of Ssslp — F Rundle 

t'oeiTTienul Ip»e'nr 3 tif*n of Cjino of P at (clowirc Spinal Anac<t .. 

A D Xfacd njld ard H k W 
■Scncus Centre’ of Ga tru SeTct»rn ~T A lit' op- 
■^cn xn r*CTcf in TraU'naiiv Shotl --D Al-me ard LOS aufhne « 

Post spinal 1 Ijiiof Pnnihjis — This is n analssis of foiir 
teen ciscs of this lOmplicalion The tuihors are forced (O (he 
conclusion that the tosicits of the spmil ^nae ihelic used — 
heiw duracaine — is the causaliie fsCior Hence ihei regard 
this substance as a dangerous nme'lhelit 

Burns — This article represents a detailed report of the 
imcsligalion of simv five cases Special reference is mide to 
the pathological findings the cau'C of toMcmia and the 
optimum jncthod of treatment 

British Journal of X’encrcal Diseases 

tc-den >cl 14 Art ‘ 

Eartr-icrul Cortnbot/Cn to Sfi-dj cl An I ic Hjrrrnhtrtrn rt xJ ec tj 
Ph -al As r < r A AHxtt Bo' errarr 
Lrcihr^cc** Si\.d> cf 00 A a e Palters n a Nrncrr } D ea o H ■"P f — 

C H Rcffiharcf XV M Bnancl ^ivd k o Sha» 

C—p -nd P 3 jn EnpJi A Liicraturr— D Amj Ps>ucr 

t ard Cau e of Phoba intli Spcci~I Refe cncc to S%ri‘ cr 
J A Hadf d 

S rhj}j~<. Ep didjr- A E XV McLachlan 

Lntfiroscopy — Reinhardt Brunet and Shuxx state thit the 
chief indications for urcthroscopv are chronic discharge dt^ 
vomfort in anterior or posterior urethra haemoxpcrmi*i 
persisicnl prostatitis premature ejacuhtion and urethral 
Mnciure Essential requirements are careful selection of 
Pcjiients cffeciixe anaesthesia gentle instrumentation avoidance 
of trauma and correct interpretation of what is teen The 
principal lesions seen m the antenor urethra are soft and 
hard infiltrations and in the posterior urethra evsts enlarged 
prostatic ducts congested and enlarged xerumontanum and 
^ofi and hard infiltrations The technique is described m 
detail and an account is given of the appearances of the 
normal urethra and of the most common pathological changes 
5een It is concluded that the use of the urethroscope is as 
necessarv to phxsicians who diagnose and treat urological 
conditions as is the stethoscope to the cardiologist 

Syphtlitic Epiduhmtus — \fcLachIan describes seven ca cs 
of sxphihtic epidjdvmiiis — a comparativelv rare lesion 
three occurred in the secondary and four in the tertian, 
period In the majonlv of ca«es the globus major was mvohcd 
but the bodv and globus Tnmor mav also be affected The 
lesions xarv in <izc from that of a pea to that of a large olive 
and mav show tense elasticitv or cartilaginous hardness sinus 
formation mav occur Histoiogicalh the changes are mamlv 
interstihal and fecundiij is not usuullv affected Diagnosis 


T»i Bunup *>' 
MtCfCAL JnCHN^L 


depends on the exclusion of gonorrhoea tuberculosis cwic 
and mihgmnt di'ci'c concomitant evidence of sxphihs — '^ero 
logic il or clinical — and possihlx demonstration of Sp piilluia 
in the epididvmil lesion and complete resolution under anii 
specific ifcttment local treatment is svmpiomaitc and con 
'i*ts in 'uppon npping of anv hxdrocelc etc as indicated 


Dtutsches ^rchix fur Klinischc Mcdizjn 

Ecrl n »rl IfC Ar^u 
C!»4f**cfa —A Ruchl *r*J S TFst-cj 

J.««t n *f D*bct! Cera and rTir»-*l aem.,. Sjmn mi o Jr ur" «<rM cf 
Ijicrnai ard Infernal I frcii m of Fark-fca — R Due«htr» ar<l H 
EuihuT 

rrecnon 4 '< i Xtn tfina Se^ ndjri lnfci.u n rn Br ^v^c•^f'Xfr' oa_ 
X! Culc tcefcr 

Vc%. ln\r»tJffaiKSW jr C J n31 rn cf V»U! C-r'niy cl L rri 1 'fen «rcJ 
VV rtren — 't Rc«ch 

X <u lA CA «n B ^CA H Afalrrurt Tur-rur^ Reioii 1 vtcnuJ Pur Torc« — 
S 'farcrT 

Pi r r m Bc'nc Marrnw i- \ fru and PafP J t al O od'i r — H Ke«lha k 
V>c n- IttiV cr*ja C'<1^t^ed liifh Fun urlVe L R xnhi d 

D '•c crt«’ D-i-tn « of •* A *Tcro rd Ccncrcn t Fen ard C r xun cr r a Ft 
K\r’v.r’af*'T — r Bc^ref 

C art. B IT aJ lr»r«tira{j n of Re ai*rA t<i»cen Fftu tarv ar-d H>r<r 
r c'*' — VX Rcftfcld 

\ 1 r iir-Ati r Otbfcn m I rire m Rer-al D lurt^r cm— P Erm” 

r^ r \ S-f^1 

Pf run om\iosiS Mmornw — A pTticnl developed a pro- 
longed I'pjcal rise of temperature alter bronchopneumonp 
fungi were found in the sputum Thi< complication xva con 
idcrcd to be pov'^ibK due to diabctCN Treatment vvuH 
lodidcv proved successful as in the onlv other ca^c prcviou i> 
reported in the literature 


Folia Hacmalolofjica 

E<fln VI • 59 h Heft - 

Gcrr*^ Rrc B xx. Cc) * ard naidetj n XtaTr-a i — -J Or Vrv 
Fr-tv * X Siefn»l ru“'*jrr4 ir P- r* i-ury Tcreri'-^t — P La^erdir li 

f u.ar Cr> al Ja^ ■* prrtr rr m B xJ Jrrum in xf d ma — B % 

B - w rf H Cri lA ard Hi P.ck. n 
r» ec fence cf Erjirrxitcv Ca^.‘^< fr-rre-rji rn »» h A l er Fi - 

r*ert ’ LraJ P t n/r- of Ka^**lt — Vt ka h^ra ard vf S rahanv 
Ilf er c r AimorAcn Dijfen in Pr «.u t n of Ca'* e » jh vrciuJ Be ct 
rr c In Bl->oO ft n in En^rvor Life — C S Er c 
Nt-n Trcj me*' r Pem nouv Anacmui St^c-^’'an. 
frrh 'IX C4n n Aruiacn «. Ar.jc-rja — S L< » "ser 
B r T ff>» cf Cerrun Haer-auf -.ca Liter lure « 1 S ' i — J Hrx.hfct. 

Er ir pAv of Ar-eri-an Haenat f'etcal L cratj c fist » j i -res 

Ornisn of Red Cells and PloicUis — B\ the u c ol a pccial 
method of Mainmg and fixation H was shown that the phtcleis 
rc not derived from the megalokarvocvics It is more 
hkclv that ihcv arc the nuclei of nucleated red blood cells 
eliminated ni the moment when these cells arc leaving the 
bone manow Bx a conbination ol phcnvlhvdrxzmc and 
lead poisoning in mice and rabbits gum platelets arc formed 
which show all the transition stiges down to free dis- 
located nuclei 

Blood Serum in \f\tlonui — Two ivpes of crwtils were 
obverxed in the scrum from cases of mxcloma One was 
found at refrigerator temperature after a few da\s and was n 
spontaneous precipitation of boat shaped rhombic semi 
morphous protein crxslals 2 to 3 mm in length with the 
richest crvsiallizaiion in the bottom laxer The others occurred 
at room temperature after ten to fourteen divs and were 
smaller and needle shaped Thex were soluble in dilute acid^ 
and aikahs at pH of from 4 5 to 9 insoluble in water saline 
alcohol and ether and had a molecular weight of about 
200000 compared with 140000 to 160 000 for ordinarv «erum 
globulins or 40000 to 70000 for Bence Jones proteo«^e 

£r\t/iropotests in Azofatnnt Anaemia — ^The «ternal bone 
marrow usuallx shows a diminished erx thropoiesis and more 
rareh an increase In azotaemic ca-^cs the anaemia is of the 
loxic form without regeneration The toxic substance either 
diminishes the erxthropoiesis or prevents ripening of the 
enihroblasiic cells "" 


TO CURRENT MEDIC \L LITERATURE 


162 G 



Ciimpla Hum- o( InmfuMoii— M Sitiir 
•LfTtHs of SiirMcil OpctaiioiK on ihi. Ilciri —A Hii«in 
KImonn of Sp».c trciM (,j UmlKcril rinthKoid.cionw -I r 
Ai)i.nonn of Li\cr — U GoHin 


•Ihird Note on Infccloity to Mm of a Sinm t, 

J"r 

^‘“""’Holbid”'^’' "’''’"“''’‘’'■'‘"“'"’'■'-G M Dcchcred a„j i„, 


5lllpcl^ anil the Hiinl —An nccoiinl is gt\cn of the effects 
of gencnl and spiml anacsthcsn on the pulse ntc nnd nKo 
ol the effects due to the openlion itself The mhous Upes 
of nmcsthctic arc discussed and graphs illustrating the pulse 
riitc in each ease arc gnen The effect of the different 
surgical procedures on the he in action is also shown b\ 
means of diagrams 


Journal of Industrial Hjgienc and To\icolog\ 

Ilaliimorc sol 10 April ISIS 

’lormiiion of Oxalic Acid from Dhjicne Glycol and Uclacd Solvents — 
r n Wiles W’ C Hiapcr'D S tlcritcn anj r R niood 
• Sir Ptirificafion in Inliihncd Roorna by SprayinR or Aiomirinit HvpiKhloriit\ 
— A T Mavtcrman 

Gavcv from Carbon Arcs — R W Coltman 

Iliolosical EITeciv of Inhalation ol Carbon Arc Tunics —E L M icOu'dily 
1 Perry Tollman Leroy W' La ToivsLy and Milward Bavliss 
ComhiiMion Products of Carbon Arcs — E L iMacQuIddy 1 Pertv Tollman 
Leroy W La' TotssKy and Mdivard Rayltss 
Vcntil ition of Motion Picuirc Dooths — I hilip Drinker and ) Raymond Snell 


CKpenmcntal T rlwdestensc Injections— A strain of 
T r/ioclesunsc transmitted by G ‘ nwrsitans from man to a 
sheep in October, 1934 and maintained tor two sears m 
sheep bv c>chcal transmission b> G momums was pasSeil 
siiccLSsnely through two reedbuck an impah a dikdik and 
then by parallel transmission to an eland and a reedbuck 
Two African volunteers resisted infection from flies which 
fed on the eland but were afterwards infeued b\ flics from 
the reedbuck and a European \olunteei resisted infection 
from a fly infected by the reedbuck Owing to the earli 
death of the flics it was impossible to test the third aoluntcsr 
with the flies that had infected the first two so that a differ 
cnce between two flies which had fed on the same amnia! 
could not be shown 


Kfinischc Monatsbiafter fur Augcnhcilkunde 

Sumaari sol 100 April 1918 


ronnalion of 0\nlti Acul — Ethylene gUcol and its dens a 
ti\es arc being increasingly used m medicine is solsents 
Animal experiment showed that their administration produced 
oxalurin casts calculi and dcgcncratiyc changes m the kidnea 

An Pitnjicaiion />a Htpoihtontes — This method offers a 
cheap and effcctne means of purify jng air in inhibited rooms 
A design for an cflicicnt spray is shown and the tethnique 
explained 


Journal of Larjmgology and Otology 

LonJon vol 53 April 
•L»mpJio cpuhcliomdn — -J I Munro Clack 

OpcraiJ'c ireatmem of Chronic M-isioid Disca^ic — Somerville * 

Strcpiococc'il Mastoidui^ nnd MeniPRUis CoUoNMne Simple TonMllcttomv wuh 
Rcco\tr> — A B Smith nnd C E Scott 
UtpTir for P-irtnl Eoss of Auricle —C H'lmblcn Tliomas 

Lunpho cpithchoniata — Lympho epitheliomata are tumours 
which arise as a rule in the tonsillar region or nasopharynx 
Clinically these tumours are characterized by an extreme 
degree of radio-sensitfvjty , but pathologicaDv there js a good 
deal of confusion m their classification formerly they ysere 
described as sarcomata Surgical extirpation should nexer be 
attempted and the treatment of choice is by y ray therapy 
yvhich usually produces a very rapid local regression if a 
good immediate result is obtained local recurrence is unlikely 
If the patient passes the three-year limit yvithout developing 
distant metastases he may be considered cured Treatment 
of skeletal deposits is probably useless Of six patients treated 
by the author, tyvo are alixe after five years and one aftei 
tyyo years Each of the remaining three survived only a little 
oyei one year after treatment 

Journal de Radiologic et d’Electrologie 

Pins \o\ 22 April 193S 

Bici.nicmr> of Luigi G ilvini — E Coitcnot 
Life ind Work of Galvam— F L ugnel Lavistinc 
Animil EJcctnciiy and Modern Bio-clcctncily — J Bcloi and H Fi>ch*oIJ 
FcstiMiies to Commemoraie GiWani Bicentemrv (Bologni Otiobcr 17-20 
195T)— J Belot 

E\pcnmcnial Sarcoma following \ Ray Irradiation —G Gambirow 
Peptic Ulcer of Oesophagus —J lerracol P Lnmatciue and P Be*ioufi-rc> 
•New Radio-diagnostic Method Pneumo-pre peritoneum — G Bornm 
Nicohs Tesla — M Kihn 

Pneunio pfe-pentonciim — ^The method described bi Bonani 
consists of injecting the air not into the peritoneal casity but 
between the fascia transversalis and the parietal peritoneum 
The injection is made under radiological control The ads an 
tages of this method of pneiimo peritoneum are discussed 
162 H 


Tuflhcr Ocuhr Studies in Uniovular Twins m Advanced Life Inltcnisn e t4 
Sent scent Cinnkes — A Vogt 

♦Ocuhr Blood Pressure with Special Reference to P til oloey of Taheik (!>.% 
Atrophy — K. Albrich and f Ivukm 
OliRodcndroBlioma Coninbiiupn to Inindunl Optic Nerve Tumaurj-E 
Schrcck 

GlioWists nnd Spongiohhsts in Origin of Retinal Tumours— f Fsiali'ti) 
•Corneal Lesions in Hcrcdiliry Palmar and Plantar Keratosis— H Rithnn 
Crvsiallinc Degeneration of Conjunctiva and Cornea —f Blobncr 

Octtloi Blood Pressure tn Tabetic Optic Atioph\ — In i cntival 
analysis of the recent yyork on the relationship of the Wool 
pressures in the retinal vessels to tabetic optic atrophy Ik 
authors conclude that on Sobanski s own findings the asvimip 
lion of any such relationship is unyvarrintcd Such thcnpcunv 
lesults as Sobanski obi lined must be ascribed to reasons oibu 
than those he advances 

CoinenI Lesions in Heieditao Keiatosis — ^To the etownt 
literature on the association of eye and skin diseases Rictiiw 
adds a report of the occurrence of epithelial changes in tk 
cornea, in i patient ysith hereditary keratosis of the palmar 
plantar areas Four other cases of eye changes in this affcv 
lion recorded in the literature are noted 


Quarterly Journa of Experimental Physiology 

London \ol 27 February 1938 

Effect of Adrenaline on Vasomotor Rcllcxcs—L Clui and P \ ^ 

Metabolism of the Isolated Mammalian Heart under Piriial Anoxia-- 

Ooguc I Chaag and R A Grcgor> rmiK- 

Inhibition of Watcr-diurcsis by Emotional Stress and by Muxettuf Li 

H Rydm and E B Vcrnt> m Pj^ 

Studicik on the Chemical Nature of the Anli fermenting PrincitMC 
Tiger snal^c Venom — E Cham and L F Goldvvvorih> 

A Compvrison of Lysozvmc Preparations from Egg white Cat 
Saliva— E A H Roberts B G Macgrutlt and H '' 


Tubercle 

London aol 19 April 19^? 


*SilicoMS in British CoalHclds — -W t Cooke . 

Ecjthrocjtc Sedimentation Rate ih Pwlmonan Tubcrmiosi; 

Dcscnsiiizition of Tuberculous Guinea pigs— 'I D Tbaytr 


5i/icom— After indicating the incidence of ‘•’f ‘’''"''^1 
ifferent parts of the country the author discii 
he mineral matter detected in the lungs anu ' 
ypes of the disease found among coalminers . j-J 
he disparity in the incidence of silicosis m ihc , 

he northern groups of the British coalfields md 
leisures of presention 



the BRITISH MEDICAL JOURNAL 


Jtu Ifi I 9 JS 




‘ Yitamili Bi cleficieucy 
an outstanding fault 

in the diet of man> imllioii>« of jiLople 

tr^'fj i6 O f loi* t *5 > 

The reduction in\itamm B, intake due to chances in 
dictar\ habits during the hst hundred \car' normaU) 
amounts to at least so per cent 'indma\ be as much as 70 per 
ccn» 1 : has becn'dcmon'^tntcd both CNpcrimemalh and 
clinicalh, that a ^ho tacc at \ itamin B aciN as a limitin’ 
facto- m the maintenance of health and nutrition and olten 
results in gasiro inie tiral disorders, lo«;s o*" appe itt indi- 
gestion constipation and if lone continued to neuritis and 
arthntis 

The. logical \sa% to rcctifj such shortage is to re to c 10 
the diet ihe\ itamm B con aining substance svhosc rcmo\ al 
IS rcsponsi'^le for the dc^cicncs 
This substance is asaiiab c in the form of Bemax 
For scars it has been the polics of the propretors ot 
Bemax to ensure its \ lumin B ac isnt\ b\ bioKgical assas 
cT.<.ry da\ s c ttf ii So far as is knossai Pema\ is the onU 
food produa to which ‘uch a claim is or can be made 
The qu nutv \ itamiu B , supplied b\ the no-mal d iK 
dose ot Bemax— one i2blesp''oniul — -is 200 International 
l-nitSj an amount sufficient to raise a dcffcicnt diet to an 
optimal lc\el 

The normal daiU do e of Bemax supplies in addition to 
N Itamm B sigmhcant quantities of Vitamin B and B 
Copper Iron and Phosphorus as well as nch quar'ities of 
\ itamm E and o her essential dictan elements 

Eemax is an entireh natural produa consisting onh ot 
tabiUsed wheat ge-ms seleacd for their Vitamin B , ac i\ in. 
With no addition whaisoe\er Clinical samp c and litera- 
ture on reouest The Bemax Labo-atones, 2>, Upper M’ll, 
Hammersmith, W 6 


Sterility and 
nabitiial Abortion 

The increasing use of Vitamin E for 
habitual aboruon and sterility of 
dietarj' origin demands a wheat germ 
oil of pro\cn high acuvity' and of 
stable Vitamin value Such an oil is 
available for the medical profession 
in Fertilol 



Wheat Germ Oil Capsules 

A highly licit t. so irci of Vitanim E 

A comphmentary box of Fartthl Copnles and 
bra huTi. sent on rc-ju^t 

\ 

I'll imins Ltd . 

(D< ])I B 6S) I pji-r II ill London W 6 


Dietary authorities agree that the 
average diet should be built 
around bread and milk. 

BREAD 

. . . for energy 

CPH 45S 



34 


THC BRITISH MEDICAL JOURNAL 


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JiU 16 193 S 


THC BRITISH MEDICAL JOURNAL 


35 


WfuXt Id a 










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can see but a balanced com 
binacion of high ^^uahty «n 
grcdients providing a vitamin 
range from A D rich m dex 
trine, malted and IffA m starch 
content Evolved by Or Go’d 
jng founder of Charmg Cress 
Hospital Recommended for 
infants from 6 months and on 
v/afds in Welfare Centres and 
Day Nurseries throughout 
the U K Used and approvcif 
by 20 Royal Nurseries 



Robbs 

NURSERY BISCUITS 

Testing samples gladly sent on receipt of professional card 
Alex Robb & Co Ltd (Dept 6) 145 Atkins Ro d 
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Heat helps you fight PNEUMONIA' 

l)> relicMiij; pniii proniolnv n’/fiTofion nn<l 
re^t nnd lessening npjinlunsion 
These ccrlamU are Ml \IK mijtorl ml » <m 
suleralions lending lo nnkt Mtur Insk 
hg/itcr h\ making ihe pilienl s comforl 
greater and einhling m>u lo c irr> llit ca«t 
along In roiiline niedicalion iinlil il li i- 
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Tlie \ iclor Indnelolhcnn olTi rs ihi iileiil 
means of healing hiiinan tissues not oiili 
hf cause of the proaed tffeelnencss of the 

basic principle short ataae circuit 

utilising eleclroatagnelic indiution — hut 
because of ihe cvlreine simphcita of appli 
cation and absolute control of dosage The 
patient’s coaenngs need not be dislurlud 
there need be no m eight on or ihrcct con 
tact Mitb the bodi there art no electrodes 
to apph to the skin surface There is 
deep, soolhin" heneficient heal that comes 
instantU ulien the siiilch is closed 
'iou should knoll the Inductothtrni mort 
intiiuateli for its use is defimteli indicated 
I'hereier heat is indicated Voii can learn 
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in IuhIutI ca«k Sur 
.. •» Ik! <loctorA 

t n ictrcc to their 
\ itiini'i wennn:; a 

(Mt h\ J Rous^tl 

kn wuu lhal uUh 
lla \ iricd ten 

n 1 u, ll irv it CTH 1»L midi to 

» \ ict na v< iri ind to LVttnfl 

f ri V iir r ui [ rl nl\ uht rt it 

i nil k J 

It \oii wouM iikk to knov’ more 
tI ui the Ron id Belt ma\ wc 
mid i< u 1 copT ot our bcTUlxfulh 
ilhi iniiil CTtalo"iic’ 


On /ia(c On(i} u( 


1 ft 1) ( Iltp 

I^U If *£..2 0 

l>' l<*ll I » h I I 

tna. I I— lira a 
1 1> I <. o > Irt' < 
£ 14 0 Pjiti 

it n £2 ^ 

\ t <1 <«j t! - 

! » tUe S. m 5 
!»« b e 1 r I er oj 
t t b te bCT oi n 
M IjtI It 
TVnt** »o I) ft \J I 


J/r/lij) 

179 / 181 , Regenf St, W 1 

Tel r^ct P itc I 

and 74, New Bond Street, W i 

Ttl ^icic , tr 16j0 

\) o at — II Ua I Jk \rthiir 
n hpm f Ildl,inl -x CT te Bourr« 

n oiith Himi hire Hou c Bri tal 

I i Trk ''t rrf nbursh J Jret 
xrtcl Nt f la ffow J SaLch-chT'l 
'• 11 e < Wt t n Kd I 

I O'* } ‘'t Lri e r rirlrs J ti f I 
ll N. t t Lo Jjt I pofil v i-oirt 
Tu n bt Manfhe «cr Q Kir? bt 
NollJn^han 2 a If ?£on it. £oh b 
purl IIt Lord Street 



36 


THE BRITISH MEDICAL JOURNAL 


Juu 16 19IS 




“I am THUNDERBOLT 

lliL c »r uil!» wliicli C ipt ‘slon sel up the 
WORLD S LAND SPEED RECORD of 312 mi1e«; 
per hour Mj Roll*? Rojce cnpincs were fitted 
uilh 

LOOOE 

THE BEST PLUG IN THE WOl(LD . 


Tor the forthcominR nlltmpl upon our 
record mj drner nnd I will n^-xu 
pm our fnith on Lodge pUu 


A new set of Lodge plugs x\ill gel ihc bcsl 
out of your ctt loo TIicj vsist cts) 
Stirling perfect iccclcrition nnd tlie alt tin 
ment of imximum power witb minimum 
fuel consumption Morco\cr iKcir long 
life of dcpendible ser\icc is unequillcd 


Lodge plugs aic oblawabh fiom V 

Made compklih t/i Enatand bv Lodgt Plugs Ltd, 





A 

household 

word 


mj HI till* 

< 4 - leallwrSoles 

for longer Tvenr 
and greater coiuforl 

° niiOO 

Ptinian Tamitnts Ltd , Runcttii, CAw-'ir 



I \^D S Ml M Il'lbl WM(n(llei,d) 

(lot Dotiors) Fully jcuclhil lever movcmtni 

Silver chrome GO or 13 p^vmcnls ol 5' Cold £5 17 G or 1C 


down nnd 11 mvmcnis of 10 10 

bcPAin MLNIS— I urs Fiif Coils 
Pluc Ciiilcrj rurniiurc cic 
II riic tor Co!aloi,iie 


profc loml 

ivcnicni XUlt «nr 1jowrm>m« 

I or 1C *»r **clrrlluii*» 

GUARANTEE rn% on \pprnvnl 

rROTISCTIVJE l\IONTHL\ 
PAYMENT TERIVIS 


E J FK \NKLAND & Co . Ltd (Oci" "i ) " i-i.m-,! 

Filab 1SS5 Phone Ccnlral lliS I ii.lt ilc Clrru I €>iulon I T I 


COMPANY LIMITED Established 1824 

Ltnkz with the Medical Profession 

I One of the three Offices which operate and administer the Pension and 
Insurance Schemes arranged by the B M A for its own Members and 
for National Health Insurance Practitioners 

II The Office which guarantees the indemnity granted to Members ol 
the Medical Defence Union in respect of Damages and Costs awarded 
in actions contested by the Council 

Needs of the Professional fAan 

I Life Assurance contracts to meet individual requirements 

II All classes of insurance transacted including non cancellable Sickness 
Insurance Trusteeships and Executorships aHo undertaken 


Chief 

Offices 


YORK - - - ST HELEN'S SQUARE 

LONDON "YORKSHIRE HOUSE," 66-7 CORNHILL, EC 3 


N unlit vl mm who In ‘ ‘”1 . 

coiiilort t>I the 1. Slipcrh Exranitii'i. Siilltl ^ 
\ mill litr 11 i inj tilhrr O ' .j 

ciervlhtiip Iioin a wiihiml lo a , 

I iiithir mli,hl luaiie Irom I'F"’ I , In' 

niiri. ..I l-r. It l.cnitth I me' ■ , 

mill 1 (lilt iliimi, ainpa liUcil i 1 ^ 

lirini. mill sii,Hrior l»Ui ' 

101 t liriiiiiiiiiii Ihiiiiii: riitm 

corners Weighs no more hilly 

llio old stylo Icath r casts cmP'yL , 

I I ilhoi niil h lor I"''''”'*" ‘V'r.paiiillii 
loilii The lat St and tlntst txatm 

Suite SOS yet produced 

24111 (Till lioniliil hi th cspia'l'i'C " 

30' 2Cin 35 28111 38 C 

Suiplu I to liiotical liiiit 
lurcr ( omhint In it nl ' 

Itrin ujF n nprlmtU 

Siililiiittiil hr niiprol il 111 an *' 

cu t( ninrv rihr lu 

/Mf. «/ irntrh. 

r<iM. fnmoCnlnut f « // jA 

ai pltcnli n iiunttonint. eo» ill 

S%rVc’o^oreyjnd^d,Va;'mnhy.h 

ALLIED MANUFACTURERS 

s.(1c D.slnlntlng 'l-'"' 

M l/HITE MAHUFACTURINC C 
” Market St Mancliester, 1 




Jl'u 16 I 9 '.«! 


THE BRITISH MEDICAL JOURN \L 


PrOTEIN 

^ -JZOO 


HEALTH BREAD 
ROLLS 
CRACKNELS 

HYGIENIC PACKING 


C\RBOHYDR \TCS 
•40 10 


^ PQLIEY AND COMPANY LIMITED 


fiSEPTID 

INSTRUMENT AND 
DRESSINGS 
CABINET ON 
STAND 

Enamelled white 
or aluminium 
bronze 




SURGERY 

B TROLLEY 
& LOOKER 

^ 16 in 16 «n 

3 i*u hish t ted 
« pljie ff’A s she 'cs 
B.3tt Rcann Ca tors 
Chrc'n u"i Plated 
ntimf price 

Can a^f eu a 

AU Surgery equipment FURNITURE 
INSTRUMENTS BLOOD PRESSURE 
APPARATUS ELECTRIC DIAGNOSTIC 
OUTFITS &c at strictly economical prices 

SATISFACTION DEFINITELY GUARANTEED 

Current List of Secondhand Instruments and 
Equipment forwarded on application 

A FLEMING & CO (?urm ) 

51 MortimerSt London \/1 ri il« 6^92 


The Picture of the Year 


A BICKIEPEG 
BABY • A picture of 
health like every 
Bickiepeg child — no 
teething troubles to 
pull him down 

To ensure a properly 
developed |aw with 
ample room for 
strong even teeth we 
suggest that there is 
nothing better than 





,_iT & 




WIDELY USED IN DIETS FOR ^ 
DIABETES, 

GASTRIC ULCER 
INDIGESTION & OBESITY 

Sample Diet Plans & Analysis Free on rcgcejl 

^M^^/lPcpl B) PLYMOUTH RD.LONDDN E 16 < 


'‘fyfoU/- ^oat/Mq 



Do ^o^l Lrow thil motor bo-rtmt: co ts \er 
laitc? i«P* inLlj liltl- Aid o! il 

pn It 15 the I ertUhlc t nrd t o I 

tl f lire 

FREE MAG\Z1NE 5 i I £ I f r fr 
r-\ cf o»r ttPi ii » 1 If t I j t s 
1 / \ 

BRITISH MOTOR BOAT MFC CO LTD 

IJ I ( ■* Ifri rr a It u e Inf n c ' a W C I 




Bickiepegs tough little biscuit bones ' 
There s a ho'e at one end for a con 
venient ribbon to be threaded through 
and they sell at 6d and 1/ per packet 

Also BICKIEPEG Veal Bone and Vetetablo 
Broth for babies from birth 2/ per )ar 


BICKIEPEGS 


PROFESSIONAL SAMPLES of each are jlad y sent 
on request BICKIEPEGS LTD Nursery Food 
2pec slists Dept 11 Welwyn Garden C ty Herts. 


UAOING MOTOR BOAT ll'UH^ 


X- RAY CAR SERVICE 




POWER ROAD CHISWICK 
TELEPHONE CHISWICK <006 


r < I HOUR anv day aht night 
ANYWHERE 

In the treatment of Varicose 
Veins where leg support is 
prescribed, Compri-Vena give 
meticulous attention to 
instructions 

They will gladly supply particulais ol 

RUBBERLESS SURGICAL STOCKINGS 

and the service they provide 

(qtipri-Vfti\a 

I <1937) UTD 

38 SOUTH MOLTOH ST^ W 1 \i-tifa 0'3Z 

TV ADIE 


IN BRON7E Free Skeleh , 

ENAMEL •>"<1 Booklet I 

OR BRASS "■11 he «enl « 

Phone receipt of ' 

CleikcnMcIl 2441 delaib , 

S J' & A Herd, -O a, k n«ell Ild ECI 


BROCHURE. SKETCHES 
A ESTIMATES FREE 
CAWonb u ry S077 

NAl^PIATES 

BRONZE STAINLESS STEEL* BRASS 

COOKE’S (Fxhmiubt)LTD 

nNsivKir fxvemcnt house 

MOORCATE. fX>.VDaV.E<C2 

Eaiim 


I KCQUEM MICTURITION 

^T5\\TT AUSOUnENT Ji^rS 

^!aIc t-a> rnttern 3 </ 

Kevt MtxJcl Feinilc i-ay r-aitcrn 4 / 

DLI LEX BAGS 
Male CT I cr’ale'dj> and r hi "0/ 

SVMTLBE” 

Tor hcTr’c«' bedridden r-iicntj “i / 

(> ir ban cat h all IcaVar* cn^ rs n nJ and NxJr 
In 1 b!c under cl hm arJ cx ily etrrtied S 
urm word *n.c bpcctal r'Uctrt let r*r h 
and a^u rft 

P errs n% fie on re,jie\t t ftfi 
JllLn\RD 1.3 Ooucbf Street Gb a C 

Addmeler Money ADDINC MACHINES 77 C p ( 

TAYLOR’S TYPEWRITERS 

SELUHinE HIRE run Tablet and Chain 

CHASE EXCHANGE r t 
BUY and REPAin ALL .. . 

MAKES of T|pewriter5 
Ouplicaiora and Catcu 

Utinc Machines the 


-una macnines 

U t If tor IJa ra n t^u 3 BIJ*(fu 
t ricne-HIUrn TlcUtr - >Nn 

BUY A CIJOU FOn t nylc m Ira M 
15 a Month t £14 145 

14 CHANCERY LANE (Helbem End) V/ C,2 


A GENTLEMAN ALWAYS LOOKS WELL 
DRESSED IN SAVILE ROW CLOTHES 
r— 7f-j SCU LIGHT 0\FRC()\rS 
jy Jl LfiLSGT DRESS SWjKISSL ns 
^ li etc b> all emtnem taiTcr^ 

Af W Schitle Ic'To L Rchcn ktlsour 

H " prices 3 to S Cm 

KLGENT DRrS<5 CO 

jrl\\l nd Floor pj cadilly Man n 1“ 
'aCfS lyi Shaftesbun V' P adHl> Cir u 
\\ HNctiCafcM ni t) < IR “l’>0 
-1 L\DICS DEPT on ht FLOOR 


NAME PLATESf[3“Lf;i”e:, 
REDUCED PRICES 

5 rtef fo Lt I in to rA« f funl Mnk 
j F OSBORNE & Co , Ltd Tel Eu$tbn48''4 
I 117 Cower Street London V/ C 1 


NAME PLATES 

Stainless Steel Brass or Chromium 
Actual Makers Ou.ck Delncr> Loi' Pn e 

The tVHlTE BRONZE Co 


NAMEPLATES 

Send tor lUustraied Brocli tre and Pn e List 

PR HA 11 p, rn ^-^5 Hew Cress Rd S E 14 
^ “ fi^tL & CO TIDeyeay 3S18 





THE BRITISH MEDICAL JOURNAL 


Juu 16 iPiit 


+H+H- 


bowdejv house, 

HARROW OA-IHC HILL, 

Foi the lesideiitial Healment of Functional Nelsons Disouleis 

No CISC under cerlificate nor under the M T A 

■*!'u the diagnostic ph\sicnn who ndsiscs on all phssieal treatment As far as 

possible all necessars pathological examinations are earned out bs the pathologist in the laborators on the premises 

STAFF 

4 ® (5ew/o/ WnjiewH) Grscc H Nicolle MA,MB (Rc^idcnl Pln^iann) 

Alfred Torrie M A M B , Cli B D P M (Medical Supermtendent) Marx Hall. MB, B Ch (Patholousi) 




CHE ADLE RO YAL HOSPITAL 

nnA "" N \\ ilcs IS tof thc ttcilmcn ind nrc ol those ol Ih Ir-i 

and Middle Classes sufTerina from MLNTAL and NERVOUS DISEASES 

Tlic Hospital IS coserned bs a Commiilec appointed b> the TRUSIEFS of the Manchester Roaal Intirmara 

In Addition ^ thc Mnin Dtnldins there ire cptntc \iUas Elxtcnsuc croimds HArd and gnss tennis courts cricket and croQuci 8roiintl> and a r ' t 
lot badminton Tiicrc nrc nho wireless instnlhiions Golf mn\ be hnd u«hm ens> distance OtcuPAtiom} thenm 
VOLUNTARY lEMPOHAR^ AND CFRlIPirD PAIICNFS rccci\cd 

7 he Hospicil IS nine miles from ^!•\nchcstcr ^0 minutes bN ttU from Liverpool *ind tl hour«; from London 

For terms md further p'lniculu'? npplj to thc McdicM Superintendent who mij be sccn m MkNCHCSIER bv APPOINTMLM 

Telephone GvTirv lincs^ 


THE OLD MANOR A PiixalL Hospital for llic Care and 

CAT TCT>T TT>T7 Trcalnienl of those of hotli sexts stiftiriiii: 

o ALilolr U K Y r, ohuMent vl disorders 

Eit-nsitc croiinds Detiched \ ilhi Chapel Garden and dair> produce froir a>vn farm Terms vct> modenie 

CONVALESCENT HOltrE Detached Xillaa standinc in 12 acrca ol ornamcnial ttoimds wllli tennis courts cl »'■ k 

at BOURNEMOUTH Voltmiarj Temporarj oi Ccriined Patients nia> \isit hi arransement lotion orshoriMaii 

Jllitstrafecl Broolmrc on application to the Medical Snpenntcnclcnt The Old Manor, Salisburx ’I’lioiio Salisliiiri “’'l 


A T -pv 17 g~^ tf^TTlT' TT ATT Rosidcntial (re itmciit of 

1 L. FUNCTIONAL NERVOUS DISORDERS 


^ UNEATON 
IV A R W I C K S H I R E 
( Phone Nuneaton 241) 


Inchidinsr •klcoliolmm "\nd other Acltllctions 
(Ctrnrnb’c Cists ^rc no received) 

fhb bciutilul nnnsion suintcd m thc hcirt of the counio (lew tinn two 
London bj LMS R ) and surrounded bj clnrmme pleisure firound> in , 

and outdoor occupitlonal ihcnpj arc ivailablc is devoted to thc hcatn 
rimciioml Nervous Disorders b> psvchothcnpcutic and anclllar) m inc^ 


//fiislrntrd hrorhifre <tntl pnrttttiinrs obfoinoMc from ABC lf?l £R U D D P U /Icsicffnr Vnfirnl Stirefmtpnrffnl 


CAMBERWELL HOUSE, 33, Pecklmm Road, London, S.E.5. 

Telcsratm FOB THE TREATMENT OF MENTAL DISORDERS ' " 

PsvciiOLiA London 


Tr/rr'B •' , , 
Roovtv 4 4 ( ' ■' 

, icresofproi'/^^,, 


Also compleleh detached \ilhs for mild cises, N\ith prnTte siutcsif desired Voluntarj piticnts received 'Iwcnlv 

Hard and Grass Tennis Courts Putting Greens Bowls Croquet, Squash Rackets Recreation Hall with Badminton Court an 

indoor amusements including Wireless and other Concerts Occupational Therapy Callisthenics, and Dancinc Qasses 

Actino therapy Prolonged Immersion Baths Operating Theatre Pathological Liboralory Dental Stirgcn 

Chapel Senioi Phssicnn Dr Hubert JaiiIES Norman assisted b\ three Medical Officers also resident, and iisitine con 

An illustntctl prospectus Biunc fees nhich ire strictli moderate mai be obtained upon applicniion to the Secretary 

Tlie Conxalescent Brnncli is HOVE VILLA, BRIGHTON, and Is 2 00 feet aboxe son Icirl 

PECKHAM HOUSE, 112, Peckham Road, London, S.E. 15. 


Telegrams “ Allex lated, London ” 


Telephonos Rodnei 2GH-26'li 


The aboie House is for the care and treatment of persons suficring from mental diseases and nenous iV' 

xoluntan and temporary patients are receised Separate houses for treatment and accommodation of speem c 
the Institution Occupational therapy, phssical drill and other forms of modern treatment There is , 1 ,^^ rcqu't' 

Court, near Doier to which patients max be sent for treatment or on holidai Motor driics arc 3 ^ "cr I'l; ^ 

ennis couits Entertainments dances and indoor amusements held tliroughout the year Terms from 
Uustrated prospectus and further particulars can be obtained from the Medical Superintendent — 

LAVERSTOCK HOUSE 

SALISBURY WILTS 

PRIVATE MENTAL HOME FOR LADIES AND GENTLEMEN ^ 

Completely up to date Losely house and grounds (18 acres) Certified and uncertified cases taken Ri 

to the seaside ESTABLISHED OVER 200 YEARS ^ SiU''"'-''' 

Apply to Med Supt for illustrated brochure 



THE BRITISH -MEDTCAt JOU RNAL 

ST. ANDREW’S HOSPITAL 

FOB MENTAIv DISOKDEBS 

NORTHAMPTON 


FOB THE UPPEB AND mDDLE CLASSES ONLi 
President Ti(C Most Hon thc MARQUESS Or EXLTCR CMG ADC 
^leriiciil Siiperlnlendent Tiiom.s TrwrNr MD M n C P DPH DPM 


Tins Recistcrcd Hospinl ,s situated in J20 acres of pari, and pleasure erounds \ oluniary patients 
rrn.Ai ' 1 incipient mental dtsordets or ssish to present recurrent attacks of ^men"al 
t pattents ind certified patients ol botli seecs arc tccciscd for treatment Careful 

male or l’''>''0>osical csaminations Priiatc rooms svith special nurses 

on be prouded Hospital or in one of the numerous sdlas in the trounds of the sariotis branches 


WANTAGE HOUSE 

This is a Reception Hospital in detached srounds with a separate entrance to ssluch patients cm 
be admitted It is equipped uith all the apparatus for the most modern treatment of Mental and 
Acrioiis Disorders It contains special dcparimcnls for liidrothcrapj bj sarious methods tnchidinit 
TiitUsh and Russian biths the prolonccd immersion bath Viehs Douche Scotch Douche Electrical 
bath Plombitrcs treatment etc riicrc is an Operatmc Tbcatrc a Dental StirecD an \ ras room an 
Ultra Violet Apparatus and a Department for Dnthcrmj and Hieh rrcqitcno treatment It also contains 
Laboratories for biochemical bacteriological and paihological research 


MOULTON PARK 

Two mtlcs from the M»in Hospital there arc scscral branch cstabUMimcnis and %iU3S <iiuntcd tn a 
park and (arm of C^O acres Milk meat fruit and Negctiblcs arc supplied to the Hospital from the firm 
gardens and orchards of Mouhon Park Occuntion ThcraPi is a feature of this branch and patients 
an. feivcn eserj faciluj for occuDjinc themscUcs m farming gardening and fruit growing 


BRYN-Y-NEUADD HALL 

The cisidc house of St Andrews Hospital li bcautifiiUy situated tn a park of 330 acres LI inlairfccban 
umidsi the finest s>ccncr> in North Wales On the Norili West side of the Est itc a mde of sea coast 
forms the bQundar> Pattgnts n\as 'fsit this Branch for a short seaside change or for longer periods 
Hic Hospital has its own prisatc bithing house on the seashore There is trout tishing in the park 
At all the branches of the Hospital there are cricket grounds football and hocKcv grounds lawn 
tennis courts (grass and hard courts) croquet grounds golf courses ano bowling greens Ladies md 
gentlemen have their own gardens and facilities arc prosidcU for handicrafts such as carpcntr> etc 
For terms and further particuhrs appl> to the Medical Superintendent (Telephone No 23S5 and 2 s? 
Northampton) who cm be seen in London b> appointment 


HAYDOCK LODGE 

NEWTON-LE-WILX.OD S LANCASHIRE 

Ttrfes Street Ashton in Makerh id P/ione Ashton m Makcrficld 7311 

for the reception and treatment of PRIVATE PATIENTS of both sexes ol the UPPER AND 
middle classes -sudenng from menta and nerveus diseases either toluniary temporarily, or 
under Certificate Patients a c clas ificd in separate buddings according to heir mental condition 
binialcC m park and grounds o 400 acres Self supported bv us own farm and gardens in which 

patients ire encouraged to occup> thtmscl Every facihiv for indoor and outdoor recreation Tor 

terms prospectus etc apply MEDICAL SUPClilNTENDENT 


NORTHUMBERLAND HOUSE, 

GBEEN LANES, FINSBURY PARK, N4 


Jut' 16 I93S 

BARNWOOD HOUSE 

a RTGISTERED HOSPITAL for ihi» rvRt: , 
TREATMENT OF LADl£s GESmsRk 
suffcririB Irom NERVOUS and mSt \1 mt 
ORDERS Within ,„o milofol ihfjvi S' 
hay and LM k s Rulnai Suncr 
Gloucester the Hospital „ casili i, 

rail from London and all parts lit th u J 
KttiEdom It I beautifully situated at the f\ 
of the Cotsuold Hills ard stands in m 
prounds of over 300 acres koliintaq r«t i 
Of both sexes arc also rccci cd for tmi c 
Special accommcdaiion for Lady \ olimtarv Pjiia , 
IS also provided at the MANOR HOUSE whkhfLj 
Its own private grounds and is cnurcl> s 
from the ^^ain Hosoitaf For particulars as loifiri 
etc apply to G W T H FLEMING MUCS 
LRCP DPM Medical Supi 
Tefephohe No 6 07 Bartiwood 


STRETXON HOUSE, 

Church Stretton, Shropshire 
A private HOME lor the trcaimtci d' 
Gentlemen sufTcrmg trom Menial And brnivi 
Illness including the allied disorders of 
Alcoholism and the Drug Habit All hT*s c‘ 
early Mental and Nervous cases arc recci\f 
wiihoiii certificates as \olutuar> Paiienis iNi 
the provtstons ot the Mental Ittauncnt V 
193D Bracing hill counto Sec tfr'iJ 
Direcforj p 232S -^Appli to the Medical S 
intcndcni I hone 10 P O Church Strenoa 


FENSTANTON, 

CHBISTCHUBCH KOiD, 
StrcTtham Hill, S H l! 


A Privaite Home for the Care and Ttnr 
ol a limned number of Ladies with Menu! » ) 
Nervous Disorders Certified Voluniab sJ 
Temporary Patients tcccued Large Mr n 
with 12 acre of grounds (See Afri d 
Director} P 2312) Apply Resident Phywu 
Telephone Tulse Hill 7151 _ 


BAILBROOK HOUSE, 
BATH. 

'For sufferers from Nervous and Menu! I> 
orders with or without ccihficatcs 
The house i gloriously situated In 
grounds of 20 acres with magnififcm ^ 
the City and the Avon \*vllcy (See w 
Dire tor} page 2122) ntf 

Tor terms apply A Cuirdihm 0'' 
B Ch DPM Rcs/dcni Physicnn 

Telephone Batheiston 8189 

BEIGHAM HALL, NORWICij 

A PRIVATE MFMAL home JY, 

of well wooded gtoiindy For t-jun 
5cnllcmen siiffcrinc from Ncrioiis or 
links Voliimary Paticnis Tcmporjrt 
md Paucnis iindc' Cemfienc ire ' 
reaimcnt Fes from 4 puincas i "''Y'*', 
iceording to tcquircmeius A « t 

or Ladies and Gentlemen at frduced le^ ^ 
ccommendaitcn of the Patient s own . f 
Ipply to Dr J A SyuLL 


A private hospital for the treatment of mentTl and nenous illnesses Coineniemly 
situated and easy of access from all parts Six acres of ground highly situated, facing 
Fmsburv Park Voluntary and Temporary Patients receded without certification 
Occupational Therapy, Psychotherapy, and other modern forms of treatment 

Telephone .STAMFORD FULL 1688 Telegrams SUBSIDIARY LONDON 

Connlesccni Home REARSNEV COURT DOVER For further particulars apply to the Medical Sup 


COURT HALL, KENTON, near EXETER, 

for the treatment of eight Ladies volunlarj, temporary, or ccrtiHed patients 
Large gardens and on n dairy 

CLIFFDEN, TEIGNMOUTH, for early and convalescent cases A well appointed 
house with' spacious balconies, and extensive views of the South Devon coast 
Sub tropical gardens own dairy in 25 acres Private road to beach 

Telephones 

_ BERTHA M MULES, M D B S Slarcross 59 

Resident Physicians aNNE S MULES MRCS LRCP Teignmouth 2S9 


THE COPPICE, NOTTINGHAM 

HOSPITAL FOB MENTAL DISEASES 

This Inslitiition is exclusneh for the reception of a limited number of Private Patients 
of both sexes of the Upper and Middle Classes at moderate rates of PV'mcnt It is 
beaulifullv situated in its own grounds on an eminence a short distance from isotting 
him and from its singuhrlv hcaltln position and comfoi table arrangements affords 
every facihtv for the relief and cure of those mentally afflicted Occupational 
Theripv Voluntarv and Temporarv Patients received 

Tel 6-, 117 For lerms etc apply la the Medical Supermiendem 


TYKEFORP ABBEV, 

NEWTOBT PAGNEf X , BhO' 
FU\CTIO\AL ACIIlOl'S 

VND CO» VLFSCL>T 

Hie Home is i Mansion 
standing In D acres of SonE^'" 

and IS Situated 14 milCi Ron 
and 12 miica from Bedford on th« . 

to Northampton Road fifty 
Both sexes ire '‘ccommoJatcU ^ 

pcutic Treatment is used ' 

cukcv Radimi Hcii X tei t 

LiBhl Dnihetmv ma Foim BJ'"’ 

Tennis etc „ _ nniiGLAS-'B’l**'’ 

''■’"Ve^i^nc^elnTr^kiL 


tC lwUHUHt. 

HILL END HOSPITAL AND 
ion Tiir iM'rvTioa ' " 'Ynuri* 
Ol airarvf VMJ ) 

(■20 mile. Iron Lanilim/ 

Lathes sulTeims Irom ^Yeri ' 
ILLNESS ire receiin! for licvne 
ints as V olunnry Ji’”'!?' n II .• 
"riv lie Palicnls ai the ** he ' ’ 
7onnlcsccni or mild u v c 

1 dclichifiil coumri mnsioa 
:rotinds known is .r^rr 

HiGiiririD ,, 

imnic nbom n iT'’' pYuisEAS F't 'V 
res TWO TO THRTL OUl ‘ ^ 

For liirihcr nariicuho 
,iint VV I T M'-Nh LR 
ST AIBV^S. BEKt 



Jun 16 19^S 


THE BRITISH MEDICAL JOURNAL 


41 



THE STANBOROUGHS 
HYDRO 


Del i:h\lu s.\ua:cd \n rn\Mc v.<>o<de<l 
park of to acTr< 00 feet abo'c sea Icsel 
On!> IS irics fro'n London 
Recen <m.*ctLnl altcraitons hase rrc~\ y 
L— rro>e<J the f^ilit*cs, ' \ddiiiom to the 
c<iu rtnent ntludc the m tallaiii n of 
ICO K\ \ R ^»5 etc. 

The well retaliated Diet Departneri for 
the mrcrsTSio** cf ndi'idual diets the 

Fh% 1 therapy Deranmenw invludirc , 
H dr thcrapT Electrotherapy Licht 
Thcrap' Occupational Theran ‘ft 

-dditicn to outdoor aTnusemertts and the 
hwr and rardens nuke The Stanboroorhs 
ser> desirable fer rhcuruti rd metabolic 
disturbances, Peuroscs and (alitme states 

pi al an I SI 1 m "• 

T'wo R^id T»1 rhj i I ns 

M d al ''upe ini n lent 

J E. CAIKNCROSS LBCr S 

FreivfCtui end iu I irfermencn 
en apriicatwn to the \tancTer 

The Stanboroughs Hii dro 

Stanborouffh Park, 

%Vatlord Herts 

Teterhere Ga slon (II ailo J 1 —6 3 


\\ithm 10 mile^ of London set in loselv 
and secluded surroundings 

Home for the Treatment of 

^AA'ORRY & NERVE STRAIN 

(Under Medical Supcfst'cn) 


Large air^ rooms — Studied dietarv — Lx 
ren cooking Pleasant garden with 
*ennis court — Friendls and cheen atmo 
phere — New emphasis on Happiness m 
the Home 

Terms from £o 5 0 per sveek 

Xrrl to— D H C GINEN MD DPH 
y DTM A H Surfeon Captain RN rc«d 
' tare Reft eat ^fecLcal Jiiperifi;en<?ef!/ Norxrorf 
j 5 crc onum Brckenhani) 

“GLEN’ROY,” 

6 , Sundridge •\^enue Bromlo Kent 

Tele hone R/(J enjtou ne -410 


NORMANSFIELD 




For Mental Defectives of cither sc\ 
Unedr private management. 

Applj to Dr Langdon Dorni, 

No na a nt fieJcL Teddinstoo 


TOME FOR EPILEPTICS 

■VL^GHCIX (near I.r\TSRPOOI.) 
FABtllSG and OPE?. WK 
OCCLP^TION for P^TPEKTS 

' >" In ="<1 end Cl Hou » 

ttS 1 st Class (men oily) from £3 pw up- 
ards. nd Oass (men and wotncnl ^ / p w 
F or tu the pert cufarj apph 

C EDGAR GKTSEWOOD A CJV, 

*<t»tap 7 -0 fl*fl an^ bi e«i Ea t Li pool 2 


CRICHTON ROYAL, DUMFRIES 

FOR 

NEIUOUS ^^D IVlENTkL DISORDERS 


Til., II xrilal ha« c\er» lacildv (dr cdiaplclc Inmlinlion dt die iborc condilicn. and pro ide aO 
I rnir cl modern irral-rcnt i clndir- r.iclicdicrar' Pla-'l dicrari ccoipalional ard recicalional dictarv 
Circs ot alTholcm and dmt add ction arc adnined The rhjsiolhcrany Dcranmcn has rwralc nniis 
full) Cduiprcd (or \ las «otV hclidihcraps shod »a.c Ihcrapy clrcim-ihcrapy and hidroiherary 
1 ■armmTnc Mh rtilcnttd hall's Scolyh and \ i hy ddu hes Plcmh ires itcaimcnt clccrtic and Tutl,. h 
haih cahmcl clc ) Ihcrc is a fully equipped nmnailum under qualified instruclprs Faetlities aic 
pr Maed imuer special recreali snal Iherap Is ( r all indvir and culeocr yan-p ipeludmr rotf eour c 
cei let Iscthall and hceley ttcunds li,n tennis and iqua h ccutt croquet and hoalnc treens 

The Hoimtal has its n.n Cinftna LIhtary and Hairdtessini Saloon Terms include regular miner drites 
rriyalc res— uiles cr silla arc asailahle and pecul raises can he rectided 

The IIiTital ttcundi estcndin to rcarly I Pot' acres arc mated in del thlful ccuniry and r hide an 
esten lie (am tl T hcru) ran-cni and crehardt 

As the He rust is «eH end »ed teems arc esccrliinally mcuerale er Tint Depanmeni 3 to 'n 
ciimeas per iseek Seecnd DepS'tment - and .1 tuineas per uccl. Voluntary and cert fed mu " ' 'd 

rci-eiyed vied -al Cen fieatcs yi'en anywhere in the Diili h I let arc yalid fn- adme icn I pal in s lir 

crospeetus nceessaty (ottm and (tnher Infonnatnn apply to 

Phys lan Surctintendcm P k McCoiy IP MD PR CP D P M BarnMcraltaw 
July lit 


Tc! Durtff<n 111*5 


CHISWICK HOUSE. 
PINNER, MIDDLESEX 

Telephone PINNCK 231 

A Pnvnfc Hospital for the Treatment 
and Care of Mental and >*cr\ous Illnesses 
in both sexes 

A modern countrx hou^c 12 mtlcs from 
Marble Arch m beautiful <ccludcd grounds 
Fees from 10 guineas pcf^’^cck mcluswc 
Cases under Certificate \ohmiari and 
Femporars patients rcccixcd for treatment 

Douglas Macaulav Nl D DP M 

ASHWOOD HOUSE, 

KINGSHINFORD STAFrORD<5HmE 

^n cW-c't-hf hed TRIX XTF HOME f r tbc care 
snj ire tfp nt of L-d a*HJ Ccntlcncf> nenjPy 
ar cteU rrcbai onary a « rsJ nt n<cr f cd 
rJticru are fcca%t<J a< well i»*e‘c fcfi>( rly 
ceri fied 

lb home « bcimjfuUy jitoaied m in c\ n 
CToufSrS of -0 

Full to lecertk^'*' 'sm tt r*ay 

be cbtiined ttom the Ro •-ert Xicctcal O'^’ce 


HALLTFORD HOUSE UPPER H\LLI 
FORD SHEPPERTON Cuebethed m if-*i 

Th“s handteme secluded resi<fcn c stanJir m a 
r-ark of '6 acres situ ted 16 nitres from Lcrucn n 
licensed for the recer of a limited number cf 
Patien s of the upper rd mdif e cl s cs suffem 
from nervous and mer ai allcctictw 

Nountary or ccriifed cad recei'ed Terns 
mod rate Patients are under ibe cor rant personal 
dec a( the Resident Medical SLCetmvn-dcnt 
Dr R A Siesvan from whom full partinj ars can 
be cfciained Tel Sonbory-on Thames “0 


THE GRANGE, 

near KOTHEPILAM. 

A HOUSE Iccncd for the reception of a 
limited number of Ladies sulTerin'* from Nervous 
and Mcnul dnerdets Doth cenified and soliin 
un patients received Approved for lempcrnry 
Patients This is a larec country hou c vvuh 
bcautilul pTOunds and park five miles from 
Sheffield Tel No 40030 Ecclcsfield Res Phys 
GiuttuT E Mono LRCP M R C.S Stauon 
Grange Lane L, A. N tl Rly 


SPRINGFIELD HOUSE 

Sear BEDFOED (Thonc 3il7 1 

Fo M nl 1 D o <f r« vaith o withoat Ce (if ai 
Resident Phys o n CtDRlC \\ BOV* ER 
O Un ▼ T n F re f oin p r 
(In ludmjr Scraraie Bedrooms where suitable ) 
ImetMcws »n London by Appo omem 


EPILEPSY. 

Owing to extenxion^ there Yrc at 
prc<cnt T few Vicrncics at the 

DWID LEWIS COLONY 

for I Tclicx ind Gentlemen who hnxe 
Epilepsy, bpt arc ol good intelligence 
and ‘iound mind 

Colonv life gives to most who 

hxvc cpilcpsx the best chance of 
happiness and conicnimcnl 
AppU to the Director, 

Tlie David Lewis Colonv, 
Warlord, Aldcrlcv Edge 
THE MAUDSLEl HOSPITAL, 

1)1 NMlIlK Mil L “ r.5 
rcUph'^nc ROD“ey i 4 l 

A Ci/S/C -tuei h\ tfe Lrn n f n 
C irnJ fo I ee rr rn ol Xrrv ut a J Ctt e 
M r I Di f> I I olur ert p„ m r!t e r rd 

New On fat c" V —Mix Xtoml yt ard fhirs 
days p rn Wn'tis TLCvdays and fridiy 
p rr Cimritis M r-jyv nd Tr «-- > loan 
In raticntv (a) heu (N di srtev) m mn- rr 
eratatc rr i uin beu in j ward r! 
Ki” s C le e Hewp tal uh hi in l e a 
tmrrrary p eve the Maud^ cy n-"r al tb) a 
pcoil ward (v* 1 d n? vmc pn a c tr*r~ y f r 
th e pjticn V cf covh vex whv arc payirc ib-- f I 
CD*! ard arc o herwi c s it b e TtRSlS i 
week but in ca c c patiertv w th a Irsal vcttlctrcnt 
in ibe Courts of Lt ndon a lew sin nay be burved 
accord! t rncarv 

Terns irclude fni h rare eveecti n) all ( m 
of treatment for wb h tb rc re cv ep r I 
faci ties „v there i a staff of Con u ni Spe lal i 
ard the Central Lab ratify if Li -don C unty 
Xfcnnl Hovrialv tv lia h-d tn the hisp al 
Inquiries of Enw in MvroTiir* Nf D ! RCP 
F R Ci Vied al SuPcnnterdert. 


ECCI ESriCLD Stap churst Kent 

(Removed from Ashford Vfiddlcvcx) 


PRU ATE H( 3 V!E fer the C\RC and CURE of 
ALCOHOLIC PATIENTS (Lac.es> Larte rr n 
son benuiifully itualcd in 100 a'Tcs of pwrk 
land Extensive views Ifomc farm. R C Chapel 
Under the rraragetnert of the Si ters ot the 
Good ^epherd Apply Rev Mother Tel 

Staplchu rst 61 

Tel and TelcRtams Hayres Cremwood 4 < ” 

UTTLETOX IIXIU DHINTWOOD Eh-EX 
Large grouni. 400 ft above sea HOVfE for 
ladies Menially afflicted \ oluntary Boarders 

received Station Brentwood and Shenhcld I 
mile Lt errool St -6 mios Apply Dr Hsvxes 

1 i<\N I y ) 


RUSSELLS 

HEMEX HEMPSTEAD RD WATFORD 

Telephone WATFORD SOI” 

A convalescem home (ot the care and ircattrent 
cf raild and recoverable nervous condnions in both 
exes The bouse ts sitaaicd hi h up in .*0 acres 
of srrounds 17 miles from London at the tcrmina 
t on of the W atford by pass One Medical Officer u 
n residence and two oibeia are in daily iicodancc 
Fees from ten stiodas a week inclusive 

Apply Resident Medical OFnet* 


Medical aupt. Ur J Lavchavi NUcallsv Tel 
Bedford - 0 


WWE HOUSE, BUXTOiN 

For the treatmeni of LTidies and Gcntlerr-n 
mentally afPiclcd Voluntary Boarders received 
S tuated I 00 ft above sea level f an" S 
ficres of ground — For terms apply to the Resident 
Medj-al Sup W \\ Ho*ton VI D Nji TeJ lyO 



THE BRITISH MEDICAL JOURNAL 


Jui\ 16, 



The MUNDESLEY SANATORIUM 


The ccnlral bmiciing makes 
the Mundesicy Samtonum 
the best equipped building 
in England for the cure of 
Tuberculosis All the bed 
rooms ln\c hot and cold 
limning water, electric light 
and wireless headphones The 
public rooms arc spacious 
and comfortable 


Resident Pliyswuvi'! 

S VCRC PEARSON 
M D (Cantab ) M R C P (Lond ) 

E C WYNNE-EDWARDS 
MB (Cantab) FRCSfEdin) 
GEORGE H DAY 
M D (Cantab ) 

For all information apply 
Tbc fjccrciary 

THE SANATORIUM, MUNDESLEY, 
NORFOLK 

Telephone Miindcsic} 94 a/id 95 
(2 lines) 

TIsHMS FROM 7i GUJNKAS 'VVEEKUk 


The buildings face SSW 
and arc sheltered from the 
sea by a pine clad ridge 
The sunshine record and di\ 
air complete a perfect site 
The medical equipment is of 
the latest kind and there is 
a day- and night nursing 
stair 


VIRGINIA 

WATER 


HOLLOWAY SANATORIUM 

A Registered Hospital for the Treatment of MENTAL DISORDERS o( 
the EDUCATED CLASSES. Founded by THOMAS HOLLOWAY in I88\ 


Tilts Institution is situated in i be lutiful and he itlij locilily within ease re ich of I ondon It is filled 
with ererj comfoit Patients can ln\c Pri\ ale Bedrooms md Special Nurses as well as (he use of 
General Sitting Rooms, at moderate latcs of pajment Volunlarj Patients can be admitted 

There is a Bianch Establishment at CANFORD CLIFFS BOURNEMOUTH wheic Patients 
can be sent for a change and be proiidcd with all the comfoits of a well appointed home 


Foi Tei/ns apply to 

The Resident Medical Superintendent, St Ann’s Heath, Virginia Water, Stirft). 


THE CORNISH RIVIERA SANATORIUM 

KOSEHIEE, PENZANCE 

For the treatment of patients sufTcring from tuberculosis 

The Sanatorium stands in us own grounds of 13 acres of garden, lawn, and woodland and is well sheltered ftom cold "iff' 
The climate is mild in winter cool in summer Artificial pneumothorax, ind other modern forms of treatment are aiaiht 
Day and night nursing staff Electric light Wireless in all rooms 

Medical Supt Fiancis Chown, M B Lond , DPH Consulting PUjsician (late Med Siipt ) Cornwall County Sanaloni.a 
Terms 6 to 7 guineas weehlj 'Phone I’ciirnnce 798 


THE COTSWOLD SANATORIUM 

Fust opened in 1898 and lebiiill in 3925 On the Colswold Hills, sc\en miles fiom Chcllenlnni, for the ticatmcnl of ruto'"'' 
and all other forms of Tuberculosis Aspect SSW, shelteicd from North and East elevation 800 feet Pure uf''™*,', 
Special Treatment by Artificial Pneumothorax (X-ja> controlled) Tuberculins and TJltra-xioIcl Rajs arc ,ij 

necessary, without extra charge X-raj plant Fulls equipped Dental Department Electric light Radiators, not 'ui‘> '■ 
basins, and Wireless m all rooms Up to date m iin drainage , , . , . 

Tuli dW 'ind mUit Nursing SnIT Tcrmn 3 pni to pnn a Inelit h i-nr;\p s 

Hfcrf SliPI GEOFFREV A HOI I MAN BA MU T C D.ib ,fw r/,n MARGARET A HARRISON Mil B S I ond ro' 

DAVLY MB B Ch CoiisiiU Lnonmlosisi CXSSIDY DEW GIBB rilCStilin CoiisiiUliiv Penial Sara GLOKGt V 
UesLoud Aoply Sccrcnry The Cotswold SanTtoratm Cranlnm Gloucester Tfl h\ thU ^2 NVnt-OMhr Grants Doif 


k 

B 


HARROGATE 

Harrogate specialises in the Treatment of — 
Disorders of the Liver — congestion, cirrhosis, 
jaundice cholecystitis cholelithiasis, and tropical 
liver Also in Diseases of the Skin— eczema, psoriasis 
the coccal infections of the skin etc The Chronic 
Rheumatic Diseases— Arthritis Fibrositis Neuritis, 
Gout Hyperpiesis, Mucous Colitis Functional Dis 
orders of the Heart Pelvic Disorders of Women, 
Convalescence from acute illness 
A wide range of Sulphur and Iron 
waters is available for dealing with 


FOR HEALTH 

the large group of disorders amenable to Spa treat 
ment Prescribed diets for Spa patients can be ob 
tamed at hotels and boarding houses without extra 
charge Complimentary and reduced ptK® 
facilities for the Cure, Accommodation and 
Amusements are available for Members of 
the Medical Profession 

Full details of Harrogate for Cure and Holiday wdibc 

„ sentfreeonapplicationtoSpaMan 

ager. Information Bureau, Harro 

gate 1 , (state ifamedicalcnijuiry) 


IT’S QUICKER BY RAIL 

Cheep monlfily rclurn tfclcets to Horrogote 
from all stations Any train any day 

HARROGATE 

THE MODERN SPA 


i 


Juu 16 19 'hS 


THE BRITISH MEDICAL JOURNAL 


4^ 



Choose a Spa in 


^QC L 



reinforced b> the 


The Spas and Health Resorts of Czecho losthia SMth ihe.r centuries old tradition of he-il 
etnerience and researches of local specialists insite Jour erious consideration 

In addition to places of ssorld aside repute such as 

PISTANY CARLSBAD 

(Picstany) (Karlovy Vary) 

ST JOACHIMSTHAU TEPLICE-SANOV 

(Jachymov) (Teplitz Schonau) 

ssnth their medicinal springs and mud baths there ore numerous smaller spas and health resorts admirably 
equipped for the treatment of manj diseases including those in the follossinj groups 
Anaemia and Chlorosis Basedoie s Disease 


MARIENBAD FRANZENSBAD 
(riananskc Lainc) (Franliskovy Lazne) 
LUHACOVICE SLtAC TRENCIANSKE-TEPUICE 


Bronchi*>1 Catnrrh Cortshtutiontl Diseases 


Scrofula Rickets Digesliae Diseases Diseases of 
Diseases of the Kidneys Diieises of the Nose 
Disorders of Bones Muscles 
and Joints Disorders of the 
Heart Disorders of Meta 
holism and Gout Gallstones 
The arrangements in the b-th cstab!: hmen 
are up to dale m e\er> the cleanlme i 

and neatness pro\crbnl the cr\ice attenti\e 
and courteous 

It is accepted that a pa cure to he fell} bene 
ficial Kould proMde a complete change of 
nirroundings and a breab \\Tth the patiert i 
normal e^cr^daJ life 

Further tnformalicn jrem cni. c/ 

THOS COOK & SON, LTD 

end ether lecimf T’o-'tu/ -frcncie 


' DOCTORS OWN SPA /o^ 

RHEUMATISM 

ar'' 1ud from Fisaiy m picks reaijr fer Forre use Sim «t n'ei 
rd no5t*«coron a! treilnent, r"ay be entrusted to ary pat ent 
cst 20s. for 20 treatmens Literiture on reqtes 


factlil} for 
fjdjpf' fj hjp” 



Bladder and Unmry Organs 
Throat Diseases of Women 
Leucaemia Neraout Diseases 
and Post Hemiplegic Condi 
tions Tuberculosis of the 
Lungs 

The Czechr'i!o\ at Spas fulfil ihii 
dmirabU ccmfortable hotels 

I s orchestras a^d darcc bands 


purpe^e 

hnt 

eacrj 


••olf S' inmin'' 


spcr!-~lenni$ 
etc 

TT^ie arc a! o pu*nerrus fulK up to date hemes 
Tor cc*\ale5ce"ce pd re | cures 


P Tiicut rs fret 


and at 

CZECHOSLOVAK TOURIST 
INFORMATION OFFICES 
in London t Resent Street S V/ t 


VOLCANtC*SULPHURIC 

MUD SPRINGS 

In delightful surroundings 

2! DAYS 

INCLUSIVE CURE 

Special facilities for doctors 
arid their 'snaes 
Secend Class Fare «» th Sleeper 
tl** IS C return 


ylSTANY AGENCY LTD.. 310 Recent S re t. Loadon W 1 Tel lAStS r^42i4 or PISTANY SPA BUREAU 25 Cccks *= eet S^/t et V H e 1) ^ '"i 


IS Unique 

among British Spas 


WOODHALL SPA 

in hawng a Bronia Iodine Waler (for all fornii of Rliciiniali«ni cic ), an IM1\L\RIIIM with TOC ROOM for llie 
irealmenl of Calarriis of (lie Rc«piralom Tract and an cnlirch RUR VL and therefore RCSTrUL Qualil\ 

Sheltered ilm and «iinnT uilli a gra\c] sub soil 

Injormalion and Liicratiire on appUcaiwn lo the Spa Director It oodhalt Spa Linci 


THE ClIIVIC 


A ISTJRSING HOME FOR SURGICVL. MEDIC VL 
AND JI VTERMTV CASES 


2(1 TlPinimllinP PInoo Fees ic mi toiFpns per 150 State Repisiered Nurses 

AJUvoJiailllC 1 IclLL. week (^vrra?— 14 gm ) rReuderr MedicaiOffi era 

8 Operating Theatres (for emergenaes) f l ^ 

Paoents onl> recew*d und-r the supervision of their osvn I ' * 

Medical Pracuuoccr * 


LandoHy \\ I 

Tcl ITe/tcc/ -f-r-/-/ (_0 Itnrs) 


Dru'’s and Drcssuigs free (cth-rthan Propnetarv Articles) 
Illustrated B ochure on appticanon to becretao 



DAX 

(FRANCE) 


THE THERMAL ESTABLISHMENT WHOSE TREATMENT B\ THE FAMOUS MUD 
BATHS WITH APPROPRIATE DIET IS U-NRIVALLED FOR RHEUMATISM 

OPEll ALL THE YEAR ROUND 
Through trams from Pans On 
the main line to Biarritz and Pin 


*0 nlo nason o Itfratu f avrly to FEDERATION OF THE HEALTH RESORTS OF FRANCE. 
BRITISH MEDICAL ASSOCIATION HOUSE TAMSTOCK SQUARE LONDON \\ C I 
or FRENCH RA1L^^A^S — NAT ION AU TOURIST OFFICE I 9 PICCADILLY LONDON \\ 
or SOCIETY DES EAL\ THERMALES DAX (FRANCE) 


4^ 


THE BRITISH MEDICAL JOURNAL 


JUL\ 16 



ViiU ruiLC of Jbdnjsithlo TroHniOHf in ITnrmH^l 
nilcs « t Ihtlit. Turki }» iji<l In un uuh< \u niid 
' JiliN l)'»n tic Mn it:c 1 1< nil iprcs rmtmcnt ‘'tuih 
w liV . In tilhtlon f r Hitlis uid otlicr 

Medicil lurpo c 1) w me Ruliint Hen Infr* rt\i 
I ifsht \iUltt 'll kunUKlit I) \j-s ii\ \1 Tlifrli VnincncA 
Dmtlicrnn Nauheim Huh Niijl. i-mm J utij. rt 
(.crti/Jed nuH fnrnowufirm J uve inter Cintcii 
Orenestn lal j n \ision I ir lo ilid Nivht \ttciid 
nice Over fO tnlntii Mil nnd liinile Nui-ve 
■Ma«;cur Mttndini etc 

Terms 13/ to 18/6 per d'\v mclusue bonrd 
lUustr'itcd Brochure M J on request 
Resident Plnsicam 

G C R HAUBINSON MB B Ch BAO 
(RUI) R MacLCLL\ND MD CM 
Phone No 17 Crams Smedlcys Matlock 


MONTANA HALL, Montana, Switzerland 

OPEN ALL THE TEAR 

THE ONLl SANATORIUM IN SWITZERLAND UNDER BRITISH OWNERSHIP 
AND CONTROL AND WITH A DAY AND NIGHT STAFF OF BRITISH TRMNED 

NURSING SISTERS 

INCLUSIVE TERMS — from 7 Eiimcis (stcrlme) per week. 


Med Supt HILART ROCHE M D (Melb ) M R C P (Lond ) Tubereiilous Dis Dip (W^IcsI 


CITY OF LONDON MATERNITY HOSPITAL 

{.Incorporated b\ Roinl Chariet) 
cm ROtD I C I 


The Hospml offers facilities to POSTGRADUATES for obserMue the work of its Antenatal 
Postnanl and Dental Clinics and to male MEDICAL STUDENTS (and Pnctuioncrs dcsirinR 
n Refresher Course) a two or four weeks Midwifcrj Course (Rcsidcntnl) Nearl> 2 000 
patients annuall> 

RALPH B CANNINGS Sccrclarj 


QUEEN CHARLOTTE’S MATERNITY 
HOSPITAL 

MABYLEBONE BOAD, N W 1 

Medical Students ind QinliRcd Practitioners ndmificd to the Practice of this Hospital Unusual oppor 
tunitic arc afforded ot sccinR Obstetrical Complications and Opcniisc Midwifery (about one half of 
the total admission bcnik primioarous cases) Otcr 2 700 patients are admitted to the Wards annual)) 
and in the Antenatal department there arc ONcr 20 000 attendances per annum Clinical demonstrations 
art si\en bv the Staff da 1> 

for rules fees etc appi) H B Stokes Secretary Superintendent 


LONDON HOSPITAL 
MEDICAL COLLEGE 


F.R.C S. 


A Course of Instruction for the FINAL 
FELLOWSHIP EXAMINATION will bcfiin on 
Thursday September Nt 1938 Fees (cxclusue of 
Operative Surgerv) 2** guineas Operati\c Surgerj 
10 guineas 

Further particulars nta> be obtained from — 
DR A E CLARK KENNEDY MD FRCP 
Dean London Hospital Medical College Turner 
Street London E I 


LONDON HOSPITAL 
MEDICAL COLLEGE 


PRIMARY FELLOWSHIP 
EXAMINATION 

A SPECIAL COURSE OF INSTRUCTION for 
the above Examination will begin on Thursda) 
September 1st 

The fee for the Course ts 15 guineas 
Further particulars may be obtained from — 
DR \ E CLARK KENNEDY MD FRCP 
Dean Turner Street Mile End E 1 


DIPLOM V IN OPHTHALMOLOGY 
DIPLOMA IN RADIOLOGA 
DIPLOMA IN LARLNGOLOGA 
AND OTOLOGA 

Short Intensive Revision Courses Oral and 
Postal in prcDTraiion for these Diplomas 
For full details wntc Secrftary Medical 
Correspondence Coltccc 19 Weibcek Street 



ROYAL COLLEGE OF PHYSICIANS OF 
EDINBURGH 

ROYAL COLLEGE OF SURGEONS OF 
EDINBURGH 

ROYAL FACULTY OF PHYSICIANS AND 
SURGEONS OF GLASGOW 

COPIES OF REGULATIONS for the TRIPLE 
QUALIFICATION (L R C P E LRCSE and 
L R F P A S G ) and the DIPLOMA IN PUBLIC 
HEALTH containing dates of Professional Ex 
aminations for the >ear 1938 1939 CurneuUim cte 
ma> be had on application to The Registrar 
Surgeons Hal! IS Nicolson Street Edinburgh 8 
or to the Registrar 242 St Vincent Street 
Glasgow C 2 


STAMMERING, SPEECH DEFECTS 

BEHNKE METHOD 3SS0 Cu'iosnon 

re^ulont treated at 39 Enil a Court Sri 
& W 6 and jn residence in the Slimmer hoh 
days atMi'sS Beiinke s house on the Chilterns 
Pie eminent success in education anl trcatmcul 
of stammering and other 'ijiecch delecl^ — Times 
Thoroughly phv biological principles — lancet 
The method is iticntificallv correct nnd perfectl) 
effective — t»nv s Hospital Cazette 

Stammering, Cleft Palate Speech, Ltspmg, 

3 9 of Mjss Bejini e 39 Earl s Court Sq S W 5 

THE CHILDREN S CENTRE 

THE 

INSTITUTE OF CHILD PSYCHOLOGY 


TRAINING and EXPERIENCE m the PSYCHO 
THERAPY of CHILDHOOD arc offered to 
Medical men and women One Year Course 
beginning in September 

All particulars may be had on application to the 
Secretary 6 Pembndge Villas London W 11 


PiehniiiiJiy E\aiiiinatioiis 


Fhe COLLEGE OF PKECEPTORS holds Pre 
Iiminary Examinations for Medical and Dental 
Students in London and at Provincial Centres 
in March June September and December For 
Regulations apply to the Secretary College of 
Preceptors Bloomsbury Square London W' C 1 


the 

HOTEL GREAT CENTRAL 

Marvlcbone Road, N W 1 

The Hotel Great Central is within a few 
minutes walk of flic irr-on Clime and 
Harlev Street 

Special terms for friends Msnmg Nursme 
Homes in Mcinitv 

Apph Manager Telephone Padd 1220 


TORQUAY 

GRESHAM COURT HOTEL 

RECENTLY OPENED Lii\iirious 
comfort combined with an earnest desire 
to please 

The resident proprietors will be pleased 
to quote special terms to members of the 
Medical profession on receipt of request for 
Illustrated Brochure ‘ M ’ Tel 3658 

CITI OF LONDON MENTVL IIOSpITVl, 
DVnXFORD^ KENT 

Ladies and Gentlemen received for ircaimcnt 
under certificates and without ccnifiaJion ai 
either VOLUNTARY or TEMPORARY PATIENTS 
at a weekly ftc of TNVO GUINC\S and upivarJa 


D octor avill receive a malt 

PATIENT modern Tudor home near 
Windsor quiet surroundings Wravsbiiry 310 
— Address No 7’03 B ^[ A House Tavivtixlc 
Square C 1 


R esident patient funchion \l condi 

t on bed ridden or oihcrvviic can K received 
in medical mans large wcllfurnwhcd house 
garden beautiful country conveniently dost to 
London from about July 28th— Addres No 
7302 BMA Hou e TaustocK Square C 1 


gOUTHERN RHODESIA MEDICAL SERMCr 

GONERNMENT MEDICAL OFFICER 

Applications arc in\itcd from fully qualified 
male Medical Practitioners for appointment av a 
GOVERNNfENT MEDIC \L OFFICER m ih 
Southern Rhodesia Medical Service . . 

Salary will be on the <calc £600-£25 £<^0 
annum There iv also a senior grade (CrO-t ' 
£900) to which promotions arc made as ^aclrtcl^ 
occur Salary will commence from the dale oi 
assumption of duty in Southern '"Rhodesia in 
addition private practice is allowed 
Tlie successful applicant will be tcquirca P 
sign an agreement for three years scrvi c in ine 
firist instance and thereafter may make appucaiivn 
to be placed on the pensionable establishment 
A free second class steamship passage to Ca^ 
Town and first-clahs railway ticket then c n 
Southern Rhodesia will be provided 

Canvassing either directly or indirectly |'v'U 
disqualify applicants , 

Tlic applicants should state (he date on 
they would be prepared to leave tnglano i 
appointed . 

Applications stating age qualifications ano c 
pcrkncc together with copies of . 

should reach the OfTicjal Secretary Ofiuc m me 
High Commissioner for Southern 
Rhodesia House 429 Strand London ^ 
(from whom further parlicuhrs and 
fomv may be obtained) not later than Jui) 

J^IDDLESEX COUNTY COUNHl 

PUBLIC VACCINATOR required for Lalch^ 

and Starnes district Must be qualified i^' 
practitioner with certificate of . 

\iccimuon Sub eel to coninct , 

accordmR lo Minislrj of Hcalili % aronwien r 
1930 embodyinc Council s scale fees ee 
ment not on pcnsiombic *"*1, 

Apolicalions B.MnB due of both 
and experience and copies of not more lb 
recent testimonials should be 
iindcrsiBncd by July 23rd in cmclcipcs 
Vaccinator No forms proMded ^ 

Kclationshtp to any member or oOiicr i ^ 
Council must be disclosed nnd cama <in« 
or indirectly disambnes 

C \V RADCLffEE Z 

Clerk ot the County Cotm il 
Guildliall gVcstminslcr S W I 


K 


ING S COLLEGE HOSPITAL 
London S E 8 


to 


BfOCffEMIST (male) required lu , 

October 1st Salary fiW) per ”"3.“ 

portunitics for Proaic e j jn^ol 

ist be medically qualincd and hayc had pe 
icricncc in Chemistry c^^.rmVr Id 

applications should be sent •’> J* KniriJl 
the House Goyernor Line s CN 
nmark Mill SE^ from sshom full prm 
the p isl may be ob aincd 












JL'!-^ 16 I 9 ^<! 


THE BRITISH MEDIC \L JOURNAL 


UE^IVERSITY OF LOS^DON 


BRITISH POSTGRADUATE MEDICAL SCHOOL idepartmevt or p*.tholog« 
DIPLOMA IN CLINICAL PATHOLOGY 


\ COURSE or STUD> m Ihc nodcmic vcir I9'.S i9 will be held for this Diploma commencin- on October Jrd 
The Course sstll occiipt twclsc calendar months The subjects embraced will be — 


H’\EM \TOLOCA AND CLINICAL P VTHOLOG^ 
PATHOIOGICAL CHEMISTRY 


R \CrFRIOLOG1 

MORBID \N\TOM^ ^ND HISTOLOG'V 


lo S 


The Course will commence with Haematoloes and Clinical Palholoes sshich will occtips about sia weeks ard will be 
followed b\ the Course in Patholoeical Cheraistrs which will occiips about the sane time The Courses in Baclcnoloes and 
Morbid Anatoms and Hisioloes ssill run concurrentK and oceiips about si\ months For the last three months of the Course 
students will be occupied in the practice of routine work in the laboratories of the Department and in resision work The 
number of places m the Course is limited and students will he selected shortls before the Course is due to commence 

Fee forts cuineas , , r > 

In addition to the full Course it will prohahls be possible to enrol a limited number of students for the subjects ot 
Patholoucal Chemistn, and Clinical Patholocs and Haematologs eparatels the Course in each subject lasting about si\ 
weeks "Fee for either Course nine guineas . ,-c c ■ r, c 

Further particul .rs mas be obtained from the Dean British Po tgraduale Medical School Ducanc Road Shepherds Bush 

London M 12 


POST-GRADUATE COURSES 


Open onl\ lo Alt mlier- 
Vni inl Siil)«oription £110 


PRIMARA FRCS PHASIOLOGA COURSE ( \uc Ulh to Nos -ih Monds Weds indFris ^ 10 p m ) MRCP Cl IN.C \L 
AND PATHOLOGICAL (National Temperance Hospital SO pm Tues and Thurs Sept fith lo 22rd) MRCP CHFST 
(Brompton Hospital S 0 p m twice sseekh) RHFUM \T1SM AND HADPOJHERAPA (week-end Sept Kith to ISth Rosal 


Bath Hospital Harrogate) 

Appls FKI L.OAA SHU OF AIEniCINK. 1 A\ impole Street lainilon W 1 (laangham 42C(; ) 


UNIVERSITY 

EXAMINATION 

pOSsTAT 

INSTITUTION 

Folsded ts 1882 

17 RED LION SQ, LONT 30 N MCI 


EXPERT PREPARATION 
FOR 
ALL 

MEDICAL EXAM INATIONS 

ORAL CLASSES 
POSTAL COURSES 


PRIVATE TUITION 


THESI S GUID ANCE 

MUSEUM DEMONSTRATIONS 

THE PRINCIPAL V/ILL ADVISE 
ON ANY DIFFICULTY THOSE WHO 
CARE TO WRITE OR CALL 
MEDICAL PROSPECTTLS (47 pp ) 

CONTESTS The method and the cost of enter 
me th Mednal Profession Pa ilct la s ot oil 
'fed/cof Examinanoni Postal Courses ^nd Oral 
Classes Su^scstions for the Hi her McdKSil 
Examinations Suf esiions for the Higher Sur 
picaj Examinations SagC'stions for the Soecta! 
D picma Examinations Refresher Counes Open 
mgs for Women Hints for WTiung theses 

Medical Prospectus gratis along xMih 1st of 
Tutors etc on application to the Prlncipaf 
17 Red Lion Sq London W C 1 CTelephonc 
Holtorn 6313 ) 


MEDICAL 

CORRESPONDENCE 

COLLEGE, 

19 VTcIbcrk lomlon W 1 


i 

i 

1 

I 

1 

IS 

H 




Candidafc^ cnlcnns for Pari I in 
November I93C or for Part** 11 
mtl in in Mas 1939 iintler ilic 
Nets TlczttIation« '•Iioubl >*ri!e for 
ftiH del'll! of nc>* «oiir»e> of 
po«ial prcpinlion ronforniins: lo 
ihc no* rcquircmcnlM of llic 
ssllabu« 

Hicbis rpi'ilifiod Tnlor'* 1 1 Ii 
acciir lie knos !cd^e of ibe '•pecinl 
fcTlurc'* of ilic**c examinations 

n me at once for booklet The 
Problem of the Final MDBS 
London Sent free on application 

Aihlrenn The Sccrclars, 
MEDIC \T rOI5RCSPO>DC>Ci: 
COLI rCE 

19, \> cibeck Slrccl London W 1 


DTPIOMA rs PUBLIC HEALTH 
The Royal Institute of Public 
Health eind Hygiene 

The Course of Instruction can be commenced 
at any arte. Spcaal p ovision ts made for 
students sxho can give only pan time to the 
work 

A prospectus and further paroculars can be 
obtained trem the Secretary 

Telephone Lan h ri J'llfZ 
S Poniard Place Lxsodoa W 1 


LM\nRsm or cvMBRiDcn 

MnOMV IN 'IfPH tl PVDTOIOri \ND 

nHTnorori 

Ihc rcti Ci^inc o Stu-v f r ^••c D - r-j b •* s 
S } (Kt N*r Jt** 1 s r- -e cs e*’ t w r* 
m nih It I f--fr e* — 
la) r ur m « ‘•s i- tf -t r t- PHYSICS PAD! 

OLO''^ aro PSTHOLOO^ 

IM Th ec r* rt**s f i- trut " i- P \Df 

OLOC\ or- FI FCTPOLDC,^ t 'Ctbe »ith 
three m r b cl al «•(.*. n the Rad xaf 
DArirtr— r a br - fjl p" oseu by tt 
hf na C '-T- tec * !*•« D -! r*i 

I ) T» r* n hs etpercr e a CLISIChL 
\SS!ST\sr n t*’e Pad -cat De-art— e-t 
rf a b-TNCiJ arr r cd h i''- Cir*r* e 
H'^-italx m Lore, n m t e Pro ir es -d 
OxcTxca haxc beer arrro ed f'* ib r rt e 
tbc C ) rse 

Exam nati Px f r Part 1 iPhx -si »ii be b i. n 
February a d July 191*) ard f r Pan 11 iRai- y 
rie-trolosfv and Path lv->) ir July a fJi.tr*“er 
J9t9 

The Lr t n I ar that if P rl n f’ul 

craie t be t anted at e I’UI The la t C fc tor 
the D ploma *>ilt i a^t in October 19J1 ,.ru l e 
lati exam rat on h ’ be f elu n Oct ber I9-»| 

The Courses are opc^ to m-n and wor-en wh >ic 
meuical Quit iva ons arc apc oxed by tbc C-rcral 
hfed cal Coural frr pup'^es of rei:“stntion ard 
who atwfy the Comm tee that ibey b-i\«- b d 
xutT lent pest grad ate dm cal cxpcricrcc 

Further m ormat on about the Courses may be 
ofctai ed f rerr — 

C STEVD M \ Secretary fyr the Dp ma 
Caxcrdi h Labo at r> Camtndrc or 
The General Secretary British Ir t u c of 
Radioft-y i Weibevk Street Lordc- W | 


THE POLYTECHNIC, 

REGENT STREET M L 
DFp\n'nH:>T oi cnEMiHTr\ \>"d i lorm i 

Head of Departrr nt 
H La tcOLFvE Nf \ M-Sc F I C 
DAY COURSE IN CHEMISTRY PHYSICS \ND 
BIOLOGh AND EXENING COURSE IN 
CHEMISTPX AND PHXSICS 
For the 1st ^IEDICaL and PRE MEDICXL 
EXAMINATIONS 
Nc*# Scss on Ck.m'rcn cs 
Day Secterrfcef _0th 19^ 

Exemng Sept-mber _oth 19 S 

Fee to London udeiLS 
Day £S S 0 per term 

E ermg £_ _ 0 per t rm 

E-rly appli-ation should be ma<!>* to th- Di emer 
of Education 


FR CS (E din) ^ 

EDIN'BtrKGH POSTAL COURSES | 

Fall details of above and Oral CLassea — 1 
H C Oiuu.\ FJl.C^^Stt.zcoo sHall Edinburgh, | 





THE BRITISH MEDICAL JOURNAL 


JuL\ 16 IQ-t^ 


jgOROUGH or ntXLCY 

ASSISTANT MrOICAL OmcCU Of 
HEALTH 

AppliCTliom TTc m\itcd from fntly qintlficd 
mcUiCTi men nnd women nol cvcccdioR 45 yeTrs 
of ICC for die post of whole time Assist int Medical 
O/Iiccr of Hcilth 

Applicants must ha\c had not less than three 
^cars postcradualc experience with special cxpcri 
ence m the manacemem and dietetics of infnncj 
children s disc iscs and practical midwifery 
The possession of a Diplomi m fiihlic Health 
\nd/or posicradiiatc diploma m midwifery will be 
considered in id\ mtacc 
The person appoinied will be Tcfnmcd to reside 
\\\ the Borouch and to work under the dircetion 
*•11 f control of the Medical Otliecr of Health 
principally in connexion with the admimstr ilion 
of the Materntfj and the Welfare ScrHccs ind of 
the Coun-'il s Maternity Home 
The salary will be at the rate of 15^0 per mniirn 
rismc b\ annual increments of £25 m a maximum 
of £700 sub eci to i dedutlion of 5 per cent 
unJet (ho Local Goicrnment and Other Oflicets 
Siipcnnnu ition Act 1922 
The sncccssfij) candidate will be rcqulnd to pass 
a medical examination 

U omen appheanis must be stnclc ind If 
appointed will he rcciuircd to rcslftn on marrnRe 
•sTIic appointment will be subject to tcrminition 
by three months nonce on either side 

forms of appheaiJon may be obtained from the 
Medical Officer of Hcilth 14 Brampton RouJ 
Bcxlejhcaih Kent to whom on completion they 
should be returned toBcihcr with copies of not 
more than three rceciu testimonials \n sealed ense 
lopes endorsed Assistatit Medical Officer of 
Hedeh by Aupust 5th 19^S at the latest 
Cindidaics must disclose in their applications 
whether to their Knowledge they arc reined to any 
member of or the holder of any senior office 
under the Council Fnlurc to do so or tan 
\assine diTcclly or indirectly will be deemed a 
ihsqtiaiihcation 

Council Officca \V WOODWARD 

Bcxlcyhealh Town Clerk 


lOUNlV BOROUGH Of MfRIinR TYDflL 


APPOINT MCNF Ol ASSISTANT SCHOOL 
MEDICAL OrnCLU (MALL) 


Appheanons are invited from men under the 
aftc of ^5 ycirs for the Abose post 
The dunes will be mamly in connection with the 
School Medical Service tocctUcr with such other 
duties as the Mtdieal OfRctr of Health may direct 
The salary wjH be at the rate of £500 per 
annum rismB by annual Increments of £25 to a 
niaximiim of £700 per tinmim with reasonable 
ttascllmt, expenses 

norms of apphciiion may be obtomed from the 
iindersikncd and completed applications atcom 
panicd by topics of not more than three recent 
testimonials should teach him not later than 
July ^Oth 1938 

Town Hdl T H STCPHLNS 

Merthyr Tydfil Medical Officer of Health 
July 8th 193S 


‘OUNTY BOROUGH OP SOUTHAMPTON 


PUBLIC VACCINATOR 


Uic Corporation mvitc apphcitions from Medical 
Practitioners for the ippomlmcnt of Public 
N accinaior for the District comprising ircas 
5 and 4 

The remuneration will be in accordance with the 
Vaccination Order 1930 which can be inspected 
It the office of the Mcdieil Officer of He ilih Ci\ic 
Centre Soul h a mpf on 

Applicants must possess _ the qualifications 
mcniioncd in the Order 

Applications endorsed Vaccinator must be 

deJnered to me not Uivr than July 30ih 19^8 

Cme Centre R RON\LD H MCOGTSON 
Southampton Town Clerk 


U 


N I V E K S 1 T y 


or 


B R I S r O L 


QCPMtTMCNT OP PUEYTMIVC MEDICINE 


\npULvtions arc intited for a SENIOR 
BACILRIOLOGIST Sthry £700 to £800 per 
annum aecordinp to qualihcaiions and experience 
Appomtment to date from October 1st 1935 
C indidates who must be fully quahhed and regis 
lered must hwe spcefahzcd m Pilhology and m 
,llio-ChcniiNiry and hue had considerable expert 
Is nee m i rccocnt/cd Puholosy department 

ApplKitions should reach the nndetsiened from 
vs horn further pDnicuhrs may be ol tamed on or 
before Aucust 20ih lOag 

WINIERCD SHAPLAND 

Secretary and lURKtnr 


X ** ” 


CHILDREN 5 


CENTRE 


THE INSTITUTX Of CHILD 
PST CHOLOGa 


UONORART ASSl^ANT PHT SICIANS re 
tjinred in September in the I yehother ipcutic 
J> partmcni for work with children — Apply to the 
Sexftiarj t 1 cmbridec Villas \S 11 


J^roiCAL STAEI PRISON SERVICE 
(ENGLAND AND WALLS) 


Applications arc Incited for the post ol male 
MTDICAI ornCLIl CLASS H m the nhmc 
Sersiec CommenemR salary CS25 per inmim 
nsins b\ annual increments to £S00 per annum 
with unfurnished house (free of rates) or n lUow 
ance in heu Tltc post is penMontblc 

Cijndid lies must be fully qualified nnd rcRls 
tcred Preference wtU be Risen to those who hue 
held House vppointmenis base hid experience 
in mental discrses and psycftoIoRicai methods nnd 
arc between the ages of 25 lud 35 years The 
commenemR salary for those holdine the Diploma 
of P ycholoRical Mcdicme wtU be £575 per intuim 

Of the whole lime Prison Medteaf Officers 16 ire 
Class ll and 12 arc Cltss I Promotions from 
Class H to the r\nk of Medical Officer Class 1 
on a saliry scale of £500 per annum risinc to 
£1 000 per annum with unfurnished house (free 
nf rates) or in allowance m hen arc made as 
Nacancies occur Three of the senior Medical 
Officers rccc»\c an uidltional allowance of £5Ci per 
innum vnd at ceritfn Prisons Medical Officers 
reecitc fees foi Riving evidence m the Criminal 
CourUv 

f orms of ipphcation can be obtained from the 
Secretary (SiifT Branch) Prison Commission Home 
Office London b \V I 


R 


oYAi N 7 socicn roR the health 

OI WOMLN and CHII DllEN (INC ) 
(I'lUNkCT SOCIEIY ) 


AVI'OINT MEN! OE Ml OICAL ADVISER TO 
THE DOMINION COUNCIL OE THE 

socin V 


or MANC ULSTER 

ASSISTANT TUriEUCULOSlS Ol I ICCR 

Hie Public Hnlih Commilicc Imhes sitphcMim 
for the position of Assistant Tuberculosis onurr 
ni a commenemR s^i uy of C6SQ per annum hum 
by inmial increments of £25 to £7^0 per anmint 
Candidates must be rckKtered Medical Ptacu 
tioners ImmR special knowlcdRc of Mcdicd ani 
burkical Tubeiculosis and houUl state wbctha 
they possess the Diploma of Piibfie Health 
Appheadons (no spceitl form Is issued) statma 
ace qiinlificaiions and experience uijh copies of 
not move than three recent testlmomals anJ 
endorsed on the envelope Assistant TubcMilosb 
Officer must be addressed to the Medical oaicer 
of Health Town HiU Manchester and not to 
memlers of the Canunittce or Council anvl n\mt 
he reetivcd by him not later than July 27th l4ts 
The Rcndcman appennted will be under the 
admimstntivc control of the Medical Offi er of 
Health uid the immediate control of the Senior 
luhercutosis Ofiiccr He will be required to devote 
the whole of his time to the duties of liis pv-wumn 
to execute the Deed of Service and to conirilmc 
to the Corporation Super vnmntion Tiind 
CauvassfoR fn any form direct or Indirect oral 
or unrteft is prohibited 
Town Hall I 1 W ARURLCk IIOR Tl I 
Minehcstcr 2 Town Ckii 

July 4fh I93S 

Q I T T O J n 1 R M I N 6 (I A M 
RDMSLLT HILL SANA101ULM (PO Itedp 
RESIDfNT ASSISTANT MfDlCAl OmCfR 


The Dominion Council of the Royal N Z Society 
for the HevUh of Women and Children line) 
(Phinkci Society) invites appllcinons from mem 
bers of the Brntsh Medical Association for the 
ippointmcni of a htcdical Adviser to tlic Society 
The ‘.ticeessful applicant will require to reside 
It Dunedin New Zealand lo enter into n conirati 
for a ptciod of hvc years and to deyote hIs whole 
time to the work 

Salary £) ‘*00 per annum New Zealand ciirrcney 
rurihcr particulars may be obfalned from Dr 
R C Jrvvr'unfRt Nf O E K C I 5 w impole 
Street Cavendish Square London W^ or from 
flic HfOlf COMMtSStONCR TOR Nf W ZtAUNP NCW 
Zealand House 415 Strand london W’C2 
The successful appheuu wdl be required to tike 
up duly early In 1939 

Anphcations giving full partrculars as to ace 
experience and qiialilietttons together with copies 
of recent testimonials wdl be received not Inter 
than September 30th 1938 and should he addressed 
to the Dominion PurstDiNT BUinKct Society 
Queen s Buddings Princes Street Dunedin New 
Zcihnd 


'OUNTV ANTRIM MENTAL HOSPITAL 
Ulster 


The Committee of Manipcnicnt of County 
Antrim Mental Hospital invite apphevtions for the 
post of SENIOR ASSISTANI MEDICAL 
Off fCER 

Applicants must be male smgfc under years 
of age duly quahTicd (n Medieinc and Surgery 
uid liavc had special experience m Bacteriology 
Commencin'? salary £400 mimj by £25 inmnllv 
to £6(10 together with furnhhed ipartmenl*- hoird 
laundry and attendance valued at £100 per 
innum 

The person appointed will require to liold or 
to obtain within three years from date of appoint 
ment a Pinloint in Psychological Medicine 
The appointment is subicet to the provisions 
of the Asvlums Olficers Superannuation Act 
1909 mtd to the sanction of the Ministry of Home 
AfTurs Sorth<;rn freiind 

Eorms of ipplicntion which may be obtained 
from the Resident Mcdle \l Superintendent piLst 
be rcturnid to him not Ivier thm Meuuhy August 
1st 1938 

JuW 6th 1935 B\ ORDER 


^HLSHIUE C O U N T T COUNCIL 

Cl ATIEHBPIDGE (C0UM\> GENERAl 
JIDSi’lfAL 

(Near Birkcnlicad) (390 Beds ) 


JUNIOR UESfDfNf ASSfSfANT Ml DICAl 
Of I ICLR 


Applications (male or female) ire muted for die 
above vppomtmeni which fills vacant on 
August Sth . r f V 

The appointment is for a period of six months 
at a Salary of £200 per annum togcdicr widi the 
usual residential allowanecs Htc ippointmcni may 
be renewed for a further period of six months 
There ts a Non Resident Mcdieal Superintendent 
a RcsiUciu Deputy Medic il Supcrmtcndcni and a 
ConsiiUirw Stdf irom Teaching Ho pitiN 
Applications to he made on forms obiaimbfc 
from the unJcrxiRneU and returned not later linn 
July 2Mh 1938 

24 Nicholas Street IAN hfACKAT 

Chester County Mcdleaf O/Iwcr of Health 


Applieitions arc invited for n UcsiiJcnt Awmm\ 
Afcdie vt Olfiecf Candid tits must be (iftmjftrci/ 
md hue held a resident hospital appomimcni fnvr 
quulifyinn I xpcrienee In the dngftous and Itiit 
nient of tuberculosiv will he a rtcomnicntJuIPf) 
Hie appointment will he hmutd in the lirvl 
lusianec to six mtuuhs rind subect to vatid di'fy 
servlet may K extended for i liirihcf su mtmilu 
The salarv will be at iht rate of £’40 per annum 
for Die first six months and E’75 per anniim hf 
the seeond six months with boird and fcsiJcnc 
in cich cast 

1 firms of application may be obtained from the 
Medici) Superintendent Romslcy Hill Samiotiiim 
JliJcsputn near Birmlnehim md vlioitUl be 
rciurntd to him not later than July Mn) !9t3 
J H C WILISIIIKT 

Town ClcA 


QIT\ or MANCUESTTR 

UOOTH ^^^LL rrOSl’tTAL TOR CUtl PUPS 
(760 BcU^ ) 

Hie Eiil'Mc Hnllli Commilicc licilwc (il'l'licilu'nj 
from rcRKtcreJ medic il men (ot 
RESIDENT ASSISI ANT MEDICAL OIIICER ii 
llie ibewcnemcel IiOiPlnl , , 

The eihry for llie nnpnlmmcnt « C™ N' 
nnnimi with iHnrd residenee nnd launOT J" 
iddiiion MiWcel 10 the Mmichcsfct ComoM'iw 
eonditions of ecreicc , , , 

The nppolmmcnt will he midc In w' "n 
ineiincc for i period of eU momhe tnneni'ic^' 
1 firrthcr -.N monllis hot noi renemh e 
roll Inforniiillon nnd forme of 'I'l’henji'"' rT'' 
he ohnined from Ihc Mcellcnl OUlccr of ll» 
loon ffril Minchesicr 2 mid '’I’l'lni 'm n 
the post must be rcecivtd by hmi not 
Julv 23rd 1938 ^ t 

I E WAUBRECK IlOWril 

Icon Ihll Toon Clerk 

Maneliester 2 
July Hih 193k 


Thi 


UNIVLRSin OI 


UNTIIIOOI- 
I (4 


The CounoJ inviics irphcations for d'C 
ffCTURIR (Uncrided) In the ” ^ 

Of PAIHOIOGY Silnrj ff'i’O iiMi'S nr 
incremente of i’k to GW' c 

Ihc eUiuee of the Lecturer evdl f , 
Oetotect 1 st Idis The ippomlnunt r , 
trme one wd the I eelurcr sviU he .j 

eorani) with the conditions of the 
Super loniniion Ss earn for „,i)i p « 

I oiir lypcwriiicn nppliemiom 
references nnJ dt die Ineti r’ 

of lesiimonuls should he . ptf it r 

S hotel ,1 Sememher tel h',,'! tr 

I not, tries tor torlhcr '"f"" "] fes- t ' 

addressed to the George » 

ih. '>>-'-Y[Vt)i 5 vinin^,,,, 

jiih lois UL - — 

nADlUAf fit AM 

IV At the Ridium tj""".' ^ o | 

1 Rtdtnc Hoii c Street tondon 

ASSI^fANt Ml DICAL OEI ICLR ('r"i 
sitrry CMd per nnmmi Sis r"^'’''' L -J o 
Applicaiionx siatms age quahfica ^ 

xVteTee »'.h coptes of Pr P 

o the Secrenry Itidliim >'rim ■'""1' 
lOt liter linn Monds) f" „„ I 1' ' E 

It ,e pnssihle for 1 ' Of r- 

mil at me ssm dm'' 'n eirry on 




juL-i 16 ig-'s 


THE BRITISH MEDICAL lOURNAL 


47 



Appointnieiits foi iMedical Office/ 'i 
III ihc EOYAL AIR FORCE 


Mcdicil nicii *irc imitid !o for Sltuil S«i'H-c Coi!in»i**'»ioiis m the Ro\ il \ir I ortr 

Candid i(c<i niii't 1)C red under ilic Mcdital Net-* ind !)l not inori tliin 31 m ir& 

of nuL on cntr\ 

The period of '•crMcc i** 1 u t \i< ndthit Co 5 xeii'v \ .^rntint} of £d00 or £1 000 
i- paxalde nt the Icrinimtion of 3 or 3 \cars i« '*p(.iH\ c]\ !'< riii \nent coniiiii ‘•lon^ irc 

aA>'irdctI in n nundicr of I lio'-e off< r a pt ll•‘lomhlc cirttr willi ihc e>pporliinit\ of 

c\tri IcnNC on full pi\ for «pctnli cd *'tud\ \pplic inC'- wlio hold— or nre hk< 1\ lo hold 
— po-l«griduntc appoinlnKtiN iii ci%d lio picaU in i\ on joinnij^ ihc Ro\al Vir force he 
seconded until the (cmitnition of their appointnu nts (for a period not cvcecding one 
^c•\r) \n nntednle of co!iinn»'*ion up to t\\«l\c iiionth'^ i*. tIIonm d for nppomlinLiilH held 
nl nppro\ed ho pit da 

Fuller information can be obtained from The Director 
of Medical Sen ices. Air Mtnislr}, hingstia^, London 


ROYAL NAVAL MEDICAL SERVICE. 


Vacancies exist for Medical Officers in the Royal Navy, and applications are invited for entry 
m September, 1938 

Candidates below the age of 28 )ears are preferred and they must be registered under the 
Medical Acts No examination m professional subjects will be held, but candidates will be 
required to attend for mtervievi by a Selection Board 

Selected candidates will be entered for Service for a period of three jears, which if desired is 
usually extended to five years at the discretion of the Admiralty 

At the end of three > ears’ service, officers may letire vnth a gratuity of £400, but those who 
serve for five years will receive £1,000 

At the end of five years Short Service, permanent commissions vmII be given to selected officers 
who viish to make the Naval Medical Serv’ice their permanent career Officers transferred to the 
permanent list will receive a gratuity of £1,000 (less Income Tax) 

Full opportunities exist for transfer to the permanent list, and periods of unemployed or half 
pay are v ery rare The assistance of private income is not necessary for the purpose of supplementing 
official pay and allowances 

Opportunities are av ailable for officers on the permanent list for post-graduate study, to specialise, 
to take-higher examinations and to obtain further qualifications 

Naval Medical Officers are mcluded in the Scheme for Marriage Allowance under the same 
conditions as for other Naval JDfficers 

Copies of the regulations for entry and conditions of service, including rates of pay, allowances 
and retired pay, may be obtained from the Medical Director General of the Nav'y, Admiralty, S W 1, 
and from the Deans of all Medical Schools 

Applications for entry from mtendirg candidates must be received not later than 
31st August, 1938 




THE BRITISH- MEDICAL JOURNAL 


Jun 16 1918 


-j8 


AMENDED ADVERTISEMENT 


QIT\ 01 COVENTRY 

ASSISTANT SCHOOL MEDICAL OTTICER 
AND ASSISTANT MEDICAL OTTICER OF 
HEALTH (MALE) 


The Co\cnirj City Council miiic inplicntions 
for the nboic post from rcEistcrcd nnie mcdkil 
practitioners under 40 vctts of 'irc Applic'inis 
should possess n Diploma m Public Hcalih and 
prcMoiis experience is desirable The duties- arc 
in connection with the medical inspection c c 
of school children and (here arc also opporiunides 
for experience in Rcneril public health work 
The commencing sa irj will be £600 risinp by 
annual increments of £ 2 s to a maximum of £700 
per mnum 

The post IS dLSicnaied under the Local Go\crn 
mcni and Other Ofliccrs Super mmiation Act 1922 
as unended in regard to innuuics to widows bi 
the Coventry Corporation Act 1936 and the 
successful applicant will ^e required to pass a 
mcdic*il examination as to fitness and to con 
tribute to the superanmt ition fund ind to the 
Covcnlrj Staff Widows and Orphans Pension 
Fund 

Vpplications stating age qualihcations and 
experience together with copies of three rcct.nl 
icstimom lU should rLach the undcrsigntd on or 
before Juh 27th 1939 

The Council House TRLDCRICk SMITH 
CoNcniri Town CIctk 

JuU Uih 193S 


(^IT\ Of SALFORD 

HOPE HOSPITAL 


\pplicaiions arc united for the post ol KCSI 
DENT OBSTEIRIC omCEU at Hope Hospital 
S Ilford to comiticnLc duty as soon as possible 
Commencing sal iry £460 per mnum maximum 
£''20 per annum phis board lodging attendance 
and laundry A deduction of 5 per cent will be 
made from sa! vry md ctimucd \ due of emolu 
ments for superannuation purposes 

The Hosnital contains I I'tO beds ind is equipped 
with Paiholot-icil Lahorators \ Ua\ and Electro 
Cardiograph and affords fud facilities for clinical 
investigation 

The Resident Obstetric Officer is one of the three 
Senior Residents and will be responsible for work 
in ^ihe obstetric and gynaecological division 
Candid ucs must have had recent extensive prictical 
experience in obstetrics and in gvnaccology and 
must possess the M C O G Diploma Preference 
wi|l be uwen to candidates who also posscis one of 
the higher surgical qualifications 
Eurihci particulars and application forms may be 
obtained from the Medical Officer of Hcdih 143 
Regent Road Salford 5 to whom they must be 
returned accompanied by copies of not more than 
three recent testimonials not later than Saturd ly 
July 23rd 193b 

H H Tomson Town Clerk 


H 


ERTEORDSHIUE COUNTY COUNCIL 


MATERNITY AND CHILD WELFARE 


ASSISTANT MEDICAL omCER OF HEALTH 


Applications arc invited for the post of Medical 
Officer for Maternity and Child Welfare work In 
the County of Hertford Applicants must be 
registered Medical Practitioners and have had 
special cxpericnvc in Maternity and Child Welfare 
and Ante natal work and have had at least three 
ycirs cxpencnik in the practice of their profession 
Commencing salary £S00 per annum rising by 
annual incremcns of £25 to a maximum of £700 
per annum 

The post IS ubject to the provisions of the 
Local Governmen and Other Officers Superannua 
tion Act 1922 and the successful applicant will 
hayc to nass a medical examination 
The Officer appointed should possess a car for 
the use of which a mileage allowance iccording 
to the County Scale will be paid 

Particulars of experience -qualifications and 
copies of three recent testimonials should be sent 
to the Clerk of the County Council Clerk of the 
Peace Office Hertford not later than Monday 
July I8th I93S 

ELTON LONGMORE 

Hcrilc d Clerk of the County Council 

July 19 jS 

C ITT AND COUNTS OF NEWCASTLE 
UPON TYNE 


NEWexSTLE GENERAL HOSPITAL (SOO Beds) 


ASSISiA'T RADIOLOGIST 


\pplieations arc invited from duly qualified and 
tcetsicred Mcdieal Practitioners for the post of 
A tant Radiolokibl m charge of the Deep Therapy 
Department at the above mentioned hospital 
Salary £..00 rising by two annual incrcmfnls of 
i 0 to £600 

^pphtalions which should give full details of 
training and cxpctwnce Kvgether with copies of 
t I testimonials should be submitted to the 
NEdical Offiecr of Health Health Department 
I wn Hall Newea tlc-uponlync 1 not later than 
W cxlncsdav July 27ih 1938 


D urham county council and 

CHESTER LE STREET URBAN DISTRICT 
COUNCIL 


COUNTY council^of^toc^west riding 


DISTRICT TUBERCULOSIS MEDICAL 
OFFICER AND MEDICAL OmCER 
OF HEALTH (MALE) 


AppHcalions arc invited for the above appoint 
ments Candidates must be registered in the 
Medical Register as holding a Diploma in Sanitary 
Science Public Health or State Medicine and 
must have had a satisfactory experience in the 
diagnosis and treatment of Tuberculosis 
The salary will be £600 per annum in the pro- 
portion of £572 15s payable by the County 
Council and £227 payable by the Chester Ic- 
Sircct Urban District Council 
The officer appointed must either have Jtcld a 
previous appointment as Tuberculosis Nlcdicai 
Officer with the approval of the Minister of 
Health or 

(i) have had at least three years experience 
in the practice of his profession 
hi) have spent in general clinical work a period 
not less than ciehtccn months of vvhich not 
less than six months have been spent in a 
Hospital as Resident Ofliecr m charge of 
beds occupied by general medical and 
surKical eases and 

(m) have received special training for a period of 
not less than six months in the diagnosis 
and treatment of tuberculosis 
Travelling and subsistence allovvanccs according 
to a scale front time to time in force will be p\ld 
bv the Cotimv Council m respect of the duties of 
District rubcrciilobis Medical Officer and the 
officer witf subject to the directions of the Countv 
Medical Officer be under the control of the Central 
rubcreufosis Medical Officer 
It will be a condition of the appointment that 
If either po l is terminated the other post will be 
luitomatically vacated 

The appointments will be subject to the •'pproval 
of the Minister of Health and the offiecr will not 
be permuted to take part in private pr ctice 
Hie person appointed will be required to live 
in or ncir Chester Ic Street 
Applications endorsed T M O and M O H 
md iccompinivd by copies of not more than 
three recent icstimonials must be addressed to 
the Countv Medic tl Ofliccr Shire Hall Durham 
md must be received by him not later than July 
23rd 1939 

Shire Hall J K HOPE 

Durham Clerk of the County Council 

July 4lh 1936 


C OUNTS BOROUGH OF BlRkENHEAD 
DEPARTMENT OF THE MEDICAL 
OFFICER OF HEALTH 


BIRKENHEAD MUNICIPAL HOSPITAL 
(560 Beds) 


MIDDLETON IN WHARFEDALE 
SANATORIUM 

APPOINTMENT OF JUNIOR RESIDENT 
MEDICAL OFFICER 

The Coiinry Council of the U cst Ridm? of 
lorkslurc invite ipphcations for the appomiment 
of Junior Resident Medical Officer (male un 
rnarned) at the Middle on fn \\ hirfcdifL Sana 
tonum near IlUey (300 Beds) Salary fuo b) 
increments of £25 to £450 per annum with hoard 
Candidates should have previously heU an 
appointment as House Phvstcnn or Hotiv 
Surgeon and experience m Pulmonary and Non 
Pulmonary Tuberculosis and \nacsihcucs will be 
mn advannjic 

The appointment will be subject to the rr*'' 
Visions of the Local Government and Oihrr 
Officers Superannuation Act 1922 
Fiirilicr particulars and form of application may 
be had from the undersigned by whom all arplica 
tions together with copies of not more Unn three 
recent icstimonials must be received not bier 
than Monday July 2^ih 1938 

J CHARLES McGRATH 

Clerk of the County Coun tl 
County Hall Wakefield 
July 19'S 


ANCNSHIRE COUNTS COUNCIL 


APPOINTMENT OF DENTAL SURGEON 


The Lancashire County Coiinei! propose lo 
appoint a full lime Dentnl Surgeon and inuic 
applications from fully quahricd and ngi icrrd 
Dental Surgeons who must not be over 40 years 
of vge The duties of the post include the dental 
inspection and treatment of school children v\ak 
under live Maternuv md Child W clfarc Acis arj 
such other duties as may from time to tune be 
imposed by the County Council 
The salary will be at the rate of per annun 
rising sub ect to satisfactory service by annjvl 
increments of £2^ to a maximum of £/0O ixt 
annum together with allowances for irwcllinc ei 
The person appointed will be reQUin-d to pa s a 
medical cxammition and to eomnbutc lowarJj the 
Council s Superannuation Seheme 
Applications must be made upon a form whi h 
can be obtained together with fiirihcr parti ularv 
from Countv Medical Officer of Ucahh ScluxM 
Medical and Child Welfare Department County 
Offiecs Preston to whom the completed f™ 
should be returned not later than July '’5th I'D" 
All communications must be endorsed I)nal 
Surgeon Canvassing is strictly forbidden »na 
will disqualify 

County Offiecs GEORGE ETHERTOV 
Preston Clerk of the County Coun il 


RESIDENT SURGICAL OFFICER 
RESIDENT MEDICAL OFFICER 


Applications arc invited for the above posts 
vvhich wiU fall vacant on October 1st 1938 The 
ippotnimcnts aft for twelve months 
Candidates-musi be male wnmarned and fully 
qualified registered medical praciitioners 
The duties a lached to the post of Resident 

Surgical Officer arc mainly surgical and obstetrical 
and preference will be given to candidates who 
have had previous post graduate surgical (including 
operative surgefy) experience either in a Municipal 
or Voluntary General Hospital 
The duties aiiachcd to the post of Resident 

Medical Officer ire mainly medical and preference 
will be Riven to candidates who have had previous 
post graduate medical experience 
Satary £390 per annum with board residence 
and laundry 

Applications must be made on forms to be 
obtained from Dr D Moricy Matlucson Medical 
Officer of Health 9 Hamilton Square Birkenhead 
Applications cndor^^cd Resident Medical 
Officer to be received by the undersigned not 
later than July 25th 1938 
Town Hall E W TAME 

Birkenhead Town Clerk 

JJAMPSHIRE C 6 U \ 7 Y COUNCIL^ 

\SSIST\NT COUNTV MEDICAL OFFICER 


Applmtions jirc invited for the post of Assistant 
County Medical Officer Possession of a Diploma 
or Degree in Public Health is essential and pro 
Mous experience m the various branches of public 
health work especially tuberculosis and school 
medical service is desirable 

Hve successful cmdidaic will devote a portion of 
Ills lime to the work of Medical Officer of Health 
of a County District The salary will be £7(7 a 
year rising on approved crvict to a minimum of 
£x00 a year (sub eel to deductions for pens on) 
in addition to iravclling expenses 
Applications "nh copies of not more than tfircc 
recent testimonials upon a form which with the 
condiiions of appoinimcni may be Obtained from 
the ciouniy Medical Offictr The Castle Winchester 
hould be sent to him as soon as possible and not 
I iitr ihan July IMh 1938 Canvassing is prohibited 
The Ca tie F \ BARBI R 

W'lnchestvr Clerk of the County Council 

Julv 2nd 


JTY OF BIRMINGHAM 


PUBLIC HEALTH DEPVRTMENT 

LITTLE BROMW'ICH HOSPITAL TOR 
INFECTIOUS D1SE/\SES 


JUNIOR RESIDENT MEDICAL OFFICERS 

Two Junior Resident Medical Officers 
and one female) required Cand dales ‘ 
unmarried and must have held previous res 
posts in general or children s hospuah 

Salary at the rate of £300 per annum toJdnr 
with board etc valued at £150 per 
■vppointmcnis arc limited to twelve ,, 

The officers ippointcd will be required 
the Council all fees allowances and 
(other than the -foregoing) received by tnejn 
will be required to take up duly at the 
September . r , .s,. nPH 

It is not feasible to attend classes for the if 
m conjunction with these appoinirn^cnts . 

Forms of application may be of 'Jin 
Medical Suncrinlcndcnt Dr J 
Bromwich Hospital Birmingham 9 ai^a » 
returned to him on or before Jub 
The Council House F H C " 

Birmingham 


Town Clerk 


^OUNTY BOROUGH 01 pURNit 

MUNICIPAL general HOSPIT'L 

JUNIOR RESIDENT MEDIC \L OFFlCEf^ 
(Male) 

Applications are invited from fuly .. 
medical men for the Pf nl 
Medical Olficcr at the Munrerpa Cm 
Burnley to take up di lies on ^ 

19^8 The appointment will he 

months £200 

Tioni).-; plM^ full ic- > 

\pplicatron< topcihrr »uh cnrin ‘ 
should be forwirdcd jn earlj •> >, 

(tcd.eil Odiccr ol UmI* 

f^tirnlcy .tapux pLOWHV'’ , 

Town Hall ifAPRV C"* 

Burnley 
July 6th 1938 


Jlu IG 193S 


THE BRITISH MEDICAL JOURNAL 


49 


Q1T1 or MVNC II ESTER 
PUBLIC HEM Til DEPLRIMENT 
APPOINTMENT Op LIXPUM P\THOLOCIST 


QOUNTT COUNCIL or DURHAM 
EDUCATION DTPARTMENT 
ASSISI ANT SCHOOL AIEDICAL OFT ICER 


QOUNTT COUNCIL OF D1 
EDUCATION DEI ARTMENT 
SCHOOL DE-NTIST 


CRUAIPSALL HOSPITAL (I -liVI BcJ 1 
AA ITHINCTON HOSl IT AL (I 1 s A 
BOOTH HOAPIT AL ('(-O Bed 1 

The PuNi Hc-Ith Co-nnittcv mMio ar*'* at ^ 
fn.*n qual fed r'-vl "al J "cn f r l^c a^po nt 
men! Tf Lccu~t Path ! k t (mn res ocrt) n 
\ tAith the r'j''n"al h'*<rtaK patho!^ 1*31 

NcniT for a rcrxl pJ arr x *natch th ec m i h 
The rm-rcrati n f the T»iii n "iH N. at the 
ntc of tlO l(H ref 

The rcr^t -r*' ed '^•55 required ii cm 
r*cn~c d » « >.n ai ^fc afid will worV 

h cr> at th CnnrNall l-K at n h t 

ru^ h \c to at at ar> of t** three hi *’ aU of 
the cr\~ee 

Tb-* a-'v.i-'P* rt K cl a tcr*'N.r'n nature arvJ 
docN p t car-> wi h It a rich of entrj i"i i the 
C rpo'ati n Su'^rrap" ati-n Fund Nt cir'mtcc 
o* re cr n of cni'cs « fTered to th lu^ev it 
camJjuate n th- e^T^t c^ a pe n utn-^t T"ron r*ert 
of a ^fPiluf n_ture hcnc O' ah shed 

Ar" "ati fu stat "t in full the ace qual hat on 
part ml ^ cf CTpcn n*e in c’ n al rvsthc "*"> anJ 
the n^nes apJ ad cf th ec referee^ and 

end r^ed on t**c cn%elc'< Lc>cu*n Pa ho! 

« e to be addre^cd to the Med al OT" er * f 
Health Tcwtj H_n Vlar h*^tcr 2 nd p to 
n'mhers of the Cc'n'**ittc^ er Cc-n il ard bv 
rckCDcd b> him ret Ltcr than Jul> th I9ts 
Pro^^^^jte capN.-ate< who desre further rar 
timlars ‘•ould ar"* j to the Med -al 0'*‘-er cf 
Halth 

Town H II F E. WARDRECk HOWCLL 

hfan hester T wo Clerk 

July llih 19t«: 


^IT\ or LINERPOOL 

HOSriTVLS AND PORT HEALTH CON MIITEE 

RESIDENT ASSISTANT MEDICAL 
OFFICERS 


Walton HcnpiI <1 B*di) 

Smthdown Ro d ul (I —0 Bm 1 

MiM Rc'd In rmao ("6 Bed ) 

Ar’'l ~'iion - e n\ti*d for t**c a** \c r'XMPt 
rrcnLt wh h fall \n >nt on O te'-er 1 t 19tc 
The ap*^ t*ner < are fc- a pcnNl of ore year 
at a r> of *2«i per -rnurr trycther with th 
usual residential ..hi nnes C mas p will be 
deemed a d «i j '1— ticn 
App atio" to N m d n f rm i hta n.ihte 
from the Nfe-ial OTj*vr of H-*a th Nfannyui! 
Annexe D ie Street LiiTfrei.! to be cn 
dtrved RcNcent A« <*-.nt Nfeu al O'*! er and 
returned to the undc-Mpr^ not kter than Nf irda 
Julv th 1<J3« 

Mun-cmal Bui -in**s W H BAINES 

Lnerrocl “> Toah Oerk 

July 19 9 


Q1T\ or LINERPOOL 
RESIDENT ASSISTANT MEDICAL OFnCER 


FAZAKEPLEN SANATORIUM ( 6^ B-d 1 


App’iaiicns arc innied for the aboic apcwlni 
tnent for a period of ont yxar at a sakry of £* 0 
per anrum toccthcr with usual icsid-ntu.1 allow 
arccs 

Candidates r-un pos c^s a re i tered medi“al and 
suiTical qu lifiauon and it is dcs rab c that they 
houIJ base held pres ous appointment m a 
teaching hospital 

Cansassng »ri be demned a disqua -at on 
AppliaLors to be made on forms ob finable from 
the Medreal O'hcer of Hea th Mun ipal Annexe 
Dale Street Lnerpool to be endor -d Resident 
A 1 lant Medial 0!I er ard returned to the 
tindcrsi-ned so a to be rccciscd not I ter than 
Monday Ju _ th 19 « 

MunT'i'v.l Bu Idings W H BAINES 

DalcSreet Liicrpool Town CTcrk 

July 19 9 


The Csunt^ Ecj-ati n C< mmittcc tnsiic applla 
ll n\ f r the post cf A pAtanl Sch I Nfed a! 
Off -rr (w many t act upa. r tbe Sehix I Medea! 
O^i r in ccnncxiin wuh the in peet on of s..hiol 
hifdrcn and iiit t ih r duties as may be required 
b the Ld icaticn Comm ttee 
C mrren tne vxliry £<(» per annum (prindcd 
the cxnd date ha bad n t less thin three years 
pAisirrjui.aie esrenciKe) n ir- bs armial mere 
mcpts f t ' ll ^<10 per ann im t petber w ih 
ira cling expemes amirdng to the County S,.yfe 
The u CCS ful -ard date wi 1 be required I des te 
her wb e time to the duti-s of the c acs. 
res c in er near the d met t \ hich he will he 
ana hed at a place to be appr xed bs the tt.JCa 
t n C — 'mmee Ibe app* tmect will be ub c t 

1 three calc"-yr month p ti c on eiibcr d 
e I'll? on the last iLiy i f ary calerdar m mh 
Arpli-art m i ha c t id cxpcti n e m the 'v rk 
I v.hxl f”-i.i-al ir peeii n and prefer-n c will 
be men t card dates whi 

la) Haxc hid exp fierce in the w rk of Swh ol 
Cl r -s 

ib> Ha e b-en a ci omed to irakc -'ecial re 
r«. r n Men Uy Oefcciive I h> t aPy 
Defcxti c Epi c** I nJ ithcr D fenf e 
Chi dren 

The rs'S'Cs cn fa D plor-a tn Pl** Health 
IS ufs rab e th ufh n't osent al 

Cam r d rcvtlx r indirc t*i i pro** b ted 
n.. will Lisqui ify 

A cedu ti n of pet ert w 11 be m c fr >01 
th s_lary in ec rdan c wuh the Lo*.jl C< err 
r~ent ard Oth-r O'*" er SuperirnuatK n Net 
ard the arr ntmcni s* H be ibc*t l tbe c rv 
i- ne pa me the med al riamtn n *' 
cennexon therewith 

r of apHicticn t h< ictufpcd r t ht t 
than Sat irx.ay Nueu t I ih I*** mav b- hr «rcd 
frem the D rector f Idt in Sh re Hall 
Dj h m < n reveip of >. a t mped a dres ed 
fx s^sp enxe! p. 

S^ire Hall TIIOS B TILLLN 

Dirham D re ter f Idt-ation 

Jutv nth 19)9 


gSSE\ COLNTN COLNCIL 

SLCOND ASSIST \NT MEDICAL OFFICfR 

Tbe C« jnt) Cot n-il cf the Ad-*mt iratne 
C ninty cf I et in te a'T ~itt rs f r the ip*^ irt 
mem of S nJ Ai tant Mcdi-al O'*" er at the 
Back Nrtlcy Santetum rear Brai tree 

This Sar ten m x rt in Oil beu for the 
ireatmert if pj m n ry and n n-p im in 
tuberculssy tn men w mcr ard ehitcren and 
ro cs -s II modern I nlitics for et cnmis ard 
irc-tmcnt -da ta f xi t nc pe ul li 

Tbe ap- imment i Im ed in a psmid of foir 
yenr the sa iry w 11 K -t the rate of £ *0 per 
anptm and will n c ubect to sail fact ry erxi e 
by anmul incrcmcr of t-5 to C4_s per annum 
to etber wuh res - ni I emolument xalucd at 
£If^ per annn Apphams mu t ha»c h Id i 
resident appcintmcn tn a g-reraJ hewp tal The 
u cessful appl art will be tequ'rcd to pn s a 
ned ml exam natnn and will be object to the 
Counal y 5 k Pay Rules and Remi! lions a copy 
of h eh will be forwarded on appUaiion 

App I at ons taiinc ace qualifi alien ird ex 
penen c accompanied by copes of not mere than 
three recert icsiimcnuls (whch will not be re 
tum-t.) should be addres ed to rre and dclix red 
at the Cojrty Hall Chelmsford net bier than 
10 a m on Thursday July Ist I93S 
C uniy Hall L S HOLCROFT 
Chclm ford Clerk of the County Coun il 

July <th 19 S 


■’OUNTN BOROLCH OF PRESTON 

SHAROE CREEN HOSPITAL 
(-50 Beds) 

JUNIOR ASSISTANT RESIDENT MEDICAL 
OrnCER (FEMALE) 


I 


I 

I 


LIN ERPOOL 


Q 1 T Y OF 

RESIDENT ASSISTANT MEDICAL OFFICERS 
(Al Jc and Female) 

ALDER HEY HOSPITAL (99_ Beds ) 


Appl»*a\sons te invited f r the above apno ni 
n^is which (all meant on Oneber Isi 193S 
inc appointments arc for a pened of one year 
at a s-lary of £_00 pet annum to ether with the 
UNual residential allow-ar cs Can n ing ill be 
deemed a disqualifiauon 

In addition to acute med al ward there arc 
pecial deparmients lor ophthalmia ear nc c and 
threat and omhcp.»cdiw cases 
Apphaiions to be made upon form obtain 
able from the Medical OfTi er of Health (Hospitals 
Depanmem) Munn-al Arne c La crpool 2 to 
be endorsed Resident Ass um Medial Officer 
and relumed to the undersijmed so as to be 
received not later than Monday July _5th 193S 
Mumcimil Bu d ngs NA H BAINES 
Dale Street Liverpool - Towm Clerk 

July 19)9 


Appliiaion are iniarcd from fully qualified nd 
reel tered pr im ntrs (ir the above apno ntmcni 
Sabry it the rate o! Cino per annum wuh full 
bo-jrd and res dcncc fhe appointment \ ill be for 
a period of six m mth and can be renewed for a 
peri'*d not cxcc-dina 1 month 

Application statin age q -ilifianons -rd 
cnp-nencc tOBCihcr with copies of xhtee icceni 
tes momal should reach the Medial Super n 
icndcm not bier than frst post on July ‘*)rd 19)9 


pRESTON AND COL^TN OF LANCASTER 

QIjEEN NICTORIN RONAL INFIRMARN 

The Board of Management in ite appliaiiors 
for the po^t of HOUSE PHNSICIAN with resident 
charge of evenly five medial bed Total rca 
dent staff eight Sabry at the rate of £1 0 per 
annum with board rcsiden c and laundry 

Appliaticn stating ape qualifi-atnms -nd ex 
pcncnvc together with copies of tcsumorual to 
be forwarded to Mr John Gibson F H O A 
Supenntcrydcni and Secrctan Royal Infirmary 
Preston 


The County Edi non Committee Invi c appli 
aiiors (r ^ fu !y qualified and ctpcricnccd 
D nti tv for app* irtm-nt av a S*.hOLl D rttst to 
It u-d r th S^-hx! Med *al O'^i er «n connexion 
with ihc treatment cf dental defects c children 
aticpo n hool m the County area and t 

inJ rtaLe h thcr duties as mav from i me t > 
iim b- reo ired bv the F Igation Cemm ttee 
Ctmmcnvin vabry £ 0*) pT an-irm rning by 
annual jn-remenL of £'*( to a m xim n of £^0) 
re* annum |-Fgetbcr w th tra e! in expeovrs in 
a orJin c WI h Ih C untv Sa e Th i ecs fu 

and d itt wi be rccur-u t> eJe (te hs ther) 
whole I me to the Jai m f th 1'^ c and to 

res*, in Of near ib di r tv n wht h he < he) 
mav K. attached -t a p j c i be ar- oved b> 

the ft. -ati n Co»~'r tee Ihc ip** ntment »il 

be b cc* to th ex. calc-J r month nti e n 

ciih f Jt -th r e t te fr mi the la t 
t.a> ' any calcruar m -th 

C inva inv d re 1 y or rci -*.tly ts pr ibi ed 
ard will d wju lit 

A ucJ -ti n ot < per -i n !1 he made frvn 
the abrv n ex ft- "xc with the L x-1 C ern 
men nJ ()*hcf OT r% S peran-u ti n Act 
19 i-d Ihc arr in men .* 1 } be ub xt to the 
cunJ life pi rg the m t. -» ex m naticn in c "V 
ncxi n Ih rcwi h 

Icfr* o apr al n 1 be ret rn t, n t I ter 

th n Sal t- « A 1 t |)t tw miy he o^ni-oJ 

fr m the Dre-t r ( fdt -i-m S'iiTc Ha!) 
D irh \m re ei ♦ f i mpt- uJfr* ed f 
p cos I pt 

IHOS n riLLLN 

I) cct f t Fdi. att n 

Sh t H ill D rh m 
Ju y Ilih l> 


gOROl OH Ol STALABRIDIjE 

MFfJICAL OJ^ICfK Of ilUALTH 

App ti n arc i itcu f f l*•e oh of 

Mx. al O''! cf ll H-a'th S h n ! M -al O"" cf 

-J Afat rr v j-d C*- !J Welf re Nf d I O*^ er 

ina‘ ) f r Ih D ah 

Th larv wi 1 be at the r te f £ iV) p r 

r m pavab c mo-th y 

C “d dates must b- only q 1 - d Nfed cal 

Pr--iiti(inc*s ret cv cedn 4 year of a e 
r'' CSV 1 rcco-ni J D r ma m Pu**!! Heath 
-nJ ih rect te oi a' -mrs retjti ed by the 

S r I D OT xrv O J t and the fc-al ti ns o 

the N!i t ter f Health to whwe appr 'sl the 

n m ni WI I he b xt 
Th p- n n> Pt will be u*' -v. i tbe 
s f the Local G •Tr~'cpi ard her 0*^1 erv 
S perarn at n Act 1 and mi) be deter 
mined b three m "th r 1 e in v n in 

Pam ’jr f d 1 es nl 11 rs f apne n 
mc"i ird f rm ot ssj -jj r- \ h had n 

wp"! - ti n 1 1 the ur-cfM -ed 

Appli-ati ro r- rVed -NleOca! 0**;cer 1 

Me ih a- -mpin eJ b c ro* f n i m r tb n 
thr “c rsent twjir* p ji muM be ent to the 
urd r ned not later th. n lul fth 19 9 

Canv in in any f m ral or 1 ntten direct 
r i-d -et will d-Nqual fy 
Dned Ju*y llih IJ) 

L O nOTTOMLEN 

Town C*cr!c 

ToAn Clerk 0 "k.c SLlvbridge 


g O R O L ( H or J A K R O W 
MTDICAL OFFICER OI HEALTH 


Appliati r re invited rrmi persons buvlng 
Ibe qualifi at ons vet out in th Sani ary Chfi -er* 
(Out ide Ltndnn) Regulations 19 9 f f the 
apnointmcnt of Nied —tl Ofli er of Health S*.h ol 
Nlcd— -1 OT r and Superintend nt of th*. In 
fc'Ti us Diwiscs H for this B». rou h 

The sa ary will be £9n0 pxr annum exeta re 
of ir ell ng nd other expenses 
A f rm of apph-aton g mg pin 

he obt tr-d from me and 


ap-o nim n 


r wn Hall Jarro-v 
Co Durham 
July Cth 19) 


by July 193S 

-T?kINS 

Town O rk 


V 


1 C T O R I A 


C F N T R AL HOSPFTAL 
\\ allasey 


General Hospital cf 1 5 Beds 


Ap-l ations statir- age and qualifications are 
invited for the folio ing portions 
SENIOR HOUSE SURGEON male £1-0 per 
annum 

JUNIOR HOUSE SURGEON male £100 per 
annum 

Period of six months from October Isi 1935 
Applioiion wuh copies of tcsumoni-ls should 
be addres ed to the undersigned 

FRANK DEAN FC I S 

Secretary -Superintend cat 


50 


THE BRITISH MEDICAL JOURNAL 


M' 


OUNTAIN ASH URBAN DISTRICT 
COUNCIL AND FDUCATION 
COMMUTE!: 


ASSISTANT MEDICAL OFFICER 


Applications nrc inMtcd from QualiHcd MtIc or 
Female Doctors for the combined posts of ASSIS 
TANT MEDICAL OFFICER OF HEALTH and 
ASSISTANT SCHOOL MEDICAL OFFICER 
under the Sanitary and Education Authorities of 
the abo\L area The officer appointed must be a 
Registered Medical Pracutioncr and wll be re 
Quircd to devote his or her whole time to official 
duties and to reside within the district The 
principal duties will be attendanc'' at Ante Natal 
Baby Schopl and Birth Control Clinics the Medical 
Inspection of School Children including cxamiiia 
tion of their eyes for errors of refraction and 
the prescription of suitable glasses and other 
public health duties Tlic person appointed will 
net under the direction of the Medical Officer of 
Health who is also School Medical Officer and 
the appointment may be terminated by either side 
giving three months noiiec 
The salary will be at the rate of £S00 per 
annum rising by annual increments of £25 to a 
maximum of £700 per annum but the commcnc 
mg salary will be increased by £25 per annum 
in respect of each year of experience in practical 
work up to a maximum period of three years 
Applications stating age qualifications and pre 
MOHS experience accompanied by copies of not 
more than three recent testimonials must reach me 
not later than the first post on Saturday July 
27th 1918 

Canvassing either directly or indirectly will 
disqualify 

CYRIL F THATCHER 

Clerk and Solicitor to the Council 
Town Hall Mountain Ash 
July nth 1938 


B 


AUU^ URBAN DISTRICT COUNCIL 


ACCIDENT AND SURGICAL HOSPITAL 


Applications arc invited for the post of 
RESIDENT SURGICAL OFFICER to commence 
duties m October next Salary at the rate of £3^0 
per annum rising by two increments of i^O per 
annum to £4^0 together with board and lodging 
the appointment to be terminated by three months 
notice on either side 

Candidates must not be over 45 years of age 
and must be capable of performing major surgical 
operations Preference will be given to applicants 
holding higher surgical qualifications and xabic to 
assist in carrying out the tray work of the 
Hospital The appointment is subject to the pro 
visions of the Local Government and Other Officers 
Superannuation Act 1922 and the successful 
candidate will be required to pass a medical 
examination 

The successful candidate wjJ! act under the 
direction of the Medical Superintendent and the 
Surgeon 

Applications stating age and full particulars with 
regard to experience with copies of three recent 
testimonials to be sent to Dr E I Davies 
Medical Officer of Health Public Health Offices 
Barry Glam so as lo teach him not later than 
July 30th 1938 

Council Offices T D HOWELLS 
Barry Clerk to the Council 

July 13lh 1938 

T H E GLOUCESTERSHIRE ROYAL 

INFIRMARY AND EYE INSTITUTION 
GLOUCESTER 
(232 Beds Six Residents ) 


Applications are invited for the post of 
CASUALTY OFFICER (male) Salary at the rate 
of £150 per annum with board residence and 
laundry 

The appointment is for six months which may 
be extended for sunilar periods by re-election from 
time to time 

Applicants must have held a resident appoint 
nicnt and have had experience in fracture work 
The elected candidate will also he required to 
deputise for the Resident Surgical Ofiictr during 
his absence 

Applications stating age qualifications cxpcri 
cnee and nationality with copies of not less than 
three recent testimonials should be sent to the 
undersigned 

The elected candidate will be required to enter 
upon his duties at once 

r J SYMONS 

July 6th 19VS Secretary 




ICTORIA HOSPITAL 
(50 Beds ) 


DEAL 


Applications arc invited for the post of 
RESIDENT MEDICAL OFFICER (male) British 
nationalitv unmarried The appointment to com 
mcnce immediately for six months Salary £150 
pa with board lodging and laundry Special 
knowledge ot Anacstheucs is desirable 

Applications stating age and qualifications to- 
gether with topics of three recent testimonials to 
bL stnt to the Stcrctary Medical Board \ ictoria 
Hospital Deal Kent 


J0L\ I6 


gARRY URBAN DISTRrCT COUNCIL 

ACCIDENT AND SURGICAL HOSPITAL 

Appliciiton'i ire mined for the post of HOUSE 
SURGEON (male) Salirs it the rate of £150 
ptr annum together with board residence and 
laundry Candidates must be duly qualified and 
registered and the successful applicant will be 
required to commence duties in August 
The appofnlmcnt will be for a period of six 
months subject to extension in accordance with 
the rules of the British Medical Association and 
will be terminable by one month s written notice 
on either sidt 

Applications stating age qualifications positions 
held with copies of three recent testimonials to 
be sent to Dr E I Dvxirs Medical Supcrin 
icndcnt Public Health Offices Barry so as to 
reach him not later than Saturday July 30ih 1938 
Council Offices T D HOWELLS 

Barry Clerk to the Council 

July I6th 1918 

CTAFFORDSHIRE WOLVERHAMPTON AND 
DUDLEY JOINT BOARD FOR 
TUBERCULOSIS 


PRESIWOOD SANATORIUM (200 Beds) 


Applications arc invited for the post of JUNIOR 
ASSISTAM MEDICAL OFFICER (mile) at the 
ibOM. named Sanatorium which is approximately 
nine miles from \\ ohcrinmpion The successful 
candidate will hive opportunities of obtaining ex 
pcncncc in the work of a Dispensary He will be 
required to take up duty during the third week 
in September Tlic appointment will be for six 
months m the first inst mcc renewable for a further 
maximum period of six months 

Salary at the rate of £300 per annum with 
board residence and latmdrv 

V Forms of application may be obtained from the 
undersigned and should be returned by first post 
on July 28ih 19JS logcthcr with copies of not 
more than three recent ti-siimonials 
County Buildings H L UNDERWOOD 
StafTo d Clerk of the Joint Board 

July nth 1938 

B irkenhead and wirral CKfLDRENS 
HOSPITAL 

Woodcimrch Road Birkenhead 


RESIDENT MEDICAL OFFICER (Senior) 
The Board invite applications for the post of 
Senior Resident Medical Officer (male or female) 
for a period of six months from October Jst 1938 
Honorarium at the rate of £175 pa with board 
residence and laundry Previous experience 
essential 

RESIDENT MEDICAL OFFICER (Junior) The 
Board mvitc applications for the post of Junior 
Resident Medical Officer (male or female) for a 
penoU of six months from October Ist 1938 
Honorarium at the rate of £90 p a with board 
residence and laundry 

The Hospital is a recognized Training School 
for Sick Children s Nurses 

Applications together with copies of testimonials 
to be addressed to the Hon Secretary at the 
Hospital not later than July 25th 


G 


RIMSB') 


AND DISTRICT HOSPITAL 
(164 Beds) 


HOUSE PHYSICIAN (Male) 


Applications arc invited for the post of 
House Physician Rununcralion £150 per annum 
with board residence etc Candidates must be 
fully qualified and registered and previous hospital 
appointment experience is desirable Duties to 
commence August 1st 19^8 The successful candi 
date will be appointed for six months and may 
apply for re election 

Applications •H'ltmK age qualifications expen 
cnee together with three recent testimonials to be 
forwarded to the undersigned immediately 
^ H B COATES 

Secretary Superintendent 


G 


RIMSBY AND DISTRICT HOSPITAL 
(164 Beds ) 


Applications arc invited for the post of 
RESIDENT ORTHOPAEDIC OFFICER Salary 
£225 per annum with board residence Tht 
appointment is for incive months subject to 
renewal Duties to commence August 1st 1938 
Candidates must be registered under the Medical 
\cts reside m the Hospital and have had cxpcri 
cnee in Orthopaedic and Fracture worl 

Applications with copic> of not more than three 
testimonials to the under igncd immediately 
H B COATFS 
S'xrctary Superintendent 

JyJTANCHESTER ROYAL EVE HOSPITAL 

JUNIOR HOUSr SURGEON required Salary 
£120 per innum Milh residence board etc 

Applieilipn («ilh copies of icstimonnis) 
endorsed House Siirncon to be addressed to 
the nndcrmcniioned ^ 

Gen Siipt and Sccrclitj 


J^ENT AND SUS SEX HOSPITM 

- ROIAL TUNBRIDGE WELLS 
(210 Beds) 

snnrrnij’''^ fot the PO'l ol HOUSE 

SURGEON Ear Nose ind Tliroit ind Ophihalmi 
Depls ind RESIDENT ANAESTHEriST to 
commence dtitj on Jiilj 29th 1938 Sahty tun 
per annum niih board residence and hirndn m 
the Hospinl ’ 

The Hospinl conmns 
ments Medical Surgical 
Ophthalmic Orthopaedic 
and EJcctrothcnpeutic 
Venereal Disca^ies etc 
Applications stating qualifications together wnh 
certificate of registration and copies of not more 
than three recent testimonials should be sent to 
the undersigned as soon as possible 
TOM B HARRISON 

July 12th 1938 Supenntendem Secretary 


the following T)c^vrl 
Ear Nose and Throai 
Gynaecological I raj 
Massage rithoIORiail 


jyjANClIESTER RO^AL iNriRMVR) 

The Board of Management of the Manchester 
Royal Infirmary invite applKations for the post 
of RESIDENT MEDICAL OmCER of the 
PRI\ ATE PATfENTS HOME 
Applicants must be registered and hold a 
Medical and Surgical qualification and must haic 
hacL at least one years resident experience n a 
general hospital 

The appointment is for twelve months renevr 
able for a further period 
Salary £250 per annum with board residence 
and laundry allowance 
Full information is obtainable from the under 
signed to whom applicants mus( send twelve 
copies of their application and testimonial on 
or before 9 a m on Thursday July 28ih Hts 
By Order 

I J CABI E 

General Superintendent and Secretary 

T he GUEST HOSPITAL DUDLEY 
(General Hospital— 139 Beds) 

The Resident Staff consists ot a Resident Sufiual 
Officer nnd two House Surgeons 

Appheaiions arc invited from rcgutcred Mediial 
Practitioners for the post of RESIDENT SUROf 
CAL OFFICER (male) Duties to comme^c 

August l?th 1938 Salary at the rate of £’5(y-£JOO 
per annum according to experience vvitn 
furnished npartncnls hoard and laundry Candi 
dates must have had experience in emergenvr 
"surgery and preference wilt be Riven to 
holding the qiiallhcation of I RCS or Ma 
Applications stating age qualtficalions and « 
pcncncc accompanied by copies of icstintoniafit 
to be sent to the undersigned 

JI RA'i MONO HURST 

House Governor and Sccrctarr 
July Ilth 1938 

T he guest hospital dudley 

(Genwral Hospital— 139 Beds) 

- - * 

The Resident SialT eonsists of n Resident Sonfa' 
OfReer ind tno House Surscons 

TWO HOUSE SURGEONS (male) m»iiN 
One to enter upon his duties 191" 

the other to commence on August U'" 

Salary at the rate ot £I0(>-£I30 
experience with furnished apartments . , j 
laundry Candidaici must be fully qualified 

'^'^Applurations tatmg age qualifications 
Pcncncc accompanied by copies of 
to be sent to »to^;nders.ned^^ 

House Governor and S acurj 

July llih 1938 


R 


O'iAL SOUTH H AN T S A 
SOUTHAMPTON hospital 
( 296 Beds) 

Apniicailons ire Inuied for the fo"™' ' 

"SSa’i ‘.”1 

had some experience in the re 
treiiment of fnctiircs . , ,„t 

for the SIX months commcncins Job , 

cieh at 1 salars of Cl'!!. ,„t he ro 

lodeinc and liundrs Cindidaics m 
ind unmarried n,oii; |Sii 

Applicilions iccorapinicd ,1, -r 

three tcslimonials should be sent 1 
sipned immediatcb BXRnK 

House Gosernor and Sectcisrr ^ 


R 


0\AL I N r 1 R M A R ■) 


rcRiJi 


Wanted two HOUSE n ^ 

temhe? 1st Sxiar, at the nic of £ 00 r<r , 

Infirmarv Perth 


Jun 16 I93S 


THC BRITISH MEDICAL JOURNAL 


51 


IT'EIGHLIA AND DISTRICT MCTORl A 

IV HOSPITAL AOrkSHlRE |W CST RIDING) 

(I 4 Beds ) (Two Residents^ 

APrOlNT'IEN’T or RESIDENT MEDICAL 
on ICERS 

Atypiitons arc invited from Rest tered Vfcv.i*il 
Pramticrerv (female) f r the fell wt'c pm < 
nm Resident Mcv. ml OfTcer Oary £160 r« 
annum to co'^m-'P c Aucusi I'th IQJs 

Second Resident Medical OE er Oary £1 0 pvr 
anpun to c'rtr*cn“e Sertember 1 t 

Proof of reC5tnn n tv be furni hed befo c 
arrointr-ent Fu I rmidimi aJ en ' -nents Tern 

1 monh rc'cwabc 

Applications w th r-rti-u-tri of ace crrcrie*' c 
and nan m ’tv toceth r with cc*' es cf two recent 
to-Lmor-i s to be sent to the undcrviRn-M not 
later than Inly 0th I'^^S 

J AOLNG 

Secretary Superirterdcrt 

\/TANCHESTER MCTORIA MCMORl Al 

IVX JEWISH HOSPITAL. 

^eclhatn 

(Non-Sectarun 10- Beds) 

Apr raiicfts arc invi cd for the rovt cf 
RESIDENT SURGICAL orriCEP (male) Salary 
f-50 per ann m i"^lLdinr board re* den c and 
laundry Tbc ap-^.j’tnetr is for twcl r'mihv 
Applicaiiops statin ate -*‘d Quilif. sviors 
toeethcr with copes of three rcccrt tc* mcna v 
t be f rwarded to the urdT«icned rot later than 
July 2_nd 19t'‘ 

By Order of the B'U'tI of Manaeement 

L C HARDING 

A vis art Secretary 

CALEORD ROAAL HOSPITAL 

0 ( ^ Beds ) 

April *311 nv are Invited Ircm duly oual fievJ 
practiti ners f r the r^t xf RADIOLOGIST (n in 
resident) f r aitcrdan c ca h rt mmg (Snndivs 
ev'*crtcvl) and at i eh timcv a rnsy be rcviuircd 
Salary per arnum Twelve m nth apmupt 

neri ren-wablc The i xc^ ful candidate will be 
tcQ ucvl ttv w vrk xtid'T the tpcrvi on of the 
Hon rary Radi logi i 

Arrh'ationv tating age an! qialEmti " 

li KthcT witfi vcmcv of tc* jm " al and 'crtfntc 

1 f reel traticn hoi U be a 1 Ire* cd n or c to the 
iindcrMcncd fr m whom all ranimtarv may he 
c** atned 

Bv Old r of the B 'ard 

H n SIirtSWCLL 

Cen ral Superin enJent and Scteiary 
lu y nd )*) X 

piRkSHlRE MENTAL HOSPITAL 

D AA allm tv. 

Apr tivn ar nvited fr m rezi tered medial 
pra ti lon'Tx f r tb~ r»v,l f SECOND ASSISTANT 
MIDICAL 01 nri K <mal rec) at the above 

Mertaf H'vptal S Ur\ O f> nv nc by an-..al 
in rem ni of l to £4 0 per m nt it tber 
with fnmtvh'M apartmen b cird and lai ndry 
valued at £PO per ann im An id— itivnal ar* uf 
i f £ i") per ar"jm 1 pty b’ »f n pvwvc n c 

Pl M Ftperene n tbc ireatm m if ner al 

d rd*rv wou’d b a rev. 'mmen-ati n The 

ar*v »*tmem 1 ub’-vt 1 the pr v 1 n <f the 

A vl m 0"i S perarn >at n Ac* I9* * 

Arpimii ** in wnm t ccihcr with ere of 
three tCNttm nal h »j d feaih ibe A(cv- *a! 

Si-pcrmtcnJetv b 1 r t p wt n Ih 'v-ay lu y -It 

r^HESTERFlELD AND NORTH DERBA 
SHIRE ROAAL HOSPITAL. 

(2-0 Sure al and Medial Beds) 

HOUSE SURGEON TO OPHTHALMIC AND 
E-AR NOSE AND THROAT DEPARTMENTS 

Appl -ations -re invited from fu’Iy quali'M rren 
fur the above rest The arroip’ment i f r x 
months frotp July 2Dth 19'^ 

Salary at the rate of £1^0 per .nium 

April atiors statn aee to“cther wiih cor o 
of three recent levtimcn ils he- d be ert to 
the u*'der pned -s soon as ro< >** e 

M H BOONE 

JoneSlst I9^S Sope^me*‘depi -rd Sic^etary 

CAMNDON and north AAILTS MCTORIA 
^ HOSPITAL 

App! -at r are tnv ted f r ih pmt if HOI SE 
SURCION r'vic Bntrvh 0 In h itrm rticd 
Nitiry £!-.< per anrtm wt h b ard rcMwcn e nd 
Uunury Appi n mem t fet x nirth in th 
f rvt in tan There arc tw > rcMdertv Th 

h 'vr'tat t full cq rred ftr general w rW arJ 
the pci. at iiev Pr ate bed no Ntetr- 
The pvM t uMe f f 3 rc^en 0 lal f ed r*an 

and there 1 line 1 r read n" AtIi ar rri. t be 
re" tered ti'Mcr i*‘e Afeu al Acts 

Appl -all m latinc a 3 rd qualf-at n w ih 

Cl “ es f ihr'c rc-mri icv «mon i! to rea h the 
under red b July )^th 

klN-NCTHN kNAPI Secret ry 

riENERAL HOSPETAL NOTTINGHAAf 

VJ (1^9 Beds ) 

A RESIDENT CASUALTA omCEP (Male) 
w required at the above In tiiution The appoint 
men n for sit months with lalary -t the nte 
of £1 0 a year with board restden c ard laundry 

Candidates -re desired to send appli ation 
staunz are qu lifations and experience together 
with copes ot testimo** al to the urdersiffn-M at 
once 

Duties to commence on July I4ih 193S 

HENRA Al STANLEY 

House Governor nd Secretary 

p OA AL NORTHERN INFIRMARA 

AA Inverne* (-C'O Beds ) 

April ation are invited f r tbc pwi H( 1 SF 

PMASICIAN (male) to tbc Phy iin C mult nt 
till hlandi a"d 1 lane Scheme) ard to the 

H • ran \i ittp f'hyvnan App ic r nu>t be 

Gtadiatev of a t m cr ty and have had v p’ontbv 

H P cvrcricn c in a large hvNpiial The a'vroi f 
mert V ill be for \.x n nth and t ren wahie 
Salary CUt) p a 

April ati n with r C5 of tevtimonul should 
N. ent to Mvdcal S ipcnmcndcnt 

gUTE HOSPITAL. LUTON 

HOUSE SURGEON (male) wanted to commence 
duucs on July Is: or -s soon after as possible 
Salary £U0 per annum with board res den c ard 
laundry 

Appli-ations slating age nationality apd cxperi 
ence to"cther with copies of not more than three 
recent testimonials Jiould be sent immediately to 
the Secretary of the Medial Advisory Committee 
at the Hospital 

R E. UNGARD 

Secretary Bute Hospital 

CrROI d ccneral hospital 

SuxJvjJ Clos 

RESIDENT AIEDICAL OFFICER required 
Candidatev mu<t be fully qua! fied -nd rem tered 
Six month appo ntment duties to commence as 
iK>n as pov iblc Salary £l(>o per anrum widi 
b« ard and laerdry 

Appliations vt tmg a-c rationality etc to- 
gether with copies of three recent icvumonial to 
b Cm to the urdCTM'Ti^ from when funher 
pani ulars may be obtain'd 

C FORD SPENCER Sc rct-ry 

\ 4 iDLAND hospital. 

Easy Row Birmingham (50 Beds) 

Apphauoos arc invited for the post of HOUSE 
SURGEON Duues to common c August 1st 
^lary £200 per annum with board residence and 
laundry 

Apphatlons stating when at liberty a c quali 
nations together with copies of recent tcsumonia s 
to be addressed to the undenigned 

OLIVE FURNEaUX Secretary 

THE H ARTLEPOOLS HOSPITAL 

(95 Beds ) 

Apphation re invited for the position of 

HOUSE SURGEON at a alary of £I 0 p a plus 
board residence and laundry 

Aproimirem for six months sub ect 10 rcncwil 
and duties to commence July l^th 

Appl ation to be made to the nnderment oned 
NORM AN 0 DEANS 

Secretary 

^OSSHAAI Al E >I 0 R I A L HOSPITAL 
^ kingswood Bristol 

appar at the end of Julv for a 
JIWIOR RESIDENT MEDICAL OFFICER 
Salary £1 0 per annum with board and laundry 
to lemam for slx months in the first instance 
Appliants (male) should be British nationality 
lully qualified and registered 

Applications with copies of recent tcstimonuls 
to be scot to the Secretary 

gRADFORD childrens HOSPITAL 

HOUSE SURGEON (Iad>) r quired immed ately 
Fully qualified Salary £l<0 with board residence 
and launcry 

Appliations with recent test monials and 

statins ag to 

J W LONOLEA 

Secretary Supenntendcni 

gUKTON ON TRENT GENERAL INFIRMARA 

April ations arc m ited for the p sition of 
CASUALTA OFFICER AND HOLSE 

PHASICIAN Salary at the rate of £1 0 per 

annum with board resid n e and laundry 

Aprhation givin" age quMifiaticns and 
national ty together with copes of icMtmonal to 
be sent to E AV Tiiogsitt S«:rctar} 

pOSSHAM MEMORIAL HOSPITAL 
^ Kingswood Bnstol 

Wanted an additional HONORARY SURGEON 
for Rcrcral surgtcil work. 

App y with full particulars to the Secretary 


T HC PRINCC or WALES S HOSPITAL, 
GreenMnk Rrjd Phnouih 
ir rrrctiy South Doon and Ean Corn-wall 
Hosr tal ) (-6^ Bcdi ) 

\rr! Jt»on< arc inMted for the po<t 5 of HOL'SE 
Pin MCI VN 3 rd HOUSE SLRGEON Salary 
Cl 0 r«.r ann m uith board rc^idcr e and laundry 
\rr< ntnert^ arc teruib c for sit morrbs and are 
sLbiC t lo renewal Duties lo comr~CfKC 
\uciJ t 10 h 

The Hr^rtal ts ul > rcciynf^cd for the 
itc at rraciicc requ red befxc adT-sMon to the 
Tinal fell h p Lta*n mtic'^s of the Royal CcHejtc 
of Phy nans and Sarjrc rts of Enjlard 

Srrii'anis mu be re sfcrcd under the Meu caJ 
A ti and be r^'^bers of either the Med cal 
Defer e t n on cr the Lordon Coun ica Medical 
Pr tcvti n Socj t> 

\Pr »,atio"s sral nz ee and qualJ^catic*^ w-h 
pi -s of three rcvcnt te'in'*nat5 to reach th* 
unJcrM''red by July . rd 

\RTHLR R CASH 

Jii y ih IQJS Sc^ctary 


T in LUERPOOL HOSPITAL TOR 
rtJSSL Ml rif>N \ND DISE\SES 
OI THL CHEST 
Mh-p I C 3 nt Lnerpov.! 

SrnL ati rs re ins fnJ fra f I LL TIME 
RTSIDI M MEDIC \L OFriCER to the H >*r‘ al 
f r r s'* urn"! n mj D teases of the Ch-^i Pic 
\ I hp'ptal c pcrierv-e dcsir Me P th McdK.al 
and Sire at lfC3tr*ent of Pu m na-y Tuber 
ct n ate i" crtjVen at thi H 'Sp j1 

Ibe rr tnurent wtj be f r a rsrr -xJ c-e 

senr Sjl r> tl o per anuTt with boarw and 
fc^ den c 

Ap''!! II n iJt ne a c national ty qua *■ a 
ti r ard esret n-c \ c*h« wuh cotnes ol three 
fee nt ipit m nal or n_'-cs of two Ifval referees 
t be ent I) the Scvrct-iry not la er than July 
.0th J9t 


T he kisr edw \pd mi welsh 

VAIIOSAL MEA10RI\L NSSOCI STION 

\p-! vji " re in tied fr "t duly rex tered 
rnl val pr*’ t t ner (na rr le) for the rest 
If Assisrvsr tLSIDFVT MEDICAL OnCER 
at the Svuih W ics s nar rim ( *6 t«u for na e 
pininry acn» Ti-^rh Bees 
S. arv £ I'D r** .nnin plu r*atnf rap c 
The pp intncri ts I rn led to a pen sj of me 
>crt 

\rp> at n Slat ne a e QJal -lat **< espen- 
cr t 1 lo'cfber wilh c *• cs of three recen 
twtimon.il h v j reach the l"- rs r*cd Pc la cf 
t n Wedn-w^ay July Mh 19^^ 

D \ row ELL 

Nt-n I O*^ cs Pn c:p-I Medcai 

Wc'tntc Str c* Catd O^ccf 


W EST kORfOLk \kD kINGS L-^NN 
CESERAL HOSPITVL HI Cedi) 

RLSIDESr HOLSF PinSICIAS 

Appiu.jti ns .re in tied for the aKis- pewt 
Salary £l h per arn m To base ch_r*tc of Meuiol 
ard (J'^hihal’ni bed aI>o to act as Re* ucrt 
Anaothet t 

The post ts for M\ t-opibs In the fit nstanvc— - 

fler saluable espcncrvc in both Ir pat ent and 
Out patient worV 

Apph-ai n with copies of resent tcstir* tnials 
shrsild be sent to the un.crsizrcd as early a 
P^w b c 

JOSEPH C SIARIEAVT ECCS 

Hou Gosernor and Secretary 


T he aaest soRroLk and kisos lan^n 

CENCRAL HOSPITAL, til- Beds > 

RESIDENT HOLSC SURGEON 

Th Go\crnine Baard invite applications for the 
above post The appointed applicant will have 
chartn. of C- ually Department and one Surytcal 
Ward Salary £l 0 per annum Th appo ntment 
I fyr sit month In the frst in tan e Preferen e 
if suitable will be e cn to the Resident House 
Surzeon wh“n the pent of Resident House Phy-s cian 
fall acant Appl cat on stat ns are nai^nalty 
Qual rcations sho ild be accompanied by lesti- 
monal and rca h the ond-rsi ned as soon as 
pen ihle 

JOSEPH E SEARJEANT ECCS 

House GoTcmor and Secretary 


'J'HE BOLTON ROAAL INFIRMARY 

( I Beda in ludm-* two AutHrary Hcnpital ) 

Application arc nvitcd from L-di"^ and Gentle 
mm for the post cf HOUSE SURGEON 

The duties of the post in ludc car nose and 
throat work and zyn-eco’o'^ 

Salary £U0 per amun with board res’dcT'^ 
and Uundry 

Applications for the po<i statin ape ratjcnality 
and etpcrim e topether with copes of lesturcm-aU 
should be forwarded to the LroJers as soon 
a pcssiblc 

H CORLESS 

SecrctarP 








52 


THE BRITISH MEDICAL JOURNAL 


Juu 16, ]Q1S 


UR\ INFIRM ary (LANCS) 

(143 Beds ) 


APPOINTMENT Of TWO HOUSE SURGEONS 


Wncancics as abo\c arise on the Resident 
Mcdicnl Si'll! and applications arc invited (or the 
posts 

Tlie Resident Stiff consists of an R S O a House 
Phuicnn ind two House Surgeons 
The appointments arc for i term of months 
and silanes pi>iblc ire it the rite of £1^0 per 
annum with board residence ind hundr> the 
silarj being increased to £175 per annum m the 
c^nt of reappointment to the same or some other 
oCficc for a period of six months 
Tlic services of both House Surgeons will be 
required on or about August Sth 
Applications stating age quaUficaiions and 
nationalil> together with copies of three recent 
testimonials arc to be forwarded to the under 
signed as soon as possible endorsed House 
Surgeon 

Tull particulars of duties mii be had on applica 
tion 

H WILKINSON 

Superintendent 


JJOSPITAL 


OF ST CROSS 
(i:0 Beds) 


RUGB> 


Apbhcations arc invited for the post of ONE 
MALE RESIDENT MEDICAL OmCER (Three 
R M O s) 

Salar> to commence at the rate of £100 per 
annum for the first three months £125 per annum 
for second three months nnd at the rate of £1^0 
per annum for subsequent months full board 
washing etc provided 

Six months appoimmcni and eligible on com 
plction of service for further cxtcns on of si* 
months 

Candidates must be prepared to commence 
duties as earl> as possible 
Hie 'practice of the Hospital offers excellent 
opporiuniiics for wide experience 
Certificates and other fees shared b> R M O s 
Applications stating age nationality and full 
details with copies of three recent ics imonials 
to be sent to the undersigned 

(Signed) W COCKBURN 

Superintendent and Secretary 


J^ING 


GEORGE S SANATORIUM 
SAILORS LIPHOOK HANTS 


roR 


(Seamens Hospital Socictj) for the Treatment 
- of Pulmonary and Non Pulmonary 
Tuberculosis 


ASSISTANT MEDICAL OmCCR (single male 
or (cm lie) required as from August Isi (or six 
months Salary at the rate of £200 per annum in 
the first instance Applications with copies of not 
less than three testimonials to be sent in immc 
dnrcli 10 the undersigned 
r A LYON 

Secretary Seamen s Hospital 
Society Greenwich S E 10 
Greenwich July 4ih 193S 




SURREY HOSPITAL 
Rcdhill Surrey 


JUNIOR HOUSE SURGEON {male or female) 
required on August ISih next Salarv at the raic 
of £100 per annum with board residence and 
laundry Candidates must be fully qualified md 
registered Appointment for six months and further 
Six months as Senior at salary £150 per annum 
^ppJieauons stating full particulars and copies 
of rcteni lesiimonials to be sent to the under 
signed before July 2sth 19 8 

C C A'iLlNG 

Secretary 


LACKBURN AND EAST LANCNSHIRE 
' RO'iAL INTIRMARA 


RESIDENT SURGICAL omCER (Male) 
required Salarv £2^0 per annum with board 
residence and laundry 

Preference will be given to applicants holding 
the rues Diploma 

Applications stating nationality qualifications 
and experience together with copies of rceent 
icstimoniaU to be sent to the undersigned 
Royal Infirmary T DE%\ HURST 

Blackburn General Supi and Secretary 


N 


OPTH LONSDALE HOSPITAL 
Barrow in furncss (164 Beds) 


\acmcy July 1st 19 8 RESIDENT CASUALTY 
on ICER (male) 

Applieaiions arc invited for the above position 
from fully qualilicd Practitioners cxperienecd m 
the admini iration of Anacsihetie's Salary £1^0 per 
annum with board residence and laundo 
Applications stating age qualifications cxperi 
cnee and nationality and accompanied by copies 
only of three recent tesiimoniils should be s ni 
to the Secretary immediately 


R 


OVAL 


CORNW ALL INHRMARV 
Truro 


APPOINTMENT OF HONORARY PHVSICIAN 


'THE ROVAL PORTSMOUTH HO’^PITW 
Portsmouth 

(Five Resident Medical OfTi ers ) 


Applications are (mticd for the post of Hon 
Physician Candidates should be Gr duates In 
Medicine of a Univcrsiiy of Great Bniain or 
Ireland and must be Fellows or NIembers of the 
R^l College of Physicians of London 
The selected candidate will be responsible for 
the care of Medical In and Out Patients and will 
be required to contract to engage m private 
practice as ». Consulting Physician only 
Applications togethe with copies of recent tesu 
monials should be received by the undersigned not 
later than Juh 26th 


Jnlv 9ih 1938 


W E GRENFELL 

Hon Secretary 


v.u uci quamicu M srt 

at the rate of £1 o per annum wuh board ct 
JO commence August 23rd 19 S 

qualified SaliT 

at the rate of £l o per annum wnh board ct 
io commence September Isi 193 S 
Six months appomimcnis Eligible on c«p- 
piction of terra for appoimmcni to other resi’cni 
posts 


Applications stating age nationahtj ct and 
copies of three recent icstimomals to be stw t^ 
the undersigned on or before August 4th 191% 
from whom a!! particulars can be obtained 


B WAGSTVrr 

Sccccary 


QLDH AM ROV AL I N F I R M A R V 

SENIOR HOUSE SURGEON required for a 
penod of Six months to take charge of the 
Casualty Depanment and to work under the Hon 
Surgeon in charge of the Fracture Clime (average 
attendance of I50 to 170 cases per week) Previous 
hospital experience essential 

Salary £250 to £300 per annum according to 
qualifications and experience wnh board residence 
and laundry 

Apphcations stating age experience and quali 
fications together wnh copies of three recent test! 
inonnls to be forwarded to the undersigned 
H EWART MITCHELL 

Genera) Supcrmicndcnt 


R O > A L EVE 
Pcvcnscy Road 


HOSPITAL 

Eavtbournc 


NON RESIDENT HOUSE SURGEON required 
to commence duty in August Hie arpomtircrt 
Will be for SIX months in the first instance 
Salary £100 per annum and allowance in lieu cl 
board residence £17^ per annum 
Applications stating age qualifications anJ 
ophthalmic experience together with recent tevu- 
monials should reach the undersigned as soon as 
possible 

Before engagement candidates have to be incr 
viewed by the Hon Surgeon from whom funhx 
particulars could be obtained in person 

H BV GRAVE Hon Secreiary 


^LDHAM ROVAL IN FIR MAR V 

TWO HOUSE SURGEONS required for a 
period of SIX months Svlary at the rate of £17^ 
per annum with board rCMdcncc and laundry 
Afiphcatforis stating age experience and qtnh 
ficatton together with copies of three recent icsti 
monials to be forwarded to the undersigned 
H EWART MITCHELL 

General Supcrmicndcnt 


R OVAL LANCASTLR INFIRMARV 
Lancaster 

(140 Beds —-4 Residents ) 

Applications arc invited for the post of HOUSE 
SURtiJEON Salary £130 per annum with board 
residence and laundry live appointment is for 
SIX months 

Applications stating age qualifications expen 
cncc and nationality together with copies of three 
recent rcstimonnls to Ic sent to the undersigned 
FRANK A MILNES 

Superintendent Secretary 


^OVAL 


SUSSEX COUNTV HOSPITAL 
Brighton (272 Beds ) 


HOUSE SURGEON (male) required end of 
August 1938 Charge of beds Sahry £150 per 
innum with board residence and himdry 
Candidates must hold medical and surgical 
qualifications of the British Empire and Ic duly 
registered under the McUual Acts 
Hicv must be unmarried and when elected 
under thirty years of igc 

Appheauons with copu-S of icstimomals should 
be sent to the undersigned as soon as possible 


N""' 


SUSSEX HOSPITAL FOR WOMEN AND 
CHILDREN 

Brighton (Inuarpontcd ) 


Apphcations arc inviKd from stunbly qualified 
Mtdicaf Women for the post of HONORARV 
OPHTHALMIC SURGEON Duties to commence 
in Sv.rtcmbcr next 

AppliLiiions with copies of testimonials to be 
sent 10 the undersigned on or before July tOih 
Board Room PERCV F SPOONER 

Wmdlcsham Road Secretary 

Brighton 


N 


ORTH ORMESBV HOSPITAL 
Middlesbrough (192 Beds) 


HOUSE PHVSICIAN (male and unmarried) 
required Salary £120 per annum with board 
residence and laundry 

Applications stating age qualifications expen 
cncc (if anv) vxiih copies of three recent tesU 
mcmials should be sent to the vindcrsigncd 
GEORGE WATTS 

Secretary Superintendent 


EV MOUTH AND DISTRICT HOSPITAL 
VS cvmouih 


Wanted July 27lh HOUSE SURGEON (malt 
European) Salarv £1S0 per annum with board 
residence and launJrv 

Applications Matinv. age qualifications and 
copies of icstimoniafv to be sent to the iindtf 
sii,ntd not later than July 20th 1938 

MORRIS LODGE 

Hon Secretary 


T he ROV \L INFIRMARV SIIErFlELD 

(V(H> Beds) 

Apphcations arc invited for the pevts of 
CLINICAL \SSfSTANT to die 

Department (male or female) The Ophtha’"* 
Department contains 6S Beds and an Oi 
Patient Department which is open daily 
Salarv £%00 per annum 
The appomimtm will be for one year su^^.\x 
to two months nonce and the officer elected will 
be eligible for rtappoimnicm Idlers statmi 
age and giving lull Qualifications dc'i js 
hospital experience etc to be forwarded to 0 
General SupcnntLndLnl and Scxrciaty immctfuf 
June 14th I93S 


R 


OVAL VICTORIV AND NVESTT HVMS 
HOSPITAL BOURNEMOLfTIl 

HOUSE SURGEON (male Dniish naiipwlijl 
required to commcm.v. ditty at the Pao’c RwJ 
HoNPUd Beds.) abourJuly -Mli Valaty £M 
per annum and additional fees with board fy 
me and washing The appomimtm is icnaKc i r 
six monihi. and candidates must be tcv * w 
according to the provisions of the Mednl Act 

Applitaiions stating pi ice of linh “•'J * 
With copies of three recent tcMimomats w ^ 
«:cni immediately to the iindcrsipntd vvorrcni 
married men arc iitthRiblc 

GORDON M SVUL 

Julv 7ih 1938 Sevritan 


SOUTH \MPT ON CHILOHNS 
1 HOSPITVL AND DISPENSVRV I OR 
WOMEN 

The Board of Manmtmtni ‘W'dc apphni ' J 
the post of RFSIDbNr AH DIC \L OFF 
(Lady) Six months nppoininitnt oJiap 
rate of £1‘'0 per annum with board resides c 

Applications stating age arid ncconi^f’^ U 
topics of testmtonuN to be 'em ♦ 

signed not later than August Mh jy , ‘ ^ 
Candidate will Ic rtqijtrtU to take up her 
September Isi »..^,iruc 

CLLA K 


0\ \L INFIRMARY 

(Regional Radium Centre) 

lousE pinsici\N IO iiic 

nrtmems (Mile) wanted Sn or ' JV i i 

oinimcnt Sahrs £17-: per innam <>iin 
dcncc and «ashm!: , r ,i. s J 

pplicationt Mai ns asc ainlirn.3 i ^ 
nous experience (not nceexxanl. in . 
ip.) with copiex of rcccnl tcxlimon^ali^^ 
sent to the undersigned as soon P' 

H TKUSSON 

It) ?th Hon e Co'cr nor and Sgrr- ^ 

DIAL UNITED HOSrirxE fMH 

OUSE SURGEON tcQUittd ■' ’ 

Ear No c and Ihroal) 
ilar) £l'0 per nnniim wnh hoa'“ 

laundr) , , ,ni- 

pphcationx xMih eopicx of tliree ^ 

a; addrcvxcd to the under'' nf ' 

1 LAWRENCE ^ 

ScLtcIat) Su"C 1' ^ 

il] Sih I93S 



JuLS 16 I9iS 


THC BRITISH MEDICAL JOURNAL 




APPOINTMENTS— Important Notice 

"Medicil pnciitioiKrs Tre requested iiol lo npplj for am ippoiniment reierred to in the folloumg 
tibk without In\mg fir^t coniniunicittd with the Secrctiiw to the Briti'^h Mcdicil \s=ociatton B M A. 
IIou'^c TaM'tock SqiniL, WC I (in the cn^e of Seotti-h appointment-, with the Scottish Secretan, 
7, Drum-heugh Garden'; Cdinhurgh) , 

(a) British Islands 


Town or D sir t 

1 Town or D w i 

Town or D snict. 

CONTRACT PRAtnee 

; CONTRACT PRACTICE— (corrd) 

PUBLIC HEALTH 

ABERTYSSANG MEDICAL MD SOCILTY 
V-ted cl e ) 

MID RHONDDA MEDICAL AID SOCIETY 
t^ititranr 'fr ctJ O'^cer) 

COUNTY or ROXBURGH 
{A%t ttant Meu cat OT e nt tlecLSh ) 

BLAENAAON MEDICAL SOCIETY 
(Ch el Med cal OC cer ) 

NLAIIl AND DISTRICT 
( \fr.- fcf AtiAt octal n ) 

GILFAOI GOCn GLAMORGAN 
(UcfAfnrrti Medical Scheme) 

OTMORT A ALLEY CLAMORCAN 
(11 ir /n C lies Met. d.! AlJ 9 leff ) 

(11 r'krrrnr ^feJ cat Sehrrre) 

DISPENS VRV APPOINTMENTS 

LLAVY'NYPIA CLY DaCH \ALL 

PENY GRAIG GLAMORGAN 
(11 o kn en s Med cel Scheme ) 

LIMERICK CITY 

III /• te if^e n tpenuiry Med cU OT-ce t ) 

OAKDALE AfON 

(Xfrifraf O^ce to Me cat AAA \oc atlon ) 


(b) 0\erseas 

Medical practitioners are requested not lo applj for am appointment referred to in the following 
table without haeang first communicated with the Honorar^ Secretarv of the DiMsion or Branch 
named m the second column or with the Secretary to the Briti-h Medical \«sociation B M A House 
Taeastock Square, M' C 1 


Town or Distnn. 

Hon Sec of Division 
or Branch 

Town Of Distri t 

Hon Sec of Divnon 
or Branch 

Town or Di tnet 

Hon Sec of D vi i n 
or Branch 

NEW SOUTH 
\AALES 

lAtl Fnendlf 

Society Appoint 
menu > 

The Medical Secretary 
New South AAales 
Branch Mac 

quar Street. Sydney 

N SAA 

^ I C T O R I A 
(Atl Inuiiute o 

Me at D t^er 
ta les ) 

The Monofary Seercury 
\ 1 torun Branch 
Bfiti h Afeui .a) As o 
c ation Medical 

Society Hall Albert 
St Last MeJbourpc 

Vi toria 

W ESTERN 
\USTRALI \ 

iCont act end 

L dte r ectiees ) 

The Hon Sec Western 
Austra!.an Branch 
Brittvh Medical Asso 
ciaijon **SheII House 

05 Si Oeorre s Ter 
race Penh AA extern 
Australia 

The Hon See Ooecn^ 
land Brar h Bnt.ah 
Mewical As ociation 

B M^ Holsc 2,5 

A\ Ickham Terrace 
Bn bane. 0 I* 

QUEEN SLATxD 
(Bnsb re Assoaaie 
Fnendly Societies 
Institute ) 


Julj 13 1938 Bj Order of the Council G C ANDPRSON Stcrciary 


^oaAL H\LirA\ iNriRVvm 

Hcppital Re o mzed by th- Roal C<d1e*c ot 
^orsco'K (Tncland) 


\\ anted a THIRD HOUSE SURGEON (male 
unmarried) Cand da^e^ must be duh qualified and 
rcjnstcred Th- apcoinirrcnt rvill be lor w months 
foUoHcd b> promotion if suitable Salary in ludin 
all tA-ues rcqi.red in conncMon »uh Pa>in 2 
Patients Ward £1*0 p^r annum with res ucncc 
board and laundry The Rc<id nt Staff consist 
of a Rend ml Surgical OfTicer and three House 
SurpeorL The Hospital contains Maternity and 
Pacing Patient BlocLs Also a Paiho’o^ical Dc 
partment a large E>c Ear Npse and Throat 
Department Radiologi-al Depanment jnd Rad urn 
Oinic 

Particulars ot the duties ma> be obtained from 
the undersigned lo uhem applications statins ast 
and nationalftj together with testimofuals should 
be sent on or before the 19th inst nt 

A MIDDLED 

July 4th 193S Secretary 


POYAL CORNWALL INFIRMARY 
iX ('^4 Beds ) 


TRURO 


HOUSE SURGEON (male) required uuh cr 
ps.ncn c of Anaesthetics to commence duties on 
August 1st neri Salary £l 0 per annum rooms 
board and washing 

Apply with copes of three recent testimonial 
to the Secrciaiy of whom further particulars ma> 
be obtained 

Truro W E GRENFELL 

July 4ih 1938 Hon Secretary 


J^OTHERHAM HOSPITAL. 

Wanted CASUALTY HOUSE SURGEON 
(male) qualified Salary £150 per annum with 
board residence and laundry To base charge of 
Outpatients (1^0 beds) 

Applications, with copies of recent testimonials 
to be sent to the Secretary G W Robchts 
8 Moorgate SiiceC Rotherham 


C OUNTS MENTAL HOSPITAL, 
WHITTINCH^M rear PRESTON 


r OUCH BO ROUGH \ND DISTRICT 
CENER VL HOSPITAL 


Spph'ati ns arc imiicd for the whole tine 
appointment of SENIOR ASSISEANT MEDICAL 
orriCER at the abose 'Icn.al Hospital The 
salary is r"(X> per annum An additional £ O per 
annum will be paid for the posses on of a Diploma 
in P >cholo«i al Mcdi me The elected candidate 
if sin tc will be required to lisc in the Hospital 
and will be provid d with board lod in~s etc 
for which a charge of £1*0 per annum i Trade 
If the selected candidate is married he nay be 
required to live within reasonable dotance of the 
Hospiu.! until a house or married quaners is avail 
able The ap"Ointmer will be subj ct to the pro- 
vt ions of the \sylums OTicers Supcrannuaii n 
Act 1909 arJ the succe ful candidate will be 
required to p^ss a medical ciamirution 

Application giving full panimlars with tcsti 
mon al (copes only) shoufd be forwarded so a 
to rcaJi the Medical Supcnmcndem on or before 
July *0»h 1938 


R oyal national hospit\l for con 

SLMPTION AND DISE-XSES OF THE 
CHEST 

\ emnor Isle of W Ight. 

SECOND ASSISTANT RESIDENT hfCDICAL 
OFFICER (male) unmarried required for six 
months commen Ing Au u i l*th 1938 Salary at 
tbe rate of £ 00 per annum with board residence 
and laundry allowance The successful candidate 
will be ell iblc for pfomouon to First Assistant 
Resident Med cal OfTLcr for a further ix months 
at a salary at the rate of £300 per annum with 
simitar emotumem Candidates must be fully 
qualified in Medicine and Surgery and previous 
expcncncc in Tobcrculo i and Bactenolo^ical work, 
will be an advantage 

Applications in candidates own handwTiting 
stating age qualifications and expenen e (wuh one 
copy of three recent testimonial ) to be sent to 
the '■fcdical Surenntendent Royal National 
Hospital for Consumption \cntnor Isle of 
Wight not later than Saturday July 23rd 193S 




and unnam-d) for 
3 HOUhE SURGEON salary £1*0 per annum 
f om \u-ust tst 

» HOUSE PflYSlCl AN salary £125 per annum 
frem July JsL 

The appoinincnts are for six months and include 
ap rtments board and hundry The House 

hjmeon must br an expenen ed anaesihcti i 
,.1 . a-e etc with copes 

of testimen als to be sent to m* at once 
n , , frank H TOONE 

9 Leicester Road Secrcjt'y 

Loughborou h 




LADY CHICHESTER HOSPITAL HO\ E 
For Fun lional Nervou. Di eases 
(60 Beds ) 


JUNIOR HOUSE PHYSICIAN (woman) re 
qtitrcd Six months appointment at £7 per annum 
all found \aluablc ctper cncc for D ptoma in 
Psychoto cal Mcdi me Duties to commence 
middle of July 

Appli-aiion. with testimonial to be s nt to the 
Secretary Mr P F Spooner 33 West Street 
Bn hton 

July nd 1938 


W EST SUFFOLK GENERAL HOSPITAL 
Bury St Edmunds. (11, Beds ) 

HOUSF PHYSICIAN wanted Duties mclud 
ih^ char-e of the Nlcdical B-nJs Matcm ly Ward 
Casually and the Adm nistration of Anaesthetics 
Six mon hs post Salary £1*0 per annum with the 
usual emoluments 

Applicants must be regist red Praaitioners 
Applications tatin- a~e expencnce ard r,uoo 
ality with copies of three recent testimonial to 
be s nt to the Secretary 
July 4ib I93S 


i/ii'Fciitrr Ms coiUm^d cn p 56) 



the BRITISH MEDICAL JOURNAL 


Juu J6 19^S 


CHARGES for ADVERTISEMENTS 

CIRCULATION OF THIS ISSUE-41,001) COPIES 

CLASSIFIED The Minimum charge is 9s , which covers up to 30 
6 words Extra words are charged 1/6 for 5 or less 

Example 33 words would be charged as for 35 
Name and address should be included when 
counting words for cost 

If Bo\ Ntimbe/ is used, it should be reckoned as 5 
words in the total 

Replies should be addressed separately to each 
Box No care of this office 

Advertisements, accompanied by renvitance, should reach 
this office^ not later than noon — ^Tuesday, to ensure 
INSERTION IN CURRENT ISSUE Please write clearly 

DISPLAYED Whole page £24, and pro rata to one-eighth page 
Special positions, dates and rates on application ' 


Every effort is rmdc to ensure the accuracy of 
advertisements appearing m the Journal No 
recommend Uion is implied 'by acceptance nnd Uic 
British Medical Association reserves the right to 
refuse or interrupt the insertion of nn) advertisement 


ADVERTISEMENT MANAGER. BRITISH MEDICAL JOURNAL, 
B M A HOUSE. T4VISTOCK SQUARE, W C 1 

EUSton 2111 



NOT CLASSIFIED 


CIGARS (ENDCUT) ALL HAVANA 

TOBACCO GOOD SMOKFS it i lo« pnee 
quality guaranteed Box of 50 for 25/ post frtc — 
Sole Manufacturers J J Freeman iS. Co Ltd 
90 PiccadtHj London W 1 (GRO J*529) 


“BIZIM” CIGARETTES 

THESE Juxunous dcJiciously snHsfying smokes ^0 s 
or 100 s at 6/3 per 100 5S/6 per ) 000 post^ 

free — Sole Manufacturers J J Freeman Co 
Ltd 90 PjccTdill> London W I (GRO 


“SOLACE CIRCLES” TOBACCO 

THE finest combination ocr discocred of Choice 
Natural Tobaccos Exery pipeful m indescribable 
pleasure 12/6 per 4 lb tin post free — Sole 
Manuficturers 3 J Freeman A Co Ltd 
90 Pjccadilly London \V 1 (GRO 1*’29 > 


A RDARA— LEAST KNOWN MOST LOVELY 
holiday resort m Ireland Best free fishing 
rough shooting golf bathing an artist s paradise 
nrst-class ACCOMMODATION proMded by 
doctor s widow Fey. guests taken Vacancies now 
— Address No 7008 B M A House TaMsiock 
Square W C 1 


F or all income tax complications 

or difficulties consult or communicate with 
. Mr C G C KILNER (late H M Inspector of 
I Taxci) 7 M Jaincb Street Piccadilly London 
f S \y I Telephone Whitehall 9-.7S for appointment 


N ational adoption society 4 baklr 

STREET WI Telephone WeIbccK 7211 
OrrtRS ASSISTANCE m the legal adoption of 
iDclH mate and orphan babies into suitable 
Family hie Chairman The Lkd\ GrNEMrrii | 
Caxendisi! I 


X APCWRITING DUPLICATING TRANSLA 
TIONS —Experts in Medical work TEST! 
MONIVLS THESES etc accuratclj copied m 
st>K that command attention — \\ oqurs Bureau 
D rayton House Gordon Street London N\ C I 
(cloac C M A Houac) EUSton J77^ 


'TiPEWRITING— SPECIALISTS IN TYPING 
-*• Medical and scientific papers Icciutcs 
theses and books Shorthand Dpists alna>s» 
a>aifablc Proofreading indexing — Margaret 
Watsov Ltd 16 Palace Chambers Bridge 
Street S W' I \\ HItchaP 3S38 


\^HEN YOU COME TO LONDON STAY AT 
YV the HAMPDEN RESIDENTIAL CLUB 
FOR GENTLEMEN Hampden Street N W 1 
Close Kings Cross and Huston 300 bedrooms 
15/- to 22/6 pvr includ baths attend and boot 
cleaning AM meals h la carte m dining room 
Mod tariff Large dab mis reading mi s(ud> 
for students lllus pros Sc*. Eusion 2244/5 


4OTH AND 6IST SOUTH MIDLAND 
DIVISIONS R A M C 

RE UNION DINNER proposed of Old Com 
rades of R A M C of these Divisions m Burning 
ham in auturiin of this year AM interested com 
municate with Lieutenant Stanford RAMCTA 
Slockficld Hall Acocks Green Birmingham 27 


ASSrSTANCrES 

W/ANTED IMMEDIATEL’^ —INDOOR AND 
» ’ Outdoor ASSISTANTS for town and coumrj 
practices With and without view to Partnership 
Good Aolanc:* offered State full pariKulars — 
British Mcdical Burcvu x 3 Cros^ Street 
Manchester 2 


W ANTED IMMLDIATELY MARRIED 
ASSISTANT (Britivh) for South Wales 
colliery practice with carl> mcw 30-35 Salary 
£4x0 and car allowance or car provided with 
free unfurmvbcd house — Apnl> with photograph 
Address No 7315 BMA Home Tavi^vtoek 
Square WCI 


W ANTED END OF AUGUST TOUNG 
ma>c indoor^ \55J5TANT EnglKh cr 
Scotch preferred for mixed practice m North 
London Time for reading Car provided 
Salary £00 — Address No 7307 BMA House 
Tavisiock Square AS C I 

W ANTED ASSISTANT FOR MIXED PANEL 
and private practice Bristol Salar) £400 
plus £SO car allowance —Address No 7319 
BMa House Tavistock Square WCI 


■VVantxd experienced ASSIST \\r 

V. ^ rxrtncrship m good-chw 

,ubmton pMcijcc w.m eood .urstcal 
m Cheshire To reside in nnd dciclan treaio 
rnlui r"«t' <0 Mcll-Qinhiicd S^d 

Good silir> and car allmiancc unlcl loih ore 

Tino^'n xV'i' prospecis —Address No 

7J09 B M V House TavisiocV Sauarc \\ c 1 

ANTED OUTDOOR ASSISTANT rvSEi 
e e and prireic praciiec near Mamhcsier Stjic 
married or single nalionahvs Salar> fsoo pa 
ind furnished rooms Cir requited Ttmeei,! - 
Address No liM BMA Home TiiouU 
Square MCI 


■RANTED INDOOR ASSISTANT (MALE) 
XT panel and private view to succexsion 
Univcrxit> town neat London £3^0 with IxurJ 
and lodging and car allowance Xddrevv. No 
73H BMa House Tavistock Square W C I 


W^ANTED INDOOR \SS1STANT 
XT Glamorgan on July 20ih or 2Hh rwcsiaw 
Irish or Scotch preferred not csscnual Ncwli 
Qiiihficd would suit £3(X> rising to £tsp — NiHrcvi 
No 730f SMA ffousc Taxmock Square \3C1 


W ANTED male indoor ASSIST VKT 
prtferabb Jewish panel and private pra ut 
m Sunderland miixt be capable driver Sabry 
£t2^ per annum all found — kddrcs^ No ft 
DMA Hou c Tavistock Square M Cl 


W^ANTED —OUTDOOR ASSISTANT M\U 
YV married p cKrrcd for Practnc near Bimvn 
ham Some experience in G P evsentwf 
house rent and rates free Sahr> £4^D pa arJ 
cir nllowanct AppK with full pariicuhtx and tw» 
monials to— \ddrts No 744r B Nl A H v 
Tnvi lock Square W C 1 


VI/ANTED INDOOR ASSISTANT TOR SIX 
»T months from Stplcmher MhcU Gen rs) 
Practice S\V coumti town Snlirj £ 00 p» 
— \ddress No 730S D M \ House Tavntovk 
Square C I 


wanted outdoor male ASSISTANT 
YV (Sv.otch or CnglivlO for Northern Cilj Sahn 
£400 p a pluv £^0 car pMovvance Sivic « 
height and experience — Xdorex. No BMA 
House Taxistock Square W C I 

\A/anted Male assistant inoojIR 

YV lor Durham County pnetue Salan 
per nnnum plus car xllnuincc — \dJrcv< V 
7 j 24 BMA House Tavistock Square WCI 

AA/ANTED PXRTTIME ASSISTANT (MM-E* 
VV from Oct Lt Central London Su/t 
doing posigtadinte work — Addr^« No 
B M A House Tavistock Square V» C i 


W ANTED ASSISTANT TO LIVE Aj 
Bnnch Siirsir, Good -alio aiM .If 
nnccs Mamed or sinslc State rwhu/i't/ur » 
and when free No oh;eciion to rcctnil> gim 
— Xddrcsx No 7^29 BMA Hou c Tam 
Square WCI 


W ANTED IN COUNTRY TONN> IV M/P 
hndi nnic Outdoor ASSIST \NT Sji7 
£400 to £4^0 nccording to experience xat r ^ 
vided Ample time for rending —Addror vo 
BMA Hobs'* Tax tsiock Square MCI 


A 5SISTANT BEOUIRED FOR OCTOBER iW 
/X m pincl nnd prune pnehee ^ t vc , 
experience cwcntnl SlIiO „ (-i 

rcMdcnce half night call and mt r> 
AppJ> with copic of ic5tiinonn)v 
cxpcricn'*c whether «mgle \ 

to drive car -Addrevv No 7U9 BM' R 

Tavivtock Sqinre XV Cl 

A SSISTANT VV VNTED J j”''?'’'; 
/X. nrci) mud be cnerfctie r " 

auehfied S3lir> in commence £i 0 ^ ^ 

iMih furni hed riom, ir,i i H- 

preferred -Addrere No j’’' " ' 

TaiBiocI. Squire WCI 

■DIRMINGHAM — 

JC5 complete clieree of btencli Si JT 

car allonnncc free rent rai^ ^ „ 
illonancc sas hehi ’"‘^"'''''’5, fj led > * 
Sfarnerf rtratr pre/eraWe mMi n^, ^ ^ 

cncreeiie-Vddrci, No .HI » 

Tan'totL Squire W C I - 


M p CllB WITH soMrvE'Ry/'/,'>f 
D , crt'C lec.s po't o" "Jn / ,1 J ' 
Larce pincl nnd club pn jtee m 'f, ^ 
prcfeircrl — Addrc« No 

Tni5tocl Squire W C I 












JUL^ 16 1938 


THE BRITISH MEDICAL JOURNAL 


P ARI TIML \SSlSr\Vl RLOl IRtD M 
n't LinJ * N\ C ci > rcn h 

m<nl nl v.hvW cic Y^c \ n I ctt— \ h Ic iJj) 
frcx Sleep in t urcen c«ert a! Rennirentt'n 
I be amnsed U tv" >!c al o ! ki m I 
ruXt-i> Auc 9th tP th (n cs ential) — Vi.dro 
N "44 B M A Hue Ta\M vK u uc W C 1 

Q UALiriED LAD^ MEDICVL RrOl^lRUD 
i> Kixc HELP n nail pra xi'c (c intn) 
£1 0 all c.^nfircmeri fees NarJ and 1 'deint 
Sen II ual tvnd — \di-rcv< No ^3 B ^1 \ 
Hiu^ la I iPcV. Niuaie \N C 1 


Loctnis 

W ANTED THlsniON AS HKLM \SMS- 
TANTSHIP r PART TIME WORK 
Experien'cd in r rel nnu pn^'atc praci -e Free 
n V. \\»J jM *.r> ^cTc — n T rrn ^ o 
{Lend n' c wdrip- N -^9 B AI V H 
TjxtNtxk Si« re W C I 


W ANTED L(X:LM M \N OR WOMAN 
fren \wC ih in Au Lo"- n 

Practi c '!u l be Brjt h a*^ M i.ri%c car 
v Gl "a a week ■ — Audrey No “-*41 B V! A 
Hou c TaM Kxk Sjujre W C I 


E xperienced practitioner practis 

ine in Lind n warw LOCLM ENCAGE 
AIENT in cpunirn Au l t cr Septenber own 
car if requi cd — Adores No “19 B M A Hue 
Ta tueck Square AA C 1 


H oliday loclais and assisiants — 

ExpcnctKcd ladic'* and ncntltnen axaiUMe 
i— ned atel\ ''X near Tutu c are in\i ed lo con 
nu^nic wnih— Ti t Mlt>ic l Ao Lin 'h 19 
Soaih rnr n Sireei Strand W C - 


L OCLAT— FOR THREE MONTHS BEGIN 
nine middle cf Autu<l '•lid arc Three 
cu ncas, all (ojnd A er> small p*a t te Any 
nanmalii> Sun ro rr duatc Vtu t dme car — 
Address No "•U” DMA Hue Ta>l to^k 
Square AA C I 


'MEDICA.L POSTS DISPENSERS | = 


M ale or iemale dispensir riolirld 

for the Borciith Ccncml ll»<rtal Shirley 
Warren Sciithimpton Salary per mnum 

P rman ni iipcranmntcd pi m n non resident 
Kr full iMritnilir app! lo ibe Medt nl On cr 
if Hcalih Cm Centre Sciithanpton 

O ALRSLAS DOCTOR <CONA ALESCENTl 
cek IIMPORARA EMPIOAMENI Lt 
pen rned in ill b in hci in hiJ n- lunacy jnJ 
tuber ul'M — AJdrc' N tI4 DMA Hou c 
1 1 I vk Rquafc A\ C I 


P OST AA ANILD AS SFCRTTARA KECEP 
TIONIST SHORIIIAND TAPIST— Mos 


Eikvn Dr>m> Cn Heme 
Cr c Park S E I 


S m nrces Aicnue 


T he ro \ vl arma mfoic-al corps 

ANsOCtAlION **< Ecc ot n Si^uire 
SAA I (Telephone A i tona “ ) tippl ct 

QT al t ed D penvers B Kikkcercrs Lab ralon 
A lant Ninitary As' lante Mi’e Nur 

Menial Spe ul Ifcatncnt Orccil “s Den al 

Clerk Or^er »c^ Piters Care aken etc with ut 
chatcc to rmpcctixe employers 


^/OINC LADA TRAINED SICRCTARA 
pur n co'^C'ti v cn c and c fKlnxcr 


ev.u ated Enc h puM x h ci! dc.ro poMli n a 
prix lie ecTctaty xi h prefer 1 nal gentleman ir 
bd — Adurex No “4 0 H At a lUuc laxi 
tiKk S<3 arc AA C 1 


^lllllllilllllllillllllllllllllllllllllllll^ 

— The Names and Addrcascs of ^ 
~ \d\crtiscrs using 

I BOX NUMBERS I 


are held br us in strict con 
fidenceand mas not be disclosed 
Applications should be 
separatel. enclosed and cicarlj 
addressed 


W/A'm.D MORSIVO SVD i:\ESING 
SURGERIES or cxennjrx onh tr «cll 
qualified man cxpencrccd »sil fccet cd reMder 
S AA 7 di int—Adcroy No -»-t B A! A Hoirsc 
Tax-utock Square AA C.1 


s: Address So — 

E BM A House = 

— Ta\ Mock Square 11' Cl — 

S All c mnunicatjons are forwarded 
^ to adxcni en under plain coxer ^ 


knowicdsc of honhand ixp n** for pood ilillllllllllllimillllllllllllllllllillilF 


practice Tn pleasant S AA London district Salary 
£. a week -—Reply statir panmlari to 
Address No 7^-0 B M A House Taxi lock 
Square AA C 1 


A LADA DISPENSER BOOKKEEPER SUP 
.Tv plied unmcdiatel) on request qualified 
and with practical expenen e in prixatc practice 
and dispcn>3ry work also traiTsl In Bactcnologiical 
Laboratones of the LONDON COLLEGE OF 
PHARAIACA FOR WOAIEN Preparations for 
Erammauens — AA nte wire or phon (Bays 
water 0969) Secretary •“ AAeitbourne Park 
Road AA 2 


A COLRSE OF TR.AINING IN DISPENSING 
4V and Pharmacy is Risen at GORDON HALL 
SCHOOL OF PHARMACA and Secretary Dis- 
pensers can be upp ed to Doaors Scs ions 
January Apnl and September — Apply Primpals 
S-hool of Pharmacy Drayton House Gordon 
Street AA C 1 Phone Euston 39^0 


■pAISPENSING CAREER FOR A OUNG LADIES 
full training for Apothecaries H 11 
Cenincaic Enrolmcius excry three month — 
Apply The Prirttpal Central School of Pharmacy 
- Moreton Street London SW 1 Telephone 
A I tona 1641 


TNISPENSER HALL QUALIFICATION SEEKS 
lull time poxi Hosp tal Surscon or Pharmacy 
Quick neat and axurate dispenser with Rood 
” Genci 1 doctors xxork — Address No 
10 B Af A House TaxisiocF Square AA C I 


TNOCTORS REQUIRING Q U A L 1 F I E D 
D pensers Nur c Dispenser^ Secretary 
Di pen ers or (ThauTcusc Durensers arc inxitrt 
W wnte Wire or phone Temple Bar S 9 The 
DispcssER s BurExi, 3 Lind ay House 1"1 
Shaftcs^'ury Axenue London AA C 2 

r ADA . SEEKS POST ONE A EAR S 
' tnininR L ndon bo piial member of B R C S 
Fixe sears bi»sinc<s tra nin knowlcdpe of t pm" 
and a counts — Mrss E \ Frost II Bark ton 
Card n Eul s Ccun S AA 5 


mAcncES 

W ANTED PRACTICE OR PARlNfPSHP 
£1 900 in town of 10 0<X> South of En ! rd 
H>t c with carden and parapc Pine! of 1 f *»> — 
Address No "t-“ B Af A House Tax t xk 
Square AA C I 



W anted ba caaibkidgl cp adl atf 

« th III yt rx ci'“'^i.r c nt-w c a-J r vx 
cb s PR ACTICT M ct cl nt b >sr'ial cxpcri 
er hare n rr t t yield r £I 00 n tt rr mr e 


Asc 

No 

AA C 1 

f~arn*d Oi jr h 
n« B A! A Hue 

f En 
Ta 

and - 
1 t xk 

Aduro 

Ss ire 

1 \\/ANUD WOAt AN S 

PR AC I Id 

SI f ri 


cicni f iw 1 r c ir 

rre 

Cart 

1 r* rre 

d itcly 

3 db c A Kre 

So 

*3 t 

r A! A 

Hiu 

la txk At,u re AA 

C 1 




W anted colntra town iractke 

with r l Osi up a t, 9 I betn 

un ics n cm nt hr** e e x^xl carden t xsc 
r od e If iirxc ovcnnal Death xacar yen 
dcTcxl curly icxcs t n Address N f 

B M A H « « Ta t vk Square AA C I 


W ANTED WOAIASS PRACTICE ABOl T 
a year tr partner hip C500 “o t (0 
rules s uth ct wot of L nd n Hou c f j ren 
Capital axailable Ltp ncre-d — .Addrrx No 

“t»< B A! A Hoo e Taxt texV Square WCl 


A NLAIBER or SMALL PRACTICFS AT 
low premium Ct ell nt op-oniirt ics f r 
pract ti ners wi hire to set a pra ti e with s. pc — 
Apply Pmcock AVD Htpuy Ltd < 6^ ChamJ's 
S feet Strand W C 


S LSSEX-COLNTPA PRACTICE AAERACL 
over £3 IP rcasinc Panel I 00 Hue 
to rent £ n Coed P'hsh'vi.rhood and hwK 

Premurm t fw .fihs bare (with in rca c later) t» ^ 
years pur ha^e— Addrex Ni *44 B Al a 
H ou c laxi txk Square W C 1 


PARTNEKSraPS 


W^ANfCD PARTNER lO DEA ELOP NEWLY 
“» luUx area Alidbnd ity site secured for 
new houxe ard ursery Exi tin" practice irr-reas- 
ins tcadHy Prcmii ra £ *0 f r share tuaranteed 
mm mum and in rements EiccIIcni opportunity 
f r younz cntrseti man — Address No “039 
D Af A Hou e Taxi to w Squa c AA C I 


^ORTHAAEST LONDON —DOCTOR COM 
A ” men in" specialist practi c in physio-thmapy 
cesires PARTNER Capital of £500 required 
Tir i-class residential di tna — Address No “317 
DMA House Tati lock Square W C 1 


pARTSER WANTED IN CORNJSII TOAA N 
^ AA clI-Qual fied physi lan married ctpcncnccd 
G P 91 ,00 at - years purchase in-rvu " later 
Good hou c garden garage Mon age If desired 
— Address No 731’ B M A House Tavistock 
Square AA C 1 / 


PARTNER A OUNG AND WELL QUALIFIED 
^ X amed for Ccnsultinc Surgical Practice 
Hospital appointment — AAntc (uU details to 
Address No “316 DMA House Taxi lock 
Square W C I 


P ARTNERSHIP AlCLDING £1200 RISING 
oil red after on year preliminary a st tarn 
hip in mixed practice in large Kentsh town ( 
miles from London modern house axailab c foi 
rent nft Appl cants mu t be under 3^ wel 
qualified and with good experience — Apply xsiil 
full particulars and recent photograph Addre^ 
No “3 B M A House Taxi lock Square W C 1 


X RAA — PHASICIAN WITH GOOD EXPERT 
en c in A ray diagnosis and own A ray p nt 
SEEKS COLLABORATION with West End 

doctor or wnh pxactii oner with larger praai e 

Address No “319 BMA Hou e Taxisiock 
Square AA C 1 



G ood middle cl ass pria ate prac 

TICF ftr immed t d’xposal on le rr 
fax lurablc to purcha cr North East Coj t 

Panel 300 Ab ui £l ^<0 gross Hou c xxqh 
surgery £1 r/'O — GxitroKTii Dklry *sn Kmc iiisr 
Solicitor Ncwca lie upon Tyr 1 


L ondon se— an old-esf ablishld 

pn ate and parcl PRACTICL on the Kern h 
border i for aT at « years purchase I here 
IS a panel of I CH'O Ca h receipts £1 iM irv- 
eluding £3-5 from tran fcrablc appoinim nt 
frcchnJ hou c on prominent corner ite A\ ill 
gentlemen with available cap tal plea c write lo 
adxcniscr — Addres No 04 BMA Hi i c 

Tavixiock Square AA C I 


L ondon sublrb (aa > practice for 

al E tab i hed almost 9 ^ -ars Pane! o cr 
“to in rcising Ci h receipt pa t year 40 
Etrxnses lox Hou e to rent Premium £9I0 
enh —Address No “310 BMA House Tixi 
stock Square AA C t 


N ucleus midland cita papidla 

growing d irci P-nel about 100 Re c 
t else months about £-00 Small hou c rent 
Good cope Qui k sale Premium £-00 or ficr 

Address No 3)0 BMA House Taxi tcx.k 

Square W C 1 

N EAR PUTNEA SAA — DE.ATH AACANCA — 
O d*csi-bli hed PRACTICE Receipt, about 
£l 00 pji Good panel Nice i rgcry prer’ cs 
on rental OfTc's, — PrxcocK wo HAOtry Ltd 

6";6S Chardos Street Strand W C^ 


N ear holborn a\c— well estab- 
1i hed PRACTICE Receipts axerage i it 
pa panel I IW Splcrdid urgery -ccorrmpd-t on 
only Long imrodu non Premium £2 (V*o — 
Apply Peacock and Haolfa Ltd 67/6® Chanucj, 
Street Strand W C— 






























56 


THE BRITISH MEDICAL JOURNAL 


Juu 16 1918 


J^EAR VICTORIA S W — WEI L ESTAB 
-J- ^ Itshcd PRACTICE Receipts Hsl yt'ir ncnrlv 
£i 000 fair tncrcasins panel Nice flat on rcninl 
Premium £850 — Apply Pfacock and Hadlfv 
Ltd 67/68 Chandos Street Strand W C 2 


O l D ESTABLISHED PRACTICE NORTH 
Manchester avcnRine £1 300 Panel 1 450 
Considerable increase possible by branch m ad 
joining suburb Good location asaihblc Good 
house four bedrooms two reception attic garage 
excellent professional rooms with separate 
entnnee Vendor acceptine fulltime appointment 
House and Practice priced low Sale urgent — 
Address No 7104 DMA House Tnsistock 
Square W C 1 


O LD ESTABLISHED PRACTICE TOR SALE 
country town and countrj South of Scotland 
casil> worked average (3 >cars) £1 600 p a House 
\sith separate surgciy entrance garden and parage 
—Address No 7440 DMA House TiMstocK 
Square \V C 1 


W OMAN DOCTOR S NUCLEUS CENTRAL 
Middlesex for sale £370 last year including 
£108 panel and P M S Scope Small house and 
tirdcn for sale or would be let One years 
purchase — Address No 6824 DMA House 
lavistock Square W C 1 


W ITHIN EASV DISTANCE Of LONDON 
small NUCLEUS with scope together 
with very attractive house Residential area 
Cottage Hospital House and Nucleus £2 500 — 
Address No 7111 DMA House invistock 
Square W C 1 


X UA\ PRACTICE WITHIN 100 MILES 

London good mixed panels private prac 
net including A ray work infn red ultraviolet 
light therapy faruhsm and galvanism Plant on 
premises Increasing branch surgery Income 

£1 703 Dispensary panel sufgciy and garage 
separate House to let or purchise 4 profes'^ 
sional rooms dining room drawing room 4 bed 
looms etc Price 2 years purchase — Address No 
733R DMA House J wistock Squire WCf 


HOUSES, CONSULTING KOOMS 

HARLEY STREET 

AND MEDICAL DISTRICT 

Tor all types of ivailibic accommodation 

BERTRAM & CO.. 

59 Connaught Street, W2 Paddington 1G42 3 


A ccommodation with full secre 

tarial services available in modern CON 
SULTING SUITE Phone Wclbcck 7351 or 
write — Address No 7336 DMA House Tavi 
stock Square W C 1 


D evonshire st wi — an excellent 

CONSUL I ING ROOM in one of the finest 
houses in the street available live sessions per 
week Rent £125 pa inclusive — Address No 
6356 n M A House Tavistock Square W C I 


D OCT or S well DETACHED HOUSE 
good parage excellent position lovely garden 
new London suburb minute golf £l 275 freehold 
— Write Dr R 57a Dean Street W I 


H arley street— exceptionally large 

Consulting room m one of the Iincsi houses in 
the siroyt rent £250 p a Another on second ftoor 
(lift) at £1^0 pa To view and for all pariiculnrs 
— Addrtss No 7110 DMA House Tavistock 
Square W C I 


F or sale one or the tinest houses 

in the Harley Str^.ct district Income from 
lettings of consulting rooms over £1 000 pa Excel 
Ictu rcsidLnlnl and consulting room accommodation 
av 111 ibJt for purchaser 1 ong lease for safe at low 
price —Address No 7109 DMA House Tavistock 
Square W C 1 


H arley street and district— a num 

ber of excellent CONSULTING ROOMS arc 
available for full and pan time use at moderate 
rents Particulars on application — -L icood and 
C o 10 Henrietta Place Cavendish Square 
W J Lang 2601 


O LTON (01 MILES CENTRE Of BlRAflNG 
ham) TTie Ideal Benefit Society arc dc 
vcloping with npidiiy 300 acres known as 
ULVCRLET GREEN ESTATE upon which 
1 ‘100 hou cs will be erected Small depoMt tnd 
casv terms arranged Ideal Bcnclii Society 
iLstatcs Dept) Coltridkc Ch»mb tn 177 Corpora 
I on S reel Birminplnm Ccutnl 5991 


For mattalfle 

COVSULTIIVG ROOMS 
PROFESSIONAL HOUSES & FLATS 

In Harley Street and the medical 
area generally fncludfng Mayfair 

LEY CLARK & PARTNERS, 

AUCTIONEERS SURVEYORS ^VALUERS 
3 4 Wimpolc Street Cavendish Square W 1 
Telephone Langham 1095-6 7 
Represented at Cannes Nice and Monte Carlo 


IV/JODFRN RtSlDTNCE IN MAIN 
tlioroughfarc ot progicssivc seaside resort 
for sale or to be lei on lease — Hanmm Mansions 
Skegness Telephone pNE 


O PHT HALMIC SURGEON HAVING RET IRED 
from practice now wishes TO LET Ins 
HOUSE The house is modern and situated in a 
charming residential district on the Lancaslilrc 
coast A suitable oculist would soon recover the 
practice TuU particulars — Address No 7005 
BM \ House Tavistock Square \V C I 


Q ueen anne strclt— 0NL^ £4o pa 

secures exceptionally fine CONSULTING 
ROOM for use wlitn reqt - 

all services Residential 
— Address No 6355 D ^ \ i* v 

Square W C 1 


OO PORTLAND PLACE FIRST FLOOR 
modern TLAT facing west licensed for 
practice Two reception bow window three bed 
bath cloak kitchen magnificent entrance lift 
Unique opportulutv to combine residence at little 
more than consulting rent — Address No 7322 
B M A House Tavistock Square W C 1 


mSCELLANEOUS SALES, etc 


IMPORTANT 

to MEMBEHS of l!tc 

MEDICAL PROFESSION 

CLOT NTS or DISTINCTION for GENTLEMIN 
of DiSCRIMINAHNO TASTE SpccnJJy Cm 
ruted and Moulded to cich individual tigurc 
made from rine>i Quality Materials and in the 
Best Possible Style cost no more than mass 
production ready made clotlies 
The invaluable I ractical Experience and Avtvicc 
of our 14 Expert West End Cutters and Titters 
IS always at your disposal 

ALI H\LL/ONI rrodnrilon* nre II\M7 
I IMbllLD IN rVCia IbSINTIVL DLTML 
VFcni ofFtn 

J\CMT Msr (In binrk or prev) £l 4 
Lined bcsi <|ii’ilit> Art Satin Art Vllk or Alpnra 
«lOl II> F\^CT BOIlbTLD inOU‘'Ln«* 

T he Idnl bull for 1 roft»* lonal <»r Ilii Ine**^ v ctt 
lOtWCI Mins CO iMcnsurc from £(i 0^ 

OVrUCOATS , £" -s 

DlfSNrn SUITS £« Bs 

Dnrss suns from £10 30« 

PIUS FOUR SUITS from 16 6 h 

THE IDrVLSull for Connery imd Sporlinp enr 
GOLD M1I>\L UIDINC DRfLCHIS from £2 2 h 
RIDING iniHJS , ID Hr 

RIDINt ROOTS , 13 

COSTUMES A lONC CO \Ts , £0 6s 

UNSOLICITED AI PRECIATION 
/ strongly adiisc oU medical wie/i ii/fo ufsh to 
hm e saUsfacuon to pofroni e ll/trr} Hall I Id as 
all On clothes J ha\e had from them during 35 
j ears hat e been perfect In Fit Xfnt and F nnsh 

(Signed) SJA MA MB FRCPS 
PATFERNS POST FRCF 
Perfect Fit Guaranteed from Simple Seif measure 
ment Form or Pattern Garments 

M llors to Lonvlon can order anri /it name day 
SpecHl Paiitrn^ >*ois1<l ebrn be cnl and 1 erfcct 
Filling Cloihcs Mipplicd aficr Wthoiit trying on 

HARRY HALL, LTD. 

Governing Director Harry Hall 
TIU Coat Rrccebc^ Ilnbil and Co%itinic 
Sped ill I#* 

181 OXFORD ST M I 119 CHI VPslDL I C2 
Telephones 

GERnrd 4905 4906 and 4907 NATional 8696/7 
Makers of Finest Quality Bespoke CivK Sporting 
and Hunting Clothes for Ladies and Gentlemen 
Hlglier>t \warilA 12 ( oltl Mcdalu 
Lsi oscr 10 years 


H igh grade car for hire speciil 

quotations to the Profession Diy and Night 
service ilso Gangc anJ Maintenance including 
collection md delivery under I ervonal Supervi ion 
Ring Padd 4'3t B Covell 3 and I Bendall 
Mews N \\ I 


income tax 

l>iir<lcii U OUR bu.lnro 
lax SipfclnR t, to il,c Mc.llcil r.n(r.,lo„ 
HARDY & HARDY 

l‘> CUVNCIUY I lOMlON «C2 

Telephone Ilolhi rn 6039 
M rite for free cop\ of Aihice on Income Tar 


pOR SALE— FULL TRIAL SET LCNSLS 
walnut case (Curry and Paxton) ad/uuaMc 
cic In good condition £20 — 

Address No 7002 BMA House laustoA 

Square W C 1 

pVTHOLOnCAL APPARATUS TOR. S\L! 
Jk second hand nearly complete oiufii TO 
Iiicubitor centrifm,** bum c colonmcicr rk — 

Address No 7313 BMA House lavhkKl 

Square W C 1 


COVERS FOR BINDING 


Vols 1 nnd 11 of the BRITISH 
MEDICAL JOURNAL for 19J7 
and preMOUS venrs enn be Ind 
pi ice 2s 6d , b\ pircel pod 
2s lOd each 

Orders with appropriate ri 
mittance, should be iddrcsscci 
lo 

THE SECRETARY 

DliniSH MCRICAU JOUKNAI 

UMA nousr iamstock so 

LONDON WCl 


APl’OlNXaiENTS — Coiitd 


True LADi ciiiaicsiCK iiosriTM 

X Hoxi. Diishtcin 

I OR rUNCTIONAt NLRVOUS DlSCASrj 
(fiO Ucil.) 

SLNIOR HObSL UDMCIAN (aomin) t( 

qinrcti six months appointment . 

all foiiml VnlniLlc cxpctium. tor Uirlcm' 

1 Sidioloslcal Medicine c„„nn 

Apphe lions ttiili icsoinonlals in the srero.n 
Allas Chambers 33 West Slrcci lloinio" 

July 9ih 1938 . 

T'lic iiospiiAL ron SICK ciiit-Wirs 

1 Ncwtasilc upon l.nc 

Apphciiions nrc 

HOUSE PHYSICIAN and SU«or 

(male or femdc) for s„ ,, 

1938 Salary at the rnic ol HW r' 
toRcthcr with hoard resulenec and ^ ,, 
Apphe Uionx stiilng «gc ^rii 

Rcthcr with conks of ttsumonjah Jo j 

me Secretary Mr Nrii Duomr CU) 
Newcastle upon fync 1 ^ 

Y O R k D f S P r N s A R 

Applications , «tc imiied < 

ItCSIDCNT MEDICAI Ol IC^ER , 

eommcncc dunes as soon is po sihic 

^ri?erce,?eSu. stud connusol .sort ^ 

^''candidates must be dul> u= ' 

>nd unmarried Experience in ibe oon 
at nnncsthciics is csseniid j l^i a, 

Silary £200 pet annum rit «-<' 

ittcndincc wiih in allow 'ince 
ind for laundry ^„>,,i, lo 

Apphcationv wiih icsiimcniah lo 

,r before July 9ih ^ pnrRS_^ ^ , 

4 New Street Vork 


I U T H f N G 


II o s r I T ' ’ 

licaiions arc inriied for the w 

rON xaeinl on Juh pi it r 

eix months Sdars at ^ „ 

\Mlh board fcti'anf ’ 

I, date fmale) 

,ye nationalil, ‘I"''"' < 

aecomp.n.ed by teson ' 

A V OAK10S 

so Sceacim 















Juu 16 I9'<S 


THE BRITISH MEDICAL JOURNAL 


57 


P RINCESS LOUISE KENSINGTON H05T1TAL 
rOR CHILDREN 

Si Ouinim Aicnue North Ken'initon lo 
(LadKcVc 01^3 ) 


The B-ord cf Marujrcfncnt •'''uc 
f r the corrbmcd post v 

TWT PH\S1CIAS »Tth beil5 and PH'^SICIAN 
IN-CHARGE of the Chi d Guidince Clim 

Arrlicams muM be praduaic< of a L.m\cnit> 
and tru t hoM the R C P (Li ndC'f'^ ®”d the 
D P 'I and t-*uRt ha>c had rraaic*‘ crrcncncc 
in a Child Guidance O ntc 

Arpltcations acconnanttd b> cor'®* tmtt 
le^tirooniaN should be ent to ihc uhdersicned at 
vht Ho^ taf ftoTi ^ho*^ an% funhef information 
can be obtained and hould reach him t'o' later 
than Jul> Pih 1015 ^ 

H J ELEh 

Secretary 


P RINCESS LOLISE kENSlNGTO'' HOSPITVL 
FOR CHILDREN 

St Ouinun A\xnue North Kcminttott 
(Ladtrotie OPi ) 

The Board of Marujrcrscnt irtjitf ar*" uations 
f r the of HONOR AR^ ASSISTANT 

PHYSICIAN with beds. 

Arrl cants r*»trst be graduates of a L n ser^tv 
and mjst hod the 'IRCPfLood n> ard the 
«ccc''<fu! candidate he requ red to ce O t 
Patients. 

Apnlicatiorts, acconaranied b> cofiC' cf th ce 
te<iJomnaIs should be ^em to the undersi ned it 
the Hospital from »hc*n any ftnher inf rmation 
can be obtained, and hould reach him n t Uter 
than Juli Oih 193^ 

H J ELEh 

Secretary 


C 


ONN aught 

\\ aUhamsiow 


HOSPITAL 

E-r 


015 Bed ^nh Four Resident Afedtcal OfTiccrs ) 


CASLALTTi OFFICER Irulel requ red to com 
mcnce duties Aucu t Ht The appo ntment mill 
be f r s« months with remoneratiPf at the raie 
cf no per annum with board res den c and 
iatndrv 

Appl cations statvra ace nationality qualif -a 
1 on and expcnenKe accompanied by ce*’* -s of not 
' more than three te^timonjl trust he deiseTew 
to the under i ned net Lter than Fridar Iu!> -«nd 
193R R HXLTON HARRISON 

Act ng Seciet-r> 


K ing ed%\ard memorial hospital 

taUn <1 ^ Bcds> 

CASE \L‘n OFFICER ANp DCPITX 
RESIDENT MEDICAL OFFICER (rraftf) requ cd 
Six men h appo niment with po*- hility of re 
e ection for a further period Sat ry ref 

annum with u ual rcAdcntj I er'otvr'cn < 

Apr icauons stat nc age ccpen-ncc and quah 
f '“aijon together w th copies of two rccert 
lestmona! hould be eni to the unders rred 

•nmed lately 

R A MICKELU RIGHT 

Hou c Co^crrrr 


M 


ETROPOLITAN HOSPITA 
Ktngsland Road London ES 


L 


Appl cal ons ait lOMttd tor the pot of 
CASLALIT OFFICER \ND RESIDENT 
ANAESTHETIST (male) Salary at the rale of 
£!W pa with board residence and laurdry 
Duties to ccTimcncc September I t Candidates 
must pex^ot a rcjr tcred medi'al and survival 
q aalihcaiion of the United K.ingdorQ 
/ Applications should be obLiined and returned 
K the undersign'd not laier than July -fih 
FRANk JENNINGS 

Hou c Goienor and Secretary 


p\ ELINA HOSPITAL FOR SKTs CHILDREN 
Southwark SE.I 

-.''^'‘rations re inxitcd for he pox of HOUSE 
^^•'OhON (male) for ix months from Aucust ] th 
(hRt two months tn the Ca ualiy Depanment) 
aaiary at tbc rate of £1.0 per annum with board 
and rcsidcn c 

Applications wuh copies of three recent lesti 
mon als should be ^ni to the undersigned not 
laicT than first ^Krst on July 15ih 

M H SIDNELL 

House Governor 


\71CTORIA HOSPITAL FOR 
’ Tite Street Chclvca S M 

(t3S Beds) 


CHILDREN 

t 


The Comniiice of Management lostic arrllca 
tlons for the posts of 

(a) HOUSE PinSlCIAN 

(b) HOUSE SURGEON 

both xacant Autnist 1st l9iR The appo ntments 
are for jit months Salaries at the mte of £I0<3 
pet annum with board lodeinc and washing 
fc) CASUALTY OFTICIR (norwrestdent) 
for a period cf three months "Duties to com 
mervet on Aiimni Ist I9ts 

Hours 9 an lo I'O pm dally (including 
Saturday) Salary at the rate of £ 00 per anm m 
with \\itvth 

Candidates arc ctpectcd to attend a SuNCom 
mince for an intcrxicw and should tend their 
application arid cop es of three testimonials to 
the Secrctarv not later than first post cn W ednes 
day the 0th instant 

D ST JOHN DAMFORD 

Secretary 


T he cordon hospital for dislasls 

OF THF RFCrUM AND COLON 
✓meent Square S 'A I 

PrC'cnt act *mmodaiM n t> Beds On complctt n 
of Reb- njin act ti m xfat ri will be 10 Bed 

SLRGICAL RiriSTRAR 


The C*'frmiitee of M racT ent invite arrl<aiions 
for the .ippo n ment of SurCKal Hm trar Card 
d-ics must hi Id tbc I RCS Dipfi'ma or tbe 
A! S teeree of a rcc«»fnucd Lni ertity 

App'i~a« n s uh cop*cs of three tcvcnt tc'ti 
mmialN. he* M be ubmtttcd by July toth nest 
ddrci ed to the Sectc..ry at the H '''* tal from 
whom detail emerntne duties and icrmv of ibe 
arroinimcni can be bt-incd 


M iller ccneral hospital 

Greenwich Road S E 10 
ANAESTHFTISr 

Arpf at ons irc m tied for the r<**t o ArvieN 
thetist (to attend on Thuivl y afternoon i fn m 
thoe who are sreaiHy cnr*ced in the pra t c 
cf apjesthctiT 

Honsrafijm at the rate of guineas per nnr n 
f r one attenw.rce a week For each addit < n. ! 
atterdan e or guinea wii be paid 

Fuller pam-^lars on appl at n ro the Secret, ry 
Apnlicatiofts to ether with copes of not m c 
than three recent rest momals to b— ten i n -r 
before I l> |9th I9)A 
July <ih 193V 


Q ueen a ap^ s hospital for the 

EAST FND 
Sir- fo d E 15 

Ap feat ins arc invi cd fi m folly qual cd nj 
resi ic ed rrp -nl men < ntyi for the ro-*! cl 
CASE ALTS AND OlTPAIIENf omCFR 
Th Ho<r tal contain I } Beds irckd nc 0 
for maternity ci_iicnts 

The appo ntr^ert I be fo is mon hv term nat 
ing on Sertember 'Oth I93h j.lary at the talc 
of f| 0 per annum 

Cund u ics who mu t be in !c and who 
hould pre 1 J 1> have held hospital appointment 
h )a!d send nrlicaiion aeccmpanied by ic ti 
monia to the under ~ncd at cncc 

RAPHAEL J \Cf SON (Afaior) 

Secretary 


Q ueen MARy s hospital tor tht east 

END 

StraUo d E IS 


An Invcsti-mjion ts bang undertaken tn case of 
Chronic Khcunatic Diseases at the above Hospital 
and a CLINICAL ASSISTANT n required for 
the specific purpose of assnim- the Physicun in 
charge of this work 

Attendance at the Hospital on either Monday or 
Thursday afternoon » required from .pm 

Applications to be ent to the unders gned as 
early as possible 

RAPHAEL JACKSON Major 

Secretary 


'WEST 


END HOSPITAL FOR 
DISEASES 

Out Pat ent Department 
73 AAcIbeck Street AA 1 


NERAOUS 


/ COUTH LONDON HOSPITAL FOR AAOMEN 
Clapham Common S 'V 4 

Applications are invited from rncdieal women a 
, CLINICAL ASSISTANTS 

W Gynaceolo cal Out patients to attend on 
Tuevlay and Friday morn ngs 
Apr jcai on$ with testimonials to be ent to 
the Secretary at tbc hospital 


The Committee ol Management m vtcs immediate 
applications for T\A O HONORARY CLINICAL 
ASSISTANTS for the Child Guidance Depanmert 
Csndidatcs arc lequcstcd to obtain fuithcr par 
ticulais a. to elinic times etc., from the under 
8 gned to whom app icauons with cop es of not 
more than three recent testimonials should be 
ported not later than Monday July ISth 

J P AAETENHALL 
Secretary and Hou c Goverror 


W EST LONDON HOSPITAL 
Hammervntith AA 6 (39 Beds ) 

There IS a vacancy for the newly-created p<nt ol 
HONORARA pMASICIAN for PsyehoJo***- t 
Medicine Candidates who may be neo or 
women should bd Members or FcllO'wr of the 
Royal College of Physicians London and should 
have had some cxfcriencc n Child Psychiatry A 
Diploma in Psycholorcal Medicine is dcstrabi- 
Thc candidate appointed would be erpeacd to 
undertake at least one Out patient Session rcr 
week and such teaching .s may be required b» 
the Afedical SvhoO* The aproimrreni does not 
carry with it tbc charge of any Ht?^iul teds 
Applt ations accompanied by copies of tC'ti 
momls nufst cexch me not later than Thursday 
August 4:h Candidates rrttst attend a mcetin of 
the Medical Coubcil at 4 30 pjn cn Friday 
August rih and prior to that date cal! upon and 
send copes of their app cation and te'timcnals 
to ea h member thereof They must rot canva 
members of th- Bpard but ne erthdess must send 
cop es of their an" icaiion ard testimonials to eu h 
rrember thereof and if so notified be in attcndar'-c 
at a meeting of the Bnard at 5 p m on Tuesday 
August 9th when the appointment will be mace 
H A MADCE Secretary 


W ORCESTEP COUN-n AND CITY 

MENTAI HOSPITAL 
Powick rear AAorceaer 

Appl aliens arc irvitcd for the post of ASSIS- 
TANT MEDICAL OFFICER 

Appli'arts mu t be male »m,Ie order th n> 
five years of ..gc «rd duly _quvl Tied m mcdtine 
afKl urrery Co^f’cn mg salary £3«0 n nr by 
anrjal ifycrcn'cnts of £.5 to a r"st mum s. r> 
of f4<n per annum to -thcr wuh furn hed ar ri 
ircnts twrd Iaur<-ry and attendance A furib-r 
£_0 per anpim will be rad if tbc sc cctcd candi 
cate h Ms or obtair a Dip o^a tn P ycholo -^1 
Atcdicire Etpcnercc in Ar^icsihetics will be a 
revomfrendai vn The appoin mem is t breet id 
the prsvi i rs of the Asylurry O'^icerx Superanr a 
tion Act 19<73 

Ap"! cat srts lahn arc and full ramcjlars of 
qual ficatiors ard etperler e aeconpanied by 
cores of th ce reccrt tcvtimoials to be fonvarded 
to ihe Afeujcsl 9 perinrendcnt not fjtcr than 
Thursday Ji ly . 1 t I 9tV 


W rST MINSTER HOSPITAL 

Broad Sarvetuary SNA I 

There is a vaeanT for a HOUSF AN AES* 
THETIST (nsn rcsiucm) for a penod cf six ntrths 
c *mmcncm" Au u It I93R 

The salary attach'd to the cTcc is at the rate 
of Cioti per anrurP 

Appjjijiions accompanied b ccpies of three 
rcccwi teitif** nials bojld be sent to the under 
ured not later thin July . rd I93S 
By Order of the Iloim Comm tee 

CHARLES M POAAER 

Secret ry 


W IMBIEDON HOSPITAL 
ThurvtJn Rosd S AA 19 

Apr itan es are rnvited for the posr cf PCSl 
DENT MEDICAL omCTR male unmart ed 
I>ut es to commence t n Ovtr)*'er I t The app' t 
ment is for a period of is mor hs The alary 
o'TcTcd IS at the rate of £1*0 per annum h 
bsard rmidence aod laurd'^ 

AppUcatiors accompar td try copes of tbice 
recent tc'timorials shou d be sent to the Hon 
Secret iry 

A B AAARD 

Actin. Hon Secretary 


W^EST KENT GENERAL HOSPITAL 
» » (In orporated) Afaid tone. 

(13* Beds ) 

Appljcations arc «n vied fir the post of HOLbE 
SURGEON who must be a male of Brii h 
naiioruliiy 

Salary ai the rate of £f5 per annum w m 
board apartments and laundry 

Card dates must possess reg tcred qual rcaiiorh, 
Applicauons stating qualifications and erperv 
ence together w ih cop cs of test monia! hould 
be sent to the undersigned immed Mdy 

EDAAARD j GREGG 
House Go ernor and Secretary 


W ARNEFORD GENERAL HOSPITAL 
Leamington Spa (164 Beds) 

RESIDENT CASU ALTY OFFICER and 
HOUSE SURGEON to one of the Hon Surgeons 
required by September *th 19 A Six month 
appointment Salary £1 0 per annum wuh board 
and laundry 

Applications from qua! fied registered r^edical 
rracjitioners should be ent together wuh three 
recent testimonial to the undersigned by July 26th 
1938 

EDUaRDL AAIRGMAN 

Hou c Governor and ScTctary 




THE BRITISH MEDICAL JOURNAL 


SS 


FINANCE 

for the acquisition 

PAYMENTS 

OIIT-OF-INOOME 

of 

Surgery and Other Furniture 
Surgical Instruments 
Medical Text Books 
X-Ray Apparatus 
Laboratory Equipment 

The ibove lc<il is illuslrilivc only 
Under ifs Cquipmenl Purcliisc Plan the 
Companj is prepared to assist doctors 
to acquire ANY article and spread llie 
cost o\er a period 

BRITISH M EPICAL 
FINANCE LTD. 

Tavistock House South, 
Tavistock Square, 

London, W C 1 



the century 

INSURANCE COMPANY LTD 

7 LEADENHALL STREET 
LONDON, EC 3 

16. CHARLOTTE SQUARE 
EDINBURGH 


Assists Doctors 
TO PURCHASE 
A PRACTICE 



NO GUARANTORS REQUIRED 
. REPAYMENTS ARRANGED 
BY EQUAL QUARTERLY 
INSTALMENTS WHICH DO 
L NOT VARY WITH FLUCTUA 
' TIONS IN THE BANK RATE 

PLE,4SE IFRtrC FOR 
PARTICULARS, STATING 
AGE NEXT BIRTHDAY 

MENTION BMJ 


Juu Ifi 


THE MEDICAL AGENCY, Ltd. 

DUDLEl HOUSE, 'Jfi-38, SOUTHAIHTTON ST, STRAND C> 
rr(ca/,o«c, -Temple Dar WU lord EsraWished in mi b, j a Kr.onr 


LONDON W12— OWcriab CP mam road 
Suit house av\il*\btc fttccipis *^r*prDX IBOO 
Select nxnci 5>00 Prem 2 >C‘n» purctn^ic 
Scone for full time 

LONDON W7^Grc»\unR PRACT new housme 
Estate Small house to rent RcccipK 15**l> 
Pincl 600 — scope fees 2/<5 up Prem £7<0 
or ncir ofltr 

LONDON S \V 12 — Old cstablislKil middle-class 
G P Rcsidcnin} loc'thiy Lxclc house splendid 
Rirdt-n Rlccipis approx £l 500 Select panel 
nearly 420 Tees 3/6 up Premium IJ scan* 
purchase or near oITcr 

LONDON SC <10 nuns Channe Cross) — Work 
inR-cIass G P >liun ihoroushfart House to 
tent Receipts £700 Panel nearly 900 Pre 
mium 2 years purchase or near olTcf 

HERTS (Border) —Middle-class PRACmCE Ucsi 
dcnini locahly Corner house carden caraBc 


/mi ranci o\cr JiX) lertt'fi 
Kna'IPr or ncir ollir 

SURRIV— Mixed O P Rcs/dcntnl hnnlm Smill 
house to rent Receipts apnroT p,rt?i 

o\cr 400 Premnim £1 hOO 

Ctoydoal— Middle-class pR\c 
Tice Residential lotalu) Medium m pi 
house for sale or rental Receipts nearly i\ ftx) 

I Premium open tooflcr 

LO^^ON S \V IS —-Middle and worKme-ebss 
G V Well populated locality Shop-frunted 
premises Receipts approx £900 Panel MX' 

Premium IJ years purchase 
LONDON N L -Middle-class G P Kcvowi 
approx £2 *500 Panel 1 200 Premium ’kjoj 
purchase or near olTcr 

LONDON E (t —Mixed O P Comer hoti (» 
rent Receipts £iC0 Panel O'*!) Prcffli m 
£1 2^0 inchisjie Scope for Eye nork 


MANY OTHERS FOR SALE 


DETAILS ON REQUEST 


THE WESTERN 
MEDICAL AGENCY 

LONDON and BRISTOL 

Dr K H ncNNCTT nnd Dr \V ) PARAMnnr who 
m\c personal aiicmloa lo c\cry cKciu 
rtfianaat Assistoftct for Purchoxers mul all 
at A/filical /nsura/tcif arran<tfi! 

LOCUMS AND ASSISTANTS SUPPUED 
WllHOUr CHARGE TO PIUNCIPAIS 
for cxchisisL Asency maximum commission is 
whn-h iiKhidcs cxcrythmR sold except housu propcrij 


1 HAMPSHIRE COASl —Panel I 600 Receipts 
£2f0D pa mcrcasmR 2 years purchase 
House rent Personally mspct-tcd 

2 S CORNWALL COAST— PKACnCl! in uc)) 

known fishing Milage WvMiufwl stcncry Re 
ccipis about £900 pa Panel 500 2 years 

purchnst or near olTvr 

a S DEVON COAST —rarounlc eoivn PRAC 
TICL started 1936 Non-dispeniinn Great 
xcopL Receipts £250 p a House for sale or 
rent 

4 S WALLS— PARTNERSHIP Bury port Panel 
2 300 Receipts £3 1^0 pa Old established 
HALF SHARE at 2 years purchase (mod 
hou!>e available 

^ KF NT— Near London NUCLEUS started 4 
years ago Receipts about 1300 pn Prcnitum 
£420 Good house on easy terms 

6 N CORNWALL — Unopposed country PUaC 
TICE AU sports Kectipts about £SS0 p i 
Panel about 500 Premium 2 years purchaxt 
Good house rent £b0 p a 

7 LONDON W 7— Mixed Find PRACTICE 
Great scope LCC Estate PineJ 600 Re 
ceipts about £500 pa Premium cn‘:h if tears 
or ofTtr 

« <Nrco 

SOUrHTRN COUNTIES— XVl Jnic several bmcrx 
v\ utuis for I RACTICCS front If 000 to f I <00 
P a 

LONDON — Vc hate definite buyers for a good 
type of PRACTICE uilhm ivvtnij miles of 
London 

PARTNERSHIPS — Wt hut mini medical men 
on our books who art looking -.out for 
PARTNERSHIPS in the Somhtrn half of 
Eih.land ■ — — 

22, Cr.ARE STREET, BRISTOL, 1 

TNt'C Mtdgcn Bristol TrJ Bristol 22(89 

15, BEDFORD ST STRAND, W C2 

Tfl Temple Bar 255i 


Csrr«t.f5uto 1V6S 

PEACOCK & HADLEY, Ltd, 

JIEDICAL TRANSFER AGE?. Cl, 

‘ ‘ -r ‘=<niHl,\VC2 

London 

Telephone t «. 554 

Tins old established Agency negotntes the Sale 
of PRVCTICCS ind PXRTNERSHHS on reason 
able itrms which cm be obtained on application 
LOCUM TCNENS and ASSIS'IANTS iupphed free 
of c harge to principals 

CAVENDISH NURSES 

-JU niAIJS AND FESIALE 

Head Ofltcc 

Si »EVUMO>T STRUT IOM^O^ 1 
Crnilcftes MASCIIESTER IT« Otford read 
GLASGOW' :s II mdsar Terrace 
' DUBUft 23 Upper flaeeni SI 
Telephones London 1277 WcIb-cL (** lines) 
Manchester 3172 Ardntc): 

Dublin 62006 Glss 477 Doochs 
Telesroms Tacleat London Siircicil Gnicoiv 
Tacicsr Manchester Taefcar DiibUn 


nsTsnLisiiro IS77 

LEE & MARTIN, LTD, 

Tilt. BirnilnsInJii Mcdicil ARdii). 
71, TEMPI E BOM, BIBiinNGlIAM 

Telezrntns Telephmr 

Locum Birminslnm 5963 Slid! md llTi i 


TRANSFER OF PKACTICFS AMI 
PARTNERSHIPS AUKANGFU 
MAXIMUM rCC £«0 If c\ liislictr 
cnirusrcd lo us 

ACcou^rs im’rsTiG {TED aud ism't 
YA\ RnURU'^ PrEEAhEP 
nCUABLC AND I D ICirNT LOPUMS 5Vf 
PLtLD AT SHORT NOHCE sho ASS15lAM!> 


(l/IAT£^D 70 PUkCtEiir 

1 IHRMINGHAM (or wiihin 50 raitcs ihfltifl- 
Good Mixed IRACTICC land of I W d r 
and receipts of from £! 500 £3 000 URfifSTll 
nrOUlRED CAHTAL AVA1LA13U 

2 RCQUIRnO—Good tndixh Seotii H ttxl 
Irixli LOCUMS ImmcOnie pmt i"" 
Atso ASS1STAN7S requited it once £«» 
w«h or without titu to P inner liip 


FOR wsro^il 

GLOUCESTERSHIRn —Well i.tiMi holmW 
und workine chss PRACTICE Rexonu n 
f I 25p pa Pint! 1 ’OO Siopc io m'd't 
and good hoiirc , , 

STArrs — Ramdis mcrcaslOB mirn) Ui'ii i i 
Panel I'RACllCE Rcexipts 1x0 ic»t tlf ’ 
Panel 1 230 Escxllent Itoiise «ii(i all '«» »• 
Picaxant locahly . 

MIDLANDS— PARiNERSIIII’ 
suceexston m xxell ext iNnhcd 
Ditoat PRACTirr Rcctipir ax H"0 Pi 
plus Appojnunsnts £350 p a liKumcr s 
liaxc F R C S and Spectalisl cipcricu c u n 
Icnl house ro rini , 

3 ORKS —Old cxial lixlicd mired 1 (i»'t • 
Panel PRACH ICE Rcctipi last icir n ' 

I incl I 3'4 Good hott c to rent 
LONDtlN —Old sxiaWolird roixcsl ' ' 

Panel 1 RACI ICE Keninix »' ^ 

P.nel 9f6 Scope lo increm at"' s™ ; j 
SOtn I! wales —Old cMaWoltsd E ja r 
xxorLinc-el tss PRaCIICE ItxsC'Pi 
£.2(10 r.»nc1 2 114 Good hone ^ 

INANCIAL ASSISTANCE nfTotdrd h’ ’ 
iphcams (or the purchase of I 
IPS on very rtvsonabk tcrni I i' 

applnation , 

RELi\nit AND rincirNT ''SJ 
sutPfftD AT snoluisr mhr^ 


Telephone 35 clhceL T ^ 
TsleRrams Assisiiaxio Lo'ho 

NURSES 

MALE OR FEi^IAlX 

TRAINLD NURSrS FOR 
MENTAL MEDICAL 

AND FEVER CASIS ^ 

Nurses rr.We on ? '' '' 

oi nUahle lor Indent raffs IJt' 

THE NURSES* 

„n con,«nction^^^|m,^;^5i„'4V 




IUL\ 16 19'«! 


THE BRITI'^H MEDIC \I- JOURNAL 


BRITISH MEDICAL BLHEAIJ 

(The Scholastic, Clerical and Medical Association Ltd.) 

{FOUNDED 1880) 

NOBTHERX BRANCH 

33, CROSS ST,, RIAIVCHESTEn, 2. 


, (Msnchestcr - Blackfriars 3»Z> 

TelaJvna (Manchester • Rusholme 2549 {Ntshl CalM 


Blackfriars 39IS 


Branch Offices 


Leeds 


TeJjjranB i 

‘•Locum, Manchester’ 

Belfast 


Recommended with every 
conOdence to the pro 
fession by the BRITISH 
MEDICAL ASSOCIATION 
as a thoroughly trust 
worthy medium for the 
transaction of all Medical 
Agency business 


TRANSFER OF PRACTICES AND 
PARTNERSHIPS INTRODUCTION 
OF RELIABLE ASSISTANTS AND 
LOCUM TENENS at Short Notice 
VALUATION and INVESTIGATION 
OF PRACTICES. Etc 


FOR DISPOSAL 

I TeW f<rrf oJm free cn rmwif I 


Practices and Partnerships 
wanted Large list of 
bona fide purchasers with 
ample capital available 
Enquiries invited from 
prospective vendors All 
information treated In 
strict confidence 


YORKSHIRE (W R ) — OlJ-estab ish<rd anJ better u rLirg-clajs 

PRACTICE. Cash receirw Iasi ear £f “6. Panel (not encourapetji 
Good house 2rece''iiTn bi"^ -j o ^ 

or mav be rented Pr^rtuum 

CHESHIRE TOWN neit -O 

lishcd iniTed Panel and Pns c n- '-u v,a i iei.L { s usi ear £^6»6 
Parti E.’^ceUcni d tached house (in o«n protinJ^) 2 reception 

rooms stud -* bedrooms. 3 Prcfesiorul r >3ms, parage « uh ser>-ani s quarters 
and Carden For sale at valuation Prtmum— PraTice—beit orer —No ll'6 
MIDLANDS— Increasing middl and n orLirs<Iass PR \CTICE in tarpe 
to n Cash receipts sear Cl O'O Panel oier I 200 S-O'^e E'celltn 
nedem bou e 2 rece-tion •* bedfhams para < and lar •« gafd'*’V For sale 
Freeho'd Premium— Pr’cti'^— £2,000— No M2J 

LINCOLNSHIRE. — \en c!d*establisbtfd PRACTICE in r crunirv 

toss-n Cash rece rts last sear £ 471 Panel about I 00 C itag* H^ptial 
Good bouse 5 b^roorns <mafl carden parag- etc Premiurn— ptacticc— 

£3 1<0 for QUJ k sa’ — N^r 1132, 

NIANCHESTER -foul'd o’d-cs abl shed PR \CTICE m ndustnaJ d strict 
Cash receipts last jear £.,.200 Panel 2.2 0 Scope Htuse 4 bedr».cfps 
2 Professiopal roorr« Ren £^r,a rrenum— best effer — No 10*^4 

MIDLAND HEALTH RESORT— PARTNER 

SHIP jn sem o!d-establi»**cd midd and better i ~ 
worktnc-class P"»cti'^ Cash receipts last >car 

£2.'00 Paren.200 Escel nt bouse with amp c _ ^ \i 

-ccommodation garace and pard n Premium 
« —one half share — sears purchase— N t ||.4 <-• e»i e»-T - k 

NEAR MANCHESTER —A>ell established ASSIST AN ‘S 
middle and bett f i^orking-class PRACTICE 

in pleasant suourban distrn m present hands For Iiiiiiictli il 

15 sears Asera-*c cash receipts o>er £t 000 p a 

Panel I fOO Good <c‘>re Good comer house - 

2 reception 4 bedrooms. ^ Professional rooms. 

taroLC ard gard n also Branch Surgerv premises. Appl% U/l/i full POrli 
Both may be rented on lease Premium — ' ' 

If sears purchase — No IHn 

NORTH STAFFS— \er> old<siabli hed better 

% orLinc and mddl <Iass PRACTICE Cash receipts last scar £2,-31 Parel 
I St-o'^e as d strict deseloping EAcel! it house "2 re'^piion 4 b^room 
maid s room separat surccrv premises garage and gard n For sale Free 
ht Id Premium — Pracii*e — 1| ears purchase or rear orcr — N-» If-O 
near MANCHESTER — Aery old-established middle and ssorkifi <Ia s 
PRACTICE in pros-erous town Aerv suitab'c for two friends tn pannership 
or nus be nm bs ore nun and an Assistant Cash receipts last sear £3 3-0 
Panel 3 000 Nice modern houac 2 reception 4 bedrooms separaic Profes 
jonaJ rooms paraoc and large garden For sale at saluatton Premium — 

bestoFer— No lla7 

AtIDLANDS — Old-establishei m«ed Panel and Private PRAC- 
nl 1 distna rear large to»Ti Average cash receipts £I 067 pj 

«nel 9 0 and transferab’ appoimitients £200 p a. ExcePent detached house 
^ bedrooms Professiorul rooms ganj'^ and J rce card n Price 
purch V— No IVI7 

PD — '^cll-cstabhshed mddl and beiier ttorkin*, -class 
rKSCiiCE on outskirts of town Scope fir increase as district de clipin'* 
t-asn receipts last sear £1 471 Panel 1 COO Excellent house (built Syeara aco) 

Z 3 bedrooms ga-ace garden 3 Professional rooms i eparate 

N**^rnT £1-00 Premium — If years purchase or r''ar offer — 

MONMOI^SHIRE— Ofd-esiablished Contract PRACmCE Cash receipts 
last sear £2 114 of v.hich over £** COO 
conaimog 3 reception 4 bedrooms 
^rden Ren{£^2pa on long leas* ] 

Premium— best offer— No li— 

SOX^H COAST ^ — PARTNERSHIP (aficr prelimmarv Ass stantsbip) in old 
evtabinned good nixcd-class PRACTlCt m pte-s-m Seaport lov n A erage 
rcrtipts last 2 ears £3 100 pa Panel 1 00 and appcinimcnts £2^pa 
for great irerease Sunatfe accomm-nlat on for irrcomir" man Salary 
as Assistant £4 Op a Prcniun>— one half or ore thud share — 2 years 

purely— No 1129 

EANCS TOWN, — Aery old-established mixed Panel „nd Private PRACTICE 
I Cash receipts last year £I 37_ Panel I 9_5 Scope Good house 2 recep- 
tion - bedroems, 3 Professional rooms (separate entrance) Prcmiom— Practice 

^li ye-rs purchase— No \l I 

jNEAR Leeds —O ld-estabI shed middle and ttorkin'’<lass PRACTICE 
•Cash receipts average £l_00pa Panel 900 ExceiJeni detached house 


— Xt \MED — 
ASSISTANTS and LOCUMS 

For Immctli itc rnricnncnis 
Apph \ilh full porliculurs lo aho\ c Ufldrtss 


2 rece*'tJort 4 bedrooTS. Pnfess orui roorts (separate emra'^'e) gara/- and 
pafi,cn Pnee £1000 Afonga-c can be arrang^ni Premium— Pr* tite— 
I* ears purchase or neat offer — N> 1125 

INL.ANO SPA — Increav p mi ed Parel and Private PRACTICE Cash 
receipts last ycxf £(00 Panel .oo Good flat to rent at EO p a Pfemiurrv— 
best offer —No 1057 

MANCHESTTR— AAcIUsiahlivhed mixed Panel ..nd Pnvate PRACTICE m 
peasant s» burban dtstr<x adjj ett n new Hnusirs Esate C.,sh recci^s 
approvimatel) £1 lOO Pan I about I 000 E *xneTt rroc-rn hou*sc 2 rccep- 
iim 4 bedrooms gara-e a^J r cc parJ i For sale ormayberened Prem un 
— If vears purchase— No 111' 

SCOTljANl) —Mixed Px- 1 ard Private PRACTICL tn rva-uEtu »n& iiwr,, 
e- I of SvotfanJ Cash receipts approxirra cl> fl^-JOpa Panel 1,^0 
Ecelert house 2 rtccptiun 4 bedrsema. Profess onal rtximx para'^e and 
garden fir sale Premium— If years purchase, or r-^ar o'^cf part by 
arran'ement — No I13' 

DLRWISH/RE— O j<$tab I ‘■eJ PR aCTICE ca'^ab e f cre.it increase Cash 
reccipis last year £740 (increasm-i Pj'^el F6« F-xeel *nt hjir'e . rece^ii n 
4 tedroor s. 3 Profcssiona) rood’s (separa e entrar,ce| para-e and pood cark,-T. 
Prtr^ium— J ractice ard bouse £) 6C») — No <)b> 

NORTH LANCS— AORKSHIRf nORPER — 

I 0 d<stab u-pppos^d Ccunirv IRACTlCC m 
present h •*2$ .0 years Cash rt-eip s £| COO p,a. 
171) — - Parel and appv irtr eris app oxjma cl £4 0 p j. 

AAellbuif bouse wi h amp’ a comrr«Jat n 
j t e-u A I ■ • H c« iral heaun eictric li b parage and '•-fu'm 

lO ImAJOUiVIo of - j rev Rent £*' pm Pre‘*'ium— ..1 00 

AenuT* ret rtrg — N i|(9 

rnriffCincnlA AIANCHLSTLR — Aerv o d<stah!i\*'ed mixed 

Panel and Pnvat- PR ACTTICE Cash re cip s 
— fast ear £1519 Pa-cl 13^0 S ope Gexjd 

bouse recepti rt 4 bcdrxms, para'x and 
iry to ahoie addrtss garu,.T Ren OOpa Premium— n vears 
purchase (to ir luue debj brj''iins in £6 per 

— week) Lrgert sat owir* to illrevs of A*''uor 

— 1134 

A ORKSHIRE (AA R ) — 0!d-estab isb d mixed Panel ard Private PR ACTICE 
m betjer 'xofkirg<bsv ard rural districT Cash receipts fast vear £1 l'6 Pa el 
f 3M S ope Good bouse 2 reception 3 bedrovms maids room 3 Pro- 
fessional rooms (separate entrance) garden with tennis court Rent £-5 put 
Garace rerted Premium — 1{ vears purchase — No 1122. 
near MANf HESTTR — P ART^ERSHIP in dd-ev’ah ish*d m xcd-class 
Pj^^>cc» owin to rcucn: death of sen or partner Avera e cash rc^ciptt 
£2.446 p a fin.,.rea-sin ) Pan'-I 2,3{X) Scope for mercase Good house to 
rent . reception •. ' bedrooms, 3 Professional rooms gar- - and small garderu 
Premium— ore half sh..fc— If years pu chase — No 1114 
NORTH \' ALF,S COAST — Afiddl <Iass PR ACTICE m select Seaside ft' n 
Cash receir*s over £1 -CO pa Par l 4|S Excellent hou e 3 revep ion 

rooms 6 7 fcedr voms gance and good garden may be rented PremiuTi — 
II ?00 or near offer — No 929 

SHROPSHIRE — Old-established unopposed Couniry PRACTICE Cash 
receipts last vear £6bS Panel 4'0 Modern house 2 re-eption ^ bed oon s 
y Professional room gara™ and larv gard n LI vtnc I '•ht. Rent £^>0 r,3 
Premium— ^besi off’er — No 10a6 

MIDLAND SPA —partnership (after prel m rary Ass staimhip) in oW 
established fracti e C-sh receipts last vear £3 ~4 Panel 1 jOO Ir ommi, 
partner may choose o^n tesiden e Posv'hil i> of Hospnal appointment 
Premium— 7 xjih share— » ears pu chase —Fu rther share m three years 
—No I0f9 

ORTHAAEST LANCS — Old-esiabitshed mixed Panel ard Pnvat- PRA<2- 
TICE in l rge town Cash receipts last year il A02. Panel over A CSCO Good 
boLse pleasantl snuaied 2 reception 5 bedrooms g-rage ard small "arden 
Preimum — Pracl cc — II cars purchas- — No II0< 

NEAR MANCHESTER —PARTNERSHIP tn very oid-esiablish d middl ard 
better workmc-class PRACTICE, WITH SLCCESSION m one or in<? years 
Cash receipts t— 6<X) p a Pane' 1 h 0 Good scope Suitable accommodation 
available Prelimmarv Axsiitantship if desired Premium — 2y'ih share— 
2 cars purchase — No llOS 

LrAERPOOL — Steadilv iraeasin*' rnixed-dass PRACTICE in suburbs Cash 
receipts la t vear £7aS Panel 6'0 ExceLcrt deiwch^ bouse 2 rec-ption 6 
bedrooms enrage and carden Preirium — Practice — b^st offer — No 10^6 


/All Communications 


to be addressed to the Branch Manager BRITISH ^ EDICAL BUREAU 33 CROSS STREET ?1ANCHEST£R 2 






THE BRITISH MEDICAL JOURNAL 


Jun 16 UlS; 



Pcdital 

' (The SCHOLASTIC, CLERICAL i. MEDICAL ASSOCIATION LTD ) Ct 

(rouNoro 18S0) ^ I 


Tele Address 

Triform, Westcent — ^London 


TAVISTOCK HOUSE SOUTH 
TAVISTOCK SQUARE, W C 1 


Telephone Euston/'*’'* 
161) 


The Association has long been fasoiirabi) known to the members of the Medical Profession as a ihoronnl.K 
triistworth> and successful agency for the tiansaction of ever> description of Medical, Scholastic and Acennn .rnp 
business, and the BRITISH MEDICAL ASSOCIATION has every confidence in recommending urS, her, 
to consult The Manager in all transactions lequiring the sersices of a Medical Agent 

Members of the British Medical Association may take ndsniitage of a reduced scale of c imrgos applicable 

REDUCTION IN FEES 

In cases where the Buieau aie sole Agents the commission in 
lespect of any sale of goodwill, book debts, furniture diugs, 
fittings and other effects (excluding sales of any freehold oi lease 
hold piopeity, or of practlees, effects, etc, outside Gieat Biitain) 

IS limited to a maximum fee of Fifty Pounds 

FULL TERMS ON APPLICATION 


Practices and Partnerships for Disposal 

1 LONDON, E C —PARTNERSHIP (with good 

scope for private practice in a speciality) in Practice mostly 
derived from valuable ippointnients Sliaie of £800 to £1,000 
at first at two >cais’ purchase Partner mubt possess the 
MD orMRCP oi IRCS and preferably have City 
connections 

2 S WALES COUNTY TOWN —PARTNER- 
SHIP in Practice, £2,800 pa Pmel over 1,000 Visits 5/ 
to £1 Is , medicine extn One half since on icasonabic terms 
Partner must hold F R C S Eng Hospital and excellent 
oppoitunity for surgical scope and -appointment on staff 
Preliminary Assistantship 

3 W OF ENGLAND— PARTNERSHIP in Prac- 
tice about £4,500 p i , in small town Ptnel 1 750 Choice 
of two houses One third shire at two ycirs ptiicliise 
Partner aged about 30, vvlio has held hospit it appointments 
Preliminary Assistantship 

4 ESSEX (Borders of Eppmg Forest) — PARTNER- 
SHIP in steadily increising Pnctice ovci £3,600 pa in 
glowing lesidential district Panel 1,700 House obtain ibit 
One fourth share at two ycais purcliase Cottage hospital 
Scope for anaesthetics 

5 KENT — Upper middle class PRACTICE tn grow- 
ing residential district Receipts, 1937 £652 Small pincl 
Modem well planned doiible-ironted Tudoi house foi sale 
01 rent Scope Premium one and a h ilf years purchase 

6 SE COAST— PARTNERSHIP m non dispens- 
ing Piactice about £4,500 p a Panel 1 400 One hfth oi one 
fourth sliaie at two years’ purchase Picliminaiy Assistant 
ship Scotsman preferred 

7 LONDON, N 12 — Middle class tncieasing PRAC- 
TICE in growing district Receipts pastycir, £420 Panel 163 
Modern labour saving house for s lie or rent Premium £630 

8 S WALES — (Contract and small private panel 
PRACTICE, over £1,900 p a , in industrial district Panel ovei 
2,100 House with surgery premises to lent Premium £3 500 

9S COAST HEALTH RESORT— OPHTHALMIC 

PRACTICE Receipts, 1958, £1,600 House to rent Un 
limited scope Piemium one years purchise 

10 LONDON, SW— ELECTRO-THERA- 
PEUTICAL PRACTICE Receipts 1937, £1 727 Lirgccon 
suiting room and treatment room to rent Premium £1 600, 
plus appaiatus valued about £750 

11 LONDON, N— LOCK-UP PRACTICE, £390 

pa lull by medical woman Panel 527 Rent at surgery 
25/ weekly Good scope Premium If years purUiasc 

12 S COAST HEALTH RESORT— Non-dispens- 
ing PRACTICE £1,250 pa No panel but ample scope 
(Commodious house for sale Premium £2 500 

13 DEATH VACANCY —ESSEX SUBURB — 
Receipts average £989 pa Pinel 753 Well situated house 
for salt. Scope 

14 N WALES — Popular seaside resort Good class 
chiefly non dispensing PRACl ICE averaging £870 p a 
No panel Excellently situated detiched residence for sale 
Good scope Piemium 5wo years purchase 

15 LONDON, E— Cash and panel PRACTICE 
averaging £2 800 p a Panel 4 300 House (5 bedrooms) 
Rent £156 pa Scope Premium (wo and a half vears 
purchase to include drugs etc 


Full Particiilurs sent free 

16 W MIDLANDS— PARTNERSHIP in Practice, 
avenging £6,000 p i , in maiket town Piiicl 3 500 One 
sixth share at fust il two yens purchise Incoming parmcr 
should be aged 28/30, and able to do general surgery and 
minor EN ind T vvoik Hospital Preliminary Assist inlship 

17 N MIDLANDS— PRACTICE in residential 
distiict near piogiessive town Receipts 1937, £770 Pmel 
about 100 Choice of two houses lor sale Good seopc 
Premium £1 000 

18 S OF ENGLAND -Well-established SANA 
TORIUM for the open iii tiealnicnt Receipts at present 
at rale of about £3,000 pa Premium £1,000, to incInJe 
furniture etc 

19 MIDLANDS— Middle and upper class non 
dispensing PRACTICE, about £1,200 p a , in piospcrmis lonn 
No panel House could be obtained Modcnic premium 

20 LONDON, SE— PRACTICE, averaging £800 

p a , in populous suburb Pmel 800 Detached double fronted 
house Price of Ic isehold £1,250 Scope Premium £ 1, 7'0 

21 FRENCH RIVIERA —Old established PRAC 
TICE M D essential Vendor at present in I ngland 

22 SW ENGLAND —Country PRACTICE, ova 

£1,400, m beautiful put Pmel about 1,100 

nice modern house standing in own grounds for sale tliimin? 
and shooting Scope Premium two years purchase 

23 EASTERN COUNTIES —THIRD PARTNK 

required m Practice, £5,200 p i in mirkct town wilin' 

90 miles of London Panel over 4 000 House lo m 
One fifth or one fourth share two years’ purchase 

24 CENTRAL LONDON PRACTICE —Better class 
part at comfortable West End family fiat £ , wJif 
branch 10 minutes distant Both incicasing ”5'icl i n 
Receipts past ye ir £1,698 (average £1,460) 2 years puis 

25 SE COAST— PARTNERSHIP m 

averaging £4,100 p a , in growing resort Panel 1 350 
house (4 bedrooms), to icnt One fifth slnrc nt first 

26'consuiting Ear, Nose and Throat 

in iiidustriil city Receipts iveragc £1 350 p i bp ',tj 
iDpomlmcnts worth iboul £850 pa) I, 3 K 

house to rent Purchiscr should hold ERCS an 
specialist experience Premium two ycirs purchise 

27 KENT— PRACTICE m developing disirici , 

12 nulcs from London Receipts past year over £ I < 
about 465 House (3 bedrooms) to rent Ample wi, 
Premium £750 to include drugs clc rmArTlCF 

28 BIRMINGHAM —Medical Woman s PRAU 
aveiaging £1,269 pa Panel nearly 900 ^"od hou 
garage and garden Price £500 leasehold Scope 

one and three quarter years purchase „„inc 

29 S AFRICA -PARTNERSHIP >n i 

Practice in N ital Share worth about £1 800 p a at ) ^ ^ j- 
purchasc Applicant should be competent surge 

fcrably an FRCS t „i r.rniind — 

30 WEST END, near Lords Cricket Groi^n^^^^ i 

PRACTICE averaging about £1,900 pa rcie ( 

part Panel about 1 500 with prospccis jrf 

Well built dctaclied double fronicd liousc "'m I 

nice sized garden Good iniroduclion Premium i 



iuL\ 16 ig'-^ 


THE bRITISH MEDICAL JOURNAL 


(The scholastic CI I RICAI CMLOICM ASSOCIATION I TO) 


Tele \ddrc<*s 

Triform A\eslccnt — london 


(The scholastic CIIRICAI a AILOICAI ASSOCIATION I TO) 

a ovNMn t 

Jress Tuisrociv IIOL’SI: soLTir 

cnt-Tond«n TUIhTOLIv SQL UtP ^^C1 


Telephone Euston j 

* I IWo 


I nctitcs and 1 arlnerNliips for ni**po*»al (continued) 


31 S W OF ENGLAND —PARTNERSHIP in mixed 
counirv lown Praciicc o\cr £6t00 P\nd 4 ^00 Share worth 
ii 200 al twb Near;* puruhiM. PrclirrunaiA A’iM'itant hip 

32 W MIDLANDS— PARTNERSHIP m non dis 

pensing Practice about £t 7^0 pj in counts town Mouse 
10 rent One fourth share at two >car’A purchase Aped about 
^0 with FRCS preferred Prclimimrj AsM^tant hip 

33 MIDDLESEX —PARTNERSHIP in steadily 
increasing town Practice about 12 000 pj Panel 1 SCO 
House to rent Premium one h ill share two scars purtha c 
Applicant should be Enclish or Stotiish 

34 SURREY —Medical Womans PRACTICE o\cr 

£ 00 p^ in outlsinc suburban district Panel PO Mouse 
for sale or rent Scope Premium £300 
3^ S AFRICA — Medical W'oman holding D O M S 
required in Ophlhclmic 1 riLitce f-xpcricnccd in operatise 
ssork and not oser 40 preferred SHARC. about £l 000 offered 
after ASSISTANTSHIP 

36 SUSSEX— PARTNERSHIP in good class Prac 
lice ncarls £3 000 m fasouiitc m r£et town land about 
1 200 House to rent Share of £1 000 at two >tJrs purchase 
PrchtTL>nar. Assisuniship 

37 S COAST— PARTNERSHIP in Practice o\cr 

£6 000 pa in seaside resort Pan 1 iboui 2 CK>0 Semi detached 
house (5 bedrooms) for sale or rcri P cmium one hilf share 
£ 000 Excellent hospital and scope for surcer> 

38 MIDLANDS— Ccunirv PRACTICE o\er £I 300 

pa m hunting district Panel M6 Good hou c (S bed 
rooms) garage and good carden Mam water and dcctricilv 
Pn e £! *i00 freehold Premium l so ^ears purchase 

39 NE ENGLAND— PARTNERSHIP in non panel 

Practice doing about £6 000 in one of the chcil towns 
Hou e asaLble One sixth slnrc at ts o scars purchase 
Partner should be surgicalis inclined 

40 LONDON SB 1 —PRACTICE jboiii £I 150 pa 
m populous district Panel 1 800 Corner hou c Kent 
£10^ pa Scope Premium tsso jears purchase 

41 S COAST HEALTH RESORT —PARTNER 

SHIP in Practice about £1 ^00 p a Panel oicr I ICO House to 
rent Premuni two-fifths sh re £1 ;so to include drucs clc 

42 N OF ENGLAND INLAND SPA —PARTNER 

SHIP in Practice about £1 900 p n Panel 1 200 Eicclkni 
house for sale Premium one half share £1 800 

43 S COAST — PARTNERSHIP in non dispensing 
Practice oser £5 600 pa in health resort Panel about t-00 
Share worth about £900 at two >cars purchase 


44 S OF ENGLAND — EasiK worked PRACTICE 

ibout £l 000 pa in Caihcdrif uiiy (clubs worth about IK-O 
and nine! I 0(<) Hou c ((» bud and dre sin^. room ) for Ssilc 
or rent Premium one and a half sears purchase 

45 WEST END OF LONDON -Good-chss non 
dt rinsing PRACTICE iboul £l 1^0 No p^ncl Layg'- 
house to rent Premium lease and praan-c £3(X>0 

^6 BUCKS —PRACTICE in growing town Receipts 
hst \car £894 PincI iboul 790 House for sale Well 
equipped hospital Premium £1 

47 LONDON W' 6 — Non dispensing PRACTICE, 
£1000p-a PlcCis,int suburb No panci Mouse t^ bedroom i 
garigc ind girden Premium hou c and pracliLC £2 ^00 

48 ESSEX — Counlrx PRACTICE about £700 pa 

Pint! about Very good hou c bedrooms) giripc md 

garden Rent £6S pa Premium £10^0 

49 LONDON S W' —Medical W'oman s PRACTICE 

about £960 p^ in oulljing suburb No panel Suitable, 
accommod ition asaibblc I remium £9^0 

50 SURREY — Medical W^oman s PRACTICE about 
£^00 m dcNUopinp disina No panel Rem of hou c 1100 
P a Scops premium £^00 

51 SMALL RADIOLOGICAL PRACTICE m 

provincia) town Good opporiumts for soung ,.blc m n 
Premium £1 600 to include modem phni (> Juc about £1 100) 

52 PARTNERSHIP in increasing Ear Nose and 

Throat Pnuics m provincial town P inner mu t ho d f R C S 

53 MIDDLESEX— FOURTH PARTNER required 
m Pricucc over £7(00 pj in residential district on the 
Thames Panel 1 (>00 Mouse (5 bedrooms) to rent Scopt 
Premium b'^Oths share £3 100 

54 LONDON N W' —PARTNERSHIP m Practice 
avcrvgmg about £5 200 p a Panel about < 000 Maisonette 
(2 bedrooms clc ) to rent One fifth share at first at two 
vears puTuhasc 

55 NE COAST — Middle and belter worling class 
PRACTICr over £l 1^0 pj in seaport town No pincl 
Pnvale residence for salt Premium £7‘'0 to inclide furnish 
mgs etc of consulting rooms 

56 LONDON W 9— PRACTICE doing between 
£900i£9‘=0 in tCNidcniial disinct Panel about (-0 but 
plcniv of scope Rem of maison..ilc (4 bedrooms) £200 p a 
Premium £1 ciOO or offer 

COLONIES— Number of Colonial PRACTICES 

Incomes range from about £7'0 p.a upwards 


Purchasers can raise additional capital for the purchase of approved practices or shares 
Particulars will be forwarded on application 


All communication’s to be addressed to The "Manager 


w M scoBt SCOTTISH BRANCH, 21, Alva Street, Edinburgh, 2 r/ 

FOR DISrOS'VL. I E E OF SCOTLAND — Countrj town 


Tr!f phene 
J nh gh 1969 


A SCOTLAND — Old established Cit> PRAC 

^-400 Panel 2 500 House 
pnee £900 Premium two jears purchase or near ofler 

Berkshire— C ountry practice Receipts 

r Excellent house with garage Price £I 200 

freehold Premium one and three quarter years purchase 

C E OF SCOTLAND — Manufacturing town Re 
wipts about £I 250 Panell 250 Aunclivc house pri''c£1500 
Premium one and three quarter vears purch-se or near offer 

D EDINBURGH —DEATH VACANCY —PRAC- 
TICE avenging £635 Ample scope for prhatc and panel 
Excellent house for sale Any reasonable offer 


E E OF SCOTLAND — Country town Receipts 
Iasi year £6S5 (appointments £112 panel 565) Excellent 
house with garage and garden Price £1 450 Premium £1 000 
F N OF SCOTLAND— Country PRACTICE 
Long cslabhshed Receipts approximately £1 000 Panel 275 
G WALES— PARTNERSHIP in country town 
Receipts £1 200 Panel over 1 000 Suitable house Price 
£800 One half share al one year s purchase 
H EDINBURGH —PRACTICE doing £4oO House 
must b'* bought Premium practice and house £1 650 
I EDINBURGH — PRACTICE averaging £1022 
Pane’ 805 Pnee of house £1 "'OO might let on Ica^e Premium 
one and three quarter years purcha e or near offer 

K EDINBURGH —PRACTICE about £400 Suit 

able house lo rent Reasonable offer considered 


For further details apply The Manager 21 AUa Street Edinburgh 

Terms on which the business of the Branch is transacted will be submitted on a'^plication to the Branch 
XIanager to whom all communications should be addressed 

REUABI^ EOCUMS and ASSISTANTS are URGENTLY REQUIRED by ALL OFFICES of the BUREAU 




the BRITISH MEDICAL JOURNAL 


1(5 1011} 


PERCIVAL TURNER LTD 

MEDICAl AGENCY 


Established 60 Years 


25, MAIDEN 

Tcff-smin, “ nPSOMiaiV, t.OTiDON" 


LANE, STRAND, LONDON, W.C. 2 

(COKMu or nrobonn siiilet) 

Tiltnhmus Tl MI'IL ItAlt 9011 (■} W.i 

Dlrr iilhri /iiiiiri, E nt(„n „„ T*oi„e> ( (' 

' «„ar, 


PRACTICES & PARTNERSHIPS FOR DISPOSAL 


3 NORT3-3ANT5 — Counffy r3?AC?/CC otif cbt \ cndor rctinnc About 
£1 600 pi ind pine) ^sonh £910 Pi 4 Anpt'* Nice house for v'jic 
Premium \\ >ciis pviTChisc 

2 HYDE PARK NEAR —Pm SICO THERAPV PRACTICE ibom £1 600 
pa N\ cR csit good ctiss Amp\c iccommodiuon on itiuil Premium 
il 500 

3 LANCS TOWN — Oldest incrcisinp £1 100 pi Sdcct nind of 1000 
Nice house implc \ccommod \iion Premium £l mcl Urups ind 
surqcr) furniture 

4 KEN1 SUBURB — Good middle chss nbout £700 n i increisinp velcci 
pincJ Msus 7/6 up MirRcrj 5f Niee Judor”homc for sdc mldn 
let Premium H >cirs purchnsc 

5 SOUTH CO \S/ -^Old cst iflisljtd ncarh £1400 pn incfeising Pair 
pinct nu^Lcl mulel c lad bcUer clis^ Niec detjiched house vmpic iccom 
modition girdcn inJ Rinpc for silc or might let Premuim l’ ^00 

6 COUNTY TOWN wtihm 100 miles of London —PARTNERSHIP with 
cirjv succession m ENT Pr ctico ibjut £( Hd pi md \ppomimems 
£8^0 pi 2 >eirs purch ISC I urch iscr should hitc TtiCS Choice of 
house 

7 DEVON '—Unopposed country oicr £1/00 na incrcisme pine! worth 
£160 pi Apromimenls £60 pi Premium Cl 8^0 r>:ecl{eni freehold 
house ample iccommodMion g trden ind e inge for sale £2 **00 Mon 
Rige irnnecd Prenmim £1 s^O 

IJ!U^^1NGH^M NEAR — Well established neirl> £800 pi increising 
good scope panel nearU 800 developing irea Compact house ttirdcn 
mtl Range for silc it or let it 27s (d pw Premium £l ^00 

9 HANTS*— -Old csnblishcd ivcnce £1 000 p i J'lncl 1 000 Appointments 
ibout £b0 po Good fimil) house nice garden md tinge to be sold 
substantial mortgage irnngcd Premium 11 jcitb purchase 

10 CONTINENTAL PRACTICE '-Atinctuc report old cstibbshed good 
$cobc M D essential 

U ^ORKSHIRX DALES —Bciutiful countrv old csdbh lied 'i\cnsic £l OCO 
'pa Large house ind grounds rcmil onh £60 pi Suit rcMdeut pittents 
Smtllct house iviiUblc I uicl worth £340 pi Premium £l 

12 NEAR VICTORIA S W 1 — Lock up about £800 pi inerciNing pihcl 
X80 good scope AmpR profcssionil vccommodition on rvniil it £70 pa 
Resident housekeeper Premium H jeirs puaftiic 

n MIDDLLSEX SUBURB — partnership Half Shire Of increasing Pne 
ticc producing ibout 12 000 pi Pinsl GOO dc'Uopiuk irci Choice of 
house Premium 2 >cirs purchase 

14 MIDLANDS —Old csliblished ncir importini town scope Vendor re 

linng About £6^0 pi Pine! 710 2 ippomtmcntsr £101 pi fremuim 

2 ycirj, putchnst House :> reception 6 Vsedroom'r sepmte swrverv ' 
entnnee good girdcn girige ind ouibuiIdlnRb for silc or might let ^ 

15 GUILDEORD — Ncirl> £700 pi fist disclopms Rcmd scope mere is ] 
mg pine! of 230 Compici house m good position on rcntil it £70 p i ' 

16 LONDON W 2 — Old cstibhsbcd iscragc £l 900 p a pinO I 100 with 
middle md better class Nice house with inipR living iccommod uion 
also professional on Rise Premium U >cirs purv-hisc 

17 LONDON N E— partnership hUf shire with cirli succession £1460 
pa Panel 2 100 implc scope Compici house on rent it £4s pi Pre- 
mium 2 ycirs purchiic 

19 LONDON N 12 — Over £s00 p i Increasing and scope Pmcl Tecs 
5/ to 10/f Conicnient home in excellent position to let Prcnmim 2 
years purchise 

19 SCOTLAND (N )—Couniri over £1 000 na induding pmcl of £i00 
pa Visits 5/ to £8 8s Vendor retiring Good house for •'tit or rtonl 
Veemutm H Kirs purtlnst or o1T».r 

20 KENT COAST TOWN —PART NERSHIP one third oc hiff shire fc 
ccipis £1680 pi Pint! over 2 000 Good house on wnivl u C8S pi 
Premium 2 scirs purthibe 

21 MIDDLESEX SUBURB— £V 0 0 pi piwcl (00 PMS ClOO pi 
dLitloping rcsidcntnl irti Compict modtrn houbt girden md gingc 
for sjIl It £1 -800 or mi£ht M Pctmmnt 2 Kir> purthisc 

22 Lidv Doctors PRACTICE London SW 6— Lockup £4v8 p^ncl 

800 Good proftssionil ictommodaiion on rent il it l^o p i Pnitmim 
n >cirs purclnst. 

21 L'vd’> Doctor s PRACTICE London t 12 — £1 400/£l 8oft p i ! mcl i 0 
muxed working ind middle cliss UcHcmupPtd living and profevsiomi 
acsommoditton on Rise it £s0 pi Ircmium U >cirs pur hist 

21 LONDON W 12 —Av tragi, ibout £800 pi ScRct panel of SCO Good 
bsopc \ endor gives only part time Nice Iioum. on mun roid for mIc 
or rcnlil Premium 2 >cirs purchisi. 

28 NUCLEUS N 12 — Dcvclopms Tcsiiknlial ma £4''0 M ^ f mcl IfO 
scops Nice double fronted house for silc or Jet Premium £7so 

26 JAMAICA B \\ I — P IRTNERSHlP JnJf sfnrt iftcc ( months \ssi t nt 
ship Income £2 000 pi Smgiwil experience in id\antigc Choice of 
house Premium 2 vcirs purchise 


2? Nor I HERN TOW N —Old established muldlc-cl is«; non mncl nf'ii'O *' 
inq ivcrigt £I MS PI good scope better chss I RACHCF Nichs 
► reception 4 bedrooms ind ittics gingc etc Ui be soM (or £1 
Premium £2 ono 

29 KENT under 20 mile's from I ontlon — Counlrv PUACriCi: aK> t 
ni Pmcl 175 cislJj worked cope Nice house ind girilcn Itu 
nr let Jremium £7so or ncir oiTtf 

-9 CROT DON — Smill jncrcisjng PU \CT1CE m tliicXh pipiiliirJ > j 
£ 6s0 Pi Inercistng pinel of 400 '‘Conipicl home on nnin maJiah 
icl It £104 pi Ptcniium £s80 or near offer 

10 SURRET SUBURB NEAR I ON DON — W elf cst int! incri-wm mb 
dgscloomi, suburb oosv about CMIO pa panel over (00 vncTCwm v 
modern compici house v\iih profcssionil rooms r irdcn ind eirai RfU 
ibj pn ) remuim £1 "’so or oiTtr 

1 IONDDN W'— DNETHIRD share inihWe in oWet \ Kar 
siijung md G P Jncpco Receipts n'crigc £1 1*00 pi D M 11 L picfcn -1 

12 London W ncir Mirblc \tch —better cliss npn vSi pcnsin? neara ’ 

1 R \CTJCC Old esi ivenpe £1 *'66 P i Premmin £l 780 or near t i 
Nice house with ample accommoefatton for sale 

11 Devon nucleus— A bout £400 pi bciuuriil coimtrv parsl f't 
encouriged Nice house 4 rooms on Rroiind door 8 b droonu laa 
oil rtniii It £68 pa Premmnt iUO to include litiincs etc 

14 London W' 6 — -Old-csiibUshcd middle ind bcUcr-ch s non panel rRw 
IICE avenging £809 pa Nice rf!»)dep)n) district Dciachcd 1* ^ 
leecpiion 8 bedrooms tisml ofJiees cbnstiUlng and wimns tixni <« "* 
md Ritipe for sale at £2 000 Premium tor Prtcnce £1 iHXt 

18 London SWI^— .WenestibhMicd inert tsine iit nuc rcsiJcntiil i t 

Ibout £850 \t pre‘:cnt Pmcl 400fs00 Chib £ 00 na Ample In t J ^ 
rrofevsioml icommodmion on rental nt £78 p a Premuim El Wet 
oner . 

16 lONDON SE 20 —Oldest middle md better ehss 

mcreiMne fociht) ni present £700/£80f> p a PincJ 3 0 Bsta 1*V r 

r. «>. trtf «!(• tAU Of 


37 


19 


reception rooms 6 bedrooms consuhma room etc for sale tAxt ec* 
It £x0 p i» Premium H icirs purchase 
SOUTH Wales— Par (NCRSH fP fntf Vlnrc seistde mKft Y 
£1 204 panel 2 100 Anrolnimcnts fccnior pirincr rcurmg T ' i- v 
facing SCI 1 reception 8 bedrooms usual olliecs itrcs of RttJ a ' 
court ginge etc for sale o reiitil Premium lor hall share t 
purchase 


HaNIS— C oimin rHACTlCE ncricc^ ilMWl C4tK) r ■> UntllJ’'*"' 
2 reel piioti 4 bedrooms consiilung waiuns tv^'m * 


Tor salt, or let at £ 8 p a 

'-Scml-coumrs rcccmis EJOO * 
bedrooms usual olTiicv ^ 

RiriRv to be let or sold nen 


Nice house 

pensoTN I acre of garden gangc 
£.00 

39 SURREV 18 miles Irom Town 
nice house 2 rcccpiion room*» s 
wVicinc room 1 acre of garden 

Practice £400 , .s 

•lO LONDON S E fi — rut incrcTiittB tlcvcIopInR irea """'’W" ' ' ', 
£7<0 PI pmcl f.50 inctciMrrs Ample icconw oiliii' n i n w”' > 
pi Rnneh ‘iurgen In ihivkl> popnliicd Pirt rremtuu 1 
drugs book debtx and fittings 

51 NOni—PARtNCRSlIlP ilnru prPiIiicmB iW pi I" 

rural Pnchce mixed w«h panel of 900 nnil n t *' 

co«nif> surroundings nice compact house on rental ttcri 
pwrthisc Suit lad> prietilioner i t e i 

42 GLAMORG \N —Small increasing iRAaiCF ^^ar . 

pa Rrowmf panel over 8(1 Nice house wiih nrr’rc‘'su>tui » 
good girden lo be sold loi tl 88f\ Iccituum I't • 
purchase I , ,-v i 

J1 MIDDLESEX SUBURB —P \KTNI KSIUP half 'hate ^ 

IRVCTICE in developing subiub Receipts CKOd pi ^ 

of E Ol) pa Panel 2 200 Smnblc muse ivaihUc 
Irtmium 2 \cars purchase m ns 

44 LINCS COVSl 1 OW N — W ell estabh hed j.vcnec 

l.aO p a Large Slop detached liinisc 2 nun /^om sci f -> 

room usual ofiiees girden and garage for 'Uc 
for Practice f 480 xrfKf ' 

LONDON W' —Old estabh hed non panel mtved ‘ *8 '^' <5 r 

reimng Av £2 200 p a \ppolninietU 

kiilrnrr 1 ro«<iilunt' TOOnis 3 rCCCPUOn aU , . 


45 


46 


Corner residence 2 consuliing rooms 3 reception an 

garage Leasehold 16 ^ear to run frenuum - > , P 

DCPR'lSHlHL-OW miWpIkO " j v o '' 

now pi p.nrtHf Appi L-onpi ' 

und 6 PcdrOPlPi consuipnc >nJ Pillini. roon p f-, - f i 

1 ac'v Milh icnnii court ind kincc 1 rcttnid 

tree H 'car purklii'c PR rift ' 

CORNW ALL — Old C'taWi'licd iinoppo'cd cminio > 

Wll PI li't'carnou l.ncl'M) ^ fr 1 

small 8 bedrooms etc surgefv wiitmc roem di pc 
ffcmmm 2 >cars purchise 


ill lA'y OTUmS NOT ADVhRTISfJ) 


W'V.NTED — rurchasers iiaitiiijr for' I KACTICES in all 
partij Incomes from £"50 upwards 


ASSISTASTS ATiD I OCUM TESES 
VAO’VJ'CtES in Town and Countrj 


^ ff 

I ill on npr 


.nU'75 



JuL\ 16 19'<S 


THE BRITISH ^lEDlCAL JOURNAL 


6'< 


BOVRIL MEDICAL AGENCY, LTD. 

ALDINC HOUSE, 

10 1"? BCDEORD STREET, STR VND LO^DO^ Vi C 2 

Tcleirnms B0\"^1EDIC\L, LrSQTjAHE LONDON Telephone TEMPI E B \R IGIG (3 Lines) 

Chairman and 'MamKinir Dlreelor Dr I ITELD IIALI 

The maximum commission pa, able on the sale of an, Praeliee or Partnership in Great Britain placed exclnsi,el 5 
in the hands of this ■\Kenc, is £o0 (fift, pounds) „hich sum co,crs good,. Hi druijs siirser, fittings fixtures and 
furniture instruments and boolr debts lint not liouse propert. Schedule of Terms ,,ill be fom-arded on application 


Accountant;, and Icgat sctmccs {timtshtd t, the Agenc, v.h«c desired at moderate inclusive charges 
No charge is made to Principals for the introduction of I ocum Tenens or Assistants 


1 SUSSEX —PVRTN'ERSHtP sith rrclimiiuo a ii amihip in ei-rro nail, 
gx>d m\cd cliss France Share t' < about £1000 pa Hou^c on 

rertal Pajr‘e’'i by arraneerrert to suitable applicant 

2. S \\ ENGLAND —FAN OURITE CO \ST TOW'N — M \LF SH \RE after 
preliminarv as Ltantship in chieflN beticr-class Practice proilucin? ncafl% 
£2,000p3 Sr~3!l panel Choire of resrden'e Must be espenenced and 
preferablj Lroviledeeof E-NT Frrm um . sears purchase pirt b) arranpe 
mert 

^ NORTHANTS— Old-cstabhshed C^unir^ PR NCTICE aseraemp £1 601 p a 
Panel of 1,500 Practicalb unopposed Premtum 1 1 sears purchase L mt. 
partr-rsh p trtroduction 

M LONDON S E— N\en-e?tab!nhed PRNCTlCr chiefls cash Receipts 
a cracc about £1 0 0 p.a., uiih panel and club prf'ducinc o cr £-00 pji 
Can be run as a led. up Suitab c premises availab’e Premium 2 >ears 

purchase 

^ LONDON— western district— NEW EST \TE —Established about 
12 months. Receipts £500 p.a. Panel of 600 P M S 30 patients Tcm 
porars accomrpodatKin Purchaser can build own house It is belioed there 
xs crrsiderable scope for increase 

6 LONDON SW — residential DISTRICT — Good rudd!e<lass 
PRACTICE produans about ll *.00 pot including panel of NX) patients and 
appointment worth about L.00 House on rental Good sc pe for enerpetiu 
ssorkerv/ Prertnum 2 >ears purchase or near ofTer 

7 SURREY — Well-established irKreasing PRACTICE situated m dese! ping 
residential district. Gross cash receipts for last 12 months about £900 
iTcludine panel of about ^00 Snail compact freehold house Pnee £S'0 
part on noneace or would rent at iS5 p a. Premium £I ^00 Ample scope 
for energetic wotVtr 

E GROWING RESIDENTIAL Dl^lCT WITHIN 10 MILES OF 
LONDON — Recemb established upper and mtddle<lass PRACTICE 
producir" about f-QO p a with definite scope for increase Selected par-l 
of 72. Fees 5 upwards. Prominent comer house mth 2 reception 5 ted 
rooms Separate entrance to Pro''«stona( rooms. NNel' laid out garden 
House on rental Premium IJ jeafs pur base 

9 SURREY— partnership— ONE HALF SHARE m deseU pm- middle* 
and better worl.inc<lass Practi*e »n fasounte residential hospital town 
Gross cash receipts for last 12 months £1 860 Parel of *00 Low e\pen«es 
Well built house with 2 reception 4 bedroorcs etc. Rent £100 pj Inpomg 
ranner should be etpenerced aced 25—0 ard able to do some soreer> 
Premium Ij \cars purchase for cuicV. j!e 

10 WITHIN 6 MILES WEST OF CHARING CROSS —Sen sound old-estab- 
l*shcd PRACTICE in good res dentia! district produ in«. over £1-00 pa 
Paosel of 1,-30 \eT> nice house tn rTomment position with all modem 
conveniences on rental Definite s-ope for ircreas- Suitab’e for two friends 

]] 


I cts «ium a b Deta bed house m own grounds with ample a commodattoti 
Ren £1*0 pa. Premium £ 000 

SW —WITHIN easy REACH OF cm ANDWESTEND — 
Well-established chieflv middle and better-class PR \CTICE with surgical 
^ope prodLcm-* about £1 4*0 p a Selected pane! of -* Fees 5 ard 7 6 
Good sized first floor fiat with all conveni nccs Purchaser should be able to 
do surger> ard FRC.S would be advart-ecous 

LONDON W C — W ell-estabUsh d PR NCI ICE produ in'* ncarl £1 “00 pa 
Average £1 -60 Panel of 1 660 Suitable accommodation available and 
surgerv premises used as lock up on rental Premum 2 >ears purchase 

14 LONDON ESTERN DISTRICT -Old-established ron-dispensmg non 
panel PRACTICE producing about £800 p a Capabl- of expansion 
e^pwiaJi^ if panel work undertaken. NNell situated comer house on mam 

would 

15 

do-mg 

unable 

works 


fN'^” O -established 

£400 fr m 
I 0 cases p a 
puiciLisc or would take £2,000 


doctor S PRACTirp _ nin 

Practice producing last 

pane! Fees 5 upwards. N 
Suirable house availab e „ ll s<ji 

in ^ “’c 

,<^QAST— FAN OURITE SEASIDE RESORT —Old-established 
ratiem?^\ producing about £670 p a Small panel 200 

i^n PrJ’K 1? town with ample accommoda 

armv Premium £1 200 Emineml> suitable for retired 

IK wishing to augment pension or there is scooe for joungcr man 

A' OURITE coast tows —OM-C labl.jhed PRACTICE 

®bout £500 p a trcludiog panel which brings in about £I*0pa 
“Oi^ on I VO floors, 2 reception 4 bedrooms et Freehold for sale 
“ >cars purchase wiih income guaranteed for first >ear 
COAST SEAPORT— PARTNERSHIP— ONE THIRD SHARE 
avmiaDie in old-established and niptdl> increasing Practice which last ear 
produced appro\imatcl> £3 3SS includin a panel of over I 600 patients 
rurchaser can choose hts own residence Practice is conducted from central 
expenses are not high 

LADt DOCTOR S PRACTICE — Several available Full details on 
application 

\ /-xn-r-x wivVi Nitw to PaTtswTsVnp m asv old 

good future prospects. Initial salary 
the assistant to live out Full details on 

dppi cation 


2^ MIDLNNDS — FWOURITT COUNTV TONN'N — SURGICAL 
OPLNING — V OUNRTCR SHNRC (a tcr prcl minarv avsistamvhip jf 
1 mortbsl ts oTcred m old-es abtishcd i crcavirj, Pra'^icc producing ap’T vxi 
iratel £J900pa Panel cf about 2 *0O Ore apfx irffrem w rth abc ut 

fl-J^pa Fees 5 to 0 No dis'vnsm'' Sui able house wi h garuct 
and paracc Rent £6< p a Premium 2 jears purchave pan by arrargenwrt 
Ingoing partrer shou J be under 3* etpen r^d ard able to do some surgery 

23 SOUTH or England — co nst tonn n — p nrtnership —a h nlf 

SHNRC in f vvJ m ed class Pra ti e established over 100 )eari averamn 
approxin atcl £3 000 p a^ with substantial panel Nprontmerts wonh 
aboutLJOOpj Siu ab ehou'seonrrntalai£IOOp a Premium->cars purchase 
.4 MIDDLESFN— P NRTNERSHIP— ONE H nlf SH \RE in ircrcaving 
Practice product"! arprvximatel> L^^Ono p a Farxl pf 600 ard increasin. 
Ilouvc with * reception 3 bcdft»oms etc. Rent £100 px Premium 2 jears 
purchase 

2* LONDON S C.— OId-c3iabliv»'cd chiefly midJIe-cIass PRNCTICF pro- 
du*ctn„f r laa !2 norths £1.254 p a. panel C*’ 6-^ Suitab c bouse cn rental 
Premium 2 years pu chase or near offer 
6 LADV DOCTORS PR NCTICE.— MIDDLESEX —Cbicny workirg<Iavs 
PR NCTICE csiahhvhcu 10 years and produting over £.i00 p a., including 
panel of 32. Two appointmena worth about £^0 p a rot nxrluceu m 
receipts Small house with 2 rcceniion 4 bedrxins Leasehold fer saL 
or would rent Premium 1* years purchase Vendor specializire 
27 SOUTH AFRICAN —Partnership —G ood surgical orenm- Present 
receipts about £2,000 px wiih ampi scope for expansion with aid of suitab c 
partner Full details on applicatiox 

2S souni NNHELSH const— partnership —one half share in 
old-established niJdlc and workir"-cIass Pranicc producing over £l orOpj 
Parel of 2,300 Good house with ample accomr-odatwn Large garden 
Freehold for sale Premium £3 *00 part bv arrangemenL 
29 NORTHANTS — OM-e*tafcli5^ed mtted-clas* PRACTICE producirg nearly 
£1 OOOpa Panel of I C*X3 Fees 3 6 to 10 6 De'aJ'cd house with good 
garden Freehold for sale or might rent Preniun £1 *00 
aO ESSEX —ATTR NCnV E COUNTRY DISTRICT — PARTNERSHIP- 
ONE H NLF SHARE of rld-established mixed<lass Practice producing 
approximattlv £Im.OO pj., with good jwope Panel brings n about £"00 p a 
Good house with 4 beJroomt etx Rent £50 p x Neo reawnabte premum 
for auitk saV 

31 SOUTH CORNISH COAST — Old-cstablisVd PR NCTICE produnng abou 
£900 p a in lydm panel of 342. Fees 2 6 to •- Good house with ample 
acco—n vdati >n brceholj for sal Premium £M00 
i: HOME COUNTIES— RLSlOrNTlNL TO^NN WITHIN 3Q MILES OF 
LONDON —PNRTNLRSHIP— ONE FOURTH SHNRE (wih in^rc-se 
later) is offered m well-esiahJijhed pmvd friscd<!ass Practi*e prodixirs about 
£44^00 pa I an 1 of 2.003 A"p)mtrrens worth over £3C0pa Ingoing 
partner muv: be experreixed m surperv and preferably bold Fellowship 
Irelimmary ass stantshin if wisVd I remium 2 years purchase 


33 LONDON W 9 — Ch Hy bcitef<lass PR NCTICE averaging £900 to £1 (X<0 
pa m resid rtial d sirn Panel (rcccnily s aned) about 0 bm \crv givnl 
Scope Inclusive rent of maisonctie £,.00 px Premium £1 000 or near oPer 

Vendor spccialinng 

34 SOUTH MIDLANDS— PNRTNCRSHrP — N ff NLF SHARE in old 
esiab'ishcd gcx)d<lass country PraT.ice in beautiful district Gross cash 
receipts approximate! £3 000 pa including parel of about 2 000 Nerv nice 
house wuh garden and garaee Freehold f r sa’c Very good huniin" 
shooting and other sport Premium 2 years pur base 

35 SOUTHWEST ENGLAND -FAVOURITE SEASIDE RESORT— Old 
established non-dispensing PRACTICE averasmg fo last 3 years £l fi-tO p a 
Selected panel of 400 Good house with ample a comrrouation garden and 
garage freehold £1 "00 or mi ht rent Premium £2,800 

16 SURREV — Old-established m xed-elass PRACTICF in favourite IoxjI ty 
within easy reach of London Nvcra're gross cash receipts over £1 00 px 
Panel and clubs bring in abou £650 p a Choice ot houses on rentaL 
Premium 2 years purchase 

37 WEST COAST — Old-established PRACTICE in residential and holiday 
resort Receipts for last 12 months pearly £I 900 Panel and appointments 
worth ah ut£504pa NNcIl built house with ample accommodation Free 
hold £I 100 Premium £3 300 Vendor special ung 

38 MIDDLESEX — RINERSIDF SUBURB — PARTNERSHIP — ONE 
FIFTH share (with increase later) in very sound old-established steadily 
increasing Practn.c producing for last 1- months approximately £5 000 
Pare! or3 600 Nppoiniments worth about £2“0 p x Good house on rental 
Premium 2 years purchase 

39 MIDLANDS — Old-established unopposed locreas ng PRACmCE. Receipts 

for last 1 2 months £740 Panel of -TO ,«> nice to^hod hm« 2 reoop .on 
4 bedrooms etc good garden Price freehold £I *00 £I 000 on mongage. 
Premium IJ years purchase ... 

40 SCOTLAND — UNIVERSITY CITY — Old-established non-dispensing 
PRACTICE produc ng for last 12 months o er £900 p a., including £531 
from panel and about £70 from appcinunenis. Suitable house with 2 recep- 
Uon 6 bedrooms etc Freehold for sale or might rent. Reasonable offer 

41 ENST ANGLIA —ATTRACTING COUNTRY DISTRICT -Mixed-class 
PRACTICE averaging for past 2 vears over £1,200 pa including abou 
£500 froTTi paixl P M5 ctx Good house vaih ample accommodation and 
modem conveniences, garden gara"e Freehold for sale Sport of all kind 
Premium £l 700 

A"* STAFFS — LA.RGE TOWN — Old-estabU hed PRACTICE. ptcdvicm» tor 
I si 12 months over £2,400 Panel of about 1,230 Good house with 2 re..ep- 
ton 4 bedrooms, etc garden garage Freehold for sale Premium IJ years 
purchase or near offer 


he Agencj has made arrangements for special facilities on \cr\ favourable terms to be afforded to approied pur 
hasers for the advance of part of the premium for anj suitable practice or partnership Full details on application 



64 


PUBLISHERS 


BRITISH MEDICAL JOURNAL 


Juu 16 191S 


Biilliire Tindall S. Cox 6 7 

British Medical Assocniion 

Co\cr til 

Churchill J Jl A Lid 5 

Lcnms H K ^LCo Ltd 3 6 


ASSURANCE INSURANCE 

Century Insurance SS 

Medical Defenec Union Supp i 
Medical Insurance At,cncy II 

Yorkshire Insurance Co Ltd 36 


INDEX TO ADVERTISEMENTS 

FOODS, BE\ERAGCS 


BANKS & FINANCE 

British Medical Finance Ltd 
Ccniurj Insurance Co 

London InNCslmcnt 5. Mort 
tiec Co Ltd 


Bickicpcfis Ltd 
Cow & Gate Ltd 
Genatosan Ltd 
G(ato Laboratories LtdT 
Homs Ltd 

Husband, J K L Co Ltd 
Lactatol Ltd 

Millers Mutual Association 
PoIIc\ Co I td 
Ra> ncr & Co L'td 
Robb Alex &Co Ltd 
R>vua Co Ltd 
Tn pboo Tea Ltd 
Vichj Ctlesimes 
Wander, A Ltd 


37 

32 
25 

Supp 

15 

16 
15 

33 
37 
12 
35 
23 

Supp It 
II 
2! 


FOOTWEAR. TAILORING, 
& CLOTHING 

CHrk C Id Ltd i: 


name plates, etc. 

CooLc s Ltd 
Hill F B S.Co 
Herd S J & A 
Lewis H K JLCo Ltd 
Osborne F & Co Ltd 
White Bronze Co 


TOBACCO & aCARETTES 

Du Mauricr 
W ills s Hirec C istles 


X-RA'iS & ELECTRO- 
MEDICAL 

Multitonc 

Portable \ Rnss Ltd 37 

Short A Mason Ltd 6 




Puritan Tanneries Ltd 

36 

\ iLior \ Ray Corpontion Ltd 

35 



Recent Dress Co 

37 

- 


CHEMISTS 


1 




Abbott Laboratories Ltd 
Allen & Hanburvs Ltd 

29 

31 

MOTORS & ACCESSORIES 

HOMES A INSTITUTIONS 

Bell 5. Croyden Ltd 

13 

Hcnlys n 

2 

Pices 38 39 40 41 

Bemax Sales Ltd 

33 

Hodgkinstvn CrossLy 

Ltd 34 



British Colloids Ltd 

28 

Lodge Plugs Ltd 

36 



British Drug Houses Ltd 

17 19 20 

W'ofscJey Motors Ltd 

9 



Boots Pure Drui. Co Ltd 

18 



HOUSE AGENTS 


Burroughs Wellcome ^ Co 

Cover II 



Pige 

56 

Coates & Cooper Ltd 

24 



Continental Laboratories Ltd IS 

PRINTING, TYPEWRITERS, 



Diincan Flockliarl & Co 

16 

etc 




Ell Lilly 4. Co Lid 

27 

Taylor s Typewriters 

37 



Eno J C 4.CO Ltd 

Cover IV 



HOSPITALS & CLINICS 


Evans Sons Lcschcr &. Webb 



London Chruc 


Ltd 

19 20 



43 

Fassett & Johnson Ltd 

15 



Ruthin Castle 

39 

Iron Jelloid Co Ltd 

14 

SURGICAL APPARATUS 



Kaylene Ltd 

22 

Allen &. Hanburvs Ltd 

31 



Parke Davis S. Co 

30 

Compri Vena Ltd 

37 



Peat Products Ltd 

64 

Curtts H E dL Son Ltd 

Supp III 

SANATORIA 


Prentif Ltd 

22 

Everett S ^ R J ^ Co 

Ltd 34 


Roberts & Co 

14 

Fleming A & Co 

37 

Cornish Riviera San 

42 

Saccharin Corp Ltd 

24 

Hilliard 

37 

CoTswold Sanatorium 

42 j 

Smith Marlin H Co 

21 

Paragon Razor Co 

Supp III 

Holloway Sanatorium 

42 

Valentine s Liver Extract 

Supp 11 

Roussel J Ltd 

35 

Montana Hall 

44 

Warner W R &. Co Ltd 

26 

Salt & Son Ltd 

Supp IV 1 

Mundcslcy Sanatorium 

42 


SPAS, HEALTH RESORTS 
& HYDROS 

C7ccboslo\ akia 
Bax V 

Harrogate 
Ptstan> Spa 
Smedlc> s Hidro 
Stanboroughs H>dro 
Woodhalj Spi 


4^ 

4J 

4' 

41 

44 

41 

4{ 


MEDICAL SCHOOI.S 
TUTORS, & LECTURERS 

PJee 44 41 

NURSING, etc 

Pice <5 


TRANSFER AGENTS 

Bo\ril Medical \gcnc> 
British Medical Burciu 
Medical Aqenc> Ltd 
Lee ^ Martin Ltd 
Peacock L Hadicv Ltd 
Turner Ptrcnal Ltd 
Western Mcdieal Acenej 


6^ 

fO fl 


CONTRACT PRACTICC 

Pige 

HOSPITAL VACANCIES, cU 

Pacts 46 47 48 45 '0 51 

S’ sj 57 

CLASSIFIED 

ADVERTISCMCNTS- 
(\Y nnted & Vncinl) 


Pages 


U 55 


GENERAL 

British Commer lal Gas Asw 
British Motor Boat Co , Ltd 
British Oxjgcn Co Ltd 
Frank/and L J A Co LlJ 
Hawkins A L. A Co L(J 
White H , Mfg Co Ltd 


PERSISTENT ERUPTIONS QUICKLY RELIEVED 


Because i! contains a perfectly natural antiseptic — distillates of 
peat — Sphagnol Ointment has a rapid and beneficial effect on 
shin eruptions It has a hsofold action From the first dressing 
It soothes irritation and burning sensations Then ns its anti 
septic peal distillates penetrate the local treatment cffccti\el> 
assists m general measures to clear away the toxic matter whicli 
ts the source of the trouble \Vc have on record many cases m 


avhich a decided improvement has been shown 

dayx and where before a week had c/apsed marked hen 

had resulted . 

In case you hnae had no personal experience of Sphagnol "C 
shall be pleased to send you a clinical size sample for 
if you will avrile to Peal Products (Sphagnol) Ltd Uep 
BMj9 2! Bush Lane London L C *1 


CONTAINS 
DISTILLATES 
OF PEAT 


Sphagnol 


medical soaps 

OINTMENT 
SUPPOSITORIES, ETC 


Published b) the Proprietors the British Mcdicil Assocntion lock Sqtnrc Fonclon \V C I -ind prinjed 

Limited CTstHirding St Meet St , London E C 4 Printed in Greni Unmn Entered as Second Clnss nt Ne« i orK, u r. 


JlL^ 16 1« ' 


TPt: BRITI'^H MfDlCAL JOLRN\L 


ARCHIVES OF 
DISEASE IN CHILDHOOD 

JU.\E 1938 

C 01 \TE!STS 

Intncnnnl H icmorrii ige in (he New-bom S Craig, M D , F R C P Ed 

\ itimin C Excretion in Children «ith Particnhr Reference (o Rhcunntic 
Fc\cr J D Keith, MD, nnd Eiehn M Hickmans, PhD, M Sc 
Otitis 'Media and Mastoiditis in Infincj B\ Grace McConkc\, M B , B Ch., 

B VO, D C H , and Edn ird C Ross Coiipcr, MB, Ch B , E R F P S 
Radiologs in the Diagnosis of Hapcrtrophic Pjloric Stenosis Bs I conard 
Findlas, D Sc , M D , F R C P 

The Blood Phosphorus in Egjptian Infants B\ ! V Sabri, MR CP, 

DTM and H, and M V Vbboud, M R C P , D C H 
Osteopetrosis. Br V M Nussei, MD, MR CP 

The Coolcs Ssndromc in an English Child B\ E G L B\ waters, MB, 

bs,m’rcp 

Case Report V Case of Diabetes Mellitus in a \oung Infant Bj John 
Deiine MB, Ch B 

PLBLISIIFD QLVRTERLV 

Icarh .uli^crttiUon (t nutubers) 25/ To men brr^ 20/- 
Single \nnihcr 7/6 

Ibsiied ba tie British ^ledical Association. Tasistock Sqiiaic. London. W' C I 


This cookciy hook is based on the latest scientific standaids 
Medical practitioners can particnlaily recommend it to those 
of then patients who haze to get a full pcnii)woith of food 
laliie fiom ciciy penny of then outlay 


THE DOCTORS’ 
COOKERY BOOK 

21 Menus and 82 Recipes for Family Meals 

21 PAGES OF PHOTOGRAPHS 

Pl/ELIShED ES THE BRITISH MEDICSE -SSOCI-,TIO\ 

c'ltcciirUrr, , S u h i tecin.r, aj Ct^e;-rrcl -f Selene! 

< tiK,!-nis!0&c B \I 1 Tc ,!c k S,....re Lc-Jen IT Cl 



PRICE 

4' 


tv 


THE BRITISH MEDICAL JOURNAL 


JUL\ 16 I9,s 


EQUIVALENT 
ALKALIZING VALUES 


The benefit to health v/hich so generally results from the use of 
diets consisting largely of frusts and vegetables . . may be 
attributable in part to the fact that these yield alkaline 
residues ... in the body” 

(Chemistry of Food and Nutrition } 


The following table, based on our lesearches and published data, 
demonstrates that a ceaspoonrul of Eno’s 'Fruit Salt’— an oi dinaiy 
dose— IS equal in systemic alkalizing value to relatively laige quart- i 
titles of fruit and vegetables Eno is also fai moie economical 


SUBSTANCE 

WT OF SUBSTANCE 

COST 

— — — — — 

ENO’S “ FRUIT SALT ” 

0 2 oz =1 teaspoonful 

.d 


Banana 

6 4 oz =2 bananas 

2]d 


Apple 

9 6 oz ~2l apples 



Tomato 

6 4 oz 

3d 


Pear 

9 9 oz =3 pears 

3d 


Dates 

3 2 oz ~2/5th box 

4d 


Celery 

4 6 oz 

4d 


1 Orange Juice 

8 0 oz ~3 oranges 



The above weights apply to edible poitions 

The potential alkali reserve of above weights equals 10 2ccs n/1 Sodium hydroxide 

^ ■ ' ■ ■ . 



NO SUGAR - NO SULPHATES 


An effective and economic systemic alkalizer 




BRITISH 

MEDICAL JOURNAL 

JOURNAL OF THE 



ASSOCIATION 


SATURDAY JULY 23 1938 

PRINCIPAL CONTENTS 


President’s Address 

Profession and Public 

P 163 

Leading Articles p 

Correspondence 

ID 

00 O' 
H H 

Treatment of Cancer of 
Pharynx and Larynx 

167 

Surgery in General Practice 
Injuries to Elbow-joint 

189 

Diagnosis of Undescended 
Testicle 

168 

Epidemiology Section 

206 

School Epidemic of Measles 

171 

Reviews 

180 

Subvesical Diathermy 
Prostatectomy 

175 

Charge of Procuring Abortion 
Trial at Old Bailey 

199 

Rupture of Uterus during 
Pregnancy 

177 

Annual Representative Meeting 
Plymouth (See Supplement) 

at 


WITH SUPPLEMENT AND EPITOME 

LONDON 

BRITISH MEDICAL ASSOCIATION 

TAVISTOCK SQUARE 


No 4046 SN-EEKLA PRICE 1,3 


Copyright 


REGISTERED AS A NEWSPAPER 






No 31 


Elastoplast in the treatment of 
displaced. Semilunar Cartilage 

{csccrpujrom the film “The Use of ‘ Ehsloplast ’ tn Modern Surgery") 



Bandage cut to form “ tails " Bandaging completed 


SURGEONS and Geneial Piactitioneis who may be interested to see 
this sectionalised film are invited to communicate with T J Smith 
-Nephew, Ltd , Dept B lo, Hidl, for details regarding its exhibition 

B M A BRANCH Secretaiies are invited to write for available dates 
for projections 

A NEW edition of “Elastoplast Technique” has recently been 
published and a complimentary copy will be sent on application to 
address above 

EldStOpIdSt THE R'lODERN SURGICAL DRESSING 

MARK 1 

ELASTIC ADHESIVE BANDAGES, PLASTERS, DRESSINGS 



BRITISH MEDICAL JOURNAL 

JUL\ 23 1938 


CONTENTS 

British Medical Association 

ONE HUYDRED AVD SIXTH ANNUAL MEETISG, PLYMOUTH 193S 
President’s Address THE PROFESSION \.ND THE PUBLIC B\ COLIN D LINDSAY M D 


ADDUCSSES AND P\.PERS 
Treatment of Carcinoma in Phar\n'C 
ana Larvnx and its Results 
Liovtl Colledge f r 167 

Diagnosis of Undcscended Testic c 

Desis Browne frcs I6S 

Conduct of a School Epidemic of 
Meas'es F G Hobson d m 
FRCP 171 

Suhiesical Diatherms Prostatcc 
tomt R 0 Ward m ch frcs 17a 
RupfureofLtcriisDunngPregnancs 
James Riddeel m d f r cj Ed 
and John Scholefield mb f r c s 177 


SURGICAL SERIES 
Injunes to Elbow -joint S L Higgs 
FRCS I b9 


CLINICAL MEMORANDA 

Concurrent Puerperal Streptococcal 
and Staphilococcaf Septicaemia 
Recoiers J Starrie md and 
G N M Wish ART aircs 178 

Simultaneous Fraclure of Both 
Wrists R Salisblra Woods aid 
FRCS 179 

Locked Twins H C Fetch m b 
and T A Best aircs 179 


MEDICO LEGAL 
Charge ot Procuring Abortion 
Acquittal of Mr Aleck Bourne at 
the Old Bailei 199 

An Aciioq Withdrawn 207 


GENERAI ARTICLES AND 


NEAVS 

London Feier Hospital 191 

Alcdual Students’* Conrcrcn''c 192 

Preparations and Appliances 182 

UnIA CRSITies AND COLLECr^ 20 a 

Mfdical Nrws 207 


leading articled 

Tile Presidential Address 1S3 

Cancer of the Lung 184 

The Trial of Mr Rourne 1S5 


SUPPLEMENT 

Annual ReprcscnIaliAcMccling 
Full Report of Proceedings 
of Julj 15 and 16 


Annual General Meeting 
Adjourned General Meeting 
Rcprcscntalnes Dinner 
Oiersta Luncheon 
Annual Exhibition Opening 


Correspondence 
Association Diary and Notices 
3 ACANCIES and AppOINTAIENTS 


ANNOTATIONS 

Incomplete Descent of Testicle 185 
ChemiCTi Aspects of Aniicens and 


Antibodies 186 

Book of Plsmouih 186 

Birmingham Medical School 187 

Eleclrocardiographic Changes due to 
Smoking ' 187 

HaricA Cushing 188 

Successful Vaceinalion with Dead 
Tubercle Bacilli 188 

National Radium Trust 188 

Half scarls Indexes 188 


EPIDEAIIOLOGT SECTION 

Table of Infectiols Dinfascs and 
Vital Statisticn 206 

Epidlshoi ocicAi Notes' 207 


CORRESPONDENCE 


Tesiimonial to Dr Robert Hutchison 
Sir I ANLFLOr BIppington Wapd 
r R r s and others 195 

Cancer and HereditA W Cpashp 
D NC 19s 

Origin of Cancer C kf Beadneli 
mrcn 196 

When to Start Sulphonsmidc Treat 
ment in Gonorrhoea D kAni 
iiEN Bidun Ain 196 

Ann venereal kleasurcs R Fopr an 
r p c s 196 

Chicken pox followed bv Panoph 
lhalmitis S G Cornir aid 197 
Psvchomaiic Illness E K 
\lACkrNPH AID 197 

The Lnconscious Mind and Medical 
Practice ERNrsT Jones md 
Chari CN Bfrc m d 198 

Abortion and the Law Lord 
Hordlp aid and others 198 


REVIEWS 

An Anthropologist Speaks Out 180 

Conlrol of Disease 189 

A Sludv of Cerebral Funclion ISO 

A Manual of Olologj 181 

Intracranial Tumours ISI 

HacmatoIog> 181 

Notes on Books 181 


LOCAL NEWS 

Enfi and and Walc_s — 

Voluniarv Hospitals Committee 


for London 194 

Vimosphenc Pollution 194 

Scotland — 

Surgical Research Department at 
Edinburgh Universiiv 195 


LXTTERS and answ ers 

Case for Diagnosis 208 

Income Tax 208 

Lunatics as Pets 208 

Bed bug in the Human Ear 208 

Qualifications for CareNking 208 

Holidavs and the Milk SuppK 208 


A KEY TO current MEDICAL LITERATURE will be found at ihe erd of the JOURNAL 




2 


THE BRITISH MEDICAL JOURNAL 



FOREWORD BY 

S]R Walter LANGDON BROWN, m d , r r c p 

Erne) lilts Pi ofessoi oj Physic, Cambndgc 

Advances in endociinology have been occuriing so 
rapidly that it is indeed difficult for the busy medic il 
practitioner to keep pace wrth them There are ' 
encycloptedic works, full ot detail, which, howercr 
valuable for purposes of reference, are on too large a 
scale for him to assimilate Theie aic also books 
dealing purely' with the physiology of the ductless 
glands, necessarily cautious m tone, which naturally 
do not include the therapeutical aspect There arc 
others which are more frankly speculative 

This IS a condition of affaiis which Dr Levy Simpson 
has set himself to remedy He is already well known 
as an oiiginai worker and writer on the subject He 
has, in my judgement, succeeded in a really difficult 
task, for within a comparatively small compass he Iws 
included all the important recent advances Where 
matters are still sub jiicbte he has stated the arguments 
for and against and then e\piesscd his own opinion , 
where there is general agreement the reader is not left 
in doubt His statements are clear and precise and 
are largely the outcome of his own esperience The 
profession at large should be grateful to him for 
providing such a useful and much-needed book 


July )9t.s 


JOHN BALE 
MEDICAL 

PUBLICATIONS LTD 


MAJOR 

ENDOCRINE 

DISORDERS 

By ,S LEVY SIMPSON, MD, FRCP 

200 pp , 25 full pages of illtislra 
lions, bound in Sundour cloth, price 

I os. 6d. postage 6(1 

85 GREAT TITCHFIELD STREET, W) 



ncj 11 I ruhliilts \yiulroiiu 



Juu 23 193*? 


THE BRITISH MEDICAL JOURNAL 


HERMAN’S 
PRACTICE of 
UROLOGY 


JUST PUBLISHED! 

A Practical Book 

h' 

LEON HERMAN, B.S , M.D. 

Professor of Urolo!;> Unisrrsit> of Penn 
sslsnnia Graduate Schcol of Medicine Octavo 
of '923 pages V ith 776 illustrations on 504 
figures Cloth 45s net 


Dr Hcrtinn ' ne« book ttuh T<i tin’s Pracltcc of Lrolos' It 
bring-- to c\er\ont cot cerned witli iiirilogn.iI di t I't t ckii conci'i ind 
specific prc-entation devoted to the pi iclicil e\<.r\di\ inethrid' ot 
dngno 1' and tieitment 

But It la tlie ramilv Pliv-icnn who util t'[)tci ilh ippiectite nid welcome 
till- worl Dr Herimn In- taken into nceount tho e l ictor- tint enter 
into the treatment ot urological di-ea-e a- it i- nio-t commonh met 
111 general piactice He de-cribe- each method ot e\ iminalion how to 
apple It and what it mean- He contra-t- normal with abnormal ..lee- 
eou te-t- .uch a- the Mo-enth il tc-t McLem urea conceiitr ition te-i 
phenol-ulphonphthalein te-t, etc and their clinical interpretation He 
j.iee-' eou method- oi tieatment that eou can in-titute at onct in eour oven 
piacticc Se-temic and dietetic mea-urc-, eeith actual prt-eiiptioii- and 
menu- jdiuretic treatment u-e ot anti-eptic-, -olulion- drug- etc and 
indication- tor surgical interterence are giecie in lull detail 

There I5 an e-pecialle fine di-cu— ion of Gonorrhoea in llie male 
covering six chapter- m which Dr Heriii 111 omit- no detail ot pricticd 
iiiipoitance and a--istance The u-e ot -ulphanilamide, di itliemiv re 
pre— ue treatment hand miection irrigation vaccine- intrapro-tatve we 
jection md otlfer method- aie de-cribed 111 the light ot Dr Herman ^ own 
clinical experience 

Five unu-uallv complete chapter- are devoted to the Prostate Gland 
and there 1- a tull con-ideiation ot venereal nleers including the 
treatment ot chancroid 


THE LANCET -iv- 

I r f Si r // rvnu i } i> L 
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Is unsurpis_ed 



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I W B SAUNDERS COMPANY, LTD, 7, Grape Street, LONDON, WC Z 



THE BRITISH MEDICAL JOURNAL 


Juu 21 

ii.. LEWIS & Co. Ltd., Publishers and Booksellers 

BOOKSELLING , TEXTBOOKS ,ncl Wo, U » Swsid, ~ 

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6 


THE BRITISH MEDICAL JOURNAI, 



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THE BRITISH MEDICAL JOURNAL 


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\ V V, 




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Illustrated above — Norton a hamlet near 
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at this picturesque cottage v*hich is reputed 
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m finding their favourite “Player’s ” on sale here, 
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l/EDIUM OR MItiD — CORK-nPPED OR PLAIN AsV lor 
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MEDlUMo 


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ANALYSIS (per Iirrc) 

Sod Bicarb sni Pot Bicirb 000^ 
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Sulph (!00J ent Mtc Cirb 0016 
gm Silicon 0\ 006 gni ProioAidc 

of Iron 000015 gm 


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TPIE SECRETARY, 

BRITISH iMEDICAL ASSOCIATION IlOUSI . 
TAVISTOCK SQUARE, LONDON, V C I 



For upwards of thirty-five years | 
prescribed for the local treatment 

GOUT RHEUMATISM ECZEMA 
SCABIES and all SKIN DISEA»> 

and Intense Itching Soothi''s \ 


J t'l 
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SULPHAQUA SOAP 


Extremely effective in Disorders of the 
Sebaceous Glands and in Eczematous 
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Relieve Pam 

Sedative in Effect Instantly prepa 
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samples and literature on 

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AFRICA CAHA6A. AUSTRAIIA HfW 




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10 


THE BRITISH MEDICAL JOURNAL 


23 


CASE STUDIES WHICH CONVINCE 




^ These untouched phoineraphs thus 
irate 1 case o! Psornsis ot fillecn 
years duration Fimlly BELZEMA 
Ointment ana BELZEMA Soap uerc 
prcscriTscd The result ms drimitii. 
Complete elimination of ihe compbm! 
was achicscd in 56 days This sinsh 
case IS tspical of mam himilrcds of 
linicil reports on out files We 
belies c tint sour confidensi in 
BELZEMA ssill be established soiinilh 
iftcr a clinical trial Trial supplies 
scill be filadly sent to any pracli 
iioncr on request 


BEIc^EMA 

SOAP 

tJc'JDs miJ ihe for the 

ib-hOrntion of BcUcmi Omimcni li is '\b 50 \n\cU 
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colouring — no free ulk \li — rcccmmcnUcd for 
person i? hvGicnc 

• 

6EL.ZCMA nKUUcity is confineft Absolutely to 
the Medical ProfessJon and the fullest co oper'i 
tion of Its manuracttirers and ourselves m^iy 
he expected 

BROOKS & WARBURTON LTD 
232 <10 Vauxhail Bridge Road London S W 1 
Sole distributors for The Belmont Laboratories Inc 


PhSMCtans reports show thtl the BELZEMA treitmenl gams conlroilinc 
power oser the progress of imnv difliciilt sCin disorders inclwding 
(hose of mtcrobic and parasitic etiology Absorption of ihe oinlmcm 
appears lo be complele and relief from The inflammation and exmhlion 
IS usti tl!\ prompt No bandaging is required 

Indications for BELZEMA brand ointment include ECZEMA, 
PSORIASIS, ALOPECIA, RINGWORM, DANDRUFF, ACNE, and 
other skin disorders 







VtTA**«N < 

rv i* j ' 

nTAnir* r 




RADIOSTOLEUM EMULSION 
WITH VITAMIN C 

Radiostolcum Emulsion with Vitamin C provides a 
satisfactory medium through which to administer 
Vitamins A C and D to infants, particularly those 
which are artificially fed It is most palatable and 
m)\es readily with the feed or it can easily be given 
direct from a spoon Each teaspoonful contains 6000 
international units of Vitamin A, 200 international 
units of Vitamin C and 1200 international units 
of Vitamin D 

Radiostoleum Emulsion with Vitamin C is issued in 
bottles of three sizes containing 46 02 , 16 fl 0/ 
and 80 fl 07 respectively 

Sample on request 

THE BRITISH DRUG HOUSES LTD 
LONDON N.x 

RjtmC/! m/S/3j6 


]UL\ 23 19'!S 


THC BRITISH MEDICAL JOURNAL 



MARMITE 


its value in reduction 
of puerperal death rate 


PARTICULARS OF GROUP 

NUMBER OF \/OMEN IN 
GROUP 

PUERPERAL DEATH PJ<Tz 
from sepsis 

(per 1 000 loj! birihi^ 

Cases receiving special 
food 

10 334 

0 0? 

Cases not receiving 
special food 

18 854 

2 91 


•ic The food given consisted of a certain milk preparation and 
Marmite The Marmite was nch in the vitamin B complex 
which was a neuro muscular stimulant 

Anoth'er point was that Marmite had a very important haemo, 
poietic action which was not understoo:^ and was probably not 
associated with any of the vitamin B ronstituents at present 
recognized <fl « Med Jou n Jar 2-nrf 193S p 191 ) 


for VITAMIN B COMPLEX 


T ■ I /-I I T 1 1 1 v I T 1 1 

l^t•rJture apply to — 

THE MARMITE FOOD EXTRACT CO LTD Walsmgham House Seething Lane London E C3 

In brs 6d 2-oz_10d A-oz 1$ 6d B-or 2s,6d 16-oz-^s 6d Speoal quptatfons fo Mirm te packed for n N»p cals d ntcs welfare c ncres eu. 



THE BRITISH MEDICAL JOURNAL 


3ui\ 21 |9<(! 



MINZ^S) 


Mmcrah Iron 
Copper Man- 
ganese with 
gh cerophos 
phates of Cal- 
cium Sodium, 
Potassium 


Vnanuns Vita 

MIN A (18 000 in- 



ternationil units) 
and Vitamin D 



f 3 000 inter 



national iiniis) per 

'■ii 


fluid oz 

% 

'ii 



n ideal reconsti iictive tonic for run-down Children « . 


S> rup Min idL\ combines tin. ictn e principles of 
two established routine remedies— s> rup fern 
phosph CO and cod User oil, the \ itanuns Aand D 
of the latter bemR incorporated as concentrates 
free from oil Clinical eaperiencc abundantly con. 
firms the \aluc of Syrup Minadea as a restoratii e 
ind form iti\ c tonic For infants it can be safely 


administered in the bottle feed, i\ hile its enjoy ible 
Ills our ensures that Syrup Minadcv is readily 
taken esen ^by “difficult” children Syrup 
Mmade\ contains no alkaloidal stimulants Ei cry 
component contributes directly to the return of 
bodily health 


Prices (excepting Eire) 6 oz bottle";, Z'6,-12oz, 4'6, 80 oz lemclicstcrs, 22'6 

Vfss uutal prcftiswuat dt cctint 

0 1 dole SEX phcn[ BVBon 




OjtjGL 250 


— ‘AMYTAL’ 

, Iso-amyl Ethyl Barbitmic Acid 

FOR SEDATION AND HYPNOSIS 


0 The liaiiquil sleep of thildieii is ahiays ihe cin> of iess forliinalc 
adults to wlioiii at tunes this hoon is denied because of sickness or 
otliei conditions ailucli upset the psyclnc or emotional erjuihhiimii 
‘ Ainjlal’ supplies the lelaxation and sleep mIucU aic essential to 
lecupeiation of aital forces It n\a) he piesciihed yilicieter ihtre is 
need to toiiihat iiisoiiiuia, restlessness, oi apprehension A nolcoortlij 
margin of safely is ehaiacieiislic of ‘ Amjtal,’ and sinct destrucliou 
of the hapnolic Mithin the body appears to he acconiphshed rapidh 
iheie is little leiidenty to unwelcome side reactions oi aflei depression 
‘Aiii)tal’ IS supplied in J-gmn, J-grain, and llgiain tablets ui 
hollies of dO and 500 



WC£ /lAAlt ^ 

K L S LILLY A N II CO M !• A A Y L I HI * T K 

2 , 3 & 1 Dean Slieet, London. W 1 , i- t 5 1 

Dt'tlnhiilint! Itre/tf trt Briittm for ELI 




JUL^ 2^ 19'>S 


THE BRITISH MEDICAL JOURNAL 


PITUITARY EXTRACT B.D.H. 

(POSTERIOR LOBE) 

Pttmtmy extiact of umfoim potency doubly standm dised 
foi piessoi effect and foi oxytocic pozvei 


PRESSOR EFFECT 
Used m the control of hsemorrhage as, 
for example, m tt-phoid fe; er Pituitaix 
Estra« B D H 15 also injected prophs- 
lactically about a quancr of an hour 
before operations upon the nose and 
throat as a safeguard against himorr- 
hage In large doses the nse of blood 


pressure produced is utilised m the 
treatment of surgical shock 

OX'iTOCIC ACTION 
Emplojed for the induction of labour 'n 
the absence of mechanical obstruction, 
and for the control of post-partum 
harraorrhage 


Ltterattcre and sample on request 

THE BRITISH DRUG HOUSES LTD LONDON* Ni 


'•'lA '^A\ t A r'AC/ U / lAVVt l^S J -Im / ■>!. ' 

(•■M 1A / IAS 'lA /HA -nS/tA "A' ''nS -IAN '^A' tA\ -lAV/'A / A / -I-^ / ^ / •'•' ■> f n /■• -lA /f-*' - 

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THROMBIN-COAGULANT-MAW DRESSINGS 
HAVE PROVED THEIR EFFICIENCY / 

in the short time'they have been on the market Maws 
T C M Dressings have achieved remarkable success 
Members of the profession who have used them have 
been impressed by the rapidity with which coagulation 
IS achieved and numerous instances are recorded of 
severe haemorrhage being checked almost instantly 
T C M Dressings are treated with Thrombin Coagulant 
Maw a preparation of natural Thrombin which acceler 
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5 15 seconds They are supplied sterile in sealed drums ready for immediate use and the series consists of special 
Lint Squares suitable for most purposes Special T C M Dressings can be supplied when required 
They cost only a trifle more than ordinary Dressings and are well worth the extra charge We ask you to give 
them a fair trial for we are confident that you will be satisfied with the results 

A Product of the Maw Laboratories 



VISIT OUR STAND AT THE PLYMOUTH EXHIBITION 

Full details and technical information on request 

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14 


the BRITISH MEDICAL JOURNAL 


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In Tins of i lb 2/3, and 1 lb 4/- 

Desci limine literatim anil clinical trial lanii'k will be v.nt on nqinst 


calcium 

vitamin D granules 

Supplies of ca|cium and phosphorus 
are essenfial to the action of vitamin D 
Whereas ordinary calcium phosphate 
contains 1 part by weight of phos- 
phorus to 2 of calcium, dicalcium 
phosphate (Co H P O4) contains 3 
parts of phosphorus to 4 of calcium 
Calcydic Granules are delicious 
Each teaspoonful contains — 

DiLilcium pho^pIntL 7' unnvs 
Vitamin D 1 SOO units 

G' ' Osu CIioloI Ul nnd Ciiil Siigir 

These granules may be given to 
children or adults, prophylacticblly 
01 therapeutically, in rickets, preg- 
nancy, lactation, osteomalacia, 
menorrhagia, convalescence, chil- 
blains, and urticaria 


Manutn luriJ in Enjind bv '' 

ALLEN & HANBURYS Ltd , LONDON, E 2 

loptii M LKU Hi (1 )| Him ritLiiiii oH in)s Hi lit 1 «inil m 



"HEPATAGEN” 

COMPOSITION— Ext C-iscirnc Ext Rlici Jxlnpin PodophiUm Cod’" 
Hydrochlor 1 20lh gi m cich flmd drnchm 

This prcporation docs not comi iindtr tin. Dangerous Drup Ad 


POPULAR icmecit foi Chionic Bilioii'-iu'-x, Cinifl* 
jatnuhee niul the Taiinthct of simple lUpitic Toipor Ij 
p tssne oi ]i ihitiiiil Conpeslion of (lie Listi it hn** Inn'"'' 
Midi imikeil Ijcnefil 

In die licalnient of aciilc oi Icniporiry coiistiliat'"'’ 
convaltbccnU and in pieginnct, oi in the coii'-lipilion * 
'-e dent'll V Inhits, to a deficienc} ot intcxtiml '•tcutioii 
periMaKi-,, the mixtuie can be picxciihed with woiidertiil clu'^ 

The dose is fiom 10 to 60 minims accoidm" to the 
eondition ot the patient One draehm is a dncct apincn! 

IS not actompanicd by gnpmg oi tenesmus 


this iiiepaiation 1*5 aKo ‘supplied "sine Cocaim, ll"- 
pi ice lemammg tlie s mic 


C. J. HEWLETT & SON, Ltd, 

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35 to 42, CHARLOTTE ROAD, LONDON, E 




JUL\ IV’S 


THE BRITISH MEDICAL JOURNAL 


15 




16 


the BRITISH MEDICAL JOURNAL 


Juu 2' 19 ,s 


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Too often ho\\e\er Us use his been discarded b\ the phssician on 
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preparations arc not alnass available 


Alasil provides the beneficial 
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a polent gtsiric sedative and antacid 


Since Alasil is belter tolerated 
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juL\ 21 lys-? 


THE BRITISH MEDICAL JOURNAL 


17 


APPLICATION OF 

B.D.H. GONADOTROPIC HORMONES 

IN THE M\LE 


Of tbc t^\o gonadotropic bonuones Scrogin and Gomn, prepared 1)\ tbe 
B D H Serogan stimulates tbc germinal epitbebum ol tbc tc^tis leading to 
actrse spermatogenesis aibile Gonan acts primanh upon tbc interstitial cells 
and correctne tissue leading to increase msizc of tbe testis marked internal 
secretor> actuate and added mobibta of tbe undcsccnded organ 

Serogan is thus indicated m tbe treatment of impotence and stcribt\ in tbe 
male Gonan is emplo\ed as ben tberc is a failure in de\clopmcnt of tbe 
secondars male sexual cbaractcristics— cspcciallj tiben tins is associated with 
undescended testis 

DOSAGE OF SEROGA^ IX MALE IMPOTENCE 

One ampoule 1000 R U tesacc weekK for one monlb Thereafter 200 R U 
injection maj be administered i\ben required 

DOSAGE or GONAN IN UNDESCEXDED TESTIS 

Gonan 500 R U tiiactxieekR for six i\eeks Since treatment is designed to 

O 

cause as gradual a descent of tbe testis as possible m order to promote closure 
of tbe processus a aginabs, a treatment-lrce intcrv al of one month should be 
alloived between each six a\eeks course The optimum age Tor treatment is 
generallj regarded as bemg betvecn 9 and 13 ^cars 


THE BRITISH DRUG HOUSES LTD LONDON N 1 

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18 


THE BRITISH MEDICAL JOURNAL 


Juu 2’’, U ? 


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1 


ini nRinsH medical journal 


A'u 23 


irOlCATlONS FOR 'SANATOGEN' 


TUBERCULOSIS 

PUBLIC ENEMY No. 5 

Since the beginning of the centur\r, the de-ith rite from ill ciuses has fillen by onc- 
third The deith rite from Typhoid has dropped from 113 per million to 6 3 in 1936, 
tint from Influenza from iSg to 109 , whilst from Measles the death rite has fallen 
from over 1 thousand to under three hundred In the first five years of the century, the 
avenge mortality rate from Tuberculosis was over 1700, in 1936 it wns 657— but it 
still holds fifth place in the list of causes of death in this countr}' 

For these improvements, better sanitation and the raising of the economic level of the 
poor aie mainly responsible Environmental circumstances aie important, but so far 
as Tuberculosis is concerned, nutrition is evudently the most important factor An 
adequate supply of nourishing food constitutes the first line of defence The food must 
be ample, digestible and absorbable , and must include a sufficiency of proteins, 
VJtwvns and mwerals 

‘SanitogeiT, wfliich is a carbohydrite-fiee product of 95% pure milk casein with 5% 
sodium glycerophosphate, has prov'^ed itself to Invc great value in building up the 
body’s resisting powder to hostile bacilli It is easily digested and assimilated, and 
markedly increases the nutiitional value of othei foods taken wnth or after it It is 
notably helpful to the debilitated , rejuvenating cellular activity (including that of the 
white blood corpuscles) and promoting healthy tissue-building 


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3 icaspoonful added to each bottle feed 


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Juu 2^ 193S 


THE BRITISH MEDICAL JOURNAL 


21 


The Scourge of Diphtheria 

can be mitigated 
by timely immunization 

The following prophylactics arc made and standardised at 
THE EVANS BIOLOGICAL INSTITUTE 


A Q 1" r A.' two dose ’ jiroplnlacliL iiiLpaied In iiictiiii- 

/A r I LVanS lalin:’ llte anligenic traction ot forinol tu\oul of 

{Alum Precipitated Tonoid) high \aluc with alntn The lirst iniection should 

be" 0 I to 0 2 ce and the final injection 0 a cc 
alter two weeks Tor ehiKhcn of eight teats 
and under 


TAP Fv/pinc T \ F should be used when the subject is more 

' ^ ‘ LVdllb tiiaii eight \eais of age TAP has a high 

(Toroid Antitoxin Fioccules) itnniuni7ing cflicienci whilst reaction is rare 


TAM Evans 

(Toxoid Antitoxin Mixture) 


Produees ininniniti more slowh and is genet all\ 
recognized to be less eflicient than A P T and 
T \ F 


FT. Evans 


pc An efficient projiln lactic It mat cause disturb- 

^ ance in some older children and in adults It 

(Formol Toxoid) js recommended that its use be restiicted to 
children between 1 and 8 lears of age 


Dosage of F T , T A M , and T A F 

Thc'.t. three do'C proplnl ictic~ are administered subciuineoush W ith the F T 
and TAM the do^es are 0 5 cc 1 cc and 1 cc , but w ith TAT each 1 cc 
A cour>t ot 0 a cc 1 cc and 1 5 cc ha'. aLo been sugge,stcd It i- recommended 
that the intenaL between the injections should be one or preterabb two week' 

In the \eri tew inAance^ where a po-itiec Schick reaction i^ obtained atter such 
a cour-.e ot treatment turther injection-, are nece --ari to establish inimuniti It 
IS recommended that the Schick Te-.t be made not earlier than eight week' attei 
the third injection 

(S'/’rcio/ prices and detailed lifciaftiic zeill be foizeai dtd to 
Public Health 4iithoi itics) 


E^^ans Sons Lescher 


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LIVERPOOL and LONDON 


.1 


22 


the BRmSH MEDICAL JOURNAL 


Your patient 


JuL\ 2^ I9^S 



has undergone an operation 



He IS ^ely >vealv His diel must include nollmij; lluu can 
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At the same time, it is impeiatne that his e\istmg sfiengih 
he maintained and iiici eased 

Heie is a case whcie the unu{U( jnopeilies ol Biand’s 
Essence can he used to full advantage Bland's is a lia&ically 
jmie stimulant, piecipilating no solids in stomach oi 
intestines and containing no ii i itants Rapid and easy 
assimilation eiiahles its piononnctd pi ole in- spa i mg 
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JuL\ 23 I93\ 


THE BRITISH MEDICAL JOLRNAL 


23 



RELIGtO MEDICAL SERIES No 152— CELTIC 


-‘WfeLLCOME’ 

DIPHTHERiA 

PROPHYLACTICS 

For Active Immunisation 

Entirely manufactured, tested and packed in 
England lour products ire -w'lil'ihlc cacli one tlic 
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uses 

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O O O o o 


AN ALTAR OF ROMAN BRITAIN DEDICATED TO THE CELTIC GODDESS 
SUL — ^There is abundant evidence of the Celtic belief in the majico-medical power 
of v.aters and their v/ells became the popular hol> wells of medieval times 
vhich preserved manv of the curious customs introduced bj the Celts Among the 
Celtic places which have become famous for their healing springs Bath is pre- 
eminent in England The Romans named it Aquae SuUs after the goddess presiding 
over its'v aters They identified Sul with their own Minerva Altars such as the 
one here reproduced % ere erected to Sul in supplication fo* health or healing or 
in gratitude for cure granted 


DATE Traditional The altar A D c 100—00 


Koiwir^i 





COPV "IGI T 





a.b; protamine inselin 

(with zjncJ SUSPEIVSIOW 


S U SPEIVSIOW^ 


The absorption of insulin injected in the form of ‘A B ’ Brand Protamine 
Insulin (with Zinc) Suspension is much prolonged and closely resembles 
the natural secretion of the pancreatic islets this insulin has a steady 
action and exerts a better control than that of ordinary insulin over the 
carbohydrate metabolism The number of injections can be reduced, a 
lower total dosage is usually necessary and the subjective symptoms of 
diabetes markedly improve 
40 units per c cm 80 units per c cm 

5 c cm (200 units) 2/4 5 c cm (400 units) 4/6 

10 c cm (400 units) 4/6 

INSULIN ‘A B ’ vs is the first British insulin ofieri-d tommercnlU to the nudinl 
profession, ind has a world wide repul ition for iK striLth sifcguarded stenlity its 
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hot dim lies 

Effect of Insulin without and with Protamine 


24 hrs 




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THE BRITISH DRUG HOUSES LTD ALLEN & HAt 




BRITISH MEDICAL JOURNAL 

LO>DO> SVTLRDW JUL\ 23 1938 


British Medical Association 

ONE HUADRED AND SIXTH ANNUAL MEETING, PL'i MOUTH, 1938 

President’s Address 

THE PROFESSION AND THE PUBLIC 

BY 

COLIN D LINDSVY, MD, 


Emeritus PInsician Pn ice of M'alcs s Hospital Phti otith 

Cortsttltt It; Phssictnn 

In the first place 1 wish to thank son for the honour 
jou base done me in electing me President of the B M A 
Specialls I s'ish to thank mj colleagues in the Disision 
ssho b> nominating me base gisen me a token of friend 
ship that I prize abose most things I consider this 
honour one of the greatest within the profession and m\ 
sense of inadequacj is at its height at this moment when 
1 am faced with the problem of delis cring an address 
that will be worthj of the head of this great Association 
Previous holders of m> office have often been pre-eminent 
in one or other branch of medical science and the> have 
made this address the vehicle of some valuable addition 
to or survev of medical knowledge I can claim no such 
preeminence For fort) jears I have been in practice 
both as a general famil) doctor and as a consulting 
phvsician Thev have been eventful vears in the develop 
ment of medicine as a public service using this expression 
in Its widest sense One might almost sav that thev cover 
the evolution of our work from a purelv private affair 
between individuals to one of the vital public services of 
- the communil) 

An Age of Planning 

It IS srine aspects of this evolutionarv process that I 
have chosen to form the subject of m) address and to 
consider once again the relationship between us doctors 
and the public for it is by those we cure and even 
more by those we do not cure (so long as they are not 
dead) that we are ultimately judged It was Mr Bernard 
Shaw who proclaimed from the mouth of one of his char- 
acters that the medical profession was not a profession 
but a conspiracy though he hastened to add that all 
professions were a conspiracy against the laity 

This IS rightly said to be an age of youth but I still 
think that there is a lot of truth in the old Latin lag 
Experientia docet I think that I can lay claim to 
that experience — experience moreover as a working 
member of the rank and file of the profession The rank 
and file from their very nature are singularly unvocal 
For that reason if for no other I welcome the opportunity 
that vour action m making me your President has given 
one of them to speak publiclv on their behalf I have 
said that this is an age of youth It is also an age of 


ConsitUtns: Phtsttiim Po al Lm Infinnart Phnwiit! 
Toxtstock Hospital 

planning Lmsscr fitire that principle beloved ot our 
fathers has done great things but it has outlived its 
lime All the signs and symptoms point to the fact that 
whether vve wish it or not in everv field of human 
aclivitv some form of control of planning is neccssarilv 
coming We mav not 111 c the thought but it i> useless 
to kick against the pricls and it rests largely with us 
what form that control is going to take 

Medicine as an Industry 

I want you to loot for a moment on medicine as a 
great industry an industry whose produci is the health 
both physical and mental of the commumtv which it 
serves I have a moments hesitation in using this simile 
as the word industry has come to have a meaning 
that throws the emphasis on the indirect product — money 
— rather than on the direct product of the labour in- 
volved This emphasis is and I hope always will be, 
foreign to our own work As I see it this industry 
IS one which is provided with a plant that is excellent 
efficient and up to date in practically everv wav I do 
not think however that the best use is made of this plant 
It has grown up haphazardly and piecemeal There is 
great want of correlation great duplication of effort 

General Practice 

First look at what we may call the selling end of the 
industry It vou want to buy some unusual article you 
go to a retail shop and make use of their experience 
with wholesalers and the like to get what you want from 
the most appropriate source Some such arrangement is 
necessary m medicine and as things are at present this 
arrangement is not working smoothly The fault is 
perhaps largely an administrative one but I believe clear 
thinking on the exact nature and function of the medical 
practitioner is also laeking The matter of health and 
Its maintenance is so essentially a personal thing that the 
personnel of this (retail) division of our health industry 
must have a close personal relationship with the public 
as individuals This relationship is only possible in a 
family doctor either in his present form or m some 
altered but essentially similar form At present there 
IS a tendency for this branch of the profession to sink 

4046 


164 July 23, 1938 


The British 
Medical Jolrsvl 


THE PROFESSION AND THE PUBLIC 


lower and lower in the estimation both ol the public 
and of the student body from which the profession itself is 
recruited 

The practice of medicine itself has been brought into 
disrepute by the indiscriminate administration of medi- 
cines The faith of the public in a bottle of medicine is 
pathetic I grant it may be used on account of the 
psychological effect, but often it is quite unnecessary and 
IS only prescribed because the public expect and insist 
on it On the other hand there is e\en a section of the 
public which considers that the training, knowledge, and 
ability of even the best doctors in the land ought not 
to be used in helping the sick , that in fact their talents 
should be hidden m a napkin and reliance placed solely 
on prayer, and not to do what I belieie the Almighty 
wishes and expects us to do oiirsehes The principle 
which I have learned to follow is to avoid drugs if 
possible, but when necessary to give them in adequate 
doses — often in much bigger doses than those suggested 
in the textbooks — until a definite effect is produced 1 
possess a very interesting work on Tlit Piaciice of 
PIi^silK written bv Dr Willan 257 years ago, in which 
the author recommended all physicians to follow what he 
invariably did and take a dose himself of every medicine 
he prescribed for others 1 imagine this is hardlv prac- 
ticable in these days — especially in the case of panel 
practitioners in the midst of an influenza epidemic' 

A ramilj Doctor Scrtice 

The Cl edit of the general practitioner I have said is 
sinking A reaction from this attitude is inevittble 
The moie the public is educated and the more the health 
services extend and intrude into the fives of the people 
the more will there be required an active and an intelli- 
gent family doctor service It will be no corps of 
clerks It will require a wide professional tiaining to 
cnsuie the early recognition of diseased states and the 
proper co-ordinaiion of the specialist services becoming 
d Illy more abundant 

A good general education will be essenti il, also 
personality and mental agilit>, so as eftectivelv to inspire 
confidence and assist in the education of a public which 
IS rapidly becoming moie enlightened Again it is in 
this sphere that the Cinderel! i of the medical sciences, 
medical psvcholog>, may well come into ns own The 
imount of minor and major functional neivous diseases 
in the communil> is admittedly very large The earliei 
'he> are recognized and treated the more hopeful is the 
outlook, and owing iC '^e lack of any obvious disabiht>, 
except in the later stages it is onlv the general practi- 
tioner who can lead the attack His position as trusted 
counsellor and family friend lends itself admirably to 
the purpose and it is true even now that all general 
practitioners are to a greater or lesser extent psycho- 
therapists Thev would be much moie eftectivelv so 
if their training included some instructions m the prin- 
ciples of medical psychology This family doctor is the 
obvious connecting link for our medical industrv All 
direct contact with the public as individuals should be 
in the first instance through the family doctor There 
should be no short circuiting or diiplicilion ot his services 

Specialism 

At the back of this family docioi seivice there must 
be 1 specialist service Medicine has grown so enor- 
mously that It IS quite impossible lor any one person 
to be proficient in every branch The specialist is con- 
cerned more with one branch of disease but in these 


days of specialism when the tendency is to dissever the 
various organs of the body it is wise to bear in mind the 
truth of the ancient saying. If one member suffers all the 
members suffer with it ’ That great surgeon the late 
Lord Moynihan is reported to have said that he liked to 
consider hinaself a phvsician who had sometimes to 
employ surgery to cure some of his cases There is 
moreover, a lot of mistakenly loose thinking on the 
subject of specialism The family doctor when all is 
said and done is also a specialist — a specialist in the 
recognition of disease in its early stages and in the helping 
of his fellow men in the many little ills and troubles that 
beset them , and these may be important, for a serious 
breakdown in health m later life may have its origin 
in trifling and unrecognized ailments of twenty to thirty 
years before To lake a case in point The intensive 
research into the origin and development of cancer points 
to the probability that malignant growths rarely ■'develop 
suddenly, but there is a precancerous stage usually lasting 
for vears in which cancer has developed from minor ail 
ments which might often have been rectified if their 
significance and possible danger were recognized 

1 would like to see more attention paid to the treatment 
of the so-called ‘ minor ailments It has been estimated 
that 40 per cent of all sickness is due to the patients 
own action If this be true (and from mv own personal 
experience I hive found it so) think what a vast amount 
of sickness and ill-health might be avoided , but this 
requires a willingness on the part ot the patient to talk 
over his minor ailments vvith his doctor instead of going 
in for self-medication assisted by the chemist Remember 
It IS the general practitioner who sees the beginning of 
disease the specialist mainlv the end There is no real 
reason vvhv one branch should be from its nature more 
eminent than the -other Thev are essentially comple 
menlarv, and each requires for its proper performance 
attainments of the highest order 

Now in order to get material for practising his art 
and facilities wherewith to treat them the consultant 
specialist IS inevitably associated vv'ith a hospital With 
the entry of the local authorities into the hospital field 
things are in a slate ot chaos in many areas There are 
strong points in both voUiniarv and municipal svstems 
and each can learn from the other The one thing that 
is absolutely essential is the will for exponents of both 
sides to get together and work out for their own par 
ticular areas a scheme that wall ensure this co operation 
of both svstems taking the ^best points ot each and 
not allowing one to swallow the other It is this will 
to get together that is all too often lacking 

Public Health and Co-opcration 

Apart from the curative specialist services there is 
another specialist service which is necessary to the modern 
community — the medical officer of health service or the 
speciahst in social and legislative medicine ^^^ule the 
knowledge necessary tor this branch is m many ways 
different from that necessary for the successful practice 
of individual Medicine, it is dependent on and very closelv 
related to that branch This correlation as things are 
at present is often extremely deficient, and for any smooth 
working of the medical services in a community more 
effective measures of amalgamation must be applied 
between the two branches 1 believe that this can be 
supplied by the provision in each administrative localitv 
ot a Medical Advisory Board consisting of representatives 
of each branch of the medical services — administrative, 
specialist, and gtneral practitioner Even now in a sma 



JbL\ 2^ 


THE PROFESSION AND THE POBUC 


«i\ there ire regtihtions «hich permit of some such 
council ind in the few neighbourhoods in which it has 
bCen tried it his been an unqinlificd success 

Timncnl Consideration 

1 hale ilrcadi said that the mam cniph isis m this 
industrs of ours is rather on the results in the nature 
of the better health that it brings to its mcmb.rs The 
real reward to the good doctor must aluaes be the tnow 
ledge of hasmg sersed the cause of humaniti Do we 
not all Know how often the cases that gi\c us most satis 
faction are those that bring us least moncj’ 

Tile B \I \ IS an Empire wide assocntion of doctors 
for the adsancement and dissemination of Knowledge and 
the maintenance of a high standard of honour in the pro 
fe-sion and secondariK for a just and fair remuneration 
from Gosemment and public bodies This l^ where the 
difference is found between the medical p'ofession and 
a trade In the former the primars motuc should be 
to help the public with profit as a subsidiars factor 
There are few indeed who could practise so time and 
soul consuming a worK on a piirclj honorare basis The 
last ma/orrtt of us must depend on our worK for the 
expenses of lismg and the upbringing of our families 

1 do not thinK I am wrong in sasing that the whole 
subject of our remuneration is one that is more and more 
preoccupjmg members of c\er\ branch of the profession 
The correspondence columns of otir journals and the 
agenda papers of our Dmsions Branches and Committees 
will bear me out I do not presume to offer a solution 
for problems the complcaits of which has taxed the 
brains of multitudes much more financialK experienced 
than ntjsclf There are howeicr one or two principles 
which are to m> mind fundamental 

Tree Clioice, and Other Principles 

The first point which is at the same time the least 
conlroscrsial is what is Known as the principle of free 
choice of doctor You mtj sax that this is hardU a 
question of remuneration That is true but indireclK 
It IS of enormous importance because its acceptance maKes 
extremeU diflicult the proxision of anx sort of salaried 
famil} doctor serxice This I belicxc must be remunerated 
on a capitation basis as under the present Nation il Healih 
Insurance sxstem We as an Association haxc jusi pre 
pared a rexised xersion of our proposals for a General 
Medical Service for the Nation, in xxhich the txxo xital 
principles of free choice of doctor and of paxment on an 
insurance basis arc reaffirmed and their wide extension 
advocated 

The first great extension we propose is the inclusion 
m the sjstem of all members of all families xvithm an 
income limit of £250 a >ear We are seeking to double — 
no less — the number of individuals who rtceixc medical 
semce through N H 1 The second extension we propose 
IS that the serxice gixen should be medicallx complete — 
that IS to sax that it should include all forms of specialist 
consultant and auxiharx serxice as well as that proxided 
b} the general practitioner I should not liKe to sax 
xvhich of these changes can do most for the public health 

Such IS our official policj far-reaching in scope and 
XX ell suited to secure the full co ordination of each and all 
of the countr> s health scrxices Our proposals xxould 
bring three quarters of the communilj within an official 
sjstem of medical service Illness is not a sfeadx exent 
from season to season or from year to jear and for this 
reason it lends itself particularlj to treatment on an 


insurance basis Both patient and doctor must surely 
prefer regular to irregular outgoings and incomings 

Within the last six months the Association has been 
instrumental in forming a National Federation ol 
P roxident Associations xxhich extends the insurance 
method up to a maximum income of £500 according to the 
number of indixiduals m the familx or to a maximum 

of £5'0 in the case of London also taking into account 

the familx income I suggest to xou that the pruiciple 

adopted is one which m the future max well be much 

more xxidelx applied It is of course the amount of 
the premium that is the difficullx No man enters the 
profession of medicine with the idea of making a fortine 
Equailx no man can possiblx tulfil the responsible and 
difficult role for xxhich ihe familx doctor of the tunire is 
siirclx cast without the possibilitx ot sutficicnt remunera 
lion not onlx to proxide the necessities ot hte but also 
the cultural and social actixities on xxhich his full ise 
fulness so much depend Anx capiialion paxment must 
proxide ihis minimum and proxide it on a basis of a 
numb-r ot patients per doctor which is not too large to 
present his giving the neeessarx time to each This 
time IS b-commg increasm_lx more as oir Kno sledge ot 
Iherapeiilie and dia 5 ,nosIie methods me ea es 

Foes fur Consultatixe \'ork 

The reinuilei atism o' lliv eO” laiXe *' ■■ s 

subject to raiher dttle ent eonotieP Pre eon i 
lixe fees are hi-h re'al xe o ihese in ihe olh- oransh,.s 
The reason lor ih s is hat ihc consul an' has a re j ex 
short earning period He ha to serve a Ion, and p ac 
ticallx unpaid ipprcnticeship Ii is hard o u' itx h s 
I xxould prcler a sxsiem where he sta us Oi cen ' 'nt 
depended on hospilal and eiinic appomimcnts ca ii;, 
a reasonable salarx which would xarx with thei e ’cnsi 
bilitx Were this so the paxments tor ou side cxnsu a c 
work could be considcrabix lowered and would -l' w ne 
xoung consultant while alxxaxs assured ol a lix'insed 
to look lorward to an improvement in h,s ci c n a-r is 
as his repute grew These salaries would eome 
the funds of the hospitals whethci these xxere supper' d 
b> the Slate or bx xoluntarx eontribuiorx schemes 
The daxs xxhen the hospitals could l>“ regarded as pure 
chanties are gone Verx feiv hospital patients eould not 
afford to join some sort ot contributors scheme 

Publicifx and Education 

Let us return a moment to our simile Exerx industrj 
apart from its productive side alwaxs has in addition a 
public relations ot publicitx side Hitherto it has alwajs 
been a kex stone ot medical pohex that publicitx or adver- 
tising IS m direct antithesis to the best interests of the pro- 
fession and ot the public alike The truth of this in regard 
to advertising bx individuals is I think still undisputed 
I think however that some torm of group advertising fax 
the profession as a whole is sertouslx overdue In fact 
this publicitx side of our mdustrx hitherto neglected 
could be developed to the benefit both of the mdustrj 
Itself and of the public which it serves Consider a 
moment this public Taken as mdmduals and in times of 
sickness and stress we all know that there can be nothing 
quite so touching as Ihe almost blind trust which thex 
repose m the science of medicine and m the particular 
practitioners that happen to be giving them the benefits 
of that science This is true of the public as sick indi- 
viduals but the public taken m the mass and in health 
does not trust either medicine or the medical profession 
Their attitude is an extraordinar> blend of ignorance and 


166 Juu 23, 1938 


THE PROFESSION AND THE PUBLIC 


Tnt British 
Medical Jourwl 


superstition, in which they ln\e unbounded conhdcncc 
Everybody thinks he knows all tbout medicine, without 
training or instruction Test it by telling a group of 
friends that you have a pun in your hip and at once you 
have It diagnosed and half a dozen difteient suggestions 
of treatment given, all of them ‘infallible fiom cairying 
a potato 111 the pocket to wearing a ring ol elephants 
hair Next day tell the same friends that y'oii have trouble 
with your neighbour, whose apple tiee has blown down 
across your wall, and as he will not lemove it you pro- 
pose to do so yourself These stme friends will at once 
advise you to do nothing lash, but to consult youi lawyei 
first Thus they think they know medicine, but are not 
ashamed to admit a complete ignorance of the law 

The public want the ailment or disease to be definitely 
named and then ask why they cannot be cured bv such- 
and-such a treatment which did so much good to their 
friends What is good toi one is good for another, ’ 
they say This is where the greatest mistake is made — 
no two people are exactly the same There is much truth 
in the old saying One man s meat is anothei man s 
poison I lemembei the case of a man who took five 
giains ot ispirin (a veiy common and usetul remedy') but 
in this case it was followed in halt an hour bv acute 
swelling of the face, tongue and throat, and he was in 
gicat dangei of suffocation until lehevcd bv the appro 
pi late remedy 

Countering Crcdulits 

What oppoitunity is theie it present foi the public to 
outgiow this Ignorance and supeistition’ In the long run 

suggest that education ot the people must be the basis 
ol any effectnc remedy I think that this theme of public 
education in health is paiticularly ipt at the moment 
The health of the nation is verv much in the public eve 
and unless we guide the enormous enthusiasm that lies 
behind this campaign theie is a leal danger that it may 
do moic harm than good I think we should go furthei 
than tint I think that teaching in element iiy biology, 
anatomy, and phisiologv should be an essential and impoi- 
tint pin ot ill education how'evei elementary Surely 
It IS up to us and to no one else to see that it is included 
in the curiicula of our schools’ Similarlv, courses of 
popuiai lectures could be ariangcd it not ofiiciallv, pos 
sibly by Br inches ind Divisions ol our own Association 
1 ha\c \eiy little doubt that weie thev piondcd there 
would be no difficulty in finding ludiences loi them 
Secondly, 1 W'ould suggest tint theie is a gieat oppoi- 
tunitv awaiting both the Press and the BBC to do more 
in the educational field Membeis of the medical pio- 
Icssion could do much to help them in that task Surely 
It should be up to us to see that a supply ot w'ell-in formed 
and informing articles is available to whatever papers 
wish to use them, and equally that the BBC should be 
gi\cn all possible help in the piovision of talks which 
w'ould satisfv these two same conditions ’ Yet, I do not 
think that we must expect too much We have to 
I cmember that both the Press and the BBC are limited 
bv the educational attainments of those they serve They 
can help and to some extent anticipate improscd educa- 
tion on these matters in the schools They cinnot I am 
ifraid take its place That is why 1 have given first place 
to education in what I have said 
Thirdlv, I feel suie that it is only thiough education 
of the public that the public credulity in regard to 
idvertised remedies can be removed You all know what 
1 mean when I speak of the evil ot patent medicines 
There arc good proprietary medicines as well as bad 


Some we make use ot ourselves, otheis we could on no 
account condone oi recommend What matters is that 
because _of the superstitious ignorance ol the public there 
has grown up an enoimous mass of adveitisement literature 
tor remedies that aie f imed to cure not only every disease 
known to the profession but also many diseases invented 
puiely for the sake of being cured by some particular 
lemcdy It may be true that many of these remedies are 
in themselves quite harmless or even beneficial when 
piopeily used That is not the point The advertisement 
IS designed to create a demand, and the demand can only 
he in ill-health, imagined or real, or (more insidiously) 
by the suggestion that a ceilain pioduct is necessary for 
the maintenlince of health These advertisers know their 
job Their writings arc carefully couched in pseudo 
scientific terms and w'e see duly in our practices how 
enormously receptive and almost universal is their 
audience It may be unreasonable to criticize unduly 
those who for their own profit play the tune which the 
public wants As I have said by no means all of these 
adveitised remedies are intrinsically undesirable It must 
be in the inteiests of the reputable manufacturers that the 
demand lor their products should be based on sound 
know'ledge and not on ignorance and fear For the rest, 
the trade as it is now conducted could only flourish in a 
public which know’s little or nothing of the true principles 
ol health and healing The schools can educate the 
public and we as a profession can tell the public The 
-more the public ti lists us the more we are able to help 
ind the soonei they will believe that we aie truly 
cndeaxouiing to piotect them against themselves It is by 
meisures such as these and not by restrictive legislation 
that the true cure of the evils which I have mentioned 
will come 

Medicine m the World of Science 

I believe luither that theie is anothei spheie ol educa- 
tion in which our entry might be ol incalcuhble value 
1 like to believe, and in doing §o 1 do not think I am 
entirely govcined by piejudice, that the scientific world 
IS a whole is to a luge extent tiec liom most of the 
jealousies which poison the inteircl ition of humanitv in 
the world to day Scientists as a body appro ich nearer 
to the ideal world community than any'' other large 
division of mankind Who has evet hcaid of class_vvarfire 
between workers in anv field ot science oi ot an embargo 
on the exchange ot knowledge, whether intia- oi inter 
national’ Even when something ot the lattei kind has 
been imposed from some political spheie it has been met 
with prolonged and emphatic piotests from the entire 
scientific vvoild The medical protession forms one ol 
the most important divisions both mimeiically and in 
fluentially' of the world ot science The profession as a 
whole IS really working for the common good of the com 
munity and not with the idea of screwing the last penny 
out of them It is a true brotheihood, and in ordmarv 
practice the individual doctors continually assist one 
another and pool then knowledge and advice to an extent 
quite unknown to the patient and the public at large, 
but It IS also unique in that world because ot its close 
lelationship with the lives ol the non-scientific laity Are 
we not, then, in an ideal position to bring the ways of life 
and thought of one world to the benefit of the other? 

I do not presume to dictate a programme, but I humbly 
suggest that there are possibilities in the idea that at least 
merit our consideration both as individuals and as an 
organized profession I would like to suggest that as 
members of this great profession vve have possiblv an 
important missionary function in this cause 



Jlu 21 193S 


CARCINOMA IN PHARYNX AND LARYNX 


Tin’ B miH 

Jo 7S4L 


16 - 


treatment OF CARCINOJIA IN THE 
PHARYiNX AND LARATVX AND 
ITS RESULTS* 

BY 

LIONEL COLLEDGE, E R C S 

Surgeon Car and Throat Department St Georges Hospital 

Tin. introduction of irradiation has rendered the problem 
of treatment in sarious situations infinitelj more comph 
cated because the results of its use are neither so good 
that the method can claim to supplant simple surgical 
treatment altogether nor so had that thej can be dis 
missed as negligible In certain situations other than 
the phar>n\ and lar\n\ the matter is much simpler tor 
example in the floor of the mouth irradiation has taken 
the place of surgerj almost entirelx whilst m the 
stomach the abdominal surgeon does not need to concern 
himself with It Unfortunateh it is also true that m 
mans situations such as the oesophagus where the 
results of surgerj are bad those of irradiation also arc 
poor and conxerselj manj of the best results obtained 
b\ irradiation are in situations where the tumour is most 
amenable to surgerx This applies to the lareaix and 
pharxnx If surgical treatment is chosen then an opera- 
tion suited to the site and extent of the tumour must 
b> designed if irradiation is chosen, then the tjpe of 
radiation and the method of its application must be 
settled 

It IS proposed to deal first with tumours in the 
orophar\n.\ — that is tumours of the tonsil and fauces — 
and then to deal rather more fullj with the lower 
pharxnx — that is, the larjngopharxTix and the larxnx 
Itself M> own endeaxour xvill be chieflj to indicate 
xxhat can be expected from surgerj, and I will leave it 
to others to show the best that can be obtained bj 
irradiation A great xarietj of tumours maj be 
encountered in the situations under consideration but I 
think that this discussion will have more value if it is 
limited to epithelioma which is the common form of 
malignant tumour 

In the oropharjTix epithelioma iisuallj begins either on 
the lower part of the anterior pillar or in the angle 
between the lower pole of the tonsil and the side of the 
tongue and is usuallj seen spreading oxer the tonsil and 
fauces and into the side of the tongue There maj or 
max not be a palpable gland in the neck often there is 
not but if the cervical glands are enlarged the size is 
often in inverse proportion to that of the primarj growth 

%Vhere_ the growth is comparativelj earlj without 
fixation and there are no palpablj enlarged glands in the 
neck the tumour maj be removed bj diathermj as 
Norman Patterson has long advocated Such cases 
must be kept under observation lest enlarged glands 
appear in the neck If a gland dissection has to be com- 
bined with removal of the primao tumour it should 
precede the diathermj operation bv ten or fourteen days 
to avoid difficulties from the changes which diathermj 
produces m the neck Patterson records that out of 
fiftj patients treated bj diathermy nine died and thirteen 
survived for more than three years 

In more advanced infiltrating growths where the tongue 
IS more invaded or the growth has become adherent to 
the inner surf ace of the mandible diathermy is not 

* Read m opening a discussion in the Section of Oto rhino 
laryngology at the Annual Meeting of the Bnlish Medical 
Association Plymouth 1938 


appitcable alone and the operation required includes 
removal of the mandible from the canine fossa to the 
condvle This is naturallv a mutilating operation and 
must be followed bv a careful reconstruction Dickie 
records that m thirtv cases so treated there were seven 
deaths and fifteen recurrences in less than five vears bat 
eight patients survived for more than five vears and one 
for over eleven years Radiation employed in such cases 
max lake the form either of radium applied at a distance 
or of the implantation of radon seeds 
The treatment by irradiation is most attractive 
because when successful the pharvnx is almost normal in 
appearance but the question remains whether m treating 
epithelioma it gives a sufficiently high proportion of 
lasting good results to displace surgerv Biopsy mus* 
take an important place in making this decision because 
sarcoma and Group IV epithelioma which in its clinical 
course may be said to have more affinity to sarcoma than 
to keratinized epithelioma give uniformly bad results with 
surgerj and are radiosensitive 

In the lower pharvnx the growths to be considered are 
those on the lateral wall of the pharynx the epiglottis 
the arv epiglottic folds the fossa pvniormis and the post 
cricoid area Of these various types the grownhs on the 
lateral wall of the pharvnx the epiglottis the arvepiglottie 
fold and in the post cricoid area max be created b 
lateral pharvngotomv combined with a subsequent plasUe 
operation it in an early stage For these lUmours m a 
more advanced stage and for tumours of the fossa 
pjTiformis almost always operation must be a pharvngo- 
larjngectomv That operation includes clearance of the 
glands on at least one side of the neck and removal of 
the whole larynx and either a portion or a comp'ete 
segment of the pharvnx A somewhat elaborate plas'ic 
operation is required later to reconstruct the pharvnx 
the patient being left with a laryngectomy 

The classification of cases in these groups mm those 
suitable for lateral pharvngotomv or for pharvngola'xn 
gectomy and those which are inoperable must be decided 
by clinical experience which takes into account the 
extent of the primary growth the invasion and degree 
of fixation of Ivmphatic glands and die general condition 
of the patient 

Gluck and Soerensen record fittv eight operations b, 
subhvoid pharjngotomv, but this method is apphcable 
only to carcinoma of the epiglottis In 334 cases of 
extrinsic cancer treated by larvngectomv combined with 
resection of the pharvnx with seventy seven deaths the, 
obtained a permanently good result in 10 per cent In 
Glucks clinic patients whenever possible were submitted 
to operation so that no attempt was made to make the 
statistics appear favourable by selection of cases Of 
my own patients treated bv pharjngotomj or pharvngo 
laryngectomy between 1920 and the beginning ot 1935 
the following are some particulars 


Table I 



So 

D:-d 

Recc* 

Remain 

Pharyosororay 

Pnvate pa rents 

13 

0 

- 

6 

HospitaJ 

: 26 

9 

10 

7 

Total 

39 

9 

! 

i 

Pharyngolarj'nstctoray 

Ftivaie patienis 

7 

1 

4 

2 

Hospital 

9 

2 

1 ^ 

4 

Tot-1 

16 

3 

7 

- 6 



168 July 23, 1938 


CARCINOMA IN PHARYNX AND LARYNX 


Tiic British 
MeDICA*. JotRNAT 


Of these cases five of pharyngotomy and two of 
pharyngolaryngectomy have remained well for more than 
eight years That is, out of fifty-five operations nineteen 
were successful, or 29 per cent Against this must be 
taken into account that some cases have to be rejected 
as inoperable and that some of the operations are of a 
mutilating character , but, again, the operation has suc- 
ceeded in some cases after the failure of radiation 

On the other hand, at any rate until recent years, the 
results obtained by treatment with r rays or radium in 
this class of lower pharyngeal or extrinsic laryngeal 
tumour were almost negligible and the condition of many 
patients was aggravated It is in this class of case, m 
which the operations are particularly difficult and require 
ceaseless care and patience m the subsequent management, 
that an alternative treatment by x rays or radium would 
be welcome if a reasonable percentage of successful 
results can be obtained 

In the group of intrinsic cancers of the larynx, 
including tumours of the vocal cords — a few being on 
the ventricular bands or having origin in the ventricle, and 
some being of subglottic origin — the operative treatment 
is either by laryngo-fissure (with which partial laryn- 
gectomy may be included) or by total laryngectomy The 
pcsition and extent of the growth here again determine 
whether simple removal of a vocal cord on one side is 
done, or whether the front of the larynx or the whole 
larynx has to be removed 

Gluck and Soerensen record, for intrinsic cancer, 141 
cases of laryngo-fissure with nine deaths from the opera- 
tion and ten recurrences, 122 patients remaining well for 
at least three yeais They also record 501 cases of total 
laryngectomy for intrinsic cancer This number includes 
a series of 100 with two deaths, and in the last 181 cases 
there were twelve deaths from the operation During the 
last ten years there were 30 per cent of lasting good 
results 

The following are particulars of operations on my 
own cases of intrinsic cancer 


Tablb II 



No 

1 

Died ' 

Recur 
rcncc or 1 
Uninced | 

Remain 

Well 

Larynto fissure or partial laryn 
gectomy ' 

Private palieDls 

16 

J 

I 

H 

Hospital 

7 

1 

2 

4 

Toni 

23 

2 

3 

18 

Toni lar>ngectomy 

Private patients 

42 

2 

9 

31 

Hospital 

33 

12 

7 ' 

14 

Total 

75 

14 

16 

45 


Of these cases nine of laryngo-fissure and eighteen of 
laryngectomy have remained well for more than eight 
years, including three for more than fifteen years 
In this group, out of ninety-eight operations seventy- 
three were successful — that is, 74 per cent Here, again, 
some of the operations are of a mutilating character, 
but m early cases where only a vocal cord is removed 
the \oice is often normal and much better than after 
treatment by radium This group also includes patients 
in whom the cartilages had been attacked by growth or 
in whom perichondritis had supervened, rendering them 
unsuitable for treatment by radiation 

It IS m this group that irradiation has had most success, 
and therefore that line of treatment is the most attractiae. 


but it has to be shown that it can produce a large per- 
centage of good results 1 suggest that if radiation be 
employed it should be in the' form of the radium beam, 
and that needles should no longer be used 

The figures for the operations have been given 
separately for the private and hospital patients because, 
although the numbers of each are approximately equal, 
the results in private practice are very much superior 
owing to the better condition, both general and dental, 
of the patients, the segregation of the patients in private 
rooms, the avoidance of changes in nursing staff, and the 
constant personal supervision of the surgeon 

In introducing this discussion I wish to avoid undue 
emphasis upon any particular method of treatment This 
IS particularly dangerous in discussing malignant disease, 
because m practice individual cases have to be considered, 
and, whatever the treatment, the prognosis of any one case 
IS always doubtful, however favourable it may appear on 
the one hand or unfavourable, short of being quite hope 
less, on the other There is therefore, when failure ensues, 
often a feeling of regret that different treatment was not 
instituted, especially when irradiation fails to cure an 
operable case Operation, too, might have failed, and 
I am concerned only to bring forward some points in the 
hope that the ensuing discussion may help to clarify the 
position 

I have to thank Mr Arthur Pereira registrar at St Georges 
Hospital, for his help in following up the fate of the patients 
and in preparing the statistical tables 


THE DIAGNOSIS OF UNDESCENDED 
TESTICLE 

BY 

DENIS BROWNE, F R.C.S " 

Sitigcoii to the Hospital for Sick Children Great Ormond 
Sheet London 

There are few conditions upon which more contradictory 
diagnosis and advice can be obtained from the medical 
profession than those which fall into the vague and elastic 
category of “ undescended testicle ” I know a parent who 
was told that her son s testicles 
(n) Needed immediate operation if he were not to be prac 
ticalh a eunuch (A surgeon of great experience) 

(h) Should be left for five jears to sec what happened 
^ (Another reputable surgeon ) 

(c) Should be treated by hormone injections (A phjsician) 
ifl) Should on no account be operated upon as the operation 
invariably failed (The family general practitioner) 

(c) Were normal (Myself) 

(/) Were held up owing to a displaced vertebra (An 
osteopath ) 

It IS hardly necessary to say that the last diagnosis and 
the treatment that followed are now held responsible for 
the present obviously satisfactory condition of affairs 
Admittedly this is an extreme case, but others like it are 
only too common 

When I first began to see numbers of these cases I 
was continually in doubt as to what advice to give, but 
latterly they appear to me to belong to certain well- 
defined groups It may be of interest to put forward my 
present classification I am far from thinking it a final 
one, but it is certainly much better than anything I had 
to start with One of my difficulties was that the testicle 
m almost all its varied positions is extremely mobile, so 



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170 July 23 1938 


DIAGNOSIS OF DNDESCENDED TESTICLE 


Tnc Bamsir 
Medical Journal 


birth, and there is never ai y question of the correctness 
of their position 

(B) Lou- Retractile —In this common variety the lower 
limit of the range of movement is the same as in the 
adult — the bottom of the scrolun But the testis is so 
light and small, and the cremaster so active, that it is 
often pulled up over the bar of the pubic bone Once over 
this It runs freely into the superficial inguinal pouch, and 
may stay there for days, though it can always be forced 
down with the fingers 

Diagnosis — It is often diagnosed as undescended testicle ” 

Treatment — I have known these patients given injections of 
pregnyl wiih excellent results 1 hope they are never operated 
upon Needless to say they only need leaving alone 

(C) Hig/i Retractile —In these the testis remains 
habitually running freely in the superficial inguinal pouch, 
and does not spontaneously descend thence during child- 
hood It can, however, be pushed down well below 
the external ring, over the pubic bone, and into the neck 
of the scrotum This lower range of movement is the 
very important distinction between it and the superficial 
inguinal ectopic position 

Diagnosis — It is almost invariably diagnosed as an “un- 
descended testicle ’ 

Treatment — I believe that this class supplies the greater 
number of the successes of prcgnvl treatment, which un- 
doubtedly in many cases does enlarge the size of the gland and 
hurrv its descent A considerable number arc operated upon, 
usually With good results 

In my experience in these cases descent invariably 
occurs spontaneously when the testicle begins to enlarge 
to the adult size and weight 1 have never seen or heard 
of an adult testicle with this range of movement Certain 
cases for which I advised operation, and which to my 
confusion developed normally without it, undoubtedly 
belonged to this category They are also the justification 
of the policy of waiting to see what happens, and account 
for ‘ undescended testis ” being about three times as 
common in children as it is m adults 

2 UNDESCENDCD POSITIONS 

(A) Emergent Inguinal — In this position the testicle 
can be felt popping in and out of the external ring, 
moving freely in the hernial sac that invariably exists, 
much as an ovary often behaves in an infant of the 
opposite sex It should be noted that the testis only 
emerges or withdraws according to the mechanical forces 
acting upon it, such as increased abdominal pressure m 
one direction or the surgeons finger m the other It is 
never pulled m by a contraction of the cremaster, which 
IS always very poorly developed in these cases 

Diagnosis — This maj be as difficult as that of a small 
inguinal hernn the testis may be easy to feel one dav and 
impossible the next This is fortunately of no great import- 
ance as the treatment is the same as that of the conditions with 
which this variety maj be confused 

Prognosis — I am not sure what would be the fate of a 
testis of this sort if left untouched till adult life, as 1 have never 
felt It justifiable to do so If bowel descends into the hernial 
sac It would probably drag the testis down into the scrotum 
with It Apart from this, as the enlargement of puberty caused 
the testis to become a tighter and tighter fit m the external 
ring It would finallv be shut out permanently, as the forces 
which drive it out are so much stronger than those which draw 
It in Probablv it would end up m the superficial inguinal 
pouch rather than make its wav into the atrophic scrotum which 
IS usiialK present in these ewes ft is impossible to sav that 
these testes never descend cither spontaneously or after the 
vviministration of prcgnvl but I have never seen one do so 


Treatment — In every case operation, at which the co- 
existing hernial sac is removed 

(B) Middle Inguiiial — These testicles run in a hernial 
sac from one end of the inguinal canal to the other 
They are invariably badly developed, soft, and elongated 
to fit the space m which they lie It is ciinoiis to sec 
how they change into the normal compact rounded shape 
if they arc successfully shifted into the scrotum 

Diagnosis — ^The mam point is that it is impossible to 
diagnose this position without operation, since, as has been 
said, it IS impossible to feel a testis m the inguinal canal Con- 
sequently till the canal is opened one cannot say whether the 
festis IS in If, m the abdominal cavity, or is absent altogether 

Prognosis — I believe that these testes never descend spon 
taneoush or as a result of hormone treatment Descent of 
bowel into the hernial sac would probably bring one down 

Treatment — Operation in every case 

(C) Entrant Inguinal — ^Thc testis vanes in position 
between the upper end of the inguinal canal and the 
abdominal cavity Its only imporlant point of distinction 
from the preceding class is the greater difficulty of bring 
ing It down at operation 

(D) Abdominal — Here the main point of interest is 
whether, if one does not find a testicle in the inguinal 
canal, one is justified in opening the abdomen to search 
for It 

3 tCTOPIC POSITIONS 

(A) Siipiificial Inguinal — In this position the testis lies 
in the lower part of the superficial inguinal pouch, free 
to move up in it to an extent determined by the length 
of Its cord To arrive there it has turned sharply up 
wards and outwards on leaving the external ring, appar 
ently because of an abnormal attachment of the fascia of 
Scarpa to the pubic bone This means that instead of 
the inguinal pouch having an open lower end, the way 
from it into the scrotum is blocked by a strong fibrous 
hammock, in which the testis lies supported As I have 
said, some surgeons recognize this common position as 
an ectopia, but many do not Ombredanne (1932) docs 
not figure it in his diagram of the directions m which 
ectopia may occur, and McAdam Eccles shows several 
examples of it in his classic worl' as irguinal reten'ion 
and not as ectopia A point of interest is that if a 
large hernia develops in this position it will descend into 
the ingumo-crural fold, not into the scrotum 

Diagnosis — The most important single point in the diagnosis 
of testicuhr position is the d stinction between this displace 
ment and the high retractile testis One needs operation and 
one does not One responds to pregnyl and one does not 
One develops normally if left alone and one does not 

Prognosis — There is no possibility of spontaneous descent 

Treatment — I have known vast amounts of pregnyl cm 
ployed in attacks upon this variety, with no result whatever 
on the position It is the one which accounts for the fact, 
still being confirmed, that cases of unilaferal undescended 
teslis average much poorer results with hormone treatment 
than bilateral ones Incidentally I would have thought that 
if one testis had descended normally it might be assumed that 
whatever was keeping up the other, it could not be lack of 
hormones However, 1 have never had this objection taken . 
seriously as a reason against giving a course The only treat 
ment is operation It is easier than in a true undcsccndcd 
testicle, owing to the extra length of cord 

(B) Emergent Superficial Ingumal Ectopic — The dis 
tinction between this and the emergent inguinal position 
IS merely a fine shade of diagnosis In everything else 
they are alike 

(C) Othir Ectopic Positions — The penile, femoral, peri- 
neal, and other well-rccognizcd positions present no diTi 



21 1 9 IS 


DI •\GNOSlS OF UNDESCENDED TESTICLE 


Ttn- B rTEiH 

^ttD CAT JOCTfVM. 


cuIliLs m diagnosi'i As i curiositj I rmj mention being 
calEd to operate upon what was diagnosed as an acute 
appendix AcIiialK it was a torsion of a testicle between 
the two oblique muscles oser McBurnev s point 

Sum man 

To recapitulate some of the points which hare been 
put lorward 

1 A testicle that IS in the inguinal canal cannot be 
felt through the skin Conserselj a testicle that can be 
felt IS not in the inguinal canal 

2 The testis is neser withdrawn into the inguinal canal 
b\ the cremaster 

1 N\hcn the testis ascends from the scrotum it runs 
into a somewhat similar pouch abose external to the 
abdominal muscles 

4 A testis that can be easdj seen through the skin an> 
where except in the scrotum is ectopic 

a A testis that can be pushed down o\er the pubic 
bone Will inxariabU descend spontaneousU b) the time 
full growth IS reached 

6 Prcgntl treatment will not bring down ant testis that 
would not hate descended without it though it will hurr> 
the descent Whether this acceleration is worth the risk 
of certain disquieting possibilities is a matter of opinion 

RtrERtxcEs 

Bntct Hamilton (1916) Disetsei of the Testtefe Lewis London 
Barrincton Ward L n917) Abdou inal Siireer^ of Children 
Oxford Unitcrsit) Press 
Broisaie Denis (I9a1) Lancet 1 AbO 

EecE W McAdam (1903) Iniperfectl) Detcenfed Testis 
Baillicre Tindall and Cor London 
—— (19-0) Siircen edited b> G E Cask and H W Wil on 
} and A Churchill London 

Ombredanne L (1932) Chtrnreie Infantile (ftc 611) Xfasson 
Pans 


mASLES 

THE CONDUCT OT A SCHOOL EPIDEMIC 

BX 

r G HOBSON, DSO.DM.TRCP 

ffoi arars Pfissician to the Radchfje liifirmari and Counts 
Hospital O xford 

W'hat should be the course and outcome of an epidemic 
of measles m a school community’’ The answer to such 
a question must depend upon a number of considerations 
— clinical seasonal domestic and economic — and yet 
each medical officer of a school community must bare 
before him an ideal that it will be his endeavour to 
realize when faced with the mer liable and recurrent 
onslaught of measles in the community for which he is 
responsible 

Agreement is still incomplete upon the elementary data 
fHobson 1934) rvhich mav conveniently be slated as 
under 

1 Measles is due to a virus — as yet unidentified — and a 
natural attack of the disease is generallr regarded as con 
ferrmg a permanent immunity Second and third attacks of 
the disease are well known to occur but are so rare that they 
can safely be ignored within the age limits of school life 
It IS frequently staled and generally assumed that an attack 
of measles atiettnated by the administration of immune 
serum confers an immunity as permanent as that which 
results from a natural attack This reasonable assumption 
mar prove to be well founded but as yet it rests upon no 
solid body of clinical evidence 

2 Infection is by droplets from the nasopharyngeal excre 
tions of infected individuals and a patient mav be infectious 


I "I 


SIX davs before the appearance of a rash (Hobson 19w) 
The catarrhal di charges of the infected nav also be the 
rectors of secondarv virulent organisms to other susceptibles 

2 The incubation period is more than ten davs and n 
serum treated cases mav be tvventv one davs In semm 
treated cases there miv be no clinical evidence of infection 
before the explosive appearance of a rash on the twentr first 
dar (Hobson 1934) 

4 Quarantine should be ob erred for twentr one davs m 
all cases 

Measles vies with influenza and whooping-cough as the 
most infectious disease in a closed or semi-cio ed com 
munity such as a school and the prospects of limiting the 
spread of the disease by earlv diagnosis and segregation 
of infected individuals are rerv small indeed KopliLs 
spots appear too late and too inconstantly to be ot anv 
real value m earlv diagnosis and mav be reeognizable 
onlv with the appearance of the rash in serum treated 
Cases 

The First Pnnciple 

If these data be accepted the first principle in conducting 
a school epidemic will be that the epidemic shall be 
allowed to take its course and that the suscepubles who 
succumb shall experience a natural attack, of the disease 
in the maximum seennts thereby acquiring a permaneni 
immumlv This principle requires amplification 

1 StiscepiihUs — In each school there will be a small 
number of delicate su ceptibles for whom an -ttaci ot 
measles will entail an unusual nsk particularly in the case of 
those children who are liable lo oto rhinological or pulmonarv 
diseases For the e cases which should be 'elected bv the 
school medical officer serum p'ophrlaxis is clearly tndi 
cated For a few speciallv delicate susceptibles the dose 
should be one that will ensure protection — such children 
should then be removed from school to avoid further exposure 
to infection on a falling tide of passive immumtv For the 
ma)oriIv of such delicate su'ceptibles the do e of serun 
(see later) should be so timed and adjusted as to ecure 
otteniiation of the attack and these protected suscepubles 
should be allowed to continue with normal school routine 
The routine u'e of convalescent serum for all su'ceptibles 
Is not rcvommcnded until the time comes when serum therapv 
has a scicnlific posologv and it has been estabhshed that 
the immunitv from an otter noted attack is as permanent as 
that which results from a natural attack of the disease The 
deliberate postponement of an attack of the disease bv 
protecting all susceptibles cannot be considered as wise 
allhough special circumstances mav justifv such a practice 
(Hobson I9j4) Such special circumstances must be pidged 
by the medical officer concerned but a coincident epidemic 
due to 5 psogenes or H pertussis might be mentioned as a 
circumstance such as would justify an attempt at mass pro 
lection or mass atlemialion 

2 Seciintx —The complications of measles present the real 
danger to health and life such complications ansmg from 
secondarv infection bv pvogenic cocci particularlv from 
V oyogenes Complications mav denve from an mtnnsic or 
extrinsic source of infection they come far more fre 
quentiv from the latter Complications are most iisuath 
secondary infections diseases ansmg from cross mfection bv 
tieichbours nur'es or doctors (Okell and Elliott, 19 j 6 
keevil and Camps 1937) Secunlv from cross infection can 
be attained onlv by stnetiv observing the estabhshed rules of 
environmental hvgiene and nursing which are familiar to 
the profession in treating all highlv infectious diseases The 
measures so indicated can be bneflv summarized under the 
headings of 

Bed Spacing — minimum ot six feet should be preserved 
belli een the edges of adjacent beds in w ell v enulated sick 
rooms or aUemativelv effective barrier nursing. (VS’here 
cubicles are available no difficulty arises.) 



172 July 23, 19j8 


CONDUCT OF SCHOOL EPIDEMIC OF MEASLES 


Tiic British 
Medical Journal 


Masking — Nurses md doctors should invariably wear masks 
when in close contact with the patients * 

StenUzatwn — All table-ware, cutlerv, etc, used by the 
patients should be sterilized after each meal 

Personal linen ton els etc must be so supplied as to avoid 
common use or exchange, while paper handkerchiefs, which 
can be destro>ed, should be employed for all nasopharyngeal 
discharges 

The fact that those who succumb are suffering from the 
same disease must never be used as an argument for 
the relaxation of any of these accepted rules 
The self-contained preparatory boarding school is an 
ideal community for epidemiological study, m that its 
inmates are usually housed in one building, have minimal 
opportunities for contact with the outer world, and have 
become salted ” to their indigenous flora The school 
environment, “ the stage ” on which an epidemic may be 
set, IS a fixture that must be adapted to the requirements 
of an epidemic, and in this process of adaptation and m 
the strict conduct of environmental hygiene in the sick- 
rooms the personal ingenuity and industry of the medical 
officer have full play (Dudley, 1926 Glover et at, 1932) 
No step should be omitted to ensure that the child shall 
sustain the attack of an epidemic disease in conditions of 
safety comparable to the isolation of an independent sick- 
room in the family home 

The power of the responsible mtdical officer to order 
the conduct of an epidemic is, however, subject to those 
limitations which may be imposed by parental acceptance 
or refusal of a proposed course of action Any course 
which involves the use of a therapeutic agent other than 
the traditional bottle of medicine, or entails a specific 
extra charge, is m practice referred for parental consent 
even when the action or dilatoriness of a few individuals 
may prejudice or frustrate a plan of action designed to 
safeguard the interests of a community as a whole 
In relation to any new prophylactic or therapeutic 
practice the measure of the average parent’s knowledge is 
uncertain, and opinions may therefore be influenced by 
prejudice, ignorance, and anxiety For these reasons a 
clear statement of the relevant facts should be sent to 
all parents without delay, with the usual notice of the 
appear ince of the initial case, since the prophylactic 
administration of serum for protection or attenuation 
must be prompt if it is to be effective The form of this 
statement is of some importance, and the following is sug- 
gested as likely to secure the co-opcration of parents, 
although It will be obvious that no attempt has been made 
to distinguish between protection and attenuation — a dis- 
tinction difficult to make intelligible to the layman and 
impossible to ensure in practice 

Quarantine Notice 

“A case of measles clei eloped on , 

and It rnust be anticipated that further cases will 
occur 

‘ B) the injection of human scrum (from persons 
who ha\e themsehes had measles) it is possible 
temporarily to protect an exposed susceptible indi- 
\idual from the disease with \er> reasonable prospects 
of success 

The inimunii> conferred is only temporary, and the 
child becomes again susceptible to the disease in from 
SIX to twehe weeks time the duration of this tem- 
porary immunitx is always a matter of doubt 

This practice merclv postpones an attack to a later 
age The normal expectation is that one attack of 
measles confers a permanent immuniU and will be 
well sustuned h\ the xasl maiorilv of children 

* The MisKon celluloid mask supplied by Down Bros, is an 

cltiLicnt nmi »« rvo * 


‘In view of the fact that reliable protective scrum 
is only available in very limited quantities it is 
suggested that any child who ma\ be considered 
delicate or for whom an attack of measles may entail 
some special risk shall be protected by an injection of 
serum 

‘ It IS suggested that in the case of children who 
are in good health events should be allowed to take 
their normal course ” 

Signed 

For “ delicate susceptibles ” a footnote is added 

“ It is recommended that your child be given an 
injection of serum It is impossible to ensure com- 
plete protection but this treatment can be expected to 
mitigate the severity of an attack ” - 

For specially selected “ delicate susceptibles ” 

“ It is recommended that your child be given 
an injection of serum at once and taken home until 
the school is out of quarantine ’ 

Serum Prophylaxis 

Since Gunn (1928) introduced prophylactic scrum 
therapy into this country there has accumulated a con- 
siderable body of evidence as to its x alue (L C C Measles 
Epidemic I93I-2, 1933-4 , Gunn, 1938) The use of 
serum prophylaxis calls for judgment and discretion, and 
It may be helpful to give a brief summary of the known 
facts 

Three preparations are available 

\ Coinalesccnt Smim— Obtained from individuals who 
have recently recovered from an attack of measles There 
IS at present no uniformity in the practice of collecting such 
serum (In the Oxford service an arbitrary limit has been 
employed — namely, that such serum should be collected 
within one month of the rash of the donor) 

B /4dnlt Sciiim — From adults yvho have experienced an 
attack of measles tin Oxford an arbitrary limit of ten years 
from the attack of measles is obserxed) 

C Immune Clobiilm (Leder)e) — This is the pooled globulin 
obtained from human placentas 

It IS yvell to recognize the comparative and common 
merits and defects of these three pieparations, the powers 
and dosage of yvhich are often stated with a precision 
which is not justified by the knoxvn facts Until such time 
as It IS possible to determine the antibody content of a 
given preparation the posology must be empirical The 
practice of pooling yvill favour an approximation to a 
standard potency, and the efficiency of the three prepara- 
tions IS likely to be in the order given The rate of 
deterioration of the antibody content of serum is unknoyvn, 
and in this respect the immune globulin may have an 
advantageous quality All three preparations, xvhen 
administered m adequate dosage prior to the “ critical 
day,’ can undoubtedly exercise a favourable influence 
upon the course of an attack of measles It is probable 
that the ‘ critical day — that day of the incubation of the 
disease after yvhich no protective therapy can influence its 
course — is the sixth day after exposure calculated from 
the first appearance of the rash of the infecting case 
(LCC Measles Epidemic, 1931-2) By this time the 
disease may have been incubating in the susceptible 
individual for six to ten days * 

♦Gunn (1938) m a resicyv of the clinicTl results of 'criiin 
proplijlixib of measlLs m LCC hospinls fails to make desr the 
basis of calculation in arrixing at the itiilc of exposure As in llic 
previous LCC reports (1931-2 1933-4) this point has never been 
clanlicti The dale of the appear inec of the rash of llic inRcling 
case must in practice be the clinical event about which there can 
be no argument or doubt A given case may have been infectious 
for one to five dajs before the appearance of the rash and ihc 
earliest diy of mfcctivily can rarclj be determined on clinical 
evidence The practice of scrum prophylaxis will be less confiistu 
if the iltiu o{ exposure is the date of the appearance of the rash 
of the infecting case 


I 



JuL> 23 193S 


CONDUCT OF SCHOOL EPIDEMIC OF MEASLES 


Tn£ 

CXL /0<. *-V tL 


1-3 


Protection — MTicre eomplclL prolec 
tion IS dssircd the nnxtmum dose 
should bi. gitcn at the earliest moment 
after exposure later ih in the third 
da\ after the rash of the infecting 
case the prospects of success arc 
small A protectise dose confers 
no more than a temporary passise 
immun!t> 

Attcmianon can be achieved b\ two 
methods (n) the carls injection of a sub 
maximal dose — that is before the third 
da> {h) the injection of a maximum dose 
late in the incubation period (L C C 
Measles Epidemic 1931-3) — that is on 
the sixth dav This latter method 
has in m> experience proved to 
be the more satisfacton and for 
obvious administrative reasons fobiam 
mg parental consent etc! the more 
practicable j — S.ticm'' of projectile iherjpv (Reprodu ed b-- 

count V of O^fo d Lniverif^ Pre » 

An Epidemic in a Prepamton School 



Tlic cpidumic now to be described dcNclope.d in charac- 
teristic fashion from a single case m the first week of the 
Lent term 1938 m a school of ninci> fut bo>s This 
school experienced a pre\ioiis epidemic in 1929 (School 
A Fie 2 Tabic ID 





Fig 4 — Mea>lej in School \ m 19^3 


There were fitn six susccptibles In 
Mew ot the tact that there was no inier- 
current infection in the school or an> 
other special circumstance which might 
expose those attacked to ans undue risk 
It was decided 

1 To attenuate the attack in all knowT 
(lencQie mneplibles with iCS) con%ale> 
cent measles serum flO c cm I on the sixth 
das after exposure to the initial case 
Delicate susceptibles were tho«e children 
who had suffered from known pulmonan 
or oto rhmological disease in the prei-ioui 
\ear or who had an unsatisfactorv previous 
medical hislon Thirteen such case^* were 
selected and the parents were ratified of 
this proposed protectne therap\ " all 
agreed to its emplovment 

2 To allow the epidemic to follow ita 
natural course m the remaining forts three 
ca'-es Parents of the<e children received 
a noijficaiton of the appearance of neasle> 
in the school with a recommendation acainst 
protection (see letter given above; The 
parents of nine children insisted upon serum 
therapv and in each case the child received 
IJ G ) immune globulin (10 ccml (£2 2.s^ on 
the sixth and sexenth da>s after exposure 
to the initial case 









174 July 23, 1938 


CONDUCT OF SCHOOL EPIDEMIC OF MEASLES 


TirnBRiTinr 
Medical Journal 


No sreofic thenpv "is emplojed for the rcimining 
thirty-four boys 

3 The en\ironmenhl hygiene tnd nursing precautions 
described earlier m the paper were rigidly observed 

The results of conducting the epidemic on the above 
principles and the clinical data so provided may con- 
veniently be summarized under separate headings 

General Results 

1 No complication of any kind occnired in the fifty- 
six cases attacked 

2 All of the CS -protected and I G -protected cases 
showed attenuated attacks (Fig 4, Table V ) 

Morning and evening temperatures were taken from the 
first day of term until the completion of the epidemic, and 
any boy showing a temperature of over 99 5° was isolated 
for observation Every child who showed any febrile 
disturbance was inspected daily 

Ptodiomal Fever — ^The prodromal fever was appre- 
ciably shortened in the protected cases In two cases the 
rash appeared on the twenty-first day after exposure to 
the initial case without any prodromal fever or the appear- 
ance of any Koplik’s spots (One case C S , one case I G ) 

Kopliks Spots — Even in the unprotected the appear- 
ance of this characteristic lesion is so late as to be useless 
as an early diagnostic sign , six of thirty-two unprotected 
cases showed no Koplik s spots before the rash , this 
applied to eleven of twenty-two protected cases 


Table I 



No 

Average Days 
Prodromal Fever 

[ A>erage Days 
Koplik s Spots 

No 

Unprotccud 

32* 

26 

to 


Protected 

22 

1 8 

05 


Unprotected 

32 

Actual Days 

Actual Days 


MaMinuni 

10 

40 

40 

1 

Mnuniurn 

7 

to 

0 

6 

Protected 

22 




Manmittn i 

2 

40 

20 

3 

Mim/nunt 

3 

0 

0 

It 


• T\no bo>s of ihc origiml four unprotected cases >\ere taken home on the 
appearance of the initial fe\cr 


Protection (th't is, attenuation) was secured by the 
administr ition of (C S ) convalescent serum 10 cem 
(thirteen cases) and (I G ) immune globulin 10 cem 
(nine cises),* which was injected on the sixth day — the 
“ critical dav With one exception — a patient who had 
been given only 4 c cm of immune globulin by his iamily 
doctor — the attack of measles was definitely attenuated 
as regards both seventy and the height and duration of 
the febrile reaction Two CS cases had aborted 
attacks — that is a minimal febrile reaction (99 5° to 100°) 
for three days and a transitory rash 
The convalescent measles serum was obtained from the 
medical officer of health for Oxford, and was “pooled” 
serum the evidence suggests that this was less potent 
thin the convalescent serum employed in School B, 1934, 
and the larger dose was given on this assumption (Fig 3, 
Tiblc IV) 


• The cliim that immune globulin modilies an attack of measles 
IS sustimi.d but as ihe author ms sceptical of the claims of this 
ricpumon 10 L cm was emplojed allhough the makers recom- 

The single case which received a 
\\\ do^c no attenuation 


Previous experience with measles epidemics can be 
graphically demonstrated and the lessons learned empha 
sized 


Table II — School A {1929) Thirty-siv SnsccpUblts 



No 

Measles 

Escaped 

Unprotected 

36 

36 

0 

Protected 

0 

0 

0 

Total 

36 

36 

0 


100 per cent infected, none escaped 6 complications (olilis 
media, 3 cases , bronchopncimionn and olitis media 3 cases) 

Lesson — The high incidence of complications was 
attributed to overcrowding, inadequate bed-spacing, and 
failure to observe a strict environmental hygiene 


Table III — School 

B (1930) 

Sntc light 

Sinccptiblcs 


No 

Measles 

Escaped 

Unprotcclcd 

65 

46 

19 

Protected 

3 

2 

1 

Total 

68 

48 

20 

70 per cent infected , 

30 per cent escaped , 

I complication, 


2 piolccled children who developed measles had modified attacks 


Lesson — Strict observance of environmental hygiene 
and a very limited use of convalescent scrum proved 
eminently satisfactory 


Table IV — School B {1934) Fift) one Siiuipiibhs 



No 

Me isles 

Escaped 

Unpiotectcd 

2 

0 

2 

Protected 

49 

10 

39 

Total 

sT 

11» 

41 


20 per cent infitlcd , 80 per cent escaped , no complicalions 
10 protected children developed measles and 6 of them Ind 
modified attacks 

Lesson — ^An extensive use of convalescent scrum 
to produce a mass “ attenuation ” produced an almost 
complete mass “ protection ’ 

During the previous term whooping-cough and a wide- 
spread nasopharyngeal epidemic due to S pyogenes sug 
gested the wisdom of such an attempt to mitigate the 
severity of measles in a population which might contain 
numerous carriers of virulent streptococci The con 
valescent serum employed lor this purpose was obviously 
of a very high potency (the bulk having been obtained 
Irom two recently recovered adults), as shown by the fact 
that the protected susceptibles were exposed for ten weeks 
to fresh cases An average dose of only 6 c cm vWas given 
on the sixth day after exposure (Hobson, 1934) 


Tabli- V— School A (1938) 
No 

Unprotected 34 

Protected 22 


ri/li wv Siisciptibks 
Measles Escaped 

34 0 


22 (aticmiated) 0 


Total 56 56 6 

100 per cent infected , none escaped , 6 complications (olilis 
protected cases all had attemnted attacks 


Discussion 

The prcparitory school of about 100 inmates is an 
almost ideal unit for purposes of epidemiologic il study', 
and the experience g lined in handling such tinils may 
reasonably be expected to provide the materials for the 
formulation of principles in the conduct of epidemic 
disease in larger communities The size, character (day 
or boarding), composition (age and sex), and location of 
a given school may introduce a number of variable 
factors into the problem of the conduct of an epidemic , 
nevertheless the principles in conducting such an epidemic 
must hold if such be correctly conceived Measles is a 
disease which is peculiarly su itable for such a study 

• One boj staled to have had measles and therefore not prolcclcd 
by serum developed measles, possibly a second iltack 



2' 19 S 


CONDUCT OF SCHOOL EPIDEMIC OF MEASLES 


Tht British 
^[£D^CA i. JOLP'-- 


17=: 


I lu'i. cndc i\oiir<.d in this article to formulate those 
principlce which seem to me fundamental and to demon- 
strite that in practice the\ cm be cflcctixe 

Conclusions 

The principles for the conduct ot an epidemic of 
measles in a self contained school communite are dis 
ctisscd and their application in practice is illustrated in 
four epidemics These principles arc 

1 That healths su ceptible indisiduals should be permitted 
to espcnence a normal ittich of measles after exposure to 
infection 

2 That delicate susccptibles should be protceted 
“Delicate susceptibles till into tsso catecorics (o) those for 
sshom complete protection should be secured (/>) those for 
sshom attenuation should be \ sullicient safeguard from 
undue rishs 

' That ensironmenlal hsgiene must be striells praetised 
in sich rooms tor all cases 

Experiences in the use of protectise scrum arc 
des ribwd and emphasis is laid upon the inherent difli 
cullies ot posologs In practice the date of administra 
tion should be calcul ilcd from the rash of the infecting 
case For prouciion a maximum dose should be giscn 
't the earliest opportunils after exposure and neser later 
than the third das For attenuation a maximum dose 
should be gisen on the sixth das 

RtllRESCFS 

Dudles S F (19.6) Mid Res CncI Spec Rep S'! bo III 
London 

Closer J A et at U9i:) Pro ro\ Sue Uet 25 1731 
Gunn \X (19231 Lancet 2 690 

(I91SI Pro- rut So- \fiil 31 323 

Hobson F G (19 41 Lamet 2 1403 

keesil \ L and Camps F E (1917) Ibid 2 207 

LCC Measles Fpidemic (1911-2) 

Ibid (193 -41 

OLell C C and Elliott S D (1916) Lnn-el 2 316 


SUB^TESICAL DUTHERMY PROST4- 
TECTOtMA 

BV 

R OGIER WARD, M Ch , F R C S 

Cansultuig Gcniio urutar\ SurRcon \f tiler Gertcrttl Hospital 
Assistant Surgeon Sr Peter s Hospital Genito 
urinary Siir-eon Rosal Masonic Hospital 

Pcurelhral resection of an obstructing prostate seems by 
noss to base sson an established place in genito urinary 
surgers Opinions sary as to the tspe of case in svhich 
It IS best emplosed though most surgeons are agreed m 
preferring prostatectoms sshen dealing svith a'proslate sshich 
IS much enlarged It should be remembered that sshen 
the enlargement is of a benign type the chief indication 
for adsising such treatment is precisely the same as sshen 
prostatectoms by ans other method is chosen — that is to 
sas the presence of residual urine If this amounts only to 
an ounce or tsso it is unnecessary to employ either per- 
urcthral resection of the prostate or ans other surgical 
treatment But although the measure of the residual 
urine is by far the most important guide to treatment 
obstruction may sometimes call for operation sshen the 
solume ot it is not large for if the act of micturition 
IS unduly difficult and prolonged the patient mas expen 
ence much inconsemence particiilarls when nocturnal 
frequency is present Attention should also be gisen to 
the csstoscopic appearances of the bladder ssall and 


marked signs of stress as esidenced bs the presence ot 
excessise trabeculation or more important still saccula 
tion are an indication for the relief of the obstruction 

The Usual Mejhod of Resection 

When earls cases are treated sery fess cuts ssith the 
diathermy loop in the middle line and to right and lett 
of It are all that is necessars and the same applies sshen 
the prostate is of the small but highls obstructise tspe 
It IS sshi-n the p-ostate is moderatels or much enlarged 
that the operation becomes more difficult and more 
formidable The dangers sshich attend it are haemor 
rhat,t and stpsts Haemorrhage is ines liable It is 
slight sshen fibrous prostates are treated and not usualls 
abundant in cases of carcinoma though in some of these 
It IS sesere It is more profuse sshen cases of benign 
enlargement are operated upon Much of the bleed ng 
comes from the region of the internal meatus xshere the 
diatherms loop cuts through the highly sascular trigonal 
mucosa beneath sshich lie also some of the most 
important arteries supplsing the prostate itself It is 
from this same region that a sers large amount of 
bleeding occurs in prostatectoms bs enucleation Sepsi, 
IS common and often serious It occurs because necros s 
IS produced bs cutting ssiih the diatherms loop In th-- 
ordinars method ot resection not onis is ihe surlace ot the 
residuum ot the gland sshich surrounds the prosiati 
urethra thus necessarils affected but a large portion ot the 
trigone IS also remosed sometimes almost up to the ureters 
for It IS only bs sacrificing this that the diatherms loop can 
be engaged in the lateral lobes after Ihe intrasesical pro 
jection has been dealt ssith This is because the loop 

onh moses and cuts along the axis ot the resecto cope 
sheath If at the end of si/ch a resection the bladder 
IS opened it svill be found that a cone of tissue has been 
resected from the prostate The apex ot this is m the 
region of the serumontanum and its base corresponds 
to the trigone and the area immediatels around the 
internal urinars meatus An explorators fingc- no s 
passes along the posterior bladder ssall oser the inter 
ureteric bar and dosvn into the prostatic region sshich 
IS found to be laid sside open because a large part of the 
bladder base has mesitabls been cut assas This is of 
course quite different from the condition sshich exists 
sshen the operation of prostatectomy by enucleation is 
emplosed sshether bs the suprapubic or the perineal 
route In such cases the internal meatus though 
expanded is still comparatisely small beneath the neck 
of the bladder there is a recess the prostatic fossa 
betsseen it and the triangular ligament from sshich the 
prostate has been remosed It is easy to feel and to see 
that the trigone itself has been left almost intact 

The Modified Technique 

It has seemed to me that such methods of peruretbral 
prostatectomy should be asoided and that an endeasour 
should be made to make the anatomical result resemble as 
closels as possible that of prostatectoms bs enucleation 
To achiese this it must be practicable to resect the gland 
from around the prostatic urethra and from beneath the 
trigone ssithout cutting or in ans ssay damaging this 
structure except to a sery limited extent in the neighbour 
hood of the posterior mid line sshere this occurs in the 
process of remosing the intrasesical projection itself With 
this in siesv I suggested to Mr Schranr of the Genito 
Urinary Company that an inclined plane should be built 
into the end of the beak of the McCarths resectoscope 
sshich ssould push forssard the supports of the loop as this 



176 Jvvi 23 1938 


SljBVESICAL DIATHERMY PROSTATECTOMY 


The Bfitish 
Medical 3oups;kL 


IS wound out of the sheath into the cutting position (See 
Fig I This h^s been successfully achieved in the model 
which he has produced for me, and as a result the whole 
extent of the loop projects in front of the sheath when 
it IS in the extreme forward position For this reason, 
and because it is firmly supported the loop when 
activated by the diathermy current can be buried into- 
the prostate much more deeply than is possible in the 
older type ot instrument At the conclusion of the cut 
It IS automatically withdrawn into the confines of the 
sheath The resection is begun m the middle line 
posteriorly first the loop may be placed over the intra- 
vesical projection in the usual manner until it is hidden 
from view , one such cut being usually sufficient After 
this the loop IS not again allowed to enter the bladder 
caxity but from now on is placed always under vision 
in position against the prostate within the urethra at a 
level immediately below the internal meatus At the 


able when this new tvpc of diathermy loop is cmploved 
is that the pieces resected are often too large to 
wash out through the resectoscope, and it becomes 
necessary to recover them at the conclusion of the opera- 
tion by aspiration, using the bulb of a Bigelow s evacuator 
attached to the sheath of the resectoscope by a short 
metal adaptor or by grab forceps Since larger pieces 
are cut avvav by these loops than by those of the original 
tvpe It IS possible to work through a smaller sheath, and 
one of 26 Charriere scale will be found very efficient 
The risk ot damage to the urethra is thereby lessened 

Die New Model Resectoscope 

The new model 6f McCarthy resectoscope made by the 
Genito-Urinary Company is in sev'eral other respects a 
great improvement upon the previous models, from which 
It has been evolved The sheath, like the recent American 
pattern, is metal outside with the exception of the 



moment when the current is turned on the loop is first 
embedded in the tissues at this level by pressing the beak 
of the sheath hrmly in the required direction, and then the 
cut IS made from there downwards In other respects the 
procedure is that usually practised — namely, as much 
resection as is desired is carried out on one lateral lobe 
before treatment of the other side is begun These cuts, 
beginning always within the prostatic urethra resect chieflv 
the lateral lobes but must be continued well loiind to 
include the fiont ot the gland on both sides Even 
with the aid of these new loops and the advantage 
which thev give, it will be found that sooner or later 
a stage IS reached when further cutting into the lateral 
lobes IS mechanic illy impossible 


At the end ot a peruielhral icsection conducted in 
this m inner it the instrument is withdrawn so that the 
objective ot the telescope lies at the level of the veru- 
montanum one finds oneself looking into a recess which 
has been excavated beneath the bladder and at the top 
of this IS a small opening into the bladder , m other 
words the result is very similar to that which is pro- 
duced alter a prostate has been enucleated The opening 
into the bl idder can easily be enlarged if it is desired, 
but I feel sure that the less of the trigone that is 
resected the better from the point of view of immediate 
haemorrhage and subsequent sepsis Because 'he 
aperture which leads from the prostatic fossa into the 
bladder is small some care is necessary in passing the 
catheter, which is to be left in position, as the point of it 
tends to be held up in the prostatic bed 


If this technique, which mav be called siibiesual dia- 
thermy prostatectomv or prostatic resection, is employed it 
will be found that h lemorrhage is less than with the older 
method and that it is more easily controlled Sepsis is 
dso much diminished owing I believe to the fact that 

cm, nniiilaKd One comphcsuon which is unavoid- 


bakelilc beak, and this part, of the instrument is now 
made shorter than in the original models — a modification 
jvhich IS essential if resection is to be carried out beneath 
the trigone, for which same purpose, as has been ex 
plained, the projecting loops have been specially designed 
The projecting loop has the further advantage that it is 
more easily seen than are those of the older patterns, 
being nearer to the centre of the telescopic field when m 
the extreme forward position from which the cut is begun 
These loops, the manner in which they are supported, and 
the new svstem of flushing are the only components for 
which I can claim originality The tap will be found 
satisfactory, as it gives simplified control and allows of a 
larger current of water Particular care should be taken 
not to over-distend the bladder, and therefore the top 
water-level in the irrigator should not be more than 
eighteen inches above the patient’s abdomen 


A course of lectures and clinical instruction for mcdicil 
practitioners on problems connected with retarded and difficull 
children has been arranged by the University Extension and 
Tutorial Classes Council, m co operation wiih the Ceninl 
Association for Mental Welfare, and will be held from 
Monday, November 7, to Saturday, November 12 It is open 
to those practitioners who have already attended the course on 
mental deficiencv and allied conditions, or who have specialized 
experience approved for the purpose of the course The 
lectures will be delivered at the University of London, Senate 
House, Bloomsbury (entrance from Russell Square), unless 
otherwise stated on the students’ time tables, and will be given 
from 10 a m to 12 30 pm each day Detailed timetables 
Will be sent by October 31 to each person proposing to atlend 
the course, and forms of application should be filled in and 
returned not later than October 7 The University "iH S'’*'”’* 
certificates ot attendance to those who attend reguiarlv', tahing 
both theoretical and practical work Registration fee, 10s 
fee for the course £3 3s All communications should be 
addressed to Miss Evclvn Fox, c/o University Extension 
Department, University of London, WCl 


Jlx\ 21 I9ls 


RUPTURE OF UTERUS DURING PREGNANC\ 


The BRm'V 

NfttHCAl. J0CV»<L 


IT7 


RUPTURE or THE UTERUS DURING 
PREGNANCY 

nv 

J VAIES KIDDLLL M D . F R C S Ed , M C O G 

Ho toriin CMiaccx^loqtcfll Sttri,ton Prttiir of If dies s 
llcsptiol ri\ month 

AND 

JOH> SCUOLEnrUD M B , Ch R rues 

Kc^utci t Stiri^uiil Ofhicr Prime of If n/t s \ Uoipitai 
Pl\ month 

The ease of rupture of the uterus tiurms pregn inc> which 
IS dcscnbccl m detail and di«:usstd in this paper uas that 
01 a primigrasida aged 20 admitted to the Prince ol 
ales s Hospital Plymouth 

Clinical Heston 

The patient ssas IhirU i\so sleeks prci.nani and had been 
auending an antenatal clinic and had enjosed health diinni, 
the whole of her pregnanes There was no htstors of ans 
pcUie pam esen during the earU weeks of pregnanes On 
the morning of admission to hospital she sat vip in bed and 
was seized with seserc abdominal pun Dunng the course of 
the mornmu she sent for a midwife ssho found her walking 
about her room complaining of a pam in the lower part of 
the abdomen on iht riuhi side The midwife put the patient 
to bed and s^nl for the famiU doctor He sent the patient 
to hospital basing diagno ed acute ippenditiiis She was 
admitted to hospital shortU after middas and was obscrscd 
bs one of us (J S ) 

On admission the patient looked pale and toxic There ssos 
not ans restlessness but her respirations sscre rather rapid and 
there was some dsspnoea The pain was referred to the right 
hspovhondnum and svas of a coheks nature There was some 
tenderness m the right hspos.hondruim but not ans rigidils 
and pressure here resulted in a "cncs of short rapid rcspira 
lions The uterus appeared normal for a thiru two week 
pregnanes and a Using child m the left occipito anterior 
pOMtton was diagnosed ‘ 

The unne was carefullv examined to exclude a psclitis and 
a phssiaans opinion obtained to exclude an acute diaphrag 
matic pleunss The tenderness appeared to be too hifeh for 
appendicitis and the histors did not suppon such a d('agnO'«is 
A proMsional diacnosis of an acute choices stitis complicating 
pregnanes was made and the patient svas placed m the 
Fowler position and put on fluids for ob ersaiion During the 
next few hours the pain did not show ans signs of abating 
and the tenderness had increa'^ed A further opinion was 
sought 

Further Evamination of the Case 

The patient was referred to me (J R ) at 10 p m on the 
evening of her admission to hospital She was complaining 
of sesere pam under the costal margins and under the shoulder 
blades and was in great distress partrcularlv with dv‘ipnoea 
There was not ans pam referred to the shoulders 
The outline of the uterus was regular and was clcarls 
defined The uterus was enlarged to the size of a thirtv two 
week pregnanev The foetal heart sounds were heard 
Above the level of the uterus the abdominal wall was flaccid 
but there vCas pronounced tenderness under the costal margins 
There was slight bleeding from the vagina The external os 
was closed The patient wxs not in labour Exafmmtion of 
the chcNt did not disclo e anv thing abnormal The urjne was 
free from pus celK and B eoU The temperature was 9SS 
puKe 120 reipiralions 28 


I w'as not able to make a diagnosis though I considered 
that an acute abdominal emergenev might be in procress 
possiblv an internal haemorrhage I wa^ not able to satiitv 
mvseif that there was sufficient evidence to warrant opening 
the abdomen that night I desired to wait and to make 
further observation An hourlv pulse chart was arranged for 
and a request was made that 1 should be called if the pul^e 
rate increased appreciabh A third of a grain of omnopon 
was administered hvpodermicalh The patient slept and the 
pulse rate fell to 90 bv 6am 

I saw the patient next dav shortK betore I pm when 
I found that the clinical picture had changed The patient 
wax keeping but her face had a more distres^d expression 
she looked pale with shallower rather quicker and slightiv 
more embarrassed respiration 

The abdominal wall was ngtd and ten^e the uterine outline 
was not manifest anv longer there was a more diffuse swelling 
of the abdomen due to some distension Liver dullness was 
ab cni 1 made a diagno is of internal haemorrhage Rupture 
of the uterus was discussed but there was not sufficient 
evidence to support that diagnosis with confidence There 
was onlv sufficient evidence to warrant a diagnosis of interna! 
haemorrhage 

Operation 

The patient was removed to the opwrating th-^atre I opened 
the periioncal cavitv through a left paramedian mui ton ptrfl 
above the umbihuus and parth below m order ^at 1 niab 
have liberlv to enlarge it upwards or dov^'^'- arJ dtoendinp 
upon what was di covered to be the Mjurcc ot tne 

bleeding 

On opening the peritoneal caviiv a bag of membrane v a 
seen Rupture of the uterus wa nov obvious The incision 
was extended downwards The uterus was felt contracted in 
the bottom of the peKis The foetus tdeadl membranes and 
placenta were removed The uterus was lifted up At the 
right cornu a four inch rent extended down the right side or 
the uterus The uterus was elongated and marro v shap*d 

At the site of the rent the wall of the uterus vas thin 
Bleeding was not m progress though there was a won iderable 
quantitv of blood in the peritoneal caMtv 1 did rot wxsU 
lime exploring the inside of the uterus The right tube was 
not continuous wnh the uterine wall It looked natural and 
healthv except that it ended proximalh m a healed stump as 
though U had been amputated The centre of the rent m the 
•uterus corresponded with the point at which the tube would 
normaHv have become continuous with the uterus The right 
ovarv was calcified The left lube and ovarv were natural 

The rent m the uterus was sutured most of the blood was 
removed from the peritoneal cavitv drainage was provided 
and the patient was returned to bed as qmckh as possible 
She recovered quicklj and went home on the fifteenth dav 
after operation 

Remarks b\ Mr James Riddell 

In the case of nipturcr of the uterus during pregnanev 
which I described in 1936 there had been previous damage 
to the uterus following miscarriages Hysterectomy was 
emploved and the patient recovered In the case novvr 
under rcviev there had not been any operation upon the 
uterus There was not anv historv of mjury or violence 
of any kind 

Munro Kerr has described angular pregnanev and 
he stales that atypical examples may be encountered pardj 

miersiiual partly angular It is suggested that this 
case IS an example of a pregnancy partK " interstitial 
partU angular Munro Kerr quotes Kupferberg \ ho 
deicnbcd a case m which the bodv of the child was m the 
tube and the head in the uterus The - interstitial 
element would account for the erosion of the lube by the 



178 JUL\ 23, 1938 


RUPTURE OF UTERUS DURING PREGNANCY 


Tilt British 
MtDicAt Journal 


trophoblast and its gradual amputation from the body of 
the uterus It is not possible for a de\ elopmental defect 
to account for the want of continuitv between the tube 
and the uterus The tube was properly developed, and 
was not in any way under-developed The uterus was 
properly and naturally developed It is possible that after 
the erosion of the tube the ovum may have moved a little 
more downwards and embedded itself more comfortably in 
the uterus 

The ovum developed not in substantia iiteii but 
towards the uterine cavity though almost wholly m it, 
and that constitutes the ‘ angular ” element which led to 
thinning out of the wall of the uterus at the right cornu 
Eventiiaily the wall of the uterus became so thin that the 
evertion of sitting up in bed was enough to rupture it 
There was not any recognizable lateral distension of the 
uterus in the region of the uterine cornu Obliquity of the 
uterus was not observed before the operation and there 
was not any evidence of it at the operation There was 
only thinning of the wall at the light cornu 

Lateral distension of the uterine cornu is one of the 
main features described by Munro Kerr Therefore there 
must be grades of cases — if my explanation is correct — 
some without much lateral distension of the uterus Most 
“ angular ’ pregnancies produce great pain and lead to 
abortion It there were not much sacculation at the 
cornu but only thinning of the uterine wall and if the 
ovum found a more secure resting place, then "abortion 
would not be likely to occur This w'ould explain why the 
patient did not abort 

If my explanation is not correct then one must suppose 
tint the ovum was properly embedded in the uterus from 
the start and that the amputated tube and the thinned-out 
cornu did not have any relation to it, but were entirely 
unconnected with it, being due to some pre existing un- 
explained disease or injury 

The patient has promised to report if she becomes 
pregnant again in order that her progress may be watched 

Summary 

1 The clinical history of a case of rupture of the uterus 
during piegnancy is reported The patient recovered after 
suture of the rent 

2 It IS suggested that the cause of the rupture was a 
pregnancy partly “ interstitial,” partly “ angular ” 

BlBLIOGRArllY 

Miinio Kcir J M (1937) Operntne Obstetrics p 700, (1934) 
British btcdicnl Joiirnnl 1, 1113 
RhJaIcII, J (1936) J Obsict Gsiiacc Bril Einp 33, 1 


The two Chambers of the Swedish Riksdag have passed a 
Bill for public dental care The new Act provides for dental 
treatment for all infants and school children, as well is for 
idiilts at a nominal charge, or free of charge in the case of 
families of small means As regards children public dental 
treatment will be available to all between the ages of 3 and 
IS xears The annual fee is 5 kr for the first child, and 3 kr 
and 2 kr for the next two children, of a family registered 
it one and the same time for receiving State dental care If 
thurc are more than three children in a family the rest will be 
treated free As regards adults treatment is to be given at 
cost price or at a reduced fee or gratis when warranted 
• The Act provides for a division of Svveden into dental districts, 
With whole time dentists and attendants for each The cost 
or organiring and maintaining the service will be divided 
etween the State md the countj councils or municipalities 


Clinical Memoranda 


Concurrent Puerperal Anaerobic Streptococcal 
and Staphylococcal Septicaemia ' 
with Recovery 

We ftel that points worthy of notice in this case are, 
first, the unusual combination of organisms in the blood 
stream , secondly, the response to staphylococcal antitoxin 
in a patient who was gravely ill , and, thirdly, the presence 
of septicaemia after a considerable amount (66 grammes) 
of sulphinilamide had been given The response to 
the staphylococcal antitoxin suggests that the presence of 
the anaerobic streptococci in this case was of minor 
importance 

Mrs M, aged 32 vears was delivered of her second child 
on Februarv 15 1938 The first and second stages of labour 
were normal, but there was delay in the delivery of the 
placenta, which was removed manuallv under general 
anaesthesia On the following dav the patient complained of 
intense headache, shivering, and insomnia She vomited 
several times In the evening her temperature rose to lOT F 

She was admitted to hospital on Febriiar) 17 Her tern 
perature was 98° F, pulse 108, and respirations 24 She 
was pale and appeared ill The fundus of the uterus was 
palpable two inches below the umbilicus and was not tender 
Vaginal discharge was scantv and haemorrhagic Examinalion 
of other organs shovved no abnormalitv Siilphanilamide 4 5 
grammes was given dailv by mouth, and 1 cem piUntnn 
hvpodermically twice a day 

The dav after admission she passed a piece of membrane 
per vaginam Next morning her temperature rose to 101 2' I 
and her pulse rate to 120 per minute Her condition became 
steadily worse, and on Februarv 24 ihe temperature was 
103 2° F and she had a slight rigor On the following day 
20 cem scarlatinal antitoxin were given intramuscularly and 
60 c cm intravenously on the 26th , after this her tempera 
tiire fell to normal for the first time for seven days but 
rose ngain next dav and continued to swing between a maxi 
mum of 104 1° F and la minimum of 99° F for the nevt 
three weeks 

On ^^arch 3 a blood count shovved Red cells 2,164 000 per 
emm White cells 3,600 per c mm (polymorphs 64 per 
cent, lymphocytes 32 per cent, monoevtes 3 per cent, 
eosinophils 1 per cent) Hiemoglobin 30 per cent Colour 
index 0 7 Reticulocytes 4 5 per cent There was marked 
anisocvtosis and some poikilocy tosis of ervthrocytes 

Blood culture on March 4 gave a growth of non pigmented 
staphv lococci which were thought to he due to contamination 
of the culture Her clinical appearance now became tvpically 
that of septicaemia, and on March 6 she was given a trans 
fusion of 15 oz of her husbands blood, this was followed 
by some temporary improvement On the 9th the blood 
culture was repeated and gave a similar growth of stapliylo 
COCCI which were haemolvtic and showed slight pigmenlalion 
of the aureus tvpe at the end of forty eight hours’ inciibalion 
An anaerobic culture was made simultaneouslv, and tins 
shovved the presence of anaerobic streptococci as well 

It was now decided to give staphylococcus antitoxin As 
she had had serum a fortnight prcviouslv she was given two 
small desensitizing doses of the antitoxin subcutancouslv at 
an interval of three hours, and later the same day (March 12) 
10 000 units miramiiscularlv This latter dose was repeated 
on the following dav By this time her condition was very 
poor temperature 104° F , pulse rapid, skin yellow, and mucous 
membranes pale, there was a systolic bruit at the apex and 
she was incontinent of urine and faeces She had abo 
developed a massive generalized oedema involving ill liinbs, 
face, and back, which may have been due to the scrum 



JLL^ 23 I93S 


CLINICAL MEMORANDA 


ThX B -ITCH 
i-jll Jo 


179 


On Mirch !4 mother 10 000 unit'i of ‘it'\ph%lococcal inti 
tovin uerc gi\en infnmusaihrh followed bs 10 000 units 
mtn\cnou<U Just iftcr this the patient collapsed but rallied 
a little on the injection of adrenaline icoral and continuous 
rectal saline and glucose Dunnq the next three dajs she 
seemed to be in extrcnns but on March 17 the temperature 
and pulse rate becan to fall and b\ the 22nd were normal 
Her general condition improved she became rational the 
oedema disappeared and she renamed complete sphmctcric 
control From this time steads progress was made without 
complications or rise of temperature 

On \pnl 22 a blood count '•howed Red cells “1046 000 per 
emm White cells S 600 per cnim (poUmorphs 55 per cent 
IvmphocMcs “^6 per cent larcc mononuclears 7 per cent 
eosinophils 1 per cent basophils I per cent ) Hacmoclobm 
6’' per cent Colour index 0 9 RcticulocMcs 16 per cent 
A blood film showed htpochromia of red cells othcnviNe 
nothing of note 

The patient was discharged well on April 30 Ollier medica 
menis used in the treatment of the ease were vaginal douches 
potissuim citrate Blands pill and \anous scdatiscs Total 
dosace of sulphanihmtdc was 66 grammes Administration 
of this latter druc was stopped on March 3 

We Wish to thank Dr W Edge medical superintendent 
LadvweU Isolation Hospital for permission to publish this 
case 

J Starkic mb MRCS DPH 
G N M WibHvRT MRCS LRCP 
Lad>'N\cU Isolauoa Hospital Salford 


Simultaneous Fracture of Both W'nsts 

The following ease of simultaneous fracture of both wrists 
may be of interest as demonstrating the npid restoration 
ol function and the minimal period of disabilitx under 
treatment by Bohicrs technique 

Case Report 

On November 7 1937 a Cambridge undergraduate a member 
the Climbing Club fell 20 feet from a tree landing on 
both hands with the wrists in flexion He could use neither 
hand owing to pain and swelling and was brought to see me 
bv a friend TTie right wrist was swollen and ven painful 
and there vsere fusiform swellings on the dorsum of the wrist 
more marked on the radial side corresponding to the exten'-or 
sheaths There was no bonv displacement palpable and no 
historx of cracking at the time or of crepitus since he 
sustained the mjurx The left wnsi joint was also gcneralK 
svsollen and there was tenderness and more marked swelling 
o\er the stvio/d process of (he ulna with no obvious sign of 
fracture The patient was unable to use either hand in anv 
wav He could not lift a cup of tea fasten a button open 
a door or do anvihing at all for himself For this reason 
he was admitted to a nursing home and the wrists were at 
orce supported bi elastoplast reinforced with interlocking 
split tailed strips of plaster the right wrist being put up 
temporanly on a Carrs splint A rav examination showed a 
fracture of the lower end of the right radius just above the 
wrist joint with no displacement and a fracture through the 
base of the stvioid process of the left ulna with minimal dis 
placement In addition there was obviously acute traumatic 
svnovjtjs of both wrist joints and acute traumatic tenosvnovitis 
of most of the extensor tendon sheaths on both sides 
On November 8 after the results of the r ray examination 
were known a 6 inch dorsal cellona slab was applied 
to the right forearm from just below the elbow to the level 
of the heads of the metacarpals The cast was completed 
according to Bohler s method of treating a Colles s fracture 
with the palm left free save for a copper wire across (he 
distal crease a modification suggested by K Pndie The left 
forearm and \ rist were treated in the same wav The patient 
was instructed to use both hands freelv On the following 
<lay at 930 am the patient was able to write his name 


IcgibU but poorlv he gripped and Used a tumbler with either 
hand picked up small objects and was able to help n 
dressing himselt Bv :> o clock that dav his signature had 
improved he was able to lift both arms above bis head and 
he could carrv a bag of instruments v jihout pain His crip 
was alrexdv much stronger Later he wa'^ able to u e a 
knife and fork and take his own dinner After three davs he 
returned to his college attended all his lectures and dined 
nighllv m Hal! In fact he lived a normal life except that 
he did not plav games Three and a half weeks later the 
plaster casts were removed and the movementb of the wn^t- 
jomls were found to be practicalh normal as regards flexion 
and extension Pronation and supination became full in a 
few dxvs time 

Cambrid^v R SvLISBLRV Vy OODS MD F R C.S 


A Case of Locked Twins 

Owing to the rarity of locking complicating labour m 
tvvin pregnancies the following notes on a case recently 
met w(th mav bt; of interest 

Histop\ or C\SE 

A vvoman aged 24 was pregnant for the second time the 
first pregnmev having ended in abortion at ix week> Dunng 
the present pregnanev she had t threatened abortion at tvehe 
weeks and later developed miid al^uminuru which beitl‘*d v i h 
rest in bed 

Labour siirted in the morning ot Febr^arv 2 a fortnight 
before term Liennc contracijons v ere v eak and infrequent 
but bv p m on Februirv 3 the “second stage of labour 
appeared to have begun At 5 pm a vaginal exarmn-tioa 
was made and a vertex (right occipito anienor) felt low down 
in the pelvis the cervix was fulU diUted and the raembrares 
ruptured Bv 6 ^0 p m no progress had been made and 
meconium began to pass per vaginam At this time the 
patient s general condition was ven fair Pams were reguUr 
the uterus \ as rather tender and irniable making abdominal 
examination difficult but a head could be made out en ering 
(he pelvis 

Vaginal examination under anaesthesia revealed a «mall 
head low douTi in the pelvis presenting as a nght occipito- 
anterior with a loop of cord prolapsed alongside it this was 
pulsating regularlv On further investigation a second head 
was found in the pelvis presenting as a left occipito postenor 
somev%hai to the left of and posterior to the first It vas at 
a higher level in contact with the anterior shoulder of the first 
foetus which it was preventing from descending fui her The 
membranes of the second sac were intact 

The second foetus was pushed up out of the pelvis and the 
first delivered with the forceps It was rather shocked but 
soon recovered After fifteen minutes the second bead was 
found to have descended on to the pelvic floor and the mem 
brancs vvere ruptured and five unit* of pituitrm given as 
uterine contractions were verv weak There was little response 
to the pituitnn so this foetus still occipito postenor was also 
delivered with the forceps It was in good condition and cried 
at "once The third stage lasted about fifteen minutes when 
both placentae were expelled together There was veo httle 
haemorrhage i 

The children were female binovular twins weighing 4 Ib and 
3 lb 12 oz respectivelv The placentae were entirelv separate 
Subsequent progress of all three patients was uneventful 

Locking of twins is generallv attributed to deficiency 
of liquor amnii in cases where there is a relativeU large 
pelvis In the case reported the pelvis was of average 
size (external measurements 20- 21-*^ and S inches) but 
the foetuses were small At the time of deliverv the 
first amniolic sac was dry and the second contained 
only an ounce or two of liquor 

H- Craven Fetch. 
Thomas A. Best 


Harrogate 



ISO JUL\ 23, 1938 


REVIEWS 


The British 
Medicae Journal 


Reviews 


AN ANTHROPOLOGIST SPEAKS OUT 

Apes Men and Moions By Earnest Albert Hooton 
(Pp 307 lOs 6d net) London George Allen and 
Unwin 1938 

Dr Earnest Hooton, the distinguished professor of anthro- 
pology in Harvard University, has come to occupy a 
favoured place in the minds and hearts of his fellow- 
countrymen This is because he has added to the erudition 
of his special subject a power to see things with the 
humorous eye of Mark Twain and the courage to force 
unpleasant truths upon the consideration of his readers 
The burden of his book is this Unless civilized humanity 
pays some attention to the kind of progeny it begets, 
then Its doom is sealed “ Man has tried to improve 
everything except himself,” he exclaims And again 
“ Man is a tottering biped and we must look to his organic 
underpinning ’ — the underpinning being man s “ animal 
self In brief, what is needed first and most is that the 
great public should become familiar with the elements of 
their own physiology But alas* it must also be added 
that Professor Hooton has no confidence in the wisdom 
or judgment of the man in the street 
It must not be inferred that Apes, Men and Moions is 
a sermon preached on a single text Taking it all and all 
it IS the best popular summary available of the hundred 
and one problems that are now occupying the attention 
of anthropologists and eugenists in all countries of the 
world Although the contents of this book represent a 
scries of addresses given at sundry times to diverse 
ludicnces, yet the subjects were so chosen that the whole 
field of anthropology is covered in a systematic manner 
The history of man, as revealed by fossil bones, is well 
told then follows an exposition of our present know- 
ledge — and lack of knowledge — of the evolution of man 
Then living races and types of mankind are passed in 
review then follows a special section — Professor Hooton’s 
own section — that of social anthropology Lastly, a 
cugenist chapter — “ What must we do to be saved?” 

There may be exaggerations and excesses here and there, 
but there is also much real wisdom as well as learning , 
there is certainly not a dull page m the book 

A K 

CONTROL OF DISEASE 

General H\gi(ne and Pre\entt\e Medicine A Textbook 
jor Colit ge Sliidtnis Medical Students Nurses Public 
Health Workers and Social Workers By John Weinzirl 
MS, Ph D Edited by Adolph Weinziri B S , M D 
(Pp 424, 18s net) London Henry Kimpton 1937 

In presenting a medical subject to the generality it 
IS sometimes difficult to fix upon a grouping or arrange- 
ment of the material which will appear sensible to the 
non-medical reader without doing violence to the facts 
of medicine The purely aetiological approach is usually 
barred since it presumes previous knowledge, and other 
ways, less good in themselves, may have to be sought 
out In their recent work on hygiene, addressed in part 
to lav persons, including teachers, philanthropists, pub- 
licists, and others. Professors J and A Weinzirl have 
grouped the disease conditions which they describe in 
ihe light of the meins adopted for their control ‘An 
niiempt has been made the\ sa\ to subordinate facts 
to mclhods So spake, or might have spoken Procrustes 
IS he lopped or sircichcd his guests to fit the notorious 


bed Here and there in the book as is almost inevitable 
in the circumstances, we encounter the Procrustean touch, 
as where it is said that the “ incubationary stage ” of 
acute alcoholism is a matter of hours Nevertheless, for 
a work written with a view to the enlightenment of 
laymen, the criterion ‘‘ what is being done ’ is, we think, 
happily chosen It is calculated to appeal to the prac- 
tically minded average man, who, after all, will not go far 
wrong if he thinks of small-pox as a disease to be con 
trolled by vaccination, scurvy by correct feeding, malaria 
by dealing with the mosquito, and moronism, Anglice 
feeble-mindedness by the application of eugenic measures 

The book by the two professors is sound m the essen- 
tials It IS wide in range, adequate in detail, and informa- 
tive without over-elaboration It will interest those for 
whom It is principally intended and will be found of 
service also by medical officers 

A STUDY OF CEREBRAL FUNCTION 

The Biain and its Cn\ironnienr By Joseph Barcroft 

(Pp 117, 30 figures 9s net 2 dollars) London 

Humphrey Miltord Oxford University Press , New 

Haven Yale University Press 1938 

This book IS founded on the Terry Lectures delivered b/ 
Sir Joseph Barcroft at Yale University in 1937 and is a 
study of the relation between the functional activity of the 
mammalian brain and the internal environment during 
the changes from intra-uterine to adult life 

The investigation has been carried out in both sheep 
and goats It is shown that the oxygen supply does not 
increase during the last third of pregnancy, although the 
weight of the foetus increases tenfold The result of this 
IS a marked fall in the oxygen pressure in the blood 
supplying the brain over this period A study of the 
reactions of the developing nervous system reveals that at 
the end of the first third of pregnancy movements can 
be elicited in response to tactile stimulation which corre 
spend to the locomotor and respiratory functions whic" 
will come into play after birth Such movements arc 
either abolished by asphyxia or are replaced by a more 
primitive and generalized response During the remainder 
of pregnancy these reflex activities are inhibited by tin’ 
development of higher centres in the nervous system which 
are themselves put out of action and he carb reflexes 
re-established by asphyxia 

At birth both the external and internal environment of 
the brain undergo abrupt change The oxygen saturation 
of the carotid blood was directly measured electrically, 
and in this way a comparable photographic record was 
obtained of the activity of the respiratory centre and the 
oxygen supply to the brain From this the author conics 
to the conclusion that the respiratory centre is stimulated 
at birth piimanly by cutaneous sensations (cold, manipula 
tion, etc), and secondarily by the effect of asphyxia m 
releasing the primitive respiratory movements from the 
inhibitory control of the higher centres It is also shown 
that the cardio-inhibitory, the cardio-accelerator centres, 
and those responsible for the inaintenance of muscular 
tone are brought into play by the advent of sustained 
respiration at birth 

With regard to the factors controlling the oxygen supply 
of the brain at birth, it is shown that the nature of the 
haemoglobin is changed before birth, so that the foetal 
type of oxygen dissociation curve is replaced by the adult 
type, which is more suitable for the higher oxygen 
pressures encountered m post-natal life Furthermore, 
evidence is brought forward to show that the ductus 
arteriosus is closed abruptly at birth by a neuromuscular 
mechanism developed during foetal life Finally, the 



Ji’i> 2T I9'(S 


RLVICWS 


7ifr UffTfsif 

fCAt 


uilhor diccussLS tlic t(Ti.ct of ch ingi-s in ihc inltm'il 
cinironnicnt in the brain of idull hiiimn beings md shows 
lint excess or dcficicnc) of o\>ten carbon dioxide 
gliieose water and sills ind sariitions in temperature 
produce cllecls which can be clissilied as either e\citilor> 
or depressive He concludes with i reaflirnniion of 
Claude Bernards words lint the fixitj of the internal 
environment is the condition of the free life — lint is to 
sav the development of the intellectual powers of min 
Clearlj this ts a valuable contribution to the siudj of 
cerebral function which is one of the most import ml 
lields of research at the present lime 

A MA^UAL or OTOLOG1 

Kur^es Hatntbucli dcr Ohrentiedt ttiuic flj Dr Hcrm inn 
Mars (Pp 846 46S figures mans in colour KM 46 
bound RM 48 SO ) Jena Gustav livelier lOtS 

Professor Marx s recentl> published Short Afrimial of 
Oro!os;\ runs to over SOO pages and covers the whole 
ground m an cxlremcl> atilc manner The matter is 
arranged on the recognized lines a general section deal 
ing with a description of the anJtom> and ph>sioIog> of 
th^ car and the ftinclionaf tests ff-42 pages) a special 
section (600 pages) dealing with the diseases of the car — 
inflammalon new growths traumatic lesions and con 
genital deformities in that order The author s views and 
theories arc mostlj the orthodox ones but in many 
sections the more individual teaching of Ihc Wurzburg 
school IS obvious In the physiology chapter the Ivmpmic 
muscles arc described as a protective mechanism and 
It IS stated that there is not su/Iicicnt evidence to support 
an accommodation theory The two tympanic muscles 
are not antagonistic and their contraction serves only one 
purpose which is to protect the cochlea against too in 
tensive sound impressions cspcci illy of the high pitched 
variety 

The semicircular canal function and tests are dealt with 
exhaustively On the other hand Ihc reflexes of the 
otolith end organs in spite of Ihc enormous literature 
which already exists on the subject are dismissed in i 
one page paragraph because it has now been shown that 
tonic labvrinth reflexes function even after destruction 
of the macula in the saccule and therefore the question 
of the reaction of position is still unsolved A most useful 
distinction is made between the pathology of acute and 
that of chronic middle car suppuration The usual end 
result of acute middle-car suppuration is reuitiiiio ad 
integrum fp 197) Chronic suppuration docs not result 
from neglected acute suppuration but has an insidious 
origin and the seeds of chronicny arc there from the 
beginning Here the author on the whole accepts 
\\ itimaack s theorv of the infantile hyperplastic changes 
in the tympanic mucous membrane Much futile dis- 
cussion would be saved if this aspect of the pathology of 
middle-ear suppuration were alwavs borne m mind 

In the after treatment of mastoid abscess Professor 
Marx advises against packing because this carries a risk 
of fistula The wound is closed straight away except for 
a strip of gauze in the lower angle The so called 
recurring mastoiditis is not an osteitis but simply a 
formation of pus in the old scar tissue a slab incision to 
let out the pus is sufficient in such cases An interesting 
end result of sinus thrombosis not usually describi.d in 
textbooks IS the organization and calcification of the clot 
A complete bony occlusion of one transverse sinus may 
result and one such specimen is illustrated In the 
chapter on syphilis of the inner car it is clearly staled that 
salvarsan is not the cause of the damage to the eighth 


IM 

nerve When dcifntvs Iiniuliis ind vertigo irivc iii the 
course of ire itmcnl the s ilv irs in injections must be per 
severed with until the inner ear symptoms divijipeir 
Aeusticiis tumours ilthoiigh irising m the cerebcllii 
pontine angle ire de ill with bcciusc they must be eon 
sidered is tumours of the e ir orgin 

The illiisirilions Ihroiighoiil Ihc bool ire well eho en 
ind well printed As i model eif elc irncss one m ly 
specially commend I ig 33 which illiislriiles the compli 
Cited inilomieil relilion of Ihc lev ilor pal ili ind tensor 
pal til muscles to the Euslachi m tube Hie senes of ictii d 
phologr iphs of benign ind m ihgnant tumours of the 
pinni ind menus md those illtistriling congenil d de 
formilics of the outer e ir ire pirlieultrly siieeessful 
We note is i useful fciliirc the full references to current 
literature which ire given at the end of each ch ipler In 
Professor Marx s own words this m mu il is intended 
for the young otologist st irlmg in pr icliee ( mgehender 
Ohren tr/1 ) and it may be confidently recommended i 
a rchiblc texibool The Germ in style is easy to re id 

IMRACHAMAL fUMOUBS 

Tumuin hurru ranu nnt % f unit Aniitrluint <h 7000 
Tioneiirt ttrilmi ii de Iciir Vtr rUiUtt Ofn rntoirt t y 
Htrvey Cushing tPp 194 III firiire taht^ vfj frsj 
Pins M isson ct Cic 1937 

The french irmslnion of Dr Hirvc/ f ii Inm book m 
/iifrutniniid 7 loiirnin whrc/i app-ar,cl in t'JJ2 his b-eri 
cnlirced by two studies on the lite results ol op-ri'iori 
for cerebrtl tumours one by Or v m \Vagcnen ind the 
other by Professor Hugh C urns fh-se 'I itistie d tithe 
show I surprisingly lon„ period no only ol surnvd but 
also of iisclid life in many forms of inlracrmid lumoiir 
Van Wagenen gives m ivenge p.nod of a or! mg life 
of 1 yeir or more in dl forms ot intracraiiid turn nir 
except medulloblastomas glioblastomas md rnrl I u- 
Cancers In Cairns s si itislics it i surprising to note t) t 
individual Cases o) ccrebr il glioma piliiii iry ul.rmia ad 
tumour of the icoiislic nerve hivc survived for t /eni/ 
five years tficr operation While the iverage 'urvi ai 
period Is much less for cases in vhich the tumour emnot 
be completely remosed the results obi lined justify the 
unique posilion vhieh Dr H irvey Cushings timic hJd 
in neurosurgery and Ihc faith in the future ol hi specidty 
which has sustained him throughout his eirser 

The Trench edition also coni iin' i short chaptc on 
basophil adenomas ot the hypophysi , a form of tumour 
which v/is sctrccly recognized it the ditc of the Ametiean 
edition and on which the author has since contribute! 
Valuable knowledge Ov/ing no doubt to difference in 
the paper used the illiisirations ippear to b, cleirer nJ 
more brilliant than in (he original edition 

ffkrMATOio&y 

A Texihonh ot ftneniatology By William Mijner MD 
DPH (Pp 39a 23 fuurcs 3 coloured pUle 3 cturls 

18 ) I ondoa 1 and A Churchill 103 ^ 

Il seems that every professO' of pathology is expected to 

publish his own book of haePnatoIogy for the sp-cnf ti - 

of bis large class of students the result is i siip-rflmty 

of hacmatologic tl textbooks overlapping eich o.licr for 

of late the format of these books his become „ 

and stercolyp-d and choice is only mrcowly 

IS noticeable that w/ith the increising n 

the professors have become more c.a 

opinions Professor Afagner inirod 

versial questions such as the dev- 

white cells the origin of plilele 



182 July 23, 1938 


NOTES ON BOOKS 


Tnr Barmii 
Medical 


views of several authors for and against some particular 
theory but refrains from expressing his own personal 
views of these questions It would be useful to know 
which special form of haemoglobinometer he favours, also 
on which haemocytometer chamber and methods he relies 
for the enumeration of cells He makes no mention 
of “ Price Jones ” mean diameter distribution curves for 
determining the size of red cells and the degree of aniso- 
cytosis, which is so essential for the correct diagnosis of 
anaemias and is in common use in this country 
Owing to the employment of surfaced paper the weight 
of the volume is unduly great but the reader is recom- 
pensed b> the excellence of the coloured plates It is a 
pity the photomicrographs are not sharp and do not 
convey very much It may be a mistake to include in a 
book of this character the clinical and therapeutic aspects 
of the anaemias described , but this is a common habit, 
and Professor Magner is in good company 


Notes on Books 

7 he Psychology of Earlv Giowih tncluding Norms of 
Infant Biltaxior and a Method of Genetic Analysts, by 
Arnold Gesell M D , and Helen Thompson, Ph D , is 
published bv the Macmillan Company at 17s This 
important book of reference comprises a summary of 
the work of Professor Gesell and his colleagues at Yale 
University on the mental development and behaviour of 
infants Thanks to this work we are beginning to obtain 
a very fair idea of what the normal infant can do at 
various ages and how tar deviations from the normal are 
to be regarded as non-pathological It is only by 
establishing this norm that we can study abnormalities 
with intelligence and discover what conditions in infancy 
may be recoverable and what must be regarded as in- 
evitably permanent handicaps The medical man who is 
concerned with the diagnosis and prognosis of injuries and 
developmental defects in infancy will find a wealth of 
material in this volume which will serve him in very good 
stead in controlling his own observations 

Dir Sdmaihsinn by F Dubitscher (Leipzig, Georg 
Thieme) is the first of a series of volumes edited by 
Arthur Guett director of the Health Department in the 
Reich and Pro sian Home Ministry, under the general 
heading Hand o tk of Hereditary Diseases The first part 
of the \olun ^/deals with mental defects (classification, 
aetiology normal personality, physical symptoms of feeble- 
mindedness, mental symptoms, general pathological-anato- 
mical and pathological-histological findings, special kinds 
of feeble-mindedness, ethical deficiency, diagnosis, social 
importance of feeble-mindedness, measures against feeble- 
mindedness legal aspects) The second part is devoted 
to intelligence tests The main tasks of the health adminis- 
tration in the fight against feeble-mindedness appear to 
be to determine biological psychic unities and to study 
the heredity of these single characters , to identify diseases, 
related to feeble-mindedness belonging to the oligophrenia 
group in the sense of Weygandt , to study the connexion 
of social conditions and feeble-mindedness , to examine 
s^stcmaticallv all the children who leave special school 
classes for feeble-minded children or who leave school pre- 
maturely VV'ill It be possible to eliminate feeble-minded- 
ness bv legal measures based on considerations of 
heredity'’ Certainly not But the problem is not “ When 
will feeble-mindedness ha\e ceased to exist’’ but “How 
much would feeble-mindedness spread in a certain period 
without Such legal measures’” 

In the dC Mciik for 1938 (first part) there 

is nn irticlc bj Dr Albert von Szcnt-Gyorgyi on “ New 
I crspeciiscs. in Viiamm Thcripeutics 


Preparations and Appliances 


ELECTRICALLY HEADED COT 
Dr William More (Stockport) writes The problem of 
maintaining the bod\ temperature is one of the chief diffi- 
culties in the management of premature infants Warmth is 
usually maintained by hot-water bottles trapped in blankets, 
by electric blankets or by some form of incubator Enclosed 
incubators in which the air is stagnant are not advisable, 
an electrically heated cot in which there is a gentle current 
of warm air is preferable In the incubator described below 
there is no thermostat, but the temperature can be maintained 



Fig 1 Fio 2 


at a level between 70' and 80° F The details of its con 
struedon are as follows The cot is made of angle iron, 
clcctncallv welded and covered with 17 s gauge gauze on the 
outside and 22 s gauge gauze on the inside A space is left 
between the inner and outer walls, the space being heated 
b\ SIX 16 c p carbon filament lamps, controlled by three 
switches, as seen m Fig 1 Each switch controls two lamps 
A glass pane is inserted in one end of the cot so that it can 
be ascertained which lamps are in use (Fig 2) All the wiring 
IS asbestos-covered and an efficient earth is provided The 
number of lamps used to attain the required temperature will 
varv With the room temperature, but once the desired tern 
peralure has been reached this remains at a constant level 
However if the room temperature vanes a great deal occa 
sional adjustment of the switches on the cot will -be necessary 
Three of these cots have been used with success in Stepping 
Hiil Hospital during the past two vears I am indebted to 
Mr Shavveross, the hospital engineer, for his skill m con- 
structing them 

A SKIN RETRACTOR FOR PLASTIC SURGERY 
Mr Graham Humby (London, W) writes 
It IS with deference that this retractor is offered because it 
IS onh of use to those who are interested in plastic surgery, 
and it IS apparent that their numbers are limited The utility 
of fine hooks for skin retraction in this work is beyond 



dispute and it is equally certain that the surgeons nerves arc 
often fraved when two such hooks arc being used, because, 
unfortunatelv, telepathic control of an assistant s hands is an 
ideal rather than a reahtj It is for this reason that two 
hooks have been joined together at their proximal ends, thus 
eliminating a separate hook and a separate tremor The 
retractor can be used as a single hook when the two arms 
arc approximated or as a double hook by inserting a finger 
in the acute angle formed bv the arms the number of fingers 
inserted determining the distance and the tautness of the skin 
between the two hooks This instrument was made for me 
bv Messrs Down Bros 



JtL\ 2i 19'(S 


THE PRESIDENTIAL ADDRESS 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDAY JULY 21 1938 


THE PRESIDENTIAL ADDRESS 
Succcssi\e Presidents of the British Medical Asso 
ciation Invc of recent jears devoted a con 
siderable portion of the president! il address to a 
consideration of the public relations of the pro 
fcssion and to a discussion of its future develop- 
ment and organization in view of the needs of the 
communili Dr Colin Lindsay at Plymouth gave 
his address the simple title ‘ The Profession and 
the Public indicating that the interrelations of 
these two bodies continue to be the appropriate 
subject of thought and pronouncement even at the 
inauguration of a meeting the intent and content 
of which arc predominantly scientific We print 
the address in this issue of the Journal at p 163 
The new President speaks from an cvpericnce of 
more than fortj jears as a general practitioner and 
consulting phjsician He emphasizes in particular 
the pressing need for continued education both for 
the public and for the practitioner, and the value 
and wisdom of the pohej of the Association in 
this regard and of its recently revised and re issued 
Proposals for a General Medical Service for the 
Nation This was both opportune and helpful at 
the end of a year during which the Council has 
devoted a great deal of time care, and attention to 
the re presentation of those proposals, to the 
formulation of its policy on some other very 
important medico sociological questions, and to 
the development of methods by which the work 
and opinions of the Association can properly be 
made more widely and accurately known and its 
influence extended 

It was timely, too that the President should 
remind the public of the unity and equality of the 
three main branches of the profession — the general 
practitioners, the consultants and the members of 
the public health service They have a common 
basic training and tradition each branch provides 
a specialist service in its own sphere and “ there 
IS no real reason why one branch should be from 
its nature more eminent that the other They are 
essentially complementary and each requires for 
Its proper performance attainments of the highest 
order’ It is probably true at the present time 
that while it is to the family doctor that individual 
members of the public give their greatest con 
fidence general practitioners collectively have a 
less high place in the public regard than the other 


TheBattish IC** 

'lEDICAl. JOVEHM. ^ 

two branches Perhaps Dr Lindsaj m his address 
o\crernphasizes this as indeed ha\e several 
recent pronouncements He goes so far as to say 
that “ there is a tendency for this branch of the 
profession to sink lower and lower in the estimation 
both of the public and of the student bodv from 
which the profession is recruited” He puts it in 
this way' merely to heighten the contrast betv een 
this situation and what the general practitioner 
really is and the fact that ‘ a reaction from this 
attitude IS inevitable The more the public is 
educated and the more the health services extend 
and intrude themselves into the lives of the people 
the more will there be requu'ed an active and 
intelligent family doctor service ” There are 
indications that this reaction has already begun 
There appears m fact to be less and less dissent 
from the proposition that any reconstruction of 
medical organization for the pubhc health must 
be based upon the work of the general practitioner 
As to this future work the President declares that 
“all direct contact with the pubhc as individuals 
should be in the first instance through the family 
doctor There should be no short-circuiting or 
duplication of his services’ and in a rather 
striking phrase he savs that the family doctor 
service will be no corps of clerks but a higlilv 
trained and skilled body of persons who will 
ensure the early recognition of diseased states the 
application in ordinary cases of those psycho 
therapeutic methods which are becoming more and 
more a national need the proper co-ordination of 
extending specialist services, and the more effective 
education of the public in medical and health 
matters 

In the President s reference, in the passage 
previously quoted to the opinion of general prac- 
titioners held by the medical students from whom 
they are to be recruited there is a shrewd touch 
It IS perhaps intended to convey to the teachers in 
medical schools a warning that it is both easv and 
very unwise to create in those schools an 
atmosphere which is unfavourable or detnmental 
to the status of the general practitioner This is 
not a new thing It was probably more prevalent 
thirty or forty years ago than it is to-day though 
the effect produced was not and is not deliberate 
or intentional Three quarters of the students still 
pass into general practice and no effort should be 
spared to present to them a high ideal of what such 
practice should be and usually is and a sense of its 
paramount importance in the medical field 

The whole Association — and indeed, the whole 
profession as well as others — will wish to join in 
the welcome given to the President at Plymouth 
and in the hope that his year of office will be both 
pleasant and successful 



184 July 23, 1938 


CANCER OF THE LUNG 


The British 
Medical Jouhh^l 


CANCER OF THE LUNG 


“Any disease which throughout a quarter of a 
century develops from a position of obscurity to 
one of comparative prominence can scarcely avoid 
exciting the interest of the inquiring medical mind ” 
This opening sentence forms the justification for 
Dr E J Simons’s monograph’^ on carcinoma of 
the lung, and affords an opportumty of reviewing 
here some of the facts and fancies about this 
condition Is the increased incidence of bronchial 
carcinoma fact or fancy 2 Is it real or apparent 
only because of such factors as improved diag- 
nosis^ There can be no doubt tliat methods of 
diagnosis have improved and that therefore more 
cases have probably been diagnosed than would 
have been formerly but in addition to this Simons 
believes that the rate of increase in cancer of the 
lung has accelerated considerably since the early 
years of the present century He also finds that 
in some localities the -greatest incidence seems to 
have been reached in 1924, and that in others it 
IS still on the increase As with cancer in other 
parts of tlie body, the question of aetiology raises 
many baffling problems There is little evidence 
of any hereditary influence, and injury to the chest 
does not seem to be important, although cases have 
occasionally been found m which a single severe 
injury preceded the development of a growth in the 
lung In the cancer of the lung of the Schneeberg 
miners inlialed dust appears to be an undoubted 
aetiological factor the dust -contains a variety of 
irritants, including bismuth, nickel, and cobalt, but 
the balance of evidence incriminates arsenical dust 
or radioactive substances Active tuberculosis is 
present m about 10 per cent of cases of bronchial 
carcinoma , this, however, cannot be held to have 
relevance to the question of causation Although 
It has been suggested that there is some connexion 
between chronic disease of the lung and cancer 
of the lung, so many different diseases have been 
suggested and so few cases have been put forward 
m support of each individual condition, tliat the 
causal relation is by no means clear-cut The 
inhalation of dust tar jiarticles petrol fumes, and 
poisonous gases has been blamed but it is not easy 
to say where the blame lies if any In view of the 
extent of tobacco smoking it was to be expected 
that the possible part played by this m the develop- 
ment of cancer of the lung should be subjected to 
inquisition From what has already been pub- 
lished It IS plain that the innocence of tobacco is 
by no means clearly established Further study 
of this question is needed 


* Prutiarx Carcittonm of thi J itnj; 
X i ir nooV PubliMur, Int Chic-ico 

Cci 21, 


6% Edwin J Simons M D 
London 11 K. Lewis nnd 


When we come to pathology we are on surer 
and more familiar ground The mam group of 
tumours is composed of undifferentiated cells 
which take their origin m the deeper layers of the 
bronchial mucous membrane This membrane 
is composed of transitional epithelium, with a basal 
layer of rounded or oval cells and a superficial 
layer of columnar cells the whole membrane is 
derived originally from the primitive hypopharynx, 
which produces the squamous epithelium of the 
moutli and oesophagus From these cells the three 
common histological types of carcinoma are 
derived the “ oat-celled ’’ (which is the most 
primitive), the columnar-celled and the squamous 
carcinoma It is not uncommon to find some 
mixture of these types in a single tumour Distri- 
bution may occur by the blood stream or by the 
lymphatics the cerebral metastases being obviously 
liaematogenous, and the thoracic and abdominal 
deposits being commonly earned by the lymphatic 
vessels The clinical study of bronchial carcinoma 
shows that it tends to occur most frequently at a 
ratlier earlier age than most other cancers, the 
chief incidence being m the fifth decade although 
many cases have been described in quite young 
patients A clinical classification is of much help, 
not only m diagnosis but also when treatment has 
to be considered Tuttle and Womack classify 
bronchiogenic carcinomata according to whether 
they arise m a major bronchus or m a bronchiole 
Rabin and Neuhof group their cases into circum 
scribed and non-circumscribed forms Each of 
tliese classifications indicates that tliere is a type 
of tumour situated in the hilum and close to vital 
structures, and another, discrete, type which in the 
earlier stages at least is situated deep m the surface 
of the lobe Cough and haemoptysis are likely to 
be early symptoms when a tumour is related to the 
mam bronchi, whereas the deeply situated growth 
may cause few or no symptoms until metastases 
have occurred 

Tlie clinical findings are not usually due to the 
growth Itself but rather to involvement of sur- 
rounding structures It is common to find 
collapse of a lobe, or of a lung, caused by obstiuc 
tion of a large bronchus When the tumour is 
situated under tlie pleura the first signs are often 
those of an effusion If the diagnosis of bronchial 
carcinoma is to be made at a stage when treatment 
can be effectively applied it is necessary to abandon 
all thought of relying on physical signs and to 
attempt to base the diagnosis on the combination 
of suspicious symptoms and judicious investigation 
Any middle-aged patient who has persistent 
cough, especially with slight haemoptysis, should 
be subjected to x-ray examination without delay 
The other investigation which is of particular 



Jvi.\ 23 


THE TRIAL OF MR BOURNE 


TkeBwtbh 

^^_DICA1. JOVILNU. 


185 


importance and which has been widely employed 
during the past few- years is bronchoscopy and 
this should ne\cr be omitted when there is the 
slightest possibility of malignant disease Lipiodol 
examinations are helpful in demonstrating obstruc 
tion in the smaller bronchi which arc out of reach 
of the bronchoscope It is as vet too earlv to 
discuss the value of tomography in the diagnosis of 
malignant disease The increasing safetv of intra 
thoracic operations has made cxploratorv thora 
cotomy a procedure which should be seriously 
considered in suspicious early cases for it mav be 
the only means by which a diagnosis can be made 
Successful treatment of bronchial carcinoma is 
still onU to be achieved in those comparatively 
rare cases in which diagnosis is made at a suffi- 
ciently early stage to enable the growth to be 
removed The usual operation is lobectomy or 
even total pneumectomy and the mortality from 
the actual operative procedure has been strikingly 
lowered of recent years but it still happens only 
too rarely that the patient maintains freedom from 
recurrence for an appreciable length of time It 
has lately been recognized that there is a small 
group of cases in which a tumour of relatively low 
malignancy projects into the bronchus, and this 
type can sometimes be successfullv removed 
through a bronchoscope The value of radio- 
therapy IS still a subject for discussion but it 
appears to be definite that tray treatment has 
not yet cured a proven case of bronchial carcinoma 
There is little reason to doubt that the duration of 
life has been prolonged in a considerable number 
of cases bv the use of deep x rays and that the 
results are steadily if slowly improving 


THE TRUE OF MR BOURNE 

On Monday and Tuesday of this week Mr Aleck 
Bourne obstetnc surgeon to St Mary’s Hospital 
and consulting obstetnc surgeon to Queen Char- 
lotte’s stood his tnal at the Central Criminal Court 
on a charge of unlawfully using an instrument with 
intent to procure the miscarriage of a girl The 
girl had become pregnant after being raped Mr 
Aleck Bournes acquittal after a heanng which 
was in accordance with the highest traditions of 
British justice expresses the jury s view of his 
motive and his action — a view which will be 
endorsed by an overwhelming majonty of their 
fellow -citizens It was courageous and public- 
spirited of him to invite prosecution in order to 
get the law declared on a matter of great impor- 
tance to the public and more especially to the 
medical profession His claim cogently stated by 
Mr Roland Oliver, K C , was “ What I have done 


is lawful right and honest and I have committed 
no offence at ail ’ The case for the Crov n put 
forward with moderation and respect bv the 
Attorney General was that what he did was con 
trary to the law Mr Justice Macnaghten in his 
summing up emphasized the point that the case did 
not touch that of the professional abortionist 
So far as the members of the medical profession 
themselves are concerned thev alone are the 
persons who could properlv perform such an 
operation It is to be hoped and expected that 
none of them would ever lend themselves to the 
malpractices of the professional abortionist No 
doubt they would act only in consultation with 
some other member of the profession of high 
standing so as to confirm the view that the 
circumstances were such that an operation had 
to be performed and vvas legal The jury having 
had the lav' expounded to them brought in a 
verdict of Not guiltv Thus Mr Meek Bourne 
has obtained the court ruling he sought and has 
earned the applause of his tollea.uts -k report 
of the trial appears at page but the medieo- 
legal asp,ets of ihe case must be reserved for fumre 
discussion 


INCOMPLETE DESCENT OF THL TESTICLE 
A trulv undesecnded testicle is an extreme rants but 
the diagnosis of undescended testicle covers a multitude 
of degrees of meomplete descent an amended ^lassin^-a 
tion of which IS suggested by Mr Denis Browne in ' is 
thoughtful and stimulating article on page 165 of w s 
issue A further terminological complication in the 
Iitcraiure of ihis difficult subject is that m this countrv 
the phrase ectopia testis is meant to desenbe a 
position of the testis other than m the normal line of 
Its descent In Continental vvntmgs the term is applied 
perhaps more logically to any position of the testicle 
other than us normal one so that it usuallv includes 
cases of incomplete descent Mr Browne tilts at the 
custom of describing as undescended anv testis that is 
not in the position which would be normal for an adult 
and he would have any position m childhood from 
which the testicle will mvanablv reach the scrotum 
classed as normal It may be urged that since it is 
normal for male children to be bom with the testicles 
m the bottom of the scrotum anv departure from that 
rule is abnormal and should not be classed as normal 
merelv because in time the abnonnalitv will right itself 
It mav be doubted too whether most surgeons have 
enough prophetic insight to enable them to sav that anv 
aiven incompletely descended testicle will be certain 
to reach the scrotum spontaneouslv Mr Dems Brow nc 
may well be nght m not taking verv senouslv those 
long lists of cases in which testicles desenbed as being 
before treatment m the ingumal canal have descended 
into the scrotum as a result of pregnvl injections yet 
It IS difficult to agree that ‘ a testis that is m the ingumal 
canal cannot be felt through the skin because it is 
a soft elongated vvormlil^ object sunk m the soft 



186 July 23, 1938 


INCOMPLETE DESCENT OF THE TESTICLE 


Tire British 
^ fEDICAL Journal 


floor of the canal, shielded from touch by the tense 
tendon of the external oblique” The tendon of the 
external oblique is not always tense, and it allows an 
inguinal hernia — which one might similarly describe as 
a soft, elongated, wormlike object — to be felt It seems 
more reasonable clinically to classify non-scrotal testicles 
a^ (1) those that can be felt — ^which may be but are 
probably not in the inguinal canal — and (2) those that 
cannot be felt, which may be anywhere Mr Denis 
Browne lays valuable emphasis on the vaneties of mobile 
testicle, in which, because of cremasteric spasm acting 
on a small gland, the testis, though sometimes lying 
III or near its normal position, is at other times much 
higher A large measure of agreement must be accorded 
to his belief that “ this class supplies the greater number 
of the successes of pregnyl treatment ” Again, in con- 
sidering cases with mechanical obstruction, he stresses 
“ the fact, still being confirmed, that cases of unilateral 
iindescended testis average much poorer results witli 
hormone treatment than bilateral ones,” and most justi- 
fiably observes that “ if one testis had descended 
normally it might be assumed that whatever was keep- 
ing up the other it could not be lack of hormones ” 
Apart from the fact that incomplete descent of the 
testicle IS usually a unilateral condition, another objec- 
tion to the present wave of indiscriminate hormonic 
enthusiasm at which he hints is the accompanying risk 
of premature sexual stimulation If the volcano is 
activated too early may it not become prematurely 
extinct? 


CHEMICAL ASPECTS OF ANTIGENS AND 
ANTIBODIES 


In order to record the rapid advances that have been 
made m the field of immunochemistry the Medical 
Research Council has issued a revised edition of Pro- 
fessor Mairack’s report on the chemistry of antigens 
and antibodies ‘ 1 hat a second edition should be called 
for within such a short space of time speaks much for 
the usefulness of this concise and lucid account of the 
chemistry of antigens and antibodies and for the success 
that has been achieved in explaining certain immunity 
re ictions in terms of the fundamental sciences The 
di\ ision of the report into five chapters has been retained, 
but the new edition has been bxtensively revised An 
account of the work of Svedberg and his school on the 
determination of the molecular weights of different pro- 
teins has been included, together with a fuller suivey of 
the bacterial polysaccharides and a critical discussion 
on the relationship that has been shown to exist between 
chemical constitution and immunological specificity A 
more detailed explanation of serological cross-reactions 
in terms of chemical and physical structure and the 
important work of Hcidelberger and Kendall are treated 
at some length by Professor Marrack and add much to 
the \aluc of the report Within the last few years 
Heidclbcrger and Kendall ha\e considerably advanced 
our knowledge of antigen antibody reaction by develop- 
ing a theoretical treatment of the combination which 


a"d Antibodies By I R MxrncV 
o\lwir ms net 230 HM Stationer 


appears to be in general agreement with the results of 
a large number of carefully planned quantitative experi- 
ments It IS unfortunate that Profcssoi Marrack did 
not include in the new edition an account of the recent 
work on the nature of bacterial antigens This work 
has developed rapidly during the last five years, and 
to-day it seems an established fact that the specific 
antigens of certain of the Gram-negative organisms at 
least are non-piotein in nature Until recently it seemed 
probable that bacterial antigens were composed of a 
polysaccharide substance, with which the immunological 
specificity of the antigen was closely associated, com- 
bined with bacterial protein which endowed the complex 
with antigenic properties The demonstration of the 
non-protein nature of some bacterial antigens again 
brings forward the question why certain complexes 
should possess antigenic properties Large molecular 
size appears to be an essential characteristic of antigenic 
molecules, but not all large molecular complexes are 
antigenic It seems probable that a detailed study of 
the chemical and physical properties of these protein 
free antigens will contribute a good deal towards our 
undeistanding of the properties essential for antigenicity 
Workers in the field of immunochemistry and others 
interested m this subject are much indebted to Professor 
Marrack for preparing for them this reliable and up to 
date account of the chemical aspects of immunity 
reactions 


THE BOOK OF PLYMOUTH 

It might be said that Plymouth needs no book, for it 
IS in Itself a complete volume on the shelf of -English 
history A statue of Drake stands on the Hoe to remind 
the passer-by of all that the sea has meant to England 
and of the greatness that has been built upon the 
audacity and courage of her sea captains From 
Plymouth Sound Sir Walter Raleigh and Sir John 
Hawkins sailed on then adventures — not all to end well 
And Plymouth has high responsibility to history because 
from here m 1620 the Mayflower sailed with the 
Pilgrim Fathers These things and others are set down 
in print m the Book of Plymouth, so ably edited by 
Mr F A Mayne, who wisely has not allow'ed the title 
to impose too strict and narrow limits on what is 
included in 248 pages of a book of exceptional interest 
He points out in some introductory remarks that both 
Devon and Cornwall are represented m the preparations 
of the 106th Annual Meeting of the B M A , and that 
therefore “ no part of these counties ” has been omitted 
in the accounts given by various experts on various 
aspects of the West Country The fii st part of the book 
IS on Plymouth itself and the second on Cornwall and 
Devon The historical notes on the former by Mr 
C W Bracken are full of interest and instruction, and 
give the reader a clear picture of Plymouth’s historical 
meaning Chapters follow on the medical history of 
Plymouth by Mr J Elliott Square, on vital statistics and 
municipal hygiene by Dr Mildred A Thynne, and on 
the water supply of the town by Mr Alan Atkinson 
In the second part of the book — on the two counties— 
special attention may be drawn to the well-ilhistratcd 
chapter, “ Before Written Record,” by Mr R Hansford 



Ju\ 2' 19^8 


THE BIRMINGHAM MEDICAL SCHOOL 


Tin E sniE 

>-UO CAl. JOLTLNi 


Worlii \\ho li.irnLdl\ cIiscuscls geological formations 
and their n.1 iiion to human skeletons found in certain 
cases On the other side of the Riser Tamar medicine 
sass Mrs Charles Henderson in her chapter on Com 
ssall has not ilssass been held in great respect and 
the spint of Moliere seems to hase dsselt in the ssriter 
of the fifteenth centurs serse plas of the Life of St 
Meriasck in this the doctor confides to his dispenser 
that 

If falsehood helps not 

\ phssieian ssill ncser rise 

The same st indard of excellence and interest is main 
tamed in the other chapters and ssc ssould finalls refer 
1 1 the pietonal maps of Deson and Cornssall bs Colonel 
M Orr Uilson sshich form the end papers of the 
solume and to the delightful photograpli of Dr Cohn D 
Lindsas the President 


THE BIRMINGHAM MCDICVL SCHOOL 

The opening of the Hosp tals Centre at Bimiingham 
sshich ssais the sibjec' o^ an irticle in our list issue 
IS the occasion for the publicaiion of a booklet b\ the 
Taeults of Medicine gising a short liistorv of the Bimi- 
ingham School and an account of its ness buildings and 
ensironment Ssstemati,. clinical instruction of medical 
students m Birmingham goes back to the opening of 
th- General Hospital more than 150 sears ago The 
foundation of the School of Medicine proper ssas the 
ssork of ^\Illlam Sands Cox the son of a Birmingham 
surgeon ssho qualified in 1S24 and in the follossing scar 
began a course of Anatomical Lectures ssith Phssio- 
logical and Surgical Obsersations ssith a class of nine 
teen students The school ssas astonishingls successful 
Bs 1835 It had ninets students and a panel of lecturers 
and in IS36 William I\ became its patron and decreed 
that Its stsle should be the Bimiingham Rosal School 
of Medicine and Surgers Aftensards Queen s Hospital 
ssas established as an institution pnmanlj for the 
leaching of students and sshen Queen Victoria granted 
a charter to the school m 1843 it became knossu as 
Queens College In 1 84 1 a risal school Sjdenham 
College ssas founded in association ssith the General 
Hospital and ssas administered bs local practitioners 
PrLsentls steps ssere taken to amalgamate the tsso 
schools This ssas successfulls' accomplished and the 
Birmingham Clinical Board ssas founded to co ordinate 
the clinical teaching at the tsso hospitals — that is the 
General and Queens The school osses a great deal 
to Joseph Mason one of the self-made men of Birm- 
mgham at sshose college the students of Queens took 
their prelimmars science training In 1892 sshen there 
s ere upssards of 250 medical students the Medical 
Pacults of Queen s became the Medical Facults of 
Mason s College The bookLi goes on to describe the 
adsent of the Hospitals Centre Scheme and the planning 
of the ness school buildings sshich are an integral part 
of the enterprise A remaik is made on the apparent 
anomals that there is no prosision for the teaching of 
medicine and surgers in the school itself this is de- 
liberate the Facults of Medicine belies mg that these 
subjects should be taught in the hospital It is proposed 


18 " 


a^ soon as the school is in ssorking order at Edabaston 
to set up three research departments — namels m 
industrial hsgiene cancer and mental diseases The 
school is prosided ssith a large department for dentistrs 
and til dental instruction including that sshich has up 
to noss been gisen at the Dental Hospital s ill m future 
gisen in the ness buildings The number of medical 
students tiken each sear ssill onls be sixts slx, a slight 
increase on the present entrs limit of sixts but facilities 
ssill be asailable for the admission of a cenain number 
01 students in excess of that figure sshen thes hase 
finished their pre clinical studies ehesshere — for instance 
at Oxford or Cambndge — and ssish to take up chmeal 
ssork m Birmingham It is also proposed at a later 
date to make arrangements for postgraduate studs see 
ing that the clinical matenal asailable m the citv and 
surrounding areas is exceptional both m its size and 
range When the ness hospital has its full complement 
of beds f740) one of the other general hospitals in the 
cits s ill probabls be resersed for postgraduate studs 
The booklet IS an interesting sousemr abls \ n'ten and 
includes an aerial photogriph of the ness buddings 
and sue 


ELLCTROCkRDIOGRAPHIC CHANGES DLE 
TO SAIOKING 

The ads ice he receises on smoking is to the patient 
ssith heart disease a most important aspect of his treat 
ment since sers often he has been a heasx smoker and 
finds drastic reduction hard to cam out It is generalls 
agreed hosseser that smoking is apt to increase blood 
pressure and the frequencs of the heart beat and cause- 
a drs cough all of sshich are better asotded in cardiac 
disease The patient is therefore usualls adsised not 
to smoke at all or at most a little after meals— a restne- 
tjon sshich he finds difficult to folloss as the habit is 
usualls ingrained and pleasurable More precise 
obsersations of the effect of tobacco smoking on the 
heart arc supplied bs A Grasbiel R S Starr and P D 
White' ssho hase insestigated the electrocardiographic 
changes in forts fise subjects four of them bemg non- 
smokers and the majorits tobacco addicts elesen had 
heart disease After a control electrocardiogram and 
other records had been taken the smoke from a cigarette 
ssas inhaled until toxic ssmptoms appeared or it ssas 
finished In some cases tsso or three cigarettes a 
pipe or cigar ssere smoked During the test tssents- 
eiaht complained of ssmptoms — cerebral cardiac 
oi gastro intestinal The electrocardiogram shossed 
changes apart from those of rate m tssents of the forts- 
fise subjects sesenteen being heass smokers and three 
moderate or non smokers The commonest change 
ssas a decrease in the amplitude of the T ssase in Leads 
I and II and in one instance T became negatise or 
diphasic flattening of the presiousls ssell-des eloped 
positise T ssase ssas not infrequent In a less cases 
atropine sulphate (2 mg mtrasenousls) ssas also tried, 
and the elTects on the tracing ssere found to be sers 
similar to those of smoking Discussing the ssas these 
changes are bre-aght about Grasbiel and his colleagues 

Anter Heart J 1935 15 S9 



188 July 23, 1938 


HARVEY CUSHING 


The: Bmtish 
Mcdical Journal 


state that only three toxic substances need be con- 
sidered — pyridine bases, carbon monoxide, and nicotine 
They believe that neither carbon monoxide nor pyridine 
bases are usually absorbed in amounts capable of 
inducing the changes recorded, and hold nicotine 
responsible for them all Some of the effects — for 
example, the increase in pulse frequency and in blood 
pressure, which occurred m the majority — may be 
attributed to stimulation of the sympathetic nervous 
system , but there is less evidence that the changes m 
tlic T wave were brought about in this way, though it 
was noted that they were conspicuous in the young and 
healthy but emotionally labile subject and absent in the 
more stolid, even with severe coronary disease Amyl 
nitrite was without effect on the altered wave, and the 
authors do not regard the changes in the T wave 
indicative of coronary vasoconstriction They believe 
that any aggravation of angina pectoris caused by 
smoking IS due not to an action on the coronary arteries 
but to the well-known action of nicotine on the fre- 
quency of the heart and on the blood pressure, which 
are usually both increased 


HARVEY CUSHING 

We welcome to this country Dr Harvey Cushing, 
emeritus professor of surgery, Harvard Umveisity, and 
congratulate him on the honorary degree of Doctor of 
Science which was conferred on Satuiday by the Univer- 
sity of Oxford Dr Cushing has many ties with this 
country, for m his early days he worked in several 
laboratories of physiology here During the war he 
came m contact with many surgeons of the British Army 
In the course of his long tenure of the piofessorship of 
surgery at Harvard he built up his world-wide reputa- 
tion as a peerless operator on the cential nervous system, 
and inculcated his methods into men from all over the 
w'Oild Eminent not only in surgeiy, he has distin- 
guished himself also in the field of letters and his 
biographv of Sir William Oslei will remain a monument 
to his literary style and his appieciation of the spirit 
and achievement of a great man It is only right that 
the biographei of the late Regius Piofessor of Medicine 
at Oxford should be honoured by the University which 
Osier graced during the lattei part of his life Those 
who have worked with or been acquainted with the 
“ Chief ” have alwavs been impressed with Di Cushing’s 
surgical skill and his knowledge of literature, and, more 
particularly, with his wisdom and understanding of 
patients in his care He has not only a genius for 
making friends but that greater genius of being able 
to keep them 


SUCCESSFUL VACCINATION WITH DEAD 
TUBERCLE BACILLI 

Some unusnallv successful results from vaccinating 
guinea-pigs with dead tubercle bacilli have been obtained 
by G Henscl * Twenty-one animals were inoculated, 
presumably subcutancouslv, with 0 005 gramme of 
tubercle bacilli suspended in 1 c cm of lanolin or soft 
pinnin The organisms had been killed by exposure 

' Brilr klm Tiiberk 1938 91 442 


for tw'o houis to a temperature of 65° C Ten to 
eighteen months later, when still tuberculin-positive, 
the animals were injected intracutaneously into the 
hind leg with 0 00001 mg of living tubercle bacilli 
from a four-weeks-old culture Ten control animals 
received the same infecting dose simultaneously 
Cultures put up from the inoculum showed that living 
tubercle bacilli were present Three months later all the 
animals were killed In the control group the focal 
glands were enlarged and partly caseous, and in nine 
out of the ten animals the spleen was obviously 
tuberculous In the vaccinated group, with one excep 
tion, not a single animal show'cd any lesions in either 
the glands or the spleen Examination of the vaccination 
site showed the presence of a capsulated lesion contain 
ing apparently unaltered vaccine material with intact 
acid-fast bacilli Only in the animal showing tubercu 
losis had the lesion developed into an abscess and dis 
charged part of the vaccine material The reasons for 
the extraordinarily successful result of this experiment 
are discussed Ihe author lays stress on the long 
penod of allergy — ten to eighteen months — elapsing 
before infection, on the smallness of the infecting dose 
used and on the choice of the intracutaneoiis route for 
infection which ensured that the living bacilli gained 
access to the tissues slowly 


NATIONAL RADIUM TRUST 

The National Radium Trust met on July 12 at the Privy 
Council Office, with Viscount Hailsham, Lord President 
of the Council, in the chair The Earl of Donoughmore 
was reappointed for a further period as chairman of the 
Radium Commission (the expert body set up under the 
Charter which allocates the Trusts radium and super 
vises it in use) Various matters were reviewed affecting 
the supply of radium to the Trust The Trust, £150,000 
of whose funds was contribufed bv public subscription 
m 1929 as a thank-ofiering for the recovery of his late 
Majesty King George V, welcomes gifts and bequests of 
all kinds in luitherance of its objects, including trusts 
subicct to special conditions, which it is expressly author 
ized to accept under the Royal Charter granted by King 
George V in 1929 Its headquarters are at the New 
Public Offices, Whitehall, S W 1 


THE HALF-YEARLY INDEXES 

The usual half-yearly indexes to the Jowml and to the 
Supplement and Epitome have been printed , they will, 
however, not be issued with all copies of the journal, 
but only to those readers who ask for them Any 
member or subscriber who wishes to have one or all of 
the indexes can obtain what he wants, post free, by 
sending a postcard notifying his desire to the Finance 
Department, British Medical Association House, Tavi 
stock Square, W C 1 Those wishing to receive the 
indexes regularly as published should intimate this 


At the quarterly meeting of the Council of the Royal 
College of Surgeons ot England held on July 14, Mr 
Hugh Lett, F R C S , consulting surgeon to the London 
Hospital, was elected President for the ensumg year 



Jlia 21 I^ls 


INJURIES TO ELBOIV -JOINT 


Tht ExmjR 

MiDICAI. JOCIUS KL 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

Tilts IS one or a senes of articles contributed by imitation 


I^JURIES TO THE ELBOW-JOINT 

S L HIGGS, r R C S 

TENNIS ELIIOII 

Much ha', been «rillcn but little is known with ccrtainis 
about this common minor ailment It u, an annosing 
condition not onl\ to the patient but also to the doctor 
as treatment so often fails to cITect a cure with con 
Sequent dissatisfaction to all corccrncd 

Diagnosis 

The condition mas sometimes be mistaken for arthritis 
of the elbow or some other painful disorder but the 
diagnosis mas be made in a few moments as the signs 
and ssmptoms are definite and sars but little The 
patient complains of pain at the outer side of the elbow 
and sometimes dovsn the forearm on gripping with the 
fingers as in shaking hands or opening a door and on 
such mosements as lifting quite small objects — a teapot 
or estn a tumbler Tennis and other games requiring 
a firm grip become impossible 
On examination the appearance of the arm is quite 
normal The elbow should be mosed passisely ssith 
the muscles relaxed No pain or stillness is experienced 
so that the joint itself is therebv excluded as the site of 
the trouble On actise extension of the wrist against 
resistance especialh if this movement is combined with 
supination the tvpical pain occurs It this active exten 
Sion is maintained the site of the pain can be localized 
There are three usual situations all of them beneath the 
common origin of the extensor supfnator group of 
muscles The first and most usual is over the radio 
humeral joint the second rather higher up in the 
region of the external epicondvle, and the third and 
least frequent rather more forward beneath the bulky 
part of the muscle ongin The moment the active con 
traction is relaxed the pain disappears An exactiv 
analogous condition is verv occasionally found on the 
inner side of the elbow just below the tip of the internal 
epicondvle at the origin of the flexor pronator group of 
muscles 

The condition is rarelv seen in patients under 35 The 
trouble is provoked by vigorous use of the arm as m 
playing tennis fly fishing and gardening Although some 
times teen in industrial workers it is the occasional over- 
use as in games rather than regular activity which seems 
!> to determine an attack There 'is often a historv of 
rheumatism lumbago sciatica and so on suggesting 
that an infective factor mav be at work Frequently the 
history is given of a tennis elbow lasting two or even 
three vears, but rarelv longer The trouble,, seems to 
run a certain course and then to disappear spontaneously 
These observations seem to throw some light on the 
nature of the disorder and to indicate the line of treatment 
When the elasticity of vouth has passed and at an age 
when focal sepsis is common unaccustomed vigorous use 
of the forearm muscles mav lead to trauma to their deep 
fibres of origin Instead of clearing up in the manner 
of an ordinary strain the painful svmptoms persist owing 


It mav be supposed to a low grade infective p oce •, 
becoming established m the damaged tissues In a case 
explored bv operation eight weeks after the onse, of the 
trouble a patch of granulation tissue was discovered — 
an observation which lends support to this theorv 

In course of time the active stage of inflammation passes 
into one of fibrosis and adhesions and uhimaielv the 
lesion heals and svmptoms disappear In these la'e- 
stages a chronic inflammatorv area resembling ash- 
leather mav be discovered at operation 

Treatment 

The multitude of methods that have been advocated 
only indicatL the uncertainty of the results Many patients 
an. se^n who have alreadv tried a number of remedies 
— massage bone setting and the like — and ase dis 

appointed at their lact of success Some accoum of the 
nature of the trouble should therefore be given and I’s 
chronic character and ultimate spun ar-ou d a Eej a 
explained The adviee hov e e' wd! dep -d ’ r 
the duration ot the double when the pa en s h'^s 

At the onset or if it has been present tor - fen v ee^s 
onlv It IS sometimes possible to cut short the attack bv 
rest heat and avoidance ot the paintul mo ements The 
arm should be kept m a slmg and heat applied bv 
antiphlogistine at ni^ht In addition diathermv may be 
given The elbow joint should or course be meved 
through Its full range each dav to p'event stiffness bu’ 
the forearm muscles must be kept out or action Focal 
sepsis should be sought and an t rav examination of -n, 
crowned dead or suspicious looking eeth carried out 
and apical infection dealt with if discovered Message 
movements and electrical stimulation appear ic male 
matters worse rather than better and should be avoid-J 
Most patients do not seek advice at the earlv stage but 
only when the condition has been present tor some 
months 

In the earh chronic stage which mav last a vear or 
more treatment is most difficult This is rather to be 
expected if we believe that a locahzed chronic infiam 
matorv process is at work During this period there is 
no actual contracture of the affected muscles and this 
would explain the frequent lack of success of rap d 
manipulative methods It should be pointed out that a 
verv certain cure within a short space of time can be 
effected bv means of an operation The majority how 
ever will not welcome this suggestion as they regard a 
tennis elbow as a minor nuisance not worths of such 
drastic treatment Nevertheless there are some who find 
a disabled arm such a hindrance to sport or work that 
thev will agree to operative measures especiallv when 
other means have failed and for them a speeds cure 
IS assured 

The Operation 

The whole arm is given the usual thorough preparation 
Then to render the operation field bloodless an Esmarch 
bandage is bound round from the hand upwards and 
finally made fast bv a few turns about the middle of the 
upper arm The lower part of the bandage is then 
unwound and the elbow held in mid flexion with its 
inner side resting on a sandbag In no circumstances 



190 JuL\ 23, 1938 


INJURIES TO ELBOW- JOINT 


The British 
Medical Jolrsm 


may the rubber bandage be kept on for more than half 
an hour, but far less time than this should be sufficient 

A slightly cursed incision four inches long is made 
on the outer side of the elbow behind the external 
epicondyle In this situation the resulting scar is hardW 
noticeable The skin is retracted forwards and then the 
muscles ol the extensor-supinator group are reflected from 
the epicondyle and the capsule of the radio-humeral joint 
In some cases definitely pathological tissue is visible 
beneath the muscles No special search is made and 
since the object is not so much to remove anything but 
to relieve tension the muscles are stitched back again 
with a few interrupted No 0 catgut sutures It is as 
well to take oft the Esmarch bandage and pick up •»ny 
bleeding points before sewing up the skin The arm is 
kept in a sling until the stitches are removed one week 
after the opeiation, and then gradual return to active use 
IS allowed The arm is usually strong and comfortable 
once more by the end of a further two weeks 

For the majority of patients other measures must be 
tried Success, by operation or otherwise, is achieved by 
relieving tension at the painful muscle origin, and the 
method described by Cynax is giving promising results , 
treatment can be carried out by a masseuse familiar with 
the technique The patient s elbow is flexed to a right 
angle and fully supinated Deep friction is then applied 
to the muscles m front of the external epicondyle over 
the tender area This is continued for four or five 
minutes alter which the elbow is extended m full supina- 
tion and the forearm adducted forcibly Some “ cracks ” 
•may or may 'not be elicited The treatment is earned 
out three times a week, and m a short time relief should 
be experienced if the method is going to be successful 

In the late chionic stage where adhesions have formed 
a tennis elbow can usually be cured in a dramatic manner 
by a single manipulation The suitable case can be 
detected in the following way The fingers and wrist are 
flexed and the forearm pronated The elbow is then 
extended By these means the affected muscle group is 
put on the stretch It the range of extension is limited 
and causes pain at the elbow we may assume that con- 
tractures have formed and that the case will respond to 
forcible stretching The manipulation (Mills s method) 
can be done without an anaesthetic, less painfully after 
an injection of 2 cem of 2 per cent novocain into the 
area of maximum tenderness, but best of all under anaes- 
thesia from cas or from an evipan injection Only a 
monvp^nis ■'relaxation is required The muscles are put 
^^n'^tlic stretch in the manner described With one hand 
the operator grasps the flexed fingers and wrist, and with 
the other the elbow, placing his thumb behind the radio- 
humcral joint The elbow is then forcibly extended and 
simultaneously the flexion of the hand and pronation of 
the forearm are increased to the full extent A “crack ’ 
is usuallv heard and felt in the region of the muscle 
origin at the elbow No alter-care is necessary', and the 
patient should be encouraged to resume active use of 
the arm 

DISLOCATIONS AND SPRAINS 

Next to the shoulder-joint the elbow is most frequently 
dislocited Unlike the former it occurs more often m 
children than m adults It is an injury fraught with 
serious consequences because of the great damage that 
mcvitablv occurs to the ligaments and their periosteal 
attachments and to the neighbouring muscle insertions 
By fir the commonest tv pc is the posterior dislocation, 
due to a fill on the outstretched arm, ciusing hvpcr- 


extension at the joint and levering of the coronoid process 
backwards over the articular surface cof the humerus 
More rarely the elbow is displaced sideways, cither m 
wards or outwards, but this is usually accompanied by 
fractures Anterior dislocation is rare 

The diagnosis is as a rule quite obvious from a con- 
sideration of the deformity and position of the bony 
points What is not so evident by clinical examination 
alone is whether or not there is associated bony injurv 
An v-ray examination is therefore most necessary 
for the purpose of both treatment and prognosis If, 
however, v-ray apparatus is not available, then to avoid 
delay and suffering the elbow should be reduced, but 
radiographs must subsequently be taken Frequently', m 
a posterior dislocation, a fracture of the coronoid process 
or radial head will be revealed and in a lateral dislbca 
tion more serious fractures involving the condyles may 
be seen 

Treatment 

In fresh cases reduction is easy', the ligaments and soft 
structures being so torn that little resistance is offered 
except by the bony contours It is more satisfactory in 
every way lor the reduction to be carried out under 
a general anaesthetic, affording good relaxation and ample 
time In a posterior dislocation the coronoid process 
of the ulna which has slipped back beneath the lower 
end of the humerus, must be made to retrace its path 
An assistant steadies the uppei arm, and the iorearm is 
grasped and pulled firmly but gently m the line of tlit 
limb If the dislocation is of several davs’ duration, or 
difficult to reduce, then hyperextension will lever the 
coronoid process over the humeral surface and the joint 
will be felt to slip back into pi ice The arm is then 
put up m fairly full flexion, but as the swelling may givt 
rise to pressure symptoms this must not be overdone 
or forced A period of rest in the flexed position is 
most necessary', not only to allow the swelling to subside, 
but also to prevent recurrence of the displacement to 
save the torn ligaments from further trauma during the 
first stage of repair A sling, vvith early movement, is 
not a Wise line of treatment It is better to immobilize 
the elbow m a moulded plaster A four-inch or six inch 
plaster bandage, depending upon the size of the arm, 
IS immersed in water and, keeping it wet, a “ slab of 
the requisite length from upper arm to wrist is prepared 
It IS then put on straight over the skin to the back of 
the upper arm, elbow, and forearm and as it sets it is 
fixed m position by a lightly applied domette bandage 
This should leave the elbow region free m front, m order 
to prevent pressure and provide for inspection of any 
swelling The whole is supported by a sling In nn 
complicated cases this splint should be retained for a 
fortnight and then replaced bv a collar-and-cuff sling for 
a few days until the elbow gams the position of a right 
angle This is follovv'cd by an ordinary siing for 
least a further week 

The comphcations to be feared are the formation of 
new bone around the joint at the site of the torn up 
penosteurn, ossification in the ligaments, and myositis 
ossificans in the tendon of the brachialis aniicus Thc 
danger ot these may be reduced but not eliminated by 
careful treatment, and therefore when the case is first 
undertaken it is advisable to inform those concerned ol 
these possibihties-and to record them m writing 

During the period when a sling is worn and also hicr 
when It has been discarded, restoration of movem-nt 
should be left to the patients own eflorls Mas'^age, 



Juu a"* 19^S 


INJURIES TO ELBOW JOINT 


i HE btrr^H 


^^lca. Jo 


stn-tching nnd forcible niS'rsiircs of ^n'. kind must be 
TbsoliUcU forbidden ns such misguided iltempts mstcid 
of Instening rmttcrs nn\ onK lead to further trauma 
and increased stillness ind cecrt to periarticul ir ossifica- 
tion that would otherwise not hue taken place Return 
to ncirmal mosement is usiialle slow but no an\ict\ need 
be felt proiidcd that the range steadilj improses Should 
this become stationare or the stiffness increase then an 
V ra\ c\amination must be made to determine whether 
ossification is occurring in the neighbourhood of the [oint 

Treatment of Complications 

Tile radiographs maj show a shadow abo\e the eoro- 
noid process of the ulna indicating the onset of nuositis 
ossificans in the brachialis aniicus muscle Complete 
fivation of the joint for a long period is essential This 
is best carried out b\ applying a wet plaster slab direct 
to the back of the arm with the elbow flexed to a 
right angle the plaster being held in place b) an ceenlj 
applied bandage T inalK a few turns of a pi ister band ige 
surround the whole In this wax immobilization is 
assured, with maximum strength and minimum weight of 
p aster The hand is left free and can be used At 
inters als of one month fresh radiographs arc taken alter 
remoxal ot the plaster case tn order to obserxe progress 
The extent of the ossification continues for a time reaches 
a maximum and then begins to xxane It max be six 
months or more before the condition becomes stalionarx 
and during the xxfiole of this time the plaster fixation 
must be continued Absorption oi the nexx bone is rarclx 
complete Usuallj a branch like growth of well defined 
bone persists The clboxx is gtxen its freedom but no 
treatment is desirable With time and aciixe use a certain 
range of moxement will return In most cases this range 
IS adequate but not complete If, howexer the limitation 
IS serious exen after a full six months of aclixit> and 
vt IS clear that rhe botxx growth has formed a block 
then this should be remoxed bx operation Too early 
surgical interxention xxill onl> lead to recurrence of the 
ossification so patience and careful judgment based on 
the t-ra> findings are neecssarx 

Ossification in the ligaments or bonx spurs at the 
periosteal attachments also require rest and axoidance of 
anx form of irritation bx massage or by passixe moxe- 
ments Complete immobilization m plaster is not neces- 
sary, but a sling should be xxorn for a month or more 
until there is radiographical cxidence that the nexx bone 
formation has ceased 

Treatment of Old Dislocations 

Although reduction of a dislocation is xer> easily 
accomplished soon after the injurx xxiih exerj day s delay 
It becomes more dilhcult In these old unreduced cases 
another method must be cmploxed as forcible stretching 
xvith the elboxv m extension may not only fail to effect 
reduction but may also cause further injury to the soft 
tissues To obtain the necessary purchase the upper 
arm is attached by means of a loop of broad firm 
bandage to a radiator or to some fixed point on the xxall 
Strong traction is then applied to the fingers and thumb 
with the elboxv bent at a right angle It is difficult how 
fixer, to get the necessary grip and Bohlers method of 
applying the pull through gauze stuck to the patients 
fingers and thumb with mtstisol’ is most xaluab’e Bx 
these means steadx force can be applied and the coronoid 
process of the ulna made to retrace us path beneath 
the loxxer end of the humerus The after treatment by 


a period of fixation followed bx increasing actixi x is 
the same 

Reduction bx open operation is rarelx eilhei- nece'ean 
or salisfactorx as it entails so much soft pan injurx '■nd 
subsequent stiffness 

Sprains 

A sprained elbow should not be regarded so hg'iiix 
as a similar injury to othe^ joints An r rax examina icn 
IS adxisable since the general swelling and sj flness max 
conceal a fracture ot the head of the radius or other bonx 
damage neglect of which may lead to serious coasc 
quences Strapping actixe use and phx steal treatment 
max suffice lor other sprains but m the case of the eibow 
rest and an unhurried and unaided return to ^clixitx 
IS the right policx It cannot be too sironglx emphasized 
that stiffness must not be treated by manipulation, 
massage or torcible stretchmg 


LONDON FE\TR HOSPITAL 

OPENLAG OF THE AEll BLOCK 

HRH the Duke of Kent on JjI open-d a new x 
lalion bfock xxhich hn^ b-en added at a cosi i hi 
to the London Fexer Hospital m ( I ng on This ,tpljee 
an older building which wai in its tir e ei n u. eJ 
most up to date I'o'ation bicel in the x arm 

The New Isolatioii B'oek 

The new bui’dinc different rom the old m 'iro i t er 
respect is the result of tnanx tears experien e ot 'e e he 
pital administration It is a three tor trusture iih u ert 
three beds so designed that each patient is isolated ur j it ' ih 
net pnncipallx as a clearing house for meoming p hent 
whose sxmptoms haxe not been clearlx dehned Dou'' il 
case xxill be observed until thex ean be pLseJ n n- r 
•xppioprxaXt eaXtaors sshaw xhas xsxU be Xtan ed o ' 

corre ponding xxnrd There max also be patients w ih m e 

than one disease xxho xxitl need single room accomrrooat os' 

Each of the three floors of the block has a wide xeranda in 
lionl continuing around both ends of the building and forming 
a scrxice corridor behind thus there are no closed spaces whish 
in ofd fashioned buildings were responsible for a certain amoanl 
of room to room infection Except for the top floor with ils 
two four bedded xxards each floor is of the same design 
arranged m single rooms The rooms are separated bx glass 
partitions which gixe the nurse a xiexx of the xxhole length 
of the floor from the central kitchen though curtains afford 
pttxacx xvhen neces'ary for adult patients N portable bath 
sink enables each patient to haxe a bath m his oxvn room 
Each patient has his own thermometer torch spatula basin 
treatment Irax and doctors nurses and xisiiors gowns 
The xsashing and sterilizing plant in ibe central kitchen is 
cast in one piece of stainless steel The crockerx is washed 
in one sink, and after rinsing transferred in speciallx designed 
r«cks to be sterilized in a steam jacketed lank There are 
manx such interesting contrixances and safeguards in this 
modern building 

Hisforv of the Hospital 

The London Fexer Hospital was the first xoluntarx lexer 
hospital in this countrx and is still the onix one of its kind 
in Ihe London area It was formed as a result of the 
deplorable social and hygienic conditions uhicn e\i^ted in 
London J40 ^ears ago Like man% other movements of the 
lime il originated in a tavern— the Thatched Hou«^e Tavern 
where a meeting of citizens was held in 1S02 to m^vtule 
means of dealing with the contagion^ disea'^e-^ then so preva 
lent Its onginal home was in Grav s Inn Lane after 
which It moved to a site nov occupied bv K.ings Cro*^ 
station It has been on Us present site in l^^lingion for 



192 JUL\ 23. 1938 


LONDON FEVER HOSPITAL 


The DRmsii 
Medical JounNii 


nearh ninety \ears During the first half of the nineteenth 
century the hospital was closel> associated iMth the pioneer 
work of those men and women who fought to awaken the 
countrt to the appalling housing md sanitary conditions then 
existing Southward Smith one of the leaders in the agita- 
tion which led to the passing of the first Public Health Act 
in 1848, was a ph)sician of the hospital Among the friends 
of the hospital who brought it into public notice were 
William Wilberforce, Florence Nightingale and Charles 
Dickens the last named in 1861 wrote a sivid account of the 
hospital in All the Year Round It was as the result of a 
senes of confirmatory tests and observations at this hospital 
tint Cdivard Jenners discoyerv that vaccination yvith vaccinia 
h mph yy as a protection against small-po\ yy as finallj accepted 
by the medical profession , it yvas here also that Sir William 
jenner, yvorking at a table yvhich is stiH preseised, established 
the clinical differentiation of typhus from typhoid fever 

The hospital receises patients from all parts of the country, 
and Its local chancier has long since disappeared Up to 
noyy it had suffered under the handicap that the public regards 
infectious diseases as a matter for the local authorities, and 
‘ feier has not the appeal of some other afflictions It has 
had great difficulty’ in raising money for its yvork, and this 
ne\y extension is financially rather a venture of faith 

Opening Ceremony 

The Duke of Kent was received by Field Marshal Lord 
Milne the president of the hospital, who referred to the 
special difficulties under which _a fever hospital had to carry 
out Its work When the life of a fever patient vvas saved 
by sound diagnosis and skilled medical attention and nursing 
little was said of it and few people were inclined to visit 
a patient unless it yvas their plain duty to do so, a very 
different state of affairs from what happened when a life vvas 
sived by surgery The result was that too few people heard 
of the work of the London Fever Hospital, and no spectacular 
gifts came its way Of the £30 000 required to build a new 
isolation block £20,000 had still to be found 

1 he DufvC or Kent praised the design of the new building, 
whciebv the possibihtv of infection from patient to patient 
w IS completely avoided The hospital provided facilities 
which were not given in the ordinary fever hospitals, and 
admitted all cases of infectious diseases except small-pox 
His Roval Highness added a special greeting to the patients, 
to whom th6 opening ceremony was relayed 

Sir William Willcox speaking to a vote of thanks to the 
the Duke of Kent, said that the special isolation block had 
been desired by the medical staff for many years He gave 
a brief outline of recent progress in the treatment of infectious 
diseases There was now he stated, a reason ible hope of 
^l imping out diphtheria by the preventive inoculation of 
healthy children with the diphtheria toxoid Municipal 
authorities were beginning to establish immunization clinics 
igainst the disease a movement worthy of every encourage- 
ment At the hospital there had been virtually no deaths 
from scarlet fever for several years The mortality for 
measles vvas now seven times that for scarlet fever, and during 
the past year over 1 000 had been completely protected from 
measles by the use of the preventive serum prepared at the 
hospital from convalescent patients 


The International Labour Office decided in 1935 to publish a 
supplement to Otcuptiiioit and Hialth which was an encvcio 
paedia of hygiene pathology and social welfare issued bv the 
Office in 192S The first instalment of the supplement has 
now been published and consists of brochures on (1) allergy 
and occupition f21 asbestos (3) berv Ilium (glucinium) (4) 
pneumoconiosis and (5) silicosis A special loose leaf 
binding cover will be offered to subscribers to the supple 
mcni The subscription rate for 500 pages including the 
cover is £i and orders may be addressed to the International 
L ibsmr Office at 12 Victoria Street London SWl 


y 

MEDICAL STUDENTS’ CONFERENCE 

THE TRAINING OF THE DOCTOR 

A naedical students’ conference under the auspices of the 
National Union of Students, was held in London from 
July 12 to 15, when the general subject of discussion was 
“ The Training of the Doctor ” The conterence was pre 
ceded by a dinner at which Lord Hordei was the principal 
guest At the end of the conference visits were paid to 
the Pioneer Health Centre at Peckhana and to three 
London hospitals — Middlesex, Royal Free, and University 
College — where special demonstrations were ai ranged for 
the benefit ot the students The conference was attended 
by delegates from ail the universities m Great Britain and 
Ireland 

The Medical Curriculum 

The first address was given by Sir Henrv BRACkENnuRV 
chairman of the British Medical Association Committee on 
Medical Education He began by referring to four important 
documents on the siibjeet issued during the last few yeirv 
These were in chronological order, a volume entitled Medical 
Education’ — an exhaustive study principally of the conditions 
m the United Slates — a valuable treatise compiled by the 
Health Section of the League of Nations the report of the 
British Medical Association committee and a report by a 
bodv representing the Universities and Royal Colleges The 
last named was compiled bv teacheis only , the B M A report 
by a composite committee 

Sir Henry Brackenbiirv described in detail the attitude of 
the General Medical Council towards the proposals in the 
B M A report Four mam suggestions came forward tl) 
that the standard o' general education for admission to the 
profession should be raised , (2) that the piehminarv scientific 
requirements should be widened (3) that departments in 
medical schools should not be segregated, and that more 
attention should be paid throughout to the preyenttve aspcctv 
of medicine and to the living body rather than the cadaver 
and (4) that there should be a period of responsibility under 
supervision at the end of the training but included m the 
medical course Some of the B M A suggestions had been 
implemented though imperfectly, by the General Medical 
Council others had been negatived including the suggestion 
that It was not necessary that dissection of the whole cadaver 
should be undertaken bv every medical student The B M A 
committee believed that a knowledge of the human frame 
could be taught partly bv dissection bv the students on a 
part of the cadaver, but also bv demonstrated dissection bv 
some more expert hand specimens m museums, and, above 
all demonstrations on the living human body One surgical 
member of the B M A committee, indeed had held that dis 
section vvas of no use at all because what had been learned 
m dissection had to be unlearned in operative surgerv The 
objection to the dissection of the whole cadaver, on vvliicli 
the General Medical Council insisted was that it took a 
great deal of time which might be saved during the first two 
years of the curricukira Another important suggestion was 
that at the end of the student s training befoic registration 
SIX or perhaps nine months should be passed as a period of 
responsibility under supervision following which there would 
be an onl examination on that experience only This was 
being pressed and he fully expected that at the next revision 
an arrangement somewhat on those lines would be introduced 

The Teaching of Psychology 

During the ensuing discussion a good deal of interest wav 
evinced by the students in the teaching of psychology Sir 
Henry Brackenbiirv in reply to questions siid ihd 
demand for the inclusion of the tciching of psvchologv >n 
the first two years in connexion with physiology and in the 
clinical years in connexion with medicine came very empluiut 
ally from the students thcmscUcs The longer a man "is 
in practice the more aware he became of the paranioun 



JUL\ 2’, I9''S 


MEDICAL STUDENTS CONFERENCE 


impornnci. of Iht tcii.hmg of p^^^.hoIo!,\ m jts clinical 
I'pccli Blit such instruction was \crj difficult — some teachers 
said impossible — lust because the student bj the mere fact of 
his south had not sufficient experience to appreciate psscho 
logical problems and again because the actual treatment of 
persons ssith psschoneuro'cs had to be conducted in seclusion 
so that It was diflicult to introduce c\cn a small bods of 
students Both these were formidable obstacles but he 
believed thes could be overcome b> proper tcaehing and 
wherever clTcctive leaching of this kind had been introduced 
to judge from the earnest attention given it was the most 
popular course of all 

Prc-clinical Subjects 

Professor C A Lo\ vtt Ev vns addressed the conference on 
the relation of prc-clinieal subjects to the medical curriculum 
as a whole He began b> quoting Stephen Leacock to the 
effect that if he founded a universilv the first thing he would 
do would be to establish a smoking room then a dormitorv 
and afterward' when funds permitted a decent reading room 
and librarv finallv going on to get some textbooks and hire 
a professor This was his wav of suggesting that the essential 
thing in univcrsitv education was contact with other people 
parlicularlv those studving other subjects British medical 
education said Professor Lovatl Evans was still one of the 
outstanding trainings in the world Other countries might 
have longer or more specialized courses or on paper more 
searching requirements or examinations but the fact remained 
that medical education in Great Bntain was of as good general 
standard as in anj other countrv and belter than in a good 
manv 

Were all the prc-clinical subjects essential to medical cduca 
tion’’ Of late there had been a good deal of talk of the need 
for a more vocattonallv directed training with rather less 
of pure 'cience Was this claim at all justified'’ People like 
himself who were educators had to examine (hem elves as 
to whether the students coming to them had the right sort of 
preliminan education whether thev were the right sort of 
student whether thev were too numerous or too few k\as 
there anv means of knowing at an carlv stage whether a 
student had an aptitude for medicine or not'’ He felt there 
was some room for improvement in the opportunities offered 
at school before entering the medical curriculum Manv lads 
who made their wav to the univcrsitv novvadavs had been 

forciblv fed in their education with a view to getting 
matriculation or a scholarship at an earlv age with the result 
that their general culture suffered Although a fair propor 
tion of students at (he Intermediate showed a reasonable 
standard of literacv far loo high a proportion had a standard 
so low and shocking as would be a disgrace to anv child of 
II or 12 and of average mcnlalitv It was clear that such 
students had an unsuitable earlv education or were Intel 
lecluallv unfitted to enter the profession Examiners had a 
dutv to the public to the profession and to the candidates them 
selves to keep such candidates from going on into a profession 
to which thev would be no credit 

Too Manj Students in Medicine'’ 

Professor Lovatt Evans went on to ask whether there were 
too man> students m medicine Up to the present it 
seemed that those entering were absorbed but in all countnes 
there were now twice as manv students as there were before 
the war and in some countries the greatest increase had been 
in medicine It would be verj serious to have an unempfojed 
professional proletariat Was there an> wav of finding out 
earl) whether students had a right aptitude'’ Aptitude tests 
had been devised m the United States to estimate a candidates 
adaptabihtj bj trjing to find out what remained to him 
after most of the forgettable things had been forgotten and 
also to test his abilitv to work under pressure A sjwicial 
mental aptitude test which had been devised showed that most 
of the medical students could pass the test ver> much belter 
than students in other branches of learning 


TBcEimsa iq** 

XLO CA_ JC 


He discussed the pre-chmcal subjects one b o^e ard ccr^e 
to the conclusion that all ot them were hclCs an 
about biologv for example'’ It shotld not be fo go je- 
that manv of the ilU which afflu ed or th eaiened the wo 
were products of the supremacy of the exact sciences v h^'e^ 
the hopes of man' ind v ere based upon the po' ib h o" 
rescue bv comparable advances m biological science mean "c 
sociologv economics ethics perhaps hereditv and race p^'-iv' 
but free from political claptrap of all finds He believed 
that the subject matter of all pre climcal subjects was o 
ample that all of them could be and usuallv were ^irarced 
so as to provide a maximum of all that was educationall dei -- 
able and vocattonallv u'cful Anatomv was of the same ab olote 
mvportance as m former vears but of le s rel tive impo-t^nse 
and m the Umversitv of London hall the students tii-e v os 
now given to the phvsiological group In the '<^5 - tn^' tt-e 
anatomv now taught was of the living bodv rather than 0^ tre 
cadaver there has been an advance in anatomical teacning. 
He regarded the phvsiological group — bioch-mistrw biophvsi/^ 
experimental phvsiolosv and pharmavoloav — a representing 
the central point of pre-clinical education In this g'oup the 
human bodv was studied along dvnamic lines and it this 
leaching «unk deep into the student 5 spin it gave him a rm 
outlook on life 

The practice in some foreign countries had been delib^mte’ 
to sacrifice the training of the general prat_titinn'*r to th“ 
interests ot the man vvjio intended to devote hm el to le ' in 
Professor Evans thought th»t was v o'^ cut in ih ccint 
the curriculum w-s not as well ad-p ed as it m -■’t re fo- 
the rc -arch worker Po sibl two sunca'jrr -o 'u r 
devised-mane for the reseai-sh woi'c' on the - e-nhe Je 
and the other for general practice bu notni'-g hoj d be 
done to make it difncult fo- a practitioner v ho found ih-t 
he had talent or opponunitv to practise re'ea cn to ined-e 
his bent Some valuable pieces of resea ch h-d ceer carried 
out m the absence of special fanhties b gene d pra 
lioncr' At the present time there v as too nuen n'rev 
available for the doing of resc-rch and not enough c me 
tnining of men to do it 

■kdequaev of the Cumculum 

Mr Epic Pcspce Golxd in addressing arothe c un c 
the conference aid that he held that there was no pro’e c 
which made the same eontnbulion to individual and coPedi'c 
well being as did the medical profession ror was there 
which made the 'ame demand upon a m-ns memo'" nis 
general level of intellect his kindliness ot heart his unc-' 
standing ot human nature and his readme s to adapt him eh 
to chsnging conditions and advancing knov ledge It this v as 
so n must follow that onlv those who were bv Natu'e endov ed 
with considerable intelleclua! gifts vvere fitted to take up he 
medical profession There were alreadv upwards o* 60tC0 
names on the Medical Register and durmg the last five \e- s 
the average annual rate of increase was -1 800 The medical 
profession was bound because of the need for numbers to 
accept a standard lower than that which might be considered 
as ideal Thus it would appear that the cumculum inev ublv 
was designed not so much to ensure a high standard as 10 
see that the standard was not too low 

Mr Pearce Could went on to discuss Ihe vanous grounds 
on which in his experience the cumculum vvas cniiazed — 
namelv that it was too full that the teaching was too much in 
the hands of specialists that speciahsts took an undue part in 
examinations that no instruction was given during the curri- 
culum in the art of practice and that too manv people were 
ploughed m examinations As a member of a conferc'-cu 
which had considered the v hole subject, he had come to the cor 
elusion that it vvas out of the question 'enouslv to lighten Ihe 
cumculum One had no choice but to accept the inclusion in the 
cumculum of some instruction in ever) branch of the practice 
of medicine and the anallarv sciences on which that practice 
was based Unless the students were given a verv wide view 
not onlv of the fundamentals but of the widening avenues of 
actual practice the> could not be given the background which 
enabled them to grasp the subsequent advances He declared 



194 JcfLV 2\ I93S 


MEDICAL STUDENTS’ CONFERENCE 


The Banrisii 
Medicai. Jolunve 


that cindid-itcs did not get ‘ ploughed tn surgery because 
the% were not surgeons The\ ploughed themselves because 
the\ had not learnt to appreciate the fundamentals of just 
that part of medical practice which happened to ha\e a 
surgical value He desired to see in all examinations in 
anilomv and physiologv actual phvsicians and surgeons sitting 
m the examinations with the professors m those subjects 


Teacliiitg the Art of Practice 

The difficultv in teaching the art of practice Mr Pearce 
Gould continued was to find the right tape of man to give the 
right tvpe of instruction Sureh the art of practice was 
something which could not be taught The difficultv of the 
examiners was to decide whether the candidates were fit the 
verv next day, to go out and assume the rights and respon- 
sibilities of qualified medical practitioners That being so, 
quite a hcavv proportion of people were bound to be 
ploughed ” 

One woman student from Birmingham University in the 
discussion, mentioned the value of lectures on national health 
insurance practice, which had been given m Birmingham b\ Dr 
Guv Dam Mr Pearce Gould said that it would be a matter 
of machinery for the Ministrv of Health to prohibit any 
qualified practitioner from going on the insurance panel until 
he had received such instruction But in his view the art 
of practice was much wider than learning the regulations of 
such a svstem as national health insurance It was fairlv 
east to give such instruction because it was all cut and dried 
He held that one could not realK teach the coming doctor 
how to handle people how to evaluate those outside conditions 
which had a bearing not onlv on diagnosis but also on 
treatment how to talk to patients, how to judge whether 
someone was telhng the truth or his motive in withholding it 
how much svmpathy to express and when to adopt if 
neccssarv a dictatorial tone 

In rcplv to another student speaker who complained that the 
curriculum was too full Mr Pearce Gould said that he saw 
a good deil of medical students and noticed verv little sign 
of serious overwork The curriculum as prescribed was only 
a das time thing The student had his evenings and vveek ends, 
and he thought it required only a moderate degree of industrv 
to get through the neccssarv reading 
One male student declared that if the protession was eqiiallv 
open to both sexes in all the medical training schools it would 
be possible to enlarge the scope of student material by 
bringing m numbers of intelligent people (women) who were 
able to make good doctors in due course 
The final event of the conference was a general discussion 
on preventive medicine which was opened In Professor W \V 
JvsirsoN 


\t a meeting of the last court of directors of the Society 
for Relief of Widows and Orphans of Medical Men, with 
Mr V Warren Low president in the chair three new 
members were elected Grants amounting to £2,421 were 
voted for the half vearU pavmenls to the widows and orphans 
in receipt of relief . Included m this sum was one of £78 for 
special grants to enable three orphans to stiidv for professional 
careers A gift of three articles of jewellers and two small 
Dutch paintings had been received from the executors of the 
late Mrs Bralev Thomas A widow of a deceased member 
applied for relief and she was voted an annual grant of £a0 
from the ordmarv funds and one of £2^ from the Brickncil 
Lund U was decided that the proposed dinner to celebrate 
the isOth anniversarv of the found ition of the societv should 
not be held The directors desire to bring to the notice 
of medical men the great advantages that mav accrue b\ 
joining the societv Membership is open to anv registered 
11 edicil man who at the time of his election is residing xvithin 
V iwentv mile radius of Charing Cross Relief is onlv given 
to the necessitous widows and orphans of deceased members 
lull parliciil irs miv be obtained from the sccretarv 11, 
et inJos Mrect Cavendish Square y\ 1 


Local News 


ENGLAND AND WALES 


Voluntary Hospitals Committee for London 


The Voluntary Hospitals Committee for London, whose 
office IS at 10, Old Jewry EC2 has recently extended 
Its area and the term of office having expired, a new 
committee has been elected for the next fixe years 
Officers have been elected as follows chairman Mr 
Oliver N Chadwyck -Healey vice-chairman Dr A M H 
Grav , treasurer Lord Annaly secretary Mr A G L 
Ives The following is a list of the members elected b\ 
the hospitals 


Hospitah iiif/i L luiiif’indiinic Schools 


Dr H E A Boldero 
Lt Gen Sir George Cory 
Professor L S Dudgeon 
Dr GeofTrev Evans 
Dr A M H Grav 
Mi Norman Lake FRCS 


Capt H L Milsoni 
Sir Frank Newnes Bt 
Mr Austin Taylor 
Mr F P Whitbread 
Mr G T Wlutelcy 
Sir Charles Wilson, M D 


Hospitals without Vndiisiaihiatc Schools 


II'es/ and West Ccidial 
Sir John Weir, M B 
South li'est 

Capt G M Eden 
Dr T A Matthews 
East 

Mr Perciv il Cole, FRCS 
Mr G A Hepworth 
Major Raphael Jackson 
Mr Frank Jennings 


Koith-ff cU 

Mr Haiold Pearson 

South-East 

Mr F A Lyon 
Mr F L Richardson 
•. Dr C E Sundell 

North 

Mr G G Panter 
Mr F D Saner FRCS 


Special Hospitals 


Childieit s 

Mr O N Chadmek- 
Healev 

Dr Reginald levvcshiiry 
Mr Arthur Morlev KC 
Sir Edward Penton 

V'otiuii and Mateiitil\ 


Mr 

J V 
FRCS 

0 Sullivan, 

Mr 

L Cirnac Rivett, 


FRCS 


Mr 

C S 
Stantev 

Wentwoith 


Chest 

Sir A Kave Butterworth 

Ophthalmic 
Mr A J M Tarrant 


Ner\ oils 

Mr J P Wetenhall 

Eai Nose and Throat 
Mr Harold kisch FRCS 


Utiqi ouped 
Lord Annaly 

Mr J Swift Joh FRCS 
Capt Robert Whitney 


Atmospheric Pollution 

Twentv-four representatives of local authorities and 
other organizations co operating with the ~Department of 
_Scientific and Industrial Research m investigations lo'o 
the nature and extent of atmospheric pollution nwl 
recently at the offices of the Department Alderman D 
Adams, M P of Newcastle presided over the conferenvi, 
which has now been meeting regularly for ten years it 
was reported that during that peiiod there had been a 
marked increase in the number of places at which observa 
tions of deposited and of suspended matter were btina 
regul irlv made by co operating bodies, and that m iddi 
lion a continually gt owing number of regular observations 
were now being made of sulphur gases m the almosphcf'- 
by methods which had since been introduced The con 
ference expressed strong belief in the import ince of con 
tinning and extending the investigation in order to providv 
the assured basis of fact necessary for determining the 
nature ol remedial measures desirable and for cstimuine 
their effect when introduced Dr G M B Dobson, F R ^ 
Chairman of the Atmosjihcric Pollution Research Coni 
mittee presented a report on the progress of the invcbtig'i 
tionv carried out under hts committct He dealt first witn 


JUL\ 23, lO'iS 


SCOTLAND 


The B mss 
Medicai. Jonetw 


195 


the work m progress Tt the speenl surxci of itmospheric 
pollution m and around Leicester Routine me isuremcnis 
had now been ssstemiticalh nude for a jear over a con 
siderible area to obtain inlomiition ibotii the behaviour 
of pollution under various wcither conditiens It was 
proposed to continue these for a further vear at least 
The work of the survev also ineluded tests under practical 
conditions of new ivpes of instrument and research on 
methods of measurement 


SCOTLAND 

Surgical Research Department at Edinburgh Univcrsitv 

The Minister of Health Dr Waller Elliot, opened the 
extensions to the surgical research department of Edin 
burgh Liniversilv on Julv 30 Thev consist ot an extra 
floor for laboratories and rcscareh rooms The operating 
the vires which were i Iciding feature in the original 
building have been refitted and compare fivourablv vvith 
those of anv mooern hospital There is also a medical 
art studio stalled bv two fuliv trained medieal artists 
When this department vv is opened in 1936 it was the first 
of Its kind in the Umpire but similir departments have 
since been introduced elsewhere Dr Elliot at the 
opening ceremonv said that the function of the depart- 
ment vvas threefold (11 the use of the experimental 
method in medical research (3) the intimate studj of the 
anatomv and the pathology of the spread of disease (3) 
the gathering together ot the younger members of the 
school for discussion of experimental phvsiological patho 
logical, and clinical problems The importance of corre- 
lating all the most recent advances in phvsiology with 
practical problems m surgen could not be over- 
emphasized That the younger generation of surgeons 
should be trained m the controlled observations of the 
laboratory vvas the best guarantee that a high standard 
of observation and record would prevail in our hospitals 
Referring to the experimental work of the department 
Dr Elliot mentioned the researches into the causes of 
gall bladder disease and of peptic ulcvration of the 
stomach and duodenum and into the cause of death in 
various forms of intestinal obstruction The mechanism 
of massive collapse of the lung following operation had 
been studied as also had the relation of kidnev disease to 
rise in blood pressure The successive changes which 
resulted when the outflow from one kidney was obstructed 
had formed the subject of a prolonged and delicate group 
of experiments A senes of experimental observations 
had been made on the relationship of disturbed nerve 
function to disorders of the abdominal viscera With 
regard to the spread of cancer in man a special feature 
of the department had been the use of microscopical 
sections of whole organs combined with a detailed studv 
of the spread by the Tvmphatic route Thus cancer of the 
stomach of the colon, and of the rectum had been the 
subjects of elaborate investigations and authoritative 
data had been obtained The feature common to all the 
research work Dr Elliot continued, had been the co 
ordination between clinical problems in the hospital and 
experimental investigation in the laboratorv It vvas this 
stimulus of human interest and human need which lent 
to the work of a surgical research department the living 
interest which was often lacking in purely academic 
inv csligations 


The tenth Trench Paediatric Congress will be held at the 
Hopital des Enfants Malades Paris from October 6 to 8 
when the following subjects will be discussed Severe anaemias 
in mfanev introduced by Dr 1 001*^6 Weill of I vons loxi 
infections in infancv introduced bv Dr R A Xfarqudzv and 
Mile Ladel and megacolon and dolichocolon introduced bv 
Drs Rohmer and Boppe Further information can be obtained 
from Dr Maunce Laroy, 94 Rue de Varenne Pans, 7e 


Correspondence 


Testimonial to Dr Robert Hutchison 

Sir— T he election of Dr Robert Hutchison to the 
Presidency of the Royal College of Phvsieians has given 
the greatest pleasure to a verv v/tde circle ot Iriends to 
whom Rob-rt Hutchison has stood for all that is sound 
in the practice of m-dicine and all that is good m tradition 
We feel that this occasion provides the opportunity of 
showing our esteem to him personally and ael nowledamg 
m some degree his fine contribution to medicine 

It IS proposed to commemorate the occas on by pre- 
senlino Dr Hutchison with his portra t and w h this 
purposw in view we venture to make known the project 
to old students triends and societies in London Edm 
burgh and the Provinces 

Personal donations should not exceed three guineas 
Cheejues should be sent to the Manager National Pro- 
vincial Bank 10 Marvlebone High S ect Lender W ! 
for the credit of the Robert Hui,.h eon Te 'imesual Fard 
— W e are etc 
Ivsitiri BvFRMtfeVV RO 
Hi m H I Bi en 
Enw IS Bkvmwi 1 L 
Dvws, ts ,1- Ptss 
Dlm vs t I Fmzw il^hms 

FRVSI |e F| ^e| R 

R S Friw iHcn Tteiuicr) 

VVlIIlVM ClOslllLS 

F J \l(Cvss 
Mvcviiirvs 
Artiilr MvcNvuv 

Cancer and Hereditv 

Sir — T he question whether malignant eelK diiler from 
normal cells in their genetic constitution is ore el b. 
Central problems of cancer If the existence ot such e 
difference could be demonstrated conclusivelv it might 
justifiably be claimed that an explanation of that phase 
of the causation ot cancer which m a recent lecture I 
Called the growth of cancer had been found The 
statement made recentlv tJoiinial Julv 9 p 9^1 by Dr 
P A Gorer in which he refers to certain observations 
as presenting evidence tor the existence of such a differ 
ence deserves therefore the most careful considera'icn 
The observations relerred to bv Dr Gorer are first that 
a virus nduced tumour m the rabbit will regress spen 
laneouslv and secondlv that the members of a pure 
line can be immunized against leukaemic cells derived 
from other members of the line 

The virus induced tumour ot the rabbit referred to by 
Dr Gorer is the infective papilloma discovered by Shope 
The argument underlving this conclusion is if I under- 
stand Dr Gorer conecilv that the production of cyto- 
toxins which he assumes to be responsible for the regres- 
sions of tumours demonstrates necessarilv the existence 
of a genetic difference between the normal cells of an 
organism and the tumour cells which have arisen 
from them It is presumably true that cvtotoxms can 
be produced in the organism bv cells having a difierent 
genetic constitution but it does not seem to me to follow 
logically that we can invert this argument and accept the 
appearance of cytotoxms as conclusive evidence of the 
existence of such a genetic difference Furthermore, 
neither the infective papilloma nor leukaemia is a repre- 
sentative example of the phenomenon of malignancy In 
fact, the frequency with which the rabbit papilloma 
regresses spontaneously after an initial cellular proUfera- 


Fki 1 1 K 1 1 R \ vif Sz Es 
On I- I N VMS 
X,t' 1. 1 R I > H 
Hi VII 1 KV Ri sT( X 
Bi US I 51 stv 
Fkl H 1 S'lLI 
G ly SnUEPLvXD 
J V Its T vvlor 
J wirs VVvLToN 
D/VVIO WlLXlE 



CORRESPONDENCE 


Tiif British 
Medical Journal 


196 JuL\ 23, 1938 


tion distinguishes the behaviour of this tumour sharply 
from the behaviour of a spontaneous malignaht growth 
The property which characterizes a malignant growth is 
Its autonomous continued growth Regression of a spon- 
taneous malignant growth is a phenomenon so exceptional 
and so incalculable that it may be given as the modern 
e\ imple of a miracle The initial epithelial prolileration 
of the Shope papilloma and its subsequent regression is 
a phenomenon exhibited also by a number of other virus 
diseases Thirty-five years ago Borrel by a close com- 
parative study of such virus diseases which he called 
cpiflielioies infeclieiises and of the epitheliomata ariived 
at the conclusion that il y a analogies il ny a pas tdenttle 

If we are to accept the spontaneous regression of the 
rabbit papilloma of Shope as evidence for the existence 
of a genetic change in the cells of this virus-induced 
epithelial proliferation, there seems to me no reason why 
such an argument should not apply also to the regression 
occurring in epithelial proliferations produced by other 
viruses We should then arrive at the conclusion that the 
entrance into epithelial cells of a number of different 
viruses leads to a change in the genetic constitution of 
these epithelial cells The regression of the virus-induced 
rabbit papilloma does not, therefoie, present very con- 
vincing evidence for the existence of genetic differences 
between normal cells and the cells of this papilloma, or 
of malignant cells generally But even if, foi the sake 
ol the argument, we accept the line of reasoning adopted 
by Dr Gorer, there remains still the outstanding fact that 
the overwhelming majority of malignant tumours arising 
spontaneously in an organism as distinct from those in- 
duced by viruses never show any regression If the 
occurrence of regression is to be interpreted as evidence 
for (he existence of genetic differences between normal and 
m ihgnant cells does the absence of regression not present 
evidence for the absence of such genetic diffeiences’ — 
I am etc 

Impcrnl C inccr Rcscirch Fund, W Cramer 

Mill Hill NW7 

The Origin of Cancer 

Sir — As an evolutionist let me assure Di J V Fiddian 
(Jonina! July 9 p 92) (hat no one was more disappointed 
than mjself on learning — after making careful inquiry at 
the lountain head — that the hypothesis of the conjuga- 
tion of the cells of a malignant neoplasm had been aban- 
doned for if true, it would have lent strong support to 
the Mcw of the genesis of cancer m terms of reversion 
But It is worse than useless hugging a fancy in the face 
ol plain plump fact Dr Fiddian will probably not 
persist in cherishing an illusion after reading the following 
statement by Dr Bashford in the Annual Report of (he 
Imperial Cancer Research Fund for the year 1905 to 
1906 than which nothing could better show the true 
scientific spirit with w'hich that investigator was imbued 
During the past \ear a paper has been communicated to 
the Ro\al Socict) {Proc Ro't Soi 1906 Senes B 77) 
showing that the nuclear figures m cancer cells beheied to 
indicate the occurrence of a true reducing division are in 
rc ihi\ of the ordinarv t>pe In that paper we withdrew 
catcgoncall> an\ support which our observations might be 
conceived to furnish to ibis hvpothcsis or to the inference 
others have based upon it that essential similarities existed 
between cancer and reproductive tissue The attempt to 
explain the continued power of growth and the fluctuations 
in c inccrous proliferation on the assumption of a reducing 
vhviMon followed bv a nuclear fusion has been abandoned ’ 
— I am etc 

Cvlum Surrey Julj 13 Ch VRLES M BeADNCLL 

Surgeon Rear Admiral 


When to Staff Sulphonamidc Treatment m 
Gonorrhoea 

Sir, — I was much interested m the letter fiom Colonel 
L W Harrison in the Journal of July 9 (p 90) His 
advice that sulphonamide remedies should not be given 
in the early acute stages of gonorrhoea has also been 
borne out in the treatment of children Since August, 
1937, at the Children’s Medical Home, Waddon, and at 
the South London Hospital for Women, twenty eight 
children, aged from 3 to 13 years, have had courses of 
prontosil album The response was most satisfactoiy 
clinically and bactenologically m all except five cases 
It IS significant that in four of these unsatisfactory cases 
treatment was started within two to seven days of the 
onset of infection They showed a slight clinical im 
piovement, but this was not maintained, and tests 
remained positive foi gonococci 

The twenty-three cases which reacted well to treatment 
had infections varying in duration fiom three days up to 
three and a halt years before their admission to the 
home They have now been watched for periods of from 
eight to thirty-five weeks since the completion of treat 
ment Thirteen have passed full tests of cure — that is, 
a minimum period of six months’ observation and at least 
twelve negative tests, including the final set after a pro 
vocative vaccine Six cases have had courses of uleion 
Three, with durations of infection of two, four, and nine 
weeks respectively, have now been watched since the 
completion of treatment for twenty-seven, twenty-four, 
and twenty weeks respectively without relapse The 
remaining three cases did not respond to prontosil album 
and they showed no improvement under subsequent treat 
ment with uleron It is noteworthy that m the treatment 
of gonococcal viiivo-vaginitis in no case where the initial 
response to sulphamlamide treatment was good has there 
been as yet a relapse while the child remained in the 
home Follow-up reports from (he venereal disease 
clinics, however, show that two of the chronic cases had 
“ suspicious smears ” and received further courses of 
sulphamlamide after leaving the home 

In recent weeks, working in conjunction with the 
venereal diseases department of Guy’s Hospital, fourteen 
children have had courses of T 693 The immediate 
clinical and bacteriological response has been excellent 
in every case, but no child has yet been watched for 
a longer period than two months since the completion 
of treatment The duration of infection before starting 
treatment in five cases has been from two up to twenty 
five days, and in the remaining nine cases from five weeks 
up to eight months It is too early at present to speak 
with any degree of certainty but there is a possibility 
that this new drug will prove more efficacious in the 
treatment of early acute cases than have other drugs of 
the sulphonamide senes — I am, etc , 

London W 1, July 12 D KATHLEEN BROWN 

Anti-yenereal Measures 

Sir — I am obliged to Miss Alison Neihns (Journal, 
July 9, p 94) for correcting the inaccuracy in my refer 
ence to the decline of syphilis m Denmark, and even more 
so for admitting that Denmark and Sweden in this respect 
have “certainly achieved better results than England and 
Wales I regret however, that she seems to be as 
hostile to compulsion as m the controversy over the Edin 
burgh Bill of 1928, when it was argued that wherever 
compulsion had been tried it had proved a failure, that it 



JuL\ 23, 1938 


CORRESPONDENCE 


TKrEivJTTSH 
JISDrCAi JOUXNU. 


197 


wns bound to rtsult in coiu-LiInKnl of dr>L->st. in resort 
to treitnicnt b> unquililu.d persons bl leknuil and police 
persecution of prostitutes If the interpretation of 
statistics IS a debitable nutter there is no inibiguitj about 
the statements in the Scindinisim Report regarding these 
other subjects Colonel Harrison and his colleagues 
(p 120) could find no esidcnee th it the operation ot the 
Law has led to coneealnient of disease to anj appreciable 
extent or imposed undue hardship on the people \s 
regards blackmail (p 1161 thee made eareful inquiries 
in Denmark and Sweden, both of the public health and 
the police authorities whether ane trouble has been ex- 
perienced in this ruspect In both eouniries we were 
informed that there had been some instances in the pist 
especialle in the \ears immediateh following the coming 
into force of the tc\ Mitirix in each countrx but thrt 
nowadays anething of this sort is very rarcK found 

With the old arguments against compulsion thus 
demolished b\ testimonx that Miss Neilans aecepts I 
would rest content but for a most misleading phrase in the 
last paragraph of her letter The choice before us 
she writes is to go on continuousK improving our 
national fight against VD on soluntarx methods or of 
abandoning our present sisiem and going all out for 
compulsion The choice is nothing of the sort' No 
sane critic of our present methods of dealing with 
venereal diseases suggests abandoning them It was xxise 
pohex to provide facilities for treatment and educative 
propaganda in the jears immediateli following the vvar, 
before making treatment eompulsorv in this countrv 
But in the opinion of manv ot us it is more than lime 
that these measures were supplemented bv the granting 
to public health authorities of powers to trace sources of 
infection and to secure necessan treatment if need be b> 
compulsion The Trevethin Committee in 192 j recom- 
mended the trial of eompulsorv measures in a limited area 
m this countrv In the light of the Commissioners report 
— their evidence itoi their conclusions — no lair minded 
person has good grounds for opposing such an experiment 

In conclusion let me remind Miss Neilans whose work 
IS directed so unfiringlj to the welfare of women that 
under the present voluntarj svstem it is the women and 
children who suffer most The infant death rate from 
sjphihs IS all but three times as great in England as it is 
in Sweden fp 1 19) In that countrj too there were manv 
who were afraid that compulsion would do more harm 
than good Thus runs the report (p 114) In Sweden 
It appears that there was acute divergence of opinion m 
the earlj vears of the present centurv on the most suitable 
methods for dealing with venereal diseases and the asso- 
ciated problem of prostitution Notwithstanding the 
divergent views held on the matter of compulsor> treat 
menl prior to I91S we did not find in anv quarter the 
opinion that the law of 191 S was a mistake and there 
appears to be general agreement that the ill results which 
some authorities anticipated would follow the introduction 
of a sjstem of compulsorj treatment have in fact not 
occurred — I am, etc 

Brentwood July 9 Robert Forgan 


Chicken-po\ followed bj Panophfhalmitis 

Sir — ^The reports of unusual cases of chicken pox in 
recent issues of the Journal prompt me to record the 
following case of chicken pox which was followed b> 
panophthalmitis The clinical history has been supplied 
bv Dr M D Mellersh house physician to the Chelmsford 
Hospital 


A male child a„ed 2 vears and 10 months was aamitted 
to Chelmsford Hospital on Febru-rv 16 19 S with fever and ■> 
peteehial rash He had had scarlet feve' at the age of 
12 months On the morning of Februarv 15 the child had 
complained of aching pains in the Iimb^ and of ^ore throat 
In the afternoon a rash appeared and duriniz that evenins he 
had a convulsion lasting three quaners of an hour On 
Februarv 16 he was delirious and vomited he was admitted 
to hospital On admission the child had a petechial rash 
mainlv distributed on the legs thighs and forearms nnd a 
temperature ot 102 F The throat was inflamed The pupils 
were equal m size and dilated hut reacted normallv No 
rigiditv of the neck was present Kemigs sign was negauve 
On Februarv 17 the temperature was 101 F and the petechial 
rash was fading The left eve showed conjunctival oedema 

I vv^s asked to see the child on February IS and found a 
panophthalmitis of the left eve with pus in the anterior and 
vitreous chambers There v as no evidence of meningeal 
iniection The corneal epithelium v as intact and shov ed no 
staining on the application of fluorescein On Februarv 19 
the child developed a tvpical chicken pox nEh at about the 
amc time other children of the same famiK developed 
chicken pov at home This fact was communicated to me 
bv the doctor v ho sent the first child to hospital the chicken 
pox in his case pursued a mild course The eve gradualK 
deteriorated and its ten ion became subnormal its contents 
were eviscerated Dr F E Camps pathologist to the 
Chelmsiord Ho pit I reported that culiu es from the pus in the 
vitreous chamber grew colonies of Siacf xloco^cux aureus 

I have b-cn unable to find anv record ol a case of 
panophthalmitis in chicken pox but cases have been 
recorded in typhus typhoid fever variola scarlet fever 
anthrax influenza and diphiheria — -lam etc, 

Chclm ford July 9 S G CORNER MX) 

“ Psxchosomatic Illness” 

Sir — A ll who, within recent years, have studied tae 
writings of Dr James L Halhdav upon vvhav one tnght 
call the psvchic side of evervdav illness must have been 
decplv impressed and influenced and the further reading 
investigation and observation to which these studies led 
have profoundiv influenced our practice I am indeed 
grateful for a widening of mv outlook and I am confident 
that mv patients to no small degree have benefited by 
mv learning even a little of what I was taught nothing 
in my student days over thirtv years ago I was, how- 
ever while interested somewhat shocked upon my perusal 
of his paper m the Journal of July 2 and the reason was 
that he should do injurv to a good case by calling upon 
the aid of Dr P L McKinlav the medical statistician 
to the Department of Health for Scotland I have great 
admiration and respect for the gifts of Dr McKinlav, 
and not a little fear 

When we consider the anxiety state created m so 
manv ot our young men at the most vital time of their 
lives bv unemployment the strain upon multitudes of 
our voung women by emplovments for which either 
mentally or physically thev w ere not created the excessive 
cocktail drinking of so many females in the veventeens 
to twenty -fives the excessive smoking amongst both young 
men and young women and the strain generallv incurred 
as a result of the work sport and the actual living of 
modern life we cannot but believe m the profound in- 
fluence of a psvchoneurosis and a disturbance of the 
psycho neuro endocrine svstem m the promotion of 
modern invalidism and the burdens — phv steal menial 
and financial — which this invalidism is inflicting upon all 
classes involved W'e must not however allow the 
realization of these facts the influence of papers bv men 
in the mental and official groove of Dr Hallidav and the 



198 July 23, ]938 


CORRESPONDENCE 


The Bmt\su 
MforcAi. ;ouRNU 


statistics of Dr McKmIay to overweigh our sense of the 
physical “Mechanistic treatment’ and inrestigation 
arc necessary in the majority of the cases of the disordeis 
of which Dr Haliiday writes 

I base had within the last few months a case of cai- 
cinoma of the stomach at the age of 19 years two cases 
at the age of 22 years, and one case at the age of 27 
years It would have been worth the risk of “fixing 
symptoms to have saved these lives by a mechanistic 
investigation and treatment, the failure to carry out 
which on account of the early vagueness of the symptoms, 
cost the h\es concerned Rheumatoid aithntis m the 
young and osteo arthritis m the middle-aged mean 
absolute luin for these lives unless we invoke every means 
of investigation and treatment It is folly to call these 
diseases “ psychosomatic ’’ — at least no proof has been 
given — and, whatever the risk of “fixing symptoms” may 
be, to avoid any means of investigation or treatment 
known would be unpardonable Then there is heart 
diseisc in the young We geneial practitioneis spend 
many moons pulling these cases over their rheumatic 
fever with its complications — pen-, myo-, and endocardial 
Our patient appears before the regional medical officer 
just when we allow him or her to move gently about, and 
the heart is apparently, but not in reality, sound 
“ Ah ' ’ says the regional officer, “ a case of defect of the 
psycho-neuro endocrine system ” Up go the statistics, 
back to duty goes the patient, and a life is mined because 
an official mind clouded by a theory ignoied practical 
experience and common sense 

I accept and admire much of Dr Halhday s work , he 
has opened up a comparatively new and most helpful line 
of thought for us all but do not let him go too far 
Above all, in such an indefinite sphere as the psychic, 
let him avoid the statistician or his whole work will 
tumble down like a pack of cards — I am elc , 

T I in Ross shire, Jul) 7 E K MaCRCNZIE 

The Unconscious Mind and Medical Practice 

Sir — In your issue of July 9 (p 93) the late Dr Harry 
Campbell complained that psycho analysts give no precise 
definition of the term ‘ unconscious This definition 
has been given so many hundreds, or thousands of times, 
ind has never varied since psycho analysis began fifty 
jeais igo that I had not thought it necessary to include it 
once more in my article U is simpW ' that part of the 
mind of which the subject is not conscious — I am, etc, 
London W I JuK 17 ErNLST JoNES 

Sir,— -One can quite understand your correspondent, 
the late Dr H irry Campbell being puzzled at a first 
introduction to the concept unconscious fantasy ’ To 
the practising inalvst all psvehogeme symptoms, dreims, 
and much behaviour are merely outward and visible signs 
of fantasies which are still unconscious If for instance, 
a patient has a phobia of entering a tunnel it means that 
he IS the victim of a fantasy that dreadful things will 
h ippen to him in that tunnel In that he does not know 
whu these things are, or, indeed why he is afiaid the 
fintisv IS an unconscious one Similarly if a patient 
asks it ihe door is properlv closed it usually means that 
he has the fantisv ot somebody listening and overhearing 
his secrets though here the fantasy may not be entirely 
unconscious It is the business of analysis to bring these 
f intasics into the patient s consciousness in order to free 
him from their domination over his feelings and con- 
uuci and as an essential step towards cure — I am etc 
LenJon VV l Jul> 15 CllVRLCS BCRG MD DPM 


Abortion and the Law 

Sir — Much ptibhcity is being given jn the lay Press 
to an alleged bieach by a distinguished medical man ot 
the law relating to abortion The question has therefore 
been laised of how fai this law is open to criticism 
on medical, social, and genetic grounds We are aware 
that the subject is now being fully considered by a 
Departmental Committee, but we understand that the 
findings of this committee will not be made public m the 
immediate future Many arguments have been advanced 
in favour of widening the grounds upon which it should 
be legally permissible for pregnancies to be terminated 
It IS to one only of these arguments — namely, the genetic 
— to which we would like to dravv attention Certain 
recommendations have been made by a Departmental 
Committee on Sterilization as to the categories of persons 
for whom facilities for voluntary sterilization should 
made available on genetic grounds We associate our 
selves with these recommendations 

From the biological standpoint we consider a 
sterilizing operation to be a more significant and diaslic 
procedure than a termination of pregnancy, in that ihe 
first measure destroys fecundity, while the second does 
not We therefore think that facilities for the voluntary 
termination of pregnancy should be made available to 
those persons specified by the above-mentioned Depart 
mental Committee on Steiilization as being appropriate 
candidates for voluntary sterilization We further think 
that similar facilities should be extended to women who 
have become piegnant as the result of an incestuous 
union or of rape That a child who has been brutally 
conceived as a result of a criminal assault on its molhif 
will be handicapped later in life by enviionmenlal and 
nurtural factors can scarcely be disputed It is no less 
obvious that the child is liable to inherit from the fathvr 
some at least of the qualities which prompted the action 
which gave it life These are not qualities which anyone 
would wish to be perpetuated 

The force of these considerations has been recognized 
by at least one foreign country In Denmark there took 
effect on April 1 of this year a law according to which 
a pregnant woman may have a pregnancy terminated in 
the following cases 

1 If Ihe termination of pregnancy is necessary in ordei 
to avert serious danger to the life and health of the woman 

2 If the woman has become pregnant as a result of an 
inccsiiious union or of rape 

3 If there is obvious danger that the child owing to 
hereditary disposition will suffer from insanity mental defi 
ciency from grave mental disorder epilepsy, or serious 
incurable phvsical disease 

(A translation of this law appears in the Lugeuics ffrueu 
volume xxx No ] (April 1938) p 43) 

The grim predicament of the mother, the future 'veil 
being of the child thus inauspiciously launched into 
existence and the interests of pos\enty simiiltaneouslj 
call for a widening of the grounds upon which abortion 
should be permuted — We aic, etc, 

Hordpr (President) 
Haxelocl Ellis 
Julian Huxlev 
E Mapotiier 
R Ruggli s Gates 
J A Rvle 
W Langdon Brown 
C P Blacker (General 

The Eugcntcs Socictv Secrenr}) 

London, S W I Jul> 20 



JOL\ 2^ 19^8 


Titi Bpmm 

^^EnlCAl. JOUILNAI. 


199 


CHARGE OF PROCURING ABORTION RE\ i BOURNE 


Medico-Legal 


CH^VRGE or PROCURING ABORTION 
Mr Bojme Acquitted 

On Juh IS nnd 19 Mr Aleck William Bourne FRCS 
wai tried at the Old BaiIi-\ for unlaw full\ using an instru 
ment with intent to procure the miscarriagi. of a woman 
(The police court proceedings wert. reported in the Journal 
of Jul> 9 p 97) The indictment as first drawn did 
not contain the word unlaw fulls This appears m the 
OITcnccs ngainst the Person Act IS6I sect on sshich 
the charge was based and the ssord w is added to the 
indictment on the motion of Mr Roland Oliser KC 
leading counsel for the defence who maintained that 
nearls the ssholc of his case rested on the interpretation 
of the ssord Mr Bourne pleaded Not Guiltj 

Mr Oliscr also asked that ans member of the jurs ssho 
might consider on religious grounds that there sserc no 
circumstances in sshich a pregnanes ought to be 
terminated should ssithdrass The Atiorncs General Sir 
Donald Somcrsell K C associated himselt ssith the 
request and ilr Justice Macnaghten ssarned the jurs 
that if ans of them bs reason of an> prcconceised siew 
felt in a dilBcuIts about gising a scrdict according to lass 
and esidcncc it ssas desirable m the interests of justice 
that he or she should retire from the Inal None of the 
jurs, hosscser left the bos Tsso members sscre svomen 

Case for the Crxmn 

The Attomej -General ssho appeared ssith Mr L A 
B>rnc and Mr Henn Elam m opening the case read the 
words of sect 58 of the Act 

Who'oescr ssith intent to procure the miscarriage of ans 
ssoman ssheiher she be or not ssuh child shall unlass 
fulls use ans instrument or other means sshatsocser ssnh the 
like intent shall be guilts of felons 

He explained that the girl had been criminalls assaulted 
and raped and a man had been consicted of the offence 
At that time she had been under 15 and a sirgin On 
Ma) 21 she ssas taken to see Dr Joan Malleson ssho 
came to the conclusion that the girl ssas pregnant and 
ssTote to Mr Bourne a letter svhich after introduction, 
slated 

Dear Mr Bourne 

“I hase been consulted bs the organizer of the Schools 

Care Committee about a girl of 14 called It is possible 

that ^ou saw in the paper some three weeks ago that this 
girl ssas assaulted in Whitehall bs some soldiers The actual 
facts were that she ss-as ssuh tsso girl fnends ssho ran off 
and left her and she ssas held dossn b> fise men and twice 
assaulted It appears that she is free of senereal infection 
but the Z.A test has just come back positise 

1 gather from the lady ssho broueht her that csersbods 
connected with the case ic the police surgeon the doctor 
at her work the school doctor etc all feel that curettage 

should be allossed her and 1 understand that Dr and 

possibls some other psschiatnsts of good standing ssould be 
prepared to sponsor therapeutic abortion I presume thes 
must mean on grounds of prophs laxis because there does not 
appear to be anj nersous disorder present All this of course 
gels us nosshere unless someone of sour standing ssere pre 
pared to risk a cause cclebre and undertake the operation 
m hospital 

Manj people hold the slew that the best was of correcting 
the present abortion lasss is to let the medical profession 
gradualls extend the grounds for therapeutic abortion in 
suitable cases until the lasss become obsolete so far as 
practice goes I should imagine that public opinion ssould 
be immensels m fasour of termination of pregnancj in a case 
of this sort 

If Ihere is ans chance that gisen adequate professional 
backing lou feel prepared to consider this 1 would take 


a lot of trouble to get people of high standing to see this 
girl and should of cour e feel that it was most saluable if 
the case was conducted pubhcls m hospital 

* am told that a rather grim issist is added to this case 
by the fact that the girl s parents are so respectable th^t they 
do not knosv the address of ans abortionist and are 
I gather basing lo set about to find one for thes could 
not possibls let her go through ssith this She seems a 
normal heallhs girl and on medical terms there is obsiousls 
nothing to he said 

J hope sou will forgiie me for troubling sou about this 
With kind regards 

5 ours sincerels 

JosN Msllesox 

BS — Unfortunatels the matter is made a little more difficult 
bs the fast that the girl ssas admitted lo St Thomas s Hospital 

under Mr who I think from the report of his atutude 

must be Catholic He took the consenlional standpoint that 
he ssould not interfere with life because the child mas be 
the future Prime \finister of England and that anshosv 
eirls alss-ass lead men on But she is not ans longer under 
his care nor is it set public that the Z,A test is positise 

On Mas 27 Mr Bourne had replied 
1 am interested in the case of rape sshich sou describe 
in sour leltcr I shall be delighted to admit her to St \fars s 
and curette her I base done this before and nase not the 
slightest hesitation m dome it acain Thcretore p\»ase let 
me hase the eirl s name and add e s o »sk her pa sr a 
send her to s^e me I base said ihai the next ume 1 his, 
such an opportunits 1 ssoild wrti<- to the Aiioracs Gsrer„I 
and ms its him to take action 

On Mas si the girls mother had iden her to sec Mr 
Bourne and esn the same das the lather bad sritten to 
him sasin^ thit he gase his cons-*n to the eo leclion 
to be done toi his daughter in St Mars s Hosp a! as 
arranged with his wife on condition that no puslieits 
ans sort was gisen to the ease On June 2 Mr Bourne 
ssrote to Dr Malleson telling her ot ihis request lo leen 
the operation entircis secret and said that he must re pect 
their ssish and that the operation would be done next 
sseck To the father he wrote assuring him that no etort 
ssould be spared to keep the matter secret Sir Donald 
added that the matter had been brought to the a'tenticn 
of the police authorities but he did not suggeH that this 
had been in ans ssas due to ans act bs the defendant or 
that he had done anslhmg inconsistent ssuh the under 
taking ciscn in his letier The operation had been 
performed on June 14 

In conclusion the Attornes General said that the jury 
ssould hase lo decide subject to the judges ruling and on 
the facts sshether there had been an unlassful use of an 
instrument to procure a miscarriage He also admitted 
that on the construction of the statute if it w ere necessary 
m order to sase the life of a mother to use an instrument 
to procure a miscarriage he ssould not submit that that 
ssould be an offence under the section 

Esidencc for the ProsSwUtion 

Giving esidence for the prosecution the girl said that 
on April 27 she had been raped bs a soldier and that at 
that lime she had been 14 sears and 9 months old "^e 
defendant had performed an operation on her Her father 
gase esidence of the correspondence with Mr Bourne 
and said in anssser to Mr Ohser that he had gisen no 
one permission to publish the case 

Dr Joan Graeme Malleson said in cross-examination 
that there ssas very great sanation of opinion among 
obstetricians and medical people generalU about what 
was lawful in regard to the orocunng of abortion Some 
went so far as to say that it ss-as not permissib'e m any 
case even to sase life and others took the siesv that it 
was lawful m the interests of the health of the mother 
She shared that siew and held that it was better to 
perform an abortion than that a ssoman should be 
physicalls menlalls, or nervously broken down by having 
a child particularly conceived in such circumstances She 
believed that was Mso Mr Bournes view Many doctors 



200 Jua 23, 193S CHARGE OF PROCURING ABORTION REX v BOURNE 


thought that miscarriage should be peimissible upon whal 
might be called ' humanitarian grounds alone, but not 
manv used that term actually for procuring an aboition 
She did not know any who thought that was legal She 
I new some doctors, hotvever, who would produce a mis- 
carriage when the child was likely definitely to inherit a 
bad trait She had heard of doctors who had taken pity 
on a woman who had been raped, and she thought that 
right In answer to the judge, she said she meant pity 
for a woman where there had been a prosecution for a 
rape in a court of justice, and not where the woman com- 
plained that she had not consented to sexual intercourse 
She agreed that danger to a woman s life was increased by 
the tact that she was only 14 and also that she had been 
injured in the process of a rape , that her mental condition 
would be such that she might be in grievous danger and 
that her nervous system stood a good chance or might 
stand a good chance of being shattered She considered 
that a proper case 

Mr P C F Wingate said he had been resident at 
St Marys Hospital until the end of June Before the 
girl was admitted Mr Bourne had told him he had been 
asked to see the girl, that she was pregnant as a result of 
rape and under the age of consent, and that he had been 
asked to admit her in order to terminate pregnancy and 
also asked to report his action to the appropriate autho- 
rities in the hope of making a test case of it He had 
understood Mr Bourne to say that the parents were 
objecting to the publicity that must follow such a case, 
but the defendant had not said whether he would report 
his action to the authorities A test for pregnancy had 
been made and the result was positive He had been there 
when Mr Bourne operated on June 14 

Cross examined by Mr Oliver, he said that it was 
proper that before performing such an operation the girl 
should be kept under obsers alien for a considerable time, 
and that it was quite proper tor Mr Bourne to do so for 
eight days It was careful and proper treatment to repeal 
the tests for pregnancy and venereal disease which had 
been done before her admission, to verify both lesults 
If she had had venereal disease the operation would not 
hue been performed because of the fear of infection He 
had been present when Mr Bourne had taken the swab 
lor the venereal lest This would not hurt her a would 
be uncomfortable She had been a little distressed and 
ciicd He had not heard Mr Bourne say anything that 
he could remember Her behaviour had not particularly 
impressed him , he had rather expected her to be dis- 
tressed IS the circumstances were \ery unpleasant for her 
He agreed that the girl was a proper subject for curettage 
Chief Inspector Walter Bridget, examined by Mr 
B\rne said that he had called on Mr Bourne on June 14 
The detendant asked whether it was about the girl and 
he iring that it was, he said I emptied the uterus this 
morning , 1 want you to arrest me ’ The witness cautioned 
him and said the frets would be reported to the proper 
uithoritics The defendant said that the gnl had been 
bi ought by her mother to his house, admitted to St 
M ir\ s Hospital and placed in his ward under his care 
and since she had been in she had been waiting for a 
pregnancy test, which was positive and tests for gonor- 
rhoei which so far had been negative As an obstetric 
surgeon m his opinion it might be dangerous for a girl 
ot her age to bear a full-grown child 
Cross examined, witness said he wrote down Mr 
Bourne s statement in his book as the detendant dictated 
It He had wished to warn Mr Bourne that in no 
circumstances could an operation be consented to but as it 
had ilread> taken place his visit was useless 

\Ir Oliver Was he rather nettled at that and did he say 
tlpt he had his dutv as a surgeon and his responsibihtv and 
could not he dictated to bv vou on a matter of that sort’ — 
No hut 1 will accept it if he savs it 

Sir accept anything he says’ — -1 would. 

This dosed the prosecution s case 


Counsel’s Submission on the Law 

Mr Roland Oliver said that as much of the case would 
turn on the foim of the learned judges direction to the 
jury md the law of the case was what his Lordship 
declared it to be, he invited the judge to direct the jur\ 
on the law at that stage" He could not he said address 
the jury and put forward a view of the law unless he knew 
what the judge held that law to be he must not put before 
the jury a different view of the law from that of the judge 
The case was not covered by any authority at all U 
turned on what the judge decided was the meaning of 
the word “ unlawfully ’ whether it meant, as the Attornev 
General said, that nothing was lawful except for the pur 
pose of saving the hie of the mother — he did not know 
where his learned friend had got that definition from' — 
or whether as he himself contended anything was 
sufficient justification for an abortion which, in the view 
of a responsible and skilled surgeon, was for the benefit 
of the mothers health in the sense that her health would 
probably be seriously impaired if it was not done Any 
thing he continued, which would induce i compelem 
surgeon to remove a limb or an eye for the sake of the 
patient s health should be sufficient justification for 
abortion , the same standards should apply It was 
fantastic to suggest that a major operation was only 
justified for the purpose of saving life In other sections 
of the Act the words “ unlawfully and maliciously 
occurred it was a felony punish iblc like abortion with 
penal servitude for life to give an anaesthetic or to cause 
grievous bodily harm ‘ unlawfully or maliciously It 
could not be said that an anaesthetic could only be used 
m a case of life and death Surgeons who took off arms 
and legs would be committing the criminal offence ot 
mayhem or maim if they were not justified by the benefit 
to the patient s health The test should be the same 
through all sections of the Act He submitted that a doctor 
was entitled to induce a miscarriage where, if he did not 
theie was a dangei to the girls health — using that word 
in the broadest sense The jury should be asked “ When 
Dr Bourne used the instrument on June 14, was he acting 
in the honest and reisonable belief, based on adequate 
knowledge and experience that it was in the best interests 
of the girl s health ih it hei pregnancy should k 
terminated^ ’ Russell on Ci/iiies said that the word 
“ unlawfully ’ excluded from the section acts done m the 
coiiise of proper ticatmenl in the inieiest of the life or 
health of the mother That stitemcnt had stood im 
challenged since 1909 

The Judge’s Direction 

Mr Justice Macnaghlcn addressing the jury, said 

This section contains the Avoid “unlivvfulh Counsel sre 
agreed, and it is my opinion that the word ‘unlawfullv 
IS not a meaningless word in this section, and it ncccssinly 
follows that there mav be a procurement of abortion which 
IS lawful The procuring of abotlion was an offence lone 
before 1861 It was an offence bv llic Common Law of 
England before ever Parliament existed It was only m the 
reign of George Jll that it was made a statutory offence 
Apparentlv there was some quesUon undei the Common Law 
whether the procuring of aboition bv the administration of 
poison was an offence and an Act was then passed niskme 
It clear that it was an offence This section was merely a re 
enactment of the previous statutory provisions 

The section begins bv making it unlawful for a woman lo 
procure her own miscarriage That undoubtedly has been ihc 
law of England from the earliest times A woman is no! 
entitled to procure her own miscarriage and the fact that she 
desires urgcnllv to be relieved of her trouble docs not juslin 
the procurement of an abortion It is true that there is no 
authority on this matter so far as I am aware The tssiic tin 
\oi will have to tr\ is an issue that has never before hccn 
raised but it is obvious that where the act is done — anvliow 
in modern times — bj a skilled person, wiilioui any risk to i te 



JuL\ 2^ 193b CHARGE OP PROCURING ABORTION REX t BOURNE 


rititnt for purpose of her life it mu?,! bt huful 

We h-wc rot Ind nn\ mcdicnl tc timon\ so far— it rpa> be 
fbit uc ire pome (o hiNC some— but las men know that there 
ire ciscN where it k rei onibls impo iblc for i woman to be 
dchxcrcd of her child and surxjxc In such ci cs an opcraiion 
for tcmiimtinc prccmncv phinh becom-'s hwful ] ha\c no 
doubt thit ha’i alu^\^ been the mcw of the judi-es of this 
counIn and of the great men who sat in Westminster Hall 
on the Kmc s Rcnch 

To“da\ the position is greatlx simplified bx an Act of 
Parliament passed in the xcar 192*^ If after a child has been 
dclixcrcd and has an existence independent of Us mother the 
mother or the ac^.ouchcur kills the un'xanicd babx that is 
murder ard alvxaxs has been murder bx the laxx of England 
There arose a ca<c m xshich it xxas thought that provision had 
TO be made where an accouuhcur while a xsoman was beinc 
delivered of a lull term child — bctau c the child was not 
wanted — killed it before it had an cm tcnce indcpcndeni of 
Its mother and vet in ciraimstanccs that did not amount to 
the procurement of abortion because the child xvas bcinc 
delivered at full lime in the ordinarx course of nature Par 
liament thought right to provide for that ease Of coll^^c it 
IS a ease that would xerx rarclx arise and even much more 
rarciv ever be known of A Bill was passed through tlu- 
House of Lords in the xcar 1928 and sent down to the Hou e 
of Commons beanne what might be thouchi the somewhat 
misleading title of the Infant Dcstniciion Bill ** — a title 
which might give rise to the idea that it was a Bill for the 
destruction of infants The Hou<e of Commons never gave 
It a second reading under that title and m the followmc xcar 
It w-is introduced again and passed into law wuh the more 
illuminating title of the Infant Life Preservation Act 1929 
It IS of tremendous value m throwing light on the law of this 
subject Section I enacts 

Anx person who with intent to dcstrox the life of a chiM 
capable of being bom alive b> anx wilful axt cause?, a child 
to (he btfore it has an cxiste’'tc inderendcni of lU molbef 
shaP be guilt) of felonx to wit of child destruction and shall 
be liable on conviction thereof on indictment to penal serviiudt 
for life provided 

And here are the words which require xour do c attention 

That no f/crson shall \k found guilix of nn offence under 
this section unHs it is proved that the «ct xshi>wh cauved the 
death of the child was not done in good faith for the purpo c 
onlv of preserving the life of the mother 

\ou will observe that b\ that proviso it is not for the 
accused to prove that it was done in good faith for the pur 
pose of preserving the life of the mother u is for the Crown 
to prove that it was not done in good faith for that purpose 
The burden of proof rests upon the Crown 
The direction which 1 propose to give vou i?, this If jou are 
satisfied bv the evidence when we have heard u all that Mr 
bourne did not terminate ihc precnanev of this girl m good 
faith for the purpose of preserving the life of the girl if 
vou arc satisfied that the Crown have proved that negative 
vou should find him GuiU> If vou think that the Crown 
have not proved the negative that the law requires them to 
prove then vou should find him Not Guiltv 
Vihat js the meaning of preserving the life of the mother'^ 
That IS a matter which must depend on the circumstances of 
the ca«e and on the evidence produced before vou U must 
be obvious that it mav be perfect]) lawful to perform the 
operation if the doctor is of opinion (hat the continuance of 
the pregnane) is certainl) going to result in the death of the 
mother Of course it ma> be — we ma) hear, we do not know 
— that if the operation has to be done the sooner ii is clone 
the better There are man> considerations which influence 
the decision of the doctor on what should be done in the 
particular case If the Crown fail to satisf) the jurv that it 
was not done for the purpose of preserving the life of the 
mother then mv direction to )ou here is that )our verdict 
should be a verdict of Not Guiltv If on the other hand 
the Crown do satisfv vou that thev have discharged the burden 
placed upon them under the section then vour verdict should 
be Guilt) I give vou that direction in law because of m) 
'lew that the provT o to Section 1 of the Act of 1929 ex 


Thz Brjtes ''VI 

VIxu cc. Jo ’x.vtt. 


pltcitl) states vvhat alwavs has been imphcitlv m the e ten 
under vvhich Mr Bourne is charged he e 

Mr Roland Oliver 1 cannot altogelbe' epamle the 
questions of whai is neccssarv to preserve life and v r_t i 
ncvcwarv to preserve health 

Mr Justice Macnaghten I quite agree with vou and it 
i« for the jurv on the facts to sav it the, thml that the 
CrovTi have di charged the burden put upon them. It is a 
question of fact in each particular ca e and nobodv can <*. 
without knowing the facts of the ca e whether the abortion 
was lawful or unlawful 

Case for the Defence 

Mr Roland Oliver then addressed the jurv He said 
that probablv never betore had a man stood in the dees 
in that court because he had acted from a motive of pu'e'l 
charitv and could sav that he had believed that he was 
i^rrving out his dulj under the Ian nh'ch was to loci' 
after his patient to the best ot his abilitv to guard her 
health and protect her from mental or nervous breal 
down Mr Bourne was at the head of his profession ard 
altogether above the suggesuon that he vvanted aoveni'e 
ment There was probablv no one in court who wou d 
not at least give him praise tor his courage he had none 
that which be believed to be right 

For various reasons vvomen would alwavs deme"d 
abortion merelv because thev did not who bear 
children and protessional aborliomsts vveuld a'v i.s b_ 
forthcoming Those ol cou e were p -.ens agi-ir r 

whom S.ciion 'is vvas directed There vws no wonder 
that the gravest misgivings had always be ei and hor-ified 
medical men in dealing with the quest on ot what cases 
were legitimate and proper for this operation The r 
views ranged from persons who thought that it 'houid 
never be performed at all to those who woulQ do it merel 
because an untortunate child had b.en raped As ihe 
law siood this was not a legitimate ground Between 
those two extremes came the views ot a great bodv ol 
medical men and women who said that the operation 
could not be limited to cases in which the mo ner s 1 te 
was m immediate danger but that a reasonable view rru.t 
be taken The operation must be done ihej said b a 
person of skill knowledge and experience and he must 
balance the ordinarv risk ot the operation against the 
danger to health m its widest sense if the operation were 
not performed 

Mr Bourne had spent his life in that controversv, and 
had experience of cases in vvhich the operation ought 
in his view to have been performed and had not been 
witR disastrous results He had been prepared to make a 
marivr of himself for the purpose of having the law 
declared his view being that if the general interests ot 
the pauents health were endangered bv having a child 
It was the surgeons dutj to operate He had not cou'icd 
publicitj but had been willing when the proper case came 
along to have the matter dealt with That this had hap- 
pened in the panicular case had been none of his doing 
The wisdom of his attitude did not concern the Court 
It vvas a ihoroughl, gallant thing to do, and no one would 
suggest that his motives had been anvthing but the highest 
from beginning to end The whole thing was a work of 
the purest charitv 

Air Bourne in the Miteess-hox 

Mr Aleck Bourne then went into the hox and was 
examined by Air Roland Oliver 

He said that he had devoted much attention to the question 
of when the termination of pregnanev vvas justified To him 
in common with all gv naecologisls it vvas a constant 
problem The views of his professional brethren vaned 
enormouslv In October I9u5, he had been about to 
terminate pregnanev in a child of 15 and his house-surgeon 
had declmed to assist him and on Mr Bournes invatation 
had walked out of the operation theatre That doctor bad 
onij recently been qualified and had objected on religious 



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CHARGE OF PROCURING ABORTION REX i BOURNE 


Thc British 
^^£DICAL Journal 


grounds This refusal had led Mr Bourne to think very 
hard and he had determined to obtain the ruling of the 
Court on the next occasion— that vas why thev were there 
He felt \ery deeply about the matter If there were adequate 
medical reisons in the widest sense on his interpietation of 
the law based on the e\er>da\ practice of reputable members 
of the profession he considered it justifiable to terminate 

pregnanes and he could not draw a line between danger to 
life and danger to health If a doctor waited for danger 
to life the woman was past assistance He regarded abortion 
as 1 m ijor operation, speaking in terms of other blanches of 
surgerv He thought that 99 per cent of his colleagues 
would be agreeable to base abortion perfoimed on such 
patients as those on whom he had done it He most 

emphatically included the presers ition of mental health and 
the health of thc nervous system among his indications He 
did not think that such physical injuries as the girl had 
received would have caused a direct difficulty in het delivers 
The circumstances of her conception were, however, such as 
to imphnt in her mind seeds of terror Those who had 

clinical insight knew that terror and fear were the most 

seiious deterrents to the unfolding of the' whole process 
whereby assistance might be needed which would in its turn 
do damage The fact that she a virgin had been raped 
and treated in that way was a very strong element to him 
in making up his mind Her age was another , the chief 
bones in the pelvis were not united Hei temperament and 
nervous make up would be an important factor He had 
naturally felt that some process of observation should be 
carried out but frankly admitted a bias m the diiection of 
relieving the child when he heard that she was connected with 
the crime 

Believing that the operation vvould be essentially necessaiv 
he had first had to exclude at least three factors He had 
felt practically certain from the first that she was no mental 
defective, he vvould not have operated if she had been 
because she vvould not have suffered mental distress in the 
pregnancy, and the quality of the child was no concern of 
his If she had belonged to the prostitute type he vvould 
probablv though not certainly have decided against operating 
for similar reasons Thirdly, if she had been infected with 
venereal disease, an operation might have spread the infection 
up thc birth canal and caused really serious illness On the 
contrarv he had decided that she was emphaticallv suitable 
to hive her uterus emptied The ward sister had reported 
with surprise that the girl had not appeared to be worried at 
ill and was unusually cheerful considering the circumstances 
7 his h id at once made him suspicious that hci cheerfulness 
was a fagadc of courage erected as a defence against her 
feelings He had not made any kind of examination before 
taking the swab for thc infection test and had been as careful 
IS possible not to cause pain then He had watched her 
demeanour when it had been first brought home to her by 
this procedure tint she was really pregnant and the memory 
of the assuilt hid come back to her Instead of her bearing 
tilt trilling discomfort with fortitude she had broken down 
and cried That had confirmed his decision and later in the 
div he had operated after seeing the pathologist himself 
about thc swab Thc mischief he had feared for her if the 
pregnancy had proceeded included as its least important factor 
the possibility of physical injury which could to some extent 
have been repaired He had however learnt from the many 
young children of this kind he had seen that much more 
important was thc mental and nervous injury for it was 
tvtrcmelv difficult to cure It would have been a source of 
nervous psychoneurotic and other troubles and there would 
perhaps have been secondary physical illnesses all her life 
In insvvcr to cross examination bv the Attorney General 
Mr Bourne said that he had never intended to operite on 
i' " Ctrl before observing her and carefully considering 
w*’i tiler she was a suitable case He had admitted her with 
a bias m favour of operation because in his experience a 
hret- number of similar cases required it His record of 
abortion would stand any examination He was ordinarily 
nuwh stricter than mans of his colleagues hut when there was 
a CISC «,th definiic indications he would not hesitate in ter- 


minating pregnancy Statistical experience showed that young 
children vveie subject to a much higher proportion of physical 
disoidcrs and serious dangers than adult women 
The Attorney General ' 1 suggest to you that there is a 
perfectlv clear line of distinction betvveen danger to life and 
danger to health’ — “No I cannot 'agree to that without 

quahfving I cannot say just Yes or No I can say that there 
IS a large gioup whose health would be damaged but whose 
life almost certainly vvould not be sacrificed There is another 
group at the other end whose life would be definitely m very 
great danger and there is a large body of material between 
those two exti ernes in which it is not really possible to say 
how far life vvould be in danger, but we find of course, that 
health is depressed to such an extent that their life is 
shortened as in cardiac cases Therefore you can say that 
life is in danger because death might occur within measurable 
distance of the time of their labour ’ ^ 

The operation said Mr Bourne, had certainly not been 
necessary to preserve her immediate life, but to say that her 
nervous system would probably be adversely affected would be 
a very mild term He could not recall personally any instances 
of neivous or mental damage, but he had had many brought to 
his knowledge by reading and by conversation in the general 
way of collecting experience by contact with medical men 
Such a point could be appreciated by one even with nidi 
mentary knowledge of thc elements of psychological medicine 
Asked whether it was not usual foi a gynaecologist in such 
a case to take a second opinion he answered that he was 
usually appealed to himself and had considered himself in 
this case as a second opinion 

Ftriher Evidence for the Defence 

The defence then called Dr Jacob Arthur Gorsky, divisioml 
police surgeon who described how he had examined the girl 
on the night of the rape and had found her verv distressed 
though giving a rational and coherent story He said that hw 
examination had revealed a physical condition consistent with 
the story of violence and rape which she had told to him then 
and subsequently at the trial of the guardsmen 

Dr J R Rees testified to Mr Bournes professional reputa 
tion and said that things of the mind were bound up with 
physical well being He was from tune to time consulted 
piofessionallv as to the advisability of terminating pregnane), 
and had often considered carefully the grounds on which hv 
would advise such treatment The tenor likely to be produced 
in (his case md thc age of the child, would strongly prv 
dispose him towards advising it He did not think tint Mr 
Bourne was putting it too high when he said that these two 
facts alone would give him a strong bias in favour of opera 
tion they would have just the same effect on his own mind 
In this case he would ceilainlv have advased the termination 
of pregnancy Thcie would have been no question about it 
because he was sure there would have been trouble in Ihf 
luture Asked what the danger was he replied that from hi' 
angle which was thc mental one the results to be expected 
were rather comparable with shell shock This girl had 
been in fact wounded, one might say that she had been blown 
up and he did not see whv she should go on and be buried 
by having to continue pregnancy She was almost certain 
to gel some form of mental breakdown He knew personall) 
of two cases where intercourse had I ikcn place iindci the ace 
of consent one w is by rape and the other by mcesliioiis 
relationship with the father Both the patients had earned 
a child to term, and hid been grownup when he first saw 
them Both had suffered from varying neurotic difficulh"' 
which had crippled them neither had made a successful 
marriage, both were terrified at all matters connected wdh 
sex and were inxious and unstable m every wav Hid the 
pregnancies been terminated he thought that without question 
thc mental state would have been better His colleagues had 
related to him a number of similar cases m some of which 
there had been definite mental breakdown — sebizophrenia— 
as well as all sorts of abnormalities He could not find an' 
case in which thc mother had remained mentally normal 
though in two cases she had been physically normal 

Thc Attorney General asked Dr Rees if it were not in' 
possible to assign specific portions of the mental dislurbanee 



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CH\RGE OF PROCURING ABORTION REX t BOURNE 


Tkt EumsH 

JOtrSLSAL 


203 


10 ihc original rage ami lire ^iihscqucnt child bearing 
rcspc^-liach Dr Rees replied that it a\aa not cntircK iin 
po eible \ recent rcecareh on child accaiilt had produced 
come e'idence to show that the dramatic cpicodc aeac not so 
important as the continued strain and the general emotional 
atmoephere For come \earc he had been collecting data about 
e-acce of rape in avhich conception had not occurred Semptoms 
ccrtainlc might appear in ciich caecs but he defimteh thought 
that the danger ol mental disturbance was reduced if 
precnance asas terminated when it occurred Preseraing life 
to him meant preccrainc health it was not possible to let a 
person drift into a mental breakdown in the future and sac 
one was preecning life The same svmploms might anse from 
other causes but he thought that the resentment the Immense 
crushing sense of inferioritc and the interference with in 
stmcticc life in the degree in which thea were found in these 
cises constituted a sandrome which was in some sense unique 

Mr William Gilliatt declared that Mr Bourne in the \icas 
ot those who knew him was a \erc competent obstetric 
surgeon well qualified to form an opinion on the desirabihlc 
of operation After hearing Dr Rees s Mews he would himself 
undouhtedlc have terminated pregnanes in this case He 
dc eribed to the Court the additional risks nin bj aoung girls 
in childbirth both from the toxaemias of pregnanca and from 
the incomplete o sification of the pelvis The maternal 
morlalitv of the Is-30 age croup was one per thousand higher 
than the average He had collected from the reports of two 
matemitv hospitals three cases of deliverv between 13 and 14 
four cases between 14 and 15 and '5 cases between IS and 16 
this girl would have been 154 at the time of delivers The 
percentage of abnormalitv in labour in these children was 
and the figure was borne out bv a German paper on 
the same subject The pnnctpal dilficultv which arose wns 
ineffective action of the uterus and delav so that interference 
was necessarv and sepsis was likelv to result This did not 
pass off if infection occurred in childbirth it remained for life 

lord Horder examined bv Mr Roland Oliver 'aid he was 
not infrequentlv consulted in cases where severe mental or 
nervous breakdown seemed likelv to occur if precnanev were 
not terminated and that he considered the operation was 
justifiable in such cases The facts of the child s age and the 
rape would have led him to the same conclusion as \fr 
Bourne had come to so far as he could judge without seeing 
ihe patient It was not his opinion that the operation should 
onlv be performed to save life from immediate danger 

Concluding Addresses bj Counsel 

Mr Oliver in his final address to the jurv, said that 
Mr Bournes attitude was that what he had done was 
lawful, right, and honest and he had committed no 
offence The statute of 1929 which dealt with the killing 
of a child at the point of birth, dealt with a case in 
which obviously immediate danger to life would escuse 
Ihe destruction of the child Applying it to the present 
case one could speak properly of the preservation of 
Ihe life of the mother in speaking of preservation of her 
health for her life ultimately depended on her health 
A wide and liberal view should be taken of the words 

to preserve the life of the mother The proposition 
that a doctor could only terminate pregnancy if the girl 
would otherwise die was a verv extravagant one and to 
say that he must not operate even if he were faced with 
Ihe practical certainty that she would have a complete 
nervous and mental breakdown revolted ones sense of 
justice and everv' other sense Mr Bourne was not re- 
sponsible for the views of Dr Nfalleson The prosecu 
tion had called no medical evidence and there was no 
evidence to throw doubt on the honesty and competence 
of the defendant or upon the proposition that the menial 
health of the girl for the rest of her life was likely to be 
g-eatly prejudiced If you sav he concluded, that 
the defendant had committed a felony one will be left 
reflecting gloomily on the sense and reasonableness of one 
branch of English law 

The Attornev General in his ccnclud ng address for the 
Crown, said that the prime reason vvhv abortion was a 


grave offence under the law and perhaps alwavs h,.d 
been was that the law was based on the sacredness of 
human Iite The destruction of an unborn child was Ihe 
destruction ol a potential human life He suggested thai 
there was a fundamental difference between preserving 
life and preserving health In anv given set of circum 
stances a doctor or surgeon would be able to sav -I 
did this to preserve the life of mv patient He would 
then mean something different from when he said I 
did this to preserve the health of mv patient Mr 
Bournes letters showed that he took a very wide view 
of the cases in which the operation was proper to be 
performed The evidence showed that the Crown had 
succeeded in proving that the operation had not been 
done for the purpose onlv ol preserving life Sir Donald 
Somervell did not minimize he said the possible menial 
effects of which Mr Bourne and the other doctors spoke 
The question was whether those mental effects grave as 
they were justified the termination ot the p-egnanev 

The Judge’s Summing up 

Mr Justice Maenaghten in summing up the ca e to 
the ]urv said that the offence was regarded bv the law 
as a grave one The pumshment might be penal servitude 
for life and the charge was onlv triable bv a judge ot 
the High Court As a rule a case would only come 
before the Courts when something had gone wrong 
because tne crime was committed secretlv but judging 
by the cases that came before the Courts the crime was 
bv no means uncommon This was the second case at 
Ihe present sessions in which a charge had been p-e- 
ferred for an offence against this section He only men- 
tioned the other case to show how different the p esent 
case was from those ol the usual type A woman with- 
out anv medical skill or qualification had done what was 
alleged against Mr Bourne she bad unlawfully used an 
instrument lor Ihe purpose of procuring the miscamage 
of a pregnant girl She had done it for monev i2 5s 
had been her fee She had come from a distance to a 
place m London to do it and a pound had been paid 
her on making the appointment She had used her instru 
meni and within an interval of time measured not bv 
minutes but bv seconds the victim of her malpractice had 
been dead on the floor She had been paid the rest of 
her lee and had gone away That was the class of case 
which usually came before the courts 

Mr Bournes case was verv different A man of the 
highest skill had openlv at one of our great hospitals 
performed the operation — whether it was legal or illegal 
Ihe jury would have to determine — as an act of charitv 
without fee or reward unquestionablv believing that he 
was doing the right thing and that he ought in the 
performance of his dutv as a medical man devoted to the 
alleviation of human suffering to do it That was the 
case which the jury had to trv 

The matter had never, so far as he knew arisen before 
for a jury to determine m circumstances such as these 
Even among learned counsel there had obviouslv been some 
doubt as to Ihe proper expression of the law Cerlainlv 
one of the medical witnesses Dr Malleson, had shown 
uncertainty as to the law It appeared from her letter 
that her views about the law were erroneous and it was 
onlv fair to her to say that her last statement in the 
witness box had been that she was a doctor and not a 
lawyer On the previous dav in response to a request 
by Mr Oliver, he had indicated to the jurv his view of 
Ihe law The jury would lake the law from him it he 
erred and they found the accused guillv the Court of 
Criminal Appeal would put the matter right He saw 
no reason to raodifv his earlier directions The question 
the jurv had to deterrame was, “^Has the Crown p'oved 
to your satisfaction, beyond reasonable doubt that the act 
which Mr Bourne admittedly did was not done in good 
faith for the purpose onlv of preserving the life of the 
girP If the Crown had failed to satisfv them of that 
Mr Bourne was entitled to a verdict of acquittal On the 



204- JuL\ 23, 1938 


CHARGE OF PROCURING ABORTION REX \ BOURNE 


The British 
Medical Ioursvl 


other hand if they were satisfied beyond all real doubt 
that Mr Bourne had not done the operation in good 
faith for the purpose only of preserving the life of the 
girl the verdict should be “ Guilty ” 

I fulU agree, said his Lordship ‘ with the criticism of 
Mr 0!i\er that the Infant Life Preservation Act, 1929 is 
dealing with the case where the child is killed while it is 
being delivered from the bodj of the mother But the proviso 
in that Act — that no one is to be found Guiltj unless it is 
proved that the act was not done in good faith for the purpose 
onli of preserving the life of the mother — expressed vvhat 
has in my view always been the law with regard to the pro- 
curement of abortion Although that proviso was not expressed 
in the Act of 1861 the use oCthe word unlawful’ implies 
the same thing that no person ought to be convicted under 
section 58 of the Act of 1861 unless the yury are satisfied that 
the act was not done in good faith for the purpose onlv of 
preserving the life of the mother 

This IS a case of great importance to the public and more 
especiallv to the medical profession It has nothing to do 
with the ordinarv cases of procuring abortion which 1 have 
had before me here Those cases concern persons with no 
skill and no medical qualifications with no pretence of being 
able to sav thit they were acting for the preservation of the 
mother s life Cases of that sort are in no wav affected by 
consideration of the question that is put before you It has 
alvvavs been the law that the Crown have to prove the 
offence beyond reasonable doubt to prove that the act was 
not done in good faith for the purpose onlv of preserving the 
life of the mother In the ordinary case no question can 
arise it is obvious that that defence could not be available to 
the professional abortionist 

We have had a great deal of discussion about the difference 
between danger to life and danger to health It mav be that 
you are more fortunate than I am 1 confess I have a great 
difiicultv in understanding what the discussion reallv meant 
Life depends on health and it may be that health is so gravels 
impiired that death results The Attorney General suggested 
to Mr Bourne that there was a clear line of distinction between 
danger to health and danger to life [his Lordship read the 
Attornev General s question] and he assumes that it is so 
But IS It’ Of course there are things that are obviouslv a. 
d inger to health without being a danger to life Rheumatism 
1 suppose IS not a danger to life but it is certainlv a danger 
to health Cancer is plainlv a danger to life according to 
experience as it exists to day mav be a time will come when 
cancer will not be a danger to life There are maladies that are 
a danger to life and maladies that are a danger to health but 
IS there a clear dividing line a perfectly clear line of dis- 
tinction'’ I should have thought not 1 should have thought 
that impairment of health might reach a stage where it was 
a danger lo life [His Lordship read Mr Bournes answer 
stating thit there was a large body of patients between the two 
extremes ot whom it was not possible to sav how far life would 
be endangered but whose health was depressed to such an ex- 
tent that life was shortened and death might occur within 
me isurable distance of 1 ibour ] The learned judge continued 
If that IS the view that commends itself to you that vou 
cannot sav that there is this division into two separate classes 
with a dividing line between them then it mav be that vou 
will agree with the view that Mr Oliver put forward when 
he invited vou in construing those words for the purpose 
onh of preserving the life of the mother,’ to take a vvide and 
liberal view of their meaning I mvsclf prefer the word 
‘reasonable to the words wide and liberal I do not think 
It IS contended that those words mean merely for the preser- 
vation of the life of the mother from instant death There 
arc cases as I expect vou know from vour own experience, 
where it is reasonably certain that a woman will not be able 
to deliver the child of which she is pregnant In such a case 
where the doctor anticipates basing his opinion on the ex- 
perience ind knowledge of the profession that the child cannot 
he delivered vviihoiil the death of the mother in tho'e circum 
slintes he is entitled — and indeed it is his duty — to perform 
tills operation vviih a view to saving the life ot the mother 


If knowledge and experience teach that that is going to be the 
result obviouslv the sooner the operation is performed the 
better It is not necessary that the doctor should wait until 
the unfortunate woman is in penl of immediate death, and 
then at the last moment if he is successful! snatch her from 
the jaws of death He is not only entitled but it is his duty 
lo perform the operation with a view to saving her life 
“You have heard of the wide variations of ojnnion which 
exist within the medical profession Some there mav be who 
hold the view that the fact that the woman desires an opera 
tion to be performed is sufficient justification for it That w 
not the law On the other hand there are others who for 
what aie said to be religious reasons, object to the operation 
being performed at all in anv circumstances That is not the 
law On the contrary a person who holds such in opinion 
ought not to be a doctor — practising anvhow in that branch 
of medicine Indeed in a case where the life of a woman 
could be saved by performing the operation if a doctor 
refused to perform it on the ground ot some religious opinion 
and the woman died, he would be m grave peril if he were 
brought before this court on a charge of manslaughter bi 
negligence He would have no better defence than a person 
who again for some religious reason refuses to call in a 
doctor lo attend to his child Where, if a doctor had been 
called in the life of the child would have been saved and a 
person for a religious reason — a so called religious reason- 
refuses to call in a doctor he is also answerable t6 the criminal 
law for the death of his child I mention those two extreme 
cases merely to show that the law which is a reasonable 
law lies between those two It does not permit of the termina 
tion ot pregnanev except for the purpose of pieserving the 
life of the 'mother But 1 think mvself that those words 
ought to' be construed m a reasonable sense if the doctor 
is of opinion on reasonable grounds on adequate knowledge, 
that the probable consequences of the continuance of preg 
nancy would indeed make the woman a physical wreck or 
a mental wreck, then he operates, m that honest belief ‘ for 
the purpose onlv of preserving the life of the mother 
‘These general considerations have to be applied to the 
particular facts of this case Everything that has been said 
here tends to confirm the view that each case must depend 
upon Its particular facts and the circumstances of each ca'C 
must vary infinitely It is very undesirable that a voung gitl 
should, be delivered of a child Parliament has recently raised 
the age of marriage of a girl to 16 , the opinion of Parliament 
IS that It IS very undesirable that a girl below 16 should marrv 
and have a child The medical evidence here establishes 
that view that it is undesirable that a young girl should ro 
through the stage of pregnancy and finally of labour Then 
regarding the effect of rape upon a child under the age of 1 5 
Dr Rees has said that from his experience and his knowledce 
the mental effect produced bv pregnanev brought about bv 
rape has a most prejudicial effect upon the mind of the girl 
It IS the merest common sense that if a girl is feeble minded 
or belongs to the class that is described as the prostitute tjpi 
for her it is a different matter But for an ordinary decent 
girl brought up in an ordinarv decent wav, bv parenb 
without anv knowledge — as Dr 'Malleson observed — of wln-tc 
they could look for a professional abortionist vou may think 
that Dr Rees was not understating the probable effects on bet 
life of having to bear this child 
' All this of course, depends upon vour opinion As far as 
danger to life is concerned of course vou cannot be certain 
that there is danger to life unless you wait until a person is 
dead Nobody asserts that the operation onlv becomes leua' 
when the patient is dead It is all a matter of opinion The 
example ot acute appendicitis was mentioned It is a matter 
of common knovvlerlgc that the surgeon prefers to 
when the appendicitis is not active Take this cise A ebd 
is suffering from symptoms which a doctor diagnoses a 
appendicitis The symptoms subside and the doctor saiv 
The symptoms have subsided and she will probably ec 
quite well again, but at the same time it mav be ' ? 
temporary lull and to morrow the condition mav he mij 
worse If you let me prepare the patient and operate to da) 



jL’t\ 23 I95S 


CH \RGE or PROCURING ABORTION ACQUITTAL 


The BfiTtsH 
Medical Jovxn^l 


205 


I on Einnntic the life of \oiir child md the operation will 
be performed in perfeet eafete If as prohahh happens 
ashen there is appendicitis the cliild tets worse the appendicitis 
becomes aeiitc and the doctor has to operate as he maa 
haac to in such circumstances that he cannot guarantee the 
life of the child the child maa die Suppose that choice is 
put to the parents W'lll aoii haac the operation to daa or 
will aoii aaait until tomorrow to sec whether the disease 
becomes aculea — what ansaaer is there to that question but 
to saa Do it now do it while aou are still safe do not 
aaait to see aahether she is near death The operation maa 
be performed and it maa be found that the appendix aaas 
quite all right but is the surgeon blamed for performing 
the operation’’ He used his best judgment The surgeon 
can onia base his opinion on knoaa ledge and experience and 
if he in good faith thinhs that it is necessao for preserving 
the life of the child in the real sense of the words not onla 
IS he entitled to perform the operation but it is his duty to 
perform it 

In regard to ana other operation on the human boda 
obaiousla no difliculta anses The onla difliculta that anses 
in the case of abortion is that the laaa of this land has alwaas 
held human life to be sacred and the protection that the laaa 
gives to human life extends to the unborn child in the womb 
The unborn child must not be destroaed except for the purpose 
of preserving the aet more precious life of the mother 

In conclusion the judge repeated the question on aahtch 
the jury had to return their aerdict He added that so 
far as the members of the medical profession themselves 
were concerned thea alone were the persons who could 
properla perform such an operation It was to be hoped 
and expected that none of them would ever lend himself 
to the malpractices of the professional abortionist No 
doubt thea would act only in consultation with some other 
member of the profession of high standing so as to 
confirm the view that the circumstances were such that 
an operation had to be performed and was legal 

The jura were absent for forty minutes and returned 
a aerdict of Not Guilty 

Mr Afccl. Bourne s defence was conducted ba Messrs Lc 
Brasseur and Oakley solicitors to the London and Counties 
Medical Protection Societa 

AN ACTION WITHDRAWN 
At Leeds Assizes on Jula 12 an action brought ba a patient 
against a hospital house-surgeon was withdrawn The 
plaintiff aaas John Neville Neaamarch a Hull rivet heater and 
he sought to recover damages for alleged negligence from 
Dr Martin Fleischer house surgeon at Hull Roaal Infirmara 
aaho performed an operation on him in October 1936 Mr 
H Ha Iton Foster counsel for Neaamarch said On behalf of 
the plaintiff I unresenedlj and in the most unqualified manner 
withdraw every allegation of negligence made against the 
defendant m this case and I ask for an order for the 
paament out of court of the sum paid into court to the 
defendant s solicitor Mr Justice Goddard made an order 
that all proceedings should be staved on terms endorsed on 
counsel s briefs and added that there would be a judges order 
if necessara 


Universities and Colleges 


UNIVERSITY OF OXFORD 

In Convocation on Julv 16 thd Vice Chancellor Mr A D 
Lindsay presiding the honorara degree of D Sc was conferred 
on Dr Harvey Cushmg CB Emeritus Professor of Surgery 
at Harvard University 

The Public Orator Mr Card Bailey presented Professor 
Cushmg as an iljustnous surgeon who had performed more 
than 2 000 successful ojierations on the brain He aaas 
descended from a long line of doctors and obtained his medical 
degree at Yale After studying in Europe he returned home 
and maintained m his wntings and proved ba his actions the 
value of the acra difficult operation on the brain which he 


himself once called The North West Passage of Surgep 
The fine services he had rendered dunng the'great w^r were 
well known to all For nearla thirtv aears he'aas Professor 
first at 'Vale Lniaersita and then at Harvard and mara of 
his pupils were to daa famous An expert with the pen ^s well 
as with the scalpel he had written mans technical treatises on 
the nerves the structure of the brain and the pituitara ela-’d 
and for the lav man the great life of Sir Vilham Osier 

The following medical degrees were conferred in Cor 
gregalion presided over ba the \ii.e Cnancellor 
D\t— A D C Bell R R Bomford 

B M — T R Savage J M Teasdale \\ E Aorng J B Atkirs 
R H Mole E B G Reeae M A Slee A Shanron 
R A Shasvyer J C HeiaeEon O I Green C W M Whiis 
J S Aslbura \\ M Gibson D R Cargill C Eaell C P B 
Welford J G Jamieson T E Ooi Ceha K. Vestropp 

UNIVERSITY OF LONDON 
BroH/t Animal Sanatory Insttiunon Commutit 
The Senate has received the report of the Brown Instuu 
non Committee for 1937 which records that the ujier- 
intendcnt has continued his research on viruses and Dr 
Nathan Raw has continued his research in human and bos me 
tuberculosis Five lectures on A Comparative Studs of 
Filter Passing Baclena and Viruses were delivered as re 
qutred under the will of the late Mr Brown At the hospitd 
dunng the sear I 298 eases were treated as out patient 
Ihttta two as in palients and the number of operations pet 
formed was 311 

Graham Lagan Committee 

Dr A \f H Gray has been elected chairman of the Graham 
Legaca Committee for the sear 1937-8 The Senate has re 
ceiaed the annual report of the Committee tor the sear ending 
August 1938 which states that the general purpose for which 
the Graham Fund was founded aaas to aid research m the 
school of advanced medical studies connected with University 
College Hospital The Graham Scholar is Mr C H Graa 
and Drs C Bolton G R Cameron M Maizels and F H 
Teale have received grants m aid of research from the Graham 
Fund Professor C R Hanngton FRS was reappointed 
Director of Research under the Charles Graham Medical 
Research Scheme for a period of one a ear from October 1 
Regulations relating to exemption from the internal imer- 
mediate examinations tn arts science engineering economics 
and commerce and from the first examination for medical 
decrees through the higher school examination of other 
oniacrsities (Red Book 1937-8 pp 89 345 489, 556 5*5 269) 
have been approved 

In and after 1939 the examination for the academic post 
graduate diploma in bactenolocy (Red Book 1937-8 p 610) 
will begin on the Thursday following the third Mondaa in 
June instead of the first Tuesdaa in July 

Mr Philip H Milchmer has been appointed a Governor 
of the West London Hospital Medical School for 19j8-9 
The sailahuses in inorganic chemistra phasics and general 
biologa for the first examination for medical degrees for in- 
ternal and external students (Red Book 1937-8 pp 264-7 
Blue Bool September 1937 pp 809-12) have been amended 
and copies can be obtained from the Academic and External 
Registrars 

GcoSres E Dmeen Tmellmg Studentship 
Applications are invited for the Geoffrea E Duacen 
Travelling Studentship of the value of £450 for re earch in 
ana aspect of oto rhino lara ngologa The studentship is 
normalla tenable in the first instance for one a ear part or 
which shall be spent in studa abroad in accordance with a 
scheme to be approved ba the Studentship Board but it may 
be extended for six months or for one or two aears and 
during the extended penod the student maa be allowed to 
undertake research at the Roaal Ear Hospital or some other 
laboratory approved for the purpose Full particulars can 
be obtained from the Academic Registrar Uniaersila of 
London WCI and presenbed forms of application must 
reach him not later than December 31 

William Iiiluis Mickle Fellowship 
Applications for the William Julius Mickle Fellowship arc 
invited and must be sent in ba October 1 The Fellowship is 
of the value of at least £200 and is awarded annualla ba the 
Senate to the man or woman who being resident in London 
and a graduate of the Uniaersita has in its opinion done 
most to advance medical art or science within the preceding 
five aears and has therein shown conspicuous ment Further 
particulars can" be obtained on application to the Academic 
Registrar 



206 JUL\ 23, 193S 


EPIDEMIOLOGY SECTION 


Thc Brituh 
Medicai 1olk\kl 


No 27 

INFECTIOUS DISEASES AND VITAL STATISTICS 

Wc print below i summar> of Infectious Diseases and Vital Statistics in the British IsLs during the t\eek ended Jul\ 9 

Figures of Principal Notifiable Diseases for the week and those for the corresponding week last >ear for (a) England and Waki' 
(London included) (b) London (administrative counts) (c) Scotland (d) Eire (e) Northern Ireland Median values for the 
last 9 scars for (a) and (b) 

Figiiret of Blithe and Deaths, and of Deaths lecoided tindei each inftctioiis disease, are for (a) The 126 great towns (124 m 1937) 
in England and Wales (including London) (b) London (administrative county) (c) The 16 pnncipal towns m Scothnd (d) The 
13 principal towns in Eire (e) The 10 principal towns (9 in 1937) in Northern Ireland 

A dash — denotes no cases a blank space denotes disease not notifiable or no return available 


Disease 

1938 

1937 (Corresponding Week) 

1929-37 (Median Value 
Corresponding Weeks) 

(a) 





(a) 

(b) ! 

(c) 1 



(a) 

(b) 

Cerebrospinal fever 

18 

3 

8 


1 

28 

3 

6 


1 



Deaths 


1 

2 

B 



* 1 

1 

B 




Diphtheria 

1,001 

127 

151 

49 

21 

927 

127 

137 

39 

19 

892 

171 

Deaths 

22 

1 2 

4 

2 

— 

28 

3 

4 

1 

— 



Dysentery 

51 

23 

40 


— 

18 

3 

9 


— 



Deaths 




' 

— 




— 

— 



Encephalitis lethargica acute 

■I 


B 

1 

— 

8 

B 

1 


— 



Deaths 

■ 

B 

B 

j 



B 






Enteric (typhoid and paratj phoid) fever 

13 

2 

6 

5 

4 

32 

B 

6 

7 

3 

50 

— 

Deaths 

B 

— 

— 


— 


B 

— 

— 

— 



Erysipelas 

B 


59 

2 ' 

> 

B 


57 

3 

5 



Deaths 

B 

2 


1 


B 







Infective enteritis or diarrhoea under 2 years 






1 


1 





Deaths 

64 

19 

10 

10 

2 

44 

14 

11 

6 

2 



Measles 



91 

■1 

■Q 



87 


2 



Deaths 

7 

3 

1 



15 

— 

— 

2 




Ophthalmia neon itorum 

113 

9 

26 

B 

B 

105 

8 

30 

B 




Deaths 




B 

B 



1 





Pneumonia influenzalt 

500 

42 

5 

1 

16 

532 

26 

3 

B 

Min 

546 

42 

Deaths (from influenza) 

11 

2 

2 

— 

— 

7 

1 

3 

B 

1 



Pneumonia primary 

B 


139 

8 


nn 


133 

9 




Deaths 

B 

15 


8 

6 


13 


6 

4 



Polio encephalitis acute 

B 

B 

B 






nm 




Deiths 

B 

B 

B 

B 



B 


^B 




Poliomyelitis acute 

6 



B 

B 




2 

2 


1 

1 


Deaths 


— 

B 

B 


1 



Hi 




Puerperal fever 

B 

a 

17 

3 



3a 

3 

17 

{■ni 

— 



Do iths 

B 

— 

i 




— 


1 




Puerperal pvrexia 

164 

17 

23 




141 

16 

20 


_ 



Deaths 


1 







B 




Relapsing tever 

1 

1 


1 


. 



B 




Deaths 


1 







B 




Scarlet fever 

1,751 

157 

295 

73 

71 

1,687 

191 

343 

so 

39 

1,658 

244 

Deaths 

2 

1 

2 

— 

— 

3 

2 

1 

— 

— 



Small pox 

1 

1 

mm 


___ 

H9 

H9 

B 




1 

Deaths 


1 

B 

B 

— 


HjS 

B 

— 

— 



Tvphus fever 



i 

B 

B 



■Mj 


B 

___ 





Deaths 



B 

E 

— 

B 

IB 

B 

— 

— 



Whooping cough 



29 


8 



49 


5 


i 

De iths 

3 

I 

5 

2 

1 

1 I4| 

1 3l 

5 

2 

— 




De Iths (0-1 vear) 

294 

63 

64 

27 

19 

283 

a4 

73 

! 23 

16 



Infintmortilitv rate (per 1 000 live births) 

49 

52 

1 



48 

45 


j 




Dl ilhs (cxeludingstillbirth':) 

3,851 

701 


175 

136 

3 796 

748 

584 





Annual de ith rate (per 1 000 persons liv ing) 

9 5 

89 


11 8 

12 1 

94 

94 

11 9 



i 


Live births 



923' 




1 225 

919 

415 

266 



Annual rate per 1 000 persons hv ing 



188’ 

1 




154 

188 

28 3 

25 5 




Stillbirths 

326 

1 




269 

47 






R lie per I 000 tot il births (including stillborn) 

46 

1 39 




38 

37 





— 


c coumv mid- niufiiSle oolv m the t injudes pnmar> form m fii,urcv for Uncbnd and VVaIi.> London fidnunis 

traUNC cojnt>) and Northern Ireland 


I 

























































































































































Juu 23, 19"S 


EPIDCMIOLOGICAL SECTION 


EPIDEMIOLOGICAL NOTES* 

Enfcric Fc\cr 

During the week under rc\icw P ca^cs of cnlcric fc\cr 
were notified in Encland and Male*; as compared with 26 
in the preMou*; week Of these 2 (S) were in London — 
] each in Camberwell and Paddington In Scotland 4 cases 
of txphoid fever were recorded — 1 each in Lanark Couniv 
Glascow Edinburch and Roxburgh Countv — and 2 cases 
of panivphoid fever both in Ross and Cromartv Couniv 
There were ^ cases of enteric fever reported in Fire during 
the week under review the same number as Iasi week and 
4 (0) cases jn 'Northern Ireland 

Diphtheria and Scarlet locr 
Notifications of diphtheria m England and Males during 
the week under review rose from 94^ to 1 001 but in 
London ihcv fell from 140 to 127 There was a marked 
decrease in the notifications for Scotland — PI as against 
176 — but in Eire there was an increase of over 44 recorded 
last week while in Northern Ireland the figure remained at 
21 Deaths from diphtheria in the 126 Great Towns of 
England md Males remained at 22 and in London at 2 Of 
the 22 deaths recorded in the 126 Great Towns 3 each 
occurred in Leeds (0) and St Helens (0) There were 4 deaths 
from diphtheria in the 16 principal towns of Scotland during 
the week under review — 1 each in Glascow (') Edinburgh 
tO) Dundee (11 and Civ debank (0) There w-as an increase 
in the number of notifications of scarlet fever in Encland and 
Males during the week — I 7^1 as against 1 641 — and in 
London — P7 as against P2 in the previous week Jn Encland 
and Moles the figures were in e\ces> of the median value for 
the last nine vears but in London thev were appreciabh less 
There were 2 deaths from scarlet fever in the 126 Great 
Towtis of England and Males during the week under review 
the same as last week no deaths from scarlet fever were 
recorded for London Notifications for Scotland fell from 
361 to 29^ with 2 deaths while in Eire and Northern Ireland 
thc> fell from S8 to 73 and from 78 to 71 respcctivelv 

Prirrarv and InffucnzaJ Pneumonia 
The seasonal fall in the notifications of pnmarv and 
influenzal pneumonia continues the figures for England and 
M'alcs dropping dunng the week from 622 to *<00 this figure 
IS well below the median value for the last nine vears In 
London the fall m the number of notifications is verv slight 
The number notified being the same as the median value 

MtasUs and Mhoopmg-''OUgh 
Dunng the last few weeks the deaths from measles m the 
126 Great Towns of Encland and Males have fallen from 
about 12 to 8 of the 7 deaths registered durin-. the week 
under review 3 were in London The number of eases 
reported in the LCC elemeniarv schools has fallen rapidlv 
the figures for the last four weeks being 6S0 422 34$ and 
250 (week under review) while the average dailv admissions 
to the LCC fever hospitals fell bv one third compared with 
the previous week Notifications dropped in three of the 
metropolitan boroughs in which measles is notifiable remained 
the same in two and rose in six — Battersea 23 (18) Fmsbun 
10 (8) Hampstead 10 (6) Lambeth 31 (17) St Pancras IS da) 
Stepnev 6 (8) in Scotland measles is also on the wane 91 
cases being notified compared with 113 in the previous week 
Dunfermline Kirkcaldv and Falkirk were the chief towns 
involved 

M hooping-cough in Scotland has replaced measles as the 
pnncipal killing infectious disease compared with 1 death 
(in Glasgow) from measles there were 5 deaths from whooping 
cough — 2 m Glasgow and 1 each in Greenock Hamilton and 
Paislcv In Eire 2 deaths from whooping couuh were recorded 
both m Dublin and in Northern Ireland 1 death was reported 
m Lurgan 

Notice was given in the London Gazttte of Fndav Juh 15 
of reg ulations ma king measles and w hooping cough^compul 

* Except where otherwise mentioned figures in parentheses refer 
to the wctk preceding the one under review 


a/)/ 

XflDICAL JoiTR-SAl. ■** 


sonlv notifiable in the Countv of London These regulations 
which arc made under the Public Health Act. 19 6 come into 
effect on October I Notification is restricted to the first case 
occurring in the same house or institution within a penod 
of two months in this wav the occurrence of the e di ea es 
IS brought to the notice of borough medical officers of health 
who Will be able to supervise contacts and have the earlie*4 
warning of the development of further cases Current prac 
ticc in London and the expected effect of general compulsory 
notification were dealt with in the Jonrnrl of April 9 (p 807) 
A possible development the scope of which cannot be deter 
mined at present is that active immunization of contacu^ bv 
means of specific vaccines mav be c*.rned out by the co 
operation of medical practitioners wuh borough medical 
officers of health 

Cholera 

The epidemic of cholera in Hong Kong conunues although 
the number of cases reported for the week ended July 9— 
225 — vvas 76 less than in the previous week In Hong Kong 
in the same week there were 4 j ca^es wuh 32 deaths Cholera 
first made its appearance in Hankow dunng the week ended 
June 25 and although no details are available as to its 
incidence since the outbreak is IikeK to spread on account 
of the large number of refugees in that ciiv and of the 
miliiarv operaiions proceeding on the '^angt«e River In 
French Indo China and in British India generallv a downward 
trend of the disease has been noted in recent weeks except 
in (he Central Provinces and in Berar where ^ fre«h wave 
occurred dunng the week ended July 9 after a period of 
decline lasting three weeks 

T\ phus 

The incidence of tvphus in Morocco has been falling in 
recent weeks 66 cases with 10 deaths were reported m the 
week ended Julv 2 compared with 71 m the previous week 
In Tunisia 55 cases were notified compared with 76 m the 
previous week and in Egvpt there were 42 cases in the 
provinces 1 m Cairo and 1 case with 1 death in Alexandria 


Medical News 


Lieutenant Colonel W L Harnett CIE MD FRCS 
1 M S (ret ) former professor of surgerv Medical College: 
of Calcutta and recenih reader in surgerv at the Bntish 
Postgraduate Medical School has been appointed medical 
secretary to the Clinical Cancer Re^^earch (iommiitee of the 
Bntish Empire Cancer Campaign The scheme of clinical 
cancer research which has alreadv started will embrace 
approximatelv 17 000 fresh cases of cancer annuallv occurnng 
in the teachinc hospitals and the specialized hospitals of the 
London area and the hospitals of the London Countv Council 
and the Middlesex Couniv Council 

M'e are asked to announce for the information of general 
practitioners that the out patient department of the Chel ea 
Hospital for Momen is clo*:ed now for new patients until *he 
fir«t week in September 

Mr A N Dixon has been appointed to the position until 
rccenllv held bv Mr P N Adamihwaite as agent (manager) 
of the Medical Insurance Agency Mr Dixon will take up 
duty on September 5 

The Amencan Association for the Siudv of Goiter will hold 
Its annual meeting for the vear of 19 8 in conjunction with 
the third International Goiter Conference in Ma«hington 
DC on September 12 13 and 14 The programme for the 
first dav will consist of the presentation of papers concerning 
endemic goitre the second dav will be devoted to a study of 
the thvroTd m relation to endocnnologv and metabolism and 
the third dav will be given up to hvperihyroidism These 
subjects will be discussed bv workers from several different 
countries 

The fifth European Congress of Mental Hvgiene organized 
bv the committee of mental hvgiene of the As'^oaation of 
German Neurologists and Psvchiatrists will be held at Munich 
from August 22 to 25 Further information can be obtained 
from 80 Rue de Levoume Brussels 



20S JuL\ 23, 1938 


LETTERS NOTES AND ANSWERS 


The DumsH 
Medical Jourvu 


Letters, Notes, and Answers 


All communications m regard to editorial business should be 
addressed to The EDITOR British MEOictL Journal B M A 
Housf Tavistock Square Vv' C 1 
ORIGINAL ARTICLES and LETTERS forwarded for publication 
art understood to be offered to the British Medical Journal atone, 
unkss the contrar> be stated Correspondents who wish notice 
to be taken of their communications should authenticate them 
with their names not neccssaril> for publication 
Authors desiring REPRINTS of their articles published m the 
Brutsh Medical Jountal must communicate with the Secretar), 
B M A House, Tavistock Square W C 1, on receipt of proofs 
Authors overseas should indicate on MSS if reprints are 
required as proofs are not sent abroad 
All communications with reference to ADVERTISEMENTS should 
be addressed to the Advertisement Manager Orders for copies 
of the Journal and communications with reference to subscrip- 
tions should be addressed to the Secretary B M A House, 
Tavistock Square W C 1 

The Teltphose NuvtUER of the British Medical Association and 
the Briitsli MedicOi Journal is EUSTON 2111 
The Telegrvphic Addresses arc 
EDITOR OF THE BRITISH MEDICAL JOURNAL Aiiioloci 
IVesiienl London 

SECRETARY Medisccra H csiccnl London 
The address of the BMA Scottish Ofhec is 7 Drunishcugh 
G irdcns Edinburgh ttelegrims Associate Edinburi;li tele- 
phone 24161 Edinburgh) and of the Office of the Irish Free 
State Medical Union (IMA and BMA) 18 Kildare Street, 
Dublin (telegrams Bacillus Dublin telephone bJ'iSO Dublin) 


QUERIES AND ANSWERS 

Case for Diagnosis 

Dr T Stacev Wilson (Birmingham) writes in tepl) to 
Fag (Journal July 9 p 105) Wtth regard to the 

patient mentioned by Fag the historv of the case 
makes it quite probable that the colic is a referred 

pain due to fibrositic thickening irritating an inter- 
costal nerve which is m relationship to the sktn area in 
which the pam is felt If this be so destruction of the 
fihrosiiic tissue b\ forcible massage will free the patient 
from pain If forcible massage over one of the ribs induces 
pain next da\ over the area where the pain is usuallv 
Rll destriiclton of the fibrositic tissue is certain to cure 
the condition This subject is dealt with m an article of 
mine in the Journal of February 15 1956 (p 298) 

Income Tax 

Arms Pa} H litle Abroad 

Captain R A M C was living abroad up to June 17 when 
he returned to this coiintrv Between April 6 and June 17 
he TcmiUcd £100 to the United Kingdom , his wife was 
here but he maintained no residence here Is he liable to 
United Kingdom income tax as well as Indian income tax 
on the £100’ 

) es He ts a British resident for the financial year 
commencing April 6 1938 and is liable on pat received 
in or remitted to this countrv He is however entitled 
to Dominion Income Tax Relief in respect of the tax 
paid m India on income assessable also in the United King- 
dom The working of that relief is somewhat complicated, 
but It will probabh recoup him for at least one half of the 
rchlivL Indian tax 


LETTERS, NOTES, ETC 


Lunatics as Pets 


This IS the bizarre title of an article bv Dr Claude Ltllingslon 
in the Julv number of Blncknoods Maimziiic Behind the 
siorv of a pltickv old ladv who preferred a lunatic to the 
conventional pel— asthmatic dog mangv cat or IwtUerv 
CTnarv — is a pica for home rather than hospital treatment 
for certain cases of mental disorder The heroine of the 


siorv taken from life was a lone widow who had just 
ctilcd into a cotton wool with hot bottle nest of her own 
"ben she received an S O S from an old friend whose 
reiitiors had deposited him in a mental institution She 
r seeded forthwith to dig him out of it and install him as 


the guest of honour in her own home His joy was bound 
less And might he have a razor'’ Razors had of course 
been taboo in the asv him Without a moment s hesitation 
his hostess supplied him not with one but with all the 
seven razors her husband had owned — one for everv day 
of the week To the warning that her guest might cut his 
throat she retorted with charming elliptical logic that she 
had newer heard of an\ lunatic being so deft that he could 
sht his throat with seven razors The guest was allowed 
to come and go as he pleased, and the neighbours were free 
to make thetr own comments when her guest was shepherded 
home bv some policeman making good the lunatics tern 
porarv loss of memorv This storv of what may have been 
a case of earlv senile dementia is a timelv reminder of the 
inability of some people whether the\ are sane or insane 
to appreciate institutional life however perfectly organized 
— people to whose angular individualism the very perfec 
tion of a well organized community may be anathema 
After confessing that he does not knoyy how this story 
ended because he had not kept in touch yvith the lady and 
her pet, the author asks if the keeping of lunatics as pels 
may not be a far more common practice than most of us 
realize he even goes so far as to suggest that the world 
IS full of such combinations and that in some cases there 
may be doubts as to ysho is the pet and yyho is the keeper 
thereof v 

Bed-bug tn the Human Ear 

Dr C E Elliott (London SW7) yyrites 1 hate read with 
interest the note by my colleague. Dr N Vert Hodge 
(Joiiinal June 25 p 1406), regarding a bed bug yshich he 
dislodged front the ear of a patient Let me assure him 
that his experience is not unique I yyell remember two of 
these creatures reminiscent of the man eaters of Txavo 
yyho conducted mghllv forages from the same diurnal 
retreat — one m each ear It yyas some weeks before vve 
could locate them Bed-bugs sometimes choose cunouv 
hiding places In his recent autobiography Noel Coward 
records a nest of these creatures, yvhtch ytas finally tracid 
to an embroidered picture 

Qualifications for Carelaktng 

“C B H” yyrites Practitioners of physical medicine have 
frequently been accused of yariotis forms of jitjii hut 
the following extract from a reply to an advertisement for 
a man and wife to act as doorman and looker after ’ of 
my instruments may perhaps only be personal to myself— 
and not significant of an inside knowledge of the subject 
1 y\ as also employ ed as post mortem attendant during 
which time I have prepared as many as five bodies in n 
day (removing all viscera etc) for the demonstntine 
pathologist so 1 am sure that you would find me suitable 
for the position of caretaker, etc, and handyman’ 

Holidays and the Milk Supply 

Dr C O Hawthorne, chairman of council and Mtss Olgi 
Nethersolc, founder and organizer, of the People s League 
of Health have sent the following letter to the Press Ma) 
we as in the past, give a word of advice to holiday mal-crv'’ 
Holidays means change m surroundings habits, occupation 
and food At home the food supply is under the control 
of the housewife, who has learned by experience to know 
where reliable foods can be obtained The holiday changes 
this position, and the family supplies are under a nevv 
supervision Quite likely this supervision is in general 

satisfactory None the less it is well to be on the safe 

side for a holiday which leads to illness is an tinhappt 

experience The milk supply in this respect is particular!) 

important At a well-known holiday resort some ciclitccn 
months ago there was an outbreak of typhoid fever which 
caused fifty one deaths including those of a number of 
summer vistiors All the primary cases were traced to an 
infected milk supply , and of great significance is the ofiicni 
announcement that when the milk was pasteurized the 

epidemic ceased The lesson is obvious To avoid ri'k 
drink only pasteurized milk or if this cannot he obtained 
protect yourself and vour family by heating the min' to 
boiling point Everyone recognizes the food value ot 
milk especially for children Yet raw milk means some 
degree of risk Pasteurization or hotline on the other hand 
means safe milk and mrlk of full food value There is an 
old adage Prcyention is better Ilian cure Here is a 
chance to apply it 


JuL\ 2"^ 19'^8 


The EamsH 
Medicai JoeiL u. 


25 


KEY TO CURRENT MEDICAL LITERATURE 

GENERAL JOURNALS 


BuPcIin of the Johns Hopkins Hospital 

\ 1 6*' An 1 

n } hn Pi J nn by E I Ihmc \ M Clrnncy S V 

LafKcy and 11 M L>JcrbcrR 
Ren njl He ir» and LIccratnc Ci litn> «— I S StilT rd 
Acii n i f In ul n on C >ci ten Rc^tr»r‘ — E ! Hr 

Lo>k rrade Fattial Ob'tfu'tirn I StuJ Intc'Unc — E Marim and II I Uncht 
Sudfo en Immi name S jb'tin c m Prcurrixx i t\I) — L D Icltm and 
G K ufTrtan 

O nrcnual Uni\-ci^3l Ir cr men'' t Pam — T R F d rd L Hiiir 

Rtuiotui} IliUts aril LUiratni Colitis — ^Ten titv of 
rcpioml ileitis tnd three of iilceralivc cohlis m '\SNOcnlion 
>\iih Umphopranulomi ire di^ciisvcd The stmihr»l\ of the 
clinical features is noted The possibiIit\ is considered thit 
the \inis of Ivmphopnnulomito is mi\ ciusc the uUcrilivc 
Ics ons in the colon ind thii the lesions of reeional ileitis nia> 
al o be due to a virus 

lininMimruss to Pam — ^Three eases are reported ot children 
in whom there wis a conpenitil indi/ferenee to painful siiirtih 
leading m one ease to severe burns nultiple fractures and 
other serious injuries There was no other evidence of defect 
of the nervous svstem It is thought that these ca es represent 
1 defective development of the sen orv svitem invohinc 
sclectivelv the pain mcchinism and comparable to con 
genital colour blindness and similar conditions 

Deutsche Medizinischc NNochcnschnft 

Berin >cl 64 M y U 19^8 

Activated Charcoal Tat eis for Emaraii m Cures —B Ra evs ky A Janitiky 
af>d A Krebs 

LynrhaiK LtuVaemu and Hcrcdiij — V\ Vtt hr 
Oin«al Pi lute and Tfcaiment ot Oravo s Dr'c' e — O S hildincvht 
rLl)neurcm)C' us after Trcatmcri of Severe Gonerrheea with Uliron — L 
Bjrfcr 

EfTcuve Economh. Trcaimcnt of Lcucorrh< a smJ Djuturttne Wounds — 
E, Betemann 

N-iural Supron ct Teel Ccniritution to Shoe Reform — K W EKChcf 
A hma in Old Aye — -P Farapo 
Mai irn ScIctcms — O G O eda 

Hifh Conn Mcdico-Ieeal Jodirments >n J9i7 — Paevh and Trembor 
Herre FTOTin Tea Species — C Majer 

/fst/ima — An account is given of the cvpcnences of a hos 
pital in Budapest with regard to asthma in old age the 
clinical picture being described and the differential diagnosis 
di cussed 

Afa/i^n Sclerosis — This studs which comes from Santiago 
de Chile and was undertaken at the Stale Uni'ersRv Medical 
Hospital deals with twelve cases of malign sclerosis in ten 
of which the patients age was under 50 with 100 cases of 
benign nephrosclerosis and forts ca<es of malign nephro- 
sclerosis The three chief manifestations of malign sclerosis 
arc high artcnal pressure a poor genc'al condition and 
albuminuric retinitis 

Journal of the American Medical Association 

Chicaso sol 110 Mo 14 193S 

Treatment of Gonococcal Vaemms wi h Oestrogenic Hormone — R VV Tc 
Linde 

Stu' JC3 in Nodular Goitre — M J SchJc ing r S L GargjJJ and I H Saxe 
Rhino'poridio* s in the US V — G T C^ld ell ^nd J D Robens 
Va 'ular Birthmjrks — H VV Kao Icr 

Rupture of Aom^ Vneurysm into Pulmonary \ncr> — M H JDelp and 
R Maxwell 

Mcra1?i Paracvlhcti'a — \ D Eckcr and H VV VVclirran 
Venereal Lymphcpranulcma — VV Frei 
Fhcrrlphih 1cm Stud es — B Fantus and J M D>'niewicz 
Nt u c of Bleeding m Jaundi c — A J Quick 

Vitamns m Rclati n to Prevention and Treatment of Pellagra — VV H Sebrcll 

^ <75CR/<Jr Birthmarks — Cavernous haemangiomata and other 
vascular naevi occurring m. infants and >oung children are 


often left alone because the usual methods of treatment are 
unpractical expensive or require special faudities Kae_sler 
recommends the injection of sclerosing solutions superficiailv 
info the vascular mass Contiguous areas of blarchine are 
produced bv 0 1 to 0 2 cem of solution Sloughing occa 
sionallv occurs but heals with little scarnng Se eral treat 
menls mav be required if the area is large 

KJjnjsche Mochcnschrift 

Berin vcl 17 VLij U l9jS 
ri.n<.tion of Hrporhixis — A Jorcs 

An mal Experiments on Effect of Testicular Hc-m n-'s I — VV &-bo<Ucr ^rd 
M Gchrke 

D-ks Ihj ical Exertion Prcdi pose to Antener Pclic— >eli a — B de Rudder 
»nd G A Pet rson 

lepLcncc ot Ultra vto ct Irrad-a ron on Xpti n Vo^bedy Reaction cf Stic 
iCu -rcous Rcacjon) — G Albas wPd F Feldcrrr nn 
In t cn e < f Glucov. on ThCT3ret.tic Vfalarul Infeaion — W de Pay 
Lctc-m n-ii n cf Lipo d phcsp**orus in Small Quantities of Bleed — H G 
Krairick 

Comri/tn-* Scan t -s of Succcssfuf Resufts — K Freed nbc.** 

S mp e vfethed for Demonstrating An iNxJics in M^n — E A Voss 
I L^cto*lavine Toxic"' — F Widerbau r and H E. Wcdcr-ever 

Plnsical Exertion end Poliom\eltus — Observations on a 
number of pupils of a boarding school during a recent 
epidemic of poliomvelitis huve definitelv proved that the 
parahsts due to this condition is more severe m children who 
have been indulging in ph>sical exertion and violent sports 

Lancet 

London vol 234 Vlay 14 19’8 
Clinical Features of Cen ral P-in — G Riddeeb 

Mrtckgy of Dcabetes Induced m Dogs b> Injccuoa cf Antenor Pinni4.ry 
Extracts —K C Ri bardjon and F G Voung 
Cl tru-k Tenours— V VV Kendall and S Thomso" 

Subvut-neoos Emphysema nd Pneumoiborax m BrcnchiJ Asthm- — R VV 
D iott 

Radiograph c Detcnicn of V|>e*ocele of Unborn Foetus —J F Brailsford 
Cutaneous Appliation of Fc'licular Hormone — B ZosdeL 
\itanin A and Carotmoius m B ood OePc*nctcs in ChUdren SuTcnns fron 
Xe-o-ihihalma — J H de H - •.nd O vieulcmans 

Cutaneous Application of Follicular Hormone — Expen- 
mcniallv this mav produce a piluitarv tumour m the raL The 
clinical use in gvnaecological practice of percutaneous applica 
lions of oestrone in 96 per cent alcohol is described It is 
vomelimeb successful combined with intramuscular injections 
of progesterone m inducing utenne bleeding in cases of 
primarv or secondarv amenorrhoea 

Medical Journal of Australia 

Sydn y vol 1 Apnl 30 1938 
Vlaiernal Welfare — A J Gibson 

Expitienccs in Excretion Lrography — B L VV Cl-rke 
Extended Schw^rtze Operauon — E Gutxendge 

Traumatic Lesions of S-cro-iIiac and Lumbo-sanral Joinu — C VV B Littlejohn 
Tieaimcni of Trigeminal Neuralgia — F 3 O-rk 

Schucphrcnjc Patients treated by Induced ConvuI'’ons — R S Ellery •nd 
D C Lear 

Medizinische Klinik 

Berlin vol 34 May 13 19^8 
Estimation of B ood \IcohoI — V Forster 

Normal and Paihocgical Vnatomy of O d Age (ID — L As heff 
Diagnostic Value cf C-rd azol Test m EpJepsy — F Stiefler and F Lan-ste rcr 
Frequent Occurrence of Ota rh>l Jaundice in D~be*i-s — W Steel and 
G W cnzcl 

Treatment of Chroni Entc txol us with EntcroviofoTn and C-rbamh cn 
— L Pet hachcr 

Re^nfusion of B ood from Pcntcncal Cavity •ftcr Ruptu*c of Liver or Sp’ecn — - 
C Spnnger 

Genuine Separation of Eptpbyvts of Neck of Femur n Ado c'cents — C Cuiig 
•nd A Herzog 

Rectaruj’ar Abduciiun Sp int for Fractures of Humerus Its Usefulness tn 
War Surgc'y — VV Bark 

Rcxicvs of Literature on Tuberculosis — G Apm. 


208 A 



26 JuL-i 23, 193S 


KEY TO CURRENT MEDICAL LITERATURE 


The British 
Medical Journal 


Cardiazol Test in Epdeps\ — The intr'ivenous injection of 

2 0 to 2 5 cem of a 10 per cent solution of cardnzol releases 
an attacl onl> in patients suffering from epileps\ In some 
cases of epilepss it was necessars to increase tfie dose in order 
to release in epileptic attack On the other hand doses of 

3 c cm mas release cons ulsne attacks in schizophrenia mental 
deficiencs and in the hebephrenic psschopathies In neuro 
and psjchopathic individuals the test except m a fess complex 
cases remained negative 

Medizinische Welt 

Berlin \ol 12 Miy 14 193‘i 

ketonL Mciabolihm in Experimental and Clinical Hipoadrcnalism — U Kuhn 
Practical Impornncc of Diathermi Loop in Dcrmatologi — P Schmidt 
Po Mbiliiics of Planned Continued Fresh air Treatment — L RtcKmann 
C iiisc of Errors in Dnpnosis — R Paschke 

Estimation of Maternal OMilaiion Cveic and Sex of Child b> Date of its 
Birth — O Schoncr 

Treatment of Insomnia iMth Dormoiit — C Pictz 
Diaphoresis by Bee \cnom Ions — K Wolff 


Munchener Medizinische Wochetisdirift 

Munich \o\ 85 May 13 1935 

Treatment of Insomnia — L R MiUlcr 
•Blood Alcohol Estimation — O Huber 
lubcrculous Infection in Hospital — W Muller 
Diet of Athletes — W Heupke and A Metzner 

Pcticnkofcr s Birthplace as Laboratory for Social Hygiene — K Klsskalt 
Epidemiology and Diagnosis of Human Psittacosis — L Stchr 
Diagnosis of Pathological Changes in the Hilum — W Naumann 
Traumatic Funciional Disturbances of Iliopsois Muscle— K Herzog 
Mode of Action and Clinical Importance of New Group of Centrd Analeptics 
— H Enel 

New rcrmcniation Apparatus for Examination of Faeces — A \ Halasx 

Blood Alcohol — Hubers thesis is that a clinical diagnosis 
of drunkenness by an examination of the reflexes, gait speech, 
niemorv concentration, and general attitude is fallible A 
chemical examination of the blood is more scientific and 
exact The presence of one to three parts of alcohol per 1 000 
parts of blood gites rise to \arying manifestations depending 
on the tolerance of the patient to alcohol 

Nature 

London >ol 141 May 14 1935 

Inicrmcdiiry Kcaeiions of Fcrmcniauon — O Meyerhof 
Cylochromt a and Cyiochrome Oxidise — D Kcihn ind L F Hartrec 
DcVtlopmcnnl Forms of Virus of Lymphogranuloma Inguinale (Chmitic Bubo) 
— G M Tindlay R D Mackenzie and F O MacCallum 
Duintcgniion of Cell wall Subsnnces m Gasiro iniestinil Traci of Herbixota — 
F B iKcr and R Mariin 
Seicndhe Tc'ts of Telcpuhy — C M Bcadncii 


New England Journal of Medicine 

Doston lol 21S May 12 193S 

LiTewl of Irriianis ind Drugs affecling Autonomic Nersous System upon Muco>a 
of Normal Rectum and Recio-sigmoid with Specnl Refercntc to 
Mucous Coliiis — B \ White and C M Jones 
Treatment of Hay Icscr by Injections of Pollen Extract EmuUificd in Lanolmc 
and Oli\c Oil — H L Natcrmin 

Adrcno-gcnual Syndrome and Adrcncxortical Tumours — G F Cahill 


Nordisk Medicinsk Tidskrift 

Stockholm vol 15 Miy 14 19 i 

Utnil In uffieiency in Artefilis — R Opvahl 
Nlortaluv and Late RcnuUs of Operations on Gall bladdur — J HclKirom 

Call bladder Operations — ^This stud) from Stockholm deals 
with 1 372 patients operated on for gallstones or cholect stitis 
m the period 1914 to 1934 The total mortahts was 7 4 per 
c<.nt that for males being 16 6 per cent and that for females 
s a per cent Under the age of 30 the mortalitt was onl\ 
0 6 per cent whereas over the age of 70 it was 29 2 per cent 
Under the ace of SO it was 4 2 per cent and over this ace it 
w i' 13 ; per cent 
20S 1, 


Polielinico 

Rome vol 45 May 9 193S (Sez Pni ) 

•Experiments with Precipuiiing Bicternl Extracts of Krumwicdu and Nobd — 
A Alessandnni 

•Treatment of Milarul Splenomegaly by Maunzio Ascoh s Method —S 
Lixierato 

Lcptomcmngeal Hicmorrhagc in ^oung Female — G Dalh Torre 

Pieapitaiing Bacienal Euiacis — Alessandnni recalls the 
method of bacterial extraction used by Krumvviede and Nobel 
for tv ping pneumococci in sputum He has found that such 
extractions of organisms of the typhoid and B coU groups giw. 
specific precipitation reactions with commercial antisera or the 
sera of convalescents The method cannot be applied to the 
detection of acid-resistant bacilli or m brucellosis The 
extracts are stable 

Malaual Splcnoniegal) — Livierato describes (1) his own 
and numeious similar recorded successes in the treatment of 
the splenomegalv of chronic malaria, and (2) successes 
obtained bj others m acute malarial recurrences and in kah- 
azar bv Ascoh s treatment This consists in a protracted 
series of intravenous injections of adrenal extract in extremeh 
small doses ( derisory according to Ascoh) The treatment 
was found to be innocuous and to lead to an increase of 
weight and a verv notable improvement in the anaemia 

^ Presse Medicale 

Pans vol 46 May 1) 

Splanchnic Ganghonsetomy and Diabetes — H Chabauicr J Br^hant anJ 
R Donaso 

•Asthma and Mcnsinnuon -~F Chude and R A Vail 

Asthma and Menstniatwn — The authors give brief accounts 
of thirty sijc cases in which asthmatic attacks appear to have 
been definitely related to the patient s menstrual historj Man) 
of these patients were improved by the administration of 
follicular hormone and corpus luteum extracts They concliidt 
that these pre-menstrual or menstrual attacks of asthma are 
probably the result of a disturbance of the already iinstahle 
vago sympathetic system due to vitiation of the secretions 
of the ovaries or other endocrine glands 

Pans vol 46 May 14 1938 

Morphine nnd Respiration — Leon Binei md M V Slrumza 
Injection of Stellate Ganglion under A Riys m Trciimcnl of Tinnitus — 
A Malherbe ^ 

Treatment of Post oiuic Meningitis sMih Sulphanihmidc — Camille Hubert 
Hypertrophic Pyloric Stenosis — Louis Pouyanne 

Attempt u Specific Immunization against Experimental Cancer — L Gro s 


Schwcizensche Medizinische Woclienschnft 

Bask sol 68 May 14 1938 

Tasks and Objects ot Gcomcdicme — J Eugstcr 
•Experiences with Protamine zme insulin — G R Constam 
Trcaimcni by Sulphoamido substances — A Alder and N Markoff 
Types of Diphtheria Bacilli — E Wisslcr 

Protamine zinc insiditi — Hypoglycaemic symptoms arc 
frequent under treatment with protamine zinc insulin tlnn 
with ordinary insulin, but harder to recognize and of gresier 
seventy The error of using protamine zinc insulin in HrSi- 
doses m ambulant treatment is pointed out together with thv 
necessity for giving instructions for reduced dosage before 
engaging in games or protracted muscuhr exertion The scope 
of the treatment is discussed and pronounced to be decicledl) 
limited The use of protamine-zinc insulin in patients long 
accustomed to ordinary insulin is not deemed advisable 

Science 

Mew York vol 87 Mvv 13 1938 

Studies in 1 otasMum Metabolism of Animal Body by Mein of il 

Radio acme Isotope — D M Greenberjt M Joseph W C Cohn J 
E V Tufts 

Treatment of SnifBcs m Hat with Sulphanilamide — N R F Staler 



Juu 23 193S 


KEY TO CURRENT MEDICAL LITERATURE 


FfTcct cl 0\>ccn I ijrht and Lactoni^ine on OiMaiton o( \ itnm^n C m Milk 
— n B Hand I S Cu\hnc inJ f F Shitp 
^!cdc of Action of iiilphtn Umtde and prontc I —R FinVchte n and 1 M 
nuLclj aI 

Increase in Niramin A Actj»ii> of Corn car/^cd by DcuNmf Nwmtcr of 
Chromosomes —L I Rand Irh and D B Hand 


UeciLrifi for I-acficr 

Ccrcnhaecn >il ICO Nfay I 1938 
Relaiionship between Male ard Female G n rrh'^a in Denmark m c 

Hiiperc 

Inflifcn e of Ccmrivaftnt on Lifcctitcnc^s cf Mandcli*. Acid in Treatment 
of r)una — r I lirm 

Determination if SuIrhanilimAlc m B nxI and Dfirc \i unt if a Mi fi> 
mcthixf — F- Lund teen C Nernebren and M Nirmehrcn 
rcim-dctcrminati n Tc»t d Rrr»ihaih In LmpJ ir~cnt in Ira ticc — N Brail 

\t(ili (jfu! Ft mall Conorrhota — ThrotiLhout Denmark 
tciwccn 1906 and 19 6 ihc inwidcncc of tonorrhoca bciuecn 
the ates of 1^ and 66 sho^^s i rem rkable chmtc m the 
rchtiNc numerical importance of the di ca«^c m the lv.o sexes 
In the male population its incidence per I 000 his fallen bv 
16 per cent uhcrcTs in the fcmnlc popuhtion it ha<; risen bv 
*JI per cent The *iuthor di<cuN<cs the tanous cau<es 
apparent and real of this pbenorrenon He attaches con 
idcrable imponince to the chance in the attitude of uomcn 
toiN'ards promiscuou> ex relationships 

Su}phiWiinmuU in Blood find Urint — The rapid absorption 
of ^ulphanihmidc when gnen bs the mouth suggests the 
dcsinbilits of giMng it frcqiientlv and m small do es if its 
concentration in the blood is to be nnintained at a fiirlj 
constant lescl An initial hrge dose of 2 4 grammes might 
be followed bs 'mall do<es of 0 6 gramme given five times 
in the iwent) four hours N\hen the functional capacit> of 


The British 77 

XUlHCAl. JOVRNIL 


the Kidnejs is under suspicion it is well to control the 
excretion of sulphanilamide in the unne in the hope of avoid 
ing sulphanilamide poisoning 

\\icncr KIini<che \\ ochcnschnft 

Vienna »ol 51 Ma> 13 19^8 

Errors m DiagncMi and Estim tiin it Papinetdema — F Fi her 
l!>r itlic-cm c Symptom Ccmplcx — R Boiler 

Indnations for Operatne Treatment cf Ccn?cnitj| C) tiv K,idnc> — H 
Hernin cr 

Sew SfcihM in Scn-<r<-cifi Therapy if Gorcrrh'ca — V Fcdcit 
Sur<T<*ucLS Application of Ctmprcss B-rd~gc t End if Atd m j 1 pu^nure — 
Xf DitrcfT 

S>nr ms and Trcatr'cni of Hiph Bind Pre urc — <3 \ Zimircrraarn 
In uhn n D.abcti-* Gan rene — k H ficnterper 

\ on Specific Thtrapx of Gonorrhoea — Foderl ad\o>-ates 
stroncK the injection of autogenous blood which ha been 
irradiated with ultra violet ravs m patients who have re isted 
other forms of anti gonococcal treatment A cour e of 
Ihcrapv consists of ten to fifteen injection two of which are 
of :> cem of blood the remainder being of 10 cem Irradia- 
tion for half a minuie is sufficient for the first injection 
and the period of irradiation is increased bv Ihirtv seconds 
for each successive injection till finally the irradiation is for 
three minufes 

NNiener Mcdizinischc Wochenschnft 

Vienna tcI gS May 14 1938 

\dJrc<s to Mcdi'al Students cn Tirsi Lecture in the New Cennany — J Meller 
S» nhcance of Vanous T>pcs cf Vaginal Hacmenhage — L Kraul 
Hacmaiurta — E I— uda 

Epidemi Serous Xfenme us Its Rclatno to Virus Dxca es of Cemral Ncf>ous 
S>stem —H Scl neder 


SPECIAL JOURNALS 


Atncncan Journal of Surgery 

New Virk tol It Apnl J938 

InporiaiKc of Oattrc-secpy In Suiridaf Diagnosis— C B Benedt t 
Nuiniii nal Dntufbcnccs a socuted with D“!eaic3 of Stcmach and Du denum 
—W G ^taddocik 

Value of Roentgen Rajs in DiaRnow cf Pepne UlccJS — B R Kirklin 
Choice cf Anaesthesia for Surgery of Upper Acdcmcn — L F Sue 
Career of Stomach — J S Her cy 

Total Ga treetom^ for Carcircma of Stomach — A VV Allen 

MaTignanc) in Chrome Ga trie Licers — VV J Mcnie Scon and G B Miden 

Multiple Gastric Poljposis — H Brunn and F Pearl 

Surgical Management of Bleeding Peptic Ulcer — D B Pfeiffer and A G 
Martin. 

Chrome GsstrK deer — VV Walters 
Acute Perfera ed Ll er — H K Shawan 

G tro- cjunoeolic F stub — C S RJfc ^ 

Primarj Carctnema of Ducsicnum — C I Alen 
Surgeons Problem m Duodenal Ll cr — R R Graham 
G istroduodenoston> — 3 Xf T Finney 
Surgery in Treatment of Duodenal Llcer — -G Crfle 
Diverticula of Proximal Intestine — D Guthne and M J Brown 
Chronic Obstruction of Duodenum — X L SfcCchcc 
Frctical Value of Cholccysto-raphy — F X Hodges 
Cholecystography and Liver Function Dctctmmaucn — C H Mclniyic 
Gall bl ddcf Shadow's in Cholecystography — VV G Scott and S Morre 
Fcrmation of Gall-stones — J E Sweet 
Observations cn \ rmal md pathological Liver Funcncn — I S Rardto 
Treatment of Disca es of Gallbladder — F H kru c 
Sutgteal Treatment of Acute Cholecystitis — F Glenn 
Treatment of Acute Cholecystitis — XT k Smith 
Acute GanTcnous Cholccy tins — VV L Estes yun 
Indications for Opcrition in Gaff-bladder Di ca c — H L Foss 
Common and Hepatic Duct S ores — F H V ahey 
)n uncs to Eatrahcpatic Bile Ducts — H k Cray 
Cl olangiography — C O Xfatcr and L HermarLcn 

Surpery of Biliary Tr as n Ch dren — O C Penbenhy and C D Bemon 
PrcT-araiion of Xaundiecd Pat ent for Operation — R W XIcNcafy 
Acute Panaeatnis — VV H Cole 

Surgici] Treatment of Carcinoma of He^d of Pancreas — A O VVbrrc 
Caranoma cf Pancreas and Estrahepatic Ducts — Henry k Ran rr 
Compfxations cf Gaff bladucr and Stomach SurgeO — H W Oulc ana 
If Albright 

Pyogenc Abscess of Liver — A. Oebsner ex al 


Lner Function — This is an evaluation of the biochemical 
lexis available for the estimation of liver function The 
glucose and laevulo^e tolerance tests are shown to be of 
rcJaiiveh IiH/e value Aiteniron is drawn (o the value cf 
fhe estimation of hippunc acid in the unne following the 
administration of benzoic acid bv mouth 

Acute Gangrenous Cholecystitis — The author reviews in 
some detail the end revolts and the fate of the remaining 
portion of the gall bladder following partial choice) s ec- 
tomies 

Acute Pancrcoiitis — This is a comprehensive di ciission of 
the diagnosis of this condition with especial reference to the 
value of the blood amvlase test 

Carcmonui of Head of Pancreas and Extrahepatic Ducts — 
The author reviews here 109 ca'es, contrasting the s>mptoms 
and the results of treatment 

Aiinalcs dHjgienc publique, Xndostnelle et Sociale 

Pans vol 16 May 1938 

OrganiiatMjn of Hygiene Offices in Department of Seme — E- Malesptnc. 

Stalling of Towrs by Dogs — M Oexe 
Social Scoufgci of the Nay— -D Nar-che 
Anfibitfwc S/rCTi'’lb of Lactate of Mercury— C Digaud 
Carcint genii. Hydrocarbcns Study of Meihylchclanhrcne — XI XI Cauet 
Oxgawuatcm of Satut-ry Servi es in Larger Towrs of Rumania —A Radu 
Aphthous Fe er among VV lid and Capavc Ammals — A Urbain P Bull er ard 
J NoUTcl 

Retrc'pecii e Test for Ex nth-matcus Fevers — p Gircud 

\aial Scourges — A review of the part plated bt the 'ocial 
di ea es — tuberculosis tenert and alcohol — in the French 
Nav\ followed b\ a discu' ion of adminislralne and practical 
methods of prevention control and after care 


208 c 



28 JuL'. 23 1938 


KEY TO CURRENT MEDICAL LITERATURE 


Thc BRmsn 
Medical Journki 


Annales dc llnstitut Pasteur 

Paris %ol bO April 19^8 

Studies of Mkrobiology of Soil and Waier I\ Mornhologi and Occologj 
of \/otobiuer — S Winogradsky 

♦MorpholoRS of Herpes Virus in Tissues of Expcnmcmallb Infected Animals 
Tormation of Inclusion Bodies so Produced — S NicoWu and L 
kopcioivska 

Contribution to Stud> of Tuberculin AUergi m Children — R Chaussmand 
Hisiopathological Change^ in Nervous S>sicm of Rabbits in EKpcrimctital 
Infceiion with Virus of Equine Encephalomyelitis — J Jabolinski 

Hirpi', ) nils Iiidiision Bocltts — In experimental herpetic 
lesions in the rabbit appropriate staining methods show large 
niimbers of minute rod shaped bodies scattered diffusely or 
aggregated within cells either in the cytoplasm or within thc 
nucleus These are believed to be particles of the virus 
The> have been found in both nerie cells and glial cells m 
experimental encephalitis m the cornea and skin after inocula- 
tion in these situations in the skin lesions of herpes zoster 
in man and spreading in peripheral nerves when the nerve 
Itself IS inoculated The inclusion bodies characteristic of this 
infection appear to be formed b> the agglutination and fusion 
of these colonies of the virus 

Tiibeiciilin Allergy — This is a record of the early effects 
of prophx lactic treatment with BCG in children in French 
Indo China Sensitivity to tuberculin develops regularly 
within two months vvhen BCG is given subcutaneouslv, but 
more slowly and sometimes not at all vvhen the oral route 
IS used in either case it is transitory diminishing and finally 
disappearing within two to five ^ears Children so treated 
and exposed to household infection usually remain persistently 
ind strongh tuberculin-positive, but in some such cases the 
reaction remains negative The author believes that m these 
c iscs the inevitable infection with virulent bacilli has assumed 
a modified form harmless in its consequences and unaccom- 
pinitd b) allcrgv ^ 

Anmls of Surgery 

Pliiladciphn vol 107 April 1938 

I’ ' 1 unesilii-iic Encepinlop lUiy (ollowins Ciclopropanc — P \V Gebauer and 
I I Coleman 

IJissncration ot llrain lollowina Niirous Oside Anacslhesia — 3 D O Bticn 
and A r Slccrman 

tVi on Vbssess ot Vlndcicimincd Aeiiolom — 3 C XasSm T C Grant and 

R \ Groir 

*lri.nmi.m of H amorrlnec and Traimnuc Shock by tmnssnous Lyophde 
Scrum — D D Rond nnd D G VVaipht 
\cuic Appcndicius m Complete Transposmon ot V'lsccra — E B Block and 
M A Mishacl 

tljcKrnl I lora of Acme Appcndicius will! Pcriionitis — V\' A Alicmcicr 
Veins VppcndieiUs from Exiernal Trauma — K H Tofticr 
Suryieal Consideraiion of Solitary folyp, of Colon — C V\^ btayo and VV E 
Buiseh 

<ipast\ati\c trciimcm ot Acuic Cholccysiius — G P Pennoyer 
Sponiancou Posi opcraiisc Uuplurc of Bile Duels — B NeisburKsr 
Detmoid Cssi of Mesemery — G C Penbcriby and K K Brovinson 
Diresi Ineutnal Hernia — L S Tallis 

CommimiealinR Veins of Lower Leg and Opcrausc Tccliniiiuc of LiRalion — 
K R Limon 

Inlrcn iiioiis LyophiU Sciiiiii — The autliors describe an ex- 
pcnmenlal sliid> of thc use of serum piescrved bv freezing 
ind desiccation and redissoKcd in witer is required for the 
restoration of blood pressure Thc possible clinical applica- 
tion IS discussed 

■Ippindiciiis III Transposition of T''isceio — A rare case of 
appendicitis in a patient with complete transposition of the 
viscera IS reported and m view of thc right sided signs in this 
piiicnt the mechanism of referred visceral pain is discussed 

krehu fur Ohren-, Nasen-, und Kchikopfheilkundc 

Bitba sol fas May IV 19VS 

: HTivElitt ol Cranial pones arising from Nose — O ApTlI tacUl 
1 \T n<JcJ Laryniyifi urc Er Corcinomi o( ^ ocal Cord — \ Muyer 7 um 
C tte^bcrcc 

E t r\ M \ v^al CorU ssuh an Imptoscd Pl^oro*CcU 

M th kJ llartmsnn ana H \L uUsicin 

20S D 


•Injury to Middle Eor by Vomiting of Caustic PoDonii —V Zdlincr 
Aetiology md TrcTimcnt of Oiosckrosis — L B SciRnh 
Diagnostic Significmcc of Audiogrims ysuh IncteT'^cd Volume of Sound — 
W Wcimnd 

Examinition of Vcstibulir runclion vvuh Precisely McTsuriblc Ciloric Stimuli — 
J Scheidclcr 

Nysngmus Postroltiorius H is Clinical Method of Examination — R 
Mitttrmiicr 

Anatomy and Evinctton of Labyctnih m Afeerbrassen (^pnriifae) — A Dk.t\k« 
•Origin of Primary Carcinoma of Middle Ear — J Betendes 

Osicoinyelitis of Nasal Oiigin — The author describes seven 
cases of osteomyelitis of nasal origin, six of which were cured 
after extensive operations The clinical features surgical 
treatment and pathology of this rare condition are fulii dis 
cussed Apffelstaedt stresses the importance of ndiogr.apln 
in diagnosis 

Mo\eincnts of Vocal Coich — These were studied in freslilj 
killed calves, and a few observations were also made on 
human specimens The authors used a photographic method 
in which a strong light was placed below the glottis and thc 
light transmitted through the glottis was photographed on a 
moving plate, thus making records in the form of curves Thc 
vocal cord movements were produced by bellows attached to 
the tracheal end of each larynx studied 

Muldle-Ear Injury by Caustics — ^Thc author describes two 
rire cases where caustic poisons which had been swallowed 
reached the middle ear bi way of the Eustachian tube during, 
thc act of vomiting The physiology of the muscles of the 
Eustachian tube and soft palate is discussed 

Piinutrv Caictnoiiia of Middle Cat — ^These nnligmni 
tumours are alwavs of the squamous celled carcinoma tipi. 
although the lining of the middle car is of columnar 
epithelium The explanation usually given is that malignant 
disease inHhis legion is always preceded by chrome middle 
car suppuration , there is an ingrowth of the stratified 
epithelium of the meatus into the middle ear, or a melaplavn 
of the epithelial lining of the tympanic cavity The author 
describes one case in which the new growth was not ptc 
ceded by chronic suppuration, yet it was a 'squamoiiv 
epithelioma He concludes that carcinoma ot thc middle car 
must be looked upon as arising from the epithelium of thv 
external auditory me itus 


Archives of Surgery 

Chicago ^ol 36 April 1933 

Acute Iliac AfJcmiis • — T GJtnn Jrivm 
•Non 'ipcciric McbcnRnc Adctuiis — W Klein 

DLNtnbuiton anil Excrclion of Water 'ind Cldoridcy after Massive Salm 
Infusions — R A Cutting A M Lands and P S Larson 
Tat Embolism — C S Scudea 

Nonna! Anatomy and Variations of Periphcra! Nerves of Leg Bnil foot— • 
M Thomas Horowitz 

Calcification and Osslficanon in Tubtrculonn of Brain — H S X'ans anJ 
C'B Cordville 

•Calcification about Hexor Carpi XJlnaris Tendon — H Milch and H H Gtccn 
•Changes m Mammary Gland of Rat produced by Glandular Preparation — 
E n Astwood and C F Gcschichtcr 
Inguinal Hcrruoplisiy with Fascial Transphni — B L Fleming 
Sixty fifth Report of Progress in Orthopaedic Surgery 

Nonspecific Mesenteric Adenitis — A report of MO ci5e> 
with reference to aetiology and diagnosis Three cluneal 
tv pcs arc described and a useful sign of shifting tenderness- 
dependent upon the mobihtv of the mesenterv — is depicted 
Calcification in Flexoi Caipi Ulitaiis Tendon — This paper 
draws attention to a syndronic at present little recognized but 
possiblv common It is chanclerizcd by pain over 'be 
pisiform with hniilaiion of movement of thc wrist ind cinr 
actcnstic v rav appearances Certain points of similaritv wilh 
c ilciFication of the supnspinatus tendon arc considered 
Changes in Manimarx Glands — ^This is a stiidv of nianimarv 
abnormalities resulting from thc administration of qcslrogvns 
testosterone progesterone ind anterior pitiiitarv substance 
Certain points of similarity with benign cvstic mastitis ln'^ 
been reproduced 



Ji'n I9V'! 


KC'i TO CURRENT MEDICAL LITERATLTRE 


The BvTtni 

'f-D CAI. JOLTLNi 


29 


Brun s Bcilr irc zur Klinisclicn ChirurRic 

Berlin <cl 157 Ac’il I I 9'5 

I rcaimcni Of V irKO'-c S)rrrt<v C oirJet — r v S anj Z. v lah^ 
In^cMiitati n, of IXac! pfricnt f ami Ounces in Vcni unr Cartilicc of Knee- 

inf Oini a} iirn ir e i f D -oc" raiMc Chanoc^ —r Ra /c a 
Jn rtA of Lerbar S>Tnfvnbcvti'n> — D 5» hnecer 

C«<-<n» G urc m Ro~i(n i Jeh I (M Surr i Ikoa 

hrjctufc if Sevk ct lemur m Chlcb^-sl -\\ Jehn 
Kr»uli of Orcrati r< in Sen lunr Cirii ire — S Dent'er 
it reeo cl ^riraJ C ru — I 0 rdu-o-b 

Immum loml Intc'ti-ntirr o Fr un Tear «. Rnbbit Torr ur by Ircvtout 
Inixuhticn wah Turn ur 1 1 tritc^ — >1 MaUuchc 
PerM nal Cirorierrco Mith T hm h vein ba cxl on ^4 OrcfaicJ Caio — 
J Raac 


Ojnical Science 

Lorn! n »cl 3 Ar»»l 

In ulm Rc«i tarve anJ Aricn tcrcin F xxl iuyar D ITeicr e — %V J 
IUcct of DifTcrcrt Den on In ulin Sen if D^abei 1 Cart. 

Bl 'cd Circulati n n Hunan Lmb Olxer'aii m m D He cn cs ben ten 
rrirXimaJ ard D tal Pan ard Rcr^atk on RcyuUti n of R 'i.j Temrof* 
lure — R T Gram ^nd R S R Pear n 
ti eels of A rh>^u ard Pm ure on Sem r> Nenn of Mm — T Le»w ard 
E E Pcwhin 

Ob«cT'aucm cn FI vxl Ofubti n in \ o untary in ^f n — R T Grant 

Ob'crtatioriA in Referred Pain an me frt.n Muv.le — J H ‘Kelleren 
Deb) of P^in Pcree-^i n m Tabes D nalJ •— C t Pcs.h n 
Unilateral Hetraai n of t.r"eT Lid in Grates s Di ea c — E E Pochin 
S«ne Ob enaijort on Renin a Pres or Subs ar e ci n amed m Sormal 
Kidro loech f »uh a NJcihod for m C o osi As ay — G W 
PiclcT nc ard Pnnmctal 

Funber Obscrsainns on Familial Pen xl Paral) w — E S Atlctt arnl 
B M Ardle 

1 fTcet of Adrenaline cn Serun P la lum Letel in Man — L 1 M Casilcden 

Efftus oj Aipln rill oil Setisdtioii — Touch cold «encc «arm 
«cn e and fa't conducted pain alt begin to fail at approxi 
matelv the «ame time when the limb ic a'phwiated Slow 
conducted pain faih later and is preceded bt hsperalgecia 
Nersc fibres do not tail in order of their conduction rates 
Injurs to a digital nerse produced hspo acsthesia and hsper 
algesia which ssere accentuated bs ssarming and diminished 
bs cooling the sue of injurj 

Eifiiri — Extracts of renal carter when injected intrasenousls 
into unamesthctized rabbits produce a 'prolonged rise of blood 
pressure Two methods of preparation of such extracts arc 
described and an account is gisen of some chemical and 
phssical properties of the aciue principle renin Assax of 
renin is accomplished bs comparing the pressor effect of a 
gisen extract with that of a standard extract 

raiiiitial Periodic Piirahsis — The obscrsation that attacks of 
familial periodic paralssis arc associated ssiih a fall in blood 
potassium and that such attacks arc relies cd bi the administra 
tion of potassium is confirmed The Icsel of blood potassium 
at sshieh attacks appeared saried in different cases los salues 
in normal subjects ssere not associated ssith ans muscular 
sseakness It is sugeested that the cause of the attacks is 
some muscular mechanism sshich is abnormal either quantita- 
lisely or qualitatiselj and svhich insolves hexose phosphate 


Endocrinology 

Boston sol 22 April 1918 

Sjndromc Charactcnrcd by Osteitis Fifcrosa Disseminata Areas of Pigmcnia 
tion and Gon>da{ Dysfunction — F Aibnght B ScosiTfc and H W 
Sulko^itch 

Clinical Results of Antenor Pituiian Therapy in Children — M Mohich and 
S Pofiako^ 

Prolactin Jis Effect on Sctrction of Woman 5 Milk — J R Ross 

BioIcRical Effects of Thymus Implantation in Thymcctomizcd Rats — N H 
Einborn 

NegatiNC Effects of Endocrine Extracts on Thymus of White Rat — R V Low 

Study of Natural Growth and Ossification in Hereditary D^arf Mice— E 
Boctuger and C M Osborn 

Autctransplaniaiion and Regeneration of Adrenal Gland — D J Ingle and 
G M Higfiins 

Work Performance of Unucated Hypophyscctomi/ed Rats — D J Ingle 

Some Effects of Adrenalectomy In Fowls — E H Hctiick «»nd O Ttf uett 


Free and ToM Cho estcrc’ Content of Whote B cod P asma as rcr-..e-- 
to Earerimcnul \aruncrs in ThyTuu Act- ity — L H Ss.^di 
H B Hughes 

Piirif an n of An cr cf Pi u(£..r> Crowtb Ho'mere fry Frsci.cna - 2 " »i 
Vmmrn urn Su rh_te — H M Esars N Lya Q P E~rt 2 nd 
M E Simpscr 

llyrcrglycacmia nith ut Gy o«una — C F Dar-i. cr 

Technque of kdrena -CTcmy ir IXch — J Freud I E LjJt._n I U 

Waierrryr 


Fukuoka Acta Medica 

Tckic to! 31 Ap'il 19 S 

Ir citlaiion ExpcTtmeris with Paihc'*cri». M u’e-s m Anruli- — K Higu 
Expcrimenta! Stud cs in Therapy of Acute Pun- nt r r 15 n Pab*- — 
V Moci 

Scire Di ca cs Cored by So phur Injcctiors — M M trn-cto T kasT.. ad 
S HiratJ 

Etrerirrcnfal Ccntribution to Patho^'crcsts of Icterus m Fbos-*' rus Perer 
ing — T ^amada 

Hi topathol gy of B am m RahbiL — ^f Y-rtasit- 

/turns in Phosphorus Poisonint : — In phoiphoru po on 
me firM the Iwer cells arc damaged and in some e uJer 
the walls of ihe bile duels are aJ«o affected The c is 
CnUTcd b\ fir'it retention and later re«orplion The k-" iruttion 
of the er\throc\les and the increased formation ot biiirubin 
arc of onK secondarv importance in paihogenesic 


Journal of Biological Chemisfr^ 

New Haven vcl 123 April 19^? 

Fcnrjjfivn of Cfuco»e-I phophonc Atfid in ETty«et5 of kfjnrm— ua Twoej 
and of ^easi— G T Ctr S P Colowxk ard C F Cert 
Aaiv-n of Nufcvotides la D rtf' e Fhc«pbor>la»cn of Glj<e-ea— G T Con 
S P Coowi k -id C F Con 

Elc^rokmcfc Mpects of Surta e Cb-tr stry \ E-ectrv. Motritj and Hir-u n 
Corves of Pro e-n* ^nJ th r Relaucrship to ibe Cal t-laoon ct R dius 
ard ^^o e-uar Weght — L S Moyer arj3 H \ At'ar cn 
Q amutivc rreci*' taiioQ of Citric Acid — V C Ruyfcr 
Buffer Action of Und "ti cd Lrne Cop titu-n s — ^A C kuypc 
ti Ijauon of Carnesne by D ph^'^ia B-cil i-s — J H MucIIt 
L. hAcho taap hin A New \»nt*io-ihyl from Pus of CaIifom.a Pl,pps 
(Esch eftoU^a ea.iforr ca) — H H Stram 
Surf cc D nat^mtion of Eg” Alhir~en— H Wu C F W..ng 
Carbohydrate Meiato' mo B am \J Isc atioi of G ycc'**n — S E. Kear 
Ate-hap n of Cytoebrone Action — T B Cod d ^ 

The pH S at 1 1 > of PapClcma \ irt.s Protein — J W Beard and R W O 
W yx off 

B o ogi *31 Assay of C-rfcohy dra c Sfc-afrcfi m Ho'mo''v. of Artt or ?• u ary — 
A J Bcr’T'-n and C W Turner 

Irfiu ncc of HcavT Water on Anyla^c FoTnation ta B«-rIey — At L C id ell 
and S E Doeb'^c m” 

Differenriti Vtgraiion of Pres->or and Otyroc’ Ho'r'ones 17 EJcctrcg^'' cic 
S odics of Entreated Press u ce of Pos cnor Lobe of Pinrt-ri — 
G W Irvirg jun and \ du Aigreaud 
Forro-Uon of Coproporphynn I ard Hacmoglo^ n durirg Emtryon-c Life — 
F Scbcnhejder 

IntcraCTio" of Aiuinin B in Enzyme Reatiocs — H Tauter 
Stream Double Refraction of ' iru Proteins — M A- L,.o'*'er and W At S an ■Tf 
Inicrracdiatc Forms of Oxidation rcdution of FL-Tires — L Alch-cis a-d G 
Scbwarzenbn b 

Properties of Hacmo"Iobin -rd Pep r in So ut-ens of Lrea and O ber AmKfes — 
J Sicinb rdt 

Live Lipoids of Laying -nd Non-Iayiag B^d — F AV Lorenz I L Cb^ikoT 
and C Entenman 

R dio-act-vc Phesphorus as an Ind cator Phnsp»’o-Ii-od Afet_bol> m U 
Rote of Stomach Small Immune ard Large In estine m Phcspho-I pcid 
Aleiabolism m Presence and Absent of Ingested F t — A Fries 
S Rub-n I Perlman -rd I L Ch_ikoff 
Periodic Acid Oxidation of Scar^fi-T^ ^cd Destm a asars of 
Moecular S^c— C G CaldwcU -nd R M Hacn 
Synthesis of 5 phospho-J-s-mbmose — P A I.eve~e and C C. ChrEtK-aN^ 

Carbohydrate Metabolism Hormone —The hormone pre 
pared bs alcoholic extraction of acelone-dned antenor lobex 
of sheep or ox puuitaries when injected into health} thming 
guinea pigs caused marked increases in their blood su> " 
content the maximum effect occurring eight hours sfier ><ie 
injection The minimum amount of extract injected 1"'™ 
pentoneallj into well nounshed male guinea pits of 
220 grammes in weight which will cause after eight hoiits iii 
increase of 50 per cent (to about 165 mg of suj- if P t 
100 cem) in the blood sugar of each of fisc or mote .iiwiut 
IS proposed as the guinea pig unit of the hormone 



30 JoL-i 23 1938 


KEY TO CURRENT MEDICAL LITERATURE 


The British 
Medical Jolrn\l 


lournal of Experimental Medicine 

BiUimorc \oI 67 ^pnl 1 193S 

Sonic I fleets of Formaldehyde on Horse Ann pneumococcus Scrum and Diph 
ihccta Anuioxm and ihcir SignificTncc toe the Thcorv of Antigen Antibody 
Acgr-'Ration — H Eagle 

Duj,rcc ot Compensatory Renal Hjpertrophy follovMng Unilateral Nephrectomy 
II Influence of Protein Intake — L L Mackay T Addis and 
E M Mackay 

Observations on Pathological Changes following Experimental Hypertension 
produced by Constriction of Renal Artery — C G Child 
•Evidence of Active Immunity to Experimental Poliomyelitis obtained by the 
Intranasal Route in Macacus rhesm — S D Kramer L H Grossman 
and G C Pirkcr 

Chemical Studies on Bacterial Agglutination IV Quantitative Data on 
Pneumococcus R (Dawson S)-anti R (S) Svstems — M Hcidclbcrger and 
E \ kabat 

Course of Virus induced Rabbit Papillomas as determined by Virus Cells 
and Host — J G Kidd 

Study of Macrophage Reaction in Pulmonary Lesions of Dogs with Expert 
mental Pneumococcus Lobar Pneumonia — O H Robertson and C G 
Loosli 

Locil Recovery m Experimental Pneumococcus Lobar Pneumonia m the Dog — 
O H Robertson and L T Coggcshall 

•Jipinesc B Encephaluis Virus Its DifTercniiation from St Louis Fnccphalitis 
Virus and Relationship to Loupmg ill Virus — L T Webster 
Influence of Inflammation on Absorption of Substances of Varied Diffustbiluy • — 
R G Miller 

*V Stable Hacmolysin Icucocidm and its Crystalline Derivative Isolated from 
Bela haemolytic Streptococci — E J CzarnetzKv I M Morgan and 
S Mudd 

Aclixe Immunity to Expeumcntal Poliomxchtis — Intrinasal 
instillalion of poliomyelitis \irus m the monke\, if it fails to 
produce an attack of the disease, gnes rise to no immuniU If 
the \irus is introduced after the pre\ious instillation of pituitrin 
and a mixture of adrenaline and ephednne sulphate infection 
of the central nervous s>stem does not follow and immunit> 
sometimes results, being indicated b> resistance to subsequent 
inoculation either tntranasal or intracerebral, and by the 
demonstration ot protcctise antibody in the monkeys blood 
The instillation ot the drugs used caused no demonstrable 
change in the nasal mucosa other than a slight inflammatory 
reaction in which eosinophils were prominent 

Japanese B encephalitis Virus — ^The author s studies of the 
pathogenicity ot Japanese B encephalitis virus for various 
animils confirm the observations of others that it is distinct 
from the St Louis encephalitis virus Its behaviour in 
inimils IS similar to that of loupmg ill virus but these two can 
be distinguished serologicallv Although the nasal mucosa is 
usually assumed to be the portal of entrv of these infections, 
contact spread docs not occur among animals 

Stable Hacmolxsin icucocidm from Beta haemahtic Stiepto- 
ciHci — From strains of Streptococcus pxagenes belonging 
lo four of Lanccfield s groups but in no case from several 
other bacteria a chemically pure substance has been extracted 
hiving the properties of a hacmohsin and a leucocidin Its 
sodium salt has been obtained in crvstalline form This sub 
stance retained its activitv for a vear when kept under sterile 
conditions resisted boiling and was unaffected bv moderate 
decrees of acidity or alkalinity It haemolysed up to a dilution 
of 1 in 128,000 and this effect was not prevented by immune 
scrum serologicallv the substance behaved as a haptene It 
w IS highlv tovic for animals Its molecular weight has been 
determined (2260) and its structure ascertained sufficientlv to 
assign It a tentative formula (C P) 


Journal of Nutrition 


Effect of Eecdins High Levels of Copper to Albino Rvis — R Bojdcn V R 
Potter and C A Elvehicm 

Studies on Vitamin B, Requirements ot GroivioB Chicks — A Arnold and 
C \ Elvehjem 

Unsatiiiated Fatt\ Acids in Niitiition — Of a series of un 
saturated fatty acids and related substances tested by feeding 
to female rats showing the fat deficiency ’ svndrome linoleic 
acid, linolevl alcohol linolenic acid and arachidonic acid gave 
curative effects Approximatelv 100 mg of linoleic ester a 
da\ were necessary’ for maximum growth response whereas 
arachidonic ester was effective an doses of 33 mg a dav 
The number of unsaturated linkages and their position in the 
fatty acid molecule appear to be related to curative power 
The carboxvl group is not necessarv although linolevl alcohol 
was less effective than linoleic acid 

N 


Journal of Phvsiologv 

London vol 92 April 14 1935 

Spectrophotometer Investigation into Differences between roctal and Matcrml 
Haemoglobin in ^(an — J Jon>.blocd 

Isotonic Extension and Shortening of Anterior Retractor of Bvssus of \iiiihti 
eiiiihs — I Singh 

ElTtCt of Adaptation to Electrical and Chemical Stimulation on Etcuabilny o! 
Anterior Retractor of Byssus ot \f}ttltis fduUs — I Singh 

Some Conditions of Foetal Respiration in the Cow — J Roos and C Romijn 

Electrocardiogram of the Guinea pig — C L G Pratt 

Antibodies Organ specific against Anterior Body of Pituitatj Ghnd — Q ke^tnef 

Interpretation of Potential Changes in Spinal Cord — D H Barron anJ 
B H C Matthews 

Action of Narcotics on Bram Respiration — M jowett 

Buffering of Vlusclc in Rigor Protein Phosphate and Carnosinc — E C Bate 
Smith 

Blood Histamine and Cardiac Activity — C F Code C L Evans ani 
R A Gregory 

Osmotic Pressure of Aqueous Humour in Normal and Glaucomatous Eye-^ 
G H Benham W S Duke Elder and T H Hodg on 


Medicine 

Baltimore \ol 17 Fcbnnri 1938 

Meniere b Disease Study based on Examinations Before, and After Jntracranul 
Division of Vestibular Nerve — S 3 Crowe 
Clinieal and Expcrimenlxl RlsuUs with Thorotrasi -~D L Reeves and R M 
Stuck 

•Pathological Physiology of Chronic Cardiac Decompensation — M D AUschul 

Chiomc Caidiac Decompensation — ^This review is divided 
into two parts In the first the phy sioiogicai mednnivms 
involved m cardiac decompensation are considered, and the 
validity of the available data concerning these mechanisms is 
discussed In the second part the cardinal signs and svmploms of 
congestive cardiac failure are interpreted in the light of this 
phvsiological knowledge A convincing case is made out for 
the view that each of the cardinal signs depends not on one 
but on several phvsiological mechanisms being deranged The 
author does not sponsor any particular theory of cardne 
failure but presents a judicial consideration of the best of ths 
evidence available on this subject 


Lc Nourrisson • 

Pans vol 26 March t93S 

•Researches on Contagiousness of Pulmonxry Tuberculosis in loung Childtcn" 
E Lesni G Dreyfus Sec and A Saenz 
Sugirfrcc Milk Concentrates — P Lassabh^rc 


Philadclphn vol 15 April 10 1935 

N!cj>uri.mcni of Efficiency of Diets Nlw Apparatus and Procedures — E B 
K \\ Svvift and A Blicl ^ 

I iirtfKr Studies on Unsituraicd Fattv Acids Essential in Nutrition — O 
Tiirpetncn 

li ilu-n c of Hvdroccnation and of \ cast in Counteracting Cod liver Oil 
ln)ur> in Hcrbivora and Influence of Salmon Oil on NtilW Fat Excretion 
'f McCay H Puil and L A Maymrd 

I t cvi t t \! Iting Punt of I at on it Utilization b> Guinea pigs M McCiy 
TPvJ H Paul 

Vrl ! n of CcUiiluc anJ I tsn.n Cotwem ro '.iiuiluc Value of Animal Ecedi — 
i VV Cfarnpion and L A Nlaynard 
20 s I 


Coiilagioiisness of Piilmonaiy Titbcrciilosis — The nithors 
emphasize the possibility of contagion from infants am* 
young children who harbour a primary' tuberculous lesion 
The stomach washings from children who showed clinical or 
radiological evidence of tuberculosis were cvamined and n 
high proportion contained tubercle bacilli The possibiliiv of 
infection from these children is evident and such children 
should be segregated from healthv ones The authors ho" 
ever consider that contagion is likely only in young children 
of low resistance 



Jun 2'' 191!> 


KEY TO CURRENT MEDICAL LITERATURE 


The B iTKH 
Medical Jol.'7^^L 


I 


I’liblic Hcnilli 

LonJ( n \ I 51 \rf J 19^S 

I fc'cnj PravtKC Jn Rcnrd t« C nrjr nt. rj Di nfc n n — Hufh P u! 

Study if Ilralih Rcbtu n hir< in Gr i « f Surcni ed Prccnn > ic^ anJ 
RcMiIth* Infmts — Aero Vi !1 

!h trict Incf Tnd D rhthcru Irn*n»n/jii ^ in LiPin D ir { f Wntcrftv 
t»«ih bcaf nh — \ J C xcr 

{ nd Dismfti lion — The balinLc ot probihiliiv ol 
inftvtjon of children home ind m chool is di cu cd 
Routine CNctuMOn of conincis from school is deprecated and 
experience in Smethwick is dcvcnhcd Terminal disintection 
gi\cs a fal c sense of sceiirilx and should he replaced h\ 
supcrxiscd soap and water clean inu 

SiipcrM^tJ Pnyfu mu\ and htti nis siud\ ha ed on the 
records of mothers and ihcir infants attending the Willcs 
den antenatal clinic and welfare centre \ summirx of the 
factors that influence the t\pe of infant (health and hchasioiir) 
IS given 

Sitirlit rc\tr and Oiphifnnn /mtninit aiitui — \ stall ticnl 
account of the practice of immunization in an urban di trici 
with an ingenious profit and loss statement of the s'lemc 
of the rates eH’ected bv (he prevention of probiblc cases 

Public Health Reports of the \ 

Wahnsion m! 53 Xprjl .9 19 ’s 

Scrums XmiuviiT' ..rj Dnirs in Tfc-im ni f Men ness. ^1 't n ti — 
Sjra E Branhjm 

Siudic* in Tri hm s X In idcn a irJ aicU ts P "i m tten Lx rr 
inatiofl cf 1 D ar*irjcm —X! O Solan arJ J *ia P rt oich 
Deaibs durm* ncek ended April (‘i^s fa) Ir Groan of L«rpc Cii n 
Lnited Siatex Ift) Death Clam rcr'>t‘d fc In ran c C nnenc' 

Pre -a cn e of D -a e in Lnited States 
Current \V eelW Stale Reports for week, cnucd Ar i 1^ nd Arnl I" 

J9t- 

Sumnvar> of Monihli Repin from StatcN 
C*. es of Xcrere^l Di^cavc repined fc Tefc ur I .it 
Cnj Repori for week ended April 9 19 s 
r reifn and In ular 

Ctba I! vna f r four weeky e^Jed Apn 9 t9ts 
Cjcch''sfoiakij Janjar> 19tC 

In h Tree Sjte X iiat SaUti'x f unh qc ncr ended Dcwcmper V| juf 
xpd 'car 19V7 

Xirpm t xnd Sot fiaptc Di ea ex /anaafy XI r h 19 
Cholera Facu'* Small por lyphu and XcMo fete 

Mcitiii^ococLtti \fcniiti,ins — This is a review of the xenim 
therapv of this disea c since Jochman s experiments in 1906 
followed b\ a criticism of methods and technique in the 
preparation and application of sera A compinson with the 
results of drug treatment (the sulphandamidex) is made and 
also some suggestive and promising reports of the results 
of combined treatment An extensive bibliocraphv (22 
references) is appended 

Tnclnnosis — ^This is a detailed description of the methods 
and apparatus used B\ a combined method (microscopv and 
digestion) agreement was secured in onlv one third of the 
cases Classified results of the J74 po ilive cases arc civen 

Washington nl 53 Xfj 6 19 fi 

Trend of Monaljty ».nd Xforbiduy durmc IV1 ^nd Rc ent Pre nf nk Xear 
Trends in Shellfish Sanitation — H N O’d 

ri nnins O canuation and Conduct of Stream Pollution Surrey — J K, HtKkin 
Care durin? Recovery Period in Paralyuc Poliomyelitis 

D'aihx durm" week ended April 16 I9*S (<j> In Gr up of Larse Cii c in 
United States fh) Death Claims reported fcy In uranvc Comp-mex 
Pre alcn c of Di ease in Lnited States 
Corrint Weekly State Report Ur wee s ended Arrl » 19tR nnd Apnl * 
IV 

Summary of Xfonthly Reports from States 

Weekly Repon from CItl*^ for week ended April 16 I9J>' 

Foreign and Imiilar 

Great Britain — England and W ales — Infectious Di cases for Th ricen week 
ended January 1 JJ3S 
Vital Stan li-s fourth quarter 1937 

Jial} Communu^btc Di ex ex four weeks ended Fehniary *7 19 ^ 

JamjK.a C mmunnib'e Di ca.ves f vur weeks ended April 16 19 >■ 
XoRCwlavia Communicable Diseases four uceL ended Mar h 7 19'^ 
Cholera Plague Smallpox Typhus Pever and X cllow Fever 


Wa h rgton vol 53 '( y 1 19 S 

Preval r i. of C mmun able D caies in Lrted Sjtcs — Vf r h "-Arnl 
|9« 

Studies on D ntal Can I Dental Sufu rd D— ^1 Neeu of E.c^e=jry 
S hocl Chil-rtn — H KI i-t C E Pa m r nd J W Kcu ..n 
Fxp ritr mat Xanadium P t onip n White Ra — £ P Da- I a-d R D Ll c 
1 fjen c of Non b cedin- -rd Fo't'r Nursin- u-'o- O-currer-e of Srs." a ere.-! 
Brea t Tumors n Strain C H Mi — K B Arderr -t _rJ W J 
Xf EIcncy 

Death dunne week ended Ar il - (a) fn Group L- c Ot ir 

Lnitetl Stat*^ <b) Death Clam reroncu b fn or - e Cm-aecs 
Pr vaJer c of Di c c n Lnit d Stares 

CoTcni Weekly State Pepm f wtekb ere ' 4 , Ar 3 o 1*3 -re! Xf y 1 
193 

Samrtary of Xfonthly Rtp* n fr m Sat's 

Pacjc Infcwtun in Crourd-sq irr ! in S-r a Cru.^ C urry Calf rn a 
Weekly Rcpvvrts frm Cities f r week erded Xpn iv x 
r re rn and Insular 

Canaca — Provirccs— C nirani jbl D -* cs 1 we k rded M rT f 
(9» 

E vr a X ital Stall ti*s IQ 

Sweden Son bl D c- cs Mar h IQ r 

Ch tcra P*aeuc Sma I rx x Typhu Fev rJ X It F r 


Wa hinti n 1 53 May i> 19 

Pri rh la I X alu of Sm l D of Pr p uicJ P rt i 1 \ ir ~XV T 
Hatri )n J P Franklin rd J A Bed 
I tiban n P noJ in C- o f Ln-ulart Fc r — A X H rcy S Fr n ard 
Xf Xf Kr>;j 

D ral rai >n Aciisitics m Pvrt an^. n Ship> m An ri -n Ccu t'^e d-nr 

J9 f fr n Inf rnati m Pri.''ared by O**! c f-tcrrano-al d Hv— cn 

Publique with Co~— en — C L xviiJun and B J Lloyd 
C«n cr Mortally m Lnited State for 19 r and Rc tni Preceding Xear 
D-ath durne week ended Apnl ft 19 •» la) In Lare Dues n L— d St- cs 
f&) D ath Cl ims report'd by In urar C npan cs 
Pr valcn c Di ca n Lpi -J States 
Currert Weekly State Report f r week cn- d Xf \ 193 and 'fay >* 19 ” 

Summary of Xfonthly Reports from States 
Pa-ue I fection f und m Flea frem W xJ rat in S vada 

Plasuc Irfecti n (n^nd 1 Cri -rwsquirr I and Hea fren Gr ard quirrc 

in (ye-o*i 

Wt kly ReptfT frc"! Cii*s f r w ck ended A-nl 0 19* 

F ret n ard Insofar 

Cuba — Provir cs— Notifta'*!- D cases f r four vc«J end d Xpril J9* 
Parana Canal Zone N t fiab e Diita es J ro-rv-March I 9 *x 
Ch tra P cue Smallpox Ty-ihu F ver and Xellow Fever 

Prmpitaied Pertussis I ttcane — A. commerwiallv prepared 
pertussis xaccine wis precipitated with alum and the precipitate 
resuspended in saline solution to the onginal xolume One 
do c of 1 c cm was gixcn to each ot eightv two children x ho 
xverc ob erxed '‘gainst a corresponding group of unvaccmxied 
children for one xear Injection reactions vxere negligible 
In the control group 19 per cent d-^x eloped clinical perm sij> 
and in the vaccinated group 12 per cent wnn a preponderance 
of mild cases The observed differenues are regarded as m 
conclusixc but sufficient to justify a large sc^Ie investigation 
which IS hem- undertaken 


Surgerj 

St Louts rot 3 Xpril 19 

Seme Ac mpl hm nt of Thora le Sure r> rd it Pre* ni Pr b em. — 
E A Cmhan 

Xfu-wlc naps »n D>Nure of Chrni Empyema C-vito — B N C-ncr 
Erd rc uli of High Ligaiiort of Xariccwt X cn — H F-xon and D XX E-rrow 
X rico c ' in with Special Referen to Treatm ri by D-aticn Sirippinc 
and Inic-tion — E Horpan 

Expenm ntal O^scrvaiitn on X 1 c ral Pam — R W 'fcore 
Carcinoma of Jejunum — H Xf Kern 
Xf-cke s Divcnicylum — J Pirbcrtoo and L Stalker 
Imponan c of Hacmatcmcbi accompanied by IMo-i- Otwini iicm — A Bj sl<r 
P oa Abs •s of Apnendtr — H XfcCorkIc and J Sie enM?n 
Ri hi Reiromc»oco c Hcmoi — B Halpert 

Repair of Dircc Inguinal Hernia by Os’c rcncr-teal Graft to P ~i ncal L ne 
of ihc Pub^ — J X eal and D Baker 

Exrcrimcnwl Study of Effect of i radiatjon on Acute Pyogem- Infection of 
Sk n and Subcutan oj TI uo — J Soto A Brun'chwig and F Schlutz 

Chromt Ewpsema Cmtucs — In this article Carter empha 
s ze^ the fact that adequate drainage bv the re«;ection of long 
egments of several nbs and wide extenonzation of the 
empvcma caviiv is the most important step in the treatment of 
chronic empxema Attention is drawn to the advantage of 
uMng pedicled muscle flaps in the closure of the chronic 
empjema cavitx that remains after drvmage has been earned 
out 


208 G 



32 Juu 23, 193S KEY TO CURRENT MEDICAL LITERATURE 


Tut 

Medicxl lotRsu 


Mcckcls OncrUciiIiim — ^Thc difiiciilt\ of making a positne 
diacnosi'; of a di‘'eased Meckel s di\ erticulum is pointed out 
The lesion is described as a dcselopmental anomah of the 
intestinal tract uhich affects about 2 per cent of the population 
although onl\ about one fourth of all cases show definite 
ssniptoms A retiew of twents consecutise cases is gi\en 
and two arc fulh described Cases are diiided into three 
classes according to their simploms and tieatment depends on 
the group to which each case belongs There are those cases 
in which no sxmptoms or signs are present those with 
simptoms or signs of intestinal obstruction and a third gioiip 
in which svmptonis and signs of intestinal bleeding are present 

Surger>, Gtnecologt and Obstetrics 

Chit-iRO \oI 66 

IttnuLntc of Strum ProUtn on Mobihis ol Snnll I B^rdtn 

N\ Tlmmpson I RTtdtn and 1 IrmK 
Non inMSut, Poicmul CTfCinomT of Ccnix — C Sic\cn>on and E Scipndcs 
AviKc Putrid Ahscc^is of Liins II Arrxl^ \ of I orii Consucumc OocrUivc 
Case*! — 11 Ncuhof and A Touroff 

Sfu J> of Hjpcrcmcsis Gn\idirum Spccnl Rcftrtnce to Blood Chemt u> 
— O G!v^^man 

Obstutni,al Shoulder Traimn — O StuLUcUt 
Bacitnil Spt.cics found m Non Mcnlc Cdgut Sutures — K Clock 
•Cndochokdocinl Sphmcicroiomi — U Coin and H Doubilci 
\ — H Sttin 

\ lUu. of D iTiCd Svnplc PcOidt Sk»n Thp in Plislic Kepair of Sv.Mp — 
\V Dims 

C'lrLinomi of Bronchus Chm«.'\l ind P viholoBicTl Studs of 164 Cases — 
J Su-in Tntl H Jo Im 

Slclctaf Distnciion of Tihii — D Bo<;\\ort}i 
C)pt.nlnl(fv in Cancer of RtwCtum — T Jones 

Iran'^NCMcal Dmhi.tm> m Treatment of Carcinoma of BlidJcr — \ Uandall 
md C Uhk 

E>u!o( Jiolcthe )w! Sphii>cici(>io)»\ — Attention is drawn in 
thib article to the relationship between disorders of the btliart 
trict the pancreas and the gall-bladder and pin siological dis 
turbanccs of the sphincter of Oddi The diflerent methods 
of relieving spasm of this sphinctei are described and then 
relative values discussed A case is fullv reported in which 
periodic ittacks of sphinctci spasm were relieved bv endo 
choledochal sphincterotomv 


over a >ear as i purgative The illness laii a favoiirablt, 
couise 

Piohlcin of Solai Infliuitcc on the Psvc/it — B and T Dull 
have attempted to test the effect of solar eruptions on the 
psvche bv examining the frequenev of suicide in a number 
of large Euiopean cities dav bv dav and correlating it with 
observed solar phenomena Their findings arc in support 
of a belief m such an effect though stalisticalh not bejond 
the bounds of what might be intei preted as a chance effect 

Zcitschrift fur Infektionskrankheifen, Parasitarc 
Krankheifcn und Hvgicnc dor Hausttcre 

Berlin sol 53 Mss lavs 

Ort n Stomach worm Dikc'i'Jc m Ducks occ'isiom.d In Tropmrus fnsisrinut 
(Dicsmp') — H LarjRc 

Ncmaio p'xratacnudac Scoltx 'mil DiRCsiion — K WolfflnlRuJ 
I iTcct of Kcid and Afkafinc f ceding on Aboriu Bing Infccdon and in 
ARiihumm T ormtuon — C Luhrs 

CtUtcvnlK and Spread of Tuhcrcaloete Contagious Abortion and 'lUlow 
Galt among iHl Caulc of a Savon Village — H Haupt 
EHcci of Supinnfcction with Swme Ttver \ iru^ on Course of I taction ol 
Simulnntous Vaccinition against Swme Pcser — Zoft ca k) 

En oonc Enccpbalilis in '^oung Silver Poxes as Hesuh of Pintjphus infection-* 
k Poltl 

Dy cmcf> )n Ducks — H Horslmann 
•Bacteriological Meal InspLClion — G Pohl 

Evptfimcmal Pccding Tuberculosis m Swmc — A HLmmcrt KaMlck and 
E UetMim* kt 

Course of \cii\c nnd Acme pavMic Irnmunlu m TtianiA — K L Bolters 
and H Dehmcl 

\ aluc of ExpunmcntalK Infected Guinea pig for RccogniUon of Infutnb 
Anaemu m Hoostd AnmnN — H iitfogcl 

Cuctciiofogv of Mint — CuUures were made ol various orgaav 
from 16 331 carcasses of animals which had either been 
cmergcnc> -slaughtered ’ or were ol hews tse suspect bactern 
of the Salmonella group were recosered from 269 The sites 
horn which positive cultures were most often obtained varad 
somewhat in different animals but the User gallbladder 
Ivmph nodes at the hilum of the liver, and sometimes the 
spleen vveie gencialh speaking the most often infected 
Enrichment in tetratluonate broth sometimes gave positiw 
cultures when other methods failed 


Zcitschrift fur Geburlsliulfc und Gvnakologie 

Sluiiiran >0} 117 ^prd ^9 

“Ihiriotn C»'c» of Milignini Cborion Epithelioma — H Hcuck and R Han tr 
ConncMon between Growth of Circtnoma and EnUov.nnc — Hin B»tl^ 
JUvuliv of Opcniivc Treatment of rrulapsc — Kurt HolKtctn 
•Inur mill Tulal pregnanev —Herbert Huber 
O Oi.ma of Newborn — H \ olz 

A koflik \kid Content of Human ^^lfk m Summer and Minttr — H \Vmkfcc 
anJ A Hem 

Inurstinal Tiihiil PugiitiiH\ — Seven cases of interstitial 
liibil prtgnancv arc described The condition is uncommon 
but IS of interest with regard to aetiologv The author found 
that contrarv to general experience with pregnanev occurring 
in other parts of the Fallopian tube there w is no evidence 
of nodose salpingitis but that uterine decidua was present in 
the tubal captllarics 

Zcifschrift fur die Gcsamlc Neurologic und Psvchiafne 

Berlin vol 162 VrU 22 IS S 

Contfibuiion lo P Vvhology of 5>w ibnn Ptople — H J Woibrichi 
Cerebral End artenev — E Svhnrrcr 

HcreJitiO H\ropb'vtit Pituitarv Infantih m — \S Drierrjn ki 
Colos-Ntuh Poly ncufwi'j — I V\ kroU 

Cortnbubort to St«dv of Nctiroftbromato (von Rcckhmtbaiiscn - Di cave) — 
E Bckk 

S-njiin and Imasc in bveing and Hearing — O Gocbcl 
P > hv^iahclocy of Dream m Schi ophrcniv. and Organic Psycho o— M Bo t 
In ‘'’cm of <^oar Influen c on P ych- — B Dull and T Doll 

CohHMith Polvtii iiritis — KroU reports a case of polvncurilis 
afTcctinc both legs in a woman who had taken colocvnth for 
u 


Zcitschrift fur Orthopadie und ihre Grcnrgcbietc 

Berlin vol 67 Annl 12 193s 

DvoiChondroplasn Muliiplk Enchondrom Ollier's Growth Dwtufban'c — 
E Gude 

Congenital Web Formation and us Consi.r\aiivu Trtamacm — MjrnuarJi 
•^Ttn Caves of Sponiantotis Cure of '•o-kiHwd Congenital Dislocation of ifiP”" 
Nagura Shigto and Shirahama Toshihtva 
Form and Function of Fckt of Mounla)i) Nomads of Amioln — Imvak Sivli 
Eunarcon in Orlhopakdic Surgktv — F HoUdack 

Spontaneous Can of Conginilal Dislocation of 
In a scries of 128 cises of congenital dislocation of the liif 
spontaneous cure was found to have occurred in ten (twclit 
joints) This surprisinglv high proportion (8 per cent) niikv' 
It hkch that such cases occur more frcquentlv at least in 
Japan than has luihcrlo been assumed The cases an 
described 

Zcitschrift fur Tubcrkulosc 

Lcinug vol 7S Mvi 1938 
Hjns Dvlvi- (obitiiarv) — r ItcdcCcr 

Biological Itcrcilinrv Bcvcarcli in Tiiti-rculovi, —XV SciBctl 
•ioBuence of Cviracis of Orson on Lvoliition of rspcnmcnrit Tiitrcrsin'ii'i 
A V Jeonv 

Oigan Extracts and Tiihcrciilosis — ^This is a long and "cH 
ilKisirited paper The experimental findings lead the aiitwf 
to offer the tentative conclusion that in those sufferine frP^ 
tuberculosis associated with anaemia liver extracts should 
administered with caution and never in large doses 



JUL\ 23 I93S 


FHE BRITISH MEDICAL JOURNAL 


25 


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the treatment of 


MACROCYTIC ANAEMIAS 


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A dose of two teaspoonfuls in a little water 
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26 


THE BRITISH MEDICAL JOURNAL 


JuL'i 23 1938 


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Medical Superintendent Dr McCLivriyi* 


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B edford 270s 






JuM Zl I9'<S 


THE BRITISH MEDICAL JOURNAL 


*1” 


STRETTON HOUSE, 

Church SIrotton '*‘hrop‘Hhire 

\ IKI\ ML HOML It t ^^c ircutr'cn c 

CcnilcrKn suj cr fri 'n M "lal arJ N t\ 

tl rc'A Ir III. n t c a i cil d rJcrs tl 
Mth 1 n apJ the Dn c Hah t Al! t>rc' of 

carit Mental TrJ Sen < c o arc rcvci ed 

^uh til ccrii‘'*3tci \oi.nt3'> lai rt< ii-^Jcr 
the r c" I ''s o the M ti al Ircaf^cnj Vet 
piO Br^arc h II c iintr> S c if t-f 
n ret \ r> ’ s — Vr- > t > il e Med tI Sii-cr 
mend rt Ph nc 10 P O Church Stretten 


ST ANDREW’S HOSPITAL 

FOR "MENTtL DISORDERS 

NORTHAMPTON 


FOR THE ITPER A>D MIDDLE CLASSES ONLY 
r <■ I fur M)m |Ir% Till MlRQLESS OF E.\ETER CMG \DC 


EENSTANTON, 

CHRISTCIILRCn ROAD 
Strc'vlh'vm Iltl! 


\ 1 rivaic H me lor the Care and Trcairreni 
1.1 a lim led n mher tf Ladci wiih Mem 1 jnd 
ScTMUs Di OTJers Cernfed \clontaf> arvJ 
Temrerary Paiienv rccciied Larce Mar on 
with I. acre* cl creundA iSe« 'fei/ et 
Di r { r r dl ) Arrh Rc^dent Phj^ ran 
Trl Ft re TuKc Hill "PI 


BAILBROOK HOUSE, 
BATH 

Fct suPerers IrAn Nctacj^ and 'lenai Dis 
erders ^ iih cr ixjthout ccni£*atet 

The Ku« I Eton inly situated in weeded 
rrounds of 0 aero iih maEnJ" ent \lc»s of 
ihc City ~nd the A\cn \ alley (Sec Medcai 
D e t y pasc U— ) 

Tct arrty S CijansuM M \ DM 

B Ch DPM Kcitdeni Phmnan 

TcRrhorc B-thea ton Sf<9 


HEIGHAM HALL, NORWICH 

A PRIVATE mental HOME situated m 11 
at cs of well wooded sroupdi For Lj;J.es and 
Gentlemen sufenne Iron Sencus cr Mertal 
1110*55 Voluniar) Paticrts Temrorary Patiens 
aru Pa icnis urd** Ccuifi ate are .dmu-d (et 
treaincnt Fes from 4 raneas a »eeE upward 
ac trdns to reouircnepts A few >*car:ci« « t 
for Lad es and Ocrilerren at reduced fce< cn the 
iecorm*ni.aiion of the Patients own PhrM'«‘» 
ArrU to Dr J A Smill Telephcn* ®0 Norwich 
lelesrams Srall ^0 Norwt h 


TYKEFORD ABBEY, 

NEWPORT PAGNEIE BLCKS 
FL ACTION VL AfnVOt •» IH'ORDl R«* MEDIC VL 
\AD CONV VLI CF>r CV’*fd! 


tf a S tee t tier e it Tl t is Tt n£\ rVD MRCP DPH DPM 


Th s Rcc tcred Up I u tu ted in I rt a res of part a*"!! pea ure ET'vrds Vou tary c_i 

wh arc Per ^ frim- m pent r* ntal o orcefi or wi h lo preieri reti.r”crt ru>J‘S wt r-rtaj 

triLhe temp rary pat rt and ccrti ed paticr ot both setes arc rccci ed fer trea^-e- C.. e^ 1 

Im j! b N-hctti al h« term Tal ad pathjl '* a! cram nafiors Pn ate r i-r-s w h petui r 

rrale rr fern le in the H r t I cr m tr tf the numertus i! js in the ertcru f th c he, 

an he pr \itcd 

IVAiNTAGE HOUSE 

Tbn n a Re ept n Hcvpj af tn det ehed ETtorus wnh _ er».rate erirari.c t ah h p..t«rts tjr 

be admitted fi ts eou pptd with all tbc apparafu> for the mo«t medem treaur-Ti of Me-taJ ed 

Ncr\c«.s D rders It enuirs speti-l departm nts ftr hydr therapy by anous r'eihods in Ic<_ •* 
Turl,ih and Rir- ijn baths the mfor'’cd mmer ion bath \i hy Dtuthc Scot t: Doc be Electnca' 
bath I 'f~b res treatment There is ..n Operat nz Theatre a Dc'^ta! Surgery an X ray rctm ar 

Ultra Violet App^aratus ard a Dep-anr-ent f'r D athemy and Hmh FrcQuercy ircaixrert. It I a o uirs 
Lafctrat rics f r b xhenit-1 ta aertof '•itui and patholomcal rc'car h 


MOULTON PARK 

Tuo mi es fr m the Main H-npital there are several branch estab hments ard ntlas situated ir a 
pari and farm of 6^0 a ro Mifk treat fruit and vezctablcs are suppl ed to the Hc-*p __f frurr the f rm 
garden ard or hards of M ultim Pari 0«.ctjpatinn Therapy t a feature of this branch rd paticr 
arc c icy every fa il ty f r x upyinz them elves in farm ng Eardenir* and fruit rryatrj'* 


BRVN-Y-NEUADD HALL 

Ihe C3 cc heme of St A»hJrc s Hc<**iul i bcautifo l> siicaicf i“ a pari of 3 res LDnfairfe b-r 
am c t the liPe^t x-cpcd n N^nh Wa’cs On the North We* ice cf the Estate a ra le of es c a t 
f rr-s the Ixundnry Pater s may ii it ihx Bran h for a *‘ort ses iJe change er for Icnzer pcriacs 
Th Hmptial ha *15 own private bathing hoir*e cn th- es h re There ts iroirt-bshJtz rn ue p-rt. 

At n the bran hCN f the H-rp-.! there -re cricket preardj football -rd hockey r’O-pi. fawr 
fcnm c rt (era s arc hard court ) ervouet proun- polf ecu es ana bowl-z treccs Lades ru 
gentlemen baie their ywn m: dnn ard faetl lcs are pro ided for hardieraft* such a carpcrTv etc 

F r terms ar— further part ni -rs app y to the 'ledical Su*^nr ccdcri (Telephor No 6 ar*- — “ 
Nerthumpf n> who 'an be cen in Lordon by app inti-ent. 


NORTHUMBERLAND HOUSE, 


The Home xs a M ntion of Hi ro cal Interest 
sjbdinp in 15 acres of s fden and ground 
and Is rituatcd 14 ptiJes tren Sonhamptan 
and 1- mlcs from Bedford cn the main London 
to Nonhampton Road fifty miles from London 
Both sexes arc a-i-ommodaied Psycho-ihcfa 
peutic Treatment is u ed ctlcr iiely in suitable 
eases Rad ant Heat \ ray ard L tra V lo et 
Lt ht Daihcrmy and Foam Baths. Billiarus 
Tennis cl- 

Apply Dr D E M DOLGL AS-MORRIS 
Te'-Thone Newport P-g^ell l-I 


HILL END HOSPITAL AND CLINIC 

ton Till rnrvFNTioN and thlvtmlm 

OF MLNrVL \ND NERVOL** DI'^ORDEn'* 
(20 m let f om Londo ) 

L-dies uflefne from all forms o MENTAL 
illness -re received for treatment cn modern 
lines at Voluntary Temporary cr Ccmflcd 
Pnv te Patients at ibe Hill Erd Hovp xal 
Convalescent or nild c es can be ireated in 
a delightful couniry man ion with ester ivc 
grounds knoAn as 

HIGHFIELD HALT 

situate about a m le away from the Host tal 
FEES TW O TO THREE GUINEAS PER W EEk 
For (unber partculars apply to tbc Medi'al 
Supt W / r KtMeER LRCP D P Vf 
ST AJLB\^S HERTS 


BARNWOOD HOUSE 

GLOUCESTER 

A REGISTERED HOSPITAL for the CVRC and 
TREATMENT OF LADIES and GENTLEMEN 
suffering from NERVOUS and MENTAL DIS- 
ORDERS Within two miles of the (3 W R-il 
way nnd L M AS Railway Sutions at 

Gloiiccitct the Hospital Is easily awcssible by 
rail from London and all parts of the United 
Kingdom It I beautifully situated at the foot 
of the Cotsaofd Hills ard stand in us own 
grounds of over 3rt0 acres Voluntary Patients 
of both sexes arc a so rccct ed for i eain-eni 
S'wial a“commcdation for Lady Voluni ry Patents 
IS al o provided at the MANOR HOLSL v hi h has 
Us own private ground "d Is entirely s par te 
from the 'lain Hospital For particulars a> to tenr 
etc apply to G \V T H FLE'flNG MRCS 
LRCP D P NI Medical Supu 
Telephone No 6 07 Barnwood 


ORtEN L.A>ES FI>SBLF1 PARK ^ 4 

A PKI\ ATb HOSPITVLforthclrealrrenlof mental and nenoiisillnes'es Conxenienth 
'itiiated and ea'\ of access from all parts Six acres of ground highh situated facing 
Finsbun Park Voluntan and Temporan Patients receised without certifii-ation” 
Occupaiional Thcraps P \chotheraps and other modern forms of treatment 
FW.r' rr SrsMrOKD HILL 6 s Fr'ff omj SLBSIDlARa LONDON' 

Ccnvalcv.cni Heme KEARSNEY COURT DOVER For further part* uLrs apply to tbc 'Icdi'ai Sup 


COURT HALL, KENTON, near EXETER, 

for flic treatment of eig^ht Eadies voluntan temporarv, or certified patients 
Large gardens and owi dam 

CLIFFDEN TEIGNMOUTH for earlv and convalescent case«i \ \ ell appointed 
house with «^pacJoub balconies and extensive views of the Sou h Devon coa t 
Sub tropical gardens own ddiry in 2 ^ acres Pri ale road lo beach 

" Telephones 

RcMdcntPhvsicians BERTHA \I MULES MD BS Starcro.s :)9 

KCMcJcnl 1 hvsicians ANNE S MULES MRCS LRCP Teignmouth 2S9 


THE COPPICE, NOTTINGHAM 

HOSriT-iL rOR iMEXTAL DISEASES 

This Institution is excUisivelv for the reception of a limited number of Private PdlienU 
of both <cxcs of the Upper and Middle Classes at moderate rates of pavment It is 
beautifullv situated in iN own grounds on an eminence a short distance Trom Netting 
ham and from its singularlv healthv position and comfortable arrangements affords 
everj facihtj for the relief and cure of those mentallv afflicted Occupational 
Therapv Voluntary and Temporarv Patients received 

Tel e-.!!- For term etc., ap It to the Meu^ SUr-enr er eri 


haydock lodge 

I N ER TON -LE-TVILLOM S LANCASHIRE 

I TeUe Street a hiea-n Maicffi d Phc'-e AsMc-.-i-vM-icF^ed “jll 

I Fc lb t ert ’» sri t esu-ent of PRIVATE PATIENTS cf boh cics c» the UPPER AND 
MIDDLE CLASSES uPemg fr m iren a ard cencus d eases eiih r voluntary ter-rcr**ry c 
i 1 ntle f'en-f tc Pat en s - ^ c a ifi d jn sera ate buildin-s ccord ng tc be* r~cru3l cc dricn 

I S tl icvJ in p-ri and *"0 n.,, o >.(’0 aer*^ Self simrorted by its own farm ar*- garde’s, m wfcjJi 

r-it nis -re cn cura-TO lo clup» trernscl c< Every Lsality for irdocr acd cudocr rccrcaticit. Fct 

icm crovccrtu etc apply MEDICAL SUPERINTENDENT 






THh BRITISH MEDICAL JOURNAL 


29 


Ju^ 2> ms 


ALDENHAM HOUSE, ELSTREE 

RESIDENTIAL HEALTH RESORT 

\ hrce toiinln lioii'c. Mttnlcd m 00 atrcs of parkland and ret onI\ I2k miles from Marble Arch 
Spccnih cqmpred for the residential treatment of patients during consalevcence and also those requinnc rest and 
relaxation treatments b\ diet or ph\ siotheraps Imchidin. Hadrotheraps Radiotherapy Electrotherapy ' Massace 
Mnnipiihijori'') ^ 

\ll trcatmcnl'. irc administered hN qinlificd mabscu^^ and mis cuscs under Ihe «iuper\ision of a consulting Ph\sn.nn 
who spccnliscs in phvsicil medicine 

Piticnis who wish to remain under ilu. superMston of iheir own medical adviser are welcomed 

Recreiiions include tennis croquet coif on private 9 hole course swimming riding fishing billiards etc 

rruil flower vcLLtablcs and dairv produce from sirdcn and home farm 

There is accommod'ition for 40 residents md most bedrooms have their own bathrooms 

lUustritcd brochure ivailablc to members of the \fcdicnl Profc sion on application to Sccretarv 

Terms with full residence and treatment from 12 cu ncis per week 


CRICHTON ROYAL, DUMFRIES 

ron 

NEinOLS \ND ME^TVL DISORDERS 

ttor tal has oerj I ci iv If cs’*^rctc insoiicatim ct t^c jbose orJ ti n rfos dcs -It 

'TT kf r*x.crn ir=aTr*cfiL in ux.j'*e r \cho hcrarv rhjsiothcrar' fv. onal and rccrcatioral ihcrapy 
"■ pf a1 "n ird cruc cud-vti n arc dm iteU the ^h^ therapy Der-anr*cnt ha< cr-arat unit 
u \ cq — ^ f T \ T3N erk hell ihcrari hon therapy e’cctfo-thcr*»'T and hydreth rapy 

wi-p'-* baih prol red hath So h and V i hy d uchc* P rrb irc^ treatnent el*uin and Turk^h 
hath cab -CM c ^ fhere w a full) cdui-ped C5mna<fu-i unu r qu_liCcd n triKtors Faa u« arc 
r- \i-ed t Twer "^ul re rc"i onal iberapi ts f r all trdx'r and cutd-'or tran« n Ilci-'* ?olf course 
k.r ket fx, ^all and hxke proutr* la n tcnrui and Qua h court croquet and bowline crecr 
Tbc Hx- tal ha us c n One~va Ubtary ard l!3l^dfe^ in- Saloon Term's i- tuJe rccular rao cf dr>\cs- 
Priia e roc— u tes or villa *.re availab'c and sp-cial rursci r*n be provid'd 

Phe tlO'P lat -r urd< cviendns to r arl> I C XI a res arc tuvtcd in ccl chtful country ard tnulude a 
cvien ive fana (T T herd) -ardenv and orchard* 

Av the Hc«pi*al is veil c-dswed icms arc esccptionaJl) moderate re Fir t D partr-ent ’ to 0 
C\i neav per week Se-ond Dcranmc-t and 21 e nea por week Voluntvry a-d cemfted paticpis arc 
received sted *31 Ccnificates civen anywhere n thu Bnci h 1 fev arc valid 1 r aumn ton cf pat e-t For 
prcopeciu ne e<Narv foirrs and fi nh r n^ormatn n ap'-ly to 

Phvsiuan Sdrcnnierdcrt P K ^1cCov^ vvJP MO FRCP DPM Barn cr at Law 
July lu Tcl Oanfne^ 1119 



TuU -- f II 4 fMlw Tf- t 1 1 In I 
»' i» t 1 th To k S »M 1 n 1 l'-< \ X 1 
V h IV hr* 'LL«j-r I t Trmtr-r t « 
h -rt c 1 rt 11 15 n I f r t * 1 n r 
Mr -U I M I t I n m 

ijtr t \n f " It I> Vr** t 1 11.^1 rp-i <m.T 
P-itL nr S nt ri I it '“oji I «r» Ijth t 
O -t *4 r III fp m In I r*- V\ tfr C r n 
r»rc -"tn spvialirr I f I I N t Vim I 
^ Or - i» imt d M I I n l< \ 

M \x^ I t 

Terms 13/ to 18 6 per day loclusne board 
Illustrated Brocbarc MJ oo reqoesL 
/kCijJcr/ Phmc 42 ns 

OCR HARBINSON MB B Oi O 
(RUI) R MacLELUAND MD CM 
Phone No I" <7 ems Smedlos \fatIock 


SHAFTESBURY HOUSE, 

Sp«T,ill built and l^ccrtved for ihc care and treatment ol a limned number ot Ladies and 
Gentlemen su^e^n fren Nenou aid Mental brcaldown Nolumary and ccnificd patienM received 
Ladies al o admitted as Temporary Patients without Certification Term moderate 

Apply Residevt PuysicMN who tray be seen at 31 Rodney Sireei Liverpool by arporntmem. 

Tel No a Formby 


ASHVVOOD HOUSE, 

IxlNGSMtSFORD STAFFORDSHIKE 

An old-evtabn hed PRIVATE HOME for the arc 
and treatment of Ladies and Gentlemen mentally 
affi led Prol^iionary cases and non-cenificd 
patients are received as well as thovc rccularly 
cenified 

The home is b autifully situated In us own 
grounds of 40 acres 

Full particulars as to reception terms etc may 
be obtained from, the Resident Medical Officer 


WYE HOUSE BUXTON AND CLINIC 

foi the PREVF-NTIOS and TREATNfENT of 
NERVOUS and MENTAL DISORDERS in both 
scscs Laree country bou c beautifully situated in 
us own rrounds Croquet lavens hard tennis court 
billiards wireless insrallaiton throushoul Every 
facility for spect»lied modem treatment includme 
psychotherapy occupational therapy ultra violet 
light du-lhermy Pnvatc rooms with special nurses 
if required \ oluniary Temporary and Certified 
patient tecci ed — For rerms apply to the Medical 
Superintendent Hrirs S E. vIvmvy M O' 

Nat Tel 130 





HOME FOR EPILEPTICS 

VLVGHFLL (near UVEKPOOL) 
FABVITNG and OFE^ AIR 
OCCUPATION for PATIENTS 

k f w iva an e* nit .nit .nd Oa ITou « 
FEES 1 t Oass (men enj) freri £3 pw up- 
wards -cd Class (men and women) 3-/ pw 

For lur he perticulan apph 

C GEISE^TOOD 

''«rrciarv 20 Ex I aoee Street Ea t U e pool 2 


TORQUAY 

GRESHAM COURT HOTEL 

RECENTLY OPENED Luxunous 
comfort combined with an earnest desire 
to please 

The resident proprietors will be pleaded 
to quote special terms to members of the 
Medical profession on receipt of request for 
Illustrated Brochure M Tel 3658 


HALLIFORD HOUSE, UPPER HALU- 
rORD SHEPPERTON Es/sbLshed m IE-.I 


This h nd om secluded residoKe siardms m a 
park of 36 acrci situated 16 mils from London ts 
licensed for the rcceptzcn of a limited number cf 
PalicrlS of the upper ard middle cLsses suffenac 
from nervous and rrcrtal affections 
Vountary or cenified cases re-eived rerms 
moderate Patierts are order ih- const_m personal 
are ol the Rcsidem Medial Supena citdecu 
Dr R A Stewart from whom fall partr-ulars an 
be ob ained Tcl Sunbury-on Thames "0 


cm or LOvnON mentvl hospital, 

D UlTFORD KENT 

Lad cs and Gentlemen receved for trair-ert 
under cenifiatcs. and w tbout ccrtifianon .sS 
either V OLUNTARY or TEMPORARY PATIENTS 
at a weekly fee of TWO GUINEAS and npwards 


THE GRANGE, 

ne^r ROTHERHAM. 

A HOUSE licensed for the reception ot a 
hmitcd number of Ladies suffennt from Nervous 
and Mental dividers Both cenified and volun 
tary patients received Vpproved f r tenporarv 
P-iicnts This b a I rgc country house with 
baiiliful grounds and park h c miles from 
Sheffield Tcl No 40030 Eccicsfictd Res Phys 
GtLBUtT E Mocio LRCP M R C.S Station 
Grance Lane L. A N C. RJy 


RUSSELLS 

llfMFL HE-MP^TEAD RD., W VTFORD 
Telei hone WATFORD SJl” 

A convalescent home for the arc and traiment 
of mild and rcAOvciablc nervous condmon> in both 
seves The bou-xc i iniated ht h up in «»0 ^cres 
of grpi nds 1 miles from London at the tcrmira 
' lion of the W aiford by pass One Medial Officer ts 
in residence and two oth-rs are in dailv *.tiendancc. 
i- Fees from ten guineas a week inclusive 
1 Apply RtsiDtxT MtoiCAL Orncr* 


A DV ICE ON THE CHOICE OF SUITABLE 

^ SCHOOLS AND TUTOFS 

fer BOYS and GIRLS wuh p ospectuscs ol 
recommended evtab •shme-ts will be given tree 
of char-c to pa ents staung ..-c of pupT dis- 
int p eferred r’n e of fees ard type of <cbool 
required 


J A J PATON 

143 CamvjT Street London E C 4 


Publishers cf 

Paten s Lri ot Schools ^ Tutors Pest free 5 6 








30 


THE BRITISH MEDICAL JOURNAL 


JuL\ 33, 193S 


J 


^or health.... 

Health in the spa waters, which aie 
specially suitable for treatment of Dis- 
orders of the Liver — congestion, 
cirrhosis, jaundice, cholecystitis, 
cholelithiasis, and tropical li\ er Diseases 
of the Skin — eczema, psoiiasis, the 
coccal infections of the skin, etc the 
Chronic Rheumatic Diseases — Aithritis, 
Fibrositis, Neuritis, Gout, 
Hvperpiesis, Mucous Colitis, 
Functional Disorders of the 
Heart, Peh ic Disorders of 
Women, Convalescence fiom 
acute illness 


A w ide range of Sulphui waters, strong 
and mild, and of Iron waters, both 
saline and puie chalybeate, is available 
for dealing with the laige group of 
disorders amenable to Spa treatment 
Preset ibed diets obtainable at hotels and 
boarding houses, without extra charge 
Complimentary and reduced puce 
facilities for the Cure, Accommodation 
and Amusements are available for 
Members of the Medical Profession 


. . and 
holiday 


Full descripti\ c BooUct of cure and holiday 
ficilities from Spa Rlaniger, 
Information Bureau, Hirrogate, 
1, or iny LNER Office or 
Agency 

"11 S QUICICER BY RAIL” 

Cheap monthlj return tickets to 
Harrosate from all stations Anv 
tram, any day 


TOR-NA-DEE SANATORIUM 

MURTLE DEESIDE ABERDEENSHIRE 

FOR THE DIAGNOSIS AND TREATMENT OF ALL FORMS OF TUBERCULOSIS 

Rlninginjt Director DAVID LAWSON, M D , F B S E 


Southern aspect Low rainfall Pure bracing air Sheltered grounds Beautiful surroundings All modern equipment 
for diagnosis and treatment including operating thcatie No extra charge for X Rajs, Artificial Pneumotliornx, 

Ultra-Violet Light, or other special treatment 

Da> and Night Nursing Staff All bedrooms have central heating electric light hot and cold running water, and wireless 

(headphones) Comfortable and airj public rooms 

Medical Superintendent J M JOHNSTON MB MRCS,DPH For terms and prospectus applv to the Secrclarj 

Telephone CULTS 107 


PENDYFFRYN HALL SANATORIUM 

PENMAENMAWR, NORTH WALES. 

All Modern Methods of Treatment Available 

IJ j!!\ smnt'^1 for ihc ireaimcnt nt TiibcrculoMs Sheltered from C nnd N F \Mndi» Climate mild and bncinc Lo\y ninfill high i\crasc of 
Ih” Simtortum is sitinlcd in its own park There arc miles of gnduated waiks thtoiigh pine Ronc and hcathtr rising to 1 fMH) ft and ( 

c\ten DL sea anJ m'^iintiin \icus Central heating clcctriu light \ ri> mMallaiion Wireless in all rooms I till da> and night nursing staff ^ 

supply from *\ lubcrvultn tested herd Easily ic'-csstblc from London (4t hours) MsNCiirsTiR LlNC^rooi BiRsttscusM and the North 

Resident Physicians Dennison PIckcrinK M D J W Pugh M B B Ch > 

For paniailirs apply tc the Stcrctary PLndNlTryn Hall Penmaennrawr North Wales - 


THE COTSWOLD SANATORIUM 

I irst opened in IS'lS ind rebuilt in 192*! On the Cotswold Hills seven miles from Cheltenham for the trcilnicnt of Piilniomf' 
and all olher form^ of Tuberculosis Aspect SSW sheltered from North ind Cast elevation 800 feet Pure bracine v 
t'Ptil it Trvatnient Iiv \rfilicnl Fnciimothonx (\-rav controlled) Tuhcrciilins iiul Lltra-xinlct Kavs arc available " “jj 
''"^ssvarv wiibout extra charge X-riv plant Fuliv equipped Dentil Department Electric light Radiators hot and 
t I'lns ind Wireless in ,|l rooms Up to date mam drainage 

'rfs-. 1 "cn In"' pn T „cpk Inriii I' p ,p S 

nwix 1 ! ' IIOIIMV'- P\ mu T C D„h Atu r/n, MVKGVUrT V IIVKRISON MB II S I ond / 'i n S 

I ■ St CVSSIDV 1)1 VV nun rPCSLdm Comu'imz Denla' Siirp GEORC L V' S MJS,n‘ 

' * ^ -d Sanjt lum Cnnb-m Cloiitcstcr 7(1 ''1 and ii- Witcompl Gramt Hoiists'* 







The SpT« nnd Henllh Reports of Chechoslovakia with their centuries old tradition of healing reinforced by the 
experiehcc nnd researches of local specialists invite >our serious consideration 
In addition to places of v^orld v ide repute such as 

PISTANY CARLSBAD rvSARIENBAD FRANZENSBAD 

(Plestany) (Karlovy Vary) (riananskc Laine) (Frantiskovy Lazne) 

ST JOACHIMSTHAU TEPUICE-SANOV UUHACOVICE SLIAC TRENCIANSKE-TEPUCE 
(Jachymov) (Tcpiltz Schonau) 

with their medicinal springs and mud baths there are numerous smaller spas and health e orts admirablv 
equipped for the trcTtmenl of manj diseases including those in the folloi ing groups 

Anaemia nnd Chlorosis Basedow s Disease Bronchial Catarrh Constitutional Diseases 
Scrofula Rickets Digestive Diseases Diseases of the Bladder and Urinary Organs 
Diseases of the Kidneys Diseases of the Nose and Throat Diseases of Women 


Disorders of Bones Muscles 
nnd Joints Disorders of the 
Heart Disorders of Meta 
holism and Gout Gallstones 
TTe arrangements in the bath est'^bli brnents 
are up to date in e\er> waj the cleanliness 
and nealnes proverbial the service attentive 
and courlecus 

It r< accepted that a pa cure to be fullj bene 
fjcial hould provide a complete charge of 
urroundir*^ and a break v ith the patients 
normal cverjdav life 

Further infermahon ffen cni efee cf 

THOS COOK & SON, LTD , 

end other /ceding Tourul /Jgcncies 



Leucaemia Nervous Diseases 
and Post Hemiplegic Condi 
tions Tuberculosis of the 
Lungs 

Tlie Czechoslovak Spa fulhi this purprofc 
admirablv comfortable hotels hr t 

class orchestras and dance bands everv 


faalilv for sport — tenni "olf sv amming 

rtdinc hshm" etc 

There are al o numerous fu!l> up to date ho-nes 
for convalescence and rest cures 


and at 

CZECHOSLOVAK TOURIST 
INFORMATION OFFICES 
-m London 21 Regent Street S W 1 — 


DOCTORS OWN SPA /o4 

RHEUMATISM 


VOLCANIC-SULPHURIC 

MUD SPRINGS 

in delightful surroundings 

2E ©AYS 

INCLUSIVE CURE 


h'ud frem P stanr in packs ready fer home use S mptesc safes Special facilities for doctors 

and rresr eecnom cal treatment may b« entitled to any pai ent and their vvnves 

Ccst2Cj cr 20 trea ments. L tcraiure on fecucst Second Class Fare with Sleeper 

P<.r tculars / er ^^''2 IS 0 return 

PISTANY AGENCY LTD 310 Rerent Street London VV1 TeJ LV/fS-m or PISTANY SPA BUREAU 25 Coc sour Street S W1 'e/ V/H/te.*i /I 2jW 


Second Class Fare with Sleeper 
£12 IS 0 return 


THE HOSPITAL FOR DISEASES OF THE SKIN 

(Estabh hed IS4I) 

71 BLACKFRIAKS ROAD LONDON S^l 

Telephone ATcrIoo COOl 

New patients can he seen at 2 o clock from Monda\ to Fndav both inclusive also from 5^0 to 6^0 on 
Tuestla and Fridnv evenings Necessitous c^ses admitted free others on pavment of a small contribution 
LIGHT THERAPY TREATMENT XR\Y DEPARTMENT 

Classes held twice a \car for post graduates bv arrangement with the Fellowship of Medicine 
/til enquiries ^houl(J be addressed to The Secretary 


A SPA UNDER ONE ROOF 

Ir Reckside are combined all ihc amenities 
ct a modem spa, tncludins ifeaimeni rc»t -nd 
cmcn-inmeni 

SHELTERED StTLATtON SPSCIOLS 
GROUNDS HIGHLY QUALIFIED STAFF 
The Baths and Treatment Rooms i?ccupy a 
recul wins accessible by lift from all fioers 
and arc fully equipped for every form of 
rhi krai treatment includine the men mod rn 
h>drclr*fical ind electrical methods ma'^afc 
and remedial exercises dietetic and occupa 
tjonal tficrapi Terms £4 4$ Od to £6 6s Cd 
Inclmivr terms for oonsoltauon fees ircauncni 
board residence and attendance from £6 6s 
W rue for Tariff to the Secretary 
Ceniuft nx PhnJaon 

c R L estrange 

ORME MB BCh 

<Camb ) M R C P (Lend ) ^ -w 


MATLOCK 


est&bushment 


HOSPITAL FOR CONSUMPTION 

AND DISEASES OF THE CHEST BROMPTON ^ 

and FRIMLEY SANATORIUM 

PAYING PATIENTS RECEIVED 
BOTH ArEDICAL and StIKGICAI. CASES 
5 to 8 guinea^ per r\eek at the Hospital 3 to 4 guineas per week at the Sanatorium 
APPLY TO THE SECRETARY —BROMPTON HOSPITAL S\\3 


CITY OF LONDON MATERNITY HOSPITAL 

itneo po ated b} Royal Charte ) 
cm RO\D EC.1 

The HfHntal offers kctlmcs to POSTGRADL \TES for ctr^erviaz the t ort cf its AnierL.tat 
Perinatal and Dental Clinics and to male MEDlCAl. STUDENTS faod Practiuoncrs dcsinna 
a Reffe»her Course) a two or four weeks Midwifery Course (Rcstdemial) Nearly 2 000 
r«iienl5 annually 

RALPH B Cannings Secretary 




POSTAL OR ORAL PREPARATIONS 
rOR AI L MEDICAL EXAlVnN ATIONS 

M.R.C.F. LONDON 

October examination 

SPECIAL CLASSES 


commencine 


Aug 2ndl Medicine 

Aug. 1 OthMicroscope Demonstrahons 
Aug. 11th Physiology 

Sfipt. 5th Museum Demonstrahons 

Special attention is paid to 
lecent work 


InrtUiT particulars can be obtaiucil 
from //it Prificr/ml 

MEDICAT PROSPECTUS (47 pp ) 

CO\TEST^ The method nnd ihc cost of enter 
im. the Nfcdical Professjon Par/icntars of all 
Mttlual Examinaiions Postal Courses 'tnd On! 
Classes Sucscstions for the Higher Medical 
Lxaminaiions Suggestions for the Higher Sur 
deal examinations Suggesitons for the Spccnl 
Diploma Examinations Refresher Courses Open 
incs for Womtn Hints for tsming theses 

Mcdital Prospectus gratis along with list of 
Tutors etc on application to the Principal 
17 Red Lion Sq London \V C 1 (Telephone 
Ifolhorn 6313 ) 


LONDON HOSPITAL 
MEDICAL COLLEGE 

PRIMARY IlLLOWSHIP 
EXAMINATION 

A sirClAL COLRSC INSTRUCTION for 
the ihoiL Ixtminiiion ^M^l htgin on Monda> 
Semcitlxr Pih * 

Ihc fee for the Course is p guineas 
1 iirihcr partisiilirs ma> be obtTincd from — 
DR A F CL \RK KENNEDY MD TRCP 
DfcTn Turner Street London F 1 


LONDON HOSPITAL 
MEDICAL COLLEGE 


F.R C.S 


CandicHtes entering for Pnrt I in 
Novcnibcr 1938, oi for Paris II 
^ncl III 111 Maj, 1939 under llie 
Nen Regiil ilioiis slioiild iiritc for 
lull del Ills of licit courses of 
postal prepanlion coiifoinimg to 
the lie IV rc<|tiirenicnls of llic 
s>II ibns 

Higlilv ({iialilicd Tutors itilb 
acciirUe knoitlcdge of the spCLinI 
fcitiiies ol ibese ev iniin itions 

U'nle at once for booklet The 
Pioblctn of the Final MBBS 
London Sent free on application 

Address The Secret aij, 
MEDICAL CORRESPO^'DC^CC 
COLLEGE, 

19 Wcibeciv Street London W 1 


ST MARY’S HOSPITAL MEDICAL 
SCHOOL, \V 2 

(UMtERSm OF LONDON) 

PRIMABl FRCS COURSE 

A Course ot Insiriiciion for ilic Notember 
ENAMINAflON will bep t on Monday Srptember 
I9ih 1938 Fee for ilic Course CI6 16s or £9 9s 
for cither section separately 
For further particulars apply to the School 
Secretary 


MASTERY OF MIDWIFERY 
M.C.O.G 
D CO.G 

Short Intensive Postal and Oral Revision 
Courses in preparation for these Diplonns 
Apply Secrctarv Medical Coirc«pondcn c 
College 19 WclbccK Street W I 


\ Course nt InNlruction for the FINAL 
ILILOVNSUn CWMINATIOV vmII begin on 
lhurNdi\ ScricmKr 1st 193s Fees (exclusive of 
Or rative Surgery) guinc'is Operative Surgery 
JO Liuntjs 

I unhtr parti ulars miy be obtained from — 
DR \ E CLXRkkESNED^ MD IRCP 
D an londcn Hospital Medical College Turner 
*'trect Lt loon C I 


NORTH TAST lONDOV 

II COIUEGE 

IIINCt OI \N VLLS S ^Gt SLR \L HOSPITAL 

T Denial K limited to 


STAMMERING, SPEECH DEFECTS 

BriINKD METHOD Evl ib IbSO C» esiion 
resident trevted nt Court Sq 

S U a iiid in rc'vidcnco iii fhc Summer hofi 
dny'* n Miss Bhinke s hoii’^con theChiUerns 
I rc-ominent «i«cccs in cducitim ’itul trextnKni 
of stammering in I other xpeech defect ~ Times 
Tharmighh phv lologiCTl principle — Lxncet 
The method i nentificnllv correct md perfectly 
effective — Guv s rio pitil Gt cite 

Stammering, Cleft Palate Speech, Lisping 
3 j of Mibit BriiM E 3^ Farl :> Court Sq S U 5 


W F R. CS (E din ) 

I EDINBURGH POST AL. COURSES 

I Full details ol above and Oral Clas es — 
I H C OiutiN F R C.S Surgeons Hall Edinburgh 


ro\niiN« 

B> M D MR CP FRCS in Surgery 
xnd Pathology for Con oint M fl or 
f cnov*shin Clasvo or individually Address 
No 7X10 n Sf \ House Tavistock Square, 
SN C I or Phone (mornings) KEN 24^0 


AMENDED ADVERTISEMENT 

f^ITY OF COVENTRV 

ASSISTANT SCHOOL MEDIC \L OmCER 
AND ASSISTANT MEDICAL OFTICER OF 
HEALTH (MALE) 

The Coventry City Council fnv/tc appJint/on» 
for the ibovc post from registered mile mcdnl 
pnciiiioners under 40 veirs of age Applicant 
should possess t Diploma in Public Healili anJ 
previous experience is dcsinblc The duties ire 
in connection with the medical inspection etc 
of school children and there ire also opporiiimiies 
for experience in general public hetlih work 
The commencing SThry vvill be £600 risms bj 
Tnninl increments of C25 to n mnximum of f/00 
per inniim 

The PON IS designated under the Local Covtrn 
ment and Other OfTlcers Superannuation Act 19 
as amended in regard to annuUies to nidotvs by 
the Covcniiy Corporation Act 1936 and the 
successful applicant will be required to pass a 
medical examination as to fitness and to con 
tribute to the superannuation fund and to in 
Coventry Staff Widows nnd Orphans rcninn 
Fund , 

Applications stating age quahncitiotis ana 
experience together with copies of three rcceni 
testimonials should reach the undersigned on oi 
befon. iul) 27th 1938 
The Council House TREDERICk SMITH 
Coventry Town Clerk 

July nth J93S 


C OUNTY COUNCIL Of THE COUN'D OF 
RENFREW 

The Countv Council invite applications 
appointment of COUNTS MEDICAL OFF CER 
TIic apphctni must be a Registered 
Practitioner and hold a Diploma in Public 
The person appointed as County Medical umj 
will be required to act as Chief ruberem 
Ofiiccr Chief School Mcdieal OfTiccr Mwi ii 
Officer of Health for the Small Burghs in tn 
County Chief Medical OfTiccr for i 

Service and Child Welfare and Inspector ol 
wives and to devote his whole time to the oi 
of these offices as the same may from 
time be dehned by the County Council ’ 
xahry £l 200 per annum with actual 
outlays incurred in the discharge of the uut’f' 
The appointment is a designated post unjrr 
County Council s Superannuation Scheme ano 
applicant will require to pass a medical eva 
tion before appointment , 

\pp!icalions stating qualifications anu 
which must not txeced 4X years except in tn 
of any app/icanr a/reaefy m the scnici. 

County Council accompanied by teswmona 
be forwarded to the undersigned on [ 

August IXth Canvassing direct or inoircc 
be a disqualification .cro 

County Buildings J C 

Paisley Count) Oftk 

Julv 18th 193S 


^IT-i or SALFORD 

INFCCTIOUS 0ISCASIS HOSPITAL 
(300 Beils ) 

Applicitions arc iruilcd lor »'S P'''' ‘’'npi'lCIF 
ASSISTSNT RESIDENT 'L OrHL;^ 

(male) ^Salarv £200 Per annum plus , , 

denec and The appmnlmcnt 

Form of apklahon ma> 

Mcd.ual OfTiccr Xs{ Health 143 „ 

Salford -i lo whom n must be returned cn 

Junior Assistant Resident Medical O 
later than A.muat^Mh^ 19^)8^^^^^ 











Jun 23 19*S 


THE BRITISH MEDICAL JOURNAL 


ROYAL 




Vncmcics exist for Medical Officers in the Rojal Naw, and applications are m\ited for entr) 
in September, I93S 

Candidates belon the age of 28 jears arc preferred and they must be registered under the 
Aledical Acts No axamination in professional subjects uiH be held, but candidates «ill be 
required to attend for interx leu ba a Selection Board 

Selected candidates anil be entered for Scraicc for a period of three )ears, aihich if desired is 
usualla extended to fiae )ears at the discretion of the Admiralty 

At the end of three years’ seraicc, officers may retire anth a gratuity of £400, but those uho 
serac for fiae years aaill rcceiac £1 000. 

At the end of fiae years’ Short Sera ice permanent commissions mil be giaen to selected officers 
who wash to make the Naaal Medical Service their permanent career Officers transferred to the 
permanent list anil receiac a gratuity of £1 000 (less Income Tax) 

Full opportunities exist for transfer to the permanent list and periods of unemployed or half 
pay arc aery rare The assistance of priaatc income is not neccssarv for the purpose of supplementing 
official pav and allowances 

Opportunities arc aaailable for officers on the permanent list for postgraduate study, to specialise, 
to take higher examinations and to obtain further qualifications 

Naxal Medical Officers are included in the Scheme for Alamage Allowance under the same 
conditions as for other Naxal Officers 


Copies of the regulations for entry and conditions of sen ice includmg rates of pay', allow ances 
and retired ^lay may be obtained from the Medical Director General of the Nax y, Admiralty, S W 1, 
and from the Deans of all Medical Schools 


Applications for entry from mtending candidates must be receixed not later than 
31st August, 1938 


ROIAL NAl'AL DENTAL SERITCE 

Appltcaticns afe in'Kcd for arpointneni to com 
m»« or^ 4S DENTAL OFFICERS in the RO^AL 
SA\^ 

Candidates «ho mu t be Bfiti h subjects bclo» 
the afc of S scar* mu t hold tbe destcc o 
d c om- of Bniish Lnisersiiy or Colletc cf 
SuTscofL and be rerstcred under the Dennt Acts 
Cf Medical Acts Lnmamcd candidates arc pre 
ferred No elimination ir professional subject ^tll 
be held but cand dates will be required to attend 
the Admiralf} for intcnicw and for rh'^sical 
c-saminaucn to their fitness for sersicc m any 
pin of the world 

Successful candidates will >e appcinied to hort 
Krvicc commissions as Surtcon Lmutenanls (D1 and 
•will reense a pram cf £<0 towards the cost of rro- 
sidmr the necessary uniform on emry \ acancic* 
n the rcrr*ianent let will be filled by e’eaion from 
4mont officers holdinx shoa scrsicc commissions 
who dc« re to make the Royal Natal Dental Scrtice 
their permanent career Officers not transferred to 
tbc Permanern List wi I on the termiruiion of their 
hcri senicc enirasericnt after sit years scrtice 
rcceitc a rraiunt of £l 000 

Orronuniiics arc ^tailablc for offi ers on the 
rcnnancni list lor post praduatc stud The 
as-Biance of pntate income is not rcccssary for the 
purpose of supplcmenunj. o^cial pay -nd allowances 
N^x-il Dental Officers arc included in the Scheme 
for Mamayc Allowan'^ under the same conditions 
< for other Natal Officers 
Application Forms and copio* ot the rcRuIaiion. 
for entry and conditions of sertnee rates of pay and 
^llowarccs etc may be obtained from the Medical 
Di ccio Gercral of the Navy Admiralty S J 
«n<l from the Deans of Dental Schools 


C m AND COUNTi or NEWCASTLE 

UPON T\'NE. 

NEWCASTLE GENERAL HOSPITAL fJPO Bed ) 

ASSISTANT RADIOLOGIST 

Arphcation. arc in tied from duly qualified and 
reel tered Medical Practitioners for the po<t of 
A t nt Radiolo 1 1 in charge of the Deep Therapy 
Depanrrert at the abotc-mentioncd hospital 
Nalart £500 nsing h i»o annual ir'Tcmcnts of 
0 to £600 

Apr icatiom whch hould gi e full cetail of 
ironing and experience toretber with copes of 
two text monials hould be ubmittcd to the 
*• cd cal Officer of Hcjlth Health Depanment 
Town Hall Newcastle uperv-Tyre I rci J-ter than 
Wedrc'day luly 2/th 19^6 


X/fEDlCAL STAFF PRISON SCRMCE 
iVi (ENGLAND AND WALES) 


Applications re in ited (or the post of rr Ic 
MEDICAL OFFICER CLASS II tn the bote 
SertKC Comnenctnp salary £5-5 per -rnjm 
rrsin? by annual locremcms to per annum 

with unfurni bed house (free of raiea) or an -I ow 
3n“e tn lieu The post i rcrtsorubc. 

Candidates must be fu !> qualified and rept 
tefW Preference will be gt'cn to those who hate 
held House appointments hate had evpcricn e 
in mental diseases and psycho ogica) methed and 

arc between ih- apes of and 3' tears The 

comnencnnir salart fo" tho*e hoMin the Diploma 
of P tchofocieal Medicine will be £5 ^ per annum 

Of the who c-*ime Pnson Medical Officers 16 re 
Oa s II and I- are Cla I I^cmotion from 
Cl- s II to the rank of Medical Offi“er Cla s I 
on a alary scale of £f 00 per annum nsme to 
^1 000 per -nnum with unfurnished bouse (free 
of rates) or an allowan c ip lieu arc m„de as 
tacancics occur Three of the sen or Medical 
OfTcers reccite an additional a) owance of £'0 per 
annum am! at certain Pn cm Medica Officers 
reccite fees fo fittn*' e tucncc m the Cnminal 
Court 

Forms of applimtion can be cb ained from the 
Secrciart tSialT Branch) Pnson Comm s on Home 
Offi c. London S W I 


^TAFFO 
J ni, 


.JPDSHIRE WOL\ERHAMPTON AND 
DLDLF) JOINT BOARD FOR 
TLBERCLLOSIS 


PRESTVN ODD SANATORILM ( CO Beds) 


Applications are ir itcd lor the post o* JUNIOR 
ASSISTANT MEDICAL OFFICER (male) at the 
-bote named San-ionom which is appeaximately 
nine miles from W olterharapton The uccessfnl 
candidate w !1 ha c opponunuics of obt- o ng ex 
pencncc in the work of a Daixmsary He will be 
required to ukc up dmt dimnp the third week 
in September The appo mmen will be for ix 
months in the first in tance renewab c for « further 
maximum period cf six ironth. 

Sal-ry it the rate of £ CO per annum with 
board residen e and laundry 

Form of apph'ation ma b“ obtained from the 
undersigned and should be fe uTied by firn po t 
cm July 5th 193^ loceibcr wt h copies of net 
more than three recent testimonial 
Count Buildings H L UNDERWOOD 
StafTord Oerk cf the Jcjit Beard 

July I’th I® S 


R O^ AL N 2. SOCIETY FOR THE HEALTH 
OF WOMEN AN-D CHILDREN (INC) 
(PLUNKET SOCIETY ) 

APPOINTMENT OF MEDICAL ADVISER TO 
THE DOMINION COUNCIL OF THE 
SOCIETY 

The Demin on Council of the Ro al N Z Scci*n> 
for the Health of Women and Children tin-) 
(Plunket Soa-ly) mites app! caticcs from mem- 
bers of the Bnttsh Vfedicaf Association for the 
appom mcni cf a Medical Adn cr to tbc S<xicty 
The ucccssful applicant will require to res,<Ic 
at Dunedin New Zeal nd to enter into a contract 
for a penod of fisc years and to desote hts whofc 
uric to the work 

Salarv-EI -00 per annum New Zealand currcrcy 
Funber particulars may be obtain-d from Dr 
R C Jeweselxy MD FRCP < WrrnpoTe 
Street Catendtsh Square London W or from 
the High Co i tissiovvR pox New Zealand New 
Zealand Hoasc 415 Strand London W C_ 

The successful applicant will be required to take 
up duty early in 1939 

Vnlicatiorts Rising full particulars as to ape 
exper cnce and qual fications to'mther wuh cope 
of recent tot monial will be received not late 
than September 0th 193S and should be addressed 
to the Dominion President Plunke Society 
Queens BuiIdinpN Pnnee Street Duned n New 
Zealand 


^OUNTV BOROUGH OF BURNLEY 
ML»N1CIPAL GENERAL HOSPITAL 

JLNZOR RESIDENT MEDICAL OFFICER 
(Male) 

Axppli •anon -re msited from fully qual f cxJ 
rr*dical men for the posiuon of Jun cr Resident 
Aledical Officer at the Muno'^l General Hospital 
Bumlcv to taltc up dutie on or about Au- si 1 t. 
JQ S Th ap'Nyntmcnt wil be for a period of 
twcl e months 

Salary at the rate of £1 0 per -nnum for the fir t 
SIX months £2P0 per annum for the second 
month plus fu’l residential emoluments 

ApphcalKins to" tber with copies of \cs'^r-<yn^\s 
should be £orw-arded as early as pcs^Ye to the 
Medical Officer of Health St J mss Street 
Burn’ey 

Tow-y Hall HARRY PLOWMVN 

Burnlev Town Clerk 

Ju 6th 19 c 




THE BRITISH MEDICAL JOURNAL 


JULA 21 1918 


:4 




N I \ E l{ S I T V 


o r 


BRISTOL 


DLrvfUMENT OI 1REVENT1\E MEDICINE 
AMENDED 


S URREI COUNT1 COUNCIL 
PUBLIC HEALTH DEPARTMENT 

SURREY COUNTY SANATORIUM 
Milford (300 Beds ) 


arc mvuccl for 'k SCNIOR 
nxCTERJOLOGISl S'ilarj £700 lo £800 per 
tnnum according lo ciualdic^tjons Tnd experience 
\ppo«ntmcnt lo date from October 1st 1938 
Cmdidatcs must be fully qualified and registered 
ind hasc had considerable experience in a 
rctogni/td Pathology department 

Xopliuafions should reach the undersigned from 
yvhoT) further pirticulars may be obtained on or 
beforu \ufiusi Oih 1938 

WINIf RED SHAPLAND 

Secretary and Registrar 


O ROUGH or BEXLEY 


\SSlST\NT MEDICAL OFFICER OF 
HEALTH 


Applitaiions arc invited trorn fully qualincd 
mtdical men and \somcn not exceeding 45 years 
of agt for the post of whole time Assistant Medical 
f)fTu.Lr of Health 

Npplicants must ha\e had not less than three 
ye s postgraduate experience svith special expert 
in t in the manat-cmem and dietetics of infancy 
thildri.n s divcaves and practtcal midwifery 

The posscvsion of a Diploma m Public Health 
and or postgraduate diploma in midwifery will be 
considered an adsantage 

The person appointed will be required to reside 
m the BofOiigh and to work under the direction 
tnd control of the Medical Officer of Health 
principally in connexion with the administration 
of tlK Maternity and the Welfare Services and of 
ihv Coiincil s Maicrnny Home 

The salary will be at the rate of £550 per annum 
rising by annual increments of £25 to a maximum 
of f/(K) sub tel to a deduction of 5 per cent 
under the Local Government and Other Officers 
Suptr innuation Act 1922 

fhc successful candidate will be required to pass 
a medical examination 

W om«.n appiKanis must be single and tf 
appomlcd will be required to resign on marriage 
The appointment will be sub ect to termination 
by three months notice on either side 

Torms of application may be obtained from the 
Medical Officer of Hcilih 14 Brampton Road 
Buxlcyhcath Kent to whom on completion they 
should he returned together with copies of not 
more than three rcvint icsiimcmiaK in sealed enye 
lopes endorsed Assistant Medical OfFiccr of 
Health by Ausiist Sth 1918 at the latest 
Candidates must distlosc in their applications 
whether to thvir knowledge they arc related to any 
men her of or the holder of any senior office 
under the Council Failure to do so or can 
» issing directly or indirectly wilt be deemed a 
disqu itifie It ion 

( luineil ('RTiees \V WOODWARD 

Bexlcybeaih Town Clerk 


jgOROUGH Oi S^AL^B ridge 

MEDIC \L OrrlcER or HEALTH 

Npphciiions ire invited for the position of 
Mt'dKil Oflicer of Hcilth School Nfcdical Offictr 
and Miicrniiy and Child W elf ire Medical Officer 
(lujltl for the Ooroiirh 

The silary isil! be at the rate of £800 per 
annum payable monthly 

Cmdidaics must be duly qualified Medical 
Prietuioners n i exLccding 4S ye us of age 
PLissess t recoenircd Diploma m Public Health 
and th^ requisite qii ih/ic iiions required by the 
Sjnitary Ofli ers Order and the regulations of 
the Minister of HciUh to whose, approval the 
ippoininient will be sub eel 
The appointment will be subject to the pfo- 
Msions of ihc Lovil Government and other Officers 
Super vmau tsion Ntt 1922 and may be deter 
mined by three month> notice in writing 

Pjrii ular-y of duties conditions of appoint 
ment and forms of application may be had on 
ai>pJication to the undersigned 

Nrplieations marked Medical Officer of 
Health aecompined by copies of not more than 
iliree recent lesiirre nuls must be sent to the 
undersune*d not later than July 30th 1938 

Canvassing in any form onl or wniien direct 
Of indirect will disqualify 
Diicd July llth I93s 

L O nOT rOMLEY 

Town Clerk 

Town Clerks Ofll e Sialybndec 


K 


INC S COLLECC IIOSPITA 
London S E 5 


BUKTIir^tlST (mjlc) required to commer 
on (Ki N:r Hi Solars £'TO rer annum w 
Iraviicc Candidal 

r.n^r^s' Bad !pct 

evrv.r 4.n e >n Chem stry 

< i1', L' , By Semember 

rtni L-B rarriui; 


JUNIOR ASSISTANT RESIDENT MEDICAL 
OFFICER 


Applications arc invited froni registered Medical 
I racimoncrx (either s>cx> for the. appointment of 
Junior Assistant Medical Officer at County Sana 
lonum Milford near Godalnuns Resident 
experience in general hospital essential Appoint 
ment IS for s»\ months renewable, for further 
period of SIX months Salary £280 per annum 
together with full residential cmoUmients Appoint 
ment IS subject to the SlafTing Regulations of the 
County Council 

Applicaiionx stating age qualihcaiions and 
expenen c and enclosing copies of not more than 
three recent testimonials should be sent to the 
htcdical Superintendent Surrey County Sana 
torium Milford Surrey to reach him not later 
than Wednesday July 27th 1938 
County Hall DUDLEY AUKLAND 

Kingston upon Thames Clerk of the Council 
July ISih J93S 


^ITY or PORTSMOUTH 
SAINT Mary s municipal hospital 

(I 050 Beds) 


Applications arc invited for the appointment of 
a JUNIOR ASSISIANT RESIDENI MEDICAL 
OFFICER Applicants must be single gentlemen 
duly qualified nd registered not exceeding vO 
years and must have had at least one years cxperi 
ence of hospital work Experience m anaesthetics 
Will be an addluoiaal qualification The appoint 
ment IS limited to a term of one year and the 
salary will be £250 per annum with rcsidLntial 
emoluments valued at £12^ per annum The 
appointment includes scrvi e at any mstmition be 
longing to the City Council and will be subject 
to termination ly one months notice on either 
side A resident Medical Supcrmicndcni Is m 
attendance 

Application forms may be obtained from and 
must be Tciutncd lo the Medical Officer of Health 
The Guildhall Portsmouth not later than Thurs 
day August llth 19 j8 

Canvassing either directly or indircctlv will be 
deemed a disqualificatton 
riic Guildhall F 3 SPARKS 

Porexmomh Town Clerk 

July ISth 1938 


C'^ 


U N T Y BOROUGH OF READING 


BATTLE HOSPITAL 


APPOINTMENT OF RESIDENT ASSISTANT 
MEDICAL OFFICER 


Applications arc invited from registered medical 
pracimoncrs for the appomtmcni of Resident 
Assistant Medical Officer (male) at the above 
Hospital at a salarv of £300 per annum with 
board residence etc Candidates must be single 
and should not be more than 30 years of age 
The selected candidate will be required to work 
under the direction of the Medical Superintendent 
The appointment (which will be determinable by 
one monih s notice on either side) will be for a 
period of one year and preference will be given 
to candidates who arc reading for higher quail 
fications 

Forms of application may be obtained from and 
must be returned duly completed to the under 
signed with copies of three recent testimonials 
not hier than TTiursday 4ih proximo Canvassing 
either dtrcctfy or vnditeclly will disqualify 
Town Hall C S JOHNSON 

Reading Town Ckrk 

July 22nd 1938 


^OUNTY BOROUGH OF ROCHD \LE 
PUBLtC HEVLTH DEPARTMENT 

The Health Committee invite applications from 
full) qualified registered Medical Pr ictitioners 
(unmarried) (or the appointment of JUNIOR RESf 
DENT MEDICAL OFFICER (male) ai ihc Birch 
Hilt Hospital (475 Beds — Medical Surgical Child 
ten and Maternity) 

The appointment includes certain scrviecs a the 
adjoining Public AssManec Institution and wilt 
be for a period of six months in the first instance 
and for a further period of six months at the 
option of the Town Council but will not be re 
ncwable Ihcreaficr 

Sal try ai the rate of £225 per annum together 
with board residence and laundry 

\pphcations must be trade on the prescribed 
form which may be obtained on application to the 
Medical Ofliecr of Health and returned addressed 
to him at the I ublie Health Offices Baillie Street 
Rovhdilt not I net than Tuesday Aueu^t ‘hh 
I93s 

Town Hall H\RR\ BVNN 

Rochdale Town Clerk 

July l<m t93? 






OF MANCHESTER 
COMMIITEE 


EDUC \TI0S 


ASSISTANT SCHOOL MEDICAL OFFICCR 


Applications arc mviicd from fully qualified 
medical practitioners for the pou of Assistam 
School Medical Officer 

Applicants must have been qualified for thrvc 
years and will be required to devote their whok 
time to the duties of the office Preference vu« K 
given to those who have had special experience w 
refraction work 

The salary is £600 per annum rising by anmul 
meremems of £2^ to a maximum of £750 There 
IS a yearly allowance of £10 for travcUins cv 
pcnscs 

Forms of application and conditions of appomi 
ment may be obtained from the undersigned anJ 
applications should be returned not later than 
Monday August 22nd 1938 

W O LESTER SMITH 

Director of Ediicaiioti 

Education Offices 
Deansgaic 
Manchester 3 

July Sih 1938 


f^OUNT\ BOROUGH OF ROTHERH 
MEDICAL SERVICES COMMITTEE 


ASSISTANT MEDICAL OmCER 


Applicaitons arc invited from duly qiiaiiflJ 
Medical Practitioners (male) for the post of Assist 
ant Medical Officer Candidates must be uitJr 
3a years of age unmarried and of Bnti^h 
nationality They must have held a resident 
hospital appointment (general) or have cn ageJ 
m private practice 

The mam duties are at Oakwood Hall Suu 
lonum (100 Beds) with other work as rcqinrcO 
in connexion with the Fever Hospital anJ 
Maternity and Child Welfare Climes The pau 
olTerjj excellent opportunities for experience nei 
only m all modern methods of diagnosis and ucat 
ment of tubcrculosts but in other aspects of pubK 
health work 

The salary is £300 per annum with board resi 
dcncc and laundry 

The appointment is subject to the provisions ol 
the Local Government and Other Officers Super 
annuahon Act 1922 and )S for one year 
terminable at any lime by two months noiive 
on cither side 

Forms of application and addressed emcippr 
may be obtained from the Medical Officer of 
Health Town Hall Rotherham and must be r« 
turned to the undersigned endorsed AssnMRf 
Medical Officer not later than noon on Awtuvt 
4lh 1938 

Canvassing will be deemed a'disqualincaiion 
CHAS L dcs FORGES 

Town Ctcfk 

Municipal Offices Rotherham 


IT\ OF MANCHESTCR 


CRUMPSALL HOSPITAL (I 543 Beds ) 


The Public HeiUlt Commiilcc Insilcs ipislicmw 
from registered medical practitioners for the p 
of RESIDENT SURGICAL omCER at 
above named hospiiil . 

The salary (or the appointment is rc'. 

annum rising by £25 annually to a 
£4X0 per annum with board residence and ^ 
in adduton subject to the Manchester Correr*' 
conditions of service , * n 

Applicants must hold n higher quDlincaiio^ 
surgery and must hive had previous exp 
residential hospital posts , 

1 ull information and forms of application ^ 
be rbtaincd from the Medical Ofiiccr of IR-* 
Town Hall Manchester 2 and applications 
post must be received by him not later 
August tOih 1938 ni 

Town Hall F E WARBRECK IIOUCLL 

Manchester 2 Town Clerk 

July 20th 1938 


0\ITHNrSS COUNTS COF''Ol 

PVBISH MEDICAL omCER WANTED 

Mcdicil OfTiccr v\Tntcd for the Piruh ^ ^ 
say incUidinR the Island of Stroma 30 » J- 
JutiLS on September 30lh next The *3iary 
ibk by thu County Council for Jlrtf ‘ 

VIcdwal Ofiitcr i> €96 ptr tnnum and the ^ 
ippllcant will bt required to enter mto a» . .. 
nent with the Local Medical Associxnon / - 
says Ciso or thereby per annum and 
tousc with hot and cold install ition ^ a 

ronvcnitnccs A grant from the Ih®" j 
islands (Medical Service Fund) I5 mao ‘ 
'3cparimi.ni of Health and there 
iracticc , jrsu-n’-’ 

Applications wuh six copies of 
hould be lodged with the Subscrihtf 
VuRusi I^th next ^ v..«.-r*Tcns 

Count) Ofiiei JNMCS Cn' 

Wick Couoiy V 

■ulv I8tli 1935 





Jtiu 2*? 


THE BRITISH MEDIC \T IQURN^L 


"Ol'Nn COUNCIL OI DIRHAM 
CDUCMION DIPARTMCNT 
A^SrSTANTSCilOOL \IEDIC\L OFflCrR 


^OUST% OF HUNTINGDON 


^SSIST\NT COlN-n MCDirXL OFRCER OF 
HCy\LlH \ND MEDICAL OFFICER 
or HFALTH 


^OUNTT COROLGH OF EST ERL'. fCH 


assistant medical officer of HE.ALTH 
^ND ASSISTANT SCHOOL MEDICAL 
OFFICER 


The C unt\ Ed jC3t n C'mnitiec in Iif ipr! 3 
irt n for the povt ol A ^^lan^ Si.h h 1 'loJctl 
t>^iccr i*t>Ttnn) tt act i ndcr the N.h m I Medtcnl 
O'*") cr in ct nnetton »nh the «n pevti o c( vhool 
children and \«ch mher duliet tray he required 
hv the Edicatian Ccmmttee 
C 'mmetH.in? valary f<00 per annun (proMded 
the candn^aie ha« had rot lev than three >eara 
p^xteraduate capctience) risirc h> anmial in*fc 
r^nt^ of to r’PO per annum trccthcr h 
traxcH ne ctpen'ct aceordinf to the Countx Scale 
The »ih3revx*ul can-iidatc *.111 be rc<3t ired to dexote 
her uhclc time to the coticx of the rCcc and 
rcs.de in cr near the d tnvt to »hi h he »ill he 
attached at a place to he approx-ed hv the Fduca 
ti n Ci--nriittee The appointment mill he subiect 
to three calendar nomhx notjce on c thcr »ide 
expiring on the b t day of anx calendar rronth 
ApplKTanti mirxt haxc had expenen e in the xxrrV 
ol v.h ml medical impeetun and preferen e »i1l 
he c'xen to canJ dates xxho 

ta) Haxc had ctpencnce in the »crk of S-hool 
Ones 

th) Haxc been ac».u tomed to make rectal re- 
pcTts on Mentally Def'Cti c Ph> tcall> 
Defcetixc, Ep lentic and other Dcfeettxe 
Children 

The piwcxxipn of a Diploma In Puhhe Health 
n dev raMc ihoush not evxentul 
Canxaxvns dnectly cr indirectly tx prohihucd 
and will dixqualif) 

\ dcducti'm of 5 per cent »ill be made from 
the sabr^ in aceerdarxee »ith the Loal Coxern- 
ment and Other OTLcrx Superannuation Act 19 « 
and the appointment will he juhtcet to the can 
d<.ate paxxjfic the medical cjamination in 
xcnrexitn therewith 

Fonrw of appl cati n to he rerurned not later 
than Sattrrdax Auritxt I3th 19 ts nuy be ohl ined 
(f n the Difcaor of Cdocation Shire Hall 
Durham on receipt of a stamped aedressed 
foo *30 enxelope 

Sh re Han THOS B TILLED 

Durbain D rector cl Fduijtfon 

Jul) lllh 193S 


QOLKTl COUNCIL OF DURHAM 
E DLCATI ON" DE P ^ RTMENT 
SCHOOL DENTIST 

The Coxintjr Education Comnittce inxite arrli- 
car rns from fu ’> qualificu ard tTfertcnccd 
Dtntixts for appoirtment ? a School Dentnt to 
ct u^dcr the School Medina OTi cr in connect n 
with the treatment of denta dcf'Cis of ehldren 
•itcp- P 2 v.hools in the County area, ard to 
undertake such other dutirt as may from time to 
lime be required by the Education Comm ttee 

Comrrencinc xabry £500 per annum rrsinc by 
annual incrcrrcnts of C2S to a m xlmom of £6nn 
per annum to-cifccr with iraxclltr** expenses in 
accordance with the County Scale The successful 
candidate will be requir’d to dexote hr« (her) 
whol rim to the duties of the office and to 
reside m or near ih distn ts in which he (she) 
nvjy be attached at a p ,»cc to be appfoxed by 
the Education (Tommitice The appo ntment x«11 
be subject to three calendar months notice on 
erhef side su h notice to date from the fa i 
day of anx calendar month 

CanxassinR dlrectl) or indirectly ts prchibued 
and will disqualif 

A deduction of < per emt will be made from 
the sabry m accordance with the Local Coxem- 
TOcni and Other OPlccrs Sjperannualion Act 
192^ and the apptinment vwin be sub ect to the 
candidate pas ms the medical ctammation in coo 
n«*on therewith 

Forms of application to be returned not later 
than Saturday August 13th 19 K may be obtained 
from the Director of Education ^irc Hall 
Durham on receipt of a stamped addres ed fools- 
cap cnrelcpc 

THOS B TILLE'V 

Director of Education 

Shire Hall Durham 

July lllh 19 S 


T he general infirmary at Leeds 

(673 Beds.) 

Applications arc inxited for the po^t of a full 
time DIRECTOR of the nexx \ ray Diapnosttc 
Dtpartmem 

The commencing salary will be at the rate of 
£l (jtxt per annum 

Candidates must be duly Rcc stered Medical 
■pT,jctTiioners wnh special experience in Radto 
lonal work and must hold the D M R E. qua} 
hcnion 

Appl caltons accompanied bx copies of recent 
testimonials lating age qualifications etc should 
he fern, to the undersigned not later than Au ust 
»Ah 1938 

S CLAYTON FRIERS 

Ffoii e Goxernor and Secretary 


\ppiculon arc in ited for the j m whoc 
lime apmunincnt of an A tant Co* rix Merii'al 
Offi er of JTcxIlh for the Adn n t ixc Count 
il Huntmedtn and Mci-«,al OTtcr of Hc-lth fo 
the Boron h or C odman heeler ih- Lrhxn D tr tx 
of O d I letton aru Rair e rd the Ru al D t'i't 
« f Nirman Crox in the ad Coxntx at a abrx of 
ptr annum with a iraxe hn** al ar e cf -lOO 
per annuT’ The c t m,.ted total popj-il on if 
the Sanitary Di tn lx named fOO 

App I -ants who houtd not he o er - years cf 
ae- mu t he dul qualfied ned ml rratiii •’er 
with whoc time erpenep c in PuhlK. Health duties 
ard mu t hold the D '' orra in Puhl-c Health or 
Its eqmxalent The of^ cr -cpoi r d will he 
required to ro de at xu h p act- m the nonhem 
p.irt of the C unty at hill he ,.rrroxed As 
remrds the dm ex of an A unt Counrx A ed al 
OTicer of Health the of^ccr xm! a'l u-^er the 
ct ntr 1 of the County Afcdial O'*" er o Halth 
and will he required to perferm xuch du irx as 
may he from i me to ipne pfcv.rihcd As rcc rd 
hit dutiex ax District Afedi-aj GIF er o Halih 
the oTi CT will he the oTccr of the Lou,. Sam 
tary Amborit ex 

The joint apps intrrcnl rx subject fa the appr xal 
of the Mm ter of Heal h ard the Board of Ed i 
at on and also so far as the r'fce o D net 
Medal OfTcer of Halth « corcerneu t the pro- 
xtsiots of the Sanitary OTi crx (Outs de London) 
Rcculaiivi 19J< The l mt appo nine**: w 1 he 
one under the Local Coxemment Superan-i ation 
Act 193“ and the selected cand date wil be 
required to pass a medial exam nation 

The joint appointment wiji be dctcfmir b c bx 
three months written notice on either .de uhteer 
so far as the ofT e of the D triet Afed cal 
of Hahh I concerned to the co** cr of the 
Mm ter of Halth 

Forms of ap-liaiion to^'cther wi h a t cf 
duties may h< obtained from the ipder icned ard 
accompamed hy copies of not m re than three 
recent testtmoo.als should be returned to hirr ri 
later than Augu t ^th I9A< 

1 B KELL) 

Clerk of the Coun > Ccur-.jl 
County Off es Huntn-don 
July I9th I93R 


J^ERBYSHfRC COLNTY COUNCIL 

APPOINTMENT OF COLNTV BaCTERIO* 
LOCfST AND PATHOLOGIST 

Applications are mxtied from rer*<teTci. met. csl 
craetmonery for the app-om ment of Ccun \ 
Bactenologt t and Paiholo'*’si. j a com— cncm- 
s,.Urx of C**) per annum nxing fc h cnr-il I’xcre 
ments of C 0 to £**1 lOx per arrum 

AppUants mus haxe had pecul ctpcricn c m 
the baacno’ojty ol water and mV rd cxperien u 
in a Paiholotrial Laboratory 
The officer apromteU will be reqo ed to uexrte 
ih whole of hi tune to the duties of the off e 
and wil be tn char e ol the wrrV of ih- Bactenew 
lo teal Laboratory under the adnm x iixc comro 
of the County Mcdi.....l Officer 

The a p po i ntment xxill be sub ect to the pro- 
xurops of the Loal Goxcrrmcnt ard Other Offee s 
Superannuation Act 19 , and the succcs fal C4.rd 
date will be required to pass a r-cdj-al cx-mm ttm 
Appliations aeeompan ed b> copies of no more 
than three recent lestimon als must Te,.ch the urd r 
signed not bier than Afondax Ao^os ^th 19^^ 

AA M ASH 

County Offices County Aledal O^ccr 

Sl Mary s G ic Derhy 
July ..0th I93S 


QIT'V OF LEICESTER 

RESIDENT MEDICAL OFFICER 

The Halth Committee of the City of Leicester 
invite apphations for the poxuion of Resdert 
Afedial (jfficer (male' at their CITA GENERAL 
hospital fi r a pened of six month rerewab e 
if satisfactory for a further s x months The 
successful andiJatc will be required to ccmraeiKC 
as oon IS possible Preference will be gt cn to 
those xxifh or rading for hi her qual ficaiions 
The Hospital I a modern bu Mme wi h 0 beds 
four Resident Medial Officers ,.nd one Deputy 
Medial Superintendenf The work that w J be 
required of thi Resident 'Icdical Officer wil be 
chiefly medial there may hOAcxer be some 
general Surs al -work- S- ary £200 per -nnum 
to-cihcr with full residential emo um nii 

Further pani-ulars of the appomt~en: may be 
obtained from the uivdersumed „nd app rations (on 
forms supplied) accompar ed by cep cs cf three 
recent testimonial mast be recei ed not later than 
August 4th endorsed R M O " addressed to the 
under igned 

E K MACDONALD 

Medical Officer of Halth 

Halth Dcrartmen 
Grey Fruirs Lmcestef 
July — nd I9»S. 


Appt Ttiic-x a C ir itcd frrm cu q a f'l, _ ^ 
fern c ed rr di gertJem n ff bexe s—-r— 
ment Ap*' ar., mas „ Dp n 

Pub c Hcilth nd fcj c had th ee ya’x txper'c xc 
mcc qal ai.cn wij* S"’eci,.i cs^e’i^C' c m 
Di>a cs cf lrL.rts ard CT dren a-d Ir -c* cl-s 
D i a cs Knowledc c TL*>tra.Icsa A!e*-_' De 
f len-y o' O-h ha!m.<. work w be deemed 
additional qu-liGaiur' A - ret to exec d ^ 
yars 

The offi cr will be uhe-t to rd tb* 

direct! n cf the AtedcaJ Off..eT cl Ha tb 

The person appointed will he rcqui eo i d e 

the whole of his lure to ttm dimes a. '•'-ct. to 

h m by the C uroi to l c m ib Be i. 

n t to cr age n pnv tc p i e 

Co-nmer-nra salarx n per an ; hi 
amal meremen s of t_5 to CO pc' r 

The cnga-c^e** wi 1 be ter— ...t c px l 

weeks noti c on cithc- d 

The apprirrrrepi iv desizn.^tcd uns.er ih L 
Go emmet! and Other Ofi-er Su'^cr 
Act 19 _ nd th ■'v.ces ul a dd tc wi i>» 

requ red to pa s » cned.al ex t rjttcr 

Ap-Ii'atioa stall g a-e q-ai ers p- *-d 
presert .-rpointmer s aro expeie- e t ectbe wi h 
cop cs of three rcce-t tcM •’'cni..ls hot. c be 
forwarded to the urdcnigncd ro Me tb r i*-' 

first po*.! on VA edre*d,.y A ~js lith 19 a..d 
should be creorved “A vi ri A *x. cal er c 
Halth " 

There are ro pcu-! appl *21 on f rm 
Town Hall G F DaRLOAA 

AA cst Brpojw eh To«r CJcr 

JuJt 19th 19tP 


^ITV OF CARDIFF 

ISOLATION HOSPITAL 

APPOINTMENT OF ASSISTA T PESIDE>T 
AfEDICIAL OFFICER (Afa e) 

Applications arc jnxited frem djl> q a hed 
medial rraem cr-rs fo the appom meet 0 ASSIS- 
TANT RESIDENT AfCDICAL OFFICER „ i t 
City I otau n Hcsptt ! Ca d !* 

The appointment *P1 be ftr o-e year cni 
and the salary will be per an L-n wf:*. fu ' 
board read •• t and laundry 
The candidate ap’vjmt d nay be res, ed when 
PccessoD to ordc'*ake g r ral duue^ m t**e P*-^ ... 
Halth Depanment 

Forms of apn lation n y be chcair»d on i*’e 
Media) Offcer of Hahh Cry HaU Card* bp 
whom apnltaticns acccmp-nied b “O'* es cf t'’Tte 
recent testifbon.ah ..rd e^dened Pc' d r 
Medical O^cer mu<t be rex.cixcd ect la cr t ar 
August fih 19 A 

Cty Hall D kENAYN PEES 

Cardiff TcxnCerk 

July 19th 10 « 


O N DON 


COLNTA COUNCIL 


Med al Pr ettuone requ red w th anre— e 
Qualifairors fo apnoin mert ,.s ASSISTANT 
PATHOLOGIST at Certrai Hi>toIC”’'al Labe 
lory Archway Hoptul Archway Re.id N 19 
Salary £6 0 by to £'C0 ETpcnentc in me t d 
hi tology -nd po>t-raortcm work essential 

Forms of appl-ation and further pani«.i..^r 
(stamped addres ed fool-<ap crxelope reccss..rv) 
from Medical O'ficer of Halth tS— ff Dixisicn la) 
County Hall AVestm rtsicr End e, S E-1 rctuTi-t e 
hy August jlst 

Canxas ing dtsqual Pcs 


CHESTERFIELD AND NORTH DERBASHIRE 
V-/ RO) L Hospital 


RO) 

) b rt al rd Med al Beds) 


Ear 


HO SE SL’^GEtJN to t phthalrr 
Nc^c and Th Jut Departm ms 

Appliaiions -re in ited from fully quaufeu men 
lor the -hose o'^st. 

The 3p*'o r.rn'ni is fir x nonth. 

Safari a the rare I _l30 r<r annt-m 
A-p ca I n t t ee to cificr w th cor « c 
three recent tcstimor.ab heud be ect to the 
u-.de, -rcuu, ao-,u 

Supe'i cr cm ard Secrc'arr 

July 1 ifi 1 v 


M 


ANCHESTER eap 

Gro^ cnof Square AH Sa 


hospital 


The Board m ite arc cat ons f«.r the c' ms 

OXIS 

RESIDENT HOUSE SURGEON S-Lry .t '■* 
lie of 1-0 per annum 

SON RESIDENT HOLSE SURGEON SiLry 
i the rate ot £1 0 rez anrim* and pania! b-*,d 
Appomtmerts stx mcnlhs Th nyr-cne bxid 
Ciandid-ics must be duly qu— fied -nd regi t-red 
AppLaborts with four coc^cv of icx^ 

loniaK to be forwarded to Mr Rernak- S 
filford (Hon. Sccraarx M-nchemcr E^ 
o Mr A\ I EJi.ir= “ Brazerove Street M-- 
heater 2 





36 


THE BRITISH MEDICAL JOURNAL 


Jut'i 23 193S 


C ARDirr ROYAL INPIRMAR^ 

(Asso''iatcd the Welsh National 

School of Medicine ) 


Applicaiions are incited for the post of 

rcsjdlnt medical officer 

Duties uiH include ease record keepinc and 
tcachinc and Nlcdital \sork under the direction of 
the Honorary Staff 

Candidates must be Doctor? of Medicine of a 
L’nivcrsitj of the United kingdom or Fellovvs of 
one of the Royal Colleges of Physicians in the 
United kingdom and must ha\e prcMOusly held 
a Resident Hospital post 

Thu silary vs ill be at the raiu of £200 per annum 
with board residence and laundry Tlic ippomi 
naent is for one year and the holder will be eligible 
to apply for reappointment and may retain office 
for three tonsctutisc years 

f iirthcr particulars may be obtained from the 
^tedleal Superintendent to whom appheationj 
(endorsed R M O ) with not more than three 
testimonials (copies) must be sent by noon on 
Wednesday August Hst 1938 
By Order of the Council 

R ARMSTRONG 

Medical Supcnntcndeni 


M ANCHESTtR RO\AL 


I^nRM^RY 


The Board of Manigcmcnt of the Manchester 
Royal Infirmary iniitc applications for the post 
of RESIDENT MFDICAL Of FICER of the 

rRi\AiF patients home 

Appheants must be registered and hold a 
Medical and Surgical quahhettion ind must have 
had at least one years resident cxpericnte in a 
genera) fiospital 

The appointment is for twelve months renew 
able for a further period 

Salary £2^0 per annum with board residence 
and tuindry allowance 

Full information is obtainable from the under 
signed to whom applicants must send twelve 
copies of ihcir application and testimonials on 
o leforc 9am on Thursday July 28ih 1938 
By Order 

F J CABLE 

General Supenmendent and Secretary 


L 


OUGH BOROUGH AND 
GENERAL HOSPITAL 


DISTRICT 


Apphcanons arc Invited from duly registered 
c'lndldatcs (male and unmarried) for 

a HOUSE SURGEON salary £150 per annum 
(tom August 1st 

ft HOUSE PHYSICIAN salary £125 per annum 
from July 1st 

The appointments ore for six months and Include 
apiTtmenis board and laundry The House 
Surgeon must b an experienced anaesthetist 

Ml appiiea tons stating age etc with copies 
of icsiimonnls to be sent to me at once 
IR\NK H TOONE 

9 Leicester Road Secretary 

Loughborough 


K 


rniRING AND 
HOSPll \L 


DISTRICT GCNCRVL 
(lOi Beds) 


\L 


CORNW ALL 
Truro 


INFIRM \R'i 


APPOINTMENT OF HONORARY PH^SICIAN 


Applicatfons are Invited for the post of Hon 
Physician Candidates should be Gr''diiatcs in 
M^icinc of 1 University of Great Britain or 
Ireland and must be Fellows or Members of the 
Royal CoflcRc of Phvsicians of London 
The selected candidate will be responsible for 
the care of Medical In and Out Patients and will 
be required to contract to engage in private 
practice as ^ Consulting Physician only 
Applications togeihe with copies of recent icsti 
moniafs should be received by the undersigned not 
later thin July 26ih 

U E GRENFELL 

July 9th I93S Hon Secretary 


R 


OVAL E ^ E 
Pcvtnsty Road 


HOSPITAL 

Eastbourne 


NON RESIDENT HOUSE SURGEON required 
to commence duty in August Tlvc appointment 
will be for mx months in the first instance 
Salary £100 per annum and allowanct in lieu of 
board residence £175 per annum 
Applications stating age qualifications and 
ophthalmic experience together with recent tcsti 
moniafs shoutd reach the undersigned as soon as 
possible 

Before »’ncagcmcnt candid ites have to be Inter 
viewed by the Hon Surgeon from whom further 
pariicuhrs could be obtained in person 

H B^ GRAVE Hon Secrciary 


R otal h\mpshire countt hospital 

W'inchciicr (187 Beds 5 Resident OITiccrs ) 
Hospital recognized by the Royal College of 
Surgeons England 


HOUSE SURGEON 


\pplK.aiions arc invited from fully qualified men 
for the above post to take up duties as soon as 
possible Sf\ months apponiment Salary £100 
per annum with board icsidcnce and laundry 
Candidates who must be of British nationality 
to make application to the undersigned enclosing 
copies of three testimom iK 

HERBERT MASLEN 

July 15th 1938 Secretary 


EST KENT GENERAL HOSPITAL 
(incorporated) Maidstone 
<13$ Beds) 


Vpplications arc Invited for the post of HOUSE 
SURGEON who must be a male of British 
nationality 

Salary at the rate of £17> per annum with 
board apartments and laundry 
Candidates must poiSCiS registered qualifications 
applications stating qualifications and expen 
cncc together wiih copies of icstimoniaL should 
be sent to the undersigned immediately 
EDWARD J GREGG 

House Governor and Secretary 


\pp!ivaiions arc invited for the po i of HOUSE 

nnsici sN 

Silary tl^O per annum with board residence 
and hiindry Candidates mnvi be fully qualified 
ind ftkivRrcd ind Ic free to commence duties on 
September Nt I9ts 

Npphcauons Matinc age nationality and quali 
fi-~iiion\ together with copies of three testimonials 
to be sent to the undersigned before August 2nd 
IMtg 

G \\ JACKSON 
Sccfetarv Superintendent 


N 


ORTH LONSDALE HOSPITAL 
Barrow in Furncss (164 Beds > 


Vicancv July Isf 1938 RESIDENT CASUALT\ 
OFFICER (male) 

Apphciiions are invited for the above position 
from folly qinlificd Praciiijontrs experienced m 
the admmi tration of Anvcsthctics Salary £150 per 
nnnum with board residence and laundry ' 
Applications staling age qualtfieaiions expen 
cncc and oaiionahiy and accompanied by copies 
only of three recent testimonials should be sent 
to the Secretary immediately 


jgUTE HOSPITAL LUTON 

HOUSF SL ROFON (maic) wanted to commence 
duticN as soon as possiMe Salary £1^0 per 
annum with board rcMdenee and Uundrv 

\pp1i'“iiion< siaung age nationality and cxperl 
cn c together with copies of not more than three 
recent testimonials should be sent immcdiitcly to 
the bccrctarv of ihe Medical Advisory Committee 
at (he Hospital 

R E LISGARD 

Secretary Bute Hospital 


XUEFORDSHIRE GENERAL HOSPITAL 
Hereford (1*^2 Beds) 


Applieation arc invited for the post of 
RESIDENT SLROICXL OFFICER (male) 

Salary it the rate of tl''0 per annum with board 
residence and lavmdrv 

Applications stating age and qualifications 
logeth r with copie of three recent testimonials 
should be tni to the undersigned 

T %\ UPTON 

Secretary 


M idland hospital 

Easy Row Birmingham (50 Beds ) 


N 


ORTH ORMESBT HOSPITAL 
MidJftsbrouHli (192 Beds ) 


Npphtanons arc inviicd for the post of HOUSE 
SURGEON Duties to commence August 1st 
Sihry t 00 per annum with beard rcsidcn e and 
laun Iry 

NppliLationv staling when at I berty age quail 
feiiK av f>c (her with eopte\ of recent tcsiimonials 
ii> tv odjfcsvcd fa the unJers gned 
OLI\ E 1 URNL \U\ Secretary 


HOUSE PH>SICI\N (male and unmarried) 
required Salary £1-0 peC annum wuh board 
rcsidenec and laundry 

Applications stating nge qualifications expen 
cnec (if tnv) with copies of three recent (csti 
nomak should t- sent to the undersigned 
CEORCC WATTS 

Secretary Superintendent 


WClILSrCR R O^ VL E\E HOSPITAL 


Il'sKyp 
V t V tvt j 
Apr t 
^•T J nj 
I*- \ I rr- 


HOLsr SUItrrON requ red S 
>n ni 'tn h n c Kvard etc 

« Iv et P cl teevimor 

.O be -.UJrc^ 


MR NUPTH 
s n S o< and Np-tciafy 


I^OTHERHAM HOSPITAL. 

Wanted CASUALTY HOUSE SURGEON 
(male) Qualifi-^ Salary £150 per annum with 
hoard rc» d-n c and laundry To hive charge of 
Out pat cuts <130 beds ) 

Appficarionx wuh copres of recent tesilmon als 
to he vent to the Secretary O A) Jlotsntrs 
8 Mootcatc Street Rotherham 


J^O>AL MATERNI TY H OSPITAL BELFAST 

The Committee of Management mvitc*? apph a 
tions for the following povls which will becom 
vacant on September 1st 1938 

RESIDENT MEDICAL OFFICER 
This appointment will be for six months from 
September 1st at a salary at the rate of per 
annum Candidates must be members of a rccot? 
nizcd organization for medical protection or 
defence 

RESIDENT MEDICAL OFFICER IN 
CHARGE REA BLOCK (Nohiionl 
This appointment will be for six months from 
September Isi at a salary at the rate of £100 pvr 
annum It offers special facilities for those cck 
ing to qualify for the MCOG Prcviouv hcivptta! 
experience is essential Candidates must be mim 
bers of a recognized organization for medical hr»>- 
lection or defence 

Applications for both posts with copies of not 
more than three tcsiimonnls must reach the 
Superintendent from whom further parlttulars may 
be obtained not later than August 6th 193x 
Canvassing forbidden (by order) 

J \ FORREST 

Hon SecrctHi 


TOCKPORT IN FIR MAR) 
(140 Bcus > 


VApplications arc invited for the post of HOUSF 
PH\SICIAN 

Applicants must be male and immarriLd Sabrv 
£1^0 per annum with board residence and hiinJa 

The Resident Staff consist of a Resident Siintiul 
Officer two House Surgeons and a Hou 
Phvsjcnn 

Applications with copies of three recent (cUi 
moniafs stiimg age nationality and qualifi anon 
to be sent to the undersigned not lifer than ih 
morning of July 27th Duties to commen v 
August 22nd 

H G PRICE 

Secretary btipcrnncntlcni 


T he SOUTHAMPTON CHILDRENS 
HOSPITAL AND DISPENSAR) I OR 
U OMEN 


The Board of Management invite npnllcanonv fer 
the post of RESIDENT MEDICAL OmCER 
(Lady) Six months appointment Salary at the 
rate of £1^0 per annum with board residence aM 
laundry 

Applications stating age and ncconipanied hv 
copies of testimonials to be sent to the iind r 
signed not later than August 5th The scfcifoJ 
enndidate will be required to take up her duties oa 
September Ui 

ELLA K MATTHEWS 

Secretary 


V^ARNEEORD GENERAL HOSPITAL 
yy Leamington Spa <164 Beds) 


RESIDENT CASU\LT\ OFFICER anJ 
HOUSE SURGEON to one of the Hon Surgeoa 
required by September 5th 1938 Six months 
appointment Salary £180 per annum with boaw 
and laundry 

Applications front quahfied registered mca< J' 
practitioners should be sent together with ihtw 
recent testimonials to the undersigned by Jub **6'” 
193S 

EDWARD L WIRGMAN 
) House Governor and Secretary 

R oyal intirmar^ rradtoro 
(R egional Radium Centre ) 


HOUSE PIILSICIAN lo the Radtum and SL" 
Departmcnis (Mile) wanted Six or twelve monin 
appoinimcni Salary £175 per annum with bcoiu 
rcvidcncc and washing , 

Applications stating asc qiiahficatlonv aa 
previous experience (not necessarily m ’“‘‘J., 
therapy) wiifi copies of recent testimonials 
be sent to the unJcrMgncd as soon as po'* ibic 
H TRUSSON 

July 9th 1938 House Governor and Sccrcr^ 

N ew SUSSCK HOSPITAL FOR WOMLN 3'*^' 
CHILDREN 

Brixfiton (fneorporaicd ) 


Applications are Invited from ‘^‘ftt^hlv 
Medical U omen for the post of HONOR v 
OPHIH \LMIC SURGEON Dufies to com-uf 
in September next k 

Apphciiions witli copies of • 

sent to the undersigned on or before 

Board Room PERC\ F SPOOLER 


Wfndlcvham Road 

Brighton 


Sctrciaf) 


HOSPfTAI FOR SICK 
Newcastle upon Tyne 


ciiannr'' 


Apphea lon^ art incited .Pr i (lS^ 

HOUSt PinSICIAN and HOUSE SURE 
(male or female) for six monihs as from Aur ^ 
I9t8 Salary at the rate of £)P9 per ^ 
together with board residence and (*• 

\ppIications stating age anJ . (t 

.. . .. fO be > ‘ , 


gether wuh copies of (esiimomalv to 

the Sccrciary Mr Nr a Ilxontr iv 
Ncwasilw upt»n lyne 1 


k t’ 











JUM 23 


THE BRITISH MEDICAI JOURNAL 


3" 


R 


01 M. \ ICTORI \ IsriRMAR'i 

'a'tlc-tiiM n*T>i;;c I BcJ ) 

wnourmtc JIMOR S^.RCTC^L 
RFCmR \R 


ArrJicaJi f arc irMtcJ th r""* if nhvl 
itmc Jjiniir Sure j 1 Revi inr 

Thc'c arPi ninen ne intrni.'il f r Crndtale% 
»*ho dc* Tc 10 cam urc lal e^renen c arJ w.h 
Ki^c ilrcaU> held a pi'^l a H ''urv n Th 
ri^t cfcri or'Vftu-iv f r ri^t sraduatc ii d> 

The arrvintmc'it tihi h Mtl cc^’nen c on 
\imr't ''th 19U wiJi in ro ca extend Nx nd 
ihtcc \cacx and he foe ire ^caf tn ihc frsi 
imtarvc renewable f r tui funh-T r<f»od< 

Fhe rale f rcriuncraiK n i fl 0 r*or anaun 
Vrplt'aiK- Mith cor ex ‘f not mofe than three 
rcicnt tr'imon all mti t he recci ed on or Kf re 
f nda> lull v bi the unJcr»tn'd from 

whnn funher iv.nj ularx r*a) he ohi ncU 
S DUN STAS 

H'nivc Gc'cmoT and Secrciarv 

JlIv l<th 19U 


gALTORD 


RO^ VL 
( *6 Bed ) 


HOSPITAL 


Aprlicati m arc imited frim diil> Qiial ( ed 
rractitl ncr« for the post of RADIOLOGIST (n n 
rcx>dcm) fir aiicndancc each m rnin* (Sundaxn 
cxccTted) ard at u h timei ax ru> be required 
ViUrx £ 00 ret anruri TmcI'c morthx 
mem tcrcxxaMc The xu ex ful canvdaie till! b' 
required to uorK under the upeni lon of the 
Hon rar> R di loeiit 

Applfcatii-n lat nc c and qua it cati r< 
loecihcr ti th pc^ of Ic timcnal arwJ ccrti''cate 
cl resnraii n xhou*d be add ex cd at on c to the 
uttderxfm'd (rem vih*^ aU parti "ularx may be 
btaincd 

Rv O'der c* ih Bo td 

H B SKELSN\ELL 
General Superintendent and Secraar^ 
luh -rd 19K 


’'HE RO'V \L INFIRMARY 
f W Bee. ) 


SMErnELD 


’ti r arc intitcd f r th po't of 
CLINICAL ASSISTANT to the O-'hthalni 
Depannen fmalc or fenale) The Ophihami 
Department contains fcv Bed apd an Out 
Patient Department v*hich p open dad 
Salari per annum 

The appointmcpt ^ill be for tne >car xubject 
to t»o months nciiT and the ofTi ef elected «tll 
he eltsibJe for rcar'^ointncnt Letterx statine as 
and jn tn^ fuU quaUf caticnx ptcmovp ho'nuat 
crrefter'-c etc to N* foraarded to the General 
SupertDietxIent a-'d Secrciar^ immedatelj 
junc I th 19 


OA AL SUSSEX COUSTi HOSPITAL 
Bnphtoa Bed ) 


R 


HOUSE SURGEON (pule) required end of 
Aujru t !9fS Charec o beds ^1ar> £1 0 pur 
annum Y*nh board tcx den c and laundry 

Candidates tpuxt hold med cal ard sur-ical 
qualineations of the British Emr re and be duly 
resixtcred und-r the Nfedi-^l Acts. 

Thc> mu t be uninamed and nhen elected 
iinder thim years of a c 

Arplicationx imh copes ol tesurno"uIs should 
be sent to the unders ned as soon as poxsibl'* 

L L N\ L.ANCASTER-GA'yE 
- Secretary StiFcnnierden i 

T he \mngfield-morpis opthopaedtc 
HOSPITAL HE\DINGTON ONTORD 

THE LORD NUrriELD SCHOLARSHIP IN 
ORTHOPAEDIC SURGERY 

MALE RESIDENT —00 per annum for tno 
yearx foHcmcd by three month ira> 1 (£100) 
Residence to corrmcn^c about Nosemter I*ih 
Some Orthopacd: cjpaicncc essential 

Information can be obtain'd from and apph-a 
non before Oaoter th hojld be made to 
Ptofesbor G R Girdlcstone 


O-yAL CORVAVALL INHRMAR^ TRURO 
(S4 Beds) 


R 


HOUSE SURGEON (male) required with tc 
rcnence of Arucsthencs to commence duucs on 
Aupusi 1st next Salary £l 0 per annum rooms 
board and »a hine 

Apply with copies of three recent testimonials 
to the Secretary of whom further particulars may 
be obtained 

Truro \\ E. GRENFELL 

July 4th 1938 Hon Secretary 


R OA AL LANCASTER INFIRMARY 
Laneaxter (140 Beds— 4 Residents ) 

Applications arc inxitcd for the post of HOUSE 
SURGEON Salary £lt0 per nnnum with board 
residence and laundry The appointment l for 
su months 

Applieat'ons statins ape qualificaiiom expcri 
cnee and nationality tosciher with copies of thre 
recent lesumonials to be xent to the undcrxigned 
FRANK A MILNES 
Supenntcodeni Secretary 


L FICESTLR ROAAL INFIRM V-RA 
(<00 Bed ) 

Snr 4HS 3 HP .CO 3 Res Araexth 
I Res Rad 

A \C\NCIES I OR OCTOBER I i I9»P 
HOLSC SURGEON 

Salary £1— < per amam Applicantx rtjxr have 
held a RcxiJcpt Htyxpiiaf p<jvt or had m Ut cx 
pcTien e of Ho piial wo L 
Lnu^ex fill candidates will be con idered f r 
Senior Ca iialty er if ih-y o intirr te 
CASUALTA OFFICERS 
S^n r Casualty OITt cr Fellow hip sia uatd 
S ’ary fl.< per annum 

Iiir Ca ualty OTi er Salary KV) per ar-un 
HOUSE PHASICIVNCIES ( ) 

Sal try tl.4 pj.f annum Applicant must h-\c 
hcM i Resident H v.r *-1 re t r bad si*** ’ar cc 
peren c if H'xpitai w rk 

RESIDENT anaesthetist 
Salary at the rate uf ci 0 per armum fo fir t 
IT r^'orths £ M per an-urj fo xecorJ « 

mo’' h t ' f r third tx months t- 0 feurth 
It norths 

Appi'atiorx with t- cs of three fce-t test 
monal to be forwarded to th Hou c Cotemor 
ard S-CTctary rot late* than Au-ni t Hih 

App*. rtnents f r xix m nth w n be n d cn 
Auruxt 4ih 

July |Cth |0 X 


O 


i\FORn COU’NTA AND OITA 
HOSPITAL 


SECOND ASSISTANT MEDICAL 
OrriCER (MALE) 


Appl -ati n arc imiicd fir the ahote-menuoned 
poxii on Appl -ant xhouIJ be ufx.cr 40 years of 
ape hat had some" pfC'toux Afem.l Hoxpiiat 
espenen c and po. "x the Dirl>ma in P ycho- 
lo< ual Med nrc ^ 

The O'b cr ap*'om cd must N. prepared to ass. t 
at the Oinit for the Out pauert trcainent of 
mcm.f iltnc' n the City of Oxford 
Conmen tr x.»iary €<00 per arnum (irJudin" 
Cif* for D P Af ) min'* by four annual tmen ru 
of £ ^ to £fi00 per annum to thcr wi h hoti'e 
li ht fuel and rarden produce xalucd for uper 
annu ti n pjrpoxcx at £I(A) pc* annum 
The appoinimept t object m tb* promx o-x pf 
the A yiunx 0*i crx Superatpiation Act The 
uxexful candidate wdi N. required to pa s a 
medical exaninaticn 

Appl cati n< ac ompan ed by copies of net r*ore 
than ton recen tcx imomal hcjld be sent to 
the Medical Sopcnnicndent Lmlcmorc Ho<rital 
rear Oxfo d bef>re Aueu t 6lh 19’ 


^NCOATS HOSPITAL AlANCHE^TEP 4 

HOUSE SURGEONS (Ttio) requ red (L-dy or 
Gcnilcman) to connen c duty on Scptcnbmr I t 
One for the Onbopacdi Depann m ard one for 
th. cenbmed pot o Hou e Surecoo to the E.r 
No^c and Throat Department ard Houxe Phxni'tan 
to c-e of the Ho op’d Ph " nar Salary -t the 
rate of CICO p^r annum ih board rcxdcccc 
laundry ct Arpom mcni for ix rnombs 
Appli aiionx xuiin" a- quald" canons e.xp^n 

en'c if any and full panimUr to be forward'd to 
th urJerx -ned on cr before AAcdncxda Aum.si 
nJ iih cimex of thre r'ceni testim ntal 
By Old r of th Board 

HEPBEPT ) DAFTORNE 

Gen Supt 3rd SccTct.r> 


B 


LACKBUPN and E-AST LANCASHIRE 
ROAAL INFIBMARA 


RESIDENT SURGICAL OFFICER (Ma’c) 
rcduired Salary £.50 per annum with beard 
rcxidencc and lauiNJry 

Prcferercc wi!j be jrnen lo applicants ho dm? 
the r R C.S Diploma 

Applicaifoos siaitrc nationalitv qualificat on 
and cxpcnencc tomjther with copies of recent 
tcxiimontals to be sent to the undersigned 
Rosal Infirmary T DEAA'HURST 

Blackburn General Supt and Sesrtetary 


S TROUD GENERAL HOSPITAL 
Stroud Gloj 

RESIDENT MEDICAL OFFICER rcqjiicd 
Candidates muxt he fu ly qualifi'd and reyixtcrcd 
Slx months apt-ointmen duticx to commence as 
soon as pos ibic Salary £.00 per annum w ih 
board and laundry 

Applications staltm* age natioitalits etc lo- 
g iher with comes of three recent testimonial to 
b'’ sent to the ond*rxi ned from whom furhe 
puriiculars may be b-ained 

C '-ORD SPENCER Secretary 

URTOS ON TRENT GENERAU INTIRAfARh 

Applications arc Invited for the pcx*uon of 
CASUALTI OFFICER AND HOUSE 
PHhSlClAN Salary at the rate of El 0 pc' 
annum wnh beard residence and laundry 

ApplicatiCKW giving age qualificauoo> and 
rationality together with cop es of tcsumonialx jo 
be cm to E AA TiioiiNin Secretary 


B 


THE GUEST HOSPITAL, DUDLEY 

A (GcptiI Hop ..1—133 Bedx ) 

Tb Rcxdmt Sta" corsib,3 of a Res d-n Scr»'cal 
O'*’ "d two House Surgeons 

Arr vati^ns arc in ited from rc-~stered Med<al 
Praetition rx f ih- pex- of PESIDENT SURGI 
CaL OFFICER (ri c> Du,,« to ccmr-esce 
Au-axt I th 15 S Salary at i’-. rate cf £— 
per annum cco di " to cxpc’^.^r^ «ah 
furn hed apartm nts bo^rd nd laerdry Cardi* 
uafs mu t b™x- b.d c.X’'cria- in eirtr emP* 
i •cry aftu p efcre"c^ wul be trxta to ihcs. 
ho inz t** qua eauen ct F R C.S c M,S 

A'’- .jfionx st-ti- a-'e uj.JLficatcns and ex 
pene^cu accempan ed b cem es of icsuCK'diah 
to tu ert to the u dwTO-med 

H PAAMOND HUHST 

Hou’Xv Gexeme .aid Secretary 

Ju ly lltb 153S 

T he guest hospital, Dudley 

(Gereral Hose j 1 — 1 9 B-da ) 

The Resdert Siaf* ccnsrsjt of a Pcsd~’t S r-^w 
O'E er nd two H use Sur-'^urs. 

TAAO HOLSE SURGEONS (c_L) reqa ed 
On* to cn er ir*on b s d .es mm-d atefy and 
tb e h r to c rr*''*r e cn \u?u-t I ib 19 
Silary at the rate of tlCO-tUO according to 
expcTicp c wi h fum’^h'd apanr— - board a"d 
laup-D Cacd dates m.al t ful F qu lt*d -nd 
reextered 

Apphcaticrs laun" ~ qr-IScaucrs a d ct 
ptnen e a ccmpaninJ by es uf tesumcra) 
to h. eni o tb- enders -ned 

H RAAMOVD HURST 
Hl-u c Gc%em'’’t and Secretary 

JuU llth 15 


“O R B A V 


HOSPITAL 
(16S Beds) 


TORQUAY 


HOUSE PHASICIAN a-d HOUSE SURGEON 
(male) required for Aumist UJi ard Se^tcr^’xer 
I'lh re'pemjxcly SaLnes l per ar**jm with 
board res u r u and laundry Card d.tcs ruxt 
be full qual fied rer t-r-d a-d unm-Tied 

Appl woi otss laiing ase n_nc--lity qoalfm 
non and cnrcoepcc, »uh copies of ro tr re than 
ibrec rec-rt tesu-'o-,«l to te reetixed by ibe 
undefx med not lata than Au a i tb 
E L GRIST 

Seer tary 

\/TASCHESTER NORTHERN HOSPITAL, 
iVi Cbeeiham Hill Read Mapc;''ea cr ^ 

((?er ra! Hcv-ial— 11a Beds) 

April aiions arc nvjtcd fc U'C povt f RESI 
DENT SURGICAL OFFICEP ce-’^o'-rg alar. 
£1 0 per xmum with board .cd resder e The 
ar-oip men c> for twelve r-omhs frera mod Aonn 
I9’'5 

Appl aiu ns statin- -gc quauficaiio- anw 
paiiopalnv wi.h cept-x of rot less than th c- 
recer lex^r-onial to be c-t to th- ‘^^etanr 
Mr Jvv ES C D METS Ban - Arcade lan- 
cbc'te- as scon a poxsit’e 


^■^^ESTMOR^AN D 


COL’N'D 
( _ Beds ) 


HOSPITAL 


HOUSE SLPGEON (fem-Ie) req-ired Sep- 
tember I t Ap-oirtme- if « tn nth 
Tcr-wable fo - funher tux mo-ths 

Salary £-00 r’-r anum with board rexiden e 
ard laundo 

Aprhcati n siatt— a— raucn-l ty ard qua i~ 
Pcatjon with copies of three rccert tesnni'nial 
to be addfcx ed to the Ho" Sec 1 'I Sorrer 
TcP not Llcr than Augu t nth 


TIE HAPTLEPOOLS 
C95 Beds) 


HOSPITAL, 


Applications 4rc faxtied fer ih. posiuon c 
HOUSE SURGEON at a salary cf £1-0 p.3 F us 

board rcsiderce. and laocd'y 

Appointinent ter six months subject to renewal 
-nd duties to commerce cmrediately 
Apn,»=.uo„s .o 

Secret- ry 


N' 


iENV St-SSEX HOSPITAL FOR UOVE^ 

' AAindlesham Road Brtshton 

Ar>f«ii.-it ens are invntcd from fully dualifi^ 
Mcdrcal At omen for the po>t of HOLSE SL^EON 
fo SIT months Duucs to commence irmn-diaieiy 
S-1 ry at the rate cf £100 per amen 

Applications with copies of three recent iexi>- 
iron— 1 to be sent to we Secretary Sew Su* cr 
Hesm— 1 AA ipdlcsh-m Road Bnghton. 

July I6dt 193^ _ 

ATTEST CORN’AAALL MINERS’ ANT) 
VV V.OMEN'’S HOSPITAL REDRUTH 

AAaned HOUSE SL"RGEON Lady September 
Ixt or October Isx. SO Beds. £1 0 per anmru 
with bx-ard aod Uosvdry 

Appljcaijom xviih tcstuuonia! 'o E. Pui't 
Hon Secretary 










38 


THE BRITISH MEDICAL JOURNAL 


Jua 23, 1938 


jyj'\NCHi:STER 


R O \ A L 


infirmary 


s 


T 


MAR’iS TIOSPITAL 


W 2 


CHirr ASsrsTNNT to medical neuro- 
logical UNIT (Non resident) 


TTic Board of Manaccmcni msuc Tppheattons for 
the appointment 

Anp’ic nfs must be rcpistcrcd Mcdicnl Practi 
tioncrs fliRhcr qualific jtions dcsinblc 

The candidate Lt required to attend on sesen 
half sessions p'*r \sceK of vshtch at least four will 
Ic mornmp sc sions Duties will include work tn 
the In patient and Out patient Departments and 
participation in icachinp Tlic candidate will be 
c p"cicd f enpace in Research work for which 
ficiluics will be presided 

Salars £^00 per innum The appointment will 
tc for one icar in the first instance but maj be 
renewed for two further periods of one >car sub- 
ject to the pro\isions of the B> Iiws as to noiitc 
etc 

Candid ites should forward fifteen Copies of their 
appliciiions Risinp particulars of asc experience 
etc topcther with copies of recent testimonials not 
later than 9 a ni on Thurvdaj Aupust 4th 19)S 
to the undcrsicntd from whom further infonnalion 
m iv be obtained 

D> Order 

r ] C \BLE 
General Supt and Sccrciarv 

July 19)R 


jyj \NCKCSrER 


R O') \L INHRMXRV 


JLNIOR \SSIST\NT MCDIC\L OFFICER 
IN R\D10L0CICAL DEPARTMENT 


CASUAIT) PH\S1CIAN 

Applications arc intitcd fn m du'j qualified candi 
dates for the post of CaMialty Ihysicnn 

Candidates must base been House Physicians for 
a full period of office at the Hospital or at some 
other General Hospital approsed by the Board 
The sahrs is £IsO per amtim with board The 
appointment is for six months and the holder is 
eligible for reappointment for a second period 
Application:* should reach the undcrsicned (from 
whom particulars of the office may be obtained) 
on or before July 28th 1938 

W PARKES 

House Gosernor 


T HL QUrCNS HOSPITAL TOR CHILDREN 
Hackney Road London E 2 
(160 Beds) 


HOUSE SURGEON required September 1st 
393'? 

TWO CASUAtTV orPCERS required Septem 
ber 1st I93*v 

Six months appointments Salary at the rate of 
£100 per year with board lodging and laundry in 
each case 

Applications must be made on forms to be ob 
tamed from the undersigned and be sent in with 
copies of not mure than three testimonials on or 
before August 12th 1938 

CHARLES U BESSELL 

July 19ih 1938 Secretary 


The Board of Manircment in\ue applications for 
the aboie whole time appointment Apphtams 
must be registered and hold a Medical ind Surgicil 
qualjfieanon and the D M R C or cquisalcnt 
The ippointmeni (non resident) li for twebc 
months renewable for a further period of twcUe 
months suh'ect to the provisions of the By laws as 
to notiec Silary is it the rate of £3^0 per annum 
Applieanis must si itc ape and send Fifteen Copies 
of their apnheation and testimonials to the under 
signed bs Ihursday August 4tli 1938 
By Older 

r J CABLE 

Oeneral Supl ond Seefciary 

July Ik 1938 


■HE Nf\NOR HOUSE HOSPITAL 
Gofdcrs Green London N \V 11 
(140 Beds) 


Applications arc invited for the post of JUNIOR 

medical ornccR 

Salary at the rate of £200 per annum with board 
residence Candidates male and unnnrncd must 
be fuHv qinlified and registered Tbe successful 
candidate will be required to take up his duties 
on Monday July 2'^th !93S Applications staimv. 
full particulars and accompanied bv copies of pot 
more than three recent testimonials hould be 
forwarded to the undersigned forthwith' 

J\MCS W LINKHORN FCCS 

Secretary 


T he L\DV CHICHESTER HOSPUAl 

Hove Brighton 

For Functional Nervous Diseases 
(60 Beds ) 


SENIOR HOUSE PHYSICIAN (woman) re 
Quired Six months ippointmeni £11)6 per annum 
all found Vahiabh experience for Diploma in 
Psvcholoncal Medicine 

Mso JUNIOR HOUSE PHYSICIAN (woman) 
required Six months apnoinimcnt at £73 per 
annum nil found Valuable experience for 
Diploma m Psycholopical Medicine Duties to 
connaence middle of July 

Appl cations with testimonials to be sent to the 
Secretary Mr P F Spooner 33 West Street 
Brighton 
July 9lh 1938 


R 


OY AL 


BUCkINGHAMSH! RE HOSPIT \U 
Ay !c bury (1!^ Beds) 


Appheaiions are invited from qualified and fcgh 
tcred cvndidatcs for the post of 
JUNIOR RESIDENT MEDICAL OFFICER 
(Male) 

Salarv £1^0 per annum with quarters m ncvvlj 
built flat board and laundry provided 
The post will be for a period of five monihv 
commencing Migtist Isi 193S after which it will 
be pcrmi:»sible to apply for the senior post 
Applications stating age qualifications and ex 
pcncncc with copies of three testimonials slioiiIJ 
be sent to the undersigned by July 27th 1938 
1 G DAWES 

Scefctary 


W 


I M B L E D O N 

Thurj»tan Road 


HOSPITAL 
S \V 19 


Applications are invited for the post of PESI 
DENT MEDICAL OFFICER male unmarried 
Duties to commence on October 1st The appoint 
mcni IS for a period of six months The salary 
ofTcred is at the rale of £150 per annum wiih 
board residence and laundry 
Appheaiions atcompanicd by copies ol three 
recent testimonials should be sent to the lion 
Seerttary 

A B WARD 

Acting Hon Secretary 


C 


umderland 


INFIRMARY 
(200 Beds ) 


CVRLISLE 


\ppli til ns arc Invited from men only for the 
t li wm*. pt ts — 

HOUSE PHYSICIAN 
HOUSE SURGEON 


\i 1 uni.r\( art for six months from October 

* ' I nd hildvr will be eligible for i further 

* 'ni Si) rv in h «.asc at the rate of £160 

I I iiiMiim with t II 1 rcstdtnct and laundry 

Uv I t <1 llol si SURGEON is recoy.niM.d 

* V lit l< ii t I Surgeons of England under 

II It (I ill I mil FcKovvshfp cxamina 

I It 

Ypi 1 I ' n I nn (.biainab’c from the 

I n f ( in s iih topics of not mors, 

hi m f I r I t III 1 I f rttcivcd not later 

lluri \i I I ih 

I S RIPPIER 

. S III if> Superintendent 

July IMU ) >3 


E AbI SLR HI) HOSPITAL 

Rtdhiil Si rr(.\ 

JUNIOI HOLSl St RL I OS (male or female) 
required «n \ugust i h uxi Sal ir> at the rate 
of fioo ptf innum ih i irj residence and 
Mundry t mdidatcs mi i t fully qualified and 

reLi lercd Nrpoinimcnt f i is m nili and further 
MX monih a Senior at sa}aT> ‘ i <^0 per annum 
\rplii. itions siaiinc full pirn ul irs and copies 
ot re eni tesiimonuls to Ik enr m the under 
teried Uf tre July 2Slh 193S 

E C \Y11NG 

Secretary 


M 


CTROPOLITYN HOSPITAL 
KingslanJ Road LonJon E 8 


Apph ations arc invited for the post of 
CASUYLTY OIFICER AND RESIDENT 
ANMSniETIST (male) Salarv at the rate of 
£IOO pa with board fcsidentc and laundry 
Duties to commence Septemb'^r Isi C mdidatcs 
must pi veess a registered medical and surgieal 
Qualirviuan of the United Kingdom 

\ppli jiions sheuld be Obtained and returned 
ic the iindtrsicncd ne>t later than July 2Sih 
I K\NK JENNINGS 

lUau c Govenor and Secretary 


ps.sr\ coLsn hospitvl colchcster 

^ (I'4 Bolv ) 


sOHrin'.',"'' /'SSISTAST HOI 

0 per annum ■ 

' -n'T,' j"'™™ 

'f-NLSl H hCsCHIT 

N“Cfctaf 


HE LONDON CHEST HOSPITAL 
Victoria Park E 2 

(Dus Tram and Rail Cambridge Heath 
L and N E Railway ) 


A vacancy for a HOUSE PHYSICIAN (male) 
will oecur on September 1st Six months appoint 
inent Saliry at iht rale of £100 per annum 
Board residence and Jawndry provided 

Appheaiions with topics of three testimonials 
should be sent to the undersigned on or before 
Wednesday August rd 

THOMAS BROWN 

Secretary 


W EST LONDON HOSPITAL 
Hanimcn»miih YY 6 


YPPOINTMENT OF HONORARY PHYSICIAN 
FOR PSYCHOLOGICAL MEDICINE 


With reference to the advcriiscmcnls In the last 
two issues will intending applicants for the above 
po t pk isc note that ii has now been decided to 
postpone the appointment until October Details 
as. to in ended dates will be advertised in Septem 
ber 

H A MADGF 

. Secretary 


^HYRING CROSS HOSPITAL 

Applications ire invited for the post of 
CLINICAL ASSISTANT in the Y ray and Electro 
therapcuties Deparinicni Candidates should have 
by rreferenee the qualification of D M R E 

Apilicjfion> together vsiih copies of three recent 
testimoniiK should be sent to the undersigned not 
liter than Vtigust 3rd I93S Honorarium £S0 
per **nnum 

Charing Cro s Hospital GEORGE J JONES 
London YY C 2 Secretary 


'HE RADIUM INSTITUTE AND MOUNT 
VERNON HOSPITAL 
1 Riding UotLC Sirc'*t London W I 


Tbert V ill shortly be a vacancy for a HOUSE 
SLRGFON at th Mount Vernon Hospital Norh 
ood The ipriinmcm will tc made for si\ 
months at a salarv at the rd** of £U0 per annum 
With board and re iJenct 

Ypphe tion sbailJ nt to the Secretary at 
the ah VC adore s 


T JOHNS HOSPITAL LEYYJSflYM S E 13 


Ypplicationi arc invited for the resident appoint 
ment of CASUALTY OFFICER (male) tenable 
for SIX month from September 1st 1938 at a 
remuneration of £100 pa 

Applications with copies of testimonials should 
teach the undersigned b> Augii i 20ih I93S 
J C GILBERT 

Secretary Superintendent 


j^mo 


EDWARD 

Ealing 


MEMORIAL HOSPITAL 
(14^ Reds) 


CASUALTY OFl IClR AND DEPUI' 
RESIDENT MEDICAL OI FJCER (male) rcQuifCil 
Six months appointment with possibility of re 
election for a further period Salary £’‘’5 per 
annum with usual residential emoluments 
Applications stating age experience and Qinl> 
ncation> together with copies of two tcccai 
lesiimoni ils should be sent to the iindcrMRftca 
immediately 

R A MICKCLYVRIGHT 

House Governor 


■y ICTORI A 


HOSPITAL 
(50 Beds ) 


deal 


Applications arc Invited for the pod oi 
RESIDENT MEDICAL OrFICER (male) firimh 
nation ihiy unmarried Tlic appointment in cwiri 
mence immediately for six months Salary fl*!* 
p a with board lodging and laundry Spccui 
knowledge of anaesthetics is dtsinble 
Applications staling age and nunlificationv li>* 
gether with copies of three recent tcvumnnnl I’ 
be sent to the Secretary Medic il Board Yictoni 
Hospital Deal Kent 


the 


DUG HAN AN HOSPIT At 
St Leon irds on-Sea (103 Beds) 


JUNIOR HOUSE SURGEON (fcnnic) icqujicJ 
to commence duties September 1st 193'? SiwT 
from €125 per annum according to experience 
Candidates must be duly registered 
Practitioners and applications which should insiuo 
three copies of recent testimonials should be w' 
to the underMRned immediately ^ 

I RANK HYRT 

Sceretjrr 


P RINCESS ALICE HOSPITAL nASTROUKSt 
(Ac hintary Genera! Hospital 120 Beds 
Two House Surgeons) 


RESIDENT HOUSE SURGEON required e" 
July 30th Salary £I50 per annum . 

Applicationv should be sent to the 
with copies of three recent tcsiimonuls b) * 
27ih W RUSSELL KUOALL 

Jul> 5ih 1938 Secfcufr 


Applications are invited for the v 

SUKGFON to the Public Hospital F.rejr^^ 
Salary £800 rising to £1 000 Cabled 3pi;j ^ . 

Will be received by the Gfey Hospital fi‘ - j 
Street (Trcymotith New 7cabncl nP * 
including August 5ih 1938 









juL\ m<!. 


THE BRITISH MEDICAL JOURNAL 


39 


APPOINTMENTS — Important Notice 

Mtilicnl pnititionci -- nrc ii.quc'ti.cl not to npph foi iin ippoininiLiil rettntd to in the tollowmg 
tihk witlumt In in< lir-t <.oninutninti.(l witli the Secrttnn to the Untish Mtchcnl A-^ociition B M A 
Hoti-i. Ti\i-to(.K ■'([inn W C 1 On tin. co'c ot Scotlnh ippointnitnt'-, with the Scottish Secretan 
7 OrtinislKtij;h Cnnkn-, rdiiihinuh) 


(a) British Islands 

Tiwn tr Di tn'i 

Tiwn If DistrKt 

1 Town or District 

CONTRVCT PRACTICE 

CONTRACT PRACTICE— (f*»«/f) 

PUBLIC HEALTH 

ABERT\SSWG MEDICAL AID SOCtlT\ 

(Xfr cal Of*ccr ) 

AllD RHONDDA MEDICAL AID SOCIETY 
( 4 1 /tint Me heal £)/F cc ) 

COUNTA OF ROXBURGH 
<A litant Medical OtHter of Health ) 

blaenaaon medical societa 

iChir/ yfed *«./ G* vr 1 

NFAHI AND DISTRICT 
lytclcat -hi -1 utaliot^ 

GILFACH COCH CLAAfORGAN 
(II Xmrn j yted col Schenjc ) 

OCMORE \ ALLEY GLAMORGAN 
<11 fndlam C lie} Med al 4il 'locicfi ) 

( f( i nen 1 Med cal et te ) 

DISPENSARY APPOINTMENTS 

LLWAN*AriA CLADACIl \ALE 
PENAGRAIG CLAMORGAN 
(H Kmrn s Me al ^cfieme ) 

LIAIERICK CITY 

(11 li le lime Dispemari Mei cal Officen ) 

OAKDALE AlO 

1 (Mclcul O/*" c / Mclcil Aid An ctai i) 


(b) 0\erseas 

Medical pi actitioiicrs arc rcqnc-lcd not to ipjiH far an\ appointiiicnt rclcircd to in the tollowinj 
table without haMni; fir-t cnniniiiiiicatcd with the Honoiarj Seeretai \ of the Dnision or Cianch 
named in the second column ot with the Seeretare to the British Medical Association B AI A House 
Taeistock Square, W C I 


T».w-n xr Di tnct 

Hon See of Dim cn 
or Branch 

1 iwn Of Di ifi f 

III n Sev of Dim i n 
xf Branch 

Town or D ytrict 

Hon Sec of Dmtion 
or Branch 

SOUTH 

ALES 

(4M Friendh 

5v«e/» App ml 
ntenit ) 

The Afedi al Secretary 
New South Wales 
Branch f** Mac 
Quane Street Sydney 
NSW 

S I C T 0 R 1 A 

t 41{ In tiiuie ( r 

Me leal D pen 
a ic ) 

The Hi norary SevTctaD 

A Id run Branch 
Brill h Medical A o- 
ciaiion Medical 

Sodcty Hall Albert 
St East Mcibourne 

A idona 

^\'ESTERN 
AUSTR ALIA 

tC nt Oft an I 

Lo he Ptad ces ) 

The Hon Sec W cstem 
Australian Branch 
BntLh Medical A-so- 
ciaiion Shell Hou e 
.0* St George s Ter 
race Perth W esiern 
Australia 

The Ht n Se Queens 
land Bran h Briinh 
Afedicat A soeiation 

B Af A House 

W ickham Terrace 
Bn bane B 1" 

QUEENSLAND 
(B fbune 4<* cate 

F nendl) S eirr e 

In iiuie ) 


Tuh 20 1938 Be Order of the Council G C WDERSON Scirttar^ 


B ury infirmary aAVcsi 

O-n Beds) 


c 


OeNTY 


ANTRIM MENTAL HOSPITAL 
Ulster 


JJOSPITAL 


OF ST CROSS 
« 0 Beds; 


RUGB\ 


APPOINTMENT OF TWO HOUSE SURGEONS 

\acanne? as abosc arise on the Resident 
McdiTiI Staff and appltcauons arc in'iicd for the 
rests 

The Rev Jcni Staff consists of an R^ O a Hou c 
Ph>-Maan and two House Surjtcons 
The appointments arc for a term of six months 
and salaries pa>able are at the rate of £1*0 rcr 
annum with twrd rcsiden e and laundry the 
•^lary being imeascd to £1"5 rcr xnnum in the 
eient of reappointment to the same or some other 
cfTi'c for a period of six m''nths 
The <cni cs of both Hoove Surgeons will be 
rcouircd on or about \ugust Sth 
Applications stating ape qiialificaiions and 
nationality to ether with copies of three recent 
icstrmoniats arc to be forwarded to the under 
ened as soon as possible endorsed House 
Surgeon 

Full particulars o! duties may be had on arrllca 

tlCfl " 

H WILKINSON 

SupcrmtcndLOi 


QOSSHAM 


MEMORIAL 
Kiagstcood Bmtol 


HOSPITAL 


The Comromec of Management of Coontj 
Nninm Mental Hovpttal m\nc applications for the 
povl of SENIOR ASSISTANT MEDICAL 
OFFICER 

Applicants mo i be male single under * >car 
of ags dul> qualified m Mcdii-inc and Surgeri 
and hate had special experience m Baaenologs 
Commen mg salary £400 n ing by £25 ennualh 
to £600 together with furnt ted apanmenis ^ard 
laundn and atiendan c salucd at £100 pt.r 
annum 

The person appointed will require to hold or 
to obtain within three sears from date of appoint 
ment a Dtploma in Psscholoeical Mcdicme 

The appo ntmem is subiect to the proMsion 
of the As)lums Officers Superannuation Act 
1*W and to the sanction of the Mimstty of Home 
^Mlairs Notthem Ireland 

Form of applicatioo which may be obtained 
from the Resident Medical Supenmendent mj t 
be returned to him not later than Mondaj Augu t 
1st 19^S 

3ul> Gth 195S B\ ORDER 


•HE ROYAL PORTSMOUTH HOSPITAL 
Portsmouth 

ISpx Rcsiden Medical Offi cr ) 


A i-acancy will appear at the end of July for a 
JUNIOR RESIDENT MEDICAL OFFICER 
Salar> £1 0 per annum with board and laundry 
to remain for sue months in the first instance 
Applimnis (male) hould be Bntish nationality 
full) qualified and registered 
Applications With copies of recent testimonials 
to be tni to the SccTciary 


QOSSHAM 


MEMORIAL 
Ktflsswood Bristol 


HOSPITAL 


Wanted an additional HONORARY SURGEON 
ter genera! surgical work 

Appl) with full particulars to the Secretary 


Applicarions are innted for the posts of 
HOUSE PHYSICIAN (male) qualified Salary 
at the rate of £130 per annum whh board etc 
To commen e Augj » _drd I9^S 

CASUALTY OFFICER (male) qualified Salary 
at the rate of £ltO per annum wiih board etv 
To commence September Hi 19**^ 

Six months 'ippointments Eligible on com 
plcti n of term for appointment to other ics dent 
posts 

Applicanons xtating a e nationality etc and 
copies of three receni tcstimotnals to be ent to 
the undersigned on or before Augu t 4th I9i8 
from whom all pameubrs can be obtained 
B W AGSTAFT 

Secretary 


Application arc in\tted for the post of ONE 
AIaLE resident MEDICAL OPHCER (Three 
R M O si 

Salary to commence at the rate of £100 per 
annum for the first three months £125 per annum 
for ecord three months and at the rate of tl*0 
per annum for subicqucni monihx Full board 
\ ashing etc proxidcd 

Six months appointment and eligible on com 
plction of sem e for further ettenston of $rx 
month 

Candidates must be prepared to commence 
duties as early as possible 

The practice of the Hospital offers excellent 
cppominities for wide expencitce 

Ctriifi'afs nnd oihcr fees shared by R MOs 
Applications stating age oaiionalny and fuD 
details with copies of three recent testimonials 

to be sent to the undersigned — 

(Signed) W COCKBURN 

Supenntendent and Secretary 


P RINCESS LOUISE KENSINGTON HOSPITAL 
FOR CHILDREN 

St Oumtin Aicfiue North Ken ington AV 10 
(LadbroJk-C OJ33 > 

7h Board of Management innte applications 
for the combing post of HONORARY ASSIS- 
TANT PHYSICIAN wtih bed and PHASldAN 
IN-CHARCE of the Child Gutdan c Clmier 
Arphcanti. must be graduate:, tf a Uniicrsit 
^nd must he'd the MRCP(London) und the 
D P M and must ha\e had pra'^ica! capcncocc 
in a Child Guidan - Clmic 

Applicatioo accompanied by cop cs of three 
tcv.unomals should be ent to the undersigned at 
the Hospital from whom any" further information 
can be obtained and hould reach bun not later 
than July aOth 193S 

H J ELEY 

Secretary 


( Appoinonrnts continued on p 4A ) 

















40 


THE BRITISH MEDICAL JOURNAL 


JUL^ 23 1938 



CIRCUL\TION OF THIS ISSUE— 41,000 COPIES 


C LASSIFIED The Minwnim charge is 9s , which covers up to 30 
words Extra words are charged 1/6 for 5 or less 
Example 33 words would be charged as for 35 
Name and address should be included when 
counting words for cost 

If Bo\ Number is used, it should be reckoned as 5 
words in the total 

Replies should be addressed separately to eaeh 
Box No care of this office 

Ad\ertisements, accompanied by remittance, should reach 
this office not later than noon — ^tuesdax, to ensure 
INSERTION IN CURRENT ISSUE Please write clearlx 

DISPLAYED Whole page £24, and pro rata to one-eighth page 
Special positions, dates and rates on application 


Every eflort is miclc to ensure the accuncy of 
advertisements appearing in the Journal No 
recommendation is implied by acceptance and the 
British Medical Association reserves the right to 
refuse or interrupt the insertion of anj advertisement 


ADVERTISEMENT MANAGER, BRITISH MEDICAL JOURNAL, 
B M A HOUSE, TAVISTOCK SQUARE, W C 1 
EUSton 2111 


NOT CLASSiriFD 

CIGARS (ENDGUT) ALL HAVANA 

lOIlvCCO CODD SMOKIS ai i low nrito 
qu'iiit> RiiannitcJ Box of ^0 for 25/ posl — 
Sole MTntihv.tiirLrs J J ruirsixs ^ Co Ltd 
<>0 IitcvUilu lonUTn \\ I (GRO 1529 ) 


“BI7IM” CIGARETTES 

IHLSl luxurious dtliciousl> satisfj ms smokes 50 s 
< lOO It 6 ^ per 100 ^S(6 per 1 000 po>t 

fret —Sole M tmif Kturers J J TRrcMXN A. Co 
Lid ^0 lu.vaUi\l> London 1 (GRO 1*^29) 


“SOLACI CIRCLES” TOBACCO 

IIIC finest combmaiion c\cr discoNcrLcl of ChOKC 
Nxiiirtl Tolxicxros Crery ptpcful in jndocrtbiblc 
pInMiic )2JC per ' )b on post frtc — Sole 
MTnuficturcr* J J rftrrsixN x Co Ltd 
^ 0 {it.adill> London W I (GRO 1^29 ) 


F or ml income tax complicmions 

ot difli uliics consult or communicate xsnh 
Mr C G C KILNCR (laic HM Inspector of 
I Txes) 7 M James Sircci Pi«uCadjII> London 
S W 1 1 civ pbonc \\ Imchall 927S for appointment 

O lriKLD IN JLRSEA TO DOCTOR OR 
o hvr ptvjfv 'itonal rntn n-cdins veserM 
months rextful chankv HOSPITVLHY b> Spcvial 
j't tcmponri > alone Lircc modern Bit facins 
ti \Il '5nc^ltle^ ^ suincas Golfer rrcfcrrvd 
— \dJrc^'‘ No '■xo** BMA House T tsistosk 
Nqu uc W C I 


T MLORING— CUSTOMERS \ ISITED AT 

ihvii surecr> or p ivatc address anywhere 
witlurt a fad us of xq miles of London by n late 

\S c i I r J til! r Sims fri m 4 cuinvis to ''I 

eiiip a Pwry carment n dc jn ibv \\ est End 
Lar s 1 •ct t n o* Worsted Saxon cs rixnnvl 
ct lades Cf'^'tu'^cs th sam pri Credit 

Ivrmst d -s ed ~-Bri V '* » Gain K n u'^h Pc id 

N I Hil s d .><0 


TTMrWkiriNO DLfLieVTING IRXSSLA 

'v - =VUJIC!, in 

II I 1 I n , ' f Iiuru 

. "i,V; ,ir- " 


TV PEVVRItiNG — SPECIAl ISTS IN TV PING 
Medical and scicntilic papers Icclurcs 
theses and books Shorthand typists always 
I asaUablc Proofreading indcxtne — Mvrcaret 
j Watson Ltd 16 I alacc Chambers Bridge 
Street S W 1 W Hlichall 3S3S 


ASSISTA^CIKS 

W ' ^ E D IMMCDIATELT MARRIED 
\SSISTANT (British) for South Wales 
colliery practice with early xicw 30 35 Salary 
1450 and car allowance or car pro\idcd with 
free unfurnished house — Apply with phorograph 
Address No 7315 B M A House Tasistock 
Square W C 1 


IMMEDIATELY MALE ASSIS 
f 'N * preferably English and unmarried 
Vine) and pruate practice in Cumberland adjoin 
ms Lakes Uispenslni: Luc rn Silary £300 
plus car allowance — \ddrcss No 7521 BMA 
House Tavistock Squar e W C 1 

\^\NTED IMMEDIMELY INDOOR AND 
Outdoor ASSISTANTS for Town and 
Countrs f r-’cticcs with and without \icw to Partner 
ship Good salaries offered State full particulars 
—British Midical Bureau 33 Cross Street Man* 
Chester 2 

W ANTED END OF AUGUST YOUNG 
male indoor ASSISTANT English or 
N^oich preferred fo mixiU in North 

London Time for rcidine Car proMded 
Salary £^00— Address No 7W BMA House 
Tavistock Square W C I 

Y\/^YNTED ASSISTANT EXPERIENCED 
GP irarned Tree unfurnished hoiivc 
fXQO pa in ludinp car allowance English or 
S-^oteh Catholic preferred bu nar cssentn! early 
view large mixed practice Cheshire — Address 
No ■’X-6 B M k Hou c Tavistock Square W C I 


W ANTED YSSISTANT IN LEEDS MIXED 
practice Salary £3X0 all found Apphea 
tion to REasoios and Bransov Ltd P Briggatc 
Lced 


W^'^TCD male assistant eor panel 

in I privat praeti'-c in cutlymg I ordon 
Miburl I t c n < apt lunirv fi r reecntiy qualified 
man— \ilJrcx Nl BMA Ho i e T Uialock 

Sv^uare AA C 1 


W ANTED LADY ASSISTANT COUNTR) 
practice South YA^ext England Live in \1! 
found Salary £2X0 rising to £300 m six monihs 
Must drive car — Address No 7517 B M /( Home 
Tavistock Square W' C 1 


W ANTED MALE ASSISTANT WITH MEW 
to partnership Protestant and total 
abstainer Able to drive Salary to commence 
£300 per annum all found car provided — Address 
No 7x22 BMA House Tavistock Square W C 1 


W ANTED PART TIME ASSISTANT (MALE) 
Sviit retired practitioner wisbinR to auemem 
income Pleasant small town North East — 
Address No 7xxi B M House TavotovK 
Square AA C 1 


WANTED EXPERIENCED ASSISTANT 
» • with a view to partnership in good-ebs 
suburban practice with good surgical opportunhics 
in Cheshire To reside in and develop growin? 
area Preference given to vvcHKiuahlicU Svot 
Good siiarv and car allowance until both are 
satisfied with partnership prospects — Address No 
7309 BMA House Tavistock Square AA' C 1 


W ANTED OUTDOOR ASSISTANT PANEL 
and private practice near Manchester State 
married or single nationality Salary £X00 pa 
and furni hed rooms Car required Provpv'vti — 

Address No 73'^4 B M A House Tavblovk 

Square AA' C I 


W ANTED OUTDOOR MALE ASSISI ANT 
for panel and private practitc by ScoUish 
doctor in the Midlands Salary £400 per anmini 
Usual bond — Address No 7XX2 B Nt A Hoii e 
Euisiock Square AA' C I 


W ANTED OUTDOOR MALE ASSISTANT 
commencing October 1st Panel and Private 
Practice Scotland Scottish Graduate (Proiv tanO 
with hospital experience —Address No 7X0’ 
BMA House Tavistock Square \A' C 1 


XV^ANTED POST OR ADUATE STUDENT TO 
▼ » do morning and cvemne AVORK in practiw 
situated 20 minutes from Charing Cross Mmt 
be willmg to live in area Eour guineas wcekl> — 
Address No 7X2s BMA House Tavistock 
Square W C I 


W ANTED MALE INDOOR ASSISTANT 
preferably Jewish panel and private practuc 
m Sunderland must be capable driver Ail^) 
£32X per annum all IcuinU — Address No 7)) 
BMA House Tawsiouk Square WCI 


W VNTED — OUT DOOP ASSISTANT MVlE 
married preferred for Pracliec near Birmifi 
ham Some experience m G I csxcniul GexxJ 
house rent and rites free Saliry £450 pa anJ 
car aUowancc Apply with full pariicuhrs mU Rsh 
monials to — Address No 7446 B M A Home 
Tavistock Square AA' C 1 


W ANTED M-VLE ASSISTANT ■'•nO'lR 

for Durham Counlv priciicc Sahiy uw 
per annum plus car allowance — Addre s 0^ 
7 24 BMA House Tavistock Square \\ C I 


W ANTED IN COUNTRY TOASN IN MID 
lands male Outdoor ASSISI ANT SibQ 
£400 to £4X0 according to experience Car 
sided Ample time for readme — Address No 71 
BMA Hot!'*'* Tavisiovk Square AA' C 1 


A ssistant reouired Scottish <>p 

Engli h unmarried young some expenet^ 
general practice preferred Rooms at Uanvn 
Kent border £3x0 per annum with carice t 
car allowance — Address No 7X64 B At A Hoo 
Tavistock Square AA' C 1 


E \nMNG SUKOERirS OK PART ’ll’''* 
AAORK. required bv woman doctor h'l t 
London — Address No 7xx(j B At A 
rnviviovk Square W C 1 

L ondon sr— unmarried ASMSTAAf 

w-inlid (or CP O toUr hi Ann 1”'’ 
rciding for higher dejrccs £300 a yvaj . 
found Usual bond — Address No 7^0*^ B 
i louse T iviNtOvk Squ e AA C I 

P ERMANENT ASSISI \N1 I OR 

Suitable for married man Hou'c “ 
State experience and all e'>sential pariicui 
Address No f.lfO B Af A Hoti c lav ' 
Squat'* AA C I _ 


Q LAiiriED Lada mpdicai pro' ip* ^ 

lo t.u HELP in mill rocncc lew 
£l‘n nil Cl niintmrn fee tioird nnJ ' ^ 

Sicn UMial bond - Adures No UU 

House Tavistock Sqiur*. A\ C I 












THC BRITISH MEDICAL JOLRNAL 


W wun LOCI M MMF FRIUSJ! \SD 
c\rcricn c \5 Scr crrlxr rJ ; n t bet 1 th 
n lu 1 c UotL 1 cbt at unrci^-r ir\ ^ rtiir n 
ret weeV >rJ y r \tnb L rj n rtJtu c 
^rrf> «uh rcfcrcn*cs — XdJrcA So fv- |i \ 
H yr^c TaM i xV . Square \\ C 1 

W/AN'ITD LOCI \! \tOSTH \LGLST TOP 
’ » larce pare! arJ » rkinc-vl pra t c ST 
Lend n Lxpcf r c o ential — Kui ro St 
R M N Uo^c T M tock Smnrc C I 

V\/\STLD HOSTITVLin LOCI M (SCPT 1 
» » mate o fcnalc » rk licht near Han—tr 
miih Post GraJjatc S^hcH>l — VdJrcsi No ♦ 
BM ^ llous^ 7 i\i toeV. Square N\ C I 


VW^SirD LOCLV* LAD^ ilPlINtRER 
»• rJ to I ih s-iali S>r« psbire nw.n Prnatc 
arrJ pare! Uetk ii ht Mu i hi\c ar Sc cn 
n ncas per »kcck — Addrese <J< DMA 

H irse 7 a>-»'to«.k Square \\ C I 


E lderly oseord mas will be )j\pn 
t d rss 7 171,7 lOSAL LOCLMS (\Tcntar 
Cervcral re»CTy Vfalem:t\) « 2 unPff Aueu t or 
Ser ember —W ri e BM nCG\ W Cl 


E \pfr!lsced doctor reolires licht 

LCKTL SI WORK noJerat feey r hosp tal i 
term f n- really ca^ practice 0 *n car Coun r> 
r ca ide prefetred — AdJro« So ■" ■* B 't A 
M yrse Tsm lock Square W Cl 


A-' LOCI M FNGVGEMtSTS i scd to panel arul 
M eharjrc Oi»n car ard refer'r ey if required 
L lul fees — Addres^ So ■* B A! A House 
luM txk Square W C I 


E SPERIESCED CP WANTS LOCUM HOS 
p f 1 tj ar^ expCTfses on!\ for self and «tf 
Late \i ru t and Septernber W est Country pre 
ferred AS ork 1 rht — A< 3 s.rcN So B A 1 A 

Hue T^r txk Square W C I 


E SPERIESCED LOCUM USED TO PANEL 
ard cencral rract e <, encaced after Aucu t 
. nd hich<b e referen ct— L ocum Byron Heu e 
Kedneld Bn i ! 


E sieriesced practitioser aged 0 

c*»n car de«irc< LOCUM ENGAGEMENTS 
Aujpj I t-^th tn 111 oe al o I 3 ^t three «eek 
Sepienber Hcppiialitt for ife ard child de^ir 
«ble — ■ Addro So * I B AI A Hou'e 
Tavr tovk Scu-re A\ C I 


E xperienced practttioner wants 
LOCUM ENGAGEMENT fr m Au u t «th 
fir about - to 4 week Ciuntry o Cxi^t pre 
felted Afid rate fee Oi n ear — Addrci No 
■* C H Af A Hou e Tail tock Square AA C I 


Eapenen-ed ftdics »rd irentlcmen -tai be 
u-rmcuiately or ne r future are innted tt com 
nunicate ujth— Tut Mroic L Aersev Ltd ^ 
Sou hatnpton Street Strand W CJI 


H OSPlTAtm LOCUAl offered (WITH 
family) Au u ; 6 th 3 cr •• »ecki Dclisht 
ful h j c ard country ea ac esiib c A en little 
aork car necc'^ry Reasonable remun ration 
aPered — Address No "««4 DMA Hou e 

Ta iMo<.k Square W C 1 


H ospitality locuai— doctor willing 

to irve hi 5 cTM es a a locum m return for 
|ian of bou e in a pleasant sea xdc place Second 
h II of Autni t fir i ip.o or three wcck.« of Sepr 
Period up ro a month Will prondc car and al! 
other CTpenses En».li h Fc ox -ecu temed to fir t 
cIj s P'S t e C npetent operator —Addres 
No B Af A Hou c Tail tock Square W^ C ] 


L ocum tenens work wanted by 

ctpcnenccd G P (En Itshrran) accu itmed 
1 1 pood-class prnatc practice panel etc Excellent 
tcitimonials abstainer no» dt cn-^ped oxn car — 
Addrc's No B M A Hoo c Tail tcKk 

Square W C 1 


■L/ Seven puincas plu one putnea Iran pen allox 
ance — Addle'S No BAJA Hou c Tuvi icvk 

Square W C 1 


L ocuai urgently required for three 

xecks from July - 9 th AJusl drive car Kent 
— Addrev No 7<&6 B A! A House Tav tock 
Square. W C 1 


medicm:- posts dispensers 


A LADY DISPENSER BOOKKEEPER SUP 
plied immediately on request qualdied 
and xith practical experience in private pr'ctice 
and di pensary work also trained m Bactenolo ical 
Laberatones of the LONDON COLLEGE OF 
PHARAIACY FOR WOAJEN PreparaUons for 
Examinations — Wnte wire or phone (Bavs 
xaicr 09 € 9 ) Secretary 7 Westboume Park 
Road W 2 


A COURSE OF TR AlNINQ IN DISPENSING 
and Phirr* -y i civcn at GORDON HALL 
SCHOOL OI IHARAIACY anJ Secret ry D- 
pen ers on be supplied to Dictors Scs ions 
Jinuiry Anil mJ S-ptc-iber ^ — Applv Primpal 
Shit if Ih rmv y Drayton House C ton 
SiTcct AA C I Ph re Eu i n 930 

D ispensing career for young ladies 

IULL TRAINING for Apoihecancs Hill 
Certifi ate Enrolments every three rrinhs — 
Applv The Primpil Cerira! S«.hooI of f^amacy 
Ml ret A Stre t LerJon SW I Teephene 
\ I lofta tWl 


D ispenser hall oualificadon seeks 

fii I time px! Ho'pital Surpeon or Pharmacy 
Oui k neat and a curate <lt pca<er with 
referen es General dtxti r s ucrU. — Addres No 
lot B M A Hou e Ta i totk Square W C 1 

D ISIFNSEP (HALL) AGED t< SEEKS POST 
with DxTir or H'sp til A\ ill make hu^'C f 
ecn rail useful cot ted dtvtot s bill kep* book 
H fhr«t ref remres charancr tiaranccd by Pm 
of Intofx — AdJrev N> o B A! A House 
Tav I txJk Square W C I 


D octors rcouiring qualified 

Di pen ers N«rve-Di pen ers Secretary 
Di penvefs or Chaiifleii e D •'cnsers are nvitrt 
ti write xirc or rhme Temn c Bar The 

Di rrxsrii s Bitrti Llnd'oy Hou c l“l 

Sbiftcvbury Avenue London AA C 2 


^llllllllllllllllilllllllllltfllllllllllll^ 

— The Namc*> and Aadre?»9es of ~ 

^ \dN critters using SI 

I BOX NUMBERS | 

= are held bv iis in sinct con- = 

— fidence and max nolbe disclosed — 
S Vpplications should be S 
= «eparatel> cncio ed and clearlj S 

— addres ed — 

“ Adilre^f No S 

~ BM A House S 

“ JuMstock Square II C I S 

III All crr**runt -tient arc forsv rded “ 
IZ lo advertivery u der pair cover ZZ 

^iiiiiiiiiiiiimiiiimiiiiiiiiiiiiiiiiiiF 


D UCrORS DaUGHJLK state rlgjs- 

t red nof'c Lend n traiT*d B A decree 
honha''d typin cx^J v crctariai expenm e 
recuirev part i nc AAORK Tre^ Sep n-ter A ■* 
— Aedrexy No "‘VAa B M A Heu c Ts'i tovk 
Squire W C I 


L AD^ offers SERVICES SECRETARIAL 
and fum b*M roirr to Med cal o D nt-l 
hu cev n Li erpe 1 cr W irral rrcferr*d tut will n* 
to irav I Refcrcncci ex diar ed — Box F I 4 Lee 
>\D NioHiPvovLr Livcrpos .1 

L ady seeks situation as secretary 

no pr icu tccretanal krow ledge t t fully 
qual fied nunc honhan., v Titer -nd tyT 

excellent rcfercncc-v — Miss Be*t Fell xev 

Road Sxi Coxt-ee N AA 


M I? Z"' D <L 0 ND) desires MORNING 
In V.' L W ORK fre^ frvn 9 0 a n 
to 1 p m — Address No 9 B AJ A Hou 
Tavistock Square AA C I 


S INGLE MAN (AGE ) EN ROY AL MZRINT 
desires POST first sm c I'*avinc Service 
Oual fied di pen cr fSoc* t> of Armhccano) 
trained ick berth attendant RN can dnvc arc 
maintain car utllirt" lo be rencraJI u eful Any 
localtl ---Addrr' No "60 B Af A Hou e 
Tavj tock Square W C I 


S TATE REGISTERED NURSE VND SCM 
require' POST as CHALFFELSE and 
ASSISFANT CO a dxrtor — DC 9 M-dcna 

A enuc Wonhinc 

T he BRITISH RED CROSS SOCIETY 
desires the cni of a qualvfed MEDICAL 
W OAIAN for ihcir Hop-pi kir« Camp at Tudclm 
Hale near TorbndKc from September "ih f r 
about txo weeks Bo-td I 'dnns l-jpdry camp 
life and an h noraniirn are cfTcrcd in ex hans** fo 
%ery hsht ervwes — Arriy Red Cross 

Socirm 9 Chc'ham Street S W I 


T'HE ROY AL ARMY MEDICAL CORF 
A, ASSOCIATION E-x csxm Square 

SW I (Felcpbo Ai-ona 2 " ) sepp ic? 

cual I'd D pemem EveUee- 's Latcm cr 
A i ta"i Sammry A- Af i- Nc 

M n .tl ard S-'cnal T cair'est 0 "*trlies D r 
Clerk OrdTl cr Por'c's Caretakers et t h'-j' 
h fee to pre pectic employ m 


\/ 0 LNG lady TRAINED SECPETAPY 

A nurxin- d mc'tic c -i e d car-dn\m 
cuii~af^ En h public bool dmres po* tion at 
pri tc ccTct-'y with r ev< ra! rent -man o 
hdy— vddrex N " 4 << BMa Hcir=e Tavi 
f<k Square W C I 


P^RTVEP SHIPS 

TLNIOR PARTNER MALE PPOTESTANT 
xanted for Paftrer h p in g -od jfcurb 1 
Gla. -ox rrc' hare ay I -a* A*tI> xiih b *) 
pariubr of etper -c et to Cr^wf rd 

Herron ~d Ca-'er n S n r Wcvt G 

Street CL gix 

\ 4 ' ■p Ch B DESIPES partnership oP 
IVl i:> PRACTICE as a a •x'xjb' H 
held rex d rt poiv in tea h n-s h -v-i p r 

CMCrtial In om miAt be aS, e tl i>X — Addrex 
No t B Af A H N. e Ta toe*. Square W C I 


P ARTNER WANTED NOW IN WOAANS 
yroxTiu: c ct c near Lo''d n Amp e xtopv 
further expan ion Expenmae dcMrable — Senu 
panunilar ii Addrc' No BMA H«'vj<e 

favi rc k Square W C I 


P ARTNER WANTED IN CORMSH TOWN. 

Welt-qualified phyx ciaa married expene- ed 
G P £I -pvt at ■* years pur **3 e mmea e later 
Good hue parden garare Afortpa - if desr-cd 
—Add ex No "tl- BAJA Hoite Tavu. ock 
Square \V C 1 


P ARTNER YOUNG AND WELL QLAUFIED 
wan ed for Cor ul-ng Surpi-a! Practice 
Hontal appuirtmcnt — Wne full dectih to 
Adures No tiF BMA House T-yiaock 
Square W C 1 


P ARTNERSHIP OFFERED YIELDING £l-. 0 O 
Two year p e‘’a e *ith e later *ifie 

hurt a t tarcy aj, g-n ral e Sroth 

C - t Apr icart T-- i be exr«T'mw‘d Bcfln 
O tybuf I w— Addres No "II BMA Hou e 
T-vo cxk Scu> e AA C 1 


T hird partner reqlired after a 

pr li“*iParT 1 t-nt h p m cry o d-ext b- 
li *'cd r act "e wuhn ^0 miles Londm Aliut ba c 
Lrivcr ny d arec m rr-dnn- fpref-raby Oxen or 
Cat -b) and expenm e in p-tho om c rad o m 
cr ho’din in add m hieb^ n“d cal cq3li5*'ii “< 
AJ'dern ho pital ebe ce of boirxe. et — Adure«s 
No " 01 BMA Houx- Ta unock S^u-rc AA C I 


W/^EST LANCS COL NTKY TOWN PARTNER 
» » SHIP n fim of three Senior retim 
Afir 'll p-nat pc’* 1 ( > avur» e rectipc* 

60 A cll-quj ih d phy lan required P'' K- 
st-P appoi tiTert ml *narv Fifth qu rier har 
two vear puffi e i uJ p” dru” book d bt. 
C -tr-I uf" n ar-_rt m pnv-t f'-^den e — 
Address No " ^ B AJ \ Heuit Ti 'x.k 
Square AA C 1 


FKACTICES 

W ANTED IMMEDIATELY SOUTH 
AS CNtctn C u-t es coun or town PR AC 
TICE rc*) P pul ertuJ Hou' rcri 
or mort-^ Stmly conf dental No arerl_ — 
Addres No J- BMA Hoj e T-vi csk 


W ANTED general PRACTICE IN WEST 
I tdin- Yo h fc ireome ^I_fX) c over 
Good hou c and ''arden e"entiaJ Suit-ble cduec 
tional facit tics Sin tly confidcnual — Add css No 
06 BMA Hou e Tavistock Square W C I 


B JRAJINGHAM - MEDICAL AS OMAN 5 
PRACTICE fir xale est_blish-d over twent 
yean Panel f 0 Ore'S i one row £I 4 rt — 
App > Afcdi-o I— Edmund Street BJin n-ham 


D evon coast -practice in popllar 
town Pan I 90*) Receipts o\ct rco p 
Od-esiatkhed I years pure*'- c H-u e sal r 

r-nt Tl E W ESTER-S AJrDiC L AGENCY — O PC 

Strevt Bn tet 1 (Bn to — ard ! Bc^f rd 
Street Strand W C2 (Ttnyl- Bar ) 


D r\\^ Q (MALE) DESIRES OPHTH \L 
U iVl O mi PRACTICE c PARTNEP 
SHIP r eferab y m oath m E-'’*-aP.d Ca-’ ul 
a ^ilabl —Addres No " B M A H j«e 
Tavi to-k Sqa-ru W C 1 ** 

F or SALE NORTHLAfBERLAND OLD- 
c abli h-d couzlD PRACTICE. Avcra'-c 
j ri 1 0 Panel nearly '00 P-ccii-m I 

cars Commcdiu house wt h gnund and rwinz 
f nc**! Sell or let with uUimatc puT-ha c 

Paniculan— Dti.y -m K-<icnTi' 

I S?1| HOTS New -a tic Jputy-Tyne J 






















42 


THE BPITISH MEDICAL JOURNAL 


Juu 2J, ]93S 


L ondon s w is— death vacnnc^ old 

tst3h!i<>hcd Pan**! 1 SOO lORCihcr with 
private I R \CTICE and appointments Hou'^c on 
lease renewable rent £60 p a RatCb approximated 
£2S pa Prcraiuai 2 jears purchase Pull details 
on application — \ddrcss No 7561 DMA 
House Tisistock Square C 1 


L ondon \\c~pr\ctice doing £i ooo 

pa Pmcl I 104 increasing Premium £2 000 
Houve rent —T he V fstern Medical Acesc\ 
Bedford Street Str -d \V C 2 (Temple Bar 
2 ^ > and 22 Clirc Street Bristol 1 (Bristol 
2V,s9) 


M edical PRAcrncE for s\le in 

residential district near Manchester Pine 
hou c with garden and tennis court Panel 1 4S0 
Income over £2 500 Premium for house and 
practice £*' 37^ — Address No 7^20 B M 
House Tavistock Square NN C 1 


HARLEY STREET 


ESTABLISHED 1S60 


AND MEDICAL DISTRICT BEDFORD & CO. 


M iddle and working class prac 

Tier wanted in Birmingham or vicinitv 
fielding ibout £1 “’00 with fairl> substantial panel 
C ipit il available Nice house essential — Address 
No 7519 B M A House Tavistock Square W' C 1 


N ear lords— old established 

private PR \CTICE non panel non dispens 
inL Gross £2 000 Fees 10s 6d £1 Is Time 
for specializing partnership introduction 21 
vears purchase — Address No 7528 B M A 
House Tavistock Square WCl 


N P COAST —BE ITER CLASS EASILY 
Cj worked opportunitj for keen man 
Average £1 UlO Commodious house best rcsi 
dtntul disirii.1 Lxcclicni p ofcssional suite garden 
gjrigL (2 cars) Reasonable offer considered — 
Aodress No 7*:n BMA House Tavistock 
Square W C 1 


O I D ESTABLISHED PRACTICE NORTH 
Manchc ter averaging £1 300 Panel I 450 
Considerable increase possible by branch tn ad 
joining suburb Good location available Good 
house four bedrooms two reception attic garage 
excellent professional rooms with separate 
entrance Vendor neccpting fulltime appointment 
House and Practice priced low Sale urgent — 
Address No 7104 BMA Mouse Tavistock 
Square WCl 


O LDtSTMJLISHED COUNTRY PRAfTTICE 
for sale £(00 pa good appointments and 
panel nice room) house i(0 and garden rates 
tl^ — Vddress No 7559 BMA House lavisiock 
Squ ire W C I 


O LD rSTVBLISHED PRACTICE NENR 
Cirdiff receipts over £s00 per annum easily 
doubled b> cncrgclie man Modern house separate 
surierv garage ( cars) Practice P >cars pur 
chisv House £sno — \ddrtss No 7^18 BMA 
II u e Tivi tiH.k Square W C I 


W OM\NS PRACTICE LONDON GOOD 
s opt. fir mercise Panel 600 About £^00 
P I I rcniium IJ >ciri purchase or near offer — 
I Mi WisirKS Ml Pit VI AtlstY P Bedford Street 
Sirand W C (Temple Bar 2^32) ind 22 Clare 
Street Bn to! I (Bristol -26x9) 


HOU'=irS CONSULTING ROOMS 


40, RUTLAND GATE 

KM( iiT^nuiD( r 

IS THIS IDLVL POSITION NEWLY 
DEC OR urn \ND CHARMINGLY fURNlSHED 
SI RMCr ELYTLEIS (SOME WITH PRIVATE 
BMHROOMS \ND/OR KITCHENLITES) 
CHW BASINS CENTRAL HEaTINC TELE 
IHONE ALL ROOMS AN EXCELLENT STAFF 
SLIPLV MEALS ASRLQLIRLD 

PRICES FROM ao' to 6 GNS MEW AT 
ONCL YOl WILl BE DELIGHTED 

40, RUTLAND GATE 


A IIRSTCLASS MODERN DETACHED 
RESIDENCE 3 rceeptioa breakfast room 
kiteli n 4 bedre'ems laihroon Prett> gardens 
girae A cr> attractive pri pcriv magnificent 
eo» Jill a n everv wa> Main road poMt on amidst 

ext n e n-w evtale Ipswi h I re hold real 

lar-iia £1 1^0 — Mo»Lfa s Acfsca Sil''nt Street 

Ip-wi h 


pONSCniNG ROOMS WITH USE OF 
N-' (^ll\ cqu pped V rav r-'O'^ eve heat clce 
t f c" 1 a i p e d d exclusive Majfair 

rss- a rci ri^ fert — Add cs No " 0- 
It vt A H t e I nt vk Sqtnr- WCl 


T^fNOSSHItr ST AA 1 — EXCELLENT 

X t ! avaivbc rvc xc x oa» pe 

n * \ If % "* “7 '5 — Ac-reax No 


For all types of available accommodation 

BERTRAM & CO , Agents 

59 Connaught Street, W 2 Paddington 1G42 3 


pvoerroRS house for sale in resi 

-L' deniial pan of Lancaster Separate entrance 
to waiting room and surgerv Spacious garage 
Possession by arrangement — Apply to owner Mrs 
Gidson 12 Rose Bank Lancaster 


T^OC TOR S WEEK-END HOUSE AT 
J-' W'orxhing for sale sit well furnished rooms 
garden and garage £200 and transfer of lease 
Owner unable to occupy — Address No 7533 
BMA House Tavistock Square A\' C 1 


pVOCTOR S WELL DETACHED HOUSE 
-L/ good garage excellent position lovely garden 
new London suburb minute golf £1 275 freehold 
AA'nte Dr R 57a Dean Street W' 1 


H arley street —exceptionally large 

consulting room in one of the finest houses in 
the St ect rent £250 p a Another on second floor 
(lift) at £150 p a To view and for all particulars 
— Address No 7110 BMA House Tav stock 
Square AV C 1 


F or SALE ONE or the finest houses 

in the Harley Street district Income from 
lettings of consulting rooms over £I 000 p a Excel 
lent residential and consulting room accommodation 
available for pur».hascf Long lease for sale at low 
price — Address No 7109 BMA House Tavistock 
Square W' C 1 


H arley street and district— a num 

ber of excellent CONSULTING ROOMS are 
ava lablt for full and part time use at moderate 
rents Particulars on application — Elcood and 
C o 10 Henrietta Place Cavendish Square 
W I Lang 2601 

TMUCLEUS AND ATTRACTIVE DETACHED B 
■i-^ HOUSE N London close to new Tube rail y 
way station Well situated six b d and three rcccp 
tion roonii* separate surgeiy entrance brick garage 
matured garden and all modern improvements 
tncUiding laud basins rent on long lease £175 per CL 

annum with v cll-cstablishcd nucleus of £3^0 per of 

annum Including panel of 270 Private advertiser Fill 

with other interest unable to accept midwifery or mai 

any night work Ample store Suitable for family Bci 

man or one desiring to take resident patients pro 

Open to any investigation Premium £600— T 

Address No 7510 BMA House Tavistock ©f 

Square W' Cl is i 


Q ueen anne street— only £40 pa 

secures cxccpHonallv fine CONSULTING 
ROOM lor use when required with attendance and 
all services Residential accommodation available 
—Address No 6355 BMA House Tavtalock 
Square AV C I 


R ADIOLOGIST OFFERS PART TIME USE OF 
CONSULTING ROOM with diagnostic 
\ rav and deep Tlicrapy apparatus London — 
Address No 7^57 BMA House Tavistock 
Square A\ C 1 


S TALY BRIDGE CHESHIRE 7 MILES FROM 
Manchester Substantially built large 
del ichcd HOUSE right in the midst of dwelling 
hoiist but not on a noisy main road Contains 
2 large entertaining rooms 4 bedrooms Has 
been in the past medical practitioner s residence 
and surgerv and is eminently suited for a 
maternity or nursing home Adjoining is a cot 
lage which would be a suitable residence for 
nurses Large garden at side Owing to the 
owners having gone into permanent residence 
abroad the whole is offered sub cct to a chief 
rent of £11 I4s lOd for the very low sum of 
£3S0 tor details and permission to view apply 
to S IITH ASP KstCMT r ALP A Highficld 
Estate OfTiec Gorton Manchester 


S UITABLE FOR PROFFSSION AND OCCLPA 
tion imposin'* CORNER PREMISES ground 
floor to let ofl mam road 20 yards bus stop 
W iMc den Green has b''cn do''tor s surgery for -5 
years Accon modalion Entrance Hall 2 Bed 
rooms Reception Room Dining Room Kitchen 
usual offices large garden garage available 
Ilental £1-0 per annum in'* A i''w by appoint 
mtni 4-t fachbrook Street S AA I Aictoria 7030 


ESTABLISHED 1S45 

ELLIOTT, SON & BOYTON 

(H C Row c F S I ) 

■\EKi: ST. DISH SQUARE, M 1 

Es ate Arerrs Auelloneeri an I Sunejors 
are the BEST LOCAL AGENTS for HOUSES and 
CONSLLTING ROOMS m the Harley AAimpoIc 
Ouc'*n Ann^ nrd other s rect:> in the Cavendish 
Nquarc distri-'t Aaluationv for all purpos'*> 

T<!e>chone 3-04 MxYFAtiL 


Survey orj Auctioneers and Estate Agents 
10 WIGMORE STREET 
CAVENDISH SQUARE W' 1 

Speciilists in Professional Houses, 
Flats, and Consulting Rooms 
In Harlcv Street and leading Medical Posiiltns 
Telephone Langham 3927 end 392S 


SUITABLE FOR PROFESSION AND OCCLT\ 
^ tion imposing CORNER PREMISES ground 
floor to let oft main road 20 yards bus stop 
AA'ilIcsden Green has been doctor s surgery for 2^ 
years Accommodation Entrance Hall '* Bed 
rooms Reception Room Dining Room Kitchen 
usual offices large garden garage available 
Rental £120 per annum me View by aproint 
mem 44 Tachbrook Street S AA' 1 Victoria »0 j0 


V^IMPOLE STREET — HIGH STANDARD 
▼▼ CONSULTING ROOMS RESIDENTIAL 
SUITE and S/C MAISONETTE available Lpa 
rentals including full sen ice and aitcndanci. Lease 
for disposal — George Carlton Esq Park West 
\V 2 Paddington 6250 


W EST END MAIN DOOR FLAT AT 
bargain price — In best part of West-enJ 
at IS GIcncairn Crescent Edinburgh contain n 
2 public rooms 3 bedrooms and maids room 
2 bathrooms kitchen pantry Being now rNon 
structed in modern manner and will be finished u 
purchasers own taste — Address No 7^08 BM\ 
House Tavistock Square WCl 


mSCELLANEOUS SALES, etc. 


IMPORTANT 

to MEMBERS of ihc 
MEDICAL PROFESSION 
CLOTHES OF'DISriNCnON (or GCNTLEMES 
of DISCRIMINATING TASTE Specially Ciik 
Fitted and Moulded to each Individual figtire 
made from Finest Qinlity Materials and In t** 
Best Possible Style cost no more thvn man 
production ready made clothes 
The invaluable Pnciiv-al Experience and Adn** 
of our 14 Expert W'est End Cutters nnd Fiiitn 
is always at your disposal 
\IL lULL^ONr Proclt.rlloiH 
FIMSIII D n EVLR'V L'i'FNTIVL DFTVrL 
SPFC! IL OFFER 

JVChFT t ^^ST (In blatk or prry) II 
I InecI bcfll C|iinlity Vrl Safin \rl SHk of Alpff* 
SOI ID ^\^C^ MOnSTLD TnOUSEIIS £2 -I 
The Idea] Suit for I rofc^xlonal or Du Jne 
I OUNCI SUlTb to measure from £6 6' 

OYFItCOATS , „ £S 

DINNER SUITS 

DRESS SUITS from £10 lOi 

PIUS FOUR SLITS from £6 6* 

THE IDI AL Sill! for Country nnd Sporting ATejr 

COLD MEDAI RIDINC IIRLECHIS from £2 
RIDING II ADITS , i 

RIDINC BOOTS 
COSTUMES LONG COATS 

UNSOLICITED APPRECIATION 

/ sironql} adnse all medical men i»/io ! 
ha\e satisfaction to patronise Harry Hall ltd c’ 
all tic clothes / ha\e had from them dunri J 
sears ha\e been perfect in Fit Cut and Fwsn 

(Signed) S J A MA MB rRCr5 
PATTERNS POST FREE 
Perfect Fit Guaranteed from Simple S If m-aju 
mcni Form or Pattern Garments 
ANIlor, to London ran order nnd fit 
Special Pattern, would then be cut and FeT i 
(ilitni. Clothe, euj plied after *vllhoiii Iryinc 

HARRY HALL, LTD. 

Governing Director Harry Hall 
THF Cent Drcccbce Habit ond Co!io«» 

Spcelalint* rr‘» 

181 OXIORDST VI 119 CHCAP^IDF.. I ^ 
Telephones . 

GERrard 4905 4906 nnd 4907 NATlon 1 
Makers of Finest Qua! ly Bespoke Civil .. 

and Hunting Clothes for Ladies and Gc'*rl 
lllt,nc,t Award, 18 ( old Alcdsl* 

E,t over 10 year, _ 


INCOME TAX 

YOUR burden I OUR I il Ine 
Ta« Sieelali I, to tlie Aledieil I fr >«•* 

HARDi A HARD! — 

W CIIANCFRY I AM lONDON 

Telephone lit Iborn .rax 

H rl e for fr e copy of Adsice on Iricom J ^ 






























Juu 2"^ I93S 


THC BRITISH MEDICAL JOURNAL 


a : 


COVERS FOR BINDING 


Nol^ I ind )I of the HKITISH 
MrOICM JOUR\ M for 19^7 
ind prcMoiiN \c\r^ cm be hid 
rrKc 2*^ 6d h\ pTrccl post 
2s lOd C'lth 

Orders with npproprntt. rt 
should fc iddresscd 

to - 

1HC SrCRLTVR't 
IlkniSlI MCDICNL JOURNAL 
b HOl^r 1 WISIOCK SO 

LONDON W C I 


APPOINTMENTS — Contd 


gT JOHN b HOSPITAL LEWISHAM SEl 

ArpI aiun ore jn>iicO ftn ft.c cfC<! med it 
prj nit oners t fill the t. c < CLINICAL 
ASSISI ANT ti the AlcUini! ON cr in Charpe of 
the Eletn at anJ Afa \ace Derarfrent The 
s. ful a’'n ant \* I? be rcvuirc^ to atfenJ the 
h '^p tal on «hr •< hilf-tJat a \ exV i an h lofanu'n 
of 0 Cuin-m rvf nn m 

AppI ati n hi uld K re».c: ed h\ the uruer 
pned \»h V.1II be plea cJ to t\e further 
panicubr 

J C GILPERT 

Sevretao Sj^'cnnicnJen! 


G eneral lmng in hospital 

^i,rk Road Lambeth SEI 

Appli’aii n are mrited for the pot of 
RCCISTRAR Preferm e 'mH be si en 10 th>'c 
-andidiies "ho po c>n the qjal fiiaiicns of 
I R CS (Efl ) 

Aprlicaiicp tmh cop e^ of thtec fe'ttm''’*u3 
n ^ ent not laier than Jul> h 19’'' to the 
SecTctan 


P RINCESS LOUISE KENSINGTON HOSPITAL 
TOR CHILDREN 

Si Oi»nim \\cTiue North Ken insion AA 10 
<Ladbrolc 0133 ) 

The n atd c! Atanjccmcnt intiie nppb ntion 
1 T ihe of HONORARY ASSISTANT 

I inStCI AN uith bcdN 

Apnli'am mtPit be sradiinc< ol n Lnpcr‘t> 
mJ mu i h Id the M RCP(London) and the 
ixo>.ful carddite ill be required to sec Out 
Put nw 

Appl jtion4 cc maimed b> cop e< of ih tc 
tc^tiomnah h u J be cm to the undcr'i'’ned at 
the H npitil from t h 'm an> further informat on 
tin be b aired and Oiould reach h m n^i later 
than JuK tOih t^JS 

H J ELE^ 

Seciciary 


R OA \L LONDON 0*‘inil ALAIIC HOSPITAL 
(AIOORIICLDS E\E HOSPITAL) 

Cii I I d L C 1 

Appl ii n arc in ilcd f r the po't of OLT 
PAItLNT OTHCER to a ic"J n Tcc^t.a'i ard 
f t dw <r"om Cl h i^cek 
Cird u t~t mi be re teted Med al Prattt 
II n ^ 

S-lir> at the r ic f fUW per n-un The 
Out pill ni or f »l be pp Pled fra penoo 
I f t »' >car ard uiH K cl b'e f r rcjpp ntment 
C p Cl of re tilat n" in lx otaiin'd on p"!! 
ation 

Ap''! at n Iih tcti m n cat n a rd 

t ) I -at on l th r r nh pho r ''h muM be 

rc Cl ed b> th iinJer sned ntt later than Aueii 
ltd 1 > \ 

A J M TARR ANT 

S-ercti y 


M 


t L D M \ ^ 
All t n S rt 


A! I S S I O N 
I B«.thnal Crecn 


HOS! JTaL 
C. 


Appli an n arc in ited for the p*^! of ASSIS* 
TANT CASLMTT OTFICER (female) tth ch 
becono laeant on September It 19 s The 
appo ntment ts non resident ard for $« non h 
S laf) £1-5 ptf ann m Dinrcr tea ard appvr 
ithen on dut> 

Candtdiic< m 1 1 be r«.e tcred under the Med eal 
A 1 ard the Mildna> Coi nol 1 ant ou that thev 
hoalJ be full> in jmpathj with the reli'*'cu* work 
of the H •wpjtal 

Appli-ton With copiet if rctcnt iC' 
h uld be cm 1 ih Medical S l•^enrtcrdml at 
orn a ro< iNc 


THE DOCTOR IN FR^aiCE O? 
ABOUT TO ENTER THEREIN SHOULD 
BE ADEQUATELY PROTEaED BY 
INSURANCE IN RESPECT OF 

HIS LIFE 
HIS HEALTH 
HIS HOME 
HIS PRACTICE 

A^D 

HIS CAR 

c 

FOR ALL THESE 
CONSULT 

The 

Medical Insurance Agency 

t Lit Tiled bj Guarantee) 

BRITISH MEDICAL ASSOCIATION HOUSE 
TAVISTOCK SQUARE WCl 

□ 

V/E CAN ALSO ARRANGE 
ADDITIONAL CAPITAL FOR THE 
PURCHASE OF A PRACTICE O" 
PARTNERSHIP 

Mn(p ns*' next birthday 
trheri tenting 


SMALL ADVERTISEMENT FOR INSERTION IN 
BRITISH MEDICAL JOURNAL 

The Minimum charge is 9^ which co^cr^ up lo 30 words Extra words are charged Is 6d 
for 5 or less Example words would be charged ns for p 5 Name and address should 
be included when counlmc words tor cost 
If Box Number is used it should be reckoned as > words in the total 



To the Adterlisement Manager BRITISH MEDICAL JOURNAL BMA House Tat istock Square London W C I 


Please insert mt adtcrlisemcnl in issues Name 

Addres'*^ 


dated 

I enclose remittance talue £ 


Date 








44 


THE BRITISH MEDICAL JOURNAL 


JuL\ 23, 193S 


ARCHIVES OF 
DISEASE IN CHILDHOOD 

JUNE 1938 

CONTENTS 

Intracranial Haemorrhage in the New-born By W S Craig, M D , F R C P Ed. 

Vitamin C Excretion m Children, with Particular Reference to Rheumatic 
Feier By J D Keith, M D , and Evelyn M Hickmans, PhD, M Sc 

Otitis Media and Mastoiditis in Infancy By Grace McConkey, M B , B Ch , 

B A O , D C H , and Edward C Ross Couper, MB., Ch B , F R F P S 

Radiology m the Diagnosis of Hypertrophic Pyloric Stenosis By Leonard 
Findlay, DSc,MD,FRCP 

The Blood Phosphorus in Egyptian Infants By 1 A Sabri, M R C P , 

D T M and H , and M A Abboud, M R C P , D C H 

Osteopetrosis By A M Nussey, M D , M R C P 

The Cooley Syndrome in an English Child By E G L Byivaters, M B , 

BS, MRCP 

Case Report A Case of Diabetes Mellitus in a Young Infant By John 
Deiine, M B , Ch B 

PUBLISHED QUARTERLY 

Yearl} snbscriolion (4 numbers), 25/~ To membeis, 20/- 
Stngle Number, 7/6 

Issued by the British Medical Association, Tavistock Squaie, London, W C. 1 


Tins cookeiy hook is based on the latest scientific standards. 
Medical pi actitionei s can paiticidaily lecommend it to those 
of then patients who have to get a full pennyworth of food 
value fiom eveiy penny of theiu Outlay 

¥HE DOCTORS’ 
COOKERY BOOK 

21 Menus and 82 Recipes for Family Meals 

21 PAGES OF PHOTOGRAPHS 


PUBIISHED THE BRITISH MEDICAL ASSOCIATION 

ksellers rct^s s. Smith s booksTalls ard Co^o^ieratne Soaeties 
All t* ju:r t t! B t Tcfitc K Sq targj Lor dorr W C t 


Juu 2*^ 19 ^ 


THC BRITISH MLDICAL JOURNAL 


THE MEDICAL AGENCY, Ltd 

DUniEli IIObSE 3G-3S SOUTHA’MTTON ST^ STTAVD WCS> 

T I r nr —Temp rUr I0»4 10 4 EswM bed lo I':93 by J ^ Fe 


LOSDOV W — P\RrSERS»IIP Suburban G P 
rc Hpuvc to rent Recopi^ ncaf!> £6 ro) 
Panel appri T 4 *^<0 One fifth hare -.1 >ears 
piirchare ».«h ty < nc third 5hare 
MinOLCSE\ l\V ) — C P f;ro«kinz ^c^ide^tlaI 
k'C'il ty Excellcm hoit«c »ith larcc ptca'an: 
rrrdcn Rcctipt appm £3^00 Panel I Ft) 
Pert 3/6 up Ptem year^ purcha c Free 
h( Id hou^ and furniture £3 COO 
WEST COUNTRY <Scasttlc»— PARTNERSHIP 
He u c to reot on lea c Receipts £3 COO Panel 
1 l'*0 Fers 3 6 up One chir I share 13 
years purchase 

LtJNDON (Rc^ideoml subi-rb) —PARTNERSHIP 
C v<d middle-sta % non-d pens G P Receipts 
approx f ^•>3 Panel ftelect) oscr 00 Fees 
** 6 up J share - yrs purchase or near offer 
LONDON \V I — OlJ-estah G P mam road 
Suit house ava UMc Re eipts appro* £500 
Select parcl 900 Prem 2 years pur hasc. 

MA\y OTHERS FOR S^E 


Ss-ope for fuM tirr- 
LONDON U —Gro^n- PPaCT ness, 

Est^rc Small hetrse to rem Receipts £_ o 
Panel 600 — scope Fees - 6 up Prem t“ f 
or near offer 

LONDON S \\ 1_ — Old-cst_fc c»bcc! ci dd e-cia 
G P Residential I cality Lartrc house ’'ferdd 
jrarden Reccicis appro* £Uro Select pan.*! 
nearly 4 0 Fees ^ 6 up Prem un IJ yc-rs 
pctclusc. or rear offc' 

HERTS (Border) -Middle-class PRACTTICE Ren- 
dental locally Corner hot^ e 'o^d-n ri*-. 
Rccei"ts nearly £1 CO Pa-el o -r ^CO Fees f 
op Premium .. years pcrch^e or near o'Tcr 
SLRREV — ^Mncd G P RcsK-cn uJ Iccalio 1 
house to rent Receipts appr x 1—0 P neJ 

oser 4C0 Premu-m £1 «tO 
LONDON N E — Middle-cL s GP Pc;.c r 
approx £-. ^OO Pare! 1 I'D Fremium yean 
pur hasp cr rear oLer 

DETAXLS ON REQUEST 


PERCIVAL TURNER 

ITD 

MEDICAL AGENCY 

■ — isT\rn»»inji m m \n»> — . - 

2 o MUDEN LANE, STRWD W Ci 

fCtf'cr of Bedf rU Street) 

Tef F am ** I P **m) n I on Ion 
Phan* Temple (1 r noil (1 Iln ) 

Mter iffce hours W aJton-on Thames 1"''^ 

A •s ants arnl Locums Pro'idcd with it fee to 
rrn ipals Practices inscstifatcd B ■s'V keep n- 
Debt Co Iccunc etc 

MAMMI'I INUI'IAF tOMMI''''ION IO» j 

Mill xtiNCT o> '.vu ov ruviTiti <m 
•*iunf ixcLi^iM Of iioi '•f rnoimrk 
rso n LL TniM*. ON III ni »>t 
FOR ni'‘rO''VU 

SURREI SUBURB— PIRTNERSHIR 

Half Share of £3 POO pj Old-est incfea in* 
mr«ucrn heu c tarden and rararc to let Premium 
HrxNl— I 

DERBl SHIRE— COUNTRI PRAC 

T1CC» about C*"0 pa tood cU select panel in 
CTca me and scope choice of house Premium IJ 
yean, purchase — 2 

MIDDLESEX SUBURB — PARTNER 

SHIP under 12 miles from London share rtoduc 
me 14X0 pa to commcrKc tn fast incrcasinp Prac 
ucc ch ICC cf bouse Premium >ts purcha e — 3 

NORTH XNTS — COUNTRI PRAC 

TICC cld-cst \ endor retinnt About £1600 pa 
end fAancI worth £910 pa 4 APPt Nice hou e 
frr Nile Premium H years pur ha e — 4 

H^DE PARK NEAR — PmSICO 

THERAPT PRACTICE about £1 600 pa Well 
ent rood class Ample accommodation on rental 
rremium £1^(0 — < 

LANCSTO\\N— OLD EST INCREAS 
ING £1 100 pa Select panel of 1000 N»cc 
house arnple accommodation Premium £1^ o 
trel drups and surpefy furTuture-~6 

KENT SUBURB —GOOD MIDDLE 

CLnSS about UCO pq incrca mr scica pane! 

us 6 up surpcD Nice Tudor house for 

c«!e nichi let fVcmium 1} years purcha e — 7 

SOUTH COAST— OLD EST NEARLA 

al -OO pa trvcTca me Fair panel maed middle 
►nd better class Nice detached house ample 
ce mmpt.-ti n eardeo and carafe for sale or 
TPisht let. Premium <5~00— f 

COUNT"^ TOWN WITHIN 100 MILES 

OF LONDON —PARTNEPSniP with early ucces- 
iL.n tn EST Practice atx>ut £13*0 pa ar>d 
arrointmenis £* 0 pa . years purcha e Pur 
ch cf should hate F R CS Choice of hou c— 9 

DEVON —UNOPPOSED COUNTRA 

c Cf £1 IPO pa iftLfeasinf panel worth £3f0 pa 
tppo nimen s £60 pa Premium Cl «*0 EtceM nt 
freehold house ample accommodation farden and 
fTifafc for sale £- *on Mofifafc arranced Pre 
mium Cl h 0 —Id 

BIRMINGHAM NEAR— M ELL EST 

nearly CF(X) pa increa-ioR food scope panel 
nearly SPO dcACloping area Compact house 
r’fdcn and farase for s-Je at £S*0 or let at 6d 
pw Prcmiura £I..(X) — II 

HANTS — OLD EST AVERAGE 

£I 000 pa Pare! I 000 Appi-iniments about £1*0 
pa Good family house nice rarden and carafe 
to be sold ubsiantal moncacc arranjjcd Pre 
msum IJ years purchase — 1 

^ ORKSHIRE DALES —BEAUTIFUL 

ccuniD old-establrshed average £1 000 pa Larpe 
hou e and trounds rental only £60 p a Suit resi- 
dent patients Smaller house available Panel worth 
£3-0 p a Premium £1^00 — 13 

NEAR VICTORIA S AVI— LOCKUP 

.iboul £500 pa incrca-inc panel 3 0 good scope 
Ample profcsMonal accommi^auon on rental at £“0 
pa Resident housekeeper Premium IJ years 
purchase — 14 

MIDDLESEX SUBURB —PARTNER 

SHIP Half Share of mcrcasins Practice producing 
about £2 000 pa Panel 600 developinf area 
ChoKc of house Premium 2 years purcha e — I* 

MIDLANDS— OLD EST NEARIM 

PORTANT town scope \ endor retinnc Aboi t 
£6 0 pa Panel 730 2 appointments £101 pa 

Premium . years purchase House 3 reception 6 
bedrooms separate surgery entrance food garden 
rarage and outbmldmfs for sale or might let — 16 

GUILDFORD— NEARLY £700 PA 

fa t developing rood scope increasing panel of 
30 Compact hou<e in good position on rental ai 
£"0 p a — 17 

SOUTH WALES — PARTNERSHIP 

huU share seaside town receipts £3 *’04 Panel , 
- 00 Appointments Senior partner rcfmng Nice | 
bouse facing sea 3 reception ^ bedroom usual 
offices 2 acres of garden tennis court garage 1 
«ic for sale or rental Premium for half share - 
years purchase — 23 

NO CH\RGE TO PURCHASERS 
financial ASSISTANCE ARRANGED 

assistants — VACANCIES IN 

Town and Coonto Indoor and Outdoor Li t on 
-cplicaiion 


EsTxeusiinv 1S77 

LEE & MARTIN, LTD, 

Thf Birmingham Medical Ajrency, 

71 TE.’lIPKE now BIBMINGHAaM 

Trirfrrami Te^ephonr 

Leveum Birmingham ** 3963 Afidland BTjqm 

Tn\NSFER OF ” PRACTI CES AND 

rARTVFRsmrs abb an geo 

MAXIMUM FEE £-0 If caclusixcly 
entrusted to u*. 

y<CCOL\TS l\t ESTIGATED A^D I\CO\f£ 
TAX RETUR\S PREPARED 
RELIABLE AND EPHCIENT LOCUAfS SUP 
PLIED AT SHORT NOTICE also ASSISTANTS. 

« XVTED TO PLRCHA^E 
1 BIRMINGHAM (or within *0 miles thereon — 
Good MtTcd PRACnCE wiih a panel of 1 -OO 
o cr and receipts of from fl OtV£ OOO 
UROESTLT required CAPITAL AS AIL 
ABLE '' 

REQUIRED —Good English Seettrsh and Invh 
LOCUMS immedate post to cTer also 
ASSIST ANTS required good posts to offer 
with Of Without view to fanner hip 
FOR onro^AE 

I —GLOUCESTERSHIRE — Well evtat hed 
middle an I worktn..wlj s PR ACTICE. Rescirt 
av £1 -30 pa Panel 1 -CO Scope to mcrea c 
and good heu e 

STAFFS —Rapidly incrcasinf mued Pnvate and 
Panel PRACTICE Receipts I- t year £10 0 
Panel I 30 Excellent house with all ervices 
Pleasant locality 

3 MIDLANDS — PARTNERSHIP with early 

succevsiort i n w ell-established E-r Np<c and 
Throat PRACTICE. Receipts av £1 0 pa 

plus Aproinimenis ff 0 p a In omer should 
have F R CSJ and Specaltst experciKc 
Excellem house to rem 

4 SOUTH wales— O ld-established middle- and 
working-class PRACTICE Receipts J-st year 
£2. 00 Panel - K*0 Good house 

A MIDLANDS — Old-estaWishcd industtial and 
niiddlc-cLss PRACTICE. Receipts avcr-gc 
£1 06^ pa Panel 96 Go od h ouse 
6 MIDLANDS — Country PRACTICE in growinv 
district. Receipts f* 0 small panel and good 
house 

financial ASSISTANCE aflorded to approred 
applicants for the purchase of Pracuccs or Partner 
hips on scry reasonable terms. Full panicuT-rs on 
applicaijon 

RELIABLE AND EFFICIENT LOCUMS 
SUPPLIED AT SHORTEST NOTICE. 


Telephone Wclteck 27 b 
lefegrams Assmu to Lontxtn 

NURSES 

MALE OR FEiMALE 


TRAINED NURSES FOR 
MENTAL MEDICAL SURGICAL. 
AND FEVER CASES 

A urses rrsidr on the premises and ere 
a a lable to u tent etdls Das ond A rght 


THE NURSES ASSOCIATION 

(In coniunciioo with the MALE NURSES' 

association ) 

29 'iork-St.,BakcrSt.,EondoTi WJi 
Mrs MILUCENT HICKS Supt 
W J HICKS Secretary 


ESTXBLiSIlEO 1*6* 

PEACOCK & HADLEY, Ltd , 

XIEDICAI. TKANSEEB AGENCT, 
67-6S,ChandosSt BedfordSf Strand \\ C-2 

TelefT ms Herbara Lesquare. Lcrd^,n. 
Telephone Temp e Bar 

LOCUM TENENS and ASSISTANTS supp ed 
free of charge to prynapaJs. 


FOR BISP0S4E. 

I NEAR PUTNEY SW— DELATH VACANtTY 
OltJ-establahcd PRACTICTE Recerts bom 
£2 (W pa m luding panel 4fcou» I EW Nrc 
surgery prctaocs on renal 0"crs 

2. NEAR HOLBORN W C — W cll-e-t b! sbed 
PRAtmCE Keccjpw average £I NX) pa- 
panel 1 104 Splerd d surgery -cct-mccaLcn 
only Long introduction Prcniurj £-0ro 

3 NEAR ALARBLE ARCH W —SHARE th rd 
or K-Jf of a good<Iaas PRACTICE. Rcveip s 
about nearly D WX) pa Preraiun accerdn'* to 
valuation Well cstab i>bcd 

4 A nur'ber of mall PRACTICES at Kw pre 
miu"* Excellent o^'rortunucN fee prac 
titionerv wi_*in" to get a Practice with «.orc. 

< GLAMORGAN COAST— HALF SHARE cf 
rlu-totablisbed PRACTICE Recerpi* average 
c cT £3 OCO p a L-rge panel \ ery Pne heme 
with '•ood ground for sale Premnrn let 
share two years purcha e parable parr by 
in lalmenu 

6 NEAR FULHAM SW — WcILcNiatl hed 
PRACTICE Re^emts L r year over *40 
parcl nearly *1%) increavin,. N^e heu c cn 
rental Prcp’iuin £I .-.0 

7 SCOTLAND — O u-est-blrsh-d PRACTICE 
\ endor rctinng Recapts £1 (XX) p a pc-cd 
pare! Good introduction £500 accented for 
immedute sale 

8 LARGE MIDLAND TOWN (Suburb) —PR AC 
TICE held I6 years by Vendor Receipts a cr 
age nearly £?00 pa good panel Arr*n e 
house on rental Premium about £I-.(X) 

9 wanted IN LONDON OR PROVINCES 
PR aCUCES with ireomcs ^00 to £-£00 pa 
Manv purchasers w-itmg ard qir fc ir3rv---tiors 
for OTimcdnte cash 

No charge made to pu chaie s o for i qw ct 


THE WESTERN 
MEDICAL AGENCY 

Dr K H Benvett atJd Dr W J Pa* 4 more, who 
giTC personal -Uenoon to ex cry cbect. 

22 , clabe STEEKT BKISTOX, 1 

Teles hiedsen Bristol Tef Bnstol 2-t- 9 

15 BEDFORD ST., STR4NT5 W C.2 

Tel Temple Bar 2532. 


THE NEW MEXTAB NURSES 
CO-OPERATION 

6 ^ Qukb CwrdenA. Law a ter Cate % 2 
(Late of 139 Ed^ware Road ) 

Spcoally named Nurses for Mental and Nerve 
case (All Nurses arc insured under the Employers 
LiabiJiry Act 19C6 ) Apply the Supt. 

Telesrems Telrph nr 

Psyconurve. Padd Lend " No 6105 Padd 




THE BRITISH MEDICAL JOURNAL 


Jui'i 21 1918 




(Tlie SCHOLASTIC, Cl EBICAL A MEDICAL ASSOCIATION 

{PoUNDtD I8b0) 


Tele Address 

Triform, Westcent — London 


TAVISTOCK HOUSE SOUTH 
TAVISTOCK SQUARE, W C 1 




Tele{>hone Euston j 


The Assocntion h^s long been fa\ourably known to the members of the Medical Piofession as a thoroiiglil> 
trustworthy and successful agency for the transaction of every description of Medical, Scholastic and Accountancy 
business and the BRITISH MEDICAL ASSOCIATION has every confidence in recommending its members 
to consult The Manager in all transactions requiring the services of a Medical Agent 

Members of the British Medical Association maj take advantage of a reduced scale of charges applicable 
to them 

REDUCTION IN FEES 

In cases where the Bureau aie sole Agents the commission in 
lespect of any sale of goodwill book debts, fuinituie diugs, 
fittings and other effects (excluding sales of any freehold oi lease- 
hold propel ty oi of piactices, eftects etc outside Gieat Biitam) 

IS limited to a maximum fee ot Fifty Pounds 

FULL TERMS ON APPLICATION 


Piactices and Partnerships for Disposal 

1 SURREY— PARTNERSHIP in Practice of about 
£3 000 p i in residential distnet Pmel 630 Modern house 
(4 bedrooms) fcirige garden To rent One half share £3 000 

2 E ANGLIA —PARTNERSHIP in country Prac- 

tice of about £2 200 p a within easy distance of coast Panel 

1 300 Well built house to rent One third share two years 
purchase with succession in five yeais 

3 NE COAST —PRACTICE of £1 400 pa in 
small seaside resorl Panel 300 Double fronted house (3 
bedrooms etc) for sale Premium 1+ years puichase 

4 LONDON EC— PARTNERSHIP (with good 
scope for privaie practice in a speciality) in Practice mostly 
derived from v iluible appointments Share of £800 to £I 000 
at hrst It two years purchase Partner must possess the 
M D or M R C P or I R C S and preferably have City 
connections 

*! S WALES COUNTY TOWN —PARTNER- 
SHIP in Pricticc £2 800 pa Pmel over 1 000 Visits 3/. 
to £1 Is medicine evtr i One half shire on reason ibic terms 
P inner must hold F R C S Cng Hospital and excellent 
opportunity for surgical scope and ippointment on staff 
Prcliminirv Assistaniship 

6 W OF ENGLAND— PARTNERSHIP in Prac- 

lice iboiil £4 300 p i in small town Pmel I 730 Choice 
of two houses One third share at two yeirs puichase 
Pinner igcd iboul 30 who his held hospital appointments 
Prcliminiry Assisi mtship 

7 ESSEX (Borders of Eppmg Forest) — PARTNER- 
SHIP in sic idilv mcrcising Priclice over £3 600 p i in 
grovvini, icsidcntiil dislricl Panel 1 700 House obtainable 
One fourili shire it two ycirs purcliisc Cottage hospital 
Scope lor in icsihclics 

b RENT — Upper middle class PRACTICE in grovv- 
inc rcsidcntiil district Receipts 1937 £632 Small panel 
Mvidcrii well plinncd double Irontcd Tudor house for sale 
or rent Scope I’remium one and a hilf years purchase 

9 SE COAST — PARTNERSHIP in non dispens- 
iim Priciicc ibout £4 300 p i Pmel 1 400 One fifth or one 
fourlli shire il two veirs purchase Prcliminarv Assistint 
ship Scolsmin prelerred 

l() LONDON N 12 — Middle cl iss increasing PRAC- 
IICI m crow itK district Receipts past vear £420 Pmel 163 
Modern I iboiir sivinc house for sale or rent Premium £630 

II S WALES — Contrict ind small private panel 

PRACIICI over £I 900 p 1 in industrial district Pinclovcr 

2 101 House wiih surcerv premises to rent Prospect of 
Ippointment Premium £1 300 

i:s COAST HEALTH RESORT —OPHTHALMIC 

PRXC'llCl Receipts 193S £1600 House to rent Un 
hmilcd s^ope Premium one vear s purchase 

13 LONDON SW-ELECTRO-THERA- 
PI bIIC\L PRACrriCh Receipts 1937 £ I 727 Large con 
siiliiiic re>om and treatment room to rent Premium £I 600, 
pill ippiriUis V ilued iboiit £730 

14 lONDON N— LOCk-UP PRACTICE £390 

pa run bv rreiliw il woman Panel 327 Rent at surgery 
7 ' weekls Good scope Premium It years purchase 

33 S CO \ST HEALTH RESORT — Non dispcns- 

(' L*' ’ ’L’ P-"* P^ncl but ample scope 

V' ms. Ill ,n, Premium £2 3CK) 


FuU Particulars sent free 

DEATH VACANCY —ESSEX SUBURB - 

Receipts ivciagc £989 pa Panel 733 Well situated house 
for sale Scope 

17 N WALES — Popular seaside lesoit Good class 
chielly non dispensing PRACTICE, averaging £870 p 1 
No panel Excellently sitiiitcd detached icsidence for sale 
Good scope Premium two years purchase 
IS LONDON E— Cash and panel PRACTICE, 
averaging £2,800 pa Panel 4 300 House (3 bediooniv) 
Rent £136 pa Scope Picmium two and a half yens 
purchase, to include drugs etc 

19 W MIDLANDS —PARTNERSHHVin Practice 
averaging £6,000 p a , m maikct town Panel 3 500 One 
sixth share at fust at two ycirs purchase Incoming partner 
should be aged 28/30, and vblc to do generil suigeiy ind 
minoi EN ind T work Hospital Prclimm iry Assistantsliip 

20 N MIDLANDS— PRACTICE m residential 
district near progressive town Receipts 1937 £770 Panel 
about 100 Choice of two houses tor sale Good scope 
Premium £800 

21 S OF ENGLAND -Well-established SANA 

TORIUM for the open air ticitmcnt Receipts at piescnl 
at late of about £3,000 pa Pieinium £1,000 to include 
fuiniture clc s 

22 LONDON, SE— PRACTICE, averaging £800 
p 1 , in populous subuib Pmel 800 Detached double fronted 
house Price of Icisehold £I 250 Scope Piemiiim £1 730 

23 FRENCH RIVIERA —Old established PRAC 

TICE M D essential Vendor it present in England 

24 SW ENGLAND— Country PRACTICE, over 
£1 400 in beautiful pait Panel iboiit 1 100 Exccplionallv 
nice modern house standing in own grounds for sale Hnniing 
and shooting Scope Premium two ycirs purch isc 

25 CENTRAL LONDON PRACTICE —Better class 
pari at comfortable West End f imily fl it Larger lock up 
bi inch 10 minutes dblint Both mcicising Pmel 1630 
Receipts past yeir £1 698 (average £1 460) 2 years piirclnst 

26 SE COAST— PARTNERSHIP in Practice 
iveraging £4 100 pa in glowing resort Panel 1,330 Good 
bouse (4 bedrooms) to tent One fifth shiic tt first it two 
ycirs purch ise 

27 Consulting Ear Nose and Thioat PRACTICE 

in indiistml city Receipts ivtiagc £1 330 p i (m addition 
anpoinlmcnts worth about £830 p i ) Centrally situated 
house to rent Purch tscr should hold FRCS and bi'c 
specialist expenenee Premium two yens purch ise 

2S KENT — PRACTICE in dev'cloping district 
12 miles from London Receipts past year over £300 Pmel 
about 463 House (3 bedrooms) to rent Ample scope 
Premium £730 to include dnigs etc 

29 BIRMINGHAM —Medical Worn in s PRACTICE 
averaging £1 269 p i Pmel nearly 900 Good house "ilb 
girage ind garden Price £300 leasehold Scope Premium 
one and three quarter years purch isc 

30 S AFRICA— PARTNERSHIP in liter tine 
Practice in Natal Shire worth about £1 800 pa at first n 
one years purch isc Applicant slioidd be competent surgeon 
and preferably in FRCS 



Z'* ]0'S 


THE BRITISH MEDIC JOURNAL 


47 


^ 34 ^ (Tin SCH0U\<:TIC ClfRICAI A A 

V \J irf»tsnTi> 

Tcic A.ldr,.. T4^ ISTOCk H 

Triform A\€«»lcent — l^ndon T\\ ISTOCK 

I mclUis and I nrtncn»hip 

3! WEST END nuar Lords Cricket Ground — 

1 RACTICE a>cnpinj. ibout £l 900 pa m ideal rcsiiKninl 
pan Panel about 1 00 proApeet'* of pood incrm c 

\\e!l buili detached double fronted houcc with garape and 
nice ircd garden Good introduction Premium £- 

32 \Y MIDLANDS— PARTNERSHIP m non-dis 

pensing Practice about £3 750 pa in count% town House 
to rent One fourth share nt (wo >cars purchase Aped about 
■*0 with FRCS preferred Prclimimrv Assistantship 

33 MIDDLESEX —PARTNERSHIP in steadily 

increasing town Practice about £2 <»00 pji Panel I J;CiO 
House to rent Premium one h'llf share two jears purchase 
Apphcani should be Lnplrsh or Scottish 

34 SURREY —Medical Womans PRACTICE over 

£■*00 pji m outlsinp suburban district Panel HO Houa^ 
for sale or rent Scope Premium £^00 

35 S AFRICA — Medical Woman holding D 0 M S 
required in OphlhJmic Pnaicc Fxpencnccd in opcniiisc 
work and not oser 40 preferred SHARE about £1 000 ofTcred 
rficr ASSISTANTSHIP 

-e SUSSEX —PARTNERSHIP m good-class Prac- 
tice ncarls £3 000 m fasou jte m rkci to^n I anel about 

1 200 House to rent Share ofi! 000 at two jears purchase 
Prchni.narv Assistanlsnip 

37 S COAST— PARTNERSHIP in Practice oyer 

£3 000 p^ m seaside resort Panel about 2 000 Semi det ched 
house bedrooms) for sale or rent Premium one half share 

I** 000 Excclient hospital and scope for surgers 

3S MIDLANDS— Countrj PRACTICE oxer £I 300 
p^ m hunting distnet PTnel Coed hou c bed 

rooms) garage and good garden Mam wntcr and clcctnciis 
Price £I 400 Ircchold PrcTium two >ca s purchase 

39 NE ENGLAND— PARTNERSHIP m non panel 
Practice doing about £6 000 m ore of the che t towns 

Hou c asi table One sixth share at tv 0 scars pu^cha c 
Partner should be surgically inclined 

40 S COAST HEALTH RESORT— PARTNER- 
SHIP in Practice about £I ^00 p a Panel over 1 100 House to 
rent Premium two-fifths share £! 2^0 to include druc etc 

41 N OF ENGLAND INLAND SPA— PARTNER 
SHIP in Practice about £1 900 pa Panel 1 200 Excellent 
house for sale Premium one half share £1 800 

*+2 S COAST — PARTNERSHIP in non dispensing 

Practice over £^600 pa m health rcvon Panel abcut 600 
Share worth about £900 at two sears purchTsc 

43 S OF ENGLAND— Easil> worked PRACTICE 
about £1 000 pa in Cathedral cits (clubs worth about £160 
^ind panel 1 06^) House (6 lx:d and dressm. room ) for sale 
or rent Premium one and a halC scars purchase 

Purchasers can raise additional capital for t 
Particulars will be for 

All communications to be 

IFDICAI ASSOCIATION LTD ) r 

oust SOUTH Telephone Euston{J®« 

lUARL VV C 1 >1645 

^ for Disposal (continued) 

44 WEST END OF LONDON —Good da^s non 
dispcOiing PRACTICE about £I HO No panel Ls.rg 
hou c to rent Premium lea c and praciKc £y 000 

45 BUCKS — PRACTICE in growing iowti Receipts 
last year £S94 Panel about 790 House for sale Well 
equipped hOipiial Premium £1.^00 

46 LONDON W6 — N'on dispensing PRACTICE 

£I 000 Pleasant suburb No panel House (^ bedrooms! 

garage and garden Premium bouce and practice £2 500 

47 ESSEX —Countr> PRACTICE about £700 pa 

Pane! about 4^0 \er> good house bedrooms) garage and 
g-irden Rent £6^ pjx Premium £800 

48 LONDON S W — Medical Woman s PRACTICE 
about £960 pja in outlyang suburb No panel Suitable 
accommodation available Premium £9^0 

49 SURREY —Medical Woman s PRACTTICE about 
£500 in developing district No panel Rent of house £100 
pj ^opc Premium £*^00 

50 SMALL RADIOLOGICAL PRAfTTICE in 

Pfovmcial town Good opportuniiv for young able man 
Premium £1 600 to include modem plant (value about £I 100) 

31 PARTNERSHIP in increasing Ear Nose and 
Throat Practice in protincial town Fanner must hold FRCS 

52 MIDDLESEX— FOURTH PARTNER required 
in Practice oser £7 600 pa in residential distnet on the 
Thames Panel 1 600 Hou e (5 bedrooms) to rent Scope 
Premium 6/^Oths share £3 100 

53 LONDON N \V— PARTNERSHIP m Practice 
aseraeing about £3 300 p a Panel about 6 000 Maisonette 
(2 b^rooms etc) to rent One fifth share at first at two 
scars purchase 

54 NE COAST— Middle and beiier itorking-class 
PRACTICE over £I 1^0 p-i m <«port town No panel 
Pnvatc residence for ole Premium £7<0 lo include furnish 
mgs etc of consulting rooms or near ofer 

55 LONDON W 9— PRACTICE doing beiyyeen 
£900 £9*^0 pa in re idcniial district Panel about 60 but 
pientv of scope Rent of maisonette (4 bedrooTtsl £200 pj 
Premium £I 000 or oTer 

56 LONDON NW4 — Middle class PRACTICE 
about £800 pJ m developing part Panel 00 House 
bedrooms) for sale or rent Scope Premium £12150 

57 HOME COUNTY'— FOURTH PARTNER 

required in practice in growing town Panel a (XIO Incoming 
partner must be energetic aced about "^0 (mamed preferred) 
with a leaning towards medicine Initial share about £1^0 
pjs Premium £ 000 Preliminary AsMSiantship 

COLONIES — Number of Colonial PRACTICES 
Incomes range irom about £7^0 pa upwards 

he purchase of approyed practices or shares 
xearded on application 

addressed to The ‘Manager 

« SCOTTISH BRANCH, 21, 

FOK DI< 

A S OF SCOTLAND— Counlr> PRACTICE 

Receipts approximalclv £i 600 Suitable house 

B SCOTLAND— Old established Cil> PRAC- 
TICE Receipts approximately £2 400 Panel 2 ^00 House 
price £900 Premium two scars purchase or ncir offer 

C YORKSHIRE— Country PRACTICE Receipis 
£I 200 Panel 500 Excellent house with garage Pnet £1 2C0 
freehold Premium one and three quarter sears purchase 

D EDINBURGH— DEATH VACANCY —PRAC- 
TICE av-cragtng £63^ Ample scope for private and panel 
Excellent house for sale Any reasonable offer 

E E OF SCOTLAND — Country town Receipts 
last year £68^ (appointments £112 panel ^65) Excellrat 
house With garage and garden Price £1 4^0 Premium £I 000 

For fuither details apply The Ma 
Terms on which the business of the Branch is trs 
Manager to whom all communications should be adc 
UEUABLE LOCUMS and ASSISTANTS are URGENT 

Alva Street, Edinburgh 2 

sPOSAJL. noA/^-TT/^C 

F N OF SCOTLAND —Counlo PRACTICE 

Long c^^abIl!,hed Receipt -pproximalch £I (XX) Punel 27i 

G WALES— PARTNERSHIP in counts town 
Receipts LI 200 Pa^el oser 1000 Siftable house Free 
£S0O One half share at one sears pi-rehase 

H EDINBURGH — PRACTTICE doing £450 House 
mu t b> bousht Premium pr-ai c hed hou c £I 6'0 

I EDINBURGH— PRACTTICE aseraging £1022 

Panel Pri c of house £K00 might let on lea e Premium 

one and three quarter V ears pu eh c o nc*.r oTer 

K EDINBURGH — PRACTICE aboui £400 Siiit- 
house to rent Reasonable offer Lorsidered 
nager 21 AKa Street, Edinburgh 

ncacted will be submitted on application to the Branch 
ressed _ 

LY required by AIX OFFICES of the BUREAU 



50 


THE BRITISH MEDICAL JOURNAL 


JuL\ 23 1938 


INDEX TO ADVERTISEMENTS 


PLiBLlSHERS 

nilc John Medical Publications 


I ruish Medical Assn 8 44 

C Tsscll A. Co Ltd 4 

ChuKliill J A. A Ltd 6 

Kitnpion Henry ^ 

Lewis H K. A. Co Lid 4 

Saunders \\ B C Co Ltd 3 

^\rlL,ht John S Sons Ltd 4 


ASSURANCE & INSURANCE 

London A. Counties Med Prol 
boc Ltd Supp I 

Medical Insunncc At^ency 43 

Medical Sickness etc Sf>cKt\ 

Ltd 9 


B\NkS & IlNANCE 

British Medical Finance Ltd 8 

N\ cstnnnster Bank Ltd 6 


CHEMISTS 


Allen S. Hanburys Ltd 

14 24 

Aluzyme Products 

26 

Betzema Products 

10 

British Dfuv, Houses Ltd 

10 13 17 

Bout ills Ltd 

26 

Burrotii,hs Wellcome k Co 

23 

Clin Ltd 

25 

Duncan riockhart ^ Co 

Supp III 

Lh Lilly & Co Lid 

12 

IcUows Med Mfi, Co 

Ltd 


Supp til 

C lies Schiclu S, Co 

25 

Glaxo Labontorics Ltd 

12 

!I wicii C J k Son Ltd 

14 

Maw S Son &, Sons Ltd 

13 

Milton Proprietary Ltd 

Supp II 

Reckiii Sons 

16 

Kiddell 1 rancis Ltd 

11 

Robinson C Sons Ltd 

15 

S P Chiracs Co 

S 

Sacchirin Corpn Ltd 

15 

Stoit k Turner Ltd 

19 

Wander \ Ltd 

16 


FOODS, BEVERAGES 


Brand & Co Ltd 

22 

Cadbury Bros 

13 

Genatosan Ltd 

20 

Marmite Food Extract Co 

Ltd 11 

Ramlova Table Water 

8 

\ Tleniine s Meat Juice Co 

Cover 111 


NAME PLATES, etc 


H d! F B & Co 

26 

Herd S J & A 

26 

Osborne F & Co Ltd 

26 

W hiiL Bronze Co 

26 


PRINTING, TYPEW RITERS, 
etc 

Tn\Ior s TvpLwnters 6 

SURGICAL APPARATUS 


Davidson F A. Co Cover tv 

Hilliard 26 

Millikin A. Lawle> 6 

Salmon Odv Ltd 6 

Salt A Son Ltd Supp iv 


Smith S. Nephew T J Ltd Cover ii 


TAILORING & CLOTHING, 
etc 

Dcimel r line Co 26 


TOBACCO & CIGARETTES 

Carreras Ltd Supp u 

Plaver s Na\> Cut 7 

VACCINES, SERA, etc 

Evans Sons Lescher A Webb 
Ltd 21 


WINES, SPIRITS, etc 

Anderson Dobson A Co Ltd 


MEDICAL SCHOOLS, 

6 TUTORS, & LECTURERS 

Pages 29 I 3 a 


VRAYS & ELECTRO- 
MEDICAL 

Bell John ACrovdtii 


9 


NURSING, etc 

Pige 


45 


HOMES & INSTITUTIONS 

Pa^ei 26 27 2S 29 


HOUSE AGENIS 

Pa^e 42 


TRANSFER AGENTS 

Bov nl Medical Agenc> Ltd 4) 

British Medical Bureau 46 47 41 
Lee A Martin Ltd 4^ 

Medical Agencj Ltd 4) 

Peacock A Hadicv Ltd 45 

Turner Percival Ltd 4) 

Western Medical Agcnc> 45 


HOSPITALS tS. CLINICS 


Aldenham House 

29 

London Chnic 

28 

New Lodge Clinic 

28 


CONTRACT PRACTICE 
rage P 


HOSPITAL VACANCIES, etc 
rages 32 31 34 3' 


SANATORIA 

Colswold Sanatorium 
Hospital tor Consumption 
PendytTryn Hall Sanatorium 
Tor ni Dee Sanatorium 


30 

31 
30 
aO 


CLASSIFIED 

ADVERTISEMENTS- 
fWanlcd & Vaianl) 


SPAS, HEALTH 
& HYDROS 

RESORTS, 

Czechoslovakia 

31 

Harroqalc 

30 

Pistany Spa 

31 

Rocksidt Hydro 

31 

Smcdley s Hydro 

29 


GENERAL 

British Taxpayers Association P 
Franklantls E J &. Co Ltd ^ 

National Ophthalmic Treatment 

Board Snrn ' 

Norwich & E of Eng Med ^ 
Prol Socy 


SNCOIVIE TAX 

!N 12 EQUAL MONTHLY PAYMENTS 


DOUBTFUL DEBTS 

CAN BE TURNED INTO 


STRICTLY CONFIDENTIAL 


CASH 


This practical convenience is praised by j A specialised' department is maintained for 
medical men I collection of medical accounts 

vmE BRITISH TAXPAYERS ASSN. LTD., GRAND BUILDINGS. LONDON, W.G.2; 


1 h-, If I top,, ,1 

1 " 11 It J T St 1 1 -ct S 


— T 

B iti^h Nlcdn^l Asso,.iilion T»\i>t<s.k Squire London \\ C I md printed bv Fere 'id Spolli'iWdi 
' Lon Ion I C 4 Printed in Great Britain I ntered as S"cond Cias-, nt Ness York USA i o t u ^ 


Jui\ 23 I93<! 


THE BRITISH MEDICAL JOURNAL 


Valentine’s Meat- 


In Typhoid Fever, Diarrhoea and Cholera 
Infantum, when it is Essential to Sustain 
the patient without irritating the Digestive 
Organs, the Ease of Assimilation and 
Power of Valentine’s Meat-Juice to Restore 
and Strengthen has been demonstrated in 
Hospital and Private Practice. 


^ I ^HE quickness and power with which 
VALENTINE’S MEAT -JUICE 
acts, the manner in w’hich it adapts 
Itself to and quiets the irritable stomach, 
Its agreeable taste, ease of admmistra- 
tion and entire assimilation recommend 
It to physician and patient 


- «_ nrocin 




Physicians arc imitcd to send for brochures containing clinical reports 


For sale bj. European and American Chemists and Druggists 


VALENTINE’S MEAT-JUICE COMPANY, 


RICHMOND, VIRGINIA, USA 



TV 


THE BRITISH MEDICAL JOURNAL 


Juu 23, 1938 


SPECIALmES OF Fo OAV IDSON & CO. 

Makers of 'Optical and Electro-Medical Appliances (Estd 1890 J 

143-149, GREAT PORTLAND STREET, LONDON, W.l 


THE “ DAVON ” (REG TR MK ) 
IMPROVED RECTOSCOPE 

ti.n I, 1 Ij 1 l.ilip 11 DnlKkr 1] L n C li 1 I <1 «lio 

\s rite-? in tlic JI \t f 


//Ir^ rN I 


The “DAVON" 
AURAL HEAD 
LAMP 


Piicc witli L\tn Imlli 
£3 3 0 

‘Di\oii’ Dr\ Bitten 
7s 6d 


hit Cl <h {<tr K<»mt time In ill the x rioiis Hpea V v \ nllJl tMIT htilli 

or I rod t i|u on tlit. tmikd I InM. r)t\istil n niofUl for ii u iii r H-tvtoreM it ca ^ ^ 

(Ik injtdion ol Jntmorrlionl I lit nrh of this ntu model .fh-r l ‘r>i.on‘ nr^ 

>r liM, -lu ^ h„k fKl.l n M tlR omc t.mc tint (Hjj » ^ 7. fB 

tli Iiumorrlirnd <lo not project into flit lurntn ot tht in»;triimtnt q — ’ ■* ^ 

•nnl tfi It tin re i no ol«(n ilor to c \n * di comfort to the jntient . , , 

»ml tr l)e 1 inn incv to the optrUor Tht instriuntni Ins httn ^ ^{lCCl U condcnsnig SVStcm liul 4-\ glS hllc^l hlllp 

niKle foi nu hv Mt r 1 Dnidon Co uho ire siipphin^ it pJOJCCt T Circle of li^ht Tboill HI cinmttei 'll 1 

nnh rihimin HJon Jnm i in tin Inndh or fiom » cijnritt (h'^tauCC ol 12iH witliout shovvJjig anj^ imn^e of Ihc 

I n fihmenl The liQht being coiicenti Uccl it the end ot the 

'tticciihmi there is no confusing light outside The limp 
ji enn nlso be used with a hr^ngcnl mirror Bt wilhdrtwiii!; 

(e» ” snnil cap it ‘ B ’ a Ipn circle is obnin ible foi geiicn! 

imrposes It is mtninted on an ndjiistihlc dm iliiint held 
— '~tT 7 T ' ' Tr* bind with sorbo pads, tnd is \cri comfoi tilde to wtir 


r ^ 






1 im j:Jad to si\ thit the htirl limps ir*. l^ootl <truc 

111(1 irt more iti';fictor> l}i n tii> I Inic 

It tht finest hcirl hmp tint I /n\t ettr ii^ed ind I ihi j 
cirrt It IS pir of m\ kit to otitljim, fnrmhon«c«’ 

M K C I RC r 

* 1 nm \crv pltj^ttl with it’ — — MD 1 K C i? 


No 'sSi With Wash ible Rubber 1 le\ £2 15 0 

'I) non ’ Drj Bittirj 0 7 6 

24/i/tS M) h t Inlltrv i (hted Sil't 1035 and is no* 

)il (iiiiti. fun lucl \[ R C S I R t 1’ 

\<> a-sai With loreh Batter, iii Handle £2 IS 0 

Prices include spare bulb 

1 he limp IS protected bi a gl iss window 'o that the 
spieidmii till be cltamd when in position 




tOSVinSOMACO ("N 

— 4-^ 



The 

“ DAVON ’’ 

SeU lllximinntetl 


SIM'STERGUSSON’S K Y 

STERILIZABLE ] | 

VAGINAL SPECULUM i | 

f’rice complete £2 10 0 2 j 

C 111 lie supplied , ith obdiiritiir “ '' 

teir tile Icr^tisseni jiorlioii it an V' 

uiditional cost of 12s 6tl ‘" ST .J 

I t lit loin 1 stl \our in truiTuiu nio 1 rttiiWe "in alls 
ficturi — I R C I 1 1 t iy I at 


“ DAVON " 

DIRECT VISION OPHTHALMOSCOPE 

A GREAT AID TO DIAGNOSIS 



Guts I cle ir magmfieel image of tht fundus v.ittwiil 
conical rtflcN m bright light, witlioiit dilajatioii ot tin 
l>upil and at an apiiroxim ite dist nice of 7in troni the 
lutieiil Puce complete in leather wallet and spare 
d-\edl hulh £5 0 0 

1 mi (letietUed iiilti eoni oiitiltntnio cope ami stcdie ci'tj 

JI K C s 1 la f 


The “DAVON” 
ALL-METAL STETHOSCOPE 

With Phoneinloscope m \\ diet with /ipb _ . 

I isfcner £1 6 0 

With Bowles Chest Piece in W' diet with /ip|i - 

I is.cner £1 8 6 

With liotli Chtsi i’ltcc^ (intciclungc'ibk) in 
Willct witli /'ipii 

^hiwn s rnr^i i jrrf c n i pi ^ ^ 

Ol MK)^U>I Z AI ( 0^1 

‘ It I t 1 iK tliL ZiL t cft-tlio cope I Ji IX c Lxer Infl " ^ 
It IS miLmtictnt in irnmunt iiul licitvr iZnn kD ^ 
hitherto iiinilit.ll - - - Mul Snp niUtiufcnl 


I iat nun I Hi >uijr in iniimm nio i rcnioic '-ni ire.a.-.r .... . « r i../ > 

' — I Rtl I I t 6 I at "THE PNCUMETTE’’ (.! aifUril n>!tl ^"''^,,’,,,0, 

THE ONL\ rOOT ARCH SURI’OKT WITH AN AIR CUSri o 
Dr\ I>*’tttr\ 7s 6tl * j Imt prt cnhtfl I nenn’ettLs lor turtl ('xtit:’ 

. "‘*h rtmarkihJ> ^ooil result in exefi ci'sl 

ain. irs-mi 11.1011 1 aiura Peari IK date I \afPHl FT on I OOT 7 KOI Itl LS null 

J ol IS .,,1, ,,t ^iw.it ni i!.t "tio ( .Her nu.cl. iis- aud.cal a pecu. t f Hal toot 1., an tniinciu I omlon 110'“ 


ai i> I ires 


^ OKSCPIWNG PULL RANGE OP “DAVON" DIAGNOSTIC AND TREATMENT SPECIALITIES 

rowsroPMERS ETC V'OULD GLADLY BE PORWARDEO, POST TREE, ON REQUEST 



MEDICA 



JOURNAL OF THE 


r? 



ASSOCIATION 


SATURDAY JULY 30 1938 


PRINCIPAL 


Mental Factors in Medicine p 209 

Radiology in the Elucidation 
of Haemoptysis 21 1 

Play-therapy for “Problem ” 

Children 213 

Treatment of Gonorrhoea with 
Uleron 215 

Pulmonary Tuberculosis in 
Diabetics 218 


CONTENTS 

Leading Articles p 224 

Scientific Sections at Plymouth 238 

Correspondence 254 

Surgery in General Practice 
Injuries to Elbow joint — 230 

Reviews 221 

Electrical Ignition of 
Anaesthetics 234 


The Annual Representative Meeting 
(See Supplement) 


WITH SUPPLEMENT AND EPITOME 

LONDON 

BRITISH MEDICAL ASSOCIATION 

TAVISTOCK SQUARE 


No 4M7 INEEKLl, PRICE 1/3 


Copyright 


REGISTERED AS A NE3^ SPARER 



ri 


THE BRITISH MEDICAL JOURNAL 


Juu 30 ms 


for 

SPASM OF PLAIN MUSCLE 

ASTHMA 

ANGINA PECTORIS 
DYSPNOEA OF PHTHISIS 


FeUol relieves QUICKLY and CERTAINLY. 
Felsol IS ALWAYS READY FOR USE 
Fehol contains NO NARCOTICS 
Felsol consists of Powders for oral admmtsii alion 


TvkphoHC 
CitrJ nvNoll 5862 


Liteiature and supply for clinical test from 

BRITISH FELSOL COMPANY LTD, 

Wigton House, 206/212, St John Stieet, 
Clerkenwell, E C 1. 


TUeff) THIS 

Snutfi Lourfori 


Valentine’s 


Meat -Juice 



I N cases of Extreme Exhaustion, at 
Critical Times, m Wasting Diseases, 
Low forms of Fever, Cholera Infantum, 
Diarrhoea, Dysentery, Influenza, Pneu- 
monia and Phthisis, when other Food 
fads, Valentine’s Meat-Juice demon- 
strates Its Powei to Sustain and 
Strengthen 


P/nsiiuiii\ art iniiutl to tend for Clinical Ripoilt Jioin 
llotpitah and Ctiitral PractilioiHn in all pans oj the •world 


For s-ile b\ European ind American Clicmisls and Driigti'rl': 


VALENTINE’S MEAT-JUICE COMPANY 

RICHMOND, VIRGINIA, USA 




BRITISH 




JUL\ 30 1938 


TABLE OF CONTENTS 


ADDRESSES AND PARERS 


LEADING ARTICLES 


CORRESPONDENCE 


Menial Eaclors in Medicine T A 
Ro^ M D r R c p 209 

3alue of Radiologj in Elucida- 
tion of HaemopUsis Frasrlin 
G Wood mb 211 

Pla\-Thcrap^ for “Problem” Chil- 
dren Ethel Dlkes lrcp A"; 213 
Trealmcnt of Gonorrlncn «itli 
LIcron D F W mjiii mb b cli 215 
Post-Mortem Record of Pulmonan 
Tuberculosis in Diab tics S 
Roodhousl Gloss-f md 21S 

Electrical Ignition of \nacslhelics 
H W ?\\sNN 2M 

SURGICVL SERIES 
Injuries to the Elbow joint — II 
Fractures S L Higgs frcs 2j0 


CLINICAL MEMORANDA 
Traumatic Rupture of External 
Iliac Arlen Amputation Re 
covers H G Pisker trcs 219 
Two Compressed Foetuses and 
Living Bahv as Cause of 
Hvdramnios E D Bllst mb 220 


REVIEWS 

The Bacteriophage 221 

\ Ravs in Dermatologv 221 

Medical Women in Past Ages 221 

Fractures and Dislocations 222 

Approach to Phv siologv 222 

Statistical Methods in Mediane 222 

Notes on Books 223 


LETTERS AND ANSWERS 

Epsom College 272 

Artificial Respiration Apparatus 272 

Sterilization of Svrinces 272 

Medical Golf 272 


GENERAL ARTICLES AND 
NEMS 

A Personal'Eaperience of Tetanus 233 


Nova ct Vetera 

Boerhaave Bicentenarv 232 

Benjamin Tamovvskv 232 

Heinrich Meibom 232 

B»it Memorial Trust 2a0 

The Cvvcer Cvmpaign 250 

Fellowships is Clisicvl Science 
AND Experimental Pathologv 2a7 

Medical Notes in Parlivment 266 

Universities and Colleges 264 

Preparations and Appliances 22’ 

Medical News 271 


Die PIv mouth Meeting 224 

Therapeutic Abortion and the Law 225 


ANNOTATIONS 


Tie Hmcnt of Mahrn 227 

Calcium and Ihc Foetus 227 

Movements in Collapsed Lungs 22S 
The Sign of the Clavicle 22S 

Ophthalmoloctcal Socictj of 
Ausinha (B M A ) 229 

Purpura from Sedormid 229 

Medical Research Council 229 


SUPPLEMENT 

Annual Rcprcscniatnc Meeting 
Full Report of Proceedings 
of July 18 and 19 


Annua* Dinner Speeches 
The Re*igious Scniccs 


Correspondence 
Associatios Diarv and Notices 
Vacancies and Appointments 


THE SECTIONS 
Summarj of Prowcdings 


Medicine 238 

Surger\ 239 

Obstetric^, and G\naccolog\ 240 

Neurology and P>\chologN 241 

Ncuroloc\ \Mlh Orthopaedics 242 

Radiologv 24 j 

Pharmacologv 244 

Phssiolog\ and Biochcmistr% 24'' 

Pathologs and BiclcnoIogs 24> 

Tuberculosis 247 

Oio rhino larsngologs 247 

SerMces 248 

DiNcascs of Children 249 


OBITUARl 

Charles H H Harold obe md 263 
Andrew \V Thomson mb cm 264 
Dasid L Talc mb frcs Ed 264 
W C Douglass MRCS lrcp 264 


EPIDEAIIOLOGl SECTION 

TsBLE of INFECTIOLS Dli»E\SES \ND 
Vital Ststictics 270 

EPIDEMIOI OGIC\L NOTES 271 


Brace. Paul Pul alor Sir William 
BR\GG DSt PRs 2''-* 

Abortion and the \ \i tci 
Bolr'^c f p c s Damd T 
MvCLW MB 2''4 

The Lncon<iciou'> Mind..nd Medical 
Practice E F Skinner m d 2‘'5 
The Final M B B S Lend C \ H 
Franllvn m d 2"''’ 

\ ra\ Screeninc Stand for General 


Practice J 

\ 

SpARkS MFCS 2 6 

Prophv 1 IMS 

of 

Mea W L 

Formth 

1 d 


Eventration 

of 

the Diaphracm 

P Stanllv 

Fostlr frcs 2^6 


Anaemia and the Gasiro inl'’stinal 
Tract Bems iin Portnoi md 
National Food Polics J P 
McGow ss M D 257 

Anlimon\ F G Cssvston md 2'>S 

Small po\ and Compul or\ Saccini 
tion A L Crsddock m b 2''8 

The Cancer Campaign ^ P 
Bertas ISTLE frcs Ed 258 

Sub\e^ 1 cal Djaiherm\ Prostatec 
tom\ Terfnce Millin frc.s 2^9 
Incomplete Descent of Testicle 
A P CSNSSDISS MD 259 

Cancer of Phar>n\ and Larsn\ 

F Holt Dicgle frcs 2>9 

Chemolherap\ of Gonorrhoea 
Ripl£\ Oddie VI B 260 

Sulphamlamide in Acute Mavillarv 
Sinusitis J ShvntnS Lvlrie mb 260 
Sulphonamide for Epilepsv J C 
Seomvn mb 261 

Complications of Gold Therapv 
H Fvrscombe mb H Warren 
Crowe dm 261 

keraioplastv T H S Tizz.ard m b 262 


LOCAL NEWS 

Encland and W'^ales — 

National Hospital New Wards 
and Research Department 25 1 
\oluntarv HospilaN of Sheffield 2^1 
Convilescent Home in Kent 251 
Notification of Measles and 
W hooping cough in London 251 
Board of Education Report 252 
Preston Hall Maidstone 2>2 

London Emergcncs Bed Service 252 
The Case for Cremation 2>3 

Scotland — 

Edinburch Graduation 253 

The \elerinarv College 2''3 

Conference on Health Education 2^3 


^fEDICO LEGAL 


Tlie Bourne Case 
point 


A Legal \iew- 

262 


THE SERVICES 

Deaths in the Services. 


263 


A KE\ TO CURRENT MEDICAL LITERATURE will be found at the end of the JOURNAL 




•7 


THE BRITISH MEDICAL JOURNAL 


Juu 30 19’S 



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J3> ILFRID SHELDON H 1) 1 K (.1 
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MEDICINE — Essentials for Practitioners and 
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Ij G E Rr\TjMONT DM IRCP 
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TAILORS PRACTICE OF MEDICINE 
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(16 Coloured) nul 104 Text fipiirc*; 
RECENT ADVANCES IN ALLERGY 
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G \V m\\ MB MKCP 
3>d Edition 107 Illustrations 1 

DISORDERS OF THE BLOOD 
By L E H CFO VC MD 

FRCP and C J C BRITTON M I) 
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3lu '0 19 THE BRITISH MEDICAL JOURNAL 



JOURNAL OF 

Neurology and Psychiatry 

July i938 


CG^TE^’TS 

Purlhcr Obscnalions on Neurological Vbnornialities in Mental Dcfcctiies R G Gordon and R M Nonnan 

The Electro Encephalogram in Coninlsions induced bi Cardiazol L C Cook and \\ Gre\ \\ alter 

The Relationship between the Blood Pressure and the Tome Regulation of the Pnl \rtenes M Fog 

Sonic Ohseriations of the Depth and Nene Cell Content of the Supragrinular Cortev in Normal and Mentalli 
Defcctiie Persons R M Norman 

The Relationship m Man of Cerebral \ctnili to Blood Flow and to Blood Constituents 

G Lennov F k Gibbs and E L Gibbs 

Obsenations on the Cerebrospinal Fluid Pressure on Simultaneous \entricular and Lumbar Punctures 

G E Sn\th and \\ R Henderson 

Critical Renew Twin Research in Psichiatri E T O Slater 

Epitome of Current Journals Book Renews 

FL'BLISHCD QL ARTCRL'i 

1 ettrh ^iib$crtplion ( i ii iiiihercj, 2ol- To members, 20 
Single l\ttinber 7/6 

Issued bj the British I\IedicaI 4ssociation Taiistock Square London. W C 1 


JUST PUBLISHED — — - 

NUMBER FOUR With j Plates Pp tii — 160 Rojal 8vo lOs 6d net postage 6cJ 

CHRONIC RHEUIVIATIG DISEASES 

Being the Fourth Annual Report of the Bntish Committee on Chronic Rheumatic Diseases 
appointed by the Royal College of Physicians Edited bj C W BUCKLEY, M D FRCP 

NUMBER ONE unth 8 Plates 12s 6d net postage 6d NUMBER TWO 10s 6d net postage 6d 
NUMBER THREE 10s 6d net postage 6d 

* all lho«;c interc ted ^^lll do \\'’ll to stijd\ this A\ork — Bpiti-'H Mfdic^u Toir'^vl 


IMPORTANT ANNOUNCEMENT 

It has been decided for the future to issue these Reports twice a year as the offoial Journal 
of the Scientihc Advisory Committee of the Empire Rheumatism Council 
Further particulars will be announced later 


NEW (SECOND) EDITION, WITH ADDITIONS AND REVISIONS 




TREATIVIENT 


NERAL PRACTICE 


THE MANAGEMENT OF SOME MAJOR MEDICAL DISORDERS 

<nr/Ct£,> RFPLBLtSIlED FROV THE BRtTUti MEDICAL JOlR’SiL 

VOLUME ONE With Illustrations Dcm> 8%o Ss 6d net po age 6d 

Diseases ^of the Respiratory Tract Acute Soecific Fevers Cardio Vascular Diseascj 

VOLUME TWO V^th Illustrations _Dem> 8\o 10s 6d n-t postage od 

Diseases of the Nervous System Diseases of the Digestive Sjstem Some Diseases of the B»ood 

Rheumatic Diseases Metabolic Diseases Diseases of the Kidrey 

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London H K LEWIS & Co Ltd , 136, Gower Street, W.C 1 

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4 


THE BRITISH MEDICAL JOURNAL 


Juu 30 0)'>8 



Eve^y home should have— 

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Most medical practitioners havCj at some time or another, needed hot water 
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For useful wformauony send for the special booklet to the Hritish Fleetrtcal Deieiopineni Auociaiwnx 
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6 


THE BRITISH MEDICAL JOURNAL 


JUL\ 30 D3S> 



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Jin JO I9’S 


THE BRITISH nIEDICAL JOURNAL 



RECENTLY ISSUED, Post Free to the Medical Profession on Application 


''Solpitur Hmbulanbo'' 


72 pages, 37 Coloured Plates, deals exhaustively with the problem 
of providing prostheses for the lower extremities for every 
type of amputation and congenital deformity Many distinguished 
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E.:H A N C E.R & D 



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ROEHAMPTON LONDON S W 15 

Branches at —Aberdeen Belfast Birmingham Bristol Cambridge Cardiff Cosham Dublin 
Edinburgh Exeter Glasgow Leeds, Liverpool Manchester, Newcaslle-on Tyne and Nottingham 




THE BRITISH MEDICAL JOURNAL 


JuLV 30 1938 


S 


LOCAL TRBATMBMT OF PSORIASIS ^ 


Nol onij docs Psornsis respond rendily lo locil IrcTlmcnl \Mlh 
Spln^nol Penl Ointment but the relief is laslinn Neither 
dnneerous nor piinful psornsis is nnoym" and unsightlj In 
f 1 es where the correction of faults in clothin_, md diet brings 
no ilisfTctorj response regular ipplicitions of Sph^gnol Pe^l 
Ointment pro\e bencficnl in t xerj short time Sphignol con 


l-iins the soothing he iling distill ites of peit It is t mtunl 
'intiseplic whose consistent use nenenlly produces listing relief 
In cise >ou hive hid no personil experience of Sphngnol we 
shall be pleased to send >oii i clmicil size sample for testing 
if you will write to Peil Products (Sphignol) Ltd Dcn| 
B M J 10 2] Bush Lane London EC4 


c 


CONTAINS 
DISTILLATES 
OF PEAT 







MEDICAL SOAPS 
OINTMENT 
SUPPOSITORIES, ETC 



If <iny of 'vour patients leqiiiie a change of fiiut juice in tlieu 
diet ^ oil can recommend Dole Pineapple Juice with confidence , 
foi not only is it a good souice of Vitamins A, B and C and 
natuial fiuit sugais, Imt it is also a delicious and tempting dunk 


A TYPICAL ANALYSIS WILL SHOW YOU WHAT DOLE 


PINEAPPLE JUICE IS COMPOSED OF- 



'1« 1 lurr 

tr t o 


A li 

0 1 % 


i Ml (rllirr xiru 1) 

0 a „ 


1 r 1 III (N < '■) 

() 1 


t rn l( 1 1 rr 

0 02 


1 Hr II lilt 1 1 1 1^ i ilrir n 1 1 

0 9 


It I« in^ ii^nr « liwrrl iipur 

1- I 


t ft fiiilrnlr I>m r tlini it^iir (\ > lifT r lu ) 

0 Dl 


D / ^ 1 ^ J ft ^ II 1 1 r / fi / /III 4 f 1 

* / * / / t ! f 1 1 \ ll C \ lu no i! 1 7 11 I N «j/ 

7 1 / ^ / 

nj riir 1 

1 <i< iiiiiii 

\‘ 

nil iis on ]< ii( ilu ul iiifl wo wiH 

•.end 

1 

n -niiifilc tin 






Dole 

Pincipplc Juice in 
the special tins reiclics >ou 
field fresh from sunny Haw iii 



Oo (a, i'uo 


£ APPLE JUI 

I' , to EASTCHEAP, LONDON, 


CE 

E C 3 




Iron Jclloicls arc in clc-ant and reliable 
nicin<; of atlminivlcnns- the piolocarbon ile 
ol iron The preparation has none of the 
disiih int ipcs of Pil Bland The iron content 
rem line frech and nnoMdired indefiniteh and 


Therapy 

injury to teeth is avoided 

The Jclloids are hij,hl> effective in the trcti 
ment of achlorhvdric in leniia and indeed in 
dl the simple an icniias in which missive iron 
therapv ts indicated 


Iron Jelloids 

dnlK inMiLcl !o ippU for simples for clmic'il lest 

//<.„/ Co, /„/ K,tu Gtortu % A\ciwc W aijnrd Hirn 









c 


THE BRITISH MEDICAL JOURNAL 


JuL> 10 19’s 


LOCAL TREATKiEWT OF PSORIASIS * 


Nd| onls does P«^om is respond readil> lo IoctI IreTlmenl \Mth 
^phT^nol PcTl Oinlmcnl bul the relief is lT‘;lino Neither 
dinj^erous nor piinful psornsis is nno\ing •'nd unsightlj In 
where ihc correction of faults in clolhin? and diet brings 
no ilisfTctor} response regular applications of Sphagnol Peat 
Ointment pro\e beneficial in a Nerj short time Sphagnol con 


tains the «;oolhmg healing distillates of peal It is •\ natunl 
antiseptic whose consistent use generally produces lasting relief 
In case >ou have had no personal experience of Sphaonol we 
shall be pleased to send \oii a clinical size sample for testin" 
if >ou will write to Peat Products (Sphagnol) Ltd Dept 
BMJ 10 21 Buch Lane London CC4 


n 


CONTAINS 
DISTILLATES 
OF PEAT 


M 





MEDICAL SOAPS 
OINTMENT 
SUPPOSITORIES, ETC 



If <111^ of }Our pcTtients icquiie a change of fiuit jiiice m their 
(lu t > on can recommend Dole Pineapple Jmee with confidence , 
loi not Old) IS It a good souice of Vitamins A, B and C and 
natnial liinl sugais, hiit it is also a dchcions and templing dunk 




Dole ~ 

Pineapple Juice in 

the special tins reaches ^ou 

field fresh from sunn> Hawaii 


APPLE JUICE 

^ E C 3 




Iron JlIIokI'; nre in elc,-Tnt nnd rcinbic 
me ins of ndmimvlcnn- the piotocnrbon itc 
ol iron The prepnniion hns none of the 
disids inliLCs of Pil Bhud The iron content 
rent iinx fresh ind iino\idi7cd indefiniich nnd 


Therapy 

injiirv to teeth is •ooided 

The Jclloids nre hitltli effeclne in the Ircil 
ment of ichlorhsdric nn lemn nnd indeed m 
til the simple m icmias in which mnssisc iron 
thcrTp\ 15 indicnted 


Iron JeUoids 

di ilK insiied to ipph for samples for clinical test 

Hold Ci’ntrnn\ ltd Kui^ Gtortte s Axenne Waljord Hirlt 


( 












JuL\ ^0 I93S 


THC BRITISH MEDICAL JOURNAL 


Prescnbing with Confidence 

The adianlas^cs of Rlumtol m the ticalmcnt of 

COLDS 

NASAL CONGESTION and CATARRH 

and all other affections of the upper respiratory tract are — 

1 Its very low ephednne content 

2 Its property o' emulsifying with body fluid owing 
to the vasogen vehicle 

3 Its complete freedom from irritant or toxic effects 

4 Its rapid yet prolonged action 

E T PEARSON & CO LTD MITCHAM, SURREY 



ifit 

H \ L COMPOUND 


P O 1 

t CV O 5 

CA*- ^ 0 1 

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L N C 


‘PEPSI 

‘NCIA^ 

Is radically different from the 

in a vehicle, it is an entire gastric 

ordinary fluid pepsin preparations 

juice evtract 

because it contains the entire soluble 

constituents, organic and inorganic, 

of the stomach glands, all the various 

comple's. potent catalytic constituents 

To prescribe Pepsencia is to give i 

the patient the benefit of a stan- n 

dardised product of long maintained i 

reputation and efficacy of established 
value in medical practice as a diges- i 

tant a vehicle and as an aid to other 

It is not made by dissolving pepsin 

treatment 

Supplied in four sizes 4-oz 

■ 

, 8-oz , 16-oz , and W. Qts 

Originated and manufactured b\ 

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1. 

Agents 

Fairchild Bros & Foster (inc nm > 

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AfTH 1 ORK and 6^ Holborn 1 lodnct 

LOS DON EC I 

LOS DOS SIDS El and CAPETOII \ 


ACIDOSIS ^ 

Osier and McCrae advise 
the employment of Sodium 
Calcium, Potassium and <1 

Magnesium Salts for the pre- SALVITAE promotes Elimination 

vention of Acidosis Alkalescence by adequately 

supplying these salts thus main- 
taming the reaction of the blood 
e oUmomtt lannin urd at practically 3 fixed and constant 

/ terature gladly sen: on 

equest pOlDC 

COATES & COOPER LTD 94, CLERKENWELL ROAD, LONDON, _ EC 1 








THE BRITISH MEDICAL JOURNAL 


JuL\ 30, 1938 





The Constipation of Childhood 

T he tieatment of constipation in infancy and 
childhood calls foi special caie The }oung 
and otten delicate oiganism cannot with iinpumU be 
sub)ected to the di istic cflects of man} depuiativcs 
Otten too theit is an associated detective assimila- 
tion which ilso icquiics the- consideiation ot the 
pin "-ician 





/)* fu/M ilont 
OucI f 

1 llninoi lunuiito 
tiucctuui /ti? 
tU/dUKf rt Put HCf 
ilw J? uot 


(_ iistolav ” ulnm ihlv meets 
llu need foi a gentle coirec- 
tne It IS perfectly harmless 
ind fice fiom the possibility 
ot habit formation This 
ellicient hibiicnit is composed 
ol ■ Wuidci ' Di\ Slalt Ev- 
il act with which IS mcoi- 
poi lied 50 pti cent of pure 
imdicinil liquid pai ifhn of 
collect \iscosit\ 


Oil iceouiit ot Its pie leant 
flu our cas 3 admiiustiatioii, 
and Its gentle jcl ellicieiit 
lixitue action, “Ciistoliv” 
IS the igciit ot choice lor 
inlauts and childieii Its 
soothing efleet on mil lined 
mucosa peiinits its use in 
infantile dnrihocis, colitis, 
nid othci iiiititcd conditions 
ol the bowel 


EXTRACT 

d iir/>/'/\ foi Cliiiual Inal nii/ fin on injinit 
Of all Pharinaml'., in bollld al 3/6 and 2/- caili 
\ \V\KDER LID 1S4 QLLrN’SGXTC LONDON, S\Y 7 




.D.H. VACCINES 


A course of treatment with B D H 
Vaccines comprises in many instances a 
scries of four or more injections totalling 
approximate!} 3 c c It is a measure 
of economv, therefore, to employ the 
special B D H rubber-capped vials (con- 
taining approximate!} 33 c c ) from 
which this senes of doses can be with- 
drawn as reqmred 

The rubber-capped vial possesses a 
further advantage, the rubber-cap being 
Itself protected by a metal dust cap the 


replacement of which after each dose 
has been withdrawn reduces the risk of 
contamination to a minimum 
In cases m which ampoules of i c c arc 
required these also are available B D H 
Vaccines are supplied also in the 
specially-designed rubber-capped vials 
of 10 c c and 25 c c respectively 

A specimen 3 c c vial containing any one 
of the B D H Vaccines mil be sent on 
1 eqiitst 


THE BRITISH DRUG HOUSES LTD LONDON Nl 

Telephone Clcrkenwell 3000 Telegrams Tetndome Telex London 




THE BRITISH MEDICAL JOURNAL 


n 



"GLANDUBOLIN CLIMCALL\ 

BIOLCK;ICALL^ TESTED OVARIAN 
HORMONE IN AMPOULES OF 100 I 000 
10 000 & 50 000 INTERNATIONAL LAITS ALSO 
IN TABLETS 

"CLANDUANTIN" the 

GONADOTROPIC FRACTION OF THE ANTERIOR 
PITUITARY HORMONE issued in 

AMPOULES 







"CORTICEN HORMONE OF THE 

SUPRARENAL CORTEX IN AMPOULES OF I CC 
& PHIALS OF 10 CC E.ACH CC CONTAINING 

4 CORTICO DYNAMIC UMTS 


GEDEON RICHTER LABORATORIES 
LONDON 14 18 Weedmgton Rd N \V S' 
and al BUDAPEST X 


PERHEPAR' LI\ER 

EXTRACTS FOR ORAL & 


LSE 


Each hatch ts cl alfy talc 



12 


THE BRITISH MEDICAL JOURNAL 


Jun 30 19 Vs 



Pe) IV Cl Oils Anaemia .. 

SETS A CLINICAL STANDARD 


^>0' - 





SMALL DOSES — WIDELY SPACED Examen Liver 
Extract protides, m each 2 cc ampoule, the specific anti- 
pemiaous-anaemia principle derived from lOO grams of 
fresh liver This unique high potency — the activity of which 
IS clinically verified m each individual batch — permits of 
small and relatively infrequent dosage 

I or treatmiftt of permetous anaemia 4 cc and then 2 cc each fortnight 
until blood count k normal For maintenance 2 cc each 3 to 5 weeks 

PURITY & SAFETY The high potency of Examen is 
contained in an average of only 10-15 mgms of total solids 
m each 2 cc ampoule These solids are protem-frec a 
technical triumph which contributes to safety of adnunis- 
tration Examen is painless on injection and produces no 
allergic reactions 


Prices 3 \ z cc GL ampoules, 13/4, 6 * 2 cc ampoules, zsi- 
12 CC vialS) 18/ Less usual professional discount 

examEn / 


Parenteral Liver Extract 


GLAXO LABORATORIES LTD GREENFORD MIDDX BYRon 3414 



DINNEFORD'S 

Pure Fluid MAG IVES I A 

has maintained, through its dependable 
efficacy, the esteem of the medical 
profession for well over 
a century 

DINNEFORD 4 CO LTD CLIPSTONE STREET LONDON W 


« 





Jlu :o iqi': 


THC BRITISH MEDICAt- JOLRNAL 



iW 



s\TrT O! 
^\TI 

TtrC (fdet 
cf r 

ni H /'T?»on 0/ 
Vr Mle 


AN AID TO HEALTHY DEVELOPMENT 

M odern mcclical r<.scnrch makes it increasinsK clear that abnor 
malities of form mental defects and even permanent constitutional 
weakness arc often a direct result of failure to obtain in infancj a 
diet adequate to the ph\sioIt>gical needs of the organism The basic 
ncccssits therefore in constructing the dietars of the infant and 
growing child is to ensure one that is complete in all the essential 
food elements 

Ovaltine finds one of its most \aluable applications in this direction 
Composed of the nutritive constituents of fresh full-cream milk eggs 
and malt in well balanced proportions it supplies calcium phosphorus 
vitamins and other accessorv food factors and its regular addition to 
the ordinar) diet of the child renders this safe and adequate 
Ovaltine’ is so delicious and easilv digested that it can be presenbed 
wwh complete cowfidewce tor cMdceo of all ages Ovalune vs easvK 
prepared and is most economical 

A liberal supph for clinical trial sent free on request 

A WANDER, Ltd 184, Queen’s Gate S W 7 

Labora'ories and Works KING S LANGLEY HERTS 







I'-i 




infections ’ 


MANDECAL 

(Compoxind Calnum Mandelate B.D H ) 

In B Coll Infections 

' I used one bottle of Mandecal m a case of 
B Cob infection no relapse occurred Before 
the Mandecal was adimmstered the unne was 
c\ammcd bactenologicallj and a heavj growth 
was reported of B Cob After the bottle was 
fimshed the urme was agam exammed and reported 
sterile I shall use it for all future cases of B Cob 
infections ’ ■■ — lrcSjLRCP 


SaPtple and literature on request 


THE BRITISH DRUG HOUSES LTD LONDON N i 
Telephone Clerkenwell 3000 Telegrams Tetradome Telex London 



14 


THE BRITISH MEDICAL JOURNAL 


Juu "^0 19 iS 





AMENORRHEA - DYSMENORRHEA 
MENORRHAGIA - MENOPAUSE 

Today, as for years, Ergoapiol (Smith) is the accepted 
medicament m combating those menstrual anomalies which , 
may be traced to constitutional disturbances , atonicity 
of the reproductive organs , inflammatory conditions of 
the uterus or its appendages , mental emotion or exposure 
to the elements 

The physician readily can ascertain whether his prescrip 
tion for Ergoapiol (Smith) has been correctly filled by 
dividing the capsule at the seam, thus revealing the 
initials M H S embossed on the inner surface, as shown 
in photographic enlargement 

Literature on request 




•rl i/o/'i'Tri . <|?V/ <'cjX< h ^ 


rrs/. -i, €J iJvo?i i fc 4 

M. iJkJ.i 


GASTOMAG 


BRAND 


^ MAGNESIUM TRISiLIGATE 


For the tieatment of hypei'chloihydiia, 
gasluc ulcers, and allied complainls 


GASTOMAG is an efficient antacid Avith a 
strong initial effect, followed by a prolonged 
action AS liieli lasts for seA^eral hours after 
adniinislration Free from all risk of causing 
Alkalosis 

GASTOMAG is unriA'allcd as a poAverful 
adsorbent for remoAnng toxic substances from 
the stomach and intestines 


Per 2 oz. carton - - 1/- 

Discoxint to the iiicihctil prof i bit on 


Obtainable tlnongb any biaiicb ol 



OR FROM THE ACHOLESALE 
AND EXPORT DEPARTMENT 



BOOTS PURE ORUG CO. LTD. 
NOTTINGHAM ■ ENGLAND 



Jim -10 ig-iS 


THE BRITISH MEDICAL JOURNAL 



^^ASCARA Sagraila «as inlroduced to the 
medical profession in 1877 Parke, 

Dans «5k. Co and Fluid Extract Cascara (P . D & 
Co ) lias brought to the attention of the British 
iMedica' Association at the meeting in Cork in 1879 

a 

Sliortli afterwards a process for the preparation 
of a palatable extract of cascara was perfected in 
the Parke-Da-vis Research Laboratories Further 
experience resulted in the production of CASCARA 
Ca ACL ant which IS to dai the most actne, 
palatable preparation of cascara a^aIlable 

Cascara E^aciiant represents the lesults of o\er 
sixt> 5 ears" experience in the manufacture of 
cascara preparations bi the firm which first offered 
cascara for clinical use 

It IS not fortified wath other laxative agents, such 
as aloes, rhubarb, podophillum or senna but 
presents the unitjue therapeutic advantages of 
cascara sagrada wathout its unpleasant bitter taste 




PARKE, DAVIS & CO., 50, BEAK STREET, 

TO A DO A, W.l. 


Lahonlones Hounslow Middlesex 


Inc USA Liabilitv Lid 



16 


THE BRITISH McDlCAL JOURNAL 


Jun JO 19 JS 




(COLLOIDAL IRON HYDROXIDE 10%) 


For the effective treatment of 

Secondary Anaemia, Debility 
and Fatigue 

Colliron replaces with advantage all the older forms 
of pharmaceutical ironi as it is readily assimilated 
' non constipating and does not aggravate the digestive 

troubles which frequently accompany the anaemias 

The dosage of Colliron 
Adults — 20 minims three times daily after meals 
Children — 5 to 10 minims three times daily after meals 

Colliion IS issued tii hollies 

•4-fId oz - 3/- 16-fld oz - 9/8 

8-fld oz - 5/4 40-fId oz - 22/- 

80-fId oz - 40/- 


Evans Sons Lescher Webb Ltd. 

Liverpool and London 



. A PRODUCT OF 
THE EVANS BIOLOGICAL INSTITUTE 


COUNTEP 




Summer heat drought flies 
contaminated food — and the 
result — Food Poisoning t Kaylene 
IS the true antidote to Bacternl 
I o\ms and To\aIbumin» m con- 
taminated food Its action is lapid 
and reliable 

Kaylene brand of colloidal kaolin 
has been shown to adsorb the toxic 
principles of Shell-Fish poisoning 
Potato poisoning and Mushroom 
poisoning — vide BMJ 1 937 1 
595 

PiK. 10(1/ 3/ , 1 Ills. 12/6 






KAYLENf 


nil rff/iiist (Bland of Colloidal Kaolin) 

KAYLENE, LTD. D„Tr,butcr. adsorbents ltd WATERLOO ROAD, london NW2 



Ji'U "(o I'J’S 


THE BIHTISH jMEDICAL JOURNAL 


17 


CRUNCHY FOODS AND 
THE DIGESTION 


■■■ i/r "iiii i ii f f' i'i III III 

It generally recognised by dieticians that hard foods are more 
easily digested than soft ones 1 he cvplanation commonK 
advanced is that soft foods are often swallowed in insufficientlv 
chewed masses , w'hercas hard foods cannot be swallowed until 
the) are properK broken up by the teeth, and m consequence 
the digcstiv e juices have a larger surface area to work upon and 
their action is more effective 

Many physicians therefore recommend that the normal diet should 
contain a fair proportion of hard, dry food They find that 
Ryvita, eaten regularly w'lth meals, supplies a valuable factor in 
w’hich the modern diet is otherwise deficient Free samples of 
Ryvita for distribution to patients will gladly be supplied on 
request 


7 H E RYVITA COMPANY LIMITED 
96-98 SOUTH U ARK ST LONDON S E 1 

Bakeries in Birmingham 


#3 } 



THE BRITISH MEDICAL JOURNAL 


JuL% 30 193}, 


INDICATIONS FOR 'SANATOGEN' 


AETEEi@=S€LEi©$iS and HYPERTENSION 

“Koom for Scepticism ” 

Tiicrc JS room for scepticism as ro the causative relation between the stress and rush 
of modern life and high blood-pressure 

Examination of mummies has shown that arterio sclerosis was common even in ancient 
Egypt, and it was recently pointed out in a medical journal that “ the active goat and the 
horse have little artcrio-sclerosis, while the placid cow and the phlegmatic duck are 
especially susceptible’ 

That food-intake is important both in the prevention and in the treatment of hypertension 
IS however, generally agreed Purins, toxins and exeessive food residues in the colon are 
all to be suspected and avoided 

In the dietetic treatment of high blood-pressure, ‘Sanatogen ’, a carbohydrate free product of 
y? per cent pure milk casein uitb 5 per cent sodium glycerophosphate, has been found 
of great serviee Its nutritive value is high ' 


BLOOD PRESSURE 

I luve been \en interested in ilic 
cfTecis produced b\ Sanatogen in 
j ense of high blood pre sure The 
p-t>cni u>oun«\voman was put on 
j rcsinctcd d*ct tar high blood 
pressure and u cd to find that in 
the middle at the mtirmng and a^icr 
puitini, her little bi> to bed sh- 
hid a tecling of extreme ueakne s 
and was often ft reed to sit or )e 
deA\n fo ses33c time bciore < c 
i .1 uld do am-hin else '■he started 
taking Sanatogen isncc a d3> and 
aher a sho-t period noticed that 
thj feclmg was not making i s 
appearance and she has never had 
It again as she is sli’l continuing 
With the Sanatogen She is also 
\cr\ much impro; cd in health 
and seems o ha%c much more 
reserse cnerg\ now The onl^ 
alteration m dietXhas been the 
additu n o* Sanj c gen 

ChM 


GENATOSAN LTD, 


NO TOXINS NO PURINS NO RESIDUE 
NO ABNORMAL FERMENTATION 


ANATOGEN 

{Tnit ifa () 

A trond of Casein and Sodmm Ctvctrophotfhale 
Sold hy all caemiits fnee Jfi to 1919 


DOSAGr Fur children and adults 
two tcaspoonsful three times daily o 
aciordin;; to circumstances For infants 
1 teaspoonfol added to < ach bottle feed 


rir 1 S\N\TO( J N Is llw Tr I ^ . i 

I > r (V 1 I t I an llmr f i w ' ' 

f I n jn } S r»f/T I Jy x* ’*■ 

A tlNVItlS^N p locxnul •> 
r 1 \A IDSSN I I I lO rr Lh I ' 


Cl mica I samples and litetatine available on request to 

LOUGHBOROUGH, LEtCESTERSHiRE 



]in 10 lOll 


THE BRITISH MEDICAL JOURNAL 


19 


Eli Lilly and Company Limited 

PhannaceiiUcal and 'Biological Products 


riCLEXTRON'- 

£u'fr Sloinacb CoiicailnUe u il/» Jr j ai d J'iliimm V Cot il>k\ 

IN "SECONDARY" ANAEMIAS 

In anaemias of the microcj tic pe, the response 
to'Lextron'brand li\ er-stomach concentrate\ ith 
iron and Vitamin B complex is rapid When he 
prescnbes 'Lextron'the phjsician is assured 
his patient w ill receive all the materials essential 
to blood regeneration jn anaemias of this class 
'Lextron' brand Ii\ er-stomach concentrate 
with iron and Vitamin B complex is supplied in 
bottles of 42, 84, and 500 'Pulvules' brand filled 
caosules 


^Prompt Jltteutioii Qwen to Projessioitai Jitditines 
2 3 \\D -1 DEAN STREET LONDON VI 



uftHa m Bntaw for 

ELI LILLY AND' COMPANY, INDIANAPOLIS, USA 





-T-I ir: DonKMJ MPrvirAl JOURNAL V ^0 U)ifi 



Thcnpcutic Substances Act, Licence No 9 


Anti-fyphoid- paratyphoid 

Vaedne (T.A.B.) 

It IS nowadays customaiy to combine in one vaccine the piottctive 
merits against t^ phoid and paratyphoid A and B fevers, which arc all 
liable to occur in similar circumstances TAB vaccine contains 
I OJO million B tyjjliosus and 100 million each of B pcmi typ/iosus 
A and B per cubic centimetre Inocul ition with this vaccine 
IS stronaly iccommcndcd for nursing staffs in fever hospitals and 
person-' procccdina to infected areas anywhere (eg, on holidays 
in manv Continental countries), or to the tropics Double inoculation 
(' ee followed b^ 1 c c 7 to 10 davs later) produces an immunity 
leairded as lastina about 12 months at the end of which a fuithcr 
dosc of 1 c e is idMsiblc to maintain the immunity 

In impoules of 0 a c c - each 2/6 

lee ^ 2/6 

InlOcc rubber capped M ils - ,15/-- 

In 2a e c , ' , 25/' 

Sti'c DntriPtiti'T^ fur tiu Licit r /iicIiIuIl 

SrlEeiTB &. 51siFalp^FY!S ttJ* 

London, E 2 




-fc* *• 




JUL^ ■'0 19 A 


THE BRITISH MEDICAL JOURNAL 


21 


RELIGIO MEDICAL SERIES No 153 — CELTIC 



dietetic substance 
first importance 


RYZA 





SRAND 


RICE POLISHINGS CONCENTRATE 


Stnmil itC' appetite 

A'Sists clia'cstion Promotes growth rnd mcu Aed 
alcrtnc^R in tho--t childien who hck weight rnd \igour 
Oi imqiie?tionahle \aluc m cases in whicii wholemeal 
bre id is precluded from the diet 

Presents ^0 units of \ itamm B, in e ich gramme 

ColhNdi to — 

15 :;r tmt i f*. \ ) t 10 ///3 

10(1 i I* approx f 10 - /> r 

Le-r-J P (fi ty fr J f t tf'" 


Burroughs Wellcome & Co . London 

^liidre s f f coff’inufttcatu r s SNOW HtLL BUILDINGS E C 7 
Lxhbittn Galirrtfs lO Henrietta Place Cavendish Square W 1 
Ho j 3 ^ 

Ne\/ York Montreal S<'Oney Cape To\/n Milan Bombay Shanghai Buenos Aires 

o o o o o 




VOTIVE OFFERING FROM THE REGION OF THE AEDUI IN GAUL PRO- 
VIDING EVIDENCE OF THE CELTS RESORT TO HEALING WATERS —The 
Romans on arrivings in Gaul found the Celts devoted to the worship of \^aters Traces 
still remain of their bathing stations where in one case the water of a spring was so 
carefully captured that not a drop was lost The sockets to which images of the 
healing deities v.ere fixed still exist Large numbers of votive o&erings have survived 
left m supplication or gratitude These sometimes took the form of the diseased 
member The one here reproduced represents a swaddled infant with an expression 
of suffering which may be intentional or due to the lack of skill of the sculptor 

DATE The votive offering A D c 100 cut 




210 JuL^ 30 19^8 MENTAL FACTORS IN MEDICINE 


TjU nKITIMI 
Midkal JOIKWI 


no ps\cholog\ he is bound to seize on this and ticat it, 
sometimes with success sometimes without E\en if 
successful immcdiitelt he may ha\e harmed the patient 
for the future by letting him think that an unimportant 
lesion like the one diseovered could have caused so much 
ill-health with its devastating corollary that one cannot 
tike too much care of very small depaitures from ti.e 
norm il On the other h.uid after exhaustive inquiries — 
exhiustise espeei dl> to the patients purse — he may be 
ible to issure himself that there is nothing wrong 
phjsicill> He will now hopelully and enthusi istically 
impart the gl id news to the patient, but not add anything 
to this purel) ncgitisc thing which leally coneeys nothing 
in the w ij ol inlormition and he is apt to be dis- 
ippoinied when the patient continues to be as ill as 
before is loud m his compi lints His disappointment 
will prob ibly deepen into annoyance when he hears some 
months 1 iter that this ingrate has been cured by an 
osieop ith or i nature-curcr or by any other of the un- 
quihried people who tike the opportunity once more to 
score over medical science not realizing the vitreous 
niturc of the houses they themselves inhabit Our 
doctor m ly even become bitter enough to think that this 
iricgulir cure was spontaneous There are of course 
spontaneous cures, but the doctor is more apt to think 
It for these than he does for his own 

It IS fairly obvious why i purely negative diagnosis, 
1 diagnosis that there is nothing wrong, is unlikely to help 

I piticnt He feels ill and to be told that these symp- 
toms mein nothtng is to infer that he is imagining them, 
ind he knows that he is not He is therefore driven to 
suppose tint the doctor has not understood the case 

II the doctor has been careless the patient can, of course, 
transfer to mother but if the doctor has been careful 
It m.iy be that the only change open to him is to change 
th^ system to go to 'omeonc who is not a doctor and 
who openly preaches that doctors know very little Such 
1 one will not m ike the psychological error of saying 
th It there is nothing wrong He will find poisoned blood, 
or pressure on nerves ind circul ition or faulty posture 
ind by his certiintv will inspire the pitient with hope, 
for the time being at leist That the immediate good 
results obt lined by these people ire genuine I ha\e little 
doubt that their remote results can be good I have the 
grisest doubts I im certain that their good results arc 
due to the psychologic il f ictois of faith ind hope but 
f nth ind hope ire not of themselves enough for lasting 
cure I im of opinion that one of the reasons whv quacks 
flourish IS that they arc better psychologists than most 
iloetors Tint is not the whole rcison which would tike 
too long to go into but it is an important one These 
piticnts line something wrong but it is not phisical it 
IS something of the nature of mental dish irmony Most 
physieiins will agree but they do not teach their students 
how to investigite this muter as they would tcich them 
how to mvcstigite a c,irdiac irrcguliritv 

There is however mother ind fundamental re ison for 
the futilitv of rcgirding the neuroses negatively When 
we eome to examine these patients from a mental aspect — 
tint IS to siv when we take their histones — we find that 
their svmptoms ire the positive responses to mxictics 
eonfliets and the like of ex ictiv the same order is svmp- 
toms m i\ bt the positive responses to phvsical stimuli 
3\c hive IS i profession learned much of the iclion of 
plusieil irritants we must now turn our attention to 
ssniptoms produced bv meni il irrit ints We shall then 
find th it there is nothing negative about the neuroses iny 
nine than there is m rhvsicilh determined illnesses 


In eveiy case of illness there arc three questions to k 
answered Are these svmptoms due to physical irritants, 
to mental irritants or to both^ No di ignosis is neirly 
complete till they have been answered 


The “Fancy” Diagnos-s 


So much for the conscientious doctor who, when this 
soil of thing happens often enough may become less so 
One not very good at the beginning, finding nothing Ihit 
he had been taught to look lor, may make i fancy di.ig 
nosis on no particular kind of evidence — a weak heart or, 
more fashionably just now, a gastritis His treatment nnv 
be followed again by immediate success neither he nor 
his pitient has the faintest inkltng that this may be due 
to the mental healing factois of faith and hope Even 
il he succeeds in his treatment he has damaged both 
himself and his patient — himself because he Ins stirlcd 
on that dovvnwaid path which leads to the belief that 
accuricy of diagnosis does not matter so long as the 
patient is told something definite it is good if the dng 
nosis IS correct but not dreadfully bad if it is not He 
has damaged the patient, who has been told that some 
oigan of his peifectly healthy body is not quite heillhy 
and who must now believe that he ought to take nri 
of It and vvhosoevei starts taking caie of a healthy bodj 
will soon have plenty of illness 
Thcie IS another unpleasant thought about all this 
In all these ways doctors aie regularly idding to ihv 
quantity of neurosis in the world instead of diminishini. 
It They do so if they succeed in the way just mentioned 
They do so if they fail because the patient soon loses 
laith m his doctor, gels bewildered and is driven dccpir 
into neurosis I have said that neurosis is common and 
] must add that it is lamentably common from this ciusc 
A patient has symptoms caused by anxiety The doctor 
says It IS due to some physical lesion The palicnl 
becomes anxious about this The anxiety causes more 
symptoms and this helps to fix the belief in phjsicvl 
disease, and so on acl infinitum 
So much for pure neurotics But in addition to them 
many sick people will add mentally determined symptoms 
on top of 1 physically determined one Anxiety from 
many sources is apt to complicate illness, especially 
chronic illness And in many instances of organic disci'c 
the only treatment we shall be able to give vvill be 
psychological 

Teaching the Next Generation 


J should like now to leave my young doctors and 
back to the vvaids and try to plan how the next genera 
tion IS to esc ipe the mess that these poor young men arc 
in At once the questions arise Where arc these stiidcnis 
to be taught by whom, and what aic they to be tauglil? 

The answer to the first two will probably be that 
IS irrangcd for ilreidy — namely, in the psychiatric « 
partment by the psychiatrist And my reply is that i 
IS not good enough, for many reasons, some of wnic 
have been given The question of neurosis musl 
raised often dl over the hospital The student mm 
continually be made clinically aware of its possibilihcs 
regards symptoms, ind every teacher ought to be i 
to say something about the elements or principles 
trcitmcnt Now what is to be taught'^ 

A physician of my acquaintance told me that it 
high lime we psychological people put oiir lioii'C 
Older, and I would respectfully ask those of our me 
friends who acknowledge that we have a case to he p 


to present it properly, as they have done 


with o'b-' 



Jtu ^0 I9-(S 


MENTAL FACTORS IN MEDICINE 


The British 

M D CJL- IovK>\L 


21 1 


Icchnicnns like "iiirgcons ind bacNriologists Thev do 
not gi\c ihuSi. people a frei. hand ^\lth their patients but 
call them m consult with them and then use them or 
not as stems fit 

There is an idea abroad that no psechological treat 
nient except psxeho anahsis is worth talking about I 
ha\t spent mv life in tr\ing to show that this is not 
true I am sating nothing against pstcho anaUsis which 
IS probablj the best treatment for certain cases but there 
are a great number of patients who do not need it for 
whom something ruite simple is all that is required 
I hate no wish that medical students should learn analtsis 
It would be impossible for them to do so cten if it were 
desirable Time would make it so For the same reason 
even if pstcho analtsis were the onlt pstchoiherapt 
mental treatment would be impossible for the majorilt 
of patients In mt tiew there are and hate been lor 
a long time simpler and shorter methods of pstcho 
therapt which arc at least as old as Freuds ststem 
and of which the greatest exponent was Dejerine of Pans 
This depends on the fact that man} s}mploms are caused 
bt conflicts and anxieties which are not necessaril} un 
conscious in the Freudian sense but which are not b^ing 
faced properlt Tat ing a full histor} in the co irse of 
which the patient mat be induced to speak of these 
worries be guided about them haxe mans of them 
explained so that the} no longer cause aiixiett will in 
mant instances bring about a great change for the belter 
in the patients mental outlook and in his health Mant 
of these anxieties will be on intimate personal matters 
and talking about them will often gite relief Mant will 
be about disease and health It is incredible what extra 
ordinar} tiews people hold about health in general and 
their own in particular and here it is that doctors should 
be more careful than some of them are in telling paoents 
that thet mat hate frail or impaired organs when the 
real truth is that these doctors themsthes are unable to 
make a diagnosis For the same reason students should 
be taught when there is phtsical disease not to put the 
gloomiest possible tiew before the patient a thing done 
often with the best intentions so as to bring a patient to 
take some care of himself but which ma} be follo'Xed bv 
disaster 

There is one essential — namelv ihat the patient and 
the iniestigator must be alone together for their talks 
People will not speak of intimate things before a crowd 
Therefore it cannot be demonstrated to students how to 
do It but students could be told the procedure and be 
superxised while the} were learning to practise on patients 
There will be cases which such a procedure will not cure 
these are for the specialist We expect a general practi 
tioner to treat man} dxspepsias kidne} diseases head 
aches and catarrhs bv himself and not to run to a 
specialist for ever} one But there will be dvspepsias 
headaches and catarrhs for which he will need a specialist 
and we expect him to learn which are those that he can 
treat himself and which are those where he should seek 
special skill The same thing applies to the neuroses 

The Teachers _ 

Who IS going to teach the students’’ Time is needed 
There should be someone who can teach them as clinical 
tutors teach them ph}sical signs These teachers ma} be 
under the psjchiatrist , but whoever is at the head of this 
department should not be locked awav in the depart 
ment of ps}chiatr} but should be asked to come to the 
wards and consult with the ph}sicians and surgeons as 
to whether there is a large emotional element in this case 


or not The medical or surgical chief and the student 
will then not lose sight of the case as thev will if the 
patient is dismissed to the psvchiatric department becau e 
the general ward has got tired of him It I am told this 
Is impracticable I answer that nothing is impracticable 
which has been done and is done Dejenne did u in his 
wards and said that he got better results than in private 
practice It is being done in America and an exiremelv 
vivid description of the psvchiatrist being welcomed m th^ 
general wards and consulted freqiientlv has been given b} 
J kasanin of Chicago (1937) 

Referencls 

Ka>amn J (t9s"l Lanctt 2 l^tS 
Pearson Bruce tl9V3) Ibid 1 4 1 


THE VALLE OF RADIOLOGY L\ THE 
ELUCIDATION OF HAEMOPTYSIS* 

BV 

FRANKLIN G WOOD, M B , D M R E 

Htuiiolo^ist to the London Chest Hospital t tetona Pari 
and to the Gerninn Hospital Dais ton 

Haemopivsis is an important svmptom in diseases ot the 
chest and was formerlv considered to be a certain indica 
tion of pulmonar} tuberculosis unless the contrar} could 
be proved We know now that it mav be a svmptom ot 
anv chronic or acute disease from simple bronchitis to 
lobar pneumonia 

Haemoptvsis in Pulmonan Tuberculosis 

If pulmonarv tuberculosis has been responsible for a 
haemorrhage from the lungs a chest skiagram will ncarlv 
alwa}s suppiv evidence of this disease But it sometimes 
happens that although the histor} and svmptoms are 
suggestive of pulmonarv tuberculosis a skiagram fails to 
show anv abnormahtv It appears probable that this mav 
be explained bv the presence of a small tocus ot disease 
which either proves abortive or goes on subsequentiv to 
the development of a more obvious lesion It is desirable 
however, that a verv careful radiological examination 
should be carried out since a tuberculous focus or even 
a small cavit} posterior to the lung root or heart or behind 
the domes of the diaphragm ma} be easilv missed The 
investigation should include a screen examination and 
radiographs taken in the oblique and lateral positions The 
semi oblique position with the patient ro'ated so that the 
clavicle on the side to be examined is parallel wiih the 
cassette is of special importance in demonstrating lesions 
m the vicinit} of the lung root Radiographs taken with 
the Potter Buckv diaphragm or a fixed grid of the Siemens 
or Lvsholm tvpe are also of value especiall} in stout 
patients 

The invention of tomographs has considerabJv enlarged 
the scope of the radiological examination of the chest and 
I think that m the future it will prove a method of con 
siderable interest in the examination of cases of baemop 
t}sis with no obvious lesion in the lungs As some of 
these patients subsequentiv develop a lesion which can be 
demonstrated radiologicall} it is important to carr} out 
serial radiographs at intervals to exclude the presence of 
disease - 

There are manv other conditions besides pulmonarv 
tuberculosis which mav cause haemoptvsis the most 

* fl'xid in opening a discussion in ihc Section of Radiologv at ibe 
AnnuiI Meeting of the Briti h Medical Association Plvnioub 
19 S 



212 July 30, 1938 RADIOLOGY IN ELUCIDATION OF HAEMOPTYSIS 


Thc BRniMi 
MtDlCH Jot »StL 


important being bronchiectasis herrt disease new growth, 
\neiir\sm and trauma A frank haemoptysis may also 
occur in earh pneumonia An interesting paper was 
published in 1928 by Vinson describing work carried out 
It the Ma\o Clinic on the relative frequency of haemop 
tysis m pulmomrv tuberculosis, bronchiectasis, and mitral 
stcno>is The history of 100 patients suffering from each 
of these diseases was contrasted, and it was found thrt 
forty nine of the 100 with bronchiectasis had haemop 
tv SIS as compared with twenty -nine in the pulmonary 
tuberculosis group uvd only eighteen among those suffering 
from milril stenosis This suggests that while it is true 
til it pulmonary tuberculcs's usually is the cause of a 
pulmon iry haemorrhage because of the greater frequency 
of the diseisc the relative incidence is much highei in 
bionehicclasis 


Drv H lemorrliagic Bronchiectasis 


The occurrence of haemoptysis in bronchiectasis has 
been known lor a long time but it is only since the intro 
duclion of hpiodol is a method of outlining the bronchi 
th It the presence of what is termed ‘ dry haemorrhagic 
bronchiectasis has been successfully demonstrated In this 
condition there are no obvious physical signs such as 
clubbing of the hngers or purulent sputum, which may 
reveal the presence of the disease on clinical examination 
The radiological investigation is therefore of considerable 
importance The preliminary ridiographs may show 
evidence of fibrosis oi the dilated bronchi may actually 
be visible as a sciics of spherical or cylindrical clear 
sp ices, but tn <iny c ise hpiodol will be required in order 
to show the extent of the diseise The lesion may be 
found cithci in the iippci part of the lung, where it closely 
simulites pulmon iry tuberculosis in appearance, or, more 
commoniv in the lower zone where it is less likely to be 
confused with other lesions When the condition is 
developmental in origin ind probably due to failure in 
budding the dil it itions are spherical in appearance, while 
in the icquircd disease the dilatations are usually 
cvlindiieil 

Tlicie lit minv methods ol intioducmg the oil in 
common use the simplest of which is to drop it on the 
b ick ol the longue ifter abolishing the swallowing and 
cough icflexcs by means of i “i pci cent cocaine spriy 
ind 10 per cent brush in each tise a little adrenaline 
being added This gives good pictures when successful, 
ind cuiscs the patient i minimum of discomfort The 
use of i n IS d c ithctei is i surer wav which enables the oil 
to be mjccled into my pirl ot the lung under screen 
control The hpiodol cm ilso be miroduced through the 
tnco ihvroid membrmc 


If the opiquc medium is iniioduccd ihrough a bioncho 
scope the resulting films are never so good as those 
ohi lined bv other methods The hpiodol tends to be 
eonccntrited in one pirt of ihe lung and the appearances 
ire often deceptive owing to locihzed ire is of alveolar 
filling winch mvV closeiv resemble civ nation in the 
lung It IS however often impossible to outline properly 
the civitv ot m ibsccss of the lung bv my other 
method 


The ridtogiaphie technique will natur illy vary with the 
ippar nils n the disposal ot the operator It is essential to 
' ike r idiogriphs m the shorlcsi possible lime and to over 
expovc ilu lilms Ii lollows from this that a set of high 
oiiipiii mil itu u^e ot 1 rot itmg anode tube will give the 
tss’ reMil's The cvposure lime should if possible be onc- 

1 ' o' j sn,oni! O'- less 


Haemoptysis in Hfart Disease 

The radiological examination of the heart is an impor 
tant branch of chest radiology that has made very much 
progiess in recent y'ears The appearances of the heart 
and great vessels on screen examination and m the tele 
ladiograph have been exhaustively studied, and more 
recently kymography has been introduced as a method of 
examination which is already proving of considerable use 
The apparatus consists of a moving grid with a scries of 
hoiizontal slits at intervals of twelve millimetres which 
lecord the movements of the beating heart as a wavy line 
Respiiatory movements of the ribs and diaphragm can 
also be registered Tn the examination of the heart the 
exposure is made with the breath held so as to avoid 
lespiiatory disturbance of the heart movements Each 
region of the hcail has a characteristic curve The aortic 
arch also gives a wave form which distinguishes it from 
opacities due to neighbouring sliuctuies 

It IS necessaiy to exclude any lesion of the heart when 
examining a patient with haemoptysis, since many of 
these patients aie in reality suffering from heart disease 
Haemoptysis is less common in heait lesions than in 
pulmonary tuberculosis oi bionchiectasis, but it is an 
important symptom in mitral stenosis Paroxysmal attacks 
of haemorrhage may occur in this disease, due to con 
gestion in the lungs oi to infarction In an early case of 
mitral stenosis the first radiological sign in an anterior 
radiograph is a prominence of the pulmonary artery and 
pulmonary conus Some enlargement of the left auricle 
may probably be detected at this stage in an oblique film 
As the degree of stenosis met eases there is a progressive 
enlaigement of the left auricle, which can be seen bulging 
into the reirocardiac space both on screen examination 
and in radiographs taken in the fiist oblique and lateral 
positions With Ol without a barium swallow The accom 
panying congestion in the lung fields is a characteristic 
feature 

Pulmonary Infarction 

Pulmonaiy inlarction is a possible cause of haenior 
rhage vvherevei there is vascular engorgement m the 
lungs Such engorgement may occiii in mitral stenosis 
and also where theie is left ventricular failure It v!*® 
occurs as a post-operative phenomenon The radiological 
changes seen in pulmonary infarction weie not well known 
before the advent of the portable radiograph As the 
patients arc usually very ill the condition is rarely seen 
in the loutinc radiognphs taken in the v-ray dcpirtmenl 
Shirley Smith (193S) in a leceni paper has descnbe<l 
thirteen cases with radiographic control The changes 
arc usu illv seen at the base of the right lung The appear 
inccs arc v inable and may consist of an area of clouding 
rather like the appearances seen m pneumonitis, or an 
irregular sh idow m ly be present resembling that seen m 
lung abscess An accompanying pleural effusion uias 
mask the area of consolidation in the lung It is worth' 
of note that in the absence of pleural effusion the hcjrt 
IS iisualh drawn slighllv towards the side of the lesion 

Bronchial Carcinom i 

A trank hacmopivsis is uncommon m , bronchial ears' 
noma although it may be i leading symptom for instance 
in 1 malignant papillom i spreading from the bronchi 
wall The lumen of the bronchus at the site of gro"^^ 
may be filled with necrotic material, and blood is n 
present in sufficient quantities to be obvious in the 
In the rclitivelv rire benign bronchial growths, sue 
papillom 1 ind endothelioma, haemorrhage is on the ol 



JLl^ jO 193S 


R\DIOLOG\ IN ELUCIDATION' OF H-\E\IOPT’i SIS 


The Birrun 
Med Cal Jdlr'-al 


2n 


li ind common md nn\ be profuse A bronchnl carci 
nom 1 usualh produces ch mges in the lungs that arc easiK 
Seen m a film, but the small benign growth will not be 
detected unless it is large enough to bloch the lumen and 
cause atelectasis It follows therefore that the radio 
logical examination mas be cntirels negattse Examples 
of such cases ssere described b\ Morlock and Scott 
Pinchin (19t5) McGibbon and Baker Bates (19s7) and 
others The latter authors describe tracheal sarix and 
non specific granuloma as causes of pulmonars haemor 
rhage The rare tracheal carcinoma mas b,. the cause ot 
haemoptssis and is sometimes \isible in the skiagram 
after lipiodol If the radiological examination is ncgatixe 
and the attacks of haemoptssis continue a bronchoscopic 
examination must be considered 

Ancurs'sm of the \orla 

In aneurssm of the aorta haemoptssis is onls seen as a 
terminal esent staining of the sputum being a ssarning 
sign of the imminence of a rupture The diagnosis of 
aneurssm is not alssajs eass to the clinician especialls if 
the posterior part of the arch or the descending thoracic 
aorta is msolsed Unfortunatelj it is not alssass simple 
for the radiologist, for ans grosvih or tumour in the 
neighbourhood of the aorta ssill simulate an aneurysm 
especialls if the growth is one in close contact ssith the 
aortic arch and insolsing the pericardium Mistakes often 
occur and the Wassermann reaction is not an infallible 
test Aneurssm may simulate a dermoid csst if it is 
directed forsvards and lateralis m the superior mediastinum 
Ksmographs is of great assistance in such cases and I 
think that in the future it should lead to a correct diagnosis 
in most cases since it enables us to separate the outline of 
the aorta from the growth and usualls gises a character- 
istic picture 

Haemoptysis following Injurs to Chest 

Haemoptssis may follosv injuries to the chest svith or 
ssithout rib fracture Where the injury is sesere the 
presence of a fracture is very easily shossn, but there are 
many cases sshere radiological demonstration of a fractured 
rib IS difficult A general radiograph of the chest some 
times fails to reseal the injurs A localized siesv may be 
of assistance This can be done by' tsso methods The 
cassette is placed in contact ssith the site of greatest pain 
and compression applied so as to prevent mosement of 
this part of the chest wall If the patient is then instructed 
to breathe lightls the part of the ribs in contact svith the 
cassette will remain stationars and the outline of the 
remainder of the ribs will be blurred ossing to the move 
ment The second method is to diminish the focal skm 
distance so as to blur the overlying ribs and bring the 
part of the chest nearest the cassette into focus 

Conclusion 

This summary of the rrfain conditions which may be 
the cause of a haemoptssis cannot be considered to be 
complete but I hope it svill base served to show that 
a radiological examination is an essential part of the 
investigation of these cases and that it may be a deciding 
"actor in the diagnosis It is well known that no examina 
ion of the chest is complete to das ssithout a comple- 
mentars radiological investigation 

References 

McGibbon J E G and Baker Bsicn E T (I9a7> British 
cheat Jottriial 1 109 

Pinchin A J Scott and Morlock H X" (I93a) Ibid 2 332 
Smith K Shirlcv (1938) Quart J Med Ness Sen-s 7 85 
\inbon P P (1928) Ann Olo rhiiwl Larjago' 37 675 


PLAY-THER.VP'i FOR ‘ PROBLEM” 
CH1LDRE> 

BV 

ETHEL DUKES, L R C P & S 

Medical Director Inslitiitt oj Chid Psschoh 

The object of this paper is to show the immediate resiilts 
of treatment and the present condition of I'-t of the 
children who attended the Institute of Child Psvcholog 
for varsing periods between the years 1930 and I93s 
With the exception of tour cases all the children included 
in the follow up were treated bs the psschological 
method known as plas the'aps according to the tech 
nique devised bv Dr Margaret Lowenteld who stared 
the institute as a small clinic for problem children in 
1928 

During the period under surses 247 children were 
accepted as patients Of these thirts two ssere consultation 
cases in which the children attended not more than three 
times and in which periodical advice as to management 
was all the treatment indicated and given Although 
we know that some of these cases are doing well thes 
hise not been included in the chart as thes were not 
treated bs plas theraps Fourteen patients were dis 
covered to be mentalls defective and ssere rejected 
tsvents three cases ssere immediatels transferred to other 
institutions for various reasons and m tsvents four cases 
the parents prosed uncooperative soon after acceptance 
and the patients ceased to attend The remaining cases 
154 m number received full treatment and are analssed 
m the chart belosv The eldest child was 17 and the 
voiingest 24 Thes are divided into four categories — 
namels neurosis anti social and behaviour problems 
physical complaints and educational difficulties 

The majorits of the children were recommended bs 
school authorities social agencies police-court officials 
hospital doctors and private practitioners The re 
mainder ssere brought bs patients or friends 

Neurosis (76 Cas“s) 

Under this heading are included cases in which the 
chief causes for reference were the following anxiets 
night terrors sleep walking excessive or unwarranted fears 
and inhibitions nervousness and hspersensitiseness 
hysteria tics and habit spasms lack of concentration or 
self-confidence inability to plas screaming fits anorexia 
nervosa insomnia and obsessions In addition to one 
or more of these ssmptoms seven suffered from enuresis 
nine from speech defect and fourteen ssere backward at 
school 

TPESTSIENT 

Twents-sesen were treated bs plas therapy alone In 
addition to play therapy forts two had some kind ot 
medical surgical or dental treatment for phssical dis 
orders discovered on examination ranging from dental 
caries to undescended testicles nine had speech theraps 
and fourteen educational coaching in ore or more sub 
jects Some children needed two or three of these types 
of treatment 

Anti-social and Behasioar Problems (38 Cases) 

These children s ere referred to the institute on account 
of difficulties such as excessive disobedience temper 
tantrums unmanageubleness truancs sagrancs Is mg 
pilfering stealing excessive bullsing sexual offences 
destructisene s gangsterism etc In addition seven ot 



214 JUL^ 30, 1938 


PLAY-THERAPY FOR ‘ PROBLEM CHILDREN 


IHtHUTlSH 
'ItDlCAl loiUMl 


TahU shomiii; An{il\MS of Cflsiv 


Condiiton on Di^clnr^c 


Present Condition Pollow up 


1 

I Moic 1 

No 

ol 

C ivcs 

\Vc!l 

Much 

Im 

proNcd 

1 

1 

Im 

pro\t.d 

Un id 
jitsted 

Unco 
open 
tuc 
iftcr 
; some 

1 Trc \l 
i ment 

Well 

1 

M ucli 
Im 

pro\cd 

Im 

proNcd 

Uma 

justed 

1 

De id 

Un I 

(need 

Tnns 

ferred 

after 

Treat 

ment 

to 

other 

Insti 

tiitions 

Axcrite 

Ate 

i 

1 

An cnee i 
No ol 
Attend 
inccs 

ANcragc: 
Months ! 

of 

Treat 

mcnl 

ANcraft 

Imcilh 

(lent 

QiKt<r{ 

NciiroMs 

2A 

le 

n 

3 


■ 

15 

B 


■ 

■ 

1 


72 

IQS 

9 

\m 


16 

12 

B 

6 


B 


B 

3 

B 

B 

2 

2 

S 1 1 

317 

9« 

IWO 

Bn.l 

16 

3 

B 

3 


B 


B 

1 

B 

B 

2 

A 


23 0 


9H 

Tut il 

76 

27 

30 

12 

5 


43 

13 

4 

5 

2 

5 

4 





Anti vuci il b«h iMiHir 

Ootid 

5 i 

i 

■ 

1 

2 1 

2 


■ 


1 



3 

\ 

Si 

B 

70 


Un5TiisfKtor> i 

13 

4 

B 

' 1 

1 

I 

B 

3 

1 



2 

\ 

If 0 

21 3 

66 

m 

Hul 

20 

4 

H 

2 

1 

I 

7 

■ 

2 

' 

5 


3 

2 

1 

90 

22 0 

61 


Ttanl 

is ; 

S 1 

12 

6 : 

4 

s 

13 

m 


m 


B 

B 

1 

1 




Medit. il 

Good 

10 

4 

■ 

I ' 

, 

1 

6 

■ 

y 

■ 


■ 

1 

S 3 

2W 

7 I 

ion 

UnviHvrictors 

IS 

5 

B 


2 


8 

B 

B 

B 


B 

B 

70 

43 0 

121 

940 

Hid 

9 

1 1 

B 

5 ' 



4 

B 

B 

B 


B 

B 

1 

1 80 

40 2 

140 

S4fl 

Tot \\ ; 

14 

in 

14 1 

6 

3 

I 

18 

8 

2 

2 


2 

1 





J due luoinl c^st^ 

■ 


1 















Good 

■ 

■ 





1 






1 

i 

21 

7 

9S 

Unvitisfiuors 

H 

B 

1 




2 





1 


tl 


4 

10" 

Hid 

H 

B 

3 




1 

1 




1 


97 

SOO 

13 0 

91 < 

Tot d 

■ 


4 




4 

1 




1 







iht. above sullcrccl Irom cmiicsis iiui fi\<. weic bickwud 
H school 

im M Ml NT 

Eighici-n were tie.UeU bv ph> therapy done in ttldi- 
iion to pin ihenpy eighteen had treatment lot physical 
disoiders ind five had educational coaching 

Plnsical Complaints (34 Ciscs) 

These children were rcfcried to the institute on lecount 
of some chronic medic \1 disorder for which, in many 
e isLS previous treatment hid been ol no avail The 
compi tints included asthma ccTcma, uiticaiia fits liinc- 
tiontl eve comphints lunctional pirilvsis muscular in- 
eoordinition gcncril dcbilitv pvknolepsv, colitis vomit- 
ing ele In some ctses there vvis in undtriving neurosis 
vvhieh minilested iiselt onlv in this m inner or there 
w IS in iccompinvmg neurosis which helped to form 
i vicious circle Eighteen hid enuresis either is the 
onlv eompl iint or in uldition to another 

iRrvTMi Nr 

Sixteen were treited bv plav-theripj done In iddi- 
lion to pi IV theripv seventeen had some kind ol dentil 
medic il or surgical treatment and three had education il 
eo idling 

Home Circumstances 

Comprehensivi. aceounts of the home conditions of these 
ehiUtren hive h<.i.n obt lined, and ire graded according 
to tlui-c eviUiitions good unsatisl ictory, and bad 

Giiot/ In these homes the materi il conditions vv^re 
t ooit s ir\in„. ontv iceording to the soci il position of 
1 I- 1 iniilv So 1 ir IS eoiilit be iscert lined the emotional 


leluions between the pueiits vveie noimtl Any psjvhvi 
logical mistakes in the nuilurc of the childicn were such n 
spring tiom a too stiong instslencc on the ordinary tiboo' 
and inhibitions prescribed by eonvention and a sense of 
respectability and a too caily oi iigid tiaining m ekmh 
ness and social behavioui Symptoms of anxiety neiirOM' 
were noticeable in some of the mothcis 

Uii\<i!isfmlo)Y — In these homes, though the invonK 
was usually suflicient for the needs ol the family nnh'' 
thcic vvis temporary unemployment, the psyctiologM 
conditions vveic not good Parent il psychonciirosis bn 
relilions between the parents, bioken homes bad mimci 
mcnl of the home adoption and illegitimacy, and gro" 
mism inagcmenl of the children were imong the diflnd 
factois in the lamily situation A tew of these chihla'' 
vveic now living in homes and hostels having had ct 
eaihei experiences 

Bad — Here the conditions vveie bad in every sin'i 
Povertv, ovcrciovvding slum conditions dninktnni ‘ 
sexuil oflences illegitimacy, feeblemindedness I'li 
beating, and desertion were prevalent ^ 

The figures show that in the neurosis, the anti 
and the medical groups (the cducitionil group 
small for comparison) there is i correlation bclween 
type of home the compi iint ind the average intclligst'^^'- 
quotient The average intelligence quotient was n" 
in the bid tvpe ol home in all three groups 
In the anti soci il group the numbers admitted for am 
social behivioiir vary directly with the type of lo 
being smallest in the ‘ good type From the 
tvpe of home cimc 52 6 per cent of the anti sociil C' 'j 
from the uns itisfactory type 34 2 per cent fr^'’^ 
good tvpe onlv 13 2 per cent 







































































Jll\ '0 193b 


PLV'i-THERAP'i FOR PROBLEM CHILDREN 


The Extch 
M_o Cal Jo tsvi. 


215 


In tin. ncuros i group th^ figiirt.s were 21 per Cent 
trom the bad t\pL of home 47 3 per cent from the 
unsatisfactore tjpc and 31 5 p^r cent from the 
good tape Neiietatter (19^8) showed that poor social 
condittons did noi pecessarih produce neurosis m 
children unless there \ ere ssmptoms of it in the paren s 
The above figures seem to confirm his findings and to 
suggest that delinquencv and crime are more likeh to 
be the end results m the bad tape of home It is inter 
esting to note that th^ highest percentage of neurosis 
cases came from the more comfortable homes \ he c 
psachological conditions sere bad 
The results of treatment the length of time taken and 
the number of attendances neccssara do not seem to b^ar 
ana relation to the tape of home Just as good and 
enduring results seem to haac come about in cases from 
bad homes as in those from the other two tapes This 
suggests that the direct method of plaa therapa can be 
successful in helping the child to oaercomc his dilfieulties 
aaithout the necessarj aid of enaironmental change 

immed a‘e Results of Treatment 

Manj of those placed under much improved on dis 
charge might have been labelled well — that is free 
from the sjmptoms for which thea were referred with 
no development of other samptoms indicating that adjust 
ment had not been reached But as we felt that con- 
solidation was still necessan after the> left they were 
designated in the case sheets much improved 

Prcs“nt Condition of Patients 

It IS satisfactora to report that many of the much 
improved cases can now be labelled well and as far 
as can be judged are completela normal Under the 
heading unadjusted are four anti social cases one of 
whom IS in Borstal and two are in Home Office schools 
These cases were prematurely removed from the clinic ba 
their parents who became uncooperative after the children 
had had a certain amount of treatment Thev all came 
from bad homes One case of neurosis from a bad 
home IS now m Borstal The present condition of the 154 
patients is as follows 


\Sell 

78 

Improved and much improved 

36 

Unadjusted 

12 

Duad or not traced 

13 

Transferred to other institutions 

10 


154 

This IS not a large number but the method of treat- 

irent was then new and experimental 

and fewer cases 


were taken than now At the Institute of Child Psycho 
logy attention is more intensiaela concentrated on the 
treatment of the patient and less on the alteration of 
environmental conditions and consequently the period 
of treatment is longer and the attendances more frequent 
than in other clinics treating similar cases by different 
methods The social worker does not visit the home 
more than once and the aim of the treatment is to 
help the child to overcome his own problems rather 
than to remove difficulties from his path On the other 
hand the constant attendance of the mothers at the 
centre and the influences exerted upon them both in 
the social workers department and in the parents 
department doubtless have an effect through the mother 
upon the home environment 


The clinic is open twice vveeklv for sess ons ot f^o 
hours each and the majorita ot the children attend tw ce 
a week unul improvement is well established when the 
intervals are extended until attendance ceases altogether 
except for reporting purposes Evera child receives a 
medical examination on entrance and at pe'iodic in e-vals 
Where necessary medical or surgical treatment is arranged 
for m consultation with the famila phvsician if mere 
IS one m order to help the child to become as phvsicalla 
fit as possible Simple medical treatment is given _t ihe 
institute itselt it Ihe parents are too poor to pav tor private 
m meal attendance In some cases convalescent holidays 
are arranged for varaing periods In certain medical 
disorders however where a psvchological origin is sus 
peeled no medical treatment at all is advised or given 
As an adjunct to plaa th.rapa and also in the interests 
of phasical fitness the phvsical re education and rhvihri 
department is of great help in treatment The formation 
of a parents department in charge of a medical psacho- 
therapist though primarila tor the purpose of helping 
the parents with their own difficulties is doubtless re- 
sponsible for the fact that once the child s treatment is 
established a large percentage of the mothers remain 
CO operative throughout however long it takes 

Acknowledgments are due to Dr Elspeth Macleod tutor 
Institute of Child Psvchologv for the he'p she has given 
with some of the cases 

Refetevce 

Neustatier VV Lindesav (19131 Lancet 1 1416 


TREATMENT OF GONORRHOEA 
MITH ULERON 

BY 

D F WALSH, 'll B , B Ch 

5 irgepti Lieiilcnnni Commander R \ 

The following is a record with observations ot forty- 
three cases of gonorrhoea of which twenty one had 
received routine treatment for at least six weeks prior to 
having iileron 

Uleron is one of the never compounds evolved m the 
endeavour to obtain a drug possessing the lowest possible 
toxicitv which would influence the largest number of 
bacterial diseases apart from streptococcal infections It 
has the formula 

N-So ^-So N(CH 1 

It IS one of three closely allied compounds which only 
differ bv substitutions in the final sulphonamide group 
and which have been found to exert a more favourable 
influence m gonococcal infections than anv of the other 
thousand compounds investigated 

Uleron is manufactured bv Messrs Baver who kindlv 
put a suppiv at mv disposal I was told quite frankly 
that thev could make no definite claims for uleron which 
was still under trial that I might find it a complete 
failure and that neither its dosage nor its non toxicitv 
was established It had been tried out in some clinics in 
Germany and a translation of the report bv Grutz, New 
Foundations for the Treatment of Gonorrhoea an 
advance proof of Fischers New Methods of Treatment 
of Gonorrhoea and Felkes On the Chemotherapy o‘' 
Gonorrhoea constituted the available literature at that 
time These three worlers were most enthusiastic about 
the therapeutic value of the new compounds Thev 
claimed their advent as the greatest advance ever made 



216 J^,L^ 30 193^ 


TREATMENT OF GONORRHOEA WITH ULERON 


TffC BRmsij 
Medical Journal 


in the trenment of gonorrhoea and weie confident that 
the long asvaittd solution to the problem o! a speed\ cure 
for thit diseise had tt length been Joiind 

Earlier Experiences nith Lferon 

Grut/ had \sorked mostly with one ot the othet com- 
pounds ot the uleron group, which he found superior to 
uieron though in his tables only two cases seem to have 
been irttied bv uleron alone In his senes of thirty-six 
cases he obtained twenty four cures The total dosage 
\aried between 6 grammes and 82 grammes Toxic effects 
Were noted m elcsen cases 

Fischer treated forty cases one hall with uieron, the 
other halt with the allied compound used by Grutx He 
observed no distinction between their lelatixe efifeacy It 
was his impression that with the allied compound it was 
the clinical svmptoms not the micioscopical hndings, that 
were more quickly affected He made careful obseiva- 
tions ol the blood pictures of his cases and noted an ilmosl 
constant diminution ot the poh morphs with a relative 
increase of the Kmphocstes towards the end ot a course 
Apirt Irom this neither preparation gave rise to any 
evidence ot toxicity He further stated that the unntry 
findings were in no way abnormal and that estimations 
of bilirubin xanthoprotein blood sugar, and blood 
calcium invariably showed figures within physiological 
limits He give 3 grammes daiiv foi three days and 
repeated the course in eight to ten diys if necessaty 
Eller he obtained eqinlly good results with 2 grammes 
duh for five davs Toxic effects were completely ibsent 
He found that non-recent cases reacted belter than acute 
ones ind tor the latter advocated either waiting ten to 
touitccn dajs before starting the treatment or stimulating 
the bods defences by vaccines injections of blood 
olobinihin or colloidal sulphui irradiations etc In his 
linilU published paper he had obtained cures in filty-five 
vises out ot fitly eight with only one rehpse and one case 
of toxic rash and pviexia 

Fclke reported on htty cases He too stressed what he 
terms the preparedness of the bodv tor cure and 
recommended tint acute cases should have a short course 
of uleron to clear up the gross symptoms then an interval 
lor J met irrigations twice daily during which lime the 
bodv defences were mobilized and onlv then a second 
course ot uleron 2 to 2 5 grimmes dailv for five or six 
diys To one case he had given 61 grammes in thiee 
weeks without causing side effects but considered such 
dosige excessive and to be avoided He hoped for still 
newer compounds requiring a smaller degree of co-opera- 
tion on the pan of the bodv Commenting on the mode 
of iction ot uleron he noted that even while taking large 
doses the blood of the patient had no inhibitorv action 
on the growth of gonococcal cultures 

Treatment of the Present Senes 

ft w is suggested to me that the results ot treatment by 
smillcr doses would be of interest A dosage ol three 
I tblels i dav — 1 5 grammes — was adopted and adhered to 
in all my eases In spite of the results already obtained 
elsewhere I begin treatment cuitioiish mv earlier patients 
receiving i three-dav course which was onlv repealed 
liter an indefinite interval ci observation for relapse 
dchved cure or toxic manifestations As it became 
evident thu such treatment was insufficient the interval 
between the courses was shortened Next the courses 
were lengthened and also the intervals the latter being 
It on shonened as the almost complcic absence of toxic 
svmploms bce imc evident In addtlion to receiving uleron 


for the periods shown tn the case records all patients were 
irrigated twice daitv with potassium permanganate 1 m 
10 000, and had prostatic massage once a week if the 
prostatic smears were pathological 
The standard of cure was not exacting All ireatmuit 
was stopped Daily examination was made for urethral 
discharge immediately on rising, as well as of the first 
morning urine by the two-giass test Other criteria wire 
the anterior urethra normal on urethroscopy , the passage 
of a large sound , a prostatic smear showing absence of 
organisms and less than four pus cells per field The 
minimum observ'ation period was eight days this was 
extended up to twenty-one days in many cases 
Complicoiions — None occurred in any patient after 
commencement of treatment with uleron 

Tomc ^Effects — One possible case, No 37 gastro 
enteritis pyrexia, and giant urticarial rash on the eleventh 
day of treatment The temperature (501 4°) became 
normal in forty-eight hours, and the rash had gone within 
seventy-two The patient blamed some tinned salmon 
for this upset, volunteering the information that on the 
previous evening he had eaten some for the first time for 
nine years Nine years ago its ingestion had b«a 
followed by severe gastro-enteritis but no rash 


Results of Treatment 


21 ensts hul Mhrcc da> coHTiyC 5 were cured 

n second course 2 (6wcrc curedafier 7 w 

» !;> dav$ uleron) 

J2 four dav course J was cured 

b second course 4 were cured 

3 I3iondi>s treifmcm No cures 

4 h\e doy course f>vas cured 

2 second course No cures (I was cured if«f w'i 

uleron) 

2 si\ d'ly course No cures 

4 se\cn da> course 2 were cured 

<. ured 22 ca«es (2 acute 20 non acute) _ 

21 c iscs of vshich 15 were imdcquaiely treated 6wereaaeQtw«‘U i 
treated 


My results seem to compare unfavourably with tho't 
of the Geiman clinics to which 1 referred earlier The 
obvious cause for this is undei-treatment due to l!ir« 
things the number of cases (sevenHtransferred from 
charge before treatment was completed (Nos 4, 6, 15, 
21, 22, 35, 36) , overcaution m abandoning ireitmen! (mf 
cases. Nos 5, 9, 12, 16, 26). and lack of uleron to 
complete treatment in three cases (Nos 38, 39, 40) Tbw 
fifteen cases are not true failures They are short 
treatment failures, and should only be assessed as saw 
They are included lest the false impression might be gu'oo 
that a high percentage of cures can be obtained aflof 
few days treatment with uieron I am recording severs 
such cures, but I regard them rather as the exception iteo 
as the rule — agreeable surprises when they occur, w 
not to be expected in nny individual case It >s 
unfortunate that nine our of these fifteen eases were i” 
the acute stage — that is, in the first three weeks of 1 1 
infection Of the six true failures it is significant 
five were acute cases and that only two of the succes'ov 
were acute 


Clinical Observations 

The immediate effects ot uleron arc remarkable 
nearly every cast the discharge dwindles rapidly an 
urine clarifies within a couple of days The 
becomes a morning dampness, and gonococci I 

almost abruptly from the urethral smears 
transitional stage seems to be entirely absent, for 
Gram negative extracellular diplococci were 
any of the slides In only three adequately treated 
did gonococci persist in the urethral discharge 
jeetive svmploms such as dysuria and painful crcc 



JUL\ "SO 1931) 


TREATNiENT OF GONORRHOEA WITH ULERON 


The BMTtiH 
tEUrCAL Jo 'X.StL 


217 


cciscd I had not the opportunitj of noting the effect 
of uleron on acute complications as most of m> compli 
cated cases had got o\er their acu'e sjmptoms when lhe> 
reached me The e\traordinarilj rapid clinical improse 
ment and decepticch clear morning urines gi\e rise to an 
capcctation of speed> cure which is not alwa)s fulfilled 
The morning dampness invariabh consists of pus cells 
and coccal organisms, Gram negatise cocci being the 
most common finding To cause complete cessation of 
this pathological dampness was the difiicultj for it 
sometimes prosed resistant to second and third courses 
of uleron to periods of irrigations alone and to complete 
rest from treatment From the patients point of siew 
the gonorrhoea was cured and it ssould be ease to over 
look this slight persistent urethritis if the patient was not 
under strict obscrsation Cessation of local treatment 
at this stage in\ariabl> led to a gradual increase in the 
amount of the discharge though gonococci were seldom 
demonstrated after thes had been absent for about ten 
da\s 

It was tantalizing to arrise almost at a cure so 
speedih onl) to be checked bj the morning dampness 
It was telt that some small alteration in tfie dosage or 
prolongation of the courses \ ou'd osercome this final 
obstacle to cure in manj cases and it was this mcentue 
which led me to pass on too quickU to seven da\ courses 
when m\ suppU of uleron was running low In spite 
of some wonderful cures "ith three-da\ and four-da> 
courses 1 felt that even two four dav courses of 15 
grammes per daj would not give the best results of which 
I believe this drug to be capable Thirteen of mv patients 
had more than eight (nine to seventeen) dajs treatment 
seven of them being cured four within the ten dav limit 
Nineteen out of mv tvvent>-two cures were obtained with 
a mavimum of ten davs treatment which I would cer- 
tainlv use as a standard basis for further clinical trials 
vvvvVv vilerow It. vs (ulli, realized that, one is uot entitled 
to draw conclusions from experiences with a couple of 
dozen cases and that the adoption of a ten daj standard 
IS arbitrarv and unproven The method of action of 
uleron is not fulij understood Fischer savs Wc 
cannot speak of its disinfectant action but rather of one 
affecting the reticulo endothelial svstem It is suggested 
that intermittent is preferable to continuous treatment m 
which case the dosage of 1 5 grammes per da> might be 
increased with advantage in the absence of toxic 
s>mptoms With the smaller dose which I emplojed I 
feel that at least two daj five daj or even seven dav 
courses would give excellent results and this matter 
deserves full clinical investigation 

Impressions from the Treatment 

The number of cases I have treated is too small to 
permit me to draw conclusions I can onlj record m> 
impressions They are 

That uleron is definitely a most valuable adjuvant in the 
treatment of gonorrhoea 

That in the dosage 1 employed uleron appears to be 
non toxic 

That with moderate doses used in conjunction with 
local treatment a cure can be obtained in a large number 
of cases more quickly than hitherto possible 

That the non acute cases seem to respond more readily 
than the acute cases 

That when the optimum dosage is established a high 
percentage of cures should be possible within three weeks 

That a small percentage of patients may prove com- 
pletely resistant to uleron treatment 


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TREATMENT OF GONORRHOEA WITH ULERON 


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58 61 

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tolumm 4^67 jnti S — The numcnls rcprcstnl iht number of tn>s that 
ihe initetmn h is been present 

Cotunm 4 — The list occisjon on s\hich were dcmonstrilce! m i 

irethril sme ir prior to eommenemi, ulcron treatment 

e - Oram positive coecf d -debris e -cpithclnl cells f— fvw- — less thin 
h «f per tieM Cc tunococci GFT- gonococcil fiention test p=»p»j»ccds 
s sperm ttoroa u uriiciru PT pntient transferred T\ - tre itmcni nban 
doneU 

The easts are not in siriet ehronologic d order Onl> the more relcvint smears 
have Ken meiuded In all failure T \ cases the dr charge \\ is present 
louritcn da\s after ulcron had been stopped 


1 wi'h to express ni\ thnnks to Surtcon Re^r Admiral 
1 Warren O B E for permission to publish these eases and 
m\ indebtedness to Surgeon Lieutenant Comni'inder A R 
Froggstt for the hbontorx reports 


BinLiocaxpib 

I stkt n (1917) Dptit mtil Withr 53 119'^ 
TisUier C (1917) rorlsclir Thu 13 “ISI 
Grut/ O (1917) meJ Wschr 84 120) 

Hoerkm ]) (1917) Pritctihoiur 139 f 5 


A POST-MORTEM RECORD OF 
PULMONARY TUBERCULOSIS IN 
DIABETICS 

BY 

S ROODHOUSE GLOYNE, M.D , D.P H 

Patlioloi^isi London Clmt Hospiial E 

The belief, based upon clinical observation, that dnkuu 
ate especially prone to tuberculosis is of long standing 
Fishbeig (1932), however, was not convinced, and re 
garded the percentage of diabetics piesenting tuberculous 
lesions at necropsy is not at all formidable Root (1934, 
1937) has investigated the point statistically by means of 
post-moitem records fiom various published papers in 
different counliies fiom the years IS88 to 1932 In 1,12! 
neciopsies on diabetics the incidence of active pulnionarj 
tuberculosis was 28 4 pet cent, and in 51,705 necropsies 
on non diabetics 229 per cent He interprets ihes” 
statistics to signify that since “ two diseases occur in atso 
ciation with less frequency than either one alone is found 
in a series of necropsies, it would appear that tuberculosis 
IS about twcToi three times as frequent at necropsj as 
would be expected in diabetes Analysing both the mor 
bidity and mortality figures which deal with American 
hospitals, Root points out that the incidence of piilmonar) 
tuberculosis in adult diabetics is not diminishing, despili 
the general deciease ot tuberculosis mortality, and that 
this sequel occurs in juvenile diabetics more than ten times 
as often as among non diabetic grade and high school 
childien m Massachusetts 

1 tm not awaie of my lecent moitahty stitislics bciring 
upon this subject in England and Wales, though Dunlop 
(1937) has published a clinical lecord of twenty ctphl 
cases in Edinburgh The Registiar-General s report (1937) 
shows that the mortality from tuberculosis is declining 
and that from diabetes is rising the total minibi.r of 
deaths in 1936 Irom tubciculosis being 28,268 and from 
diabetes 7,119 

The Material Inicstigafed 

The post-mortem lecoids of the London Chest Hospital, 
which IS piimanly conccined with the treatment of mtra 
thoracic disease, show twenty-one deaths (0 75 percent) 
Irom diabetes in 2,826 neciopsies (1,138 with active tuber 
culosis and 1 ,6SS with non tuberculous diseases) btltmo 
1888 and 1937 Ot the twenty one diabetics four mr* 
not associated with tuberculosis and i fifth htd einiy 
olctrcoiis tubeicles with puckering oL the lung '’pices 
The rem unmg sixteen h tcl ictive pulmonary tuberculosis 
and comprised 1 4 pei cent of the I 138 necropsies wit 
iclivc tuberculosis 

Roots collected recoids ot 3 575 1 titl cisis o! diabdo 
show 5 11 pci cent with tubciculosis The tswrrb' 
evses of diabetes with a mortality Irom active pulnionar' 
tuberculosis ol 76 19 per cent arc too lew to be eom 
pirable with Roots figures Moicovcr, > sekem^ 
influence has obviously been it work in admitting to 
chest hospital dnbetics with tubciculosis Some inform 
tion however, may be denved from the details of 
necropsies Eleven of them occurred before the m ‘ 
duction of insiitm and five after Four of iho si'*-^ 
cases were of the young adult ly'pe — » m ilc aged 
a female aged 20 in the pre-msulin period and l"0 nn 
aged 28 and 23 in the insulin period The igcs ol^ 
other twelve ranged from 40 to 65 md were thirca 
of the middlc-agc gionp Eleven of the ptlicnts ' 



JUL\ 30 193S PUL\IONAR\ TUBERCULOSIS IN DIABETICS 


nulLi "ind fi\t, fcnnlirs Tht ijpu of lesion noted was 
predommanllj cnscous frcqiientlj with tuberculous pneu 
monia and all but one had caeities the caeities being 
multiple in 60 per cent of cases This exception a male 
aged 20 was the onl> case showing signs of quiescence 
He had onh a few widely scattered tubercles the size 
ot a large pin head in all lob^s which were almost cal 
cireous There were three instances of acute miliare 
spread two of fatal haemoptxsis two of empeema and 
one of psopneiimothorax Pleural adnesions were noted 
in dll cases except one where there is no record on the 
point This IS interesting in xiew of the fact that some 
American obserxers — for example Perla (1936) — haxe 
noted a less frequent occurrence of adhesions in tuber 
culous diabetics than in tuberculous non dnb^ties ol com 
parable ages Onh one patient was noted as basing died 
in coma The most significant finding of all howescr 
was the absence of tuberculosis elscsvhere excepting one 
instance of miliars tuberculosis in the kidney Esen 
tuberculous laryngitis and enteritis sshich are such 
common features of the tuberculosis necropsies through- 
out the records ssere not found No tuberculosis was 
noted in the pancreas No instance of amsloid disease 
was recorded Chronic non tuberculous lesions were 
apparently not more common than might base been 
expected in a group of cases of sshich 75 per cent ssere 
middle aged There ssere tsso cases of chronic kidney 
disease tsso of fibrosis of Iiser tsso of atheroma one of 
renal calculus and one of uterine fibroid No significant 
differences can be made out in comparing the tspe of 
lesion found in the pre insulin and the insulin period 

Summao of Data 

The data mas be summarized as follows 

1 The figures recorded are too ttw and of too selectise 
a character to throsv ans statistical light on the question 
sshether or not diabetics are more susceptible to tuber- 
culosis than are the general population No figures 
appear to exist for this country to confirm or refute the 
clinical impression that the diabetic is a fasourable soil 
for the tubercle bacillus but the extensive American 
figures on the whole support the siew 

2 The majority of the patients in the present series 
were of the middle age group 

3 The type of tuberculous lesion found was that of 
excavation with extensive caseation often pneumonic or 
bronchopneumonic in distribution The common sequel 
of tuberculous laryngitis and enteritis was not encountered 

4 No tuberculous foci were found elsewhere in the 
body (including pancreas) except one example of miliary 
tubercles in the kidney evidently a terminal lesion 

5 No instance of amyloid disease was recorded 

6 Only one instance occurred in which there was any 
sign of quiescence 

7 No significant differences were noted in the 
necropsies of the pre insulin and insulin periods 

Commentary 

Obviously the diabetic is exposed to the same risks of 
infection as the rest of the population but the salient 
features which stand out from this record are that (1) 
when tuberculosis developed in the diabetic it was almost 
invariably the uncomp'icated pulmonary form of the 
lisease and (2) signs of healing of the tuberculous process 
vere rare These points confirm the observation of Perla 
m a comparable series of necropsies on diabetics and 
ion diabetics with tuberculosis that m the former there 
' a greater rapidity of development of the tuberculous 


TKTBjimSH 7|Q 

NtSDrCAi J TtN AI. ^ 


process The effects of altered metabolism in the diabetic 
stale are however so numerous that it is imposs ble at 
the present time to attribute to any one of them alone 
the blame for providing the fasourable soil fo' the grovsih 
ot the bacillus Possib'v the low respirators quotient as 
found in the diabetic animal (Ralli Canzanelli and 
Rapport 1931) and in certain cases ot diabetes in man 
(Joslin 1917) may be important in this connexion 
References 

Dunlop D M (1937) Ec/wb med J 44 ^51 
Finhbvrg M (1932) Pulmonary Tuberculosis 2 4th ed 
fvimpton London 

Jo Iin E P (1937) Treatment of Dnbetci 6th ed H-n v 
K.impton London 

PtfrJj D (1936) Quoted b> Winner and K.a\ee -irr r Re\ 
Tubert 34 179 

Ralli E P Canzanelli A and Rapport D (19 I) Am^r J 
Phsstol 96 ^ 1 

ResiNtrar General (1937) Stati-stical Review of England and Vale 
for the ^ear 19 6 Part I Medical HM Statior-rv O^ce 
London 

Root H F (19^4) i\^i Eiml J \{ed 210 I 7S 127 192 
(19 7) Jo>Im i> Treatment of Diabetes p 496 London 


Clinical Memoranda 


Traumatic Rupture (Complete) of External 
Diac Arterj Amputation Reco\en 

This ca^e so tar as I know is unusual and one might 
sa\ rare enough to justifv publication 

C^SE Record 

A quarrMTiEn aged 35 removing a relief valve** 

from a Diesel engine which was still running — he standing m 
direct contact with the valve— was struck in the right groin 
He wav thrown backwards for about four feet and was verv 
badlv shocked This took place at about 10 45 am on 
April 12 1938 

Some ten mmuiCb after the accident he was een bv Dr 
F \V A NNatl of Tavistock who telephoned to me about 
11 lo am The patient being badlv shocked we agreed that 
1 should call later m the dav thus allowing time for the 
shock to be treated in hospital I saw him at about 4^0 p m 
the ^ame dav His temperature was then subnormal and his 
pulse which had been taken everv halt hour was 130 verv 
ihin and win and of poor volume He was still badlv 
shocked His nght leg was useless the toe nails were 
blanched and there was no puKation m the posterior iibial 
popliteal or common femoral artenes This leg was con 
sidcrablv colder than the left There was an enormous 
swelling which filled up the nght Scarpa s tnangle and e\ 
tended into the nght iliac fos’^a It did not pulsate nor was 
anv pulsation felt or heard m either swelling The skin was 
intac* but extensive bruising was present over the lower 
abdomen not onlv on the nght side but also on the left 
This bruising al'^o extended up the outer side of the abdomen 
into the nght axilla as well as into the scrotum It w-as 
perfecth clear that he had ruptured the nght external iliac 
arterv and that he would lo e his leg but as there was good 
reason to think that he had ceased to bleed we decided to 
Mill vvail until his recoverv from the shock 

I was kept informed as to his progress from da> to da> 
and saw him again on Apnl 1 5 He then had a pulse of 80 
of good volume and regular and as we thought it unhkelv 
that his general condition would improve further we deuded 
to operate the following morning — that is Apnl 16 The 
condition of the limb on Apnl 15 was about the same there 
was no pulse m anv vessel but on auscultation over the 
swelling in the nght groin transmitted pulsation could be 
heard Bv this time he had a distinct line of demarcation 
in the lower limb This extended from a line about eight 
inches down from the iliac crest honzonlallv inwards to a 
point about three inches below the pubic crest in front, to 
meet a line which practically took the gluteal fold behind 



220 July 30 1938 


CLINICAL MEMORANDA 


The B^nnii 
Medicai 


The sKin and limb were warm above the^e lines but quite 
cold below with a patchv reddish-blue mottling There was 
some sensation over the warm area but none below We 
did not consider it advisable to give him a blood transfusion, 
as his recovers from the shock had been so satisfactory, and 
we did not w int to raise his blood pressure too much, as this 
might po^Mblv again bring on bleeding 

0 pi ration — With a premedication of morphine and under 
light gas and ow een anaesthesia I operated on April 16 I 
decided to use the extraperiloneal approach, and made my 
incision as 1 thought accordingly about three-quarters of an 
inch above Poupart s ligament but on dividing the skin and 
deep fascia 1 tame down upon the clot This was rapidly 
turned out and confined below to the attachment of the deep 
f iscia to that in the outer half of Scarpa’s triangle, with 
Poupart s ligament elevated so that it took a concave shape 
with the external iliac which was raised from its bed in the 
iho psoas and presenting itself under the middle of Poupart s 
ligament, leaving a space of at least 4 inches between the 
proximal and distal ends of the vessel The lumen was 
filled with a firm clot and one could clearlv see the torn 
and twisted intima I placed two floss-silk ligatures round the 
arterv and vein and as the patients condition justified it 1 
proceeded to do a quick amputation by unequal lateral flaps, 
cutting just above the line of demarcation described The 
femur was divided about two inches below the great trochanter, 
the circulation in the muscles and bone being excellent He 
stood the operation well and was little the worse when it 
was finished He has since made an uninterrupted recovery 

Commentary 

The relief valve ’ which caused the injury is of solid 
steel eight inches in length , the outlet end, which carries 
a handle, has a diameter of three inches, and the inlet end 
has a diameter of two and a half inches It weighs 12 lb 
and was expelled at a pressure of 400 lb to the square 
inch 

The interesting points ot this case are 

1 The man was in contact with the valve, which must 
have struck the external iliac vessel at a point on the 
pelvic brim near where one would normally compress 
the common femoral vessel, completely dividing u 

2 Had he been standing a distance away, other than in 
direct contact with the valve, the chances of it breaking 
his pelvis and possibiv rupturing his abdominal wall, with 
grave intrapenloneal injuries to viscera, vessels, etc , would 
hivc been considerable 

1 The importance of waiting, if possible, in cases of 
extreme shock eouid not be better exemplified than m 
this inst tnce Glucose and saline should be judiciously 
idministertd A very close wttch must be kept on the 
pulsu, so IS to IV Old giving an amount that might raise 
the blood pressure ind so bring on haemorrhage 

4 It was interesting to note at the end of three days the 
amount of collateral circulation that had taken place from 
the intern il iliac and tho lumbar branches, a matter which 
IS so important m cutting the skin flaps 

1 am greatlv indebted to Mr L W Proger to whom I 
sent the small specimen of the distal end of the vessel for his 
kindness in looking through the Librarv of the Rovai College 
of Surgeons for anv record of such a case This search 
proved unproductive but he has kindlj sent me a bibliographi- 
cal list although none of the publications, so far as I know, 
quite meet the case quoted 

PHmoiiih H G PiNKrR FRCS 


Bibliography 

Tcrran T (I9S<1) Bi,!l Soc nat Chr 55 161 
Jc-in t> tl9Zt) ] Chr 21 301 Abstract in J Awer mce, 
Asj 80 16S2 

la Roqu G P (1921) Ann Siirg 73 26S 
I ctpiia (t9ISJ 111, II \l,m Soc Chr Pans 41 tS03 

^ Bordeaux 43, 692 

ViiUivX 1 C (.1901) Boimii med snry, J 144 183 


Two Compressed Foetuses and Liiing Babi 
as an Unusual Cause of Hydramnios 

The patient whose case I report had probably started with 
a triplet pregnancy, including uniovular twins which had 
died when they vvere about five months mature, and at 
that time the hydramnios occurred Owing, I presunii, 
to the fact that there was still one living foetus and 
placenta, there was still enough of the necessary hormonci 
available to prevent the expulsion of these dead foetiisc', 
the living one growing normally and compressing the 
dead ones The hydramnios was, I suppose, reabsorbed 


Clinical Record 


A muUipara, aged 29, with one child aged 4 years, consulicd 
me on October 10, 1937, having had a slight vaginal haeraor 
rhage of a few day s duration following two months amenot 
rhoea the last menstrual period having started on Julv <0 
On examination on October 19 she was not losing, the uterine 
os was closed, and she appeared to be about three months 
pregnant 


I saw her regularlv and the pregnancy progressed quilc 
normally until December 23, 1937 when the uterus suddcnli 
became enlarged to the size of at least a thirty six wcets 
pregnancy, and the abdomen was so tense that foetal parts 
could not be felt Tlte patient complained of nothing cvvepi 
a little difficulty in bending, and as she had to go avvav the 
next day vv as not examined bv x rays, though I xvarned hn 
of the possibility of twins or some abnormahtv, and mslmded 
her to see a doctor at her home if any thing untoward occtirroi 


I did not see her again till Februarv 28 1938 when the 
uterus, though somevvhat soft was of normal size for the icrni 
of pregnancy, then about thirty weeks, having diminuheJ 
considerably m size during the interval Foetal parts ot 
one foetus onlv, could be felt per abdomen, one foetal heart 
onlv could be distrnguished, and everv thing appeared to he 
normal The pregnancy continued apparently normallv «n!'' 
April 6, one monlii before the expected date for the babv to 
be born when the patient started labour spontaneously and "a 
delivered of a living male infant about four weeks prematore. 
and weighing 64 lb After the deliverv of the babv the iiforoi 
felt large and hard, but not large enough for the pre ooic 
of a twin to be suspected After ten minutes a second bicol 
membranes presented, and vvith only one further uterine con 
traction the placenta, together with an unruptured bic ot 
membranes, which contained foetal parts, was expelled w 
examination this proved to be tvvin foetuses, surrounded bi 
and embedded in a brown clavev substance each in a seporatt 
amniotic sac There vvere two placentae , one of normal st e 
healthv, and with the cut cord of the living babv and its o'm 
amnion and chorion, was fused along one border ^ 
shrivelled white fibrous one containing numerous infarcts vn 
having two amniotic sacs, each containing one of the ooi 
pressed foetuses, with two small cords and onlv one chonos 
The twin foetuses vvere both female and were not mic 
macerated and vvere not deformed Thev vvere 9 inches ifS'. 
ind weighed approximatelv 12 oz each 
The further historv of the case is also of interest 
perfectlv normal puerpenum with no pvrexia and good "" 
tion, what appeared to be a complete succenturiate 
about 4 inches across, and with membrane attached 
passed on the eleventh dav The living babv for the 
three weeks after birth suffered from projectile 
intractable constipation and caused us some anxict' 
pylorus was palpable and elongated and he lost weigh j 
siderablv A diagnosis of congenital stenosis of the 1" 
was made, but with small hoiirlv feeds of expressed 
and dailv stomach and occasional bowel washouts he ^ 
a good recovery and at one month had entirely c 
vomiting had nearlv regained his birth weight, and ww 
to feed from the breast He has got on vvcll ever since 


E D Blunt, MB, BS, DCOG 


Hastings 



30 193S 


REVIEWS 


The Bwnsa 
VtolCAt 


221 


Reviews 


THE BACTERIOPHAGE 

he Flit nomine tie lo Giurison Jans les MiJaJies 
Iniccttenscs B\ F D Hcrcllc {Pp 416 19 figures 
including 4 phles 7^ fr) Pins Mnsson cl Cie 19^7 

Professor F D Htrelle has rLcenlh added to Ihe alreadv 
long list of monographs on the baclcriophagc which come 
from his pen This last one bears the title Li Flu 
r online de la Giicnson dans les Maladiis Infectieiises 
but as a matter of fact it is onl\ the second half of the 
monograph which deals with this problem the first two 
hundred pages being deroled to a consideration of the 
bacteriophage and Ihe technique of its stiidj Beginning 
With a brief historical account of the discos er> of Ihe 
bacteriophage the author considers in turn the technique 
of isolation of phages how to obtain them in pure 
culture the estimation of their sirulence phage mutation 
and the characters and nature of bacteriophages All 
this IS presented in lucid sule and one notes that D Herelle 
aoheres to his original conception of the bacteriophage as 
a Itsing autonomous parasite of bacteria Considerable 
space is given to the question of the production of Ksins 
b> bacteriophages and one gathers that the author con 
siders that bacterial mutation is the result of phage action 
— bacterium phage s>mbionts — and that opsonization of 
bacteria ts brought about b> phage Ivsins 

In the second half of the monograph the author dis 
cusses the role of the bacteriophage in the recovers from 
disease and the evolution of epidemics For D Herelle 
recover) from bacterial infections is a function of phage 
action and cessation of epidemics is brought about bv 
the dissemination of bacteriophage b\ convalescents 
Bacteriophage therapy of various bacterial diseases is also 
discussed and the results obtained are stated to be 
umforml) successful so much so that one wonders vvhv 
other methods of treatment are still cmplojed 

\RAAS AND RADIUM IN DERMATOLOGA 

A Rnvs and Radium in the Trealmeni of Diseases of the 
Shin Bs George M MaeKee M D Third edition 
thoroughl) revised (Pp 830 308 figures 31 charts 

2 coloured plates 4as netl London Henrv Kimpton 
19 j8 

There is no need to stress the importance of r ravs and 
radium in the treatment of diseases of the skin In fact 
It is difficult to imagine what the practice of dermatolog) 
would be like if suddenlj deprived of these powerful thera- 
peutic agents The textbook before us which is now in 
Its third edition is certainlj the fullest and most complete 
account of the subject in the English language Dr 
MacKee has been interested in radiotherapeutics for manv 
>ears and this book first appeared nearl) twentj jears 
ago In this Ihe third edition he has had the benefit 
of the assistance of a large number of collaborators who 
have contributed chapters on those sections of which 
thev have special knowledge In particular Dr Edith H 
Quimb) has written important chapters on the phvsics 
biolog) apparatus, and measuring instruments required 
and dermatologists who wish to have more than a rule 
of thumb knowledge of what the> are doing should study 
her writings with care 

The clinical part of the book is mostly written bv 
Dr vlackee himself whose clinical experience is un 
rivalled but in certain departments other physicians have 


collaborated with him There is also an interesting and 
important chapter on the medico legal aspects of r my 
and radium therapy by Mr Harold Bouton This is 
founded of course upon the legal practice and procedure 
in vogue in the United States of America but after all 
since the legal svstem of this country is founded on the 
same principles it will be read with interest by British 
dermatologists Manv will be anxious to see what opinion 
Dr Mackee has of the value of the so called Grenz rays 
which are reallv x rays of long wavelength which will 
not penetrate ordinarv glass and consequently necessitate 
the use of tubes in vvhich a window made of special 
lithium borate glass is set to permit their escape Some 
optimistic workers have prophesied that these rays will 
one dav entirely replace r ravs of shorter wave-length in 
dermatologv but Dr Mackee does not agree He is ot 
opinion that enough work has not yet been done to sub 
stantiale the rather extravagant claims made bv Buckv 
and others on their behalf We have to add that like 
most other American books this volume is well prinied 
and wt.ll illustrated and wdl furnished with references to 
original papers ft should be in every dermatologists 
Iibrarv 

MEDICAL WOMEN IN PAST AGES 

A Htstors of B omen in \iedicine from the Earliest Times 
to the Beemninc of the Nineteenth Centiin Bv kate 
Campbell Hurd Mead M D (Pp S 69 70 illustrations 

including a frontispiece 6 dollars ) Haddam Con 
necticut The Haddam Press 1938 

Dr kate Hurd Mead deserves well of every woman who 
has adopted medicine as a profession She has read much 
and travelled widelv to produce an excellent and well 
illustrated Hisiors of IFoinen in Medicine It has the 
double merit of being interesting as well as accurate 
except for a few slight errors of fact The history begins 
with medicine in primitive times and is carried down Ihe 
ages until the eighteenth century The method is to 
consider the practice of medicine by women in ns relation 
to contemporary social history The book therefore con 
lams many details of the domestic life of women at 
various periods independently of their professional work 
and this alone would make it attractive to the general as 
well as to Ihe professional reader 

It appears that from classical times until the end of the 
fourteenth cenlurv women held a recognized position m 
medicine acting for the most part as advisers often a.s 
curers of minor ailments and sometimes as operating 
surgeons Midwifery was alwavs in their hands but in 
everv country at one time or another they were licensed 
to practise medicine and in a few universities they were 
allowed to graduate on the same terms as the male students 
This was especiallv the case at Salerno and Dr Hurd-Mead 
makes a brave fight for the corporeal existence of Trotula 
Ihe woman doctor whose influence on midwitery lasted for 
so many hundred vears that her name has come down 
to our own times as Dame Trot Many great names 
arc brought under review Dr Hurd Mead believes that 
both Moses and his wife Zipporah were instructed at the 
medical school at Heliopolis It is certain that Aristotle 
was helped by Pythias his wife in collecting matenal for 
some of his scientific treatises Manv roval ladies were 
interested in and some actually practised the medical art 
St Hilda of UTiitby Queen Afargaret of Scotland the 
good Queen Maud (wife of Henrv I) Eleanor of 
Aquitaine Berengaria and St Hildegard are all com- 
memorated Then came a long period of eclipse when 
women were relegated to minor duties in the sick room 
though as in London m the seventeenth century they 



222 July 30, 1938 


REVIEWS 


THEBRmsjt 
Medicai JolILSU 


received special instruction before they were licensed to 
practise as midwives 

The book must necessarily reach a second edition, so 
a few minor errors may as well be pointed out The 
caption of the illustration facing page 232 is clearly 
wrong The ward is in a French, not an English, hospital , 
the sisters are engaged in the homely task of making the 
bolsters which preceded sandbags and not in sewing dead 
patients into their shrouds as is stated Mirfeld (p 262) 
was only in minor orders and was certainly never a prior , 
Mr John Flint South has been confused (p 269) with Sir 
James Paget and his work should be quoted as the 
memorials not the memories But these are only minor 
blemishes in a very satisfactory and pleasant book, which 
IS proMded with an excellent index and a list of errata 

FRACTURES AND DISLOCATIONS 

rriuliiris imd Dislocations for Piactitioners By Edwin 
O Gcckcler MD (Pp 252, 213 figures iSs) London 
Bailliere Tindall and Cox 1937 

The author tells us in his preface that this book is written 
as a complete yet simplified guide to the management of 
bone and joint injuries, his purpose being to condense the 
subject of fractures and dislocations without omitting im- 
portant details He has achieved his object m an attractive 
little work of convenient size, clear print, and good illus- 
trations, and has been enabled to do so by adopting the 
sound policy of advising only what he considers the one 
most practical method of dealing with a particular lesion 
There is much to be said for this in a guidebook because, 
as the author points out, in emergencies the choice of the 
most appropriate treatment may be both confusing and 
time-consuming 

The work is divided into two parts, the first dealing 
with fractures, the second with dislocations Provided the 
initnl treatment is adequate, only a very small proportion of 
fractures require open reduction, and therefore description 
of operative technique has been limited to that of skeletal 
traction and subcutaneous leverage Plaster technique is 
explained in detail and an interesting chapter deals with 
follow up treatment This practical little guidebook should 
not only prove useful as a work for ready reference but 
also be of value to the busy practitioner who wishes with 
a minimum of effort to familiarize himself with modern 
meihods of fracture treatment 

APPROACH TO PHYSIOLOGY 

The Lning Bods A Textbook m Human PInsiologs 
B> Charles Herbert Best M D D Sc F R S and 
Norman Burke Taylor MD FRCSEd (Pp 563, 
283 figures 15 coloured plates 3 60 dollars) New 
York Henry Holt and Company 1938 

The ipproach of students, including medical students, to 
the subject of physiology is a matter of the greatest 
moment Its basic importance to medicine, which can 
only be freed from mumbo-jumbo by a proper apprecia- 
tion of Its principles, together with its fundamental value 
as a subject of general education, make it one of the 
most useful of modern sciences As a rule the medical 
student at the outset of his physiological studies chooses 
one of the larger textbooks, often of vocational flavour, 
and most teachers will agree that the consequences of such 
an introduction are by no means good Yet teachers of 
the subject will also generally agree that elementary text- 
books often lease much to be desired, or may even be 
positncly misleading Leading investigators are often in- 
sufTicicnttv acquainted with the broad outlines of the 
subject and competent teachers too occupied, or have 
oo much of an exc to examination needs, to devote time 


and thought to the preparation of a book that misht 
bring them little kudos, or even some scoin from their 
highbrow colleagues 

It IS a hopeful sign of the times that two such dis 
tinguished physiologists as Professors Best and Taylor, 
the one world-famous for his own research, the other 
as a teacher and investigator, should have bent them 
selves to such a task It is an agreeable task for a 
reviewer to be able to say that they have done a true 
service to their subject and that their work will be of 
value 

In this book the mam facts of physiology, brought right 
up to date, have been presented in a readable, informal, 
and accurate manner Apart from some of the half tone 
blocks which have come out poorly, the illustrations— 
283 m number — are well chosen and often original 
Some preliminary knowledge of physics and chemistry 
IS assumed on the part of the reader, but little biologv, 
histology, or anatomy is expected The authors state in 
their preface that the book is “ written primarily for th* 
usual college course in human physiology, a statement 
which indicates that Canada can give us points m genera! 
education they also had “ in mind its use as a ie\l 
in nursing schools as well as in the physiological insira 
lion of dental and agricultural students Students of 
medicine may find it serviceable m gaining a birdete 
view of the subject before reading more detailed tevis ' 
Its scope in Great Britain should be much the same, 
in fact we should be happy if nurses and dental stadenis 
had knowledge to so good a standard The book is a 
good job well done, and it can be heartily recommended 


STATISTICAL METHODS IN MEDICINE 

The Treatment of Clinical and Laboiatory Data An 
Introduction to Statistical Ideas and Methods for Mcdiwl 
and Dental Workers Bv Donald Mainland MB.ChB 
D Sc (Pp 340, 23 figures 15s net) Edinburgh ind 
London Oliver and Boyd 1938 

Professor D Mainland’s book. The Treatment of Clinnal 
and Laboratoiy Data, like Dr A Bradford Hills reccnil) 
published Pi maples of Medical Statistics is intended lo 
provide first aid to medical men and laboratory workers 
in the use of statistical methods Dr Hill s book covered 
a rather wider field Professor Mainland s book gi'^| 
more detail, particularly with regard to the handling ef 
small samples Practically all the methods of staiisiicw 
analysis likely to be of use to a medical worker nnj 
primarily concerned with epidemiological or official 
statistics are lucidly explained or illustrated The mclhodi 
of Professor R A Fisher rightly receive particular alk'' 
tion , indeed the book is in a sense, an introduction la 
that author s treatise, issued by the same publisher 
This, however, is not to say that Professor Mainland is a 
mere compiler At several places — for example, PP 
et seq pp 283 et seq and in his discussion of the inter 
pretations of particular results — criticisms and suggcslio > 
put forward have been the product of medicai know 
ledge and experience well used We think ' 
author s treatment sound We should, perhaps, ha 
been inclined to stress even more than he does j 

tions of usefulness of coefficients of correlation Gal o 
original idea of regression retains all its value, but 
statisticians now attach much importance to coenici 
of correlation ‘ m the air, dissociated from 
regression We have no doubt that my 
or laboratory worker who reads this book carciu 
avoid pitfalls in which many writers are entangle a 
daily 



Jll\ 30 19'^ 


NOTES ON BOOKS 


Th_ Bumsir 
M>o ckl Jo ?^^,L 


Notes on Books 

Till. 1 lor Book, of Niuroloj^\ Pwcliiam ami Cmto 
cnnolo^.^ conlinues its usi-ful cari.t.r In tht. \olume for 
]9 j 7 ittention is called to the tendencv to relj on the 
development of electric and acoustic technique to investi 
gate the functions or djstunctions of the nervous sjstem 
though the editor regrets the lack of synthesis of the 
vast research material which leaves manv clinical syn 
dromes uncvpiaincd There is a full discussion of the 
treatment of schizophrenia by insulin and of the thera 
peutic value of oestrogenic hormones It is emphasized 
that the need for clinical discrimination in cndocrinologv 
IS still urgent Towards that end this volume should 
certainly be helpful It is published in this country bv 
H K Lewis and Co at 12s 6d (postage 6d ) 

Gordon W Allport s Personahi\ A Psychological 
hiicrpretaiion is published by Constable and Companv at 
16s In this highly technical and not very readable 
book the author attempts to studv the laws which 
determine the mental constitution of the individual in 
contrast to the general laws of mental process sup 
posedly applicable to most or all individuals He defines 
personality as the dvnamic organization within the 
individual of those psvchophysical sv stems that deter- 
mine his unique adjustments to his environment 
In order to understand personality the units of analvsis 
must not be too simple and the author lavs stress on 
what he calls traits The book is divided into five parts 
The first is historical and discusses the various methods 
of approach The second discusses the origins growth 
and maturation of personality the third and fourth the 
units of structure and analvsis of personality respectively 
and the fifth the understanding of personality 

Mental Deficiency by J Ditncan is published bv C A 
Watts and Companv as No 10 of their Changing World 
Library and costs half a crown It is a pleasantiv written 
essay which covers the ground from tne educational rather 
than the medical point of view since the author is head 
master of a special school He lays stress on the 
importance of the backward group in the population and 
points out that both these and the feeble minded may 
learn though they can onlv be taught with difficulty and 
that modern methods of education may not be best suited 
to their needs He regards this group as potentiallv of 
great danger to the community and thinks that the only 
solution lies in selective breeding the spread of birth 
control knowledge among the lower classes m the 
true sense of the word and some measure of State control 
over those who have produced mentally defective children 

Gestalt psychology has won many adherents amongst 
those interested in both normal and abnormal mental 
processes That the mind deals with units of fairly 
elaborate complexity rather than with conglomerations 
of sense perceptions seems a reasonable conception and 
IS certainly useful in helping to explain many phenomena 
which obtrude themselves on our attention in the study of 
mental mechanisms A Source Book, of Gestalt Psychology 
by Willis D Ellis (Kegan Paul 21 s) is a well arranged 
series of abstracts in English of the papers published 
chiefly in German between 1912 and 1929 on which the 
theory has been built up The reader may discover 
from these that Gestalt psychology is not merelv an arm 
chair construction of what perhaps might happen — ^and 
if It did how convenient it would be for our understanding 
of the mmd — but that it is derived from a long series of 
controlled experiments both of animals and man The 
author has sought and has certainly largely succeeded in 
giving experimental respectability to his subject 

The first edition of Dr C Seyfvrths little book Der 
Arzte Knigge on the duties responsibilities and behaviour 
of hospital residents was jioticed in this column on 
October 26 1935 That a third edition has now been 


called for seems a proof of its usefulness The publisher 
Is Georg Thieme of Leipzig price RM 4 SO plus 2v per 
cent abroad 

Dr H E Cons Chemnal Analysis of Foods is a 
useful little laboratorv manual which has proved its 
worth by the call for a second edition The new edition 
(J and A Churchill 21s ) shows manifold signs of 
attentive revision and although there is no great increase 
in the bulk of its contents the new presentation is such 
as to give the book the stamp of being fuliv up to date 
The matter is condensed to the extent necessary tor its 
usefulness as a laboratory manual but is nevertheless 
adeqiiatelv descriptive Apart from the requirements of 
unusual investigations this book will provide a working 
scheme for the chemical analyses of all ordinarv foods 


Preparations and Appliances 


A MASTOID BRIDGE FORCEPS 
Mr T G Wilson MB FRCSI (Dublin) writes 
It hajy often occurred to me «hde performing the raditjl 
masioid operation that the final stages of remoMng the 
bridge would be much facilitated b> the use of a suitable 
punch forceps The instrument makers catalogues illustrate 
several forceps which could be used for the purpose but none 
of them seemed to me quite satisfactorv I therefore com 
missioned Messrs Maver and Pnelps to make up a bridge 
forceps to m\ desi-n as illustrated b\ the accompanving 
engraving Its principal features are two 

(1) The angle of bite is greater than a right angle so 
that the lower jaw can more readilv fit into the aditus 

(2) The curved shank allows the action of cutting to be 
easilv seen 

The instrument is made on sound and therefore efficient 
mechanical principles The method of use is quite simple 



The bndge la reduced to a thickness of about one-eighth 
inch or more in the case of children bv the usual method 
It IS then seized bv the forceps and cut awav vuth a slight 
rocking motion After this mallet and chisel are again re>orted 
to but the use of the forceps v«.ill be found to have saved 
a considerable amount of lime To junior surgeons v ith 
whom the facial nerve is still a bugbear as well as a 
landmark the added secuniv given bv the use of the forceps 
should prove a boon 

OVARIAN HORMONES 

The gvnoestrvl products (Roussel Laboraiones Ltd 30 
Cavendish Square \\ 1) include the following products 
(1) Gvnoestrvl tablets each of which contains 0 025 mg 
oestradiol (250 international units) (2) Benzo gvnoestrvl 
ampoules which contain oe^tradiol benzoate in strengths of 
0 \ \ and 5 mg per ampoule Oestradiol benzoate I rag 
corresponds td 10 000 international units (3) Sedo gvnoestrvl 
ampoule> which contain oestradiol 0 1 mg with <odium 
bromide and hvo^evamus extract 

Ovarian hormones are finding increasing clinical u>es The 
makers suggest a total dosage I to 2 rng. bv mouth of 
oestradiol benzoate for trertmenl of ovarian hvpofunciion 
and about ten times this do^e for treatment of severe ovanan 
deficiencj 



224 JuL'i 30, 1938 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDAY JULY 30 1938 


THE PLYMOUTH MEETING 

The pace set by the organizers of Annual Meetings 
has of recent years perceptibly quickened Each 
successor has determined not to be outdone by 
Ins predecessor — and even to outdo him So long 
as the desire to emulate does not provoke too much 
anxiety or strain, this competition m the production 
of excellence should be all to the good But 
perhaps the time has come when they may well 
ask themselves the difficult question, “ Wherein 
does excellence lie'^ ” Is it in the magnificence 
of the receptions, the number of the excursions the 
tonnage consumed of food and drink, the intensity 
of private and public hilarity'’ Before this 
question is examined further it must be said at once 
that Plymouth with the high example set it by 
Belfast, played to perfection the part of generous 
and charitable host The city took the B M A 
into the ordered routine of its domestic existence 
With such a friendly disregard of pomp and circum- 
stance that for a short week the visitor felt himself 
indeed to be a Plymothian Each Annual Meet- 
ing has Its own atmosphere, and the prevailing 
emotional tone of the Plymouth Meeting was one 
of domestic friendliness It was a family affair, 
and It was fittingly presided over by one who 
for years had been a family doctor. Dr Colin 
Lindsay It was a happy chance that at this 
moment, when the general practitioner is being 
asMiled from all points of the compass, he should 
find himself so worthily represented m such high 
office by one who epitomizes in his own person 
those qualities of sincerity and integrity that are 
the hall-mark of the English doctor The need for 
such men is paramount 

Dr Lindsay was ably and eneigclically seconded 
by those two hard-working members of any Annual 
Meeting team — the Honorary Local General Sec- 
retary Mr Cyril F Mayne, and his assistant Dr 
T T P Murphy We ^should like, too, to pay 
tribute to the gracious President of the Ladies’ 
Section, Mrs Lindsay, and to all those who, work- 
ing under her guidance arranged things so well for 
the wives and daughters of the menfolk These 
efforts were aided by the beautiful country round 
Pl\ mouth the rivers and the moorland and the 
vv irm sunny weather that prevailed and were 
seconded by the kind attentions of the Civic and 
Nivit authorities The scene was set for enjoy- 


TitcnRmm 

^IED^CA.L JOLfRWL 

ment We would not for one moment undervalue 
the importance of the social side of an Annual 
Meeting, nor even suggest that this was too heavily 
stressed at Plymouth But attention should be 
drawn to the fact that during recent years social 
events have tended to lure people from the 
Scientific Sections This is not to the good The 
excellence of an Annual Meeting must m the last 
resort reside m the debates conducted by tlic 
Representative Body and the discussions held at 
the Section meetings The latter, coinciding with 
the height of the social activities and coming to- 
wards the end of the meeting, inevitably suffer more 
than the former- The “representative mind” 
comes off decidedly worse than the Representative 
Body, which argues a lack of balance between tk 
two 

The generally poor attendance mt the Scicntik 
Sections was by no means a reflection on the 
standard of the papers read or of the discussions 
that followed them One of tlie most successful 
was the combined meeting of ffie Sections of 
Orthopaedics and Fractures and of Neurology and 
Psychological Medicine, when Professor Joseph S 
Barr drew attention to the significance of the pro 
lapsed disk in the aetiology and treatment of 
sciatica and Professor H Ohvecrona to the possi 
bility of treating spasmodic torticollis by section of 
the cervical nerves The discussion on organo- 
therapy held by the Section of Medicine attrackd 
a good deal of attention, and in that on anMCiy 
states m general and industrial medicine the rc 
mark of one speaker that it was important to " gd 
hold of the children ” drew from Dr T A Ross 
the apt retort that it w'as more important first of 
all to get hold of the medical student But the 
most stirring event was the description given by 
Mr R R Blewett of the medical and socwl 
changes that had taken place at St Day, a derelict 
mining area in Cornwall We would also mention 
the excellent films that were demonstrated on the 
three days the Scientific Sections met, those by Mf 
L O’Shaughnessy on surgery of the heart and bj 
Dr C C Ungley on liver therapy and on pol) 
neuritis being of special interest 

The Annual Representative Meeting 
notable for one event — the last appearanc'- 
in an official capacity of Dr C O Hawthorne, wbo 
has decided no longer to seek election to tb<^ 
Council The warm reception that greeted him on 
the platform must have assured him of the affection 
and esteem m which he has been held for nimy 
years His gift of silvery speech and his constan 
upholding of principle when this was m dangvi 
of being overcome by expediency have for Ion- 
been the admiration and instruction of those " 
listened to him In spite of Dr Hawthorne > 


THE PLYMOUTH MEETING 



Juu 30 19-!S 


THERAPEUTIC ABORTION AND THE LAW 


TheBwtch 
Med cal JotTs^t 


22 


eloquent and logical opposition the Representatise 
Bodj \oted overwhelming!} in favour of the 
recommendation that a measure of recognition 
be accorded to chiropodists One of those who 
argued on behalf of this recommendation spoke 
with gratitude of the chiropodist who had 
“spotted ’ two cases of diabetes for him which 
perhaps rather begs the question What is a 
chiropodist’ Apart from this the meeting was 
enlivened by a discussion on the activities of the 
Association m the field of propaganda and pub 
licit} and the Representatives went into committee 
so that the fullest freedom of speech could be 
allowed The champion of democratic principles 
Dr Murra} of Banff made an eloquent attack on 
what he considered to be the unconstitutional 
action of the Council in setting in train a new line 
of polic} without first of all consulting the Divi 
sions But his indictment was more than matched 
b} the masted} presentation of the case for ’ by 
the Chairman of Council who as a speaker goes 
from strength to strength His skill in debate 
coupled with the quick watchfulness of the Chair- 
man of the Representative Body for any departure 
from the business in hand indeed made the 

platform appear at times too strong for those 
in the body of the meeting Nevertheless the 
Representative Bod} showed on more than one 
occasion that it had a lively sense of its responsi- 
bilities and was zealous on behalf of the rights 
of the general practitioner as could be seen in the 
modification it secured of paragraph 101 of the 
revised scheme for a General Medical Service for 
the Nation 

The local and the national newspapers have 
always been generous in the attention they pay to 
the Annual Meetings of the Association, and it is 
not safe to make comparisons between this year 
and former years But the impression remains 
that printers ink has flowed more freely than 
before and that there has been more comment and 
more informed comment than previously This 
must be to the general advantage because the 
public in many respects is still lamentably 
Ignorant of the aims of Medicine and the means it 
wishes to adopt to achieve them 


THERAPEUTIC ABORTION AND 
THE LAW 

The true physician s only desire is to do his best 
for his patient His problem is often to choose 
between two evils the possible ill effects of his 
treatment and the probable consequences if he 
does nothing The gynaecologist sees many preg- 
nant women who if they go to term will probably 
suffer some harm This may be slight or so grave 


that It will almost certainly cause death In many 
of these cases he is convmced that an abortion is 
in the best interests of the patient His choice 
however is complicated by the knowledge that if 
he terminates pregnancy he will destroy a potential 
life and also that the law forbids abortion in some 
circumstances Many doctors have for a long 
time been anxious to know exactly what the law 
allowed them and did not allow them to do They 
found one answer only The Offences Against the 
Person Act 1861 Sect 58 said that a person who 
‘unlawfullv’ used an instrument with intent to 
procure the miscarriage of a woman committed a 
felony for which he could be punished vvith penal 
servitude for life They asked the meaning of 
‘ unlawfully and were told that it had never been 
defined either by Parliament or by a judge but 
that the law almost certainly allowed the termina- 
tion of pregnancy for the purpose of saving the 
mother s life When they discussed the subject 
among themselves they found wide variations of 
opinion on what the law was — apart from much 
wider variations of opimon on what the law ought 
to be They felt anxious and insecure and a 
strong movement grew up among them to have the 
law clarified 

At the same time a number of lawyers who had 
paid special attention to the problem were aw ire 
that the law was vague but felt convinced that 
this very vagueness was a good thing They 
realized much better than the doctors the essence 
of the English legal system a man may do anv- 
thing which is not expressly prohibited by law 
and where authority is lacking the law is wntten in 
the hearts of the people to be interpreted by the 
judges The undefined word unlawfully ’ 
allowed the authorities to give the medical pro 
fession whom they knew to be with very few 
exceptions not only responsible but conscientious 
a free hand to decide for themselves what was 
lawful in therapeutic abortion The lawyers were 
content m other words to assume that an abortion 
was carried out lawfully when a doctor performed 
It in good conscience after careful thought and 
observation and under proper conditions for the 
substantial benefit of the patient They felt that 
so long as the law refrained from saying what a 
doctor could do the question of what he could not 
do need not arise so long as he acted bona fide 
he could be left outside the sphere of cnminal law 
and practice altogether and the police could devote 
their energies to detecting and prosecuting the 
people against whom the statute was directed — 
namely the professional abortionists lay or 
medical, about the unlawfulness of whose activities 
there was no possible doubt This attitude how- 
ever did not allay the anxiety of medical men and 



226 JUL\ 30 1938 

the Situation was resolved last week m an English 
court of law 

Mr Aleck Bourne has for some time been 
amons the chief of those who have desired to know 
clearly where they stood under the law He is a 
leading obstetric surgeon with keen clinical and 
psychological insight He felt that m some cases, 
to do his best for his patient he must perform an 
abortion He also felt that the true interpretation 
of the law must allow abortion where it was in the 
best interests of the patient and he formed the 
resolution to take the first suitable opportunity of 
having the legal position made clear In this 
country a legal ruling can only be obtained in 
relation to a particular case, whether it be a civil 
action or a criminal prosecution He was there- 
fore prepared to take the extreme course of risking 
his liberty, life’s work, and reputation by sub- 
mitting to a criminal prosecution in which the 
Crown would differ from him on the interpretation 
of the word ‘ unlawfully ” As it happened, when 
the suitable occasion arose he was barred by a 
promise of secrecy from actively presenting himself 
as a sacrifice and it is understood that the Crown 
moved on information which he had not supplied 
A girl less than fifteen years of age was assaulted 
by some soldiers and raped under as revolting a 
set of circumstances as could be imagined She 
became pregnant and was taken to see Mr Bourne, 
who admitted her to St Mary’s Hospital for obser- 
vation He had a strong bias from the beginning 
in favour of an abortion but he did not perform 
It until he had satisfied himself, by tests and 
observation, that the girl would in all probability 
if she had gone to term, have suffered grave and 
lasting nervous damage which would have ex- 
pressed itself in psychoneurotic and physical illness 
perhaps for the whole of her life Though he 
acted openly, he did not consult any of his 
colleagues, his reason being that in such cases he 
was accustomed to act as the ‘ second opinion ” 
liimself He was charged under Sect 58 of the 
Act of 1861 with unlawfully using an instrument 
with intent to cause miscarriage and the case 
turned on the interpretation for the first time of 
the w'ord ‘ unlawfully ” 

The trial took place on July 18 and 19 at the 
Old Bailey before Mr Justice Macnaghten ' and 
will long be remembered as one of the most re- 
markable that has ever taken place even in the 
Old Bailey The accused was treated throughout 
with admiration and respect his motives w'cre 
regarded with what must have been almost unani- 
mous approsal It w'as less a criminal trial than 
a co-operative effort by judge, jury, counsel, and 
create law out of strong but ill-defined 

■ /friM/i VfrtJu.,,; Jonrnr! Julj 23 19 ^g pp 199-205 


Thi BMTisn 
MrDiCAL jQmsa 

feeling The foundation was laid by the judre 
after the Attorney-General, Sir Donald Somervell, 
K C had closed tlie Crown case he defined the 
word “ unlawfully ” by importing a phrase from 
the Infant Life Preservation Act 1929 That Act 
was passed to prevent the killing of a child in the 
short interval w'hen it is capable of being bom alne 
and therefore comes outside the law of abortioa 
but has not yet acquired an existence independent 
of that of its mother and therefore cannot m law 
be murdered Sect 1 of that Act contains a 
proviso that no person shall be found guilty of 
the offence of cliild destruction unless it is proved 
that the act which caused the death of the child 
was not done in good faith for the purpose only 
of preserving the life of the mother The learned 
judge held that this proviso expressed what had 
always been the law in regard to abortion and was 
implicit in the word “ unlawfully ” of the 1861. 
Act He therefore ruled that the question for the 
jury would be “ Has the prosecution proved to 
your satisfaction, beyond reasonable doubt, that 
the act which Mr Bourne admittedly did was not 
done m good faith for the purpose only of pre 
serving the life of the mother^ ” 

No one doubted Mr Bourne’s good faitli, but he 
himself admitted that he had not acted to save the 
girl from immediate death The next step in the 
case was therefore to determine the meaning of the 
phrase ‘ preserving the life of the mother” There 
was no doubt that the girl’s health would almost 
certainly have been gravely injured Tn fact, the 
Attorney-General greatly clarified the case b) 
admitting as much at the end of his closing speceh 
He said, “ I do not minimize tlie possible mental 
effects of which Mr Bourne and tlie other doctor!, 
spoke The question is whether those mental 
effects, grave as they are, justify under the law 
the termination of pregnancy ” In answering tlwt 
question the judge used words which will probab!) 
be quoted for a long time to come as a statement 
of the attitude which the law requires of the docioi 
who performs a therapeutic abortion He said, 
in effect, that no line can be drawn between dangu 
to life and danger to health , that no doctor knows 
vv'hether life is m danger until the patient is dead . 
and that if on reasonable grounds, basi-d on 
adequate knowledge after consultation "'U 
colleagues, a doctor forms tlie opinion that ib^ 
probable consequences of the continuance of pri-g 
nancy woula make the woman a physical or a 
mental wreck then he is not only entitled, but i 
IS his duty, to perform an abortion In saying t 
his Lordship was — most fortunately — saying 1!"“ 
the law and the physician s duty arc in harmony^ 
To preserve a woman s life he implied is 
merely to save her from death , it is also to sau- 


THERAPEUTIC ABORTION AND THE LAW 


Juu 10 193S 


TREATMENT OF MALARIA 


TfcB^r n g f 

^{£OtC^i JotTNlL 


227 


her from illness which would destroy so much of 
her life that it would hardlj be worth living With 
this view the jury agreed as is shown bj their 
verdict and it is now the declared law until it is 
corrected or modified b> the Court of Criminal 
Appeal in some other case 

The trial Rex \ Bourne has therefore ven 
tilated the whole subject of therapeutic abortion 
and produced a statement of the law which sub- 
stantially allows the conscientious medical man to 
do what he has been doing already But the law 
hitherto vague has' now been clarified and after 
the Ministry' of Health s Inter-Departmental Com 
mittee on Abortion (the Birkett Committee) has 
issued Its report it may be clarified still more 


TREATAIENT OF MALARIA 

/ 

Methods for the treatment of malaria and particularly 
for personal prophylaxis still furnish a field for con 
troversv as tvyo recent Bulletins of the Health Origan 
ization of the League of Nations show ‘ Despite the 
claims and hopes that haye arisen the drug prophylaxis 
of malana is still far from satisfactory It is true that 
phsmoquine in relatively large dos^s can exert a lethal 
action on sporozoites but in doses which may safely 
be continued for long periods its value is very slight 
neither can atebnn excepting in large doses nor quinine 
be considered true causal prophvlactics since expen- 
mcntal evidence which is supported by practical expen 
crice shows thai their action on sporozoites is doubtful 
The findings of the third report of ihe Malana Com- 
mission published in June 1933 based upon expen- 
ments v'lth P i/vax therefore still stand Up to the 
present no drug is known which when taken in harmless 
doses dunng the penod of infection will effectively 
destroy tne causal organism of malana (sporozoites) 
before they are able to continue their life cycle in the 
human host Nevertheless the regular use of either 
quinine or atebnn mav be of value through the inhibiting 
effect these drugs exert upon the development of the 
asexual forms of the malana parasite whereby clinical 
manifestations are damped dowu or suppressed For this 
purpose atebnn has not proved clearly supenor to 
quinine and possibly mav be more toxic Furthermore 
the harmiessness of quinine maues it a suitable drug for 
ad'mnistration bv subordinate personnel without con 
stant medical supervision whereas such supervision is 
essential in the case of atebnn There therefore seems 
little ground for displacing the established daily dose 
of 5 grains of quinine where personal prophylaxis of 
malana is praetised The report concludes that in 
primary infections a mean daily dose of 15 grains of 
quin ne may bnng about the disappearance of tropho 
zoites of benign tertian or quartan malaria on an 
average on the third day although relapses occur in a 
percentage of individuals which may be as high as 50 
in the case of malignant tertian infections doses up to 
30 grains daily may be necessary Quinine in the doses 
Bull Hill, Org L o ^ 1937 6 6S3 895 


indicated exercises its parasitieidal activities on the 
young forms of F i/ior and P malanae capable of 
producing gametocytes and also on fullv developed 
gametoevtes but on the fullv developed gametoevtes 
of P falciparum its action is only very slight 
Quinine therapy with the usual dose has no adverse 
efl'tct on the patient s general condition and is generally 
free from depressive or toxic action if the penod of 
administration is limited to the number of davs Sinetlv 
necessary nor is there anv good reason tor thinkmg that 
this treatment hinders the process ot immunization 
Atebnn in daily doses of 0 3 gramme has a shghtlv more 
rapid action on trophozoites of P mat and P malanae 
than quinine in the usual dose of U grams on the 
trophozoites of P falciparum differences between the 
strains of parasites prevent the drawing of uniform con 
elusions The parasitieidal action appears to continue 
for a longer penod in that the phase of latency lasts 
rather longer after the end of treatment than wath 
qiiinine TTic action on gametoevtes is like that of 
qiiinine Unfortunately the vellow coloration of the 
skm vs a disailvaTiVagt: tsipeciaViv d’liTiTig pi-oVoTiged 
prophylactic treatment and the drug mav have other 
toxic effects The action of plasmoqume on the tropho- 
zoites of P mor and P malanae is slight and on those 
of P falciparum almost nil though op the gametocytes 
Its effect IS marked There is therefore no advantage 
in using plasmoqume alone to combat the svmptoms of 
art acute attack in any of the forms of malana Tne 
simultaneous idministration of atebnn ana plasmoqume 
appears to aggravate the toxicitv of each and is not to 
bo advised The consecutive treatment with atebnn 
first followed bv plasmoqume has no appreciable 
influence on the clinical manifestations or the proportion 
of trophozoites m the blood out the methoa has the 
advantage of decreasing and devntahzmg the gamete 
evtes especially those of P falciparum moreover from 
the clinical point of view it duninishes substantially the 
number of relapses The combined use of quinine witn 
plasmoqume causes/less frequent and less intense toxic 
symptoms than that of atebnn with plasmoqume There 
IS therefore no particular contraindication to the simul 
taneous use of quinine and plasmoqume and themiethod 
has the advantage that the duration of 'reatment is 
shortened It is stated that the association of quinine 
with plasmoqume represents one of the most efneanous 
methods of treating benign tertian and quartan malaria 
A erage doses of quinme and plasmoqume greatly 
reduce (perhaps more than anv odier method) the 
number of relapses in benign tertian and in some cases 
also in malignant tertian 


CALCIUVf AND THE FOETLS 

The quantity of calcium administered annually to preg 
nant women is so enormous as to be onlv computed 
in terms of tonnage for it has become customary to 
presenbe this mineral almost as a routine during preg 
nunev That this is justified has been proved n 
innumerable researches and it is certain that it effectively 
prev..nts the almost universal drop in serum calcium ip 
tnc later months of gestation The effect on the foetus 



MOVEMENTS IN COLLAPSED LUNGS 


228 July 30, 1938 


has however, been generallj- ignored and Finola and his 
colleagues' have now drawn attention to possible dangers 
in this connevion In an exhaustive investigation they 
found that the normal foetal excess of serum calcium 
and inorganic phosphorus was increased by the admims- 
tiation of these minerals during pregnancy and that there 
was moreover definite evidence of increased bone 
dcnsitv in the majoritv of infants born of mothers so 
treated The significance of this latter finding leaps to 
the eye for it is obvious that excessive osteosclerosis 
in the foetal skull might restrict moulding In the great 
majoritv of eases this is of little importance, but it is 
conceivable that it might be crucial in a “tight fit” 
disproportionate labour That this does not occur more 
often IS perhaps due to the fact that calcium is usually 
pi escribed in a practically unassimilable form , but where 
It IS given scientifically (as dicalcium phosphate com- 
bined witht vitamin D) this possible cause of dystocia 
should be borne m mind and the drug supplied to 
women with undcrsired pelves only where indicated by 
an abnormally low calcium content 


RESPIRATORY MOVEMENTS IN COLLAPSED 
LUNGS 

The movements of the lung when collapsed by an arti- 
ficial pneumothorax have been studied radiologically 
by Andrew L Banyai - In each patient radiographs 
were taken at the end of inspiration and expiration, 
the margin of the collapsed lung was outlined, and the 
pulmonary aiea was measured by means of a plam- 
meter The radiological-respiratory ratio — that is a 
hundred times the radio’ogical area at maximum expira- 
tion divided by the radiological area at maximum inspira- 
tion — was then calculated This ratio is inversely pro- 
portional to the extent of the respiratory excursion In 
collapsed lungs it varied from 54 to 99, indicating that 
111 some naticnls respir itory movement persists in such 
degree that the radiological area of the lung m 
inspiration is almost twice as large as that in expira- 
tion, whereas in others the respiratory excursions of 
the treated lung are almost ml Banyai found that so 
long as the intrapleural pressure remained negative the 
movements of the affected lung were determined mainly 
by the stage of deflation and the movements of the 
overlving thorax , he indicates how both these factors 
arc to be measured Changes in this relationship may 
be caused by various factors such as the extent and 
type of the tuberculous lesion and particularly the 
presence or absence of extensive fibrosis or consolida- 
tion pleural effusion extensive adhesions contraction 
of the thorax, the condition of the respiratory muscles, 
and the extent and tvpe of disease in the contralateral 
lung The radiological-respiratorv ratio was between 
50 and 69 in half the patients investigated, between 70 
and 89 m 45 per cent , and between 90 and 99 in only 
5 per cent A comparison with a control group of 
normal persons showed that a respiratory ratio between 
90 and 99 was not found ir healthy indi.-iduals , on the 
other hand the proportion of respiratorv ratios between 


THtrsWH 

VftDICAl louva 

50 and 59, indicating marked respiratoiy excutsion« 
was four times greatci in the pneumothorax group thin 
in the controls The author emphasizes the fact that 
the conclusions based on investigation of the movcmi.nt 
of the entire collapsed lung are not applicable to iVe 
diseased part of that lung The movement of the 
affected area was less than that of the iininvohcd ,irca 
m 63 per cent of cases, equal to it in 25 per cent , and 
more than that of the unaffected lung area in the rtmam 
ing 12 per cent When the radiological respirator)' 
ratios derived from the measurement of forced respira 
tions are reduced proportionately to a level correspond 
mg to that of quiet respiration, it becomes apparent 
that the respiratory excursions of a diseased area cm 
be substantially restricted by an artificial pneumothorax 
Marked limitation of movement followed the induction 
of a pneumothorax in 19 5 per cent of cases , and thc«i 
patients had respiratory ratios between 90 and 99, which 
do not exist m normal persons Further companbon 
with healthy adults showed that the proportion of 
lespiratory ratios between 80 and 89, indicating Iimitu! 
movement, was more than three times greater in tk 
group in which the movements of the diseased area w 
a collapsed lung were measured than in the conlroN 
Occasionally, however a pneumothorax seems to 
increase rather than decrease the respiratory excursions 
of the diseased lung Finally, comparison of tht 
respiratory excursions of the lung before and durin’ 
treatment by artificial pneumothorax revealed that tht 
movement of the diseased area of the treated lung was 
less than that of the entire lung before treatment in 541 
per cent , the movement of the two areas was rmith 
the same in 18 per cent , and the extent of the mow 
ments of the diseased area during treatment was graw 
than that of the entire lung before treatment m 2/1 
per cent 


“THE SIGN or THE CLAVICLE” 

As far back as 1927 Dr G C Higounicnakis' ofll 
staff of the Evanghehsmos Hospital (Athens) and hud 
of the skin and venereal diseases departments 
attention to the fact that in congenital syphilis t« 
sternal end of the clavicle is sometimes enlarged, sr“ 
since then he has come to the conclusion that it is or' 
of the most certain and most common stigmata of i 
disease and is met with neither in healthy persons no 
in those with acquired syphilis The swelling is dr 
to a hyperostosis resulting from a syphilitic osuiii' 
and there are three reasons why it should occur at 
site The first is anatomical The inner third of j 
clavicle IS derived from a secondary centre w 
appears from the eighteenth to the twentieth 
whereas the acromial end and middle arc ossified ca^ 
from a centre which appears from the thirtieth to 
thirty-fifth day of mtra-uterine life Also, the ossi 
tion of the clavicle takes place directly from 
tissue and unlike the other long bones, , 

formed cartilage Secondly, the Sp palluin 
predilection for connective and lymphatic ' , 
Thirdly, by reason of its function the sterna c ^ 
the clavicle — particularly the right— is irnta — ^ 

’ Amt Derm S)pU Pins 1937, 8, 939 


'Amrr J Obsfet Gutec 1937 3 4 955 
Amrr Kri Tiibert 1937, 36 740 



Jix\ ■50 ig'is 


The British 
' lEDrCAl. JOCTLSAL 


229 


OPHTHALMOLOGICAL SOCIETY OF AUSTRALIA 


continued shocks due to the mo\enient of the arm and 
bi-ing menibrinous bone like the flat bones of the 
skull IS a convenient place for the Sp pallida to settle 
in When the patient begins to use the arms the extra 
stress stirs up the spirochaetes and an osteitis is set 
up (In this connexion it is interesting to note that 
tile author has demonstrated thirteen cases in which 
tl e left clavicle has been involved in left handed people ) 
In support of his thesis Dr Higoumenakis quotes a 
number of other observers including French American 
and Greek who have, also noted the sign and claim to 
have proved its svphihtic import The ages of twentv 
patients who showed the clavicular sign vaned from 
15 to 56 no verv joung children are included The 
kkassermann reaction was negative m eleven cases 
positive m eight and not stated in one Fourteen 
o'' these patients seem to have been fairlv tvpical cases 
of congenital sjphihs and one was apparcntlv a case 
of third generation svplnhs but the diagnosis of 
liereditarj svphihs is not altogether convincing in the 
other five TTie author claims that the value of the 
‘ sign of the clavicle in the diagnosis of congenital 
svphihs IS greater than that of other stigmata on account 
of Its frequencj and the ease with which it is demon- 
strated It would be interesting to know in what per- 
centage of cases of undoubted congenital svphihs this 
sign occurs since its existence does not seem to have 
been recognized bv manv eminent sv philologists and 
also whether it ever occurs in acquu'ed svphihs or in 
Other conditions A more detailed description of the 
pathological and radiological findings would be in 
valuable including an examination of sections for the 
Sp pallida In the meantime sv philologists would do 
well to keep a watchful eve for this sign and maintain 
an open mmd with regard to its frequenev and 
diagnostic significance 


OPHTHALMOLOGICAL SOClETi OF 
V AUSTRALIA (B M A ) 

In this counirj we are accustomed to the formation and 
existence of independent clinical societies which are 
the meeting grounds of groups of local practitioners 
or of wider groups of practitioners who are engaged 
in some form of special medical work Our Asso 
ciation was onginallv a combination of the former 
and each Annual Meeting provides the latter to some 
degree in the Scientific Sections Nevertheless inde 
pendent societies still exist because of our liking for 
old traditions There are weaknesses inherent in the 
small independent societies for thev can rarelj unite 
for common action In Australia the members of the 
B M A have evolved a more excellent wav The 
ophthalmologists of the Commonwealth felt thej needed 
a societv in which those practising this branch of 
medicine could unite for the advancement of their 
specialtj by meetings publications libraries and 
museums research work and the provision of pnzes 
for research work and by postgraduate lectures 
Instead of starting an independent bodv thev have 
formed such a society within the Association — The 
OphihalraologiCal Societv of Australia (Bntish Medical 


Association) Those eligible for ordmarv membership 
are all those members of the BMA who speaalize 
in ophthalmologv and whose qualifications are approved 
bv the Council of the Soaetv Its rules show that it 
IS completelv autonomous vet it is part of the Assoaa 
tion The first president is Su: James Barrett (who 
was President of the Association m 1935) with Dr 
James Flvnn as vice president Dr Darev Wilhams 
honorarv secretarv and Dr Leonard Mitchell honor 
ary treasurer We congratulate our Australian 
colleagues upon their achievement and wish the new 
societv everv success An article in the Medical Joimial 
of Australia of Apnl 9 ends thus We welcome an 
intramural societv with the hope that its success mav 
induce some of the existing extramural bodies to become 
part and parcel of the Bntish Medical Assoaation 
That IS a hope that might be fulfilled nearer home 


THROMBOCVTOPEMC PURPLRA FROM 
SEDOR3HD 

An enormous number of new svnthetic drugs have 
bi.en introduced dunng the present centurv and manv of 
them have become firmlv estabhshed in clinical use 
In recent vears there have been some notonous proofs 
of the fact that it takes a long time to discover all the 
potentialities of a new drug The occasional appear- 
ance of toxic jaundice after cinchophen and of agranu 
locvtosis after amidopvnn ire cases which illustrate 
this point Thrombocvlopemc purpura has been 
known for some time to be caused bv a vanetv of 
therapeutic agents — ^for example x lavs radium 
benzene arsphenamine and quimne Five new cases 
of thromoocvtic purpura induced bv sedormid have 
been reported recentlv ' This effect is rather surpris 
mg because sedormid (allvl isopropvl acetvl carbamide) 
does not contain a benzene nng and it is aromatic 
compounds which most often lead to undesirable 
changes in the blood Hoffman and his colleagues' 
suggest that the carbamide radical may be the active 
toxic agent Thromboev topenic purpura after sedormid 
Is evidentlv a verv uncommon side effec' of this drug 
since only about a dozen cases have been reported in 
the literature Its occurrence is however of interest 
as providing a new example of the cunous idiosvn 
crasies that are being brought to light by the increasing 
use of a wide vanetv of svnthetic drugs 


AIEDICAL RESEARCH COUNCEL 

By an Order of the Committee of Pnvy Council made 
after consultation with the Medical Research Counci 
and with the President of the Roval Societv C R 
Hanngton, Ph D F R S (professor of pathologicat 
chemistrv in the University of London) and W W C 
Toplev MD FRCP FRS (professor of bacteno 
logv and immunologv in the Universitv of London) are 
appointed members of the Medical Research Council 
in succession to Professor A J Clark M D FRCP 
FRS and Sir John Ledingham DSc FRCP FRS 
who retire in rotation on September 30 

J Amer nied Ass 1938 110 725 
Ibid 726 



230 JuL-i 30 1938 


FRACTURES IN ^REGION OF ELBOW-JOINT 


The British 

^lEDlCAl. JOIRSAI 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

Tilts IS one oj a series of articles contributed by invitation 


FRACTURES IN THE REGION OF 
THE ELBOW-JOINT 

BY 

S L HIGGS, F R C S 

Fncturcs m\oI\mg the elbow are common, especially in 
children and their treatment is often a matter of difFciilty 
and anxiety Although painful at the time, theie may be 
no \ery obvious deformity or alarming incapacity, as in 
the case of a broken leg, and parents are apt to regard 
ireitment as a simple matter and blame the doctor if 
the result does not come up to expectations 

Reduction mav' be difficult or impossible without surgical 
intervention Restoration of movement may be slow or 
imperfect because of the peculiar liability of the elbow 
region to form excess of bone and undergo fibrosis around 
the joint Deformity through interference with giowth 
m i> be unavoidable At least some of these dangers and 
difficulties should be pointed out to those concerned at 
the beginning rather than wait until they arise Efficient 
treatment demands a ray examination, repeated as often 
IS necessary probably a general anaesthetic and adequate 
nursing and supervision, at any rate for a day or two 
Where unhappy results occur it is usually found that in 
order to save trouble or expense some of these measures 
have been neglected Failure to provide the best treat- 
ment must be made the responsibility of the patient or 
pircnts as the case may be, and not of the doctor 

Supracondviar Eractiircs 

A tall on to the extended arm in in adult is likely to c lusc 
I dislocation of the elbow but in a child the weakest 
point IS just ibove the lovvei epiphvsis of the humerus 
and this common type of injury will pioduce a supra- 
condylar fracture The most usual age is between 8 and 
12 vears The condition is easily lecognized The arm 
h mgs straight or is supported with the other hand Palpa- 
tion may help very little because of the swelling but the 
slight b ickward displacement of the elbow combined with 
the iinnituril side to side movement makes the diagnosis 
dc ir enough Movements of the finger and the hand should 
be tested m order to detect possible nerve injurv 

I irst aid consists in supporting the elbow in the 
position of deformitv with i thick layer of wool and 
b ind igc perhaps combined with a light splint No 
ittempt whatever should be m ide to bend up the elbow or 
to reduce the fracture until preparations have been made 
\lthough the longer the fricture is left the more difficult 
reduction becomes this applies to days and not to hours 
There IS therefore time enough to allow the child to get 
over the immediate effects of the accident to obtain some 
r-ray films of both elbows for comparison and to allow 
1 reason ible period to elapse since the last meal before 
giving i full general anaesthetic Gas is not enough, and 
local anaesthetics are unsuitable in the case of children 

Rl DUCT ION 

Rcdiiction IS accomplished in the following manner 
An issistant stcidies the upper arm while firm traction 
IS ipphcd to the pronated foreirm with the elbow in 
extension While still maint lining the pull on the forearm 


the elbow is flexed gradually, and at the same time forwtrd 
pressure is applied to the olecranon and lower end of thi 
humerus by the thumb of the opeiators other hind 
The sensation of reduction should be experienced If it 
IS not, the lower fragment has probably got caught behind 
the shaft, and further flexion must not be pressed When 
reduction takes place the forward position is mainliined 
by thumb pressuie, while any side displacement is checked 
and corrected The elbow is then brought up into full 
but not forced flexion, in which position the fracture is 
stable The forearm should be pronated to relax th 
muscles, which otherwise tend , to rotate the lower 
fragment 


How should this position be maintained with seciirin 
and safety i A collar-and-cuff sling supports the wmt 
frorrt below the neck, but may cause twisting of the 
fracture and subsequent loss of the ‘carrying angle 
Strapping which encircles the flexed arm may cause dannr 
from pressure, and must not be employed A satisficiori 
method is to apply a wet plaster-of-Paris “ slab, ’ nndt 
from a four-inch bindage, diiect to the back of the elbow 
from the top of the upper arm to the palm of the hand 
At no point does it go more than half-way round 
the limb, and it cannot constrict It is closclj 
moulded to the skin, and so gives firm support H 
IS held in position by a few turns of bandage around 
the foiearm and uppei arm, but nothing whativa 
enciicles the elbow itself The bend of the elbow is 
therefore uncovered and free for inspection When 'd 
the whole is suppoited in a sling Without delay an i m 
examination should be made to check the position If 
this IS unsatisfactory the arm must be dropped again into 
semi extension until a further attempt is made The child 
should rem iin in bed for twenty-four hours at least willi 
the arm resting on a pillow and a constant watch should 
be kept for any disturbance of the circulation The sicns 
of this lie pain, congestion, and numbness of the linccf' 
and weakness or loss of voluntary movements The* 
are the danger signals of beginning ischaemia The frw 


tore Itself becomes a matter of secondary importance 


All 


piessure in the antecubital legion must immedntch 
relieved by removing eveiythmg from the hmb i” 
reducing the flexion of the elbow It should be rcnicni 

bered that it is not as i rule the swelling and flexed position 
alone which cause pressure, but flexion in the presence 
of an unreduced fracture Hence the importance o 
obtaining t ray evidence of reduction before rcslir 
content 


AITUR-TIU AT MENT 

After-Ire ument consists in maintaining fixation on' 
union of the fracture is firm This usually 
weeks At the end of this time the plaster spl'”’ 
removed ind a collar-and-euff sling substituli-d In n 
days by gradually lengthening the sling, the elbow n i 
be let down to a right angle, and IhcrT in ordinary 
can be substituted Active movements arc cncoiira^^ 
and a eareful watch kept for any tendency for 
of flexion to become diminished This may j 

occurrence of myositis ossificans which would dcnia 
further period of rest Radiographs will show this 
The last st ige before full movement is restored 
many months The p ircnts must be m idc to iindersl m 



JUL\ 10 1938 


FRACTURES IN REGION OF ELBOW JOINT 


rHEBunss “Til 
Mumcax Jowvu, “ 


nnssige \igorous stretching or nnnipiilation of the joint 
vould not onl\ retard reco\er> but probablj lead to still 
further stiffness In certain cases some treatment from a 
reliable masseuse \sho will help to restore the child s 
confidence but confine herself to heat and gentle actise 
mosements and exercises mas help the sitOation and 
present the parents from seeking unskilled ads ice 

Fractures of the Condjles 

Injuries sshich cause cither abduction or adduction 
strains of the elboss mas lead to fractures of either the 
outer or the inner side of the losser end of the humerus 
The> occur most commonlj in children because of the 
sseakness associated ssith the multiple centres of ossifica 
tion For the accurate interpretation of radiographs a 
knowledge of these ossific centres and their appearance at 
different ages is necessarj Mistakes hosseser mas be 
asoided If exactlj corresponding films arc taken of the 
uninjured and the injured elboss Careful comparison ssill 
disclose an abnormahtj and the error of mistaking a 
separate bon> centre for a fracture is asoided It must 
be remembered that the losser end of the humerus in earlj 
childhood IS largcfs cartilaginous and that a torn off epi 
condjle mas be much larger than the r ras appearance 
suggests 

INTERS VL CONDSLE 

Forcible abduction of the elboss joint at anj age up to 
16 mas cause asulsion of this part of the bone through 
a pulE exerted bs the attached flexor group of fore 
arm muscles The importance of the injurj lies m the 
close proximity of the ulnar nerse svhich may be dapiaged 
at the time or become the seat of delayed neuritis m 
after years Exact diagnosis of the injury is not alssays 
■eass ssithout an x ras examination but if displacement has 
occurred a mosable lump can be felt beloss and in front 
of the normal situation of the epicondsle and there is 
lateral instabihts of the joint with a great deal of bruising 
Nerse pressure symptoms must be sought Treatment 
depends upon the degree of the injury 

1 Fractures Mithout displacement can be treated ssith 
a collar and cuff sling for a fortnight and afterssards the 
resumption of actise use 

2 Fractures nitli doHimard displacement are best 
treated bs open operation The steps of this consist of 
first a dissecting free of the ulnar nerse sshich is often 
tightly stretcheef across the broken surfaces then reposi 
tion of the condyle and attached muscles fixing them in 
place by a fess catgut stitches or a beef bone peg and 
lastly the transposition of the ulnar nerse to a muscle bed 
m front of the condyle to make sure that it svill escape 
a traumatic neuritis later on The arm is fixed in flexion 
by means of a posterior plaster splint for three sveeks and 
then actise mosements are begun If for any reason sur- 
gical treatment is impossible a fair result as regards 
function follows treatment by simply keeping the elboss 
flexed for three sseeks The condyle ssill not unite how 
eser and some lateral instability of the joint ssill persist 
together svith a sariable degree of cubitus sarus deformity 
Furthermore there is the risk of ulnar nerse irritation 
from friction behind the irregular condyle 

3 Fracture mth Displacement of Condile into Joint — 
Although by manipulative methods it has been found 
possible to extricate the condyle yet m almost all cases 
operatise treatment is necessary The ulnar nerse is often 
affected from the beginning and this may demand explora- 
tion The condyle is fixed back in position and the freed 
nerse transposed to the front 


EXTERN SL COVDIXE 

Fractures ot the external condyle usually insolse a part 
of the articular portion of the humerus and are not con 
fined to the epicondyle itself In children particularly 
the large fragment mas carry the sshole of the capitellum 
and esen part of the trochlear surface For purposes of 
treatment there are tsso sarieties first fractures ssithout 
displacement sshich should be dealt ssith on the lines ot a 
supracondylar fracture secondls those with displacement 
In the latter the broken off portion is pulled out ot the 
joint and drass-n dosvnssards bs the muscles and operause 
treatment is imperatise This mas not prose a sery eass 
matter as the fragment is often rotated and at a distance 
from the joint Some patience may be necessary to make 
out exactls boss to fit it back without separating us muscle 
attachments When in place it mas be secured bs a cat- 
gut stitch or by a small beef bone peg The elboss is held 
at a right angle ssith the forearm supinated and the ssTist 
a little dorsiflexed bs means of a posterior plaster slab and 
bandage This is retained for three sseeks before starting 
gentle actise mosements No phssical treatment is 
required 

Fraefunes of Head of Radios 

A point to remember is that a supposedly sprained 
elbosv mas often contain a fractured radial head It is 
usualls produced by a fall on to the hand There are 
none of the signs of gross fracture Pain m the elbow 
on tssisting the ssTist is suggestise Examination with the 
thumb oser the radio humeral joint sshile rotating the fore- 
arm ssith the other hand will reseal localized tenderness 
limitation of mosement and often irregularity of the head 
ot the bone \ ras examination will show theitype of 
fracture and determine the line of treatment 

1 A cracJ mth little or no displacement should be 
treated bs fixing the elbow in full flexion ssith the arm 
in supination This position is most easils maintained 
by a sers light posterior plaster splint supported by a 
collar and cuff sling It should be retained for a month 
after sshich a sling should be ssom for a further sseek 
Exercises and actise mosements are to be encouraged but 
mosements especialls extension are slow to return 

2 Fractures of a segment Kith displacement do sery 
badly ssith consersatise treatment Pain and stiffness 
persist and traumatic arthritis deselops later in the elbow- 
joint The broken off fragment should be remosed bs 
operation ssithout delas The radio humeral joint is 
approached through a lateral incision sshich passes just 
behind and beloss the external epicondyle The muscles 
are raised for a short distance from their origin and the 
capsule of the joint incised The joint will be full of 
blood and svhen this has been cleared assas the damage 
can be inspected The broken segment and any small 
fragments are remosed as gentls as possible leasing the 
standing portion of the head if this is undamaged Some- 
times the articular cartilage of the adjoining capitellum is 
broken and rough It should be made smooth with a 
knife and a sharp spoon The capsule is closed and the 
muscles are replaced ssith a few interrupted catgut sutures 
and the skin svilh interrupted stitches The exposure and 
svork inside the joint are carried out with bleeding con- 
trolled by an Esmarch bandage but in no circumstances 
should this be left on for more than half an hour 

3 Coniniiniited fractures of the radial head demand 
surgical treatment The whole of the head should be 
remosed together ssith ans loose fragments After partial 
or complete excision of the radial head the arm is sup- 
ported at a right angle by means of a thick layer of wool 



232 JUL\ 30 !938 


FRACTURES IN REGION OF ELBOW-JOINT 


TiicBRnisB 
Medicai. Jo uMi 


md a firm bandage Rotation movements ot the forearm 
ire encouraged from the start, and flexion and extension - 
of the elbow after a fortnight 

Fractures of Olecranon 

In these cases the question to be decided is whether or 
not to idMsc operation The age and occupation of the 
pitient, which arm is injured, and the degree of comminu- 
tion or separation of the fracture must all be taken into 
consideration The pull of the triceps and consequent 
separation cannot be efficiently overcome bv any method 
of splinting, not even m full extension with strapping and 
pads Bony union will not be secured, but nevertheless 
a remarkably useful arm mav result from a fibrous union 
with separation of the fragments 

In elderly patients who are not required to do hard 
manual work the best course is to support the arm in a 
sling at a right angle and encourage active use from the 
beginning In all other cases operative treatment is the 
method of choice It should be earned out as soon as 
the skin condition is surgically satisfactory Only a few 
points of technique need be mentioned The patient lies 
prone with the arm stretched out from the side and with 
the front ot the elbow resting on a flat sandbag An 
Esmarch bandage is used lor the first part of the operation 
The incision should be a curved one, passing to the inner 
side of the point of the elbow The resulting scar is not 
m an exposed position and is hardly visible — an important 
point in women patients Aluminium-bronze wire, made 
of mans strands and flexible for tying, or two strands of 
strong fishing-gut, will serve to hold the fragments 
together Silver wire is quite unsuitable The wire 
should he within the bone, only emerging at the sides of 
the lower fragment, to get a grip on the cortex, and deep 
in the triceps insertion where the knot is tied A flexed 
post opcritive position of the elbow is desirable, but the 
imount ot flexion will depend on the security of the 
fragments This can be tested before sewing up the 
wound A posterior plaster slab outside the diessings aids 
fixation and comfort In the average case active move- 
ments ma> be started in three weeks 


Nova et Vetera 


university in which Boerhaave graduated M D on Julj js 
1693 The arrangements are in the hands of a committee 
headed by Dr L C Kersbergen of Haarlem, whose offici, 
address is Keizersgracht 327, Amsterdam 
Before turning to the study of medicine Boerhaave took 
his degree? in philosophy at Leyden in 16S9, m 1701 ht 
was appointed lecturer on the institutes of medicine at 
Leyden and in 1709 professor of botany and medicine 
In 1714 he was appointed rector of the univcrsitj and 
professor of practical medicine, and four vears later pro 
fessor of chemistrv In 1728 he was elected into the 
French Academy of Sciences, and in 1730 the Rova! 
Society of London made him a Fellow “ His genius so 
raised the fame of the University of Leyden, especially 
as a school of medicine, that it became the resort of 
strangei s.from every part of Europe ” 


BENJAMIN TARNOWSKY, 1838-1906 

Piofessor Benjamin Tarnowskv, the first Russian svphilolo 
gist, was born on July 9, 1838, in Poltava After medical 
education at Moscow, where he qualified m 1859, he went lo 
Pans, where he studied svphilology and urologv under Ricotd 
On his return lo Russia he settled m St Petersburg where he 
became attached to the Kahnkine Female Lock Hospital In 
1863 he published his lectures on the diagnosis of svphilism 
women and children, the first Russian manual on vcncrul 
diseases In 1868 he was appointed to the Militarv Medical 
Academy of St Peteisbiirg where he lectured to voiing soldiers 
on the dingers of exposure lo venereal disease, and was nude 
assistant professoi of svphilology in the medical fauilli, 
becoming full professor three vears later He also foiindeJ 
a school for the special education of midwivcs in svphilolo^ 
In 1885 he founded a socictv of dermatologv and svphiloloej 
which was the first societv of the kind not onh in Russia but 
also in the world, and served as its president for manv 'car* 
In addition to numerous original articles on various aspKls 
of venereal disease most of which he published in tht 
ArUm fin Dermatologic iiiiii Syphilis Tarnowskv transhW 
Lanccreaux s monograph on sv philis His work met with wik 
recognition both at home and abroad The Russian Govem 
ment confeired on him various distinctions, and he was clcclw 
honoraiv member of numerous Russian and foreign nicdiiJi 
societies Throughout his married life he received valuablt 
help from his wife Dr Pauline Tarnowskv, who was one ot 
the first medical women in Russia and was well known tof 
her work on psvcliiatry and craniologj His dcith took phoe 
on Mav 17, 1906 


BICENTENARY OF BOERHAAVE’S DEATH 

Tridiv September 23, 1938, will be the two hundredth 
nnivcrsiry of the death of Herman Boerhaave, -the 
Iciding phvsician of his age At Leyden where he prac- 
tised md died the Nederlandsche Maatschappij tot 
bvV ordering dcr Geneeskunst, in association with other 
!c irned bodies m Holland, will commemorate the occasion 
Dutch phvsicnns and colleagues from other countries have' 
been invited to pav homage to Boerhaave and a com- 
memorative volume IS to be prepared, which besides the 
uidresses given on September 23, will include tributes 
from foreign physicians, botanists and chemists "At the 
end of the ceremony a wreath will be laid before the 
siitiie ot Boerhaave and visits will be paid to the church 
vshere he is buried to the old wards of the former St 
C iclilia Hospital where he taught clinical medicine, and 
lo his counirv seat Poelgeesl near Levden The 
following dav has been set apart for an excursion lo the 
sie inge at Voorhout where Boerhaave was born on 
ULLcmber 31 1668 and thence to Harderwwk, the ancient 
1 c oun near the Zuvdcr Zee, where formerly stood a 


HEINRICH MEIBOM, 1638-1700 

From the stately davs of the seventeenth century to roJ 
into the burned atmosphere of modern spccialiMlion i ^ 
name of Mcibomius, the tercentenary of whose birth occum 
on June 29, engenders feelings of envy and mchUEno' 
regret Though he has found a narrow memorial in 
Meibomi in glands of the evelids which he dcscribcu 
accurately m 1666 ( De vasis palpebrarum novis, 

— these had previously been noticed hv Giulio 
(1561-1616) — through the verv act of eponymous 
tion however pious, we lend lo drift away from Ihr 
behind the name Like so manv of liis 
was indeed a child of Apollo god of culture, poetry, p 
and healing While still a medical student (he bccanic * 
at Angers m 1663) he was appointed to and m 
the professorship of medicine in the Umvcrsitv of 
Fourteen vears later he accepted the additional ctiai ^ 
history and of poetry He further showed his ^ 

straving into the pleasant fields of archacologv, f"' p,, 
and philosophv and all his life he was an insatiate ra ^ 
His father, Johann Heinrich Meibom is a familiar if 
medical hi'torv, hut his son, Brandanus, also a phj'i 
a comparative stranger 



Jll\ I9^S 


PERSONAL EXPERIENCE OF TETANUS 


The Bjirnsa 
'l£D CAL Jo TLNA^ 


233 


A PERSONAL EXPERIENCE OF TETANUS 

\\c print bclovN in abridged iccoiinl of a personal experi 
cnee b\ Trcvor H Knights MB Ch B N Z of 
the Baptist Mission Hospital ^akllsu Belgian Congo 
It has been communicated to the Journal b\ Dr C C 
Chesierman O B E medical officer and secretarv Baptist 
Missionar> Socict\ 19 Furnital Street London EC 

Source of the Infection 

In NoNcmber 1937 a native patient operated on m the 
\akusu Hospital for a large hvdroccic suddenU developed 
tn^mus and died fortv eight hours after the onset of svmptoms 
There are no horses or cattle in the region and tetanus has 
alwavs been considered as cxccedinglv rare or non existent 
The source of the infection remained obscure but thanks to 
the help of Professor GeofTrev Hadfield M D FRCP of 
St Bartholomew s Hospital cultures have since been made 
of a large vanelv of matcnals from the hospital and have 
resulted in n growth of Cl tetam of slighth diminished 
virulence being obtained from the sweepings of the theatre 
floor Whether these came from or were the source of the 
original native infection is unknown but precautions have 
now been taken to prevent soiling of the theatre floor bv the 
feel of those whose dutj it is to enter it 
Two months later Januarv 19 1938 Dr knighu inter- 

rupted his morning list of operations between the clean and 
septic cases and removed with the help of his native drcsser 
a couple of irritable pigmented moles one from his left arm 
and the other from his right forearm Novocain 2 per cent 
was used and the wounds were dressed and strapped with 
elastopiast no catgut was used Both wounds were subse 
quentlv irritable and neither healed bv first intention 

Onset and a Canoe Tnp 
Dr Knights writes 

On the twelfth dav after the operation Januan 31 1938 
awav on a bush joumev 1 had a headache and slight dvsphagia 
Next dav the dvsphagia had gone but 1 had an irresistible 
desire to vawn without the momentarv relief from weariness 
which usuallv follows this exercise M> face felt tied up 
but I failed to detect nsus sardomeus in the mirror and dis 
missed it as tetanophobia and cjcled fifteen miles to inspect 
a dispensary 

\i 7 am next morning I set out on a similar errand but 
fell tired after the twentv-eighl'mile non stop ride Lving 
down on the hard table of the rest house I took a dnnk and 
suddenly mv yaws went into spasm Hurncdlv altering notes I 
had written to various native chiefs and colleagues about mv 
future plans I completed the inspection of the dispensarv had 
a short sleep on the table and changed mv clothes sodden 
with perspiration at the unsuccessful efforts to lake a meal 
and rode back twentv eight miles through a tropical downpour 
to the river bank 

While waiting for paddlers for the canoe I turned up 
Tidv and found I had probablv four davs to live Re 

turning later to find my messenger still propping up the 
doorwav I remonstrated a little angrily when suddenlv mv 
larvngeal muscles went into spasm and the resulting shnek 
sent the native off at the double 

At last With no doubts left in mv mind I began the long 
two-dav canoe trip up to Yakusu taking onlv a few drugs 
and papers leaving my other ku as never wanting it again 
1 lav on a deckchair covered with a camp bed mattress in 
an open canoe and as evening fell found that mv back was 
stiffening so that at midnight I was verv glad to be lifted 
out on to another rest house table just as a storm was brewing 
I passed the remainder of the night fitfuliv dozing amid the 
snores of paddlers the thunder and the noise of the ram on 
the leaf roof In the blackness of earlv morning I was 
assisted down through the elephant grass to the beach and 
we got off once more poling and paddling past the fiickenng 
lights of the fires in passing canoes The shimmer over the 


water gave me a headache but bevond an aspinn I took no 
drugs as 1 wanted to keep mv head e’ear having several 
reports to make and monev matters to arrange 

The entry in mv personallv made case notes at this time 
was Stiffness of jaws, still more marked in moving spa«m 
Neck still remains free of stiffness which is noted across b^ck 
Eating an agonv and brings on free perspiration Spasm of 
left arm with hand in accoucheurs position Spasm of bodv 
leg-i arms and across chest 

At 2 p m we drew alongside the Mission motorboat in 
which mv colleague Dr Browne had responded to an urgent 
forest call that morning and to which he was due to return 
at dusk A native engineer look matters in hand and in 
sisted on putting me on board and taking me up to Aalu^u 
but though phvsicallv easier Ivmg on the cane bunk I was 
tortured with the thought that 1 with so little chance of 
survival had possibh delaved somebodv eNe with a le "^er 
complaint 

Twentv eight hours after setting out on this tnp which I 
fell was the last in mv life 1 was once mo e lving on a decent 
bed The onlv scrum we had 6 000 units was injected b\ 
the nurse as an intramuscular barrage and a cvclist sent off 
to SianlevAille for more At 5 a m next morning Dr Browne 
arrived in the motor boat which had returned to fetch him 
Later I had 6^ 000 units A T^ fnon concentrated vaneiv) intra 
nvuscutarh 

Horrors of Opisthotonos 

That mght I woke after a few hours sleep vMth the feeling 
that something was about to happen It was and did' Sud 
denU a great hand seemed to take rre across the chest render- 
ing respiration impossible Another two such hands forced 
mv head backwards towards mv heeK and mv heels towards 
mv neck while m\ whole bodv poured perspiration I felt 
some of the dorsal musculature give wav with a tearing 
agonv and this made the pain worse at the slightest movement 

Bv the tenth dav from the onset I was thoroughlv worn out 
and began to have thoughts of turning in the struggle even 
requesting two grams of morphine when mv colleagues saw 
that I was m unbearable agonv Bv this time I was making 
vocal protestation which relieved mv feelings each time I felt 
the drumming pulse and tightening compression of mv chest 
muscles 

Then came the greatest contraction of all when I am told 
mv pulse became imperceptible and mv respiration ceased for 
two minutes Then the miracle for I dropped off to sleep 
and woke knowing I was going to live and though stiff as a 
ramrod and verv weak fell that no more convulsions were 
commg mv wav and neither did thev 

In conclusion I would like to pav heartfelt gratitude to 
mv colleague Dr Browne and to the nursing staff whose 
skilful care and unremitting attention are without doubt 
responsible for mv being able to tell this somewhat 
adventurous tale 

An Objective Postsenpt 

Mr Stanley Browne F R C M R C P adds the 
following note 

The eighth and ninth davs of this illness showed a clinical 
picture of rapidlv increasing senousness but the will to live 
v'as verv strong the patient voluntanlv sucking up fluids 
through a rubber lube together with chloral and bromides 

On the ninth evening I gave him 70 000 units ATS in 
travenouslv and 9 000 inlramuscularlv Lumbar puncture was 
iiTipossible as he begged me not to give him an anaesthetic 
At this time morphine seemed to have no effect The svmptoms 
Were complicated bv bromide rash and a serum rash and 
catheterization was necessarv 

Convalescence was complicated bv an acute internal de 
rangement of the nghl knee probablv caused bv a fattv 
fringe a condition from which he had suffered before when 
exhausted or emaciated The heart was dilated and a svstolic 
mitral murmur appeared An impulse on coughing over the 
ruptured right quadratus lumborum disappeared and flat feet 
were prevented bv massage and exeroses 



234 JUL\ 30, 1938 


ELECTRICAL IGNITION OF ANAESTHETICS 


TmBumsii 

Medical 


ILECTRICAL IGNITION OF ANAESTHETICS 

BY 

H W SWANN 

Hn Maiesty s Senior Uectncal Inspectoi of Factories 

Two papers on electrical ignition of inflammable anaes- 
thetics were recently read at the Institution of Electrical 
Engineers and, with the discussion which followed, showed 
that useful research work has been done towards reducing 
the risk The purpose of this article is to summarize the 
more recent contributions to the subject and to suggest 
their application in practice 
Whilst explosions attended by serious results are for- 
tunately rare the Ministry of Health in 1935 thought it 
desirable to issue a memorandum entitled “ Precautions 
Against Anaesthetic Explosions m Operating Theatres 
This was of a preliminary character, and may be supple- 
mented now that further information is available The 
Ministry is aware of a number of accidents, information 
on which has been, gathered from vanous sources 
Although this figure may bear no relation to the actual 
number of cases, it indicates where the chief risk may lie 


Table I 


Cause of Isniuon (Electricity) 

Non Fatal ■ 

Fatal 

Total 

Static elcclricily i 

3 

4 

7 

Surgical hmp m mouth ! 

2 

4 

6 

Cauteries 

1 

3 

4 

Surgical diaihermy 

2 

t 

3 

Jiot nonle denial sjnngc 


1 

1 

Tabic lamp (switch) 

1 


1 

\ ra> apparatus 

t 


1 

Totals 

10 

13 

i " 


Table I summarizes the information available, and it 
will be seen th it in recent years twenty-three cases of 
explosion arc known to have occurred in this country and 
ibroad which are attributed to electrical ignition in some 
form or other 

The Chief Risks 

It will be noted that static electricity and the use 
of surgical lamps in the mouth constitute the chief risk, 
ind although some degree of danger must inevitably 
attend the use of the general electrical equipment for 
lighting sterilizing, Nentilating, etc, attention has focused 
on the first two causations especiallv as Coste and ChaplinT 
line found b\ experiment that the room distribution 
of ether vapour during operations under open-mask anaes- 
ihesii resulted in low concentrations The air at about 
two inches Irom the patients mouth contained less ether 
than would form an explosive mixture, and the proportion 
fell oil rapidlj as the distance from the patient increased 

Another bearing on the subject mav be obtained from a 
statement bj Dr H W Featherstonel to the effect that 
from time to time he had heard of a minor pop when 
i small lighted electric bulb had been inserted into the 
mouth during ether-air anaesthesia Dr Featherstone 
described a ctse in which an explosion occurred in the 
patients mouth and was attributed to defective contact 
between the lamp and the holder which caused a spark 
He also discussed the possibilities of the leakage of ether 
into the gas stream even when the anaesthetist, m 
endeavouring to guard against risk thought he had shut 
it off 


•Memo 191 Medical Mmistrv of Ucallh 1935 , S O Mo 32- 
•>999 

t J !! CoMc 1 t C r In<a P formerly chemist m chief London 
C minty Cotmcil -md C A Chijilm Ph D B Sc A 1 C , of vhc 
Coim'^l Public Heaiih Dcpnrtmcnt London County 


. t river, o) i/.e SncicU </ Mill, cine vot 2S, Pjtl I 


These and other opinions indicated that attention should 
be focused, in the first instance at least, on the eleclnnl 
Ignition iisks m the immediate vicinity of the patient, md 
of these risks those attending nose and throat operations 
appeared to be the most important It must not bv 
assumed, however, that risk in other positions can be dis 
missed as negligible, especially where ventilation is bad 
Dr C F Hadfield* particularly stresses the danger of foot 
switches in relation to accumulations of ether vapour at 
floor level 


Intrinsic Safety Surgical Lamps 


There is a wide variation in the design, construction, 
and maintenance of the different forms of surgical lamps 
m use, and with the limitations necessarily imposed on size, 
and the need of sterilization, it becomes difficult to suggest 
forms of construction which could be considered gas 
tight or immune from electrical defect While there is 
little doubt that from the point of view of ignition risk 
design could be improved, it was thought that there was 
more hope m the direction of intrinsically safe circuits, 
which, if practicable, could be applied with less difficulty 
and delay This principle has many successful industrial 
applications, but it was realized that there was no e\ 
penence with mixtures possessing the inflammable char 
actenstics of ether-oxygen The problem has, however, 
been tackled by Professor W M Thorntonf, whose re 
searches are detailed m a paper read on February 24, 1938, 
at the Institution of Electrical Engineers Thornton found 
that with hot wires, such as cauteries, ignition can occur 
within limits as wide as 3 to 80 per cent of ether in 
oxygen With sparks the limits are in general much 
narrower The researches described determine these limits 
and also the least currents that cause ignition when broken 
slowly or suddenly or by fusing wires Second only to 
hot wires as a possible risk are the "fizzling sparks which 
may occur between fine wire ends, such as at an inter 
mittent break m a fine wire flexible Thornton found 
that when the current is kept below certain well defined 
values Ignition did not take place, and thus he was able 
to specify the resistance for any given voltage which would 
limit the current m that circuit to safe values This 
resistance is, of course, located at the source of energy 
— for example, battery or transformer — and is independent 
of lamp or other circuit resistances Its effect is to limit 
the energy, which appeals as a spark caused by an open 
or short circuit anywhere in that circuit Thornion 
advocated a factor of safety of 2 as being an mipie 
margin Table II takes account of this, and is amplified 
by a graph (Fig I) 

Table II 


Direct Current 

Alternating Current 

Volis 

Minimum Safe Limiting 
Resistincc 

Volts 

Minimum Safe Limfi'fS 

Rcsisnncc 

0—2 

0 25 ohms 

0—2 

1 25 ohirn 

2—4 

1 25 , 

2—4 

6 00 , 

4—6 

3 25 „ 

4—6 

14 00 „ 

6—8 

7 00 „ 

6-8 

25 00 „ 

8—12 

27 00 , 

8—13 5 

54 00 , 


The curves relate to fizzling sparks, which over mo 
of the range of the experiments were the more danger ' 
It is worthy of note, however, that the curve for pt 
break A C would cross the fizzling break at about J- 
volts, which means that the plain break may become 
more dangerous at voltages above this figure 
the curve for plain break D C would cross the iiwi 
break curve at 3 volts, and thus again plain break 


• Diveuvsion on Professor Thornion s and Dr Rajner s r O' 
Fcbiuxtv 14 1936, vbe InsVilviUon of Etccuical Engineers ^ 
t The Electrical Ignition of Xlixturcs of Ether Vapour A 
Oxjgcn, ’ by Professor W M Thornton, O B E , D oe . 

Past Presittent 



Jtu "SO I9'8 


ELECTRICAL IGNITION OF ANAESTHETICS 


Tkz BJtrma 
^LDICAL JotTv 


the more dingerotis below that figure Onb the fizzling 
curve; arc shown and the scale figures on the right hand 
ordinate are those found e\p-rimentalh b\ Thornton 
while those on the left side allow a factor of safet> of 2 



Hot wire Ignition and Spark Ignition 

Thornton distinguished between hot wire ignition and 
spark Ignition and the importance of the point has been 
brought out bv Dr H L Saunders PhD FIC who 
found that although circuits incorporating the prescribed 
value of resistance ma> be safe as regards most forms of 
sparks a special case arises when a circuit is completed 
through a single strand of fine wire which mav get hot 
Under certain conditions the temperature of the ether 
mixture maj thus be raised above its ignition point 
causing explosion or sufficientlj to predispose to spark 
Ignition should the fine wire break Intermittent contact 
in a partl> broken flexible conductor involving a combina 
tion of hot wire heating and sparking is undoubtedlv the 
most insidious form of danger as a much smaller spark 
energj ma> be enough to cause an explosion This is a 
particularlj difficult case to define accuratelj and mav not 
be full> covered b> Thornton s formulae Ver> finel> 
stranded flexible is thus likel> to be more dangerous than 
coarse strands as the heating will be greater m the last 
strand to break ]ust before severance due to wear and tear 

Saunders has suggested that the onl> safeguard against 
this dangerous combination is to test the resistance of the 
circuit regularly A partial break in a flexible will show 
up as an increase above the usual resistance and indicate 
the need for examination and repair Lamp resistances 
var> and it would be best to replace lamps b> a low value 
of constant resistance for purposes of the test advocated 

The “ Cool Flame 

Another aspect of the subject with an important bearing 
on the risk of ignition has been pointed out b> Dr 
D T lA Townend* in connexion with that peculiar l>pe 
of combustion usuallj referred to as a cool flame 
In the c ase of ether-air mixtures in a 2 5-cm tube t here 

* D cu vion on Profe> or Thornlon s paper February 24 i9aS 
the lOitilution of Electrical Engineers 


23-1 


IS a range of inflammable mixtures which at atmospheric 
pressure is capable of normal flame explosion ben een 
about 3 and 9 per cent of ether in air and a quite distinct 
range for the cool flame between about 19 and 34 per 
cent of ether in air Within the normal flame range the 
mixture can be ignited by sparks but to mitiale a cool 
flame it is necessary to use a hot wire — a distinction of 
great importance Townend places the ignition tempera 
ture range of cool flame between area 170 and 270 C 
and describes cool flame combustion as verv incomplete 
and invisible except in darkness The flames travel 
slowly with a speed of something file 20 cm per second 
in a tube 3 5 cm in diameter and at about atmosphenc 
pressure which is that approximatelv customarv in anaes 
thesia the ranges overlap as the normal flame range 
starts at about 250 C 

Much the same type of system is formed with ether- 
oxygen enriched mixtures as with ether-air mixtures 
though with the former the ranges are naturallv much 
wider Townend showed that a cool flame initiated by 
hot wire could travel some distance in a tube leavmg 
behind it incompletely burnt products capable ot normal 
flame explosion and ignitable frpm the p eceding cool 
flame Thus where the velocitv of the supplv Ol anaes 
thetic is low a cool flame initiated at the patient s mask 
during anaesthesia mav travel back along the rubber tube 
to the gas producing equipment and mav cause a normal 
explosion either by ignition as above or on encountering 
a more explosive mixture 

Townend also discussed the possibilitv that although 
sparks of normal intensitv such as those from an induction 
coil or a broken wire do not inmate cool flame there mav 
be a range of neak spark intensities capable of doing so 
and the point has an obvious bearing on explosions caused 
by static sparks which mav attract the attention of an 
interested investigator 

Overrunning Surgical Lamp Bulbs 

Surgical lamps are often used in conjunction with some 
form ot regulating resistance which allows of overrunning 
The little bulbs are as a rule rated at between 2-5 to 3 5 
volts and when overrun to the point of burning out the 
glass may reach temperatures capable of igniting ether 
mixtures A valuable contribution to this subject has 
been made by Mr C T A Harper who has measured 
bulb temperatures of typical lamps when overrun to an 
extent causing collapse and burning out of filaments He 
emploved a special fine thermocouple which was kept in 
intimate contact with the bulb thus avoidmg the use of 
material which might act as lagging and so produce a 
higher temperature than would normallv be obtained 
Capped lamps did not reach such high temperatures as 
uncapped bulbs possibly owing to the increased area of 
dissipation and it is worthy ot note that in no case did 
the collapse of the filament result in bursting or damage 
to the bulb 

Harper recorded his measurements on graphs of which 
Table 111 is a summary The graphs are reproduced as 
Figs 2 3 4 and 5 


Table III 


I>->cnption 


Ba'b Terr^ra ere 




At Rated 
% oU-3* 
(A\cni'“) 

At Bum-out of Fllarrent 

Tjpeof Lamp 

Number 

Tested 

Rated 

Vokas* 

Lci-es 

Value 

No “d 

HiJ’.est 

V a ue 
Not'd 

Surgical unc-pped 

4 

2.5 

120 C 

jor c 

35r c. 

capped 

Uret^ro>^.ope 

5 


60 C 

rrc 

Z}(rc, 

capped 

NN ard s fienWe 

4 

3.5 

SO c 

C 

2*0= C 

capped 

4 

3S 

70 C 

2is’a 

2~0 C. 


In most cases the filaments appear to bum out at just 
under double the rated voltage 




236 July 30, 1938 ELECTRICAL IGNITION OF ANAESTHETICS 


TiirBumni 

MIDICAL JOURSAL 


The importance of this work is seen when it is rerfiem- 
bered that the ignition temperature range for normal ether- 
flame explosions lies between 250° and 350° C and for a 
cool flame between 170° and 270° C It seems likely that 
some explosions in anaesthesia may have been due to over- 
running, as It IS believed that burning out of bulbs from 
this cause is not uncommon The limiting resistance 
specified by Thornton for intrinsically safe circuits tends 
to diminish the risk of overrunning, but it will be obvious 
that It is in addition necessary that the rated voltage of 
the lamps should not be materially less than the voltage of 
the battery or transformer constituting the source of 
supply An intrinsically safe 6-volt circuit would still 
allow a 2 5-volt lamp to be dangerously overrun 

CONCLUSIONS 

The following conclusions may now be drawn as to the 
conditions under which surgical lamps may be used with 



Fig 2 — Rehtion between applied ^olt■lge and bulb tempera- 
ture Surgical lamp, 2 5 aolts, uncapped 



dPPLieO VOlTtCt 


Fig 3 — Relation between applied voltage and bulb tempera- 
ture Pharyngoscope lamp , 3 5 volts capped 


resistance, which diminish the light considerably The 
utility of the battcry-fed circuit is therefore the greater 

Static Electricity 

Although the climate of this country can as a rule be 
depended upon to produce a degree of humidity which is 
incompatible with the retention of static charges, the 
modern practice of supplying large buildings with cleamd 
and conditioned air tends to neutralize the climate, and 
Dr Rayncr has presented a paper,* read on February 24, 
1938, at the Institution of Electrical Engineers, which is 
devoted to a study of the manner in which static charges 
can be built up in operating theatres Explosions attri 
biited to static have occurred, and it has been found that 
rubber-tyred vehicles used for carrying patients can be 
electrified by withdrawing a warm dry blanket Bulgint 
says that an ordinary standard tyre of specific resistance 
10* to 10’ ohms will generate enough static to raise the 
potential of any vehicle to about 5,000 volts at a speed of 
ten miles an hour on a smooth road during_svarm weaiher 
55 xpin'KX rnc pitidneeii an LVicxe or oabex xvays Wi^y rmi} 
jump not only to an earthed object or person but also to 



Fig 4 — ^Rehtion between applied voltage and bulb tempen 
turc Urethroscope lamp 3 5 volts, capped 



Fic 5 — Relation between applied voltage and bulb tcmpeiv 
turc Lamp for Ward s Flexible , 3 5 volts, capped 


comparative safety in the presence of inflammable ether- 
oxygen mixtures 

adoption of uhornton’s formulae for mtfinsi- 
Qafly safe circuits will pre'yent any form of spark ignition 
on either AC or D C c ircuits 

2 The danger of hot-spot or hot-wire ignition, or a 

combination ol this with sparking at the moment when the 
hst strand ot a flexible breaks, may be minimized by a 
regular test of the circuit resistance and the keeping of 
records , 

3 The supp\v voltage should not exceed the rated 
voltage of capped lamps by more than 25 per cent Un- 
capped lamps should not be overrun 

Experiments made to demonstrate the utility of circuits 
conCorrtuag, to coaclusioas I a.wd 3 a.bQve. showed that a 
ustCul degree of light was obtainable, especially on D C 
circuits At the higher values of A C voltage the induc- 

vc effect has led to the necessity of high values of 


a rubber-tvred vehicle carrying an anaesthetic 
Thus the most likely place for static appears to 
immediate vicinity of the patient, where the risk ot e '■ 


concentration is greatest 
The risk with rubber-tyred vehicles is easily 
by the use of light trailing chains, but there is “ 
of misconception as to the conditions under "hicn in 
are likely to be successful Chains are usualiy ejfecliv 
most floor surfaces, excepting rubber and 000 

quite high surface resistances, of the order of 
ohms, are permissible The point is easily settled in 
vidual cases by producing electrification uithout 


* ‘ The Risk -of Explosion due to Elcctnfication m 
Theatres of Hospitals,’ by Dr E H Rajner N A U 
Rayners work was done at the 'National Physical Laom j 
the Depatlxaeat. of ScreaUfiA and lodustnal Research in con , 
with the Anaesthetics Committee jointly appointed h> 

Research Council and the Royal Society of ^^edicme institu 
t Discussion -on Dr Rayner s paper, February 2'!, i 
tion ot Electrical Engineers 





Juu 10 191S 


ELECTRICAL IGNITION OF ANAESTHETICS 


ThT BVTIiH 
^^£{? CAt Jo TLNt^ 


chain and then attempting to repeat it after the chain 
has been attached In the absence of a suitable instru 
ment a charge can be detected b\ holding a finger tip 
about one-eighth of an inch a\ea> from the metaf work 
of the aehicle eehilc a dr) blanket is smartlj pulled awav 
A form of rubber possessing conductiee properties has 
rccentlj been dc\ eloped with special reference to the risk 
of static in operating theatres and has sceeral similar 
industrial applications It can be used in the shape of 
teres or m sheets for flooring but losv values of resistance 
arc both unneccssarv and apt to be dangerous Rubber is 
inhercntl) inflammable and if the resistance is low there 
IS risk of fire should electrical leakage occur through it 
as for instance from a defective vacuum cleaner or a 
detective pedestal tjpe lighting standard At 230 volts 
a specific resistance of the order of 100 000 to 150 000 
ohms should be free of fire risk and jet quite effective 
for dispersal of static 

Electrical practice has alwajs associated non conducting 
properties with anj form of rubber and if accidents are 
to be avoided it is imperative that the new conductive 
varietv should be plainlv marked in a permanent manner 
It IS known that the India Rubber Manufacturers Associa 
tion has both resistance standardization and marking 
under consideration 

Dr Rajner also gave attention to the possibihtj of static 
being produced at the anaesthetic equipment bv discharge 
of gas from high pressure storage cj finders Some earlier 
work* on the electrification of oxjgen cv finders has been 
done at Birmingham Central Technical College from 
which It was concluded that m the absence of foreign 
matter in the gas stream there appears to be no electrifica 
tion The point is no doubt relevant also to c> finders 
containing carbon dioxide and nitrous oxide and as a high 
degree of puritj is ensured in manufacturing and bottling 
the risk IS small and maj be minimized still further b> 
maintaining electrical conductivitv between all gascjlinders 
and other metal work comprising anaesthetic equipment 
supplemented b> earthing either direct or through con 
ductive rubber This measure will prevent sparking 
between components or to other bodies but does not deal 
With the rare case of combustion at the oxjgen valve 
The design of the latter has however recentlv been 
improved bj the elimination of ebonite for purposes of 
valve seating The usual precautions of opening valves 
genllj and keeping them free from oil or grease are of 
course desirable 

Gas cjlinders max be located at a central point awaj 
from the operating theatres the gas supplj being distri- 
buted bj permanent pipe fine This affords an oppor- 
tunilj for reducing the cjlinder pressure in two stages 
that m the pipe line being maintained at saj 60 lb per 
square inch This arrangement would reduce risk and 
has alreadv been adopted in America and in a few cases 
in this countrj not onij for the distribution of oxjgen 
but also for nitrous oXide and other gases 
In cases of exceptional drjness the use of rubber shoes 
maj insulate the person sufficiently’ to allow static charges 
being set up by friction vvith the floor and of being 
carried Rayoer found that a similar condition may arise 
With leather shoes on cork carpet This would mean the 
possibilitj of sparking from the finger tips a phenomenon 
almost unknown in this country but well recognized in 
very dry climates An effective safeguard lies in the use 
of conductive rubber for the shoes 

CONCLUSIONS 

The following conclusions may now be drawn as to the 
means of dispersing static charges 

1 Rubber tyred vehicles should be earthed by trailing 
chains or conductive rubber 

2 Electrical conductivity should be maintained between 
gas cylinders and other metal components of anaesthetic 
equipment and the equipment should be e arthed direct 

• G F Partridge' B Sc M 1 E E in a report dated April I 
19 N to the Bntibh Oxjgen Co Lid 


or through conductive rubber Gas evlinders mav with 
advantage be situated at a central point outside the 
theatres 

3 In exceptional cases of dryness rubber shoes should 
be conductive 

\ Rav Apparatus and Electrical Equipment 

The information recorded in Table 1 shows that although 
static and the use of surgical lamps constitute the chiet 
risks there are other matters which mav probablv be 
regarded as of secondary importance such as the diag 
nostic use of r rav apparatus dunng anaesthesia and ihe 
general electrical equipment of the theatre Surgical dia 
thermy or the use of cauteries in (he presence of an infiam 
mable anaesthetic would of course be a mistake but 
modern forms of r rav equipment probablv iniroduee 
little risk except as regards defects such as in flexible 
conductors during use The general electrical equip- 
ment — pendants switches plugs sterilizers etc — is not 
as a rule in the immediate vicinitv of the patient but 
the degree of risk depends entirely on this factor and the 
fortunate lack of coincidence between an electrical defect 
and the presence of a mixture nch enough to ignite With 
the exception of mercurv type switches there is little that 
can be suggested in connexion with the general equipment 
which would not involve revolutionarv changes and thus 
the greatest importance attaches to efficient ventilation 

Collabo ation 

The inquiries made in connexion vviih anaesthetic expio 
sions and the result of the work desenbed in this paper lead 
to Ihe conclusion that some central representative bodv is 
required which could influence the design of electrical 
apparatus for the operating theatre or perhaps for the 
hospital as a whole and advise on its use The emplov 
ment of electro medical apparatus is increasing as the 
applications of electncitv become more numerous and 
such a bodv might without retarding progress foresee 
risks and combine the views and requirements of surgeons 
and engineers to the best advantage 


STUDENTSHIPS AND FELLOJXSHIPS IN CLlNICkL 
SCIENCE ANTJ EXPERIMENTAL P\THOLOG\ 

The Medical Research Council mviic applications for a third 
series of studentships and fellowships intended to encourage 
voung Bntish medical graduates of special abilitv and ongmal 
nimd lowards becoming investigators in those branches of 
medical science which are concerned directlv with disease as 
11 occurs in human beings This field of research includes 
investigaiions into disease or manifestations of disease in 
patients together with experimental work of an immediatelv 
relevant kind 

Posli;ratliiate Stiulentships — Postgraduate studentships are 
offered for medical graduates who have alreadv held house 
appointments and are stronglv inclined to a career in clinical 
science or expenmenlal pathologv Each student chosen will 
receue a stipend at the rate of £200 per annum dunng a 
period not exceeding twelve months for personal maintenance 
while undertaking approved courses of studv in this countrv 
such as mav be regarded as best calculated to advance hu 
training in methods of research This studv mav include 
modern languages and such advanced phvsiological palho 
logical and special clinical work under recognized teachers 
as m'*v be regarded as forming a suitable preliminary to 
senous research” vs oi k to be undertaken later but the approved 
course mav not include studies of vshich the purpose is lo 
enable the student to pass funher examinations 

Research Felton ships— The Council also offers res^rch 
fellowships for candidates of similar quabfications who have 
alreadv had some experience in the use of research methods 
E-ch fellowship will be tenable tor one vear at ihe ordinarv 
value of £2x0 per annum and will be renewable iir approved 
instances at the rale of £300 per annum for a second vear 
These fellowships are intended as probationan appointments 
for research in clinical science or experimental pathologv under 
suitable direction m this countrv Research expenses mav be 
provided in addition to stipend Applications should be 
lodged with the Secreiarv Medical Research Council '8 Old 
Queen Street London S V\ I before October 1 1938 Forms 
for the purpose writ be supplied on requesL 



238 July 30, J938 


ONE HUNDRED AND SIXTH ANNUAL 
MEETING 

of the 

British Medical Association 

HELD IN PLYMOUTH, JULY, 1938 


THE SECTIONS 


SUMMARY OF PROCEEDINGS 


During the next few months theic will ht piiblishcil in 
the British Medical Journal the opening papers tont- 
miimcated to the Scientific Sections of the Annual Meeting 
at Plymouth The leports of ehstussions in this and 
siacessnc issues ore intended to gi\c inenibeis who neie 
not pnsent a gmcial idea of the piocecdings 


SECTION OF MEDICINE 
Wedmeday Jiil) 20 
Toxic InfcctHC jRundicc 

With (he Piesidcnt of the Section, Dr T H G Shore fPlj- 
mouth), in the chair, Dr C E Lakin opened a discusMon on 
toxic and infective jaundice 

Dr C E Lakin said he accepted the conventional classifica- 
tion into obstructive haemolytic, and that form of the 
disease caused by liver damage He was concerned onlv with 
this last toxic or hepatogenous jaundice Exogenous poisons, 
bacterial toxins, virus infection, and autogenous intoxication 
were the principal causes of this disease, in which the patient 
was likely to be more ill than jaundiced Gencrallv the 
stools remained normal in colour, but the urine might con 
lam bile in addition to urobilin and albumin The liver 
parenchyma underwent pathological changes, ranging from 
the severe necrosis due to massive doses of toxin to gradual 
replacement fibrosis when the poison was less virulent 
According to present day conceptions acute yellow atrophv 
at one end of the scale and cirrhosis of the liver at the other 
fell into line Until recent years ordinary catarrhal jaundice 
had been regarded as a form of obstructive jaundice While 
there w.as pathological proof of this, a disease clinically 
indistinguishable occurred in epidemic form In a recent 
outbreak among nurses at the London Fcvei Hospital the 
incubation period appeared to be twenty one days The in- 
fecting organism had so far not been discovered, but in one 
epidemic nasopharyngeal ‘droplet infection seemed to be 
the method of spread Hurst had tikcn (he view (hat there 
were two varieties of catarrhal jaundice, but Dr Lakm was 
doubtful of their existence He had seen cases of epidemic 
cat.arrhal jaundice ushered m with fever several davs before 
the jaundice ippearcd, while vomiting and abdominal dis- 
comfort had shown themselves in the pre icteric period He 
found It difficult to differentiate these symptoms from (hose 
of the acute gastritis which were emphasized as preceding the 
obstructive form of citarrhal jaundice Perhaps a dcepci 
jaundice and paler stools suggested a blocked duct, while 
enlargement of the spleen was more constant in mild sub 
acute hepatitis The Van den Bergh and lacvulose tolciancc 
tesls could not be relied upon to differentiate these diseases 
The work ot Bloomfield m America had suggested that 
catarrhal jaundice might be followed by peimanent oi even 
progressive hepatic damage Dr Lakin had seen cases vvhich 
supported this view, and he wondered whether changes of this 
tvpc m the hver might explain the varying effect that alcohol 
had on different people 


TiitRumvi 

VIcniCAL JOUSJI 


Professor G R Camiron referred to the toxic subsnnccs 
vvhich might damage the liver The pathological chaijgcs 
could be divided into four groups according to Ihcir scveriiy 
In (he most acute forms vcilow atrophv produced rapid 
shrinkage of the liver and death , next came subacute atrophv 
vvhich was followed by i regenerative process , ilnrdiv, lew 
severe poisoning resulting in multiple nodular hvpcrplaca 
(toxic cirrhosis), with its brunt often on the right lobe, and, 
fourthly a slow pathological change, which might after some' 
years be followed by primary carcinoma Jn two thirds of all 
cases the kidnevs were affected, and in a smaller proportion 
(he heart The action of hcpatotoxic substances was influenced 
by the amount of the poison, the spacing of the do'cs, per 
sonal idiosyncrasy, diet, and the presence of associated infcc 
lion The voting were more susceptible than the old, while 
pregnancy and alcoholism might aggravate the effect of sny 
poison 

Major H C Brown discussed Wcils disease, its occumnee 
in the British Isles, and its differential diagnosis In colhbora 
tion with Alston he had recorded 142 cases in Great Britain 
in four vears from Juiv, 193T The causal organism was 
known to be earned in the kidncvs of 41 per cent of brown 
rats Human infection took place through the abraded shin 
coming into contact with material contaminated wilh theimnc 
of infected rats The disease could also be acquired from 
bathing in infected water Almost every case in the Briii'h 
Isles had been traced dircctlv or indirectly to the agenev cl 
lats — for example, a dog bite might convev the disease if the 
dog had rcccnilv killed an infected rat Men were aflecifii 
far more frcquentlv than women, except m fish working md 
tripe dressing occupations in which manv women were 
cmplovcd Differential diagnosis from epidemic catarrhal 
jaundice might be very difficult , prostration, ocular conto 
tion albuminuria and haematuna were found in both di'ca'C' 
hut the intense muscular pain in Weil s disease was an irapot 
lant factor in diagnosis The differential blood count was cl 
value a polymorphonuclear count of S5 per cent or 90 per 
cent being usual in Weils disease, whereas m cpidciwv 
catarrhal jaundice there was a considerable relative incm'c 
in the mononuclear cells Stokes and Rvle in Flanders had 
shown that manv patients with Weils disease were act 
jaundiced Obscure influenzal attacks among the labounaj 
classes were to be looked upon with suspicion when as'ccn 
tion with rats could be traced 

Dr G W M Findlav considered that the common foim ct 
infective hepatic jaundice vvas epidemic catarrhal jaundiW, 
although obstructive cases certainly occurred Many wotUo 
in otliLr countries had produced overwhelming evidence th't 
the condition vvas a hepatitis He advocated rcpHcmg iw 
term ‘ epidemic catarrhal jaundice ’ bv epidemic hcpiWi' 
The aetiology vvas unknown, although'a virus might bt resgot' 
siblc the long incubation period of four to five weeks sup 
ported this All efforts to infect experimental animals hi 
failed During recent work on immunization against vcUO'' 
fever It became obvious (hat the initial slight reaction n"v 
be followed bv jaundice several weeks or months aftuw't 
This occurred in ninctv -three out of 3,100 patients inocuW 
The wine became dark and the skin vcllovv a prodroim 
period with fever might occur the Van den Bcrgli reac i 
being diphasic It became clear that some virus was 
cultivated in association with the strain of yellow ''.'J 
in use subsequentlv methods had been found to abohsn 
risk of jaundice after these inoculations 

Dr E R CuLLiNAN described a svndrome in 
of jaundice, without apparent cause, were assocnied 
acute necrosis of the liver fn its early stages it miu 
confused with recurrent catarrhal jaundice, cholanpdis, 
creatitis, Hanots cirrhosis or biliary cirihosis Later it n 
be difficult to differentiate the condition from splenic am 
Band s disease, or portal cirrhosis The onset resemble 
of catarrhal jaundice , there was no fever or severe r'"|’ ^,^,1 

jaundice often fluctuated The liver vvas enlarged t . 
the gall bladder The illness might be 
jaundice might last anv period from two weeks to 
Deepening jaundice with increasing anaemia, ..jio 

puBe heralded a fatal issue The Van den Bergti 


THE SECTIONS SUMMARY OF PROCEEDINGS 



Juu 30 I93S THE SECTtONS SUMMARY OF PROCEEDINGS 


g'lNc no help in the diagno'iis bin ihe hcMiIosc tolerance lest 
import ml in disiinguishmc this disease from malignant 
obstriicli\c jaundice Correct diagnosis as bet\sccn these l\so 
conditions was essential as Iaparotom> in these cases was 
frequenth fatal Treatment should include the administration 
of large amounts of glucose calcium and alkali were also 
of saUie 

Sir Nrthlr Hlrst was consinced that there were two t>pes 
of catarrhal jaundice In that associated with hepatitis the 
patient was more ill and had fewer preliminars ssmptoms 
the prognosis was good on the whole The laesulosc tolcr 
ance test showed impaired liver function in this group while 
in obstructive catarrhal jaundice it gave a normal result He 
agreed that operation was cxtrcmelv dangerous in toxic 
jaundice Cholecvstographv had sometimes been misleading 
as the absence of a gall bladder shadow might lead to the 
inference of gall bladder disease whereas the liver wasactuallv 
at fault in being unable to excrete Atophan which was wtdelv 
used in cases of arthritis was in his opinion a cause of toxic 
jaundice 

Dr Donvld Hlster made the broad clinical distinction 
between catarrhal jaundice and ^\ells disease that in the 
former the patient was not ill whereas the latter was charac 
terized bv severe illness and haemorrhages The statement 
that Weils disease occurred onlv in the poor might be mis 
leading and he quoted the case of a well to do patient who 
died of this disease which he contracted while bathing in a 
contaminated stream He agreed with Sir Arthur Hurst that 
atophan was verv dangerous and he never used it there were 
safe and effective drugs available for the treatment of gout 
Dr G S Aston (Barnstaple) desenbed his recent expenence 
of epidemic catarrhal jaundice in three separate households 
His obsenations supported those of Dr Lakin in indicating 
a twentv one dav incubation penod Pain was not severe 
except in one case and several patients had prodromal svmp 
toms Dr H F Bell Wvlker (Balfour South Afnca) 
desenbed a form of epidemic jaundice which occurred in 
South Africa Fluctuation in the incidence of epidemic 
jaundice corresponded with plagues of rodents Rat bites were 
unusual but rat flea bites were common Manv of the 
patients were children and there was no case to-case infection 
There was evidence that the infection resulted in permanent 
damage to the liver 


SEcrrioN OF surgery 

Jl edncsda\ Jul\ 20 

Acute Appendicitis 

W^th Mr V ZvCHVRV Cope President of the Section in the 
chair Professor G Grev Tlrn'Er opening a discussion on the 
treatment of acute appendicitis stated that according to the 
Registrar General s statistics there were 3 000 deaths from 
appendicitis annuallv in Great Britain This was equal to 
12 per cent of deaths from diseases of the digestive svstem 
and 0 61 per cent of deaths from all causes He had taken 
the combined figures of two large general hospitals — the 
London Hospital and the Ro>al Infirmarv Newcastle — for the 
five vears 1933-7 to determine the present position of opera 
live mortalitv Of acute cases excluding localized abscess 
there were 6 725 with 247 deaths a mortalit> of 3 67 per cent 
In 604 cases with localized abscess there were fiftv one deaths 
— 8 44 per cent mortalit> These two acute groups combined 
gave a mortality rate of 4 07 per cent In the total series of 
9 9*^3 cases acute subacute and interval there were 308 
deaths — a mortalitv rate of 3 10 per cent Appendicitis he 
said was at its inception a local disease and the essence of 
success was both earlv diagnosis and earlv operation Once 
infection was well established m the peritoneum or in the 
veins a secondary nidus was established which might go on 
in spile of removal of the onginal focus As to earlv diag 
nosis he did not think that Murphv s dicta regarding svmptoms 
had been improved upon These were abdominal pain of 
abrupt onset nausea or vomiting abdominal sensitiveness 


The Bums*! *^^*0 

MEDICU. JOUR>*T. 


settling in the region of the appendix and nse in temperature 
An> variations in the order of these symptoms caused Murphv 
to question the diagnosis The omissions from Murphv s list 
were he thought significant fndiscnmmate diagno-^is wa<c 
the great fault Too commonh such a thing as abdominal 
influenza was diagnosed Rutherford Monson had put 
fonvard a statement that if pain in the abdomen required 
morphine the case was a surgical one and must be thought of 
in terms of operation The time for operation apart from 
ver> few exceptions was as soon as the diagno is was made 
With regard to cases apparentlv subsiding it was not good 
practice to delaj unless all the svmptoms were subsiding spon 
taneouslv He believed in doing an operation vshich vsa^ 
essentialh local and this vvas best performed through Ruiher 
ford Monson s muscle cutting incision parallel to Poupart s 
ligament Professor Grev Turner concluded bv quoting 
Murphv s dictum that carlj operation vvas the onlv safe 
practice 

Mr R J McNeill Lov^e confined his contnbuiion to the 
discussion to cases which presented themselves with an 

appendix mass For these he advocated delaved treatment 
because of the diflicult> of operation and of the breaking 
down of adhesions which were limiting infection The pro 
cedure vvas the adoption of the Fowler position the applica 
tion of fomentations and the maintenance of a constant 
Watch on the pulse temperature and changes in the characlei 
of the mass Whereas previouslv a limited amount of fluid 
used to be given bv the mouth this had been discontinued 
because of the relaxation of the ileo-caecal valve so caused 
With consequent local penstalsis Instead the patient had 
saline and glucose administered to him bv continuous intra 
venous infusion Expectant treatment was not suitable for 
children or the aged — in the former because of the difficultv 
of obtaining a satisfactorv hisiorv and because frequenth the 
mother had administered a purgative m the latter because 
of the common rapid development of gangrene The results of 
expectant treatment were that in 65 per cent resolution 
occurred and a clean operation could be performed three 
months later in about 25 per cent of cases an abscess 
formed which might require drainage but might be absorbed 
in about 10 per cent of cases operation became imperative 
because of increased sevenlv of the svmptoms He denied 
that complications were more frequent with delaved treatment 
and thought Ihau whereas the probable mortalitv in these cases 
was about 6 per cent if immediate operation was performed 
It was onlv 3 per cent if expectant treatment was emploved 
He agreed however that experienced surgeons had produced 
as low figures as the latter bv immediate operation but main 
tamed that most cases were operated upon b> the less 
experienced 

Mr H C W Nlttall (Liverpool) said that much of the 
difficult) in such a discussion vvas the lack of uniformitv in 
classification so that similar senes could be compared He 
suggested a classification first into the unperforated the 
perforated and the complicated TTie unperforated he further 
subdivided into the non obstructed and the obstructed The 
perforated group might develop into localized peritonitis 
diffuse peritonitis or localized abscess In the complicated 
group he included onlv immediate complications due to direct 
spread of the infective process to neighbounng structures- the 
most important being p>lephlebitis ileils residual or sub 
phrenic abscess and cellulitis of the abdominal wall He 
did not advocate delaved treatment although he thought that 
in exceptional circumstances and m inexoenenced hands it had 
Its place The amateur surgeon was out of place in either 
the immediate or the delaved treatment of acute appendicitis 

Mr H H RvV'ner (Manchester) said that despite the 
national mortalitv rates he thought there had been a striking 
improvement in results due to the realization of the value of 
earlv operation the use of the continuous intravenous drip of 
saline and glucose and the aspiration of the stomach contents 
when necessarv through an indwelling catheter He em 
phasized the care necessarv to remove an appendix on the 
point of rupture In cases with local peritonitis he was m 
favour of immediate operation except in the verv fat the 
alcoholic and the patient with chronic bronchitis and 



240 July 30, 1938 


THE SECTIONS SUMMARY OF PROCEEDINGS 


TiitBRtiim 

MEDICAI. InUKNAt 


cmphysenn In these the risk of opention was greitcr than 
the risk of waiting for spontaneous subsidence Where there 
was a local lump uhich appeared to be more in the nature of 
inflammatory infiltration rather than an abscess he fas cured 
delay, provided the patient was placed under proper hospital 
conditions 

Mr W Sampson Handley thought that practically all cases 
of acute appendicitis were of the obstructive tspc, and that 
for twelve to forty eight hours the inflammation was limited 
to the appendix Removal during this period left an “ aseptic 
patient” In cases m which the appendix had ruptured a 
trickle of pus often escaped into the pels is, and to meet this 
danger m late cases he advocated an initial small suprapubic 
incision to pass down a diagnostic swab 

Mr H H Brown (Worthing) referred to the occurrence of 
septicaemia in some cases operated upon after the first forty - 
eight hours There was, he considered, a negative phase 
about the third to the fifth day m which operation might 
induce a septicaemia In these cases no sign of local infection 
was found post mortem 

Mr Victor Hurley (Melbourne) said that it was a dis- 
appointing fact that in Australia as well as in England and 
the USA the mortality from acute appendicitis was still 
rising The practice in Melbourne was immediate operation 
except in occasional bad risks, and he agreed with Mr Raxner 
on the subject of obese patients He thought the most 
dangerous cases were those of pelvic appendicitis, both from 
the diagnostic and operative points of Mew 
Mr Herbert Caiglr (Sheffield) endorsed a preMous 
speikers plea for not attempting remosal of the appendix 
where such removal appeared difficult 
Mr W McAdam Eccles described how in three genera- 
tions, of which he was the senior, prompt and immediate 
operation had been employed with success 
Mr H C Ruthertord Darling (Sydney, New South 
Wales) doubted if the obstructive tape of appendicitis was so 
common as supposed He also thought it often impossible 
to determine the position and state of the appendix from 
clinical examination With regard to expectant treatment he 
thought that resolution did not necessarily occur in cases 
which subsided He had twice performed late operations for 
cases so treated, only to find dense adhesions and the stump of 
an appendix 

Mr Harold Dodd analysed five deaths in the past five 
years Two patients died from bronchopneumonia Both 
had had a common cold recently One had died from 
pylephlebitis Two had died from ileus, and he deprecated 
any active treatment in this complication 
Professor Grev Turner, m replv, said he did not object 
to expectant treatment in experienced and competent hands 
But there was a great danger, if the practice was widely 
preached and advocated, of an increased mortality The 
trouble was that the inexperienced frequently stretched the 
possibilities of a method far bevond what had originally 
been advocated 

Mr A M Bovd read a short papei on aiteiiography 


SECTION OF OBSTETRICS AND GYNAECOLOGY 

Wednesday July 20 

Occipito-postcrior Positions of the Vertex 
Professor J Chassar Moir (Oxford) opening a discussion on 
occipito posterior positions of the vertex and their compli- 
cations, said that most posteriorly placed occiputs rotated to 
the front during labour, and a spontaneous dehverv was the 
rule rather than the exception About one third of cases 
of failed forceps were associated with undiagnosed occipito- 
posterior cases The real cause of the difficulty in delivery 
was, he believed, a simple one, and was essentially a mal- 
adjustment of the shape of the foetus to the shape 
of the birth canal Face to pubes ’ was a common 
method of spontaneous delivery and occurred when the 
mother s pelvis was large and the foetus small But this was 
not an argument in favour of delivering occipito posterior 


cases in the face to pubes position it was much easier to 
rotate the occiput to the front Recent radiological mvcsii 
gallons by Thoms ind Caldwell, Molov, and D Esopo had 
thrown new light on the mechanics of labour They hid 
suggested that m some cases an occipito posterior case mighl 
be more easily delivered as a face to pubes case The 
actual causes of a persistent occipito posterior position were 
a large pelvis, a small foetus, and a deficient perineum 
Increased pelvic inclination and an extended foetal head 
favoured a posterior he while minor degrees of pelvic con 
traction and abnormalities of uterine action were also com 
plicating factors The foetal mortality m non rotated owes 
was high Forceps were apt to slip and damage the child s 
brain, and a gross damage to the pelvic floor was easily 
sustained The foetal mortality m neglected cases might be 
as high as 25 per cent In the diagnosis of occipito posterior 
position the presence of short inefTcctual and severe pains with 
no advance should be regarded with suspicion 

Professor J M Munro Kerr (Canterbury) said the common 
est diameter in which the foetus engaged was the Iransvene 
diameter of the pelvis — that is, the occiput lay LOT or 
ROT If the occiput was directed further posteriorly then 
a primarv posterior position resulted , more commonly the 
occiput did not rotate backwards until the onset of labour, 
giving rise to a secondary posterior position Oxley had 
shown that m 90 per cent of such cases spontaneous rotilion 
and dehverv would occur Of these about 10 per cent Mere 
delivered face to pubes The foetal mortality was about 
1 2 per cent In large maternity hospitals there was a hicb 
percentage of spontaneous deliveries with a low foetal mor 
talily in cases from the district, but m in patient departments 
where early interference was undertaken the foetal mortahlj 
rose sharply 

Professor Farquiiar Murrax (Newcastle) advised thecotrcc 
lion of occipito posterior positions of the vertex during the 
later weeks of pregnancy bv means of a pad and binder He 
always delivered such cases in the “cross bed” position, as 
it made the recognition of the obliquity of the head in relilion 
to the outlet much easier Foetal distress with a still incora 
pletely dilated cervix required verv careful extraction past 
the cervix and a rapid dehverv after an cpisiotoniy it lha 
outlet, owing to the possibility of the' cord being round Iha 

neck Mr Brian Williams (Liverpool) considered that many 

of the so called persistent occipito posterior positions I'crc m 
reality cases of ‘ transverse arrest of the head” He con 
sidered that this complication was imperfectly recognized and 
taught m this countrv, and that it presented far more dmi 
culties than the occipito posterior position Out of 30(4 
dcUveries m the Walton Hospital the previous year there 
were fifty-three cases of persistent occipito-posterior posilion 
Spontaneous dehverv occurred in forty one of these, and inter 
vention was required in twelve, with no foetal or milcrMi 
mortahtv There were forty eight cases in vvhich inlervcntioij 
was necessary for a transversely arrested head, the miterMl 
morbidity rate being 27 per cent and the foetal mortaWi 
27 per cent" In deep transverse arrest manual rotation ajs 
difficult or impossible, and the application of forceps to tM 
unrotated head led to a high foetal mortality Kjclhrris 
forceps, in the hands of the expert, were of great help m ''*'• 
cases The use of intrapartum radiology should be I'idch 
extended 

Mr L Caunac Rivrrr emphasized the necessity for 
diagnosis m nonrotition of the head Frequent 
examinations should be made, and the head rotated as so 
as possible Professor J Preston Maxwell (Pekin) s'l ' 
that most cases could be rotated and easily delivered 
also stressed the importance of measuring the outlet m 
cases Mr James W G H Riddell (Plymouth) 
important fact that pains in occipito posterior positions '' 
severe early in labour It was no use encouraging •1’® 
to bear down too earlv Internal version describe 
Smcllie, was occasionally necessary Professor F J 
recounted the original description of rotation bv am 
He emphasized the need for deep anaesthesia tno 
“ ironing ” out of the vagina with plenty of lubncan , 
the insertion of the whole hand in the vagina 



Jun 30 I93S 


THE SECTIONS SUMMARY OF PROCEEDINGS 


SECTION or NEUROLOG\ AND PSYCHO- 
LOGICAL MEDICINE 

II trdneula\ Jul\ 20 
\ng! 0 graph\ 

With the President Ntr Gt:oFrRE^ Ji rrtRsos m the chair 
Professor Herbert Ou\tcrosv (Stockholm) in a paper on 
anciograph\ said that the risks of this procedure must be 
considered in determining the indications for it He would 
not examine the possibilits of i delased radio active efTect 
of retained thorium dioxide the amount injected was probablv 
too small for this and speculation m the absence of clinical 
or pathological material was idle There were two other 
undesirable effects of angiographj One was the development 
of thrombopenia pointed out some time ago bv Lohr which 
might be complicated bv oedema of the glottis This wa^ 
of minor importance because with proper care there need be 
no such sequel If the thrombopenia was marked a blood 
transfusion should be given A more serious effect was the 
plugging of small vessels bv thorotrast demonstrated bv 
Nordmann (19^6) and bv Northfield and Russell (1937) 
Their observations had been amplv confirmed bv Eksirom 
and Lindgrcn in the speaker s clinic This injorv had been 
the mam cause of death m two or three cases and possiblv 
a contnbutorv factor in some of the others In the light of 
this knowledge it was necessarv to revise our attitude towards 
arienographv and Protessor Olivecrona agreed that it should 
be used onlv where information necessarv for treatment 
could not be obtained bv other means It should be limited 
to cases where specific information on the condition of the 
cerebral blood vessels vvas required such as aneurvsms In 
dealing with arteriovenous aneurvsms it might be preferable 
to perform an explorator> craniotomv if the evidence in 
favour of aneurvsm was equivocal Other indications for 
arteriographv lav m the diagnosis of glioblastoma and in those 
rare cases where localization was impossible and vcntnculo 
graphv had been unsuccessful He stressed the importance 
of limiting the amount of thorotrast bv everv precaution 
Onlv where strictlv necessarv should there be exposure in 
more than one plane and bilateral injections 

Mr Normxn Dorr (Edinburgh) considered that arterio 
graph> was of special service in studvmg lesions of the blood 
vessels especiall) congenital aneurvsms of the larger cerebral 
artenes Such aneurvsms might act as tumours bv com 
pressing adjacent structures or might make their presence fell 
bv leakage or frank rupture It was m the latter that 
angiographv was of special value for there was usuallv no 
other means of precise localization From his experience 
Mr Dott advocated expectant measures consisting of rest 
and the maintenance of a low blood pressure m patients over 
50 jears In vounger patients angiographv followed b> 
ligation of the internal carotid arter> or local treatment 
of the aneur>sm according to its site was preferred In such 
cases angiograph> would show the degree of palcncv of the 
aneur>smal sac its exact site and relation to the arterial tree 
and the state of the locaK cerebral arculation Mr Dott 
emphasized the importance of the last point since ligation 
of the carotid arter> in the presence of an impaired circulation 
might lead to an extensive softening and was therefore contra 
indicated Proceeding on these lines he had performed 
fourteen carotid ligations since 1933 with onlv one fatalitv 
that could be attnbuted to the operation 

Mr D W C Northfield endorsed Professor Olivecrona s 
plea for caution in the use of thorotrasL and described certain 
clinical and histological sequels when thorotrast caused 
blockage of the small vessels about a compressing lesion 
of the brain Because of these sequels he now rcstncied the 
use of thorotrast to cases where the regional and pathological 
diagnosis could not otherwise be established and to clinch 
the diagnosis of spongioblastoma multiforme He con 
sidered with Mr Don that angiographv was most clearlv 
indicated in cases of cerebral aneur>sm and vascular mal 
formations Dr Hardman (Manchester) in a series of 


TheEvtok nii 

Vt£D CAL Joe? S 4L ^ ^ 


lantern slides demonstrated peculianties m the an^no 
architecture of certain tumours ot the brain The vessel 
were visualized in postmortem specimens either bv injection 
of barium gelatin or bv Pickworlhs benzidine method Bv 
these techniques a charactenslic vascular architecture had 
been demonstrated in three tv pcs of tumour spongioblastoma 
muUiforme astroevtoma and meningioma The existence 
of numerous large venous sinusoids v as a stnking feature 
of spongioblastoma muliiforme but no arteno venoJs 
anastomoses could be demonstrated 

Mr Jefferson agreed that in border line cases of arteno 
venous aneurvsm it might be advisable to perform a cranio 
tomv first for diagnostic purposes and to define the extent 
of the lesion later b> artenographv 

Spasmodic Torticollis 

In a paper on spasmodic loriicolhs Proiessor Olivecronv 
pointed out that m most cases the aeuologv was obscure 
Opportunities for examination at necropsv were rare The 
association of the condition with epidemiL encephalitis and 
parkinsonism had among other observations supported the 
view that the essential lesion was extrapvramidal in situation 
Although spontaneous remissions sometimes lasting tor vears 
might occur the disabilitv was often so great that patients 
insisted upon some form of treatment Medical treatment 
both with atropine and bv the cultivation of an antagonist c 
gesture was sometimes effective in the milder tvpes It 
such measures failed surgical intervention should be 
attempted Since operations aimed at the paralvsis of tho>e 
muscles which contracted during the spasm it was necessarv 
accuratelv to_ assess the muscles involved and to plan 
accordingly Out of thim three cases four showed slight 
svmptoms and were treated medtcallv In five the spinal 
accessorv nerve was divided with complete or nearlv com 
plete relief In another the three upper cervical sensorv root 
were divided on one side with nearh complete relief In 
the remaining iweniv three cases division ot the upper cervical 
motor roots was combined with peripheral division of one or 
occasionallv of both spinal accessorv nerves In two third 
of this group the patients were compleielv or almost com 
pletelv relieved of spasm and were able to work thev shov ed 
fair compensation towards the effects of the operation and 
the earlv instabilitv of the head graduallv disappeared 
some Stiffness of the neck persisted In the remammg third 
the results were unsatisfactorv either because the general 
condition of the patient was poor or because there were other 
ailments In some the spasm had extended mto adjacent 
muscle groups or a major extrapvramidal svndromc had 
developed Tliese patients were theretore incapacitated from 
some cause outside the scope of the operation 

Dr M^cdonxld Critchle\ divided cases of spasmodic 
torticollis into four tvpes (I) purelv psvchogenic a varietv 
of lie (2) following epidemic encephalitis m this the torti 
coilis might be transitorv (3) forming part of a more wide 
spread extrapvramidal molililv disorder such as chronic 
progressive chorea bilateral athetoMS etc and (4) a slowlv 
progressive tome clonic spasm not confined to the jieck 
muscles The last group was the commonest and he regarded 
such cases as intractable Investigation often showed an occupa- 
tional background and possiblv a psvchogenic basis He was 
sceptical about the surgical treatment of the condition largelv 
because it appeared unscientific A more rational approach 
might lie in the operative ablation of cerebral cortex on the 
lines of the newer technique for the relief of hemi athetosis 
Dr H V Dicks supported Dr Cntchlev in his pessimistic 
outlook He admitted an organic basis m spasmodic torn 
coUis but fell that a functional element was al o p eseni in 
the sense in which p>vchologists spoke of purposiveness 

Professor Henrv Cohen regarded Dr Cntchlev s clasMpea 
lion of torticollis as a useful clinical basis The psvchogenic 
cases were more commonlv «een in the voung the movement 
was purposive in origin and this tvpe of case was usually 
amenable to psvchotherapv There were three features of 
chronic encephalitic torticollis which mented comment first 



242 July -30, 1938 THE SECTIONS SUMMARY OF PROCEEDINGS 


Its extreme nnty , secondly, its tnnsitory chtractei , and, 
thirdly the torticollis was part of a more general dj stoma 
and might be preceded or followed by Parkinsonism The 
natural histoiy of the fourth group was fairly constant The 
patient was usually over 40 years of age and showed a 
unilateral tome clonic torticollis sometimes with bilateral 
retronuchal involvement Occupation, ocular muscle im- 
balance, psNchopalhic tendencies, and other factors might play 
a predisposing part, but treatment directed solely to these pro- 
duced at best only partial and temporarv alleviation In 
selected cases operation at this stage, though purely palliative, 
was a most helpful measure 

Dr Dorothy Russfll recorded the accidental experimental 
production of torticollis in a monkey This had followed an 
intracardiac injection made by a colleague The animal s brain, 
examined about eighteen months later, showed a symmetrical 
bulterflv shaped area of softening in the subthalamic region 
which histologically appeared to be an infarct Dr F R 
Ferglson (Manchester) recognized the psychological clement 
in spasmodic torticollis, and agreed with Professor Cohen that 
a distinct tvpe could be recognized in the elderlv He did not, 
however, agree that the spasm in these patients was confined 
to the neck He advocated a combination of physiotherapy 
and surgical treatment until the part plaved by organic and 
psvchogenic factors could be more clearly defined 

Mr Jefferson in a warm tribute to Professor Ohvecrona, 
urged that the organic background of this neglected disorder 
should be more fulh explored, and that the surgical treatment 
should be taken up more vigoroush in this country 


COMBINED SECTIONS OF NEUROLOGY AND 
ORTHOPAEDICS 

Wcdnciday July 20 

Sciatica 

After the chair had been taken bv Mr Geoffrey Jeffcrson 
(Manchester) President of the Section of Neurology and 
Psychological Medicine, Dr Wilfred J Harris opened a 
discussion on sciatica Dr Harris, in a general review' of the 
subject, said that sciatica might be of the high type, in which 
case the lesion was above the level of the sciatic notch, or 
low, when the lesion was at oi below the level of the notch 
In the first group the possibility of skeletal changes must 
always be borne in mind — conditions such as congenital 
abnormalities of the spine, new growths, or inflammatory 
lesions such as tuberculosis, and, lastly, hernia of the nucleus 
pulposus The spinal cord or nerve roots might be the site 
of a neoplastic or inflammatorv process, requiring investiga- 
tion as in cases in which the lesion was at a higher level 
Low sciatica was more difficult to elucidate, for after such 
well defined causes of neuritis as lead poisoning or diabetes 
were excluded (or more rarely found) cases remained in which 
chill, slight trauma, or focal sepsis were the only detectable 
factors, and a considerable residue in which the nerve pain 
had to be labelled “ idiopathic ’ The truth was that there were 
still unpleasantly big gaps m our knowledge of the aetiology 
of sciatica 

Professor Joseph S Barr (Boston, Mass , U S A ) described 
only one tvpe of sciatica — that resulting from compression of 
a nerve root by a prolapsed intervertebral disk, or hernia of 
the nucleus pulposus Although this lesion was found in only 
a minority of the cases it was of great interest as being the 
most recent and well defined addition to our knowledge of 
sciatica Though lesions of the intervertebral disks had been 
described m such admirable detail bv Schmorl, he was not 
aware that posterior protrusions could be of clinical signifi- 
cance In brief, he noted merely' that more or less posterior 
protrusion was present in about 15 per cent of spines 
exarnmed post mortem Although a displaced disk might 
rarciv produce complete paraplegia the typical syndrome was 


TlfCBRtTBlI 
AftOICAL 

a sciatica with astonishingly few clinical signs referable to the 
nervous system The crucnl finding in localizing the com 
prcssion was a constant filling defect opposite one of the lower 
lumbar intervertebral disks in the radiographic picture oblsmcd 
after the injection of 5 c cm of hpiodol into the spinal theca 
Operative removal of the mass was iisimlly indicated, and 
laminectomy with removal of the hernia had been performed 
in eightv three cases seen at the Massachusetts General Bos 
pital The results were most satisfactory 

Professor Henry Cohen (Liverpool) discussed the common 
type of sciatica in which ‘rheumatism’ was the only obvious 
cause — a lesion allied to fibrositis He invited consideration 
of four points which had a direct bearing on the problem 
First, that nerves and muscles had a fascial covering which 
contained a small space lined with mesothelium this allowed 
gliding movements to occur, and, as in joints, interference 
with movement and pain would result if the space contained 
adhesions Secondly, an inflammatory focus in the soft parts 
of the lumbar region frequently caused pain referred along the 
course of the sciatic nerve injection of the affected area wiih 
a local anaesthetic abolished imt only the local pain and 
tenderness but also the secondary sciatica Thirdly, the pen 
articular areas of the lumbar region were supplied by ntne 
filaments arising from the fourth and fifth lumbar and first 
sacral nerves Fourthly, there was a rich Ivmphatic anaslo 
mosis in the lumbar region which enveloped nerves as well as 
muscles a localized infection might therefore rapidly become 
widespread In a senes of 420 pnvate cases of sciatica he 
had found that most of his patients rccoyered complelel) 
within a relatively short period they behaved as if they were 
suffering from an inflammatorv lesion which ran a fairly well 
defined course In the early davs rest m bed and sedaliies 
were essential If recovery did not follow within five or sit 
weeks, persistent pain was due either to the presence of 
adhesions or to a major lesion which at first had not been 
apparent As with joints the presence of adhesions called 
for treatment designed to break them down Manipulation 
and the epidural injection of saline solution were two wws 
of accomplishing this He favoured epidural injection and 
employed 2 per cent (hvpertonic) saline solution, which had 
the effect of disturbing intraneural relations so tending W 
break up scar tissue within the nerve trunks 

Dr Macdonald Critchlev described various caines of 
sciatica none of them common but all of importance Ht 
described cases in which minor traumata or abnornialii) of 
posture were followed bv sciatica commercial Invelltrs 
driving for hours in small motor cars with badlv spiimv 
seats, the fiont rims of which pressed into the back of ih' 
thigh , miners sitting t iilor fashion in low galleries , and an 
artists model who was required to sit for long periods in an 
unaccustomed attitude Daimgc to the sciatic trunks dunnt 
the course of a protracted labour was a well known entil', 
and it was often found that the lateral (external pophital) 
division was the more liable to suffer This was due to Iht 
lateral division being compressed against the ischium, whetta* 
the medial division rested on the less resistant pyrifoimn 
muscle Sciatica might also result from varicosity of tw 
veins draining the nerve trunk The presence of vans'' 
in the legs of a pitient with sciatica was always suggest''' 
though varicositv of the v eins of the nerv e might occur 
an isolated lesion Sometimes the varices could be fell 
a soft mass when the patient was examined uv thf 
position 

Dr Fergus R Ferguson (Manchester) dislinginshcd ihR' 
types of sciatica neuntic, neoplastic and nuclear n ll 
surprised him to find that the neoplastic type was o ' 
characterized by a sudden onset He emphasized the imp® 
tance of lumbar puncture and determination of the ft® 
content of the cerebrospinal fluid The presence of a 
was suggested bv finding xanthochromia, an increase in 
protein content, and absence of manomctric T , "d (o 

jugular veins were compressed Such findings shoii d le 
localization of the block by the injection of hpiodol A 
same time it must be remembered that an increase i 
protein content of the cerebrospinal fluid was often jou 
the nciiritic type The President, who had operated o 



-Jll\ ^0 I9-!S 


THE SECTIONS SUMMARY OF PROCEEDINGS 


Tht Bvtish 
Mzdicai. Jo tcn^l 


ciscs of neurofibroma causing sciatica in the senes of cases 
reported b\ Dr Ferguson said that this t\pe of tumour was 
easil\ missed To overlook a crowih of this tvpe was all the 
more unfortunate secinc that surcical removal so often resulted 
in a complete cure 

Most of Dr HloH G GvRLvsDb (Leeds) cases of idio 
pathic sciatica had been dealt with bv epidural injection of 
s.iline solution He felt that it was the volume rather than 
the nature of the fluid that mattered and there was little 
to choose between 0^ per cent novocam and normal saline 
solution He reported ihirtv seven cases in which fifiv two 
injections had been given Immediate and noteworihv im 
provement often amounting to complete relief was seen in 
80 per cent In the remaining cases further injections had 
been given but the results were discouraging In other words 
It a first injection failed it was unlikelv that a later one would 
suLwCed The onlv complication he had seen occurred in 
four cases in which after the injection of about ^0 cem of 
fluid (he usuallv injected 60 to 160 cem) the patient went 
into an epileptiform convulsion losing consciousness for a 
few seconds He attributed this to a sudden rise in intra 
cranial pressure fortunalelv no lasting ill effects had been 
oKserved 

Chill as a cause of sciatica had never appealed to Dr J B 
Mfssell There were records of people being chilled on 
a Nerv large scale — as when the Titanic went dovvn — vet 
nothinc had been heard of sciatica among the "survivors 
although thev had been exposed to cold for manv hours 
scantilv clad and silting on hard seats His experience had 
led him to pa) great attention to focal sepsis 


SECTION OF RADIOLOG\ 

H edfics(fa\ Jttl\ 20 

\ Ravs and Hacmoptjsis 

With Dr R Boulton Mvles in the chair Dr F G \Sood 
opened a discussion on v ravs in the elucidation of 
haemopl)sis Dr Woods paper is published in this issue 
at page 21 1 

Dr ^\ E Llovd speaking parlicularlv of tuberculosis 
said that haemoptvsis could occur at an> stage in the disease 
and there were man> cases in which it was the first svmptom 
Patients rarel) ignored this svmptom and this gave the 
doctor opportunities of diagnosing ver> earl) case> in which 
phvstcal signs were absent It was well known that in the 
davs before accurate radiographv the patients in such cases 
who had had sanatorium treatment at once became well and 
remained well Clinicians now had the added advantage of 
accurate radiological investigation The earliest radio 
graphical evidence of tuberculosis m Dr Llovds experience 
was an apical area of infiltration with or without evidence 
of incipient cavitation Tomographv should be helpful here 
Reliance on radiographic appearance alone was onlv 
justifiable when a single cavitv was demonstrable When 
the appearance was doubtful further radiographs should be 
taken after a month at the end of which period cases of so 
called pulmonitis would have cleared up whereas a tuber 
culous focus would remain Frequent sputum examinations 
were a valuable aid to diagnosis but in some cases of 
haemoptvsis due to tuberculosis there was no sputum Basal 
infiltration alwa)s suggested bronchiectasis and this could 
be confirmed b) hpiodol but basal tuberculosis was not 
so uncommon as it was once thought to be In more 
advanced cases where the clinical diagnosis was simple radio 
graph) indicated the extent of the disease Haemoptvsis 
occurred in fibroid pulmonarv tuberculosis where the condi 
tion was clinicall) inactive the phvsical signs were those of 
chronic bronchitis and emphvsema Radiological invesiiga 
tion revealed the true nature of the disease Sometimes there 
was collapse of the lung, usuall) when the haemoptvsis was 
profuse Aspiration of blood might alter the radiographic 
picture temporanl) 


Dr S Whvtelv Dvmdsos (Newcastle-on Tvne) «aid that 
with the development of thoracic surgerv it was essential to 
obtain evidence of active disease in the lung and of the 
progress of the disease after operation The difficulties were 
doe to the thoracic bonv structures pathological changes round 
the lesion Iipiodol residues and operauve procedures such 
as thoracoplaslv and plonbage Much information could 
be gained bv ordmarv radiographic methods but su^'h in 
formation was often not enough for the thoracic surgeon 
Indiscriminate use of hpiodol was to be deprecated on account 
ot the residues which might take months to disappear and 
might therefore prevent successful re-examinalion and ob er 
vation of progress The tomographic method was CNNential 
in selected cases and might obviate the necessiiv tor hpiodol 
Twining of Manchester had placed it withm the reach of 
Bntish radiologists It was possible bv this me hod to lo< ate 
filling defects in bronchi and to demonstrate cavities whiwh 
remiin uncollapsed after procedures such as tho-acopl-stv 
and plombage The follow up of cases bv radiographv was 
important and was a means of encouraging collaboration 
between clinician and radiologist 

Dr E L Rubin (Liverpool) discussing haemoptvsis v iih 
special reference to cardiovascular disease said that radio- 
graphv was of greater value in excluding lung disea e than 
in establishing the presence of heart disea e but that it 
might be verv helpful in the latter condition The com 
monest cause of haemoptvsis in heart disease was mitral 
stenosis If there was undue prominence of the middle arc 
on the left border of the heart in a case of haemoptvsis 
oblique views should be taken in order to demonstrate or 
exclude enlargement of the left auncle Haemoptvsis might 
happen in earh cases with little structural change while m 
cases with marked enlargement of both auncles this svmptom 
might be absent In congenital heart disease haemoptvsis 
was commonlv the result of supenmpo«ed pulmonarv tuber 
culosis but u did anse even m ca«es where there was complete 
Stenosis of the pulmonarv arterv 'and no patent ductus 
arteriosus The blood suppiv to the lung in such cases came 
via the bronchial artenes which were enlarged and athero- 
matous Haemoptvsis occurred occasionallv m cases of 
hvpenenMon and r rav examination might be the onlv means 
of demonstrating the previous presence of high blood pres ure 
Radiographs showed elongation and lortuosiiv of the 
thoracic aorta and sometimes tortuositv of the oesophagus 
Aneurvsm was a cause of haemoptvsis which might also 
result from pulmonarv artenosclerosis Infarction of the 
lung was not often seen radiographicallv \Iassive infarction 
was rapidlv fatal and small infarctions produced the appear 
ance of localized collapse — Ihev could not be diagnosed 
radiologicallv unless the clinical evidence suggested their 
presence Haemoptvsis might anse from congestive changes 
in the lungs due to heart failure but the radiographic 
appearances were subject to wide vanation and might 
simulate metastatic carcinoma or pulmonarv tuberculosis 
Dr E 'C W v'N-s'E Edw VRDS (Nfundeslev) discussing the 
occurrence of haemoptvsis in known cases of pulmonarv 
tuberculosis stressed the importance of radiographs in the 
lateral and oblique positions in addition to the anlero- 
postenor position and drew attention to the need for 
tomographv in some cases It vvas important in a given 
case to decide whether haemoptvsis was a cause or onlv 
a svmpiom of a spread of disease TTiere were certain cases 
in which ihere was recurrent haemoptvsis without obvious 
deterioration in the condition of the lung or in the general 
health There were however two other ivpes m which a 
radioeraph following a haemoptvsis showed a fresh area 
of disease In one "this area had reallv been present before 
the haemoptvsis and was often excavated in whole or in pan 
In the other the legion v^as fiuffv in outline and was usuallv 
in the lower lobe It might be a true tuberculous extension 
or an area of pneumonitis due to aspiration of blood Sub- 
sequent radiological investigation would estabbsh the diagnosis 
because the latter condition would clear up after a tune A 
third tvpe was that in which there w-as collapse of a whole 
or part of a lobe due to bronchial blockage bv blood clot 
The differential diagnosis in such a case was important 


244 Juu 30 1938 


THE SECTIONS SUMMARY OF PROCEEDINGS 


Tiir IlMTisii 
MtDtCAI. loVUSAl 


because the patients required diffeient treatment He would 
like to knou whether ridiologists had anv method ot deciding 
in a gi\en case to which of these causes spread was due 

Dr E J E Topham drew attention to new growth of the 
lung as a cause of haemoptysis and quoted two cases in which 
it had been the first symptom Referring to a statement by 
Dr Llosd, he said he doubted whether a radiologist was 
justified in diagnosing pulmonary tuberculosis on radiographic 
ippearanccs alone 

Dr P KhRLEY said that he had seen cases in which haemop- 
tjsis was the first symptom ot an abscess in the lung The 
ladiographic appearance of blood in the lungs was im- 
portant from a diagnostic point of Mew Inhaled blood 
gave the appearance of incomplctelv resolved lipiodol The 
best radiographs he had seen were taken with a rotating 
anode tube Dr Kerlej quoted a rare case of recurrent 
haemoptysis in which the radiographic appearances were 
those of inhaled blood Theie were no indications of other 
disease and the abnormal radiographic appearances disappeared 
soon after each haemoptysis Bronchoscopy revealed a haeman- 
gioma of the trachea 

The Chairman stressed the importance ot close collabora- 
tion between clinician and radiologist without which it was 
impossible for the radiologist to get the best results It was 
important that radiologists should have more opportunities of 
following up cases 

Dr Wood in reply said that the orthodox view had 
alwavs been that the left auiicle formed no part of the 
left cardiac border This was based on post-mortem 
appearances which were obviously misleading Kvmography 
revealed different wave forms in different parts of the heart, 
and recent papers by Stumpf and b\ Bordet on kymography 
confirmed the fact that the left auricle formed part of the 
lateral bolder 


SECTION OF PHARMACOLOGY 
Wetlnesrhiy July 20 
History of Anaesthetics 

At the opening meeting of the Section of Pharmacology’, 
Therapeutics and Anaesthetics, the President Professor A J 
Clark (Edinburgh), gave an address on certain aspects of the 
history of anaesthetics 

Professor Clark said that this subject had a unique interest 
for the pharmacologist because anaesthetic agents were the 
first svnthetic organic chemical products emploved to pioducc 
a therapeutic effect of major importance The discos ciy of 
the pharmacological action of nitrous oxide was of special 
local interest, because Sir Humphry Daw, born in Penzance, 
published in 1800 his Riscaiches Co/itcriiinc Nitrous 0\i(lc, 
in which It was suggested that the gas could be used with advan- 
tage during certun surgical operations This prophecy, 
however, was forgotten, and it was not fulfilled until forfv 
years later Professor Qlark surveyed the earlv work of 
Hickman in connexion with carbon dioxide and the early use 
of nitrous oxide bv Wells The news of Mortons successful 
employment of ether m 1846 quicklv reached this country and 
created considerable interest in anaesthesia, which led to the 
discovery of the anaesthetic properties of chloroform by 
Simpson in 1847 For the next fifteen vears many other drugs 
were investigated, only to be discarded in favour of the original 
three agents — nitrous oxide, ether, and chloroform , not until 
1923 were there further apprecnble advances in this subject 
He believed that further progress in anaesthesia was only 
likely to be made by co-ordinated work and by carefully 
organized large scale trials of new agents He regretted that, 
while this country was a pioneer in the investigation of 
problems m the early days of anaesthesia, recent advances had 
been made mainly abroad 

The President then exhibited a cinematograph film showing 
individual variations in the effect of sodium evipan upon mice 


Variations in ElTcctnc Aiiacs lutic Doses 

Opening a discussion on variations in clTccfivc anacsthclic 
doses Dr J W TurVAN described a senes of experiments m 
which mice were subjected to intravenous injection ot 
piraldchydc He showed that, owing to the overlap of the 
statistical distributions of the fatal and of the anaesthetic 
doses, no single dose, the administration of which would ensure 
th.il all mice were anaesthetized without killing more than 
one in 10,000, could be prescribed This could not be over 
come by giving the dose in six fractions The only feasible 
method w is slow continuous infusion of a dilute solution 
which was slopped when inacsthcsia had reached the desired 
level Similar results had been obtained with sodium amytal, 
sodium evipan, and avertm 

Dr C J M Dawkins referred particularly to the effect of 
clnngcs in the weather as a cause of individual anaesthetic 
response in the patient In a senes of 675 dental cases he 
had found that induction time increased as the birometnc 
pressure fell With relative humiditv the lower the percentage 
the shelter was the induction lime He had also investigated 
the connexion between the complexion of the patient and 
the induction period, and he found that, whereas the averate 
time taken to produce inacsthesia in fair-haired patients aas 
fiftv two seconds, the figure for dark haired vvis sixty I" o 
seconds, and for red h tired sixty eight 


Spiml Anaesthesia 

Professor A D Macdonald (Manchester), referring to spinal 
anaesthesia, considered there was onlv one way m which a 
spinal injection of v loc tl anaesthetic might kill an aninial- 
ntmelv', Ivy respiratory depression and paralysis Provided the 
phrenic roots and respiratory centre were not exposed to 
paralvsing concentrations of the drug, the anaesthetic seemed 
perfectly safe If adequate oxvgcnation vvas maintained it 
was exlremelv difliciilt to kill an animal with a local amestheiic 
irrespective of the method of administration The principle 
of individual variation seemed to appiv to those cases in which 
paralysis of tail, bladder, and rectum vvas observed ito 
spinal anaesthesia He believed that this effect vvas provoled 
solely by the anaesthetic drug and he disregarded mechanical 
traum i and other constituents of the solution, such as dilnle 
alcohol or glycerin, as possible causal agents 


Basal Anaesfhesta 


Dr B P Hill (Reading), discussing basal narcotics said 
that ciscs showing hvpersusccptibility were very rare when 
paraldchvde vvas employed More frequent susceptibihly 
observed with avertin and more information as to the can'c 
and avoidance of svmptoms vvas available He thought tha 
the damage to the liver cell produced m certain cases indicate 
livpcrsusceptibilily', and vvas due to deficiency of a substance 
which normally protected this organ from necrosis duf'nt 
deioMcalion of the drug Hv persusceptibilily to barbituniev 
vvas inconstant even in the same individual Certain inconSian 
factors predisposed to in undue reaction after a normal do' 

There vvis no reliable test bv which a hypersusceptible patten 

could be detected he had tried out a skin test which pro'^ 
to be quite unreliable 


The Presidlnt asked if individual variation could No'’ 
trolled by fractional dosage He believed that adminisln 
of a non-volatile anaesthetic m a dosage per ^’'°8i'''nin'e 
body weight vvas unsafe In practice, however, susccpliW^^^ 
to paraldehyde per rectum vvas not such as might be 
from animal experiments Dr R K Foulkcs (Excicr; 
qviired if liver extract should be given before the adminisiri 
of chloroform and avertin m order to minimize the f' 
toxic effects Dr O C Carter (Bournemouth) hvd gi ^ 
1,500 administrations of avertm without anxiety and hnd n 
obseivcd damage to the Itvcr cell He had used this 
operations upon the gall bladder, and even when „ 

jaundice Dr B P Hill (Reading) quoted a case of 
lo the liver following avertm m which sc'crc 
ing dehydration, and conjunctival icterus "cre 
feat 111 cs 



Jll\ 30 193S 


THC SECTIONS SUMMARY OF PROCEEDINGS 


TjfEBRrmn 
MirH-'AL JociL^t 


245 


Proftvsor \\ r kiNNim (Biuluhti) stated ih^t the depth 
and duration of a%crtm nartosjs Naricd conMdcrabl> in different 
piticnl^ and so the amount of suppltmcntara anaesthetic 
nettsNarv uas a sariahle quanlilv He bejie\td the amncMa 
produced b\ avcrlin to be a great ad\anlagc Mr W 
EthfrincjTos Wil>on (Torqua\) emphasized that a safe and 
well ihoucht*out technique was important in helping to 
eliminate the \arious dangers of spinal analgesia He drew 
ittcntion to the method of timed \erlical ascent based upon 
moek spinal experiments This was » safe and simple method 
achieving real control It was he believed safe to administer 
spinoeain b\ this technique and he desuribcd a small senes 
of cases in which pcrcaine 1 in 2 ^00 had been given to 
infants With satisfactorv results 

Oranan Thcrapv 

Dr P M F Bishop in a paper on ovarian therapv stated 
that the oestrogens of which ocstrone oestriol and oestradiol 
were available had a therapeutic effect when given bv the 
mouth Intramuscular administration however was preferable 
and csienficaiion of the hormone enhanced the effect The 
action of ocstradiol benzoate administered in this fashion lasted 
for three davs and the desire to increase further the interval 
between injections had led to the institution of crvstalline tablet 
implantation With this method a small compressed tablet of 
crystalline oestradiol benzoate was introduced under the skin 
through a small incision b\ reason of the slow absorption there 
was a continuous constant effect over a period of time The 
oestrogens were of value in the treatment of true menopausal 
svmpioms but he believed that even in large doses thev were 
ineffective in conditions commonU thought to be associated 
wath the menopause — for example menopausal arthritis 

SECTION OF PH\S10L0G\ AND BIOCHE\nSTR\ 

B ednesdas Jul\ 20 

Methods of Testing Colour ^ ision 

Professor R J S McDovv sLL look the chair when the pro 
gramme in this section was opened with a paper bv the 
President Professor H E Rosf (Livcrpooll on methods of 
testing for colour vision and theoretical deductions from 
observations on colour vision 

Professor Roaf referred to the fact that in the spectrum 
there are two mam maxima of colour discrimination corre 
spondmg to the sensations of vellow and blue green These 
two regions had been studied to determine whether the sharp- 
ness of discrimination was related to an\ speaal recognition 
of theiC colours when there was no fixed wave length with 
which to compare them The method of investigation using 
the spectroscope was illustrated first in respect of the jellow 
sensation the range being marked between extreme points 
where the subject saw the yellow to be just tinged with the 
neighbounng colours of the spectrum Figures obtained with 
respect to normals showed a narrower range of wave length — 
that IS a higher power of discrimination — than for those with 
defective colour vision Similar studies in the blue green had 
led to the conclusion that subjects with defective colour 
vision had no special difficultv m distinguishing colours pro 
duced b\ this region Professor Roaf then went on to 
discuss the various methods in use for testing for defective 
colour vision mentioning first the fundamental lantern 
method In regard to the Nagel anomaloscope he cited 
evidence which suggested some svstemalic defect in this 
method Passing next to the use of pseudo isochromatic 
plates on which the normal person could see a design not 
Visible to the subject with defective colour vision he con 
sidered Ishihara s plates as probablv the best form and ex 
plained how they worked Finally he dealt with binocular 
colour fusion and instanced practical applications that might 
anse out of a studv of this aspect of the subject 

Professor McDow xll asked whether perception of anv one 
t'olour was more acute than the rest Dr A Ssnd (PIvmouth) 


raised the question of the mechanism of conveving colour to 
con ciousness and also referred to colour perception in the 
lower animals Professor Rovf in repiv illustrated the 
retinal cones with their different colour filters in birds which 
would explain a three colour vision Dr T S Hele (Cam 
bndee) inquired whether there was anv evidence ot defective 
colour vision being associated with vitamin deficiency A 
number of interesting points were then raised bv Dr \\ R G 
Atmss (PIvmouth) whether didvmium glass would be of 
use in detecting defective colour vision how far colour vision 
was affected bv fatigue and to what extent the owl was 
sensitive to infra red Dr L H N Coopep (Plymouth) 
drew attention to the desirabilitv of testing the colour vision 
of chemical analysts who have to match colours, accuratelv 

Hearing in the Lower Animals 

VNiln the President Profes^^or H E Roaf m the chair Dr 
A SvsD (PIvmouth) opened a discussion on heanng with 
special reference to the lower animals 

Dr Sand stated that in fishes the organs of the lateral line 
had a histological structure almost identical with the hair 
cells of the organ of Com and thev arose m embrvological 
development out of the same aniage as the eye so that one 
spoke of the acoustico lateral svstera which included the 
lateral line and labvnnthme organs Bv physiological 
experiments recording the active potentials from lateral line 
nerves it was found that lateral line receptors were exceed 
inglv sensitive to vibrations of low frequency Moreover 
perfusion expenments showed that a constant deformation of 
the hair cell provided a slow adapting rhvthmical response ic 
single fibres Extending these conceptions to the organ of 
Com one was led to recognize that the frequency of dis 
charge was not determined bv the mtensiiv of the stimulus 
which was an alternating (or oscillating) mechamcal change 
but was dnven bv the frequenev of the stimulus up to the 
limit of frequenev of which the nerve wws capable There 
followed phenomena of alternation and equilibration which 
dcstroved the direct connexion between the frequenev of the 
sound stimulus and the frequency of the nerve impulse dis 
charge Thev were thus led to the resonance or place 
thcorv of pitch discrimination and the interpretation of loud 
ness in terms of the number of senson elements excited 
Fishes had been shown to have excellent heanng and to be 
capable of discriminating pitch to wilhm a minor third But 
fishes had no cochlea and so the resonance theorv could not 
appiv to them 

Dr H C PLRCER SviiTH (Barnes) raised a question regard 
ing high levels of inlensiiv in relation to the sensation of 
pain while the President drew attention to the possible 
relation of intensity to the number of hair cells affected 
Dr SvND in repiv stated that loudness was conveved bv the 
greater or less width of basilar membrane set in osallation 

In the afternoon the section attended the Manne Biological 
Station where a senes of extremely interesting demonstratiooi 
were given bv members of the staff and visiting members 

SECTION OF PATHOLOGY, BAtriERIOLOGY, 
AND IMMUNOLOGl 

U ednesday July 20 
Aetiology of Rheumatism 

With the President Dr M H Gordon in the chair Dr 
H J Gibson (Bath) opening a discussion on the aetiology 
of acute rheumatism and rheumatoid arthritis proposed first 
to discuss the phenomenon of throat infection with Str 
haemohucus followed by a latent penod which m turn was 
followed bv an attack or relapse of acute rheumatism The 
epidemiological and serological findings taken together pro- 
vided a mass of evidence in favour of the aetiological relation 
ship of the haemolvtic streptococcus to rheumahe fever 
Conlrarv evidence from sporadic cases not susceptible to 
bacteriological studv in the pre rheumatic stages was less 



246 July 30, 1938 


THE SECTIONS SUMMARY OF PROCEEDINGS 


TiiEB*m'n 
Medic*.!, /ovicsa 


convincing Two alteinative theories appeared to fit the 
observed facts either the disease was an infection with Str 
haemolyticus or some other specific rheumatic agent was 
primary and the streptococcus merely one of a number of 
secondary inciting causes Direct evidence for the former theory 
was slight, though failure to find organisms vvas not conclusive 
evidence against a low-grade generalized infection Failure 
to find the organisms had led to the theory of allergy The 
acceptance of this presupposed that we knew that the patho- 
genic potentialities of the streptococcus were insufficient to 
explain how chronic infection with it could cause disease of 
the rheumatic type by ordinary means Such an assumption 
was unwarranted The allergic theory had, however, received 
support from recent histological and experimental studies, and 
the hyperergic reaction probably had a place, whatever the 
nature of the primary infecting agent, and vvas an important 
field of investigation that would certainly lead to a fuller 
understanding of the pathogenesis of the disease Thera- 
peutic evidence of the effects of Dick toxin, passive immuniza- 
tion with serum, or administration of sulphanilamide did not 
support the streptococcal viewpoint or disprove it The alter- 
native hvpothesis of a specific rheumatic infective agent vvas 
an almost equally satisfactory explanation of the facts as we 
knew them, and there vvas much to be said in favour of it 
The relation between acute rheumatism and rheumatoid 
arthritis was a subject of much controversy Clinically there 
vvas little similarity, but on the pathological side there was 
evidence that the diseases might be related Haemolytic 
streptococci had been recovered from the blood and joint 
fluid in rheumatoid arthritis and these streptococci agglutmated 
with the patient s serum The agglutinins resembled the 
natural antibodies of normal sera more than immune 
agglutinins following infection or immunization 
Dr G H Eagles said that the possibility of a virus plaving 
a part in the causation of rheumatism had been considered by 
several investigators Schlesinger, Signv, and Amies had 
shown in rheumatic exudates particles morphologically similar 
to those of known viruses which were specifically agglutinated 
bv the sera of rheumatic patients in the active stage of the 
disease This investigation suggested that these particles were 
true elementary bodies and were the actual infective agent 
Eagles, Evans, Fisher, and Keith extended these observations 
Elementary bodies were obtained from acute rheumatic 
exudates, cerebrospinal fluid from chorea with carditis and 
nodules joint fluids from rheumatoid arthritis and, as a control, 
fiom non-rheumatic exudates Morphological examination 
did not suffice to differentiate between those of rheumatic 
origin and those of non rheumatic Morphological evidence 
alone was therefore insufficient Considerably greater signifi- 
cance attached to serological evidence gamed by agglutination 
of these particles by patients sera The distribution of posi- 
tive and negative agglutination was very similar to that 
observed with the preparations from cases of rheumatic fever, 
and suggested a common factor in the causation of rheumatic 
fever, rheumatoid arthritis, and chorea Adequate controls 
with non rheumatic suspensions suggested that positive results 
were confined to rheumatism Experiments had been made 
to establish the infectivity of these particles in monkeys In 
certain instances the ctinical behaviour had suggested grave 
cardiac damage as a result of inoculation These, along with 
some abnormalities in electrocardiographic records, were sug- 
gestive, but had not been supported bv pathological findings 
He emphasized the need for adequate mtection experiments 
with any supposed elementary bodies before these could be 
accepted as the aetiological agent 
Dr D H Collins (Harrogate) said that no one of the 
pathological phenomena of rheumatism or rheumatoid arthritis 
vvas specific to the disease in question Experimental pro 
duction of various connective tissue changes should not be 
too readily accepted as having direct bearing on the problem 
of rheumatism The ultimate aim of experimental work must 
be to produce rheumatic disease rather than microscopical 
appearances In view of the fact that so many of the patbo 
logical data were of doubtful specificity and that the clinical 
differences between rheumatic fever and rheumatoid arthritis 
were so pronounced it was better to regard these two diseases 


as independent The histologist could sec in rheumatic fever 
phenomena which indicated vvidesprcad damage throughout 
the body, caused either by an infective agent or by its 
soluble products, together with phenomena resulting from 
tissue hv pcrscnsitiv iiv produced as a phase of the infection 
These changes might be followed at any time by the non 
specific processes of repair In rheumatoid arthritis the duea«e 
vvas more clearly localized to the joints and to the subcu 
tancoiis tissues vshich were exposed to trauma Baaeno 
logical researches m both forms of rheumatism seemed to 
incriminate the streptococcus The histological findings, 
though unlike those of anv hitherto proved streptococcal 
disease, did not weigh against the possibility of a streptococcal 
aetiologv, since the protean capabilities of the streptococcus in 
pathogenesis were onlv just beginning to be explored 

Dr C 'k Grfen (Edinburgh) said that m a group of 
200 subjects acute or subacute rheumatic manitestalions had 
been found to be preceded by nasopharv ngeal infection ra 
78 per cent and m 58 per cent hacmolvtic streptococci were 
still present in the nasopharynx at +110 onset of the rheumaUe 
svndrome A relatively high incidence of recent naso 
pharyngeal infection, 46 per cent vvas found in a control 
group, and haemolytic streptococci were found m 30 per 
cent Of the strains from the rheumatic group 87 per cent 
were of Group A, while onlv 42 per cent of the control strains 
were of this group Further indirect evidence of streptococcal 
infection m rheumatic persons vvas provided by their raised 
anli-hacmolvsin litres In tlie quiescent phase the suheu 
taneous injection of haemolvlic streptococcal nucleoprolem 
might induce local reactions clinically indistinguishable from 
erythema nodosum and a general reaction simulating a nalur 
ally occurring recrudescence of the acute phase of illness As 
direct evidence of such infection cultures from heart vahes 
vvith vegetations or from pericardial lesions had vieldcd haemo 
Ivlic streptococci m nine out of ten consecutive cases of acute 
rheumatism examined post mortem Control cultures Irom 
healthv valves without vegetations from the same hearts and 
of heart blood vverc negative for haetnoly tic streplovoco 
From six of these cases haemolytic streptococci had teen 
recovered fiom the nasopharv n\ during life and in all 
instances these were serologicallv identical with those isolated 
post mortem Rabbits inoculated with post mortem pen 
cardial fluid trom rheumatic subjects died as a result ni 
haemolytic streptococcal infection and showed a peculiar dis 
tnbution of cocci m their tissues The same distribution could 
he recognized in tonsils infected with streptococci, and a 
similar appearance could be demonstrated' in human henrl 
valves with rheumatic vegetations 

Dr E P PoULTON said that, in collaboration with 0^' 
Koerner, Gray-Hil) and Todd he had observed high anii 
streptolvsin litres in various conditions which had been 
hitherto regarded as associated with haemolytic streptocouu 
infection Apart from acute rheumatism erythema nodosuin 
chorea and acute nephritis where a high litre had alrcadi 
been described, thev had found high values in purpura wheiwr 
the platelets were normal or reduced and m two cases where 
fever and glands following sore throats were the onij simf 
toms He suggested that acute rheumatism might be ^ 
svndrome due to different exciting agencies The 
b icilliis appeared to be the cause in one instance ami 
telation of the svndrome to the haemolvlic streptococcus mic 
be regarded as p irallel to the relation of epituberculosis lo 
tubercle bacillus 

Dr M H Gordon said that he himself had ''’1^'^*^ 
rabbits intravenously with a highly virulent virus 
rabbit testicle passage from a case of small pox * 
rabbits developed pen articular swellings from which 
was recovered in greater concentration in the 
exudate than from the other organs I jions 

lesions showed the same changes as had been seen m usi ^ 
of fibrosiiis in rheumatism Control experiments "J*” . 
horse serum, Slaph^lococLus epidcrmidit ^ 

atiieiis and Bait coli were negative Haemolytic strep 

however did produce irthiitis He then tried the e >■ 
mixing virus and streptococci In these evpcrinicn 
streptococcus alone sometimes pioduccd arthritis, i» 



JUL\ '0 I 93 S 


THE SECTIONS SUMMARY OF PROCEEDINGS 


nlonc nc\cr but the mixture aU\n\«: The streptococcus could 
nc%cr be sub^cquentU isolitcd from the lesions but the xirus 
nluaxs present in great amount In \itro the mtus had 
no inhibiting action on the <.trcptococcus but when the 
mixture was inoculated inlradcrnnlls the •streptococcus again 
disappeared though the \irus could be rccoiercd from the 
le<^ionx 

Sir N\n.uxM Willcox said that progress in our knowledge 
of this subject was due to recent adiances in bacteriological 
technique Rheumatism was not a specific disease but a 
sxndromc Fibrosiiis occurred m man\ other diseases such 
as gonorrhoea bacillarx d\scnter\ brucella infections etc 
Tic urged that in\cs igaiions should be carried out on \irgin 
soil — that IS to sax m pnmar^ attacks of rheumatism 


SYCnON OV TCBCUCULOSIS 
n fdiiesdnx* Jul\ 20 
Radicgrapht of the Chest 

With Dr Erstst Ward President in the chair Dr GnoRt c 
JE5SEL (Leigh Lancs) opening a discussion on radiographx 
of the chest said that csen when pulmonars tuberculosis had 
been diagnosed radiograpb\ w*as often of much saluc par- 
ticularly in treatment bs artificial pneumothorax and in 
surgical procedures and m ascertaining the progress of the 
disease Caution must be exercised m interpreting radio 
graphs because the r ra\ appearances of sc\cral chest con- 
ditions might at times be indistmguibhable from each other 
Dr G T Hebert said that the radiological interpretation 
of fibrosis in the luncs had become more difficult since it had 
been shown that the lung markings were due to shadows 
caused not b\ the bronchi but bs the xessds He classified 
fibrosis into (1) perifocal gi\ing nodular shadows and caused 
b\ tuberculosis or silicosis (2) intcniitial giving haziness or 
a ground glass appearance and frequenth associated with 
cmphvsema and (“1) pen bronchial simulating conccsiion 
Dr Hebert described how thirts radiographs of patients he 
had fullv investicated or whom he had been able to follow 
up long enough to be certain about the diagnosis were sent 
without clinical details to about <e\enlv radiologists 
phvsicians and tuberculosis officers for an opinion as to 
whether fibrosis was present or not In regard to some films 
a correct diagnosis was given bv S*? to 90 per cent of the 
examinees in regard to others an erroneous diagnosis 
was given bv over 50 per cent From this investigation he 
concluded that it was difficult with certain exceptions to 
recognize fibrosis of the lungs from the radiographic appear- 
ances alone a diagnosis of fibrosis made in this wax xxas 
usuallv based on inference rather than on shadows actually 
cast bv fibrous tissue Contraction of the lung was good 
inferential evidence of fibrosis The earlier stages of the 
nodular form of silicosis might be simulated bv several non 
fibrolic conditions One should beware of ascribing linear 
shadow^ to tuberculous fibrosis unless there was much 
nodular or confiuent shadow in the neighbourhood and of 
regarding the wall of a circular or oval cavity as fibrous just 
because it was dense And above all one should beware 
of diagnosing general fibrosis vxhen the pulmonarv markings 
were merelv more prominent or more streaks than usual 

Dr \\ Blrton Wood without minimizing the importance 
of the phvsical examination suggested that phvsical signs 
were almost useless m the diagnosis of pulmonary tuberculosis 
On the other hand radiologv could not be relied on alone 
He deplored the use b\ some radiologists of the terms active 
and non active when ihev were based solelv on radio 
graphic appearances Several chest conditions could give 
simihr appearances He expressed some doubts of the 
value claimed for tomographs 

The President emphasized that radiological examination 
was essential but some phvsicians were <ipeciallv gifted m the 
elicitation of phxsicxl signs For contact cases an elaborate 
examination of the chest in addition v\as generallv not neces 
•=arv parlicularlv as contacts were often much more Iikelv 


T»fE Bwrnn -1^7 
XltDiCAL JotTi> it 


10 agree to having a radiograph taken All patients referred 
to the tuberculosis, officer should be r raved 

Dr G Greoorx Ksx'N'E (Stame>>y expressed surprise ihai ro 
radiologist had been chosen to be one of the openers of the 
discussion even though all the three openers practi ed 
radiological examination of the chest This would help how 
ever to irtss the fact that a knowledge of radiologx was 
nov\ an essential equipment of the tuberculo is phvsici**n 
But the radiologist was still required for consultation m 
difficult cases and for advice on anv xncillan radiological 
examinations that should be earned out to elucidate a 
doubtful ""cise — for example bronchographv oblique filrrs 
tomographv etc He referred to taking films in vertical shift 
for the detection of small shadows behind the ribs The 
interpretation of tomograms might be mi leading as 
demonstrated bv a rcLentlv published case — the tomograms 
showed a vxhole svstem of cavities at necropsv shorth ^lier 
wards onlv one cavitv wa<i found Radiological examination 
was of the greatest value in the prevention of tuberculosis for 
It enabled the deteclioji of minimal lesions in the apparenilv 
healthv Dr Heberts investigation stressed the fact that 
skiagrams should not be interpreted m terms having a 
pathological connotation 

Dr Peter \\ Edw xrds (Market Dravton) stres ed the \ 3 Iue 
of thorough screening The interpretation of tomograms wa< 
slill uncertain but there wts no doubt as to the value of the 
method Stereoscopic films were useful in the diagno is ot 
earlv cases and in locating foreign bodies In regard to 
cutting of adhesions radiologx was of little value — one must 
insert 1 thoracoscope and look in He stressed the value of 
scnal skiagrams both in diagnosis and in deciding treatment 
and referred to the confusion that might arise from shadows 
persisting after injection of Iipiodol 

Dr H T Chvtfield (Plv mouth) referred to the frequenev 
of pulmonarv tuberculosis among naval men from the China 
Mation as compared with those from other s.tatior\s Dr 
A Mck FlfmP'G (Gibraltar) contributed some remarks on 
the recent organization of the anti tuberculosis campaign in 
Gibraltar Dr J R Gillespie (Belfast) recommended the 
use of the subcutaneous tuberculin test in diagnosis Dr 
D A Powell (Cardiff) stressed ihe value of screening and 
the need for revision of the nomenclature m radiological m 
tcrprcntion of radiographs Dr Scott (London) speaking as 
1 general practitioner defended the u«:e of the stethoscope 
Dr" H S Howie Mood (Shanklin) suggested that radiologists 
with small but adequate plants should be allowed to take 
radiographs even if someone more expert was a^ked to interpret 
ihe films 


SECTION OF OTO RHINO LARYNGOLOGY 
B edi Jul\ 20 

Malignant Disease of the Pharj’nx 

Mr Lionel Collfdge (the text of who<e paper was published 
m the Journal of Juh 23 p 167) opening a discussion on the 
treatment of malignant disease of the pharxnx and larvnx and 
Its results said that the problem of treatment had been com 
plicated bv the introduction of irradiation especiallv as m 
so manv cases tumours which responded to this were those 
particularlv amenable to ordinarv surgical me<isures He 
divided the malienant growths into tumours of the oropharvnx 
and of the lanngo pharvnx confining the d» cussion to 
ep.Ihel.omata «h,ch «ere b^ far the commonest Lnless 
he found b\ biops\ that the epithelioma «as of croup ]\ a 
parlicularh radio sensin' e t'pe he preferred surgical treat- 
ment In the oropharsnx diaiherm' gase on the "hole the 
best results While admittinc that the functional result m 
vUrcical treatment of carcinomata ot the lar'nco-phar'nx and 
larCnx "as not so uni'ersalh good as in irradiation he said 
that the percentage of cures "as so much higher in the former 
that It should alwa's be the procedure ot choice 

M> C Hsmblen Thomas m a paper on the treatment of 
such tumours b' irradiation said that an operation "hen 
possible should be preferred to irradiation basing regard 



248 July 30, 'l93S THE SECTIONS SUMMARY OF PROCEEDINGS 


ahvays to preservation oi restoration of function The 
suitabilitv or otherwise of a growth for tieatnient bv irradiation 
depended upon its situation and the character of its cells 
The presence or absence of enlarged Ivniph glands also in 
fluenced the choice of treatment glandu'ai metastases being 
highlv resistant to uradiation In manv cases inadiation could 
be a most usetui preliminarv to operation provided not 
more than about twentv five davs elapsed between the two 
treatments On the whole he preferred ladium needles to 
radon seeds and deep \ rays to the radium bomb To ensuie 
better results from irradiation ail cases should be treated as 
in patients institutional accommod ition foi theuse people 
was at present hopelesslv inadequate 

Mr E Misr.RvvE Woodman (Biimingham) said that he 
had gradually abandoned diathermv for the oropharvngcal 
growths in favour of irradiation Further he found better 
results from radium needles than from radon seeds In 
extrinsic caicinonn such as post cricojd growths one must 
not hesitate to sacrifice a healths laivnx if b\ such an 
operation one could save the patients life 

Mr F C ORXfEROD then showed lantern slides to illustrate 
the technique of treatment of circinoma of the pharvnx and 
larynx by the radium bomb together with radiographs illus 
trating the results of treatment of post-cncoid growths and 
metastases m the cervical glands 

Injuries of the Nose 

Mr T PoMFRET Kilnfr in discussing injuries of the nose 
stressed the importance of earlv and complete disimpaction 
and setting of ail simple fractures He considered intratracheal 
anaesthesia and efficient blood suction apparatus essential for 
careful unhurried work and advocated the use of a simple 
• splint of stent moulded over lead tor one to two davs after 
operation In fractures accompanied bv external skin 
wounds he deprecated debridement there bfing insufficient 
skin in this particular region to allow of trimming of the edge 
of the wound without producing distortion A c ireful search 
should be made for foreign bodies in such wounds, ind all 
glass and road metal fragments should be removed Frag 
ments of wood were partjcularh apt to be overlooked 
Completelv separated bone fragments should be removed and 
in the absence of infection an attempt should be made to 
manipulate displaced fngments into coireci position The 
wound should be sutured acciiratelv but looseiv and a sharp 
watch should be kept foi infection calling foi eaily removal 
of sutures Associated fractutes — toi example of the malar 
bone — should be looked for and tiealed In cases in which 
there was loss of surface skin he advised earlv free skin- 
grafting to prevent distortion Wheic the loss involved all 
thicknesses he advocated careful mucous membrane to skin 
suture around the defect thus paving the wav for future 
reconstruction 

Mr Kiiner showed lantern slides illustrating various 
types of injurv and the results of treatment of these bv 
simple disimpaction and setting surgical refractuie hump 
reduction shortening c irtilage and bone grafting and rccon 
struction by forehead and other 11 ips 

Mr E WvTsoN Williams (Bristol) thought that simple frac- 
tures of the nose were the province of the nasal surgeon but 
was anxious to hear from Mr kilner the best method of 
treating fractures involving backward displacement of both 
superior maxillae Mr Hamblen Thomas pi eferred to operate 
if possible within seven davs of the injurv He asked if Mr 
Kilner could guide him m the treatment of collapse of the 
alae nasi Mr I Simson Hall (Edinburgh) asked whelhei 
cartilage or bone grafts Were preferable Mr Grimwadf 
(Birmingham) asked if a chisel were preferable to a rasp foi 
removing humps of the nasal bridge 

Mr Kilner m replv said he preferred cartilage to bone 
grafts being so much easier to mould and manipulate except 
in small children In the case of fractures he advocated im- 
mediate reduction and replacement the next best time was 
as soon as swelling had subsided but even as long asT five 
wctkN after the accident it was often possible to manipulate 
the fragments without rcfracture A chisel was preferred to a 


The Britiiii 
M tDICAL JOHSIL 


rasp as the litter left much bone dust He bad not hid 
cases of collapsed the referred to him but thought that such 
cases would benefit by a shortening operation on the septum 
rathei than bv Inv plastic alar operation 

Deflection of the Septum 

Mr W S Syme (Glasgow) opened a discussion on septa! 
deflection He maint lined that there were many reasons vihi 
a septa! deflection tended to be bl imed for more ills than it 
deserved and through this to be treated surgically more 
frequentlv than was acluallv necessary It was easy to 
diagnose, gencr illy simple to treat surgically and such treat 
ment did not usuallv cause extreme discomfort or lasting harm 
Deflection was reported as occurring in from 60 to 80 percent 
of Europeans with no ill effect and was stated bv some to 
be commonlv due to trauma bv others seldom so Was it 
abnormaP Its most troublesome effect was the blocking of 
sinus drainage Nature made compensation for the differenu 
m size oi the two nasil cavities When was surgical inter 
vention justified ’ 

Mr T Ritchie Rodgfr’ (Hull) questioned whether thert 
had been excessive operation on the septum in earh davs 
He thought that submucous resection still had a great sphere 
of usefulness both as i means of increasing the patients com 
lort and to facilitate surgici! approach to other nasal conditions 
requiring operation 


SERVICES SECTION 

V 

]Ve(liieula\ Juh 20 

Evacuation and Treatment of Gas Casualties 

With Surgeon Rear Admiral F J Gowans (PK mouth) in ih' 
chair Major E H Hall R A M C (Porton) opened a di> 
cussion on the treatment andatvaciialion of gas casiiaUics 
Confining his lemarks to the problem as it alTeded iF 
R A M C oflicer who had to deal with gas casualties in the 
forwaid areas during actual warfare Major Hall pointed out 
that gas casualties in these areas were first dealt wath hy 
regimental stretcher bearers and brought to the reginvenb! 
aid post Here those suffering from the effects of licrimaton 
gases could be reassured and returned to their units Alst 
at this post the diagnosis must be made between patienti 
severely affected bv sensorv irritant gases and those If" 
severeh affected bv lung irritant gases The former shod 
be retained at the post until fit to return to their units os 
the latter must be regarded as stretcher cases and treated "w 
rest and warmth and removed to the field ambulance as 
quicklv as "possible Vesicant gas cases would probabH fouo 
the bulk ,of the gas casualties and for dealing with 
Major Hall advocated the marking off at the aid post « a 
dirtv area a decontamination area, and a clean area TK 
should also be extra transport to provide supplies of clew 
clothing This would ensure that no cases were sent to 
next medical unit not properlv decontaminated Major Ha 
considered that m a war of rapid movement the pro'F'o 
of special units purelv for dealing with gas casualtic' '' 
impracticable At the field ambulance cases severeh ^ 
with lung irritants and with vesicants could 
treatment, such as the administration of oxvgen 
infusions before being removed to the casiialtv vrso 
station This unit should also have sub units "ith oc 
lamination centres to deal with cases occurring m 
dme vicinitv and medical personnel that might have 
contaminated The gas proofing of advanced orc'^^^ 
stations was impracticable but if a mam dressing **^*'°" i,i 
situated in a building a room and operating Ihealrc 
be gas proofed for the reception of the seriously j,, 
who could not wear respirators At the casinltv c 
station special wards might be set aside for the 
gas cases and oxvgen administered simultaneously to 
Here iho simple decontamination cenUes might be ne 
to deal with cases occurring in the area of the 
elaborate centres were probably not necessary Maj 
did not deal with cases arising at the base, as mcasu 


JuL\ ■<0 193S 


The Bvti_h 
Med Cal Jol-xnal 


249 


THE SECTIONS SUMMARY OF PROCEEDINGS 


Ihccc were cxictK vimtlar lo iho«^c for cnilian populations 
and Mere puen in the \ R P handbook 

Surgeon Captain E St G S Goodwin RN ^aid that 
acLiiratc as^c^sment ot the NCNeniv of eases and their treat 
ment at adsanced posts would sa\c the time of medical officers 
and also much hospital work This applied especiallv to the 
sorting out of patients who onU bclie\cd themselves to have 
been gassed The speaker aPo emphasized the importance 
of the rcLOgniiion of the dclaved action of some lunc irritant 
gases He advotated that where possible special wardt> 
should be made for gas eases or at least that thev should be 
segregated from the other patients for a time Methods for 
dealing with gas eases OLCurnng at sea were in principle 
similar to those clcarlv explained b\ Major Hall 

Colonel F R Sxndtord RAMCTA considered that 
special anti gas units should be formed to deal with the 
treatment and evacuation of gas casualties in forward areas 
These could be mobile and be moved quicklv to the scene of 
anv gas attack This would leave the field ambulances more 
free lo deal with ordmarj casualties 

Squadron Leader C J S O Mxllex RAF emphasized 
the importance of reassurance in dealing with gas cases He 
agreed with Colonel Sandford that anti gas units should be 
formed as onU in this wav could adequate training be 
provided He spoke of the difficultv of getting suflicient 
equipment for practical instruction in gas work in his own 
Service 

Major Hsll m replv held that segregation was not called 
for and that urgent treatment for wounds might require 
immediate admission to the acute surgical ward He also 
considered that special anti gas units besides being imprac 
ticable owing to the rapid movement of troops placed too 
much importance on the use of g'ls as a weapon of attack 
in modern vvarfare 

SECTION OF DISE.ASES OF CHILDREN 
If cdn€S(h\ Juh 20 
Breast Feeding 

\Sith Dr Lindssx A Dei Mce president fSvdnev NSW' 
in the chair Dr J C Spence fNew castle) m opening a dis 
cussion on the modern decline of breast feeding said that 
m the eighteenth centurv there were few women who did not 
either feed iheir babies or hire a wet nurse Now owing to 
the invention of the feeding bottle and the rubber teat the 
cow was the mother substitute With an infantile mor 
tahtv rate twice as high as that in manv other countnes and 
about 20 000 preventable deaths each vear among voung 
infants, it was important to combat the tendencj — shown even 
in the preventive medicine service — to deprecate the xaluc of 
breast feeding Anahsis of figures led to the conclusion 
that 20 to 30 per cent of babies were artificiair> fed from 
birth in most big towns and not more than one third of the 
mothers of these towTis were fulh feeding their babies until 
the sixth month Dr Spence stressed the likelihood of late 
evil effects in the adult who had been artificial!} fed in 
jnfanev The effect on the mother who cut short the repro 
ductive cvcie had also to be considered It was essential he 
continued to studv closelv the different stagci in the full 
establishment of lactation and the large variations in the 
quanlilv and qualitv of breast milk Onlv 5 per cent of 
mothers who did not succeed m feeding their infants failed 
because of physical abnormalities The remainder either 
would not or did not know how to feed their infants on the 
breast Ignorance and selfishness were important factor' 
and the fault often lax not so much in the mothers as in 
their advisers Mismanagement was the chief cause of the 
failure to establish lactation Better education of doctors and 
matemitv nurses was among the most important wavs of 
correcting this 

Dr S J Follev fNational Institute for Research in Dairv 
ing) describing recent work on the endocrine control of lacta 
tion said It was probablv true thit m the development of 
the human breast the corpus luieum hormone was nccessarj as 


well as the oestrogenic hormones of the ovarv and it was 
likelv that mummarv growth was induced indirecih bv the 
action of oesirogens upon the pituUarv causing this gl^nd 
to secrete a mammogenic hormone The prolauin o' me 
antenor pitultarv activated the adequatelv developed mammarv 
gland Crude extracts of this substance were more effective 
than refined preparations in initialing and maintaining lacta 
lion in hvpophvsectonized animals and this was explicable on 
the lines that the inlegrii} of the adrenal conex was essential 
for lactation the crude prolactin supplving this Adminis 
tration of thvroid gland to cows in declining lactation «tirou 
latcd secretion of milk It was possible that there was more 
than one lactogenic factor m the anieno piiuitarx 

Dr Aldrex Rlssell pointed out that clinical studies o the 
factors controlling lactation were complicated bv the frequent 
spontaneous return of ovarian activiiv dunng lactation 
Investigation of the lactation and menstrual hi tones of a 
large group of mothers in St Pancras where the figures fo' 
successful breast feeding seemed to be about 2 per cent 
higher than those given bv Dr Spence for the Nonh of 
England indicated that there was a definite relation between 
amenorrhoea and successful lactation Although failure of 
lactation was possibh due to endocnnal changes m less than 
10 per cent of women in fullv xq per cent the cause was 
mechanical inefficiencv of suckling and emptving of the breast 
The maintenance of this secretorx reflex was most important 
and Dr Russell desenbed an ingenious method of introducing 
a catheter into the babv s mouth to give complementarv 
feeds at the same time as breast feeding was going on m 
cases, of insufficient secretion in order to encourage good 
suckling despite the poorlj filled breasts 

Dr Ethel Cvssie (Birmingham) said that among matemitv 
and child welfare workers she had found the belief wide 
spread that breast feeding was diminishing, that this vvas the 
result of maternal overanxieiv or because the mothers were 
going out lo work and that as artificial feeding was now so 
easv and safe this slate of affair^ did not matter It vvas 
obvious that if «uch views were held advocaev of breast 
feeding could not alwavs be as whole he<irted as manv people 
desired Dr Cassie thought that the mother s diet especiallv 
as regards fir't-class protein was not sufficientlv talen into 
account Figure^ for Birmingham showed that while the 
babies were under the care of the midwife onlv 3 per cent 
were artificiallv fed, and that b> the time the health visitor 
tool charge the figure had jumped to 12 per cent Belter 
management of breast feeding and careful instruction of the 
mothers was the mam solution of the problem 

Dr C K J Hvmilton thought that proper management was 
the most important factor in success it was a mistake to 
imagine that breast feeding vvas a natural process which could 
be left to maternal instinct as vvas shown bv the fact that 
breast feeding had been re established successfullv m fifiv out 
of fiftv four cases Failure began when the mother left her bed 
and went back to household duties and it was important that 
mothers should be able to obtain prompt advice when there 
was anv temporarv diminution in secretion Advice at the 
ante-natal clinics should be of great help Test feeding vvas 
most valuable in estimating the degree of failure and m 
helping in its correction 

The CH\IR^LXN (Dr Lindsax Dev) emphasized the great 
importance of breast feeding dunng the first three months of 
life Postgraduate instruction of doctors in this matter was 
neccssarv Dr J Greenwood Wieson (MOH Cardiff) 
agreed that more knowledge of the advantages of breast 
feeding over bottle feeding was needed \\orking back from 
a <enes of children leaving school he had been unable to 
detect anv difference between those who had been breastfed 
and tho'e who had been bottle fed in infancv He thought 
from personal expenence that well managed bottle feeding 
was easier to attain than well managed breast feeding Modern 
unrest and pleasure seeking were perhaps the strongest 
influences against breast feeding Dr P De Fremery 
(Holland) desenbed the activjiv of the lactogenic and oe^^lro- 
genic hormones ^n goats Under the influence of oc'trogcnic 
'ub'tances the udder developed percutaneous administration 
being best Dr A G Watklns (Cardiff) thought that the 



:<i> Jin If) }')>'' 


niJI Mr MOIHAL TRUST 


TiicBstijsjf ^ 

MtlilCXV Jdvxnu 


xiiliition t'l i)k pti'Mcniv of lii.tiIion licj in x'lih iJn. 

nlc<|i' lie Ininiii) ol im.i)u il stiulinl'> nuf nurses I’liblie 
lieililt Miirfscrs in ('irln-iiln rti/nifCil more tlciiifctl priclicil 
iiisliiisltoii Insiitisiion of inoilicis ifiirinc ifit .infe ii il iJ 
rsnoJ IMS most csscntiil Or Run Vuy, fNcn DcHn) 
s.iii( lltil in fmlii tfit ini/orin of inf nils »»)io snruicd Ilie 
bvs\ mwwU stuwest i siLuh inernse in sscitbt up to the 
scscufU or culul. inonih of life Vf ll.e tliu of nnnr of 
the inotficrs IMS tsfrciiiefi dckai^c icconlini, to minUx 
ascplctl sumirnls otien heUnr, cntirch in first chss prolun 
trequentis in fit and somclinics in fresh vctclables It was 
possible therefore tint defectne diet w is not such an im 
port ml eiuse ol fnlurc of breist fecclmt as had been 
Mieeested Dr M sms H D Gvntuik (Cshcr) speaking ss a 
mother who had breast ted her babj pointed out that breast 
fccdinc entailed i big social sacrifice ind it was also fai too 
much \s rapped up ssith modests Mothers fed their babies 
in sohtsrs state and licked cncbiirigcnicnt Dr DoROTin E 
Mssov (Bethnal Green) described the o\cr feeding that 
resulted from rigid insistence on a foiir-hourh programme 
In her district recentiv abscess ot the breast had appeared as 
in important cause of failure of hreist feeding and might be 
due to non cmptiing of the breasts Dr E C Dawson 
(Derbt) stressed the significance of psichological fr.ctors The 
bab> ssas most often brought to the general practitioner foi 
fretfulness and he found small doses of sedatue drugs 
(bromide and chloral! most valuable as a first step in getting 
things right again 

Dr F M B Allen (President Belfast) rennrlved tint the 
problena had evisted m ancient Rome As a teacher he 
found tt essential to be dogmatic with definite rules, espccnlB 
pajtng attention to the difficulties and how the\ might be 
o\ ercome ^ 


BEIT MEMORIAL TRUST FOR MEDICAL 
RESEARCH 

A meeting of the Trustees of the Beit Memoiial Fellow- 
ships for Medical Research was held on July 13 for the 
election of Fellows and other business 

The total number of Fellowships held by full-time 
workers during the year I937-S was twenty-three The 
number ot candidates at the present election was higher 
than usual Five applied from Canada and three from 
Australia Fortunately leserve funds made it possible 
to award more Junior Fellowships than are ordinarily 
given each year and the election of twehe new Juiiioi 
Fellows brought the total of those elected since the 
beginning of the Trust in 1910 to exactlj 200 A 
tresh edition has been printed this year ot the Green Book, 
which summarizes briefly the after careers of each Fellow 
and their present position in research 


Election of New Fellows 


The following elections were made 

Scinoi Fellowship (\alue £700 a \ear) — David Ezra Giecn 
M Sc Ph D To continue his research on the role of 
vitamin B, in the oxidation of pvrirvic acid and to sludv a 
new fiavin-protem compound in milk (Institute of Bto- 
chemistrj Cambridge Universitv) 

Toiiiili } lai Fellowship (value £a00 a vear) — Mver Head 
Salaman M A M D To continue his research on vaccinia 
and animal po\ viruses (Listei Institute of ^Preventive 
Medicine London) 


Jiiiiioi Felloxi ships (normal value £400 a vear) — Geoffrev 
Bourne D Sc Biochemist Commonwealth Advisor> Council 
on Nutrition Svdnev NSW I9S7 Proposed research the 
significance of vitamin C in the endocrine svstem (Depart- 
ment of Human Anatomv Oxford UniversU)) Andrew 
Lawrence Chute BA M D Proposed research evperi 
mental studies in naetabolism of the brain (Department of 
Ph>sioIogv Universitv College London) Robert Oswald 
Leonard Currv M A Ph D Proposed research the phvsio 
logv of speech disorders bv photographic studv of larvngeal 

D°meTb" R London) James Frederick 

D nictVi B Sc Ph D Proposed research the permeahilitv 


of normal md denerv Ucd muscle to vnetAbolic products and in 
drugs finsiiiule of Biochemislr> Cambridge Universitj) John 
George Dew an A M D Proposed research msulm 
shock treatment of schizophrenia b> experimental studies ot 
brain metabolism (/nstitute of Biochemistry, Cambridge Umvet 
sitv ) Catherine Olding Hebb, M A , Ph D Proposed research 
the effect of thoracic sympatbectomy on the activities of tk 
lung (Department of PhjsioJogs, Edinburgh Umversiiv) 
Bernhard Katz M D Ph D Proposed research elccim 

excitation and transmission of impulses in nerve and nwsde 

of animals (Department of Biophysics Universitv Collece 
London) Jonas Henrik Kellgren M R C P , F R C S Pro 
posed research painful conditions of the limbs and had 
(Department of Clinical Research Universitv College Bos 
pitil) John James Duncan King Ph D L D S Proposed 
research denial canes and parodontal disease (Medical 

School Sheflield Universitv) Hermann Lehmann, MD 

Ph D Proposed research blood sugar in animals, and iron 
metabolism m plants (Institute of Biochemistrv Cambridte 
Universitv) Walter John O Connor MB BS Proposed 
research effect of strophanthin on the oxvgen consumption 
of the heart (Laboralorv of Pharmacology Cambridse 
Univcrsiti) Harold Scarborough MB Ch B Proposed 
research mode of destruction of vitamin C in the human 
bodv (Clinical and Chemical Laboratories Royal Infirmari, 
Edinburgh) 

All correspondence of Fellows and candidates should be 
addressed to Professor T R Elliott M D F R S honoran 
sccretarv Ben Memorial Fellowships University Collece 
Hospital Medical School Universitv Street, WCl 


THE C\NCCR CAMPAIGN 

Viscount Hailsham 'presided at the sixtv seventh qvnileilv 
meeting of the Grand Council of the British Empire Cancer 
Campaign held at 11 Grosvenor Crescent on Jiih H 
On the recommendations of various committees the follovun' 
grants were made totalling £171^ in addition to Ik 

sum of approximatelv £4“! 000 which Ins alreadi been 
approved in grants for the calendar vear 1918 il iK* 

towards the expenses of the work of the Radium Bewi 

Therapv Research £7s0 for the expenses of the re'eanb 

being earned out bv Mr F C Pvbus at Newcastle £300 'a 
Dr P R Peacock at the Glasgow Roval Cancer Hospital 
for the salarv of a whole time assistant £49'i for the salat) 
o'" the phvsicist at the Strangevvavs Research Laboratoi) 
Cambridge £750 for the expenses of certain iiivesugatioii' 
heinc cained out under the diiection of Dr P M F Bobop 
and Mr H J B Atkins at Guy s Hospital £270 to Dr khn 
Bruce at Edinburgh Universitv, for part time investiEations 
and £a0 for a replacement in apparatus at the StTaogv'i.vis 
Reseaich Laboratory 

The Council decided that the fifth biennial informal cob 
ference of cancer research workers should be convened bv w 
Campaign m the spring of 1939 It was gratified to learn tw 
King Edwards Hospital Fund for London had mlmwt™ 
willingness to cooperate with the Campaign in ils nevv' 
inuigurated scheme for the coordination of clinical eaa 
research bv stimulating the establishment of efficient folW’ 
up systems for cancer patients tn the hospitals 

A selection committee is considering applications w’’'* 
post of fuU-tiTvae Medical Secretarv and Registrar 
appointed the successful candidate will proceed to 
States and other centres to studv the latest methods of oi-a j v 
With statistical information The new departme^ *^I 7 (K 1 () 
Campaign will deal with the lecords of approximate!' ^ 
nevv cases of cancer annually, supplied by over 100 1'O‘P 
m the London metropolitan area r nr G 

Gland Council approved of the reappomiment ^ 

Cranston Fairchild as the William Morns Research reu 
Radiologv at Mount Veinon Hospitil for a lurtlier p- 
of three vears subject to an annual recommendation _ 
Council of the Radium Institute and the Mmmt 
Hospital This Fellowship vvas created bv the , £,( 

1931 at the request of Loid Nuffield who provided a '' 

£25 000 for the purpose of promoting research ju 

studv concerning the treatment and cure of cine 
radiology 



Jll\ 30, I93S 


ENGLAND AND WALES 


Tifr BjimsT? 

'•llDtCxL JOLB'.AL 




Local News 


ENGLAND AND WALES 

National Hospital Nc« Wards and Research Department 

The new wing of the National Hospital for Diseases of the 
Nervous Sjslem perhaps belter known as Queen Square 
Hospital, London which was opened bj Queen Marv on 
Juli 19 increases the accommodation of the hospital be 
43 beds and provides two entire floors and a basement lor 
research work The building adjoins the old hospital over- 
looking the square, and is severely simple in its lines with 
no ornamental detail 

The two highest of the seven floors are devoted to single 
bed wards where patients can have the privacv that is often 
so desirable in an institution for this class of case Each 
ward has one of its walls consisting almost entirelv of window 
which can be opened out upon the gardens and trees of the 
square below The fifth floor contains two operating theatres 
with a large sterilizing room and a room for a rav diagnosis 
Students galleries are built in the theatres in such a wav that 
their occupants can obtain a close view of an operation from 
the best possible angle although separated from the mam 
theatre bv sloping glass screens Below this theatre floor there 
are three floors occupied bv four bed wards two of them 
surgical and one medical and here again one of the walls 
Is glazed and can be opened out to give the ward the effect 
of a balconv The first floor ground floor and basement are 
given over to the purposes of laboratory research and teach 
ing The post mortem department is in the basement with 
two small chapels attached one for Jewish riles On the 
ground floor there is a large leclure theatre and two sets of 
consulting rooms where the phvsicians and surgeons of the 
hospital can see private patients and all the remainder of the 
space on these floors apart from a libran and a refectory 
IS occupied by laboratone The furnishing of these labora 
tones has had special atienlion and in the search for ideas 
some of the best equipped laboratories in various parts of the 
world have been visited including the famous physical 
chemistry institute of fjpsala The complicated system of 
electneal and mechanical services has been installed in such 
a wav that in the finished building thev obtrude themselves 
to the least possible extent ■Ml the benches are standardized 
and movable and can be placed anywhere around the walls 
or in the centre of the room with the certainty that the 
necessary services will be available at anv point On each 
landing there is a clock which dials the number of anv member 
of the staff who is wanted and the number is dialled fifteen 
times in succession until the truant is traced Electrically 
controlled blinds close the windows when a bution is pressed 
In the private wards the lights can be dimmed from outside 
without the necessity of entering and disturbing the patient 
There are innumerable contrivances of this kind Another 
amenity is the provision of waiting rooms on each floor for 
the friends of patients 

The new building which is not vet occupied — the 
shortage of nurses here as m other new hospitals is one 
cause of delay — is by no means the end of present develop- 
ments at Queen Square It is hoped to build a new 
nurses hostel for which a neighbouring sue has been 
acquired and to reconstruct the out patient department 
The new wing especially the research department has 
been rendered necessary by the fame of the research work 
in neurological medicine and surgerv done at this hospital 
The accommodation for research became inadequate and 
in 1935 the Rockefeller Trust gave £60 000 towards the 
building on condition that another £60 000 was raised 
The Trust gave a like sum to be invested for the endow- 
ment of research The second £60 000 was more than 
secured from three sources — £29 000 from Lord Nuffield 
£II 600 in response to a broadcast appeal and £20 000 
from picture house collections In addition there have 


been many othe large gifts including £I 000 from the 
Corporation of the Citv — recalling ihe'lact that the ho< 
pilal Itself was started as the result of a Mansion House 
meeting — and the building fund has now reached tl^btXKi 

3 oluntarv Hospitals of Sheffield 

The Duchess of Gloucester \isited Sheffield last wed 
to inaugurate an appeal for £1 000 COO for the ciiv s voliin 
tarv hospitals During the dav she attended a meeting 
at the Citv Hall opened a new ward at the Children s 
Hospital for the treatment of children under 1 year 
suffering from dietetic disorders and laid the tounda ion 
stone of the new maternity block at the Jessop Hospital 
It was announced bv Mr W R S Stephenson chairman 
ol the executive committee of the appeal that two third' 
of the sum required would be found bv employees and 
employers m the district who already contributed to the 
maintenance of the hospitals through the penny in the 
pound schema The remaining third would it was 
hoped be subscribed bv the general public and public 
bodies The aim of the scheme ot reorganization ot the 
Sheffield hospitals was to centralize all specialized work 
At the Jessop Hospital Mr James Henderson chairmar 
of the board of management explained that additional 
maternity beds were the most urgent of Sheffields hos 
pital needs and the financing of the new block at that 
institution would be the first call on the £1,000 000 appeal 
fund 

A Conialescent Home in Kent 

The opening of a convalescent home near Tunbridge 
Wells bv Sir Kingsley Wood on JuK 1 marks the recog 
nition bv the Kent County Council of the need tor 
restoring the individual to fuller health than is afforded 
bv actual hospital treatment The establishment of this 
home has been made possible through the generosity of 
Mrs Vera Salomons whoJias presented the house and 
grounds by deed of gift The house was formerly the 
home of her family and is being named the David 
Salomons House m memory of the father of the donor 
It IS a spacious countrv house standing in about thirty 
five acres of beautifully wooded grounds and has been 
adapted bv the Countv Council to provide accommodation 
for seventy female patients between the ages of 15 and 
45 In view of the importance of diet during convales 
cence a cook dietitian has been appointed and every effort 
has been made to depart from the hospital atmosphere 
and to create restful and pleasing surroundings There 
are adequate facilities for rest and recreation both indoors 
and out and there is a well-equipped theatre attached 
to the house for the entertainment of the patients Until 
recently conyalescent treatment has only been possible 
through the agency of voluntary bodies or by the private 
arrangements of the patient and the fact that the Kent 
County Council has provided such treatment as part of 
Its public health service is a noteworthy advance in the 
care of the sick The decision to use the home for 
female patients m the 15-45 age group is important 
While the average man after his discharge from hospital 
has some time on sick benefit before returning to work 
the housewife who will be represented bv many patients 
m this group often goes straight from hospital to full and 
arduous work in the home 

Notification of Measles and M hooping-cough m London 

The Minister of Health on July 15 inserted a notice 
m the London Gazette advertising regulations which it is 
proposed shall come into operation on October 1 next 
for the compulsory notification by medical practitioners 
of all cases of measles and whooping cough occurring in 
the Administrative Countv of London except in the 
following cases 0) If a previous case of measles or 
whooping-cough has occurred m the house and has been 
notified within the preceding period of two months (2) 



252 July 30, 1938 


ENGLAND AND WALES 


Tiic BumsH 
Medical Jolils»i 


It the case is being treated in a hospital for infectious 
diseases (3) Where the patient has been admitted into a 
hospital belonging to the London County Council 
Regulations which are already in operation in, certain 
Metropolitan Boroughs for the notification of one or both 
of these diseases will be rescinded by the new regulations 
Measles and whooping-cough are notifiable only in those 
places for which special regulations of this kind have been 
made Reference to this matter was made m our 
Epidemiological Notes last week 

9 

Cost of Medical Care to Local Authorities 

The Minister of Health has now issued Part 1 of the 
Costing Returns for the year ending March 31, 1937 
(H M Stationery Office, Is 3d ) The returns relate to \ 
all the principal institutions (other than infectious disease 
hospitals) for the treatment of persons in need of medical 
or surgical care and attention which are administered 
or utilized by local authorities in England and Wales 
The institutions for which particulars are given comprise 
Poor Law hospitals, general hospitals administered by 
local authorities sanatoria and other residential institu- 
tions tor the treatment of tuberculosis and maternity 
homes and hospitals The mam object of this publica- 
tion IS to assist local authorities in the economical 
administration of the institutions under their control by 
enabling each authority to make comparisons between the 
average costs of their own institutions and of the com- 
parable institutions belonging to other authorities Care- 
ful investigation into the causes of divergencies in unit 
costs is a valuable method of securing economies and 
improvements in methods of administration 

Board of Education Report 

The annual report of the Board of Education for 1937 
(Cmd 5776, H M Stationery Office, 3s 6d ) covers the 
calendar year and is, as usual, combined with the Board s 
statistical tables, most of which relate to the period 
ending in March or July The introduction to the lepoil 
mentions some of the outstanding events of the year One 
was the introduction of the Government scheme for the 
development and extension of opportunities for recreation 
and physical education , a fuller account of this is given 
m Chaptei I The Board s total estimate for the year 
1937-8 was £49,500,000 — nearly £1,500 000 more than that 
for the previous year Most of this increase was due 
to larger expenditure bv local authorities on elementary 
and higher education Substantial progress was made in 
all branches of educational activity including the School 
Medical Service, and in particular the report comments on 
the more rapid growth m the provision of nursery schools 
Widespread attention has been given by local authorities 
to the institution of preventive and instructional measures 
designed to promote the safety of children on the roads 
The results of an inquiry into children s homework and the 
conclusions of the Board on the subject were published 
m 1937 The Board again calls attention to the impor- 
tance of the appointment of organizers of physical educa- 
tion At the beginning of 1936, out of 316 local education 
authorities, only 124 employed these organizers By the 
end of last year the number had increased to 232 authori- 
ties Steps were taken to meet the need for an increased 
supply of teachers capable of giving instruction m physical 
training The Board explains in some detail the circum- 
stances in which the Government scheme for the develop- 
ment of opportunities for recreation and physical training 
was launched During the past quarter of a century 
educational practice has been steadily moving from a 
narrow interpretation of formal training to the widei 
conception of developing the individual A similar change 
has transformed physical education in the schools from a 
system of formal drill into one of free exercise embracing 
not onI> gymnastics and physical exercises but games 
swimming and all sorts of outdoor activities This wider 
vilw of the educational process was recognized m the 


Education Act of 1918, which gave local authorities poviLr 
to supplement and reinforce the instruction given in thi 
schools oy providing opportunities of social and dijsical 
training for school children and young persons But the 
opportunities for young people to indulge these tnterestb 
have tn the past been incomplete These considerations 
moved the Government, spurred on by the British Medical 
Association Report, to set up the National Fitness Council, 
and through the Physical Training and Recreation Act 
1937, to confer on local authorities new and extended 
powers for providing gymnasiums, playing fields camps 
community centres, swimming baths, and the like The 
report gives some account of the work which the National 
Fitness Council has already accomplished From the 
section on school meals and milk it appears that onlj 
about half the children in public elementary' schools lak 
advantage of cheap milk The number of authoritiu 
providing school meals or milk during the year ending 
March 31 1937, was 247, compared with 235 in the pre 
ceding year by the end of the calendar year 1937, 2i9 
authorities were providing meals or milk The Board \ 
points out that the Advisory Committee on Nutrition 
recommended that children should take from one to tno 
pints of milk a day, and it regrets that parents do not 
appreciate more fully the opportunity provided b\ th 
miik-m-schools scheme of obtaining so valuable a food 
for their children at half-price 

Preston Hall, Maidstone 

Two matters call for special notice in the report of the 
medical director of British Legion Village, Preston Hall 
for the two years ended September 30, 1937 The lint 
concerns the future of this settlement It has been obwoui 
for some lime that Preston Hall could not continue as a 
centre for the treatment of e\-Service men only indeed, 

38 per cent of those now under treatment are not ex 
Service men The council of management has iheretoie 
recommended to the National Executive Council that tin. 
British Legion should continue to be the owners of Preston 
Hall and be responsible for its future and that a separate 
appeal should be made on behalf of Preston Hall ‘"M 
the clear understnnding that the money would be required 
to carry on a national work for the whole of the com 
munity, and not for e\-Service men only ’ The second 
matter is the “ arrested-cases scheme ’ A number of 
patients in whom the disease has been arrested and "ho 
are still working in Preston Hall industries are now resi 
dent not in the Village Settlement itself but in houses 
m the neai neighbourhood These houses are being bmit 
by private enterprise, and are purchased or rented, sonx 
times w ith the assistance of the British Legion In ad^ 
tion, twenty-four settlers considered to be within wr 
category of “ an ested cases ’ have left the Village ana 
are working elsewhere in England It is emphasized inJ‘ 
no pressure of any kind is brought to bear on these nun 
to move that no relapses have been reported m 
group and that the introduction of this scheme has m 
no effect on the number of fresh applications w 
admission to the settlement 

London Emergency Bed Service 

The Voluntary Hospitals Emergency Bed Service ha| 
now completed its fifth week of working, and in spifc 
having taken deliberate steps to avoid any rush of » > 
when It was opened it has already dealt with "clI 
500 cases The actual cases offered have varied 
considerably, and though all types of medical and surg 
emergencies hax'e been dealt with, the average leog 
time between receiving a message from a 
obtaining admission for his patient is still m tne » ^ 
bourhood of five minutes It is possible, if Mi ^ 
cumstances are favourable, to complete the arrang 
for the admission of a patient within three nni 

done in the case of a doctor who telephoned at i 
asking for admission for a patient suffering tro 
appendicitis , by 1 18 pm the Milter Hospital na 



JuLV 30 I93S 


ENGLAND AND WALES 


Thx Bxjtkh 
M aj cjll Ioct>u. 


253 


to take the case at 1 19 p m an ambulance had been 
ordered and at I 20 p m the doctor was informed that 
an ambulance would call for his patient Manv doctors 
are apparently still reluctant to use the Sera ice as is 
eaidcnccd ba the fact that on 'caeral occasions doctors 
aaho haac made use of it haae said that ihca had already 
tried three hospitals all of aahich had recommended them 
to nng Metropolitan S7S1 In one instance a doctor said 
that he had spent oaer an hour traing to gel admission for 
his patient and aahen he finalla rang the Seraice admission 
aaais obtained in seaen minutes The Seraicc is noaa capable 
of dealing aaith ana call that maa be made upon it, and 
It IS no longer neccssara lor doctors to hold back for fear 
of oacraa helming an untried institution 

The Case for Cremation 

A conference organized jointly by the Cremation 
Society, of aahich he is president and the Federation of 
British Cremation Authorities aa-as opened by Lord 
Horder on Jula 22 at Balliol College Oxford Lord 
Horder said that earth burial aahich had long been a 
luxury aaas to day a social crime On Ihe score of lack 
of reaerence this at least could be said for cremation — 
that It spared the irreaerence of exhumation aahich avas 
the lot of so many thousands of bodies and it spared also 
the neglect of graaes so eaident in many cemeteries 
Moreoaer, the crematorium chapel avas more comfortable 
than an open graaeside and spared much to mourners 
aaho often attended funerals m an impaired state of health 
due to the anxiety of the period through aahich they had 
passed Cremation ba reason of its system of certifica- 
tion enforced by the law both presented and detected 
crime Death certificates signed ba medical men aaho had 
not examined the bodies after death were impossible m the 
case of cremation, for aahich two medical certificates aaere 
demanded and these must be completed to the satisfaction 
of a medical referee before cremation could take place 
Leeds City Council was represented at the conference and 
this week Alderman Masser has opened a neav crema- 
torium at Cottingley Hall Dr J Johnstone Jems 
medical officer of health for Leeds in a handbook 
describing the Cottingley Hall Crematorium writes If 
anyone aaere to ask me aahat, m ma opinion aaas the ideal 
method of disposing of the dead I aaould unhesitatingly 
reply cremation The reasons for this answer are first 
that It is the most hygienic method secondly that it is the 
most expeditious method and thirdly, that it is the method 
best suited to the times in aahich we liae WTio aaill say 
that a graveyard m the midst of a thickly populated city 
or eaen in a suburban area, is a benefit to the peoples 
health? 


SCOTLAND 

Edinburgh Lmversrty Graduation 

At the medical graduation of Edinburgh Uniaersity 
on Julv 20 Lord Taaeedsmuir aaas installed as Chancellor 
of the Uniaersity in succession to the late Sir James 
Barrie There aaere thirteen recipients of the honorary 
degree of LL D including the Goa ernors General of 
Canada India and Australia and tavo Cabinet Ministers 
one of avhom aaas Dr Walter Elliot the Minister ot 
Health Lord Taaeedsmuir in his address, said that 
a uniaersity avas not a mere wicket gate aahich once 
passed was no more thought of it should influence every 
stage of life- It had tavo plain duties — to transmit 
knoaaledge and to adaance knovaledge — and both required 
equal emphasis Genera! culture aaas of little value to 
a young man if he was going to starve but on the other 
hand if they had only aahat had been called the service 
station conception of a university they aaould haae men 
entering a profession without having been taught to 
think The purpose therefore of the university should be 


to combine humanism with technique The other primary 
function of a uniaersita was to pursue truth ba research 
experiment and speculation Our forefathers based all 
learning on the study of philosophy and Lord 
Taaeedsmuir suggested that thea should return to an 
insistence upon the liberty of the mind If thea could 
give to the youth minds accustomed to think and 
inspired with a reaerence for thought and at the same 
time give them the perspective created ba understanding 
our long human stora they a ould be endowed with con 
fidence and hope It was often said that modem youin 
lacked the enterprise stamina and fortitude of their 
fathers, but he believed this to be untrue Those aaho 
to day entered the church medicine law or commerce 
found the technique of these professions more elabora e 
than It was in their fathers day that delicate structure 
called civilization had to be maintained in a world tuU 
of destructive forces The mechanism of society to-day 
had become so intricate that it was far more exposed 
to disaster than the simpler mechanism of earlier daas 
and they could only preserve the standards bv the 
constant exertion of intelligence The Chancellor after- 
wards conferred the M D degree upon sixteen graduates 
and those of MB Ch B upon 163 graduands 

Principal of the Vetenn 2 r\ College 

The Governors of the Royal (Dick) Vetermary 
College Edinburgh haae appomted Colonel Sir Arthur 
Olaer CB CMG FRCVS to be prmcipal of this 
institution in succession to the late Dr O Charnock 
Bradley Sir Arthur Olaer who is 62 recently retired 
from the post of Animal Husbandry Expert to the 
Imperial Council of Agricultural Research m India 
In 190S he was appointed Assistant Director General of 
Army Veterinary Services and for his work in the war 
he was awarded the CMG and C3 He was 
instrumental in introducing many improvements in 
animal husbandry and veterinary education , among them 
were daira farms in each of the five provincial aeterinara 
colleges of India He also drew up the scheme for a 
higher-grade veterinary college m India m which he laid 
special stress upon the subjects of animal nutrition and 
animal genetics 

Conference on Health Education 

At a conference organized by the Department of 
Health for Scotland in the Empire Exhibition, Glasgow 
on July 19, Mr H J Scrymgeour Wedderbum 
Parliamentary Under-Secretary of State for Scotland 
who presided said the future of Scotland depended on 
the health of the young people who were leaving school 
at the rate of 90 000 a year Mr Joseph Westwood 
M P suggested that the three routine medical inspec- 
tions during school life could be cut down to two and 
that medical staffs might thus be freed for work among 
preschool children Medical services should be pro- 
vided for the family m the same way as they were for 
the insured worker The law should be amended so that 
local authorities might provide meals for school childrerr 
as a preyentive measure a good midday meal wou'd 
prevent much of the debility which they were now seek 
ing to remedy The medical profession must work in 
the closest harmony with the local municipal services, 
and the State must give local authorities the necessary 
financial assistance Mrs Walter Elliot speaking of the 
young citizen pointed out that there was really no 
control after boys and girls left school there were 
many voluntary organizations to cater for them hut 
these did not attract more than one m th-ee of the 
juvenile population 3XTien people were removed from 
the slums to charming new houses their social interests 
and leisure time should also be catered for Sir John 
Bovd Orr considered that the physique of the youth of 
today was better than that of his fathers generation 
and he believed that twenty years hence there would be 



254 July 30, 1938 


SCOTLAND 


TtiEBumsH 
Medical Journal 


sli\l further improvement The extension of the school- 
leaving age by another year would be a great benefit in 
providing another year s discipline and much could be 
done in the last two years of school to impress upon the 
child that Its future lay in its own hands A healthy 
physique and character were of more importance for 
success in life than a good deal of money or a great deal 
of academic learning The youth of to day was not 
so much impressed with the necessity for getting on in 
life as was the youth of twenty-five or thirty years ago, 
but he was beginning to realize that he was a debtor to 
the community, and that he had to make some contribu- 
tion foi all he had received from it The chairman 
said that Scotland was a small nation with a population 
under five millions The fall in the birth rate had raised 
many issues of high policy in the State and one problem 
was to secure that those who were born were equipped 
to lead a full and useful life The conference had 
bi ought home to them that the health organization of 
Scotland was doing a great work, although it was not 
perfect and was not sufficiently used They were now 
spending £20,000 000 m Scotland on health services of 
every kind, but he doubted whether they were getting as 
high a return for it as they ought 


Correspondence 


Bragg-Paul Pulsator 

Sir — O n July 8 an SOS message was sent out by the 
British Broadcasting Corporation asking for a Bragg- 
Paul pulsator, which was required for a case of respiratory 
paralysis at the Ipswich Hospital A pulsator was at 
once sent off from the London Hospital, but did not 
anive in time In a recent article (Bntish Medical 
Jotiinal June 4, p 1206) Dr C J McSweeney, of the 
Cork Street Hospital in Dublin, described the use of the 
pulsator, which he said had enabled him to tide over 
the period of complete paralysis of the thorax muscles, 
and to save life, in twenty-six cases Quite recently a 
pulsator was required for a serious case in Belfast , 
fortunately, a spare pulsator had just arrived at Dr 
McSweeney s hospital, and was sent off at once It was 
huiried through the Border Customs, and arrived in time 
to be applied successfully It is hoped that by this 
time the child is out of danger It seems obvious that 
pulsators should be kept in readiness at known centies 
so as to be available for immediate use by qualified 
practitioners 

The particular form of apparatus which goes by the name 
of the Bragg-Paul pulsator had Us origin in an attempt to 
give relief to a friend of mine and to his familj My friend 
suffered from an extensive paralysis he was quite unable to 
breathe For months he was kept alive by nurses and 

lelations who used a simple method resembling that which 

IS prescribed for cases of apparent drowning 1 thought that 
It might be possible to reduce the labour and inconvenience 
and I arranged that a football bladder should be bound upon 
mv friend s chest connected with a similar bladder fixed 
between two hinged boards Bv closing and opening the 

hoards the chest was alternateU compressed and allowed to 
recover b> Us natural elasticitv It was very much a home- 
made apparatus but it worked and was in use for a long 
time 1 then asked mj friend Mr Robert W Paul to 
improve the design and if possible to draw power for 

working It from the water mains electricity was not then 
ivailable This he did in a very ingenious manner For three 
years or so mv friends breathing was accomplished entirclv 
hv the pulsators we made He lav in bed all the time The 
vpplication of the apparatus caused him no inconvenience nor 


did It intcifere with his nursing The tube connecting the 
pulsating machine with the hollow bandage which had now 
replaced the football bladder was hidden by the coverings of 
the bed and there was no evidence of anything unusual 
except the quiet click-clack of the pulsator in another part 
of the room 

Mr Paul then designed the apparatus for use on the 
electric ciicuit and has recently improved il m many 
ways, which have been suggested during Us use m hos 
pitals Among other changes the electrically driven 
gearing is enclosed in an oil bath, and the new pulsator 
IS practically noiseless Several pulsators have been mide 
by Mr Paul, or under his direction, because he is 
naturally interested in perfecting the design I am sure 
that Mr Paul (69 Addison Road, London, W 14) will 
gladly give advice to any person or institution proposing 
to procure one of the new pulsators To avoid mis 
understanding I would add that 1 am not financially 
interested in the apparatus — I am, etc , 

The Royal Institution, London, W t, W H Bragg 
J uly 21 

Abortion and the Law 

Sir — There has been so much discussion in the lay press 
on the different aspects of my recent prosecution that, 
for the first time, I should like to make some points clear 
to mv fellow members of the profession through your 
columns 

Before this case was brought before the courts it is a 
fact that, despite what has been said to the contrary, the 
question of even therapeutic abortion has been a source 
of great anxiety to doctors, chiefly those in general 
practice Uncertainty exists because it is so difficult to 
define what constitutes an indication for the operation 

We all know that there are many vague and almost 
indefinable conditions which, as serious danger to health 
though not to life, are much more important than imm 
straight cases of heart or chest disease The latter often 
suffer little or no real depreciation of health, but the) 
carry the label of a named disease, which is readii) 
accepted by laymen , the former class, by reason of the 
lack of concise clinical definition, may not be readih 
convincing cases in any subsequent legal investigation 
These patients form the real problem 

It IS comparatively simple for the consultant obstetrician 
behind his defence of special knowledge and experience, 
particularly in large centres, to induce abortion, but it is 
a very different problem for the general practitioner m a 
small town or country district Between the pressure 
exerted on him by the patient and her husband on the 
one hand and the justifiable fear of misinterpretation o 

his action by gossips, or even the police, on the other, hi 
position can be very difficult , 

For years I have been impressed by this difficulty aij 
decided to bring forward a test case, when the opportum ) 
arrived, in which there would be no real danger to i/^ 
(except suicide, which is occasionally committed by £i 
patients) but m which one .might very strongly , 
great danger to health I was also concerned to esia i^^ 
in the eyes of the law that mental health vvas fi'* 
important as physical health and in certain cases pet 
even more so This does not mean that I regard a or 
as necessary in most cases of insanity I arn dpp 

my colleagues practising psychiatry that the 
plays little or no part as a treatment or prophy a 
most forms of insanity I also wish to state jg 

that 1 did not bring the case forward as an 
alter the law by direct action, but to obtain a 
definition of the present law 



JuL\ 30 I93S 


COR RESFONDENCE 


The \ltornL\ Gencnl aclmitlcd that abortion is legally 
I rceognized when life is in danger Now wc know that it 
IS also admitted where there is sirioiis danger lb health 
Much emphasis must be placed on the italicized word 
scriotir I would not ha\e it be beliesed that I ha\e 
worked for a loose interpretation of a law which I ha\e 
obsersed meself perhaps too rigidh Nesertheless I 
cannot help feeling that the majoritj of the profession 
would feel that thc> are on safer ground if the precedent 
just established were incorporated in a new Act passed 
in da\s of much more knowledge of medicine surgerv, 
and psjchologs than was asailabic in 1S61 — 1 am etc, 
London 1 Jul\ 2s ALECK BoURNE 

Sir — ^\Ve read in the newspapers here that bfr ^leck 
Bourne is being prosecuted in London on account of the 
performance of an illegal operation From what 
one has seen it would appear that the operation was the 
production of abortion in a girl who had become pregnant 
through rape It would also appear as though he had 
done this openU perhaps as a lest case If this is so 
he surelj deserses not onlv the thanks of his medical 
colleagues but also the gratitude of the public, who may 
at an\ time be Mctims of such assaults No doubt he 
will have the utmost support from the great bodj of his 
colleagues at home 

The subject has of course received a good deal of 
publicitj in vour columns of late and different views have 
been expressed I think it was recentlj reported that, 
during a discussion on the subject Mr Justice Humphrejs 
had expressed the opinion that a doctor feeling he 
should take this course would be advised to collect his 
colleagues about him thus being open m the matter, and 
that he then would have little to fear from the law It 
would appear that this is what has here been done, and, 
if so It IS to be hoped that the law will play its part 
fairly and honourablj 

Why after all, the inconsistency'’ If it is techmcallv 
illegal to procure abortion, then why has it been winked 
at where the reason was the preservation of health if 
an attempt is to be made to enforce it in cases where the 
motive IS to relieve the patient and her relatives of what 
IS to them a verv real misery'’ It has long been realized 
bv manv', and prominent among them the late Mr 
Justice McCardie that it was high time that such 
abortions were legalized and now surely it is more than 
time that this should receive official recognition Doubt- 
less a good deal will appear in the Journal regarding this 
case from better informed and abler pens than mine, and 
members of the profession will follow events with interest 
and feeling — I am, etc. 

Natal S Afneo July a David T MacLAV M B 

The Unconscious IMmd and Medical Practice 

Sir — In the Journal of July 9 (p 93) the late Dr 
Harry Campbell confesses to a difficulty in understanding 
what the unconscious of the psycho analysts may be, and 
blames them for not giving a precise definition of the 
term Speaking not as a psycho analvst but as a medical 
man interested in psv chological medicine I share his diffi- 
cultv but recognize the impossibility of defining one un- 
known quantity m terms of another Like Dr Campbell, 
I do not wish to initiate a useless discussion on terras 
and I have found the psychoanalysts view of the un- 
conscious quite clearly put forward bv Galton many 
vears before psycho analysis had become the httle under- 


ThxBju-ieh 05s 

VEdICAI, IoLTLN.IL 


stood but freely discussed and much misused term that 
It IS to day True, Gallon explams it by analogy onlv 
but perhaps this is as far as it is possible to go Inierested 
readers should refer to the EverVTnan s Lib-arv edition of 
Inquiries into Human Faculty wherein is a great deal 
of extremely stimulating matenal of which the 'ection 
on psychometric experiments has most bearmg on the 
present question On page 131 Galton writes 

The furniture of a man s mind consists of his recollections 
and the bonds that unite them As all this is the fru t of 
experience it must differ greatlv m different minds according 
to their individual experiences 

When I am engaged in trving to think anv thing out the 
process of doing so appears to me to be thus The ideas 
that he at anv moment within mv full consaousness eem to 
attract of their own accord the most appropriate out of a 
number of other ideas that are Iving do e at hand but im 
perfectly within the range of mv consciousness There «eeras 
to be a presence chamber in mv mind v*here a full consaous 
ness holds court and where two or three ideas are at the sane 
time in audience and an antechamber full of more or less 
allied ideas which is situated just bevond the full ken ot 
consciousness Out of this antechamber the ideas most nearlv 
allied to those in the presence chamber appear to be summoned 
in a mechanically logical wav, and to have their turn of 
audience 

The passage is too long to quote further but it is of 
interest to note that it was written in 1883 — I am, etc, 

Sheffield July 20 E FretSOX Skinner 

The Final M B , B Siond 

Sir — S ir Ernest Graham Littles letter in your issue of 
July 16 (p 153) seems to suggest that there is now some 
cause for congratulation at the recent decision of the 
Royal Colleges not to co operate with the University of 
London in regard to the final medical examinations 
With all due respect to Sir Ernest with whom I have 
for many vears maintained the fnendliest relationship 
max 1 as a general practitioner who is a graduate of 
London University and a holder of the Conjoint diplomas 
as well but who has also maintained close touch vvith 
his university ever since graduating on Convocation and 
as a member of the Standing Committee since 1927 be 
allowed to express a contrary opinion'’ I would like 
everyone to take the broadest possible view of the whole 
matter 

Ninety per cent of medical men enter into general 
practice — that is, into mediane m the widest sense AMien 
we begin a course of study at one of the London 
medical schools we do so with one object in view — 
namely to get qualified to get upon the Medical Register 
to be able to earn a hving in the field which we have 
chosen and to be able to attend people m sickness and 
.distress Once engaged in general practice the question 
of what degrees or diplomas we hold plays no part in 
the scheme of things at all Onlv one thing counts — • 
work — and for that we require not degrees but common 
sense energv keenness concentration and an insight into 
the patient s mind If further help specialist skill or addi- 
tional advice are required we must know where to get 
them whom to call in and the right moment to do so We 
who hold the MB B S Lond degrees are not conscious 
of superiority over our colleagues who possess merely 
the Conjoint diplomas Not only the public but ihe 
profession itself pavs no more deference to the M B 
B S Lond than to the Conjoint diplomate \fany London 
medical graduates are anv thing but a success in practice 
whereas many a Conjoint man has the biggest and most 
successful practice m the whole distnct We must look 


256 JULI 30, 1938 


CORRESPONDENCE 


TflC BRrTRH 
McojcAt JoiRsa 


these facts in the face and see them as they are and not 
just as we would like them to be It is popularity that 
counts in general practice not the possession of degrees 
Since 90 per cent of our medical students are engaged 
primarily in securing a registrable qualification in order 
to be allowed to practise, is it not fantastic that twenty 
men in one class should all end up with different degrees 
and diplomas after the same course of study‘s Is not the 
greater plea not merely for one common final examination 
in London but for one State final examination for every- 
one'^ After that, specialistic and higher degrees and 
diplomas would still be available in medicine, surgery, 
midwifery and gynaecology laryngology ophthalmology, 
and so on 

I maintain that every medical man, after five to six 
years study, should be a giadiiale and should exercise 
a graduate s Parliamentary vote It is not really difficult 
to arrange a final medical examination in London which at 
once gives the MRCS, LRCP diplomas and ipso facto 
passes three-quarters of the final London MB B S 
leaving only one quarter such as more advanced papeis in 
medicine, etc , to be completed to get the degrees — I 
am etc , 

Charles A H Franklin 
L incoln July 17 MDBSMRCS.LRCP 

X-Ray Screening Stand for General Practice 

Sir — I should like to congratulate Di Douglas 
Goidon on his description of a screening stand suit- 
able for fluoroscopic examination of the chest and 
abdomen {Journal July 2 p 21) 1 feel however 

that his description of the simplicity of this method 
of examination may be misleading as it is by no 
means an accurate method of assisting in diagnosis , 
in fact It may easily prove to be the reverse Early 
lesions in the lungs are often not visualized by screen 
examinations and when of sufficient density or tians- 
lucency to reveal themselves can seldom be differentiated 
Such a screen examination is more profitably made after 
an examination of the preliminary chest radiograph A 
screen examination of the abdomen without utilizing an 
opaque meal is only likely to give useful information in 
cases where the presence of a foreign body is suspected 
In such cases a negative finding of necessity would have 
to be verified by radiography 
I trust that none of these criticisms will deter any 
medical practitioner from making the fullest use of radio- 
logy in his practice, while realizing the limitations of 
fluoroscopy per se In congratulating Dr Gordon on the 
design of his stand, which should prevent any recurrence 
of ‘ the sudden attack of alopecia, one cannot help 
remembering that it is the patient who receives most of 
the rays A filter of 1/2 mm of aluminium should be 
helpful — I am, etc, 

London W 1, July 19 J V SpARkS 

Prophylaxis of Measles 

Sir — During the months of May and June we have 
had the usual administrative difficulties m the children s 
wards of the Royal Northern Infirmary at Inverness on 
account of measles In our efforts to immunize not yet 
infected children Lederles immune globulin was used 
exactly as described by Dr T N Parish {Journal July 9 
P G's) The results were disappointing as in every case 
in due course measles developed All the remedy seemed 
to do was- perhaps to limit the seventy of the clinical 
piclvirc \nd to delay the incubation period — at much 


expense to a voluntary hospital I am further prompted 
to write this letter as I have just read the following mj 
a Northern paper under the heading “ Boy loses eye afier 
measles Gets 13,500 damages 

Three year old Joseph Henry West, of Dickens Street Mil s 
PI uting Manchester received £3,500 and costs at Manchester Assn*, 
yesterday for the loss of his right eye after an attack of measles 
Through his father he sued the Manchester Corporation for 
damages for personal injuries 

‘ Mr G J Lynskey, KC, for the boy, said that he had had 
an attack of measles, and following this an attacL of scarlet fescr, 
after which he was adnutted to Monsall Hospital Manchester 
While m hospitrl he had another attack of measles, as a result 
of winch his eyes became septic and the right one had lo be 
removed The claim on behalf of the boy Mr Lynskey contended 
was that he was not given anti measles serum and that he was 
exposed while sufTcrmg from scarlet fever, to risk of infection Irom 
anolher child who was a suspected case of measles 

— I am etc 

W Leonard Forsvth, MD 
Med Supt Royal Northern Infirmaiy, 
Inverness 

(Emeritus Professor of Bacicrioloin, 

Inverness July 12 ’University of Cairo) 

Eientration of the Diaphragm 

Sir —In the Journal of April 30 (p 948) there is a reporl 
by Mr A L McFarlane and Dr W N Dickenson of 
a case of hernia through the diaphragm The case 
reported seems to be ilmost identical with one winch 1 
saw some years ago, and which was fully described in 
the Aiistrtdian and New Zealand Journal of Snrgcrv of 
October 1932 My patient vvas a schoolgirl aged N 
who had an ovarnn cyst Openilion showed a complete 
absence from the general abdominal cavity of small 
intestine ascending colon, and half the traasveoi. 
colon and subsequent v-ray examination revealed thes 
organs lying above the liver within the thoracic cavih 
The diaphragm, greatly elevated, seemed to be above the 
intestines She had had no other disability, and tool 
an active part in her school games Such a condil'on 
was described by Petit in 1774, and later Cruveilhicr also 
gave account of it He gave to the condition the nam' 

“ eventration of the diaphragm, under which name some 
half-dozen cases have been reported in the Ann’ricoi 
Journal of Rociitgenologs — I am, etc 

Chriitchurch, New Zeiland June 17 ^ StANLEV FOSTER 

Anaemia and the Gastro-mtestinal Tract 

Sir, — Dr Janet 'Vaughan in her recent article on anaemu 
and the gaslro intestinal tract {Journal Jul) 9, P ' 
states “ There is no evidence that intestinal abnorntah lo 
affect the utilization of vitamin C In actual fact, 
ever, there is abundant evidence to the contrary • 
becoming increasingly evident that deficiency stales 
occur even when individuals are taking diets adeqin > 
supplied With vitamins That vitamin C may^ nf' 
utilized although taken in adequate quantities is s" 
gesled by several interesting observations 

1 Scorbutic-hke syndromes may develop m indiudosii 
taking three oranges daily (Wright and Lilienfeld 19 oi 

2 Scorbutic patients who have failed to respond 

juices or ascorbic acid orally do so when the hllcr i' 
ministered intravenously (Birch el at 1933) ^ 

3 Wnght and I ihcnfeld (1936) have actually 

lapses in such patients by placing them on a (ffjj 

vitamin C orallv, then cured the relapses by the pi 
exhibition of the vitamin ,, 

4 Mahlo ano Multi (1936) believe from 

that there is a failure of absorption of vitamin C m P 



Juu ^0 19^S 


CORRESPONDENCE 


THzE^msB 
VliDicu. locrjisjc.. 


ZSl 


unh gi^lro-cnlcriti"; o\Mng lo ihc presence ot a specific 
peroMdase which dcsiross Ihe \ilamin in Ihe slomach 

^ Stepp (19161 Schroeder (I9i61 and Einhauser (1916) 
chini that certain bacteria especialh B cn/i coini/mnis mac 
cause destruction of the \itamin Mann (I9'6) reports that 
orallt administered Mtaniin failed to cure a case of scun> 
in sthich B coll and pants phoid B organisms ssere present 
m the intestinal Inct 

In the same \sa\ that anaemia is often found in 
association ssith sarious disturbances of intestinal func- 
tion so arc dcficicncs states commonij associated with 
gaslro intestinal disease MacKic and Pound (1915) for 
example found esidencc of deficicnev states m 63 per 
cent of scsent} fise cases of chronic ulceratise colitis 
although a histor) of a deftctise dietarj was seldom 
elicited — I am, etc, 

Bevismin Portnoi M D 
Department of Qinieat Intcsiipations and Research 
The Ro\al Infirmars Mandiestcr )ut> IS 

REFrRENCES 

Birch T \\ Hams L J and Ras S N ((9 1) \tiiiirt 131 27j 
E mhau-er M (19 6) Z eer np Mrd 98 -61 
Machic T T and Pound R E (19 S) J 4,ner inert -iss 104 
6t1 

Mann P (t9s6) Sfiiierin nird 2 25 
Schroeder H (ina61 \Uinch nierJ It scJir 21 S71 

and Einhauser \! (1936) Ib d 23 921 

Siepp 1\ (J9’61 tbid 28 1119 

Wright I S and Lilicnfcld A (1916) Arch intern Med 57 241 

National Food PoIic\ 

Sir, — I was onI\ a little less astonished at the contents 
of Ihe special report Towards a National Food PoIic\, 
than I was at the commendatory terms in which it is 
referred to in the Journal of July 16 (p I4I) RareH 
can one ha\e seen sponsored as it is such an inconsequent 
melange of mutually contradictory suggestions One 
suggestion howe\er, appears to ha\e been placed in the 
forefront and as from the context we max suppose that 
It IS regarded as a serious construcii\e effort 1 propose 
to Single It out for discussion On page 5 of the circular 
the following statement occurs Our argument is that 
basic food should be taken defifaeratefy out of the normal 
field of supply and demand m that food is a primary 
necessilx and must be guaranteed inalienably to all 

The law of supph and demand is a law of Nature as 
inexorable the law of graMi% Treating the matter more 
<;eriousU than it desenes however let us tr\ to find out how 
cxactU It IS propo'^ed to realize this aspiration On page 5 it 
IS suggested that boards should be established to handle the 
whole distribution of food from the point of production or im 
port to the home of the consumer Clearh this implies that 
these boards will be the purchasers of the foodstuffs How 
demand m the form of the mouths of the populace to be 
filled and supph in the «:hape of competing home colonial 
and foreign sources are to be brushed aside and ignored is 
not and indeed ne\er can be clear It is possible that owing 
to Its general indefiniteness there ma\ lurk somewhere in this 
circular somelbmg that mas be construed as a suggestion such 
as has indeed been made elsewhere b\ one of the signatories 
that foreign competition should be excluded and that by 
means of a Government grant lo the undernourished food 
stuffs should be purchased from the home farmer thus at one 
blow according to the original proposer setting the farmer 
on his feet doing awav with undemutniion and encouraging 
trade If such a suggestion exists apart from pointing out the 
difficulties jn getting the undernourished to spend this extra 
monev in the w-av desired I am content to leave it to be dealt 
with bv the arguments emploved b\ the Prime Minister in his 
Kelienng speech of Juh 2 

Fortunaielj in the interests of space this subject need 
not be pursued further, nor need attention be gnen to 


the related proposals tor dealing wuh the distributor and 
middleman for it has to be stated that strange as it max 
appear the real crux of the case has entirelv escaped 
Ihe notice or the committee against malnutrition 
Their proposals as just outlined it has to be emphasized 
contemplate interference with the food supph of each 
and e\ert inditidual in the nation Let us therefore 
examine what necessitt there exists for such a procedure 

It has been stated that 50 per cent ot the population of 
this counin are rn a state of undemuirition On the eiiderce 
submitted bv the author of this staterrent it is impossible tor 
anvhodv to believe it nor is there anvthing lo show even if 
such undemutrilton did exist that it could be aitnbuted to Uck 
of food and not to other conditions which evervbodv knovs 
are active in producing undemutrition Further evenifunder- 
nijtntion lo the degree alleged existed and even it it were 
due to lack of food nobodv can believe that in the majontv 
of cases It IS caused bv an actual tack of monev wherewith to 
buv food Monev is often through ignorance misspent in 
buving Ihe wrong tvpe of food or in purchasing what under 
the circumstances can onlv be termed luxuries 

It would seem therefore that of the population there is 
onlv a certain minontv smalt in proportion to the whole 
whose stale of undemuintion maj justifiablj be attributed to 
actual lack of monev wherewith to bus food To suggest that 
Ihe food suppiv of Ihe whole nation should be turned upside 
down and subjected to control under the ill considered scheme 
here suggested m the interests ot this minontv is as if one 
were to contemplate the burning down of a palace in order 
to fn an egg 

The irony ot the situation is that there is not, and 
never has been, anv need fo" the mental agomzmgs of 
committees formed or forming themselves for the pur- 
pose ot finding a solution '^s I have pointed out else- 
where, and as must have been obvious to evervbodv for 
decades vve have the precedent and practice of hundreds 
of vears standing in the shape of public dispensaries for 
providing medical and other help to those unable to afford 
such The matter appears so simple and common sense 
that I have the greatest hesitation m elaborating it 
Brieflv stores — Government and otherwise— could be 

established m poorer districts m which foodstuffs pur- 
chased wholesale m large quantities to effect an economv 
could be sold (or in some cases given away) to those 
unable through lack of means to buy them m the ordinarv 
wav Bv such means the expenses and profits of the 
distributor and middleman could be largelv eliminated 
and such places could under the direction of sax the 
medical officer of health not only serve the purpose of 
giving ad' ice lo individual purchasers as to the best 
manner of expending the money available but also act 
as centres for the dissemination of correct ideas regard ng 
Ihe purchase utilization etc of foodstuffs The lat.er 
aclivitv, be it said in parenthesis is apparently the only 
practicable method of dealing with the group who having 
money to spend spend it so unwisely as to lack suitable 
food 

Moreover with the experience of the parent institutions 
as a guide the scheme could be put into practice forth- 
with and function practically from its inception a situa- 
tion vastly different from that envisaged on page I ot 
Ihe circular It is doubtful whether dielarv survevs 
owing to the intrinsic nature ot the subject will ever 
produce anvthing of academic interest e en to the ethno 
iogisf not to speak of the practising nutritionist Time 
and monev it would seem could be employed more 
usefully m carrying out practical schemes such as the 
one just outlined — I am elc^ 

J P McGov vN 

\bcrdeen Juh 19 



258 JUL\ 30 1938 


CORRESPONDENCE 


TutBprrmi 
Medical Jolxs^ 


Antimouy Therapy 

Sir— Drs Hans Schmidt and F M Peter are to be 
congratulated on their English edition of Athances in 
the Theiapeiitics of Antimony which may well be com- 
pared with what IS included in Dr G M Findlay and 
C M Wenyon s Recent Advance’s in Chunotheiapv 
Unfortunately the report states on page 112 that the 
first patient to receive the tartar emetic treatment was 
not cured, though Dr J B Christopherson' recorded 
absence of ova and a negative antigen reaction Difficulty 
in obtaining evidence of cuie is specially difficult in 
laponiciiin infection and for this reason the advocation 
ot proprietary remedies m place of tartar emetic must 
be taken with caution 

I have recently had the opportunity of obseivmg a 
giadual increase of degenerative changes in the ova of 
Si lustosomuin mansom which was the only type present 
in ihe unne of a little schoolboy of 11 whilst undergoing 
tieatment with anthiomahne I obseised between forty 
and fifty of these ova during treatment Four months 
lalei, though no symptoms of infection were detected I 
observed one ovum of Schistosointtni haematobitmt thus 
confirming a report from the Natal Pathological Labora- 
tory ot mixed infection some months before I had seen 
the case This suggested that a total of only 30]- c cm 
in twenty-seven days had been insufficient to effect a cure 
ot this patient, thus confirming the opinion that it is 
seldom wise to discontinue treatment before the twenty- 
eighth day — -1 am, etc , 

Durbin South Africa, July 11 F G CaWSION 

Small-pox and Compulsory Vaccination 

Sir — I am indebted to Dr C Kilhck Millaid for 
the information contained in his letter {Joinnal July 
16 (p 151) I admit ignorance of the cuirent views 
among those most familiar with the questions ot 
the aetiology and prophylaxis of small-po\, and his 
letter was therefore enlightening perhaps to some 
others as well as myself I should be interested 
to hear to what infoimed opinion does attubute the 
decline of small-pox in this country , is it considered 
to be naturally dying out*’ Most of us have heard the 
opinion expressed that the repealing of compulsory vaccin- 
ation might expose the next generation to a severe epidemic 
of the disease Having recently witnessed the effects of a 
se\ere epidemic m a country in which small-pox is endemic 
perhaps I may be pardoned for feeling that we should 
be absolutely confident of the results before abolishing 
compulsory vaccination and those who advocate it must 
presumably ha\e a sound basis for then confidence 

The fact that Leicester, where compulsory vaccination 
was abandoned over fifty years ago, has had such a 
fortunate experience is perhaps not such a convincing 
criterion as a similar experience might be in a city like 
Luerpool, where exposure to infection is presumably 
greater Has the experiment of abolition been tried in 
this city or in any other large port'^ It would appear on 
the surface that Leicester s experience might be misleading 
in that compulsory vaccination may have been respon- 
sible for a reduction in the incidence of infection from 
which the whole country including unvaccinated areas 
might have benefited I was chiefly concerned in my 
previous letter with the question of compulsory diphtheiia 
immunization and if it was somewhat startling to hear 
from Dr killick Millard that both the Associati on of 

p J B Bniisti Medical Journal October 8 1921, 


County Medical Officers of Health and the Socieij o' 
Medical Officers of Health have passed resohitio'-j m 
favour of the abolition of compulsory vaccination at least 
It would be interesting to know whether they would recom 
mend its replacement by compulsory diphtheria imnium 
zation — I am, etc , 

London, W 12, Jiil> 2t A L CrADDOCX 


The Cancer Campaign 

Sir — A re we conducting the cancer campaign arighF 
Judging by the meagre results obtained the question nn 
hardly be answered in the affirmative Great efforts ire 
being made to discover the cause but, as Mr Hastings 
Gilford in his thoughtful letter {Journal July 2, p 411- 
one of the best 1 have seen — points out, already mans 
of the causes are known, to which may be added tertian 
syphilis, especially of the mouth also lupus Mr 
Lockhart-Mummery {Sing Gynec Obstet 193S, 66 2s7| 
considers that the condition is bound up with eugenics 
which, m my humble opinion, is a very promising field 
of research, enabling tainted stock to be watched carefiillj 
for early manifestations, though marriage on eugenistic 
grounds is a far cry I understand that negroes are much 
less liable to the disease than the white and yellow races 
so that a guess may be hazarded that civilization is a 
factor It vvould appear that cancer tends to attack the 
previously healthy rather than those stricken with other 
disease, but this is unproven 

Like Mr Gilford, 1 think that possibly a cure may b 
found, as witness the striking successes of sulphanilamide 
in the treatment of streptococcal infections It is not 
light to discourage research work on these lines One 
solid rock of truth stands out in this sea of mystcry- 
Ihe lact that the knife can cute in the earl) vtnsw 
Admittedly this is a crude weapon, but its results compare 
favourably with those of radium and v-ray therapy whivh 
likewise demand early diagnosis 

To my mind the most obvious method of attack is ih« 
dissemination of knowledge already possessed regardinj 
the early symptoms and the discovery of new ones 
Nowhere is this called for more than in the case of tL 
commonest of all — gastric cancer Lord Moyniliafl usid 
to teach that the symptoms of caicinoma of the stomach 
were loss of interest in life loss of appetite, loss of blood 
(anaemia) to which may be added loss of abdominal 
comfort due to meteorism in a patient of previous gow 
health Now he would be a bold surgeon who woul 
operate for these symptoms, but fortunately we 
radiology to clinch the diagnosis At the very onset t 
stomach becomes lazy peristaltic waves are few, nn^ 
pictures taken at intervals present the same pattern 
have diagnosed a cancer 1 cm in diameter on this findms 
alone The peristaltic waves may be constantly arristv 
at a particular point, proving destruction of rnusciilaiu'' 
often by malignant disease ' An ulcer of large dimension 
IS suggestive A patent pylorus, permitting the conliniiom 
entry of barium into the duodenum, means destriiclio^ 
of the sphincter A small stomach with obsiriic 
signifies malignant disease (L A Rowden) Looi izv 
disappearance of the mucosal rugae indicates cancer 

All these signs appeal long before the classical sym^ 
toms occur Let us examine these symptoms 
This occurs with a number of gastric and 
conditions Coffee-giound \oniit The “ grounds 
present blood altered by long contact with the 
juice, not necessarily due to cancer Tinnour fauna ' 
This is of the utmost value when piesent , 
the commonest cancers do not produce palpable gr 



Jm *0 I9'<! 


CORRESPONDENCE 


Th£ British 
^ rClCAi JOtTO-Al. 


:‘i9 


Ctulixui But surtU this is i sign of hopelcssnLss ns is 
Virchow s ghnd at the termination of the thorncic duct 
Thus It is apparent thnt carcinomn ot the stomach m 
its operable stage is diagnosable b\ x ra\s long before 
classical signs and sxmptoms manifest themsehes 
Similarh oesophageal and colonic — not including rectal — 
cancers art diagnosed with greater ease and atcuraev 
with r rax-, than clinicallx Renal pelxic groxxths lend 
themselxts xxell to this form of diagnosis as do cerebral 
growths Consecutixe films rexeal bronchial carcinoma 
long bclore clinical signs arc present 

Mx idea of a cancer campaign xxould be the xxholesale 
education of the profession in clinical as distinct Irom 
technical radiologx This xxould bt attained bx the 
establishment of an t rax museum on the lines indicated 
prtxiouslx (Journal 1937 2, 1054) a place xxhere men 
could xxandtr imbibing Tnoxxledge as Ihex can m that 
magnificent displax of the Pathologj of the Lixing the 
\3ellcome Museum of Medical Science organized bj 
Dr Daukes It xxould be supplemented bx short mtensixe 
courses ot demonstrations I do not agree xxith Dr 
Douglas \3ebster that the difficultx xxould be m finding a 
- "ator Proxided adequate remuneration xxas axailable 
manx men could be found Monex is being poured out 
on apparatus all oxer the countrj xxith scant justification 
judging bx some of the results in bone radiologx xet 
no one seems to realize xxhat a tremendous help a 
museum xxould be I beliexe xxith Dr Webster (Journal 
1937 2 1152) that a long time xxould be necessarx 

Rome xxas not built in a dax but on one particular day 
It was started The museum xxould nexer be complete, 
but therein would lie its fascination I agree xxith Dr 
Webster that a suitable resting place should be tound for 
apparatus xxhich has represented stepping stones in 
the dexelopment of the beautiful apparatus of to dax — 
I am etc, 

London W 1 Julx 10 A P Beptxx ISTLE F R C S Ed 

Subxesica] DiatherniA Prosfatectomj 

Sir, — ^T he short article on stibxesical diathermj prosta- 
lectomx m the Journal of July 23 (p 175) bx Mr R Ogier 
W ard raises some points xxhich appear to call for comment 
The perurethral operation as he rightly sa>s is noxx firmlx 
established as a therapeutic measure of the greatest use 
in urological surgerj Mr W’ard in adxocating his sub 
xesical operation claims that in the ordinary resection 
operation a large portion of the trigone sometimes 
almost up to the ureters is remoxed If this xxere so 
the operation xxould long haxe been abandoned eytensixe 
resection of the trigone inexitablx predisposes to sepsis 
in the underlxing space xxith serious consequences The 
operation as carried out to da> bx urologists xersed in this 
type of operation means xirtuallx a subtotal prostatectomy 
It has long passed bexond the stage of being a tunnelling 
or xxhittling procedure anything from one quarter to 
four-fifths of the gland is remoxed The subxesical opera- 
tion adxocated is that xxhich is normally carried out on 
the subxesical type of gland but xxhere, as is certainly' 
more common there are intraxesical projections of the 
lateral lobes a more radical procedure is manifestly 
required _ The remoxal of a single piece from the region 
of the postenor commissure folloxxed bx intra urethral 
resection of tissue from the floor and lateral walls as 
I interpret Mr W'ards recommendation leaxes the upper 
limits of the lateral lobes projecting into the bladder 
and ideally situated for a ball xalxe mechanism to come 
in'o play at an early date so leading to recurrent obstruc- 
tion It xxould to me appear more rational to remoxc 


as much of the obstructing tissue as is mechanically' 
possible bearing in mind of course the danger of en 
croaching too far on to the trigone Familiarity xxith the 
operation should guard against this — I am etc 

London \\ t Julj 22 TERENCE MlLLtN 

Incomplete Descent of the Testicle 

Sir — Undescended testicle is not it_elt a disease but 
is simply one symptom of a general constitutional disturb 
ance ot diencephalo pituitary origin Inxestigation of the 
morpholog) reactixitx psychology and biochemistry 
ot such patients if carried out with the precision with 
xxhich the testicles are palpated points distinctly to this 
fact Failure to perform this general constitutional in- 
xestigation IS responsible tor manx mistakes in treatment 
To attempt surgical correction of undescended testicle 
xxithout prexious correction of the basic constitutional dis- 
turbance IS contrary to all the rules ot contemporary 
medical practice The assertion made bx Mr Denis 
Broxxne in his interesting paper (Journal July 2^ p 168) 
that pregnxl treatment xxill not bring down any testis that 
xxould not haxe descended xxithout it is sxxeepmg and 
goes against the experience ot most recent xxorkers on 
this subject In the first place pregnxl and all other preg- 
nancy urine gonadotropic substances are far from con 
stituting the xxhole endoenne metabolic treatment ot un 
descended testicle Further, I often see in mx exerxday 
practice tragedies resulting from the abandonment of cases 
of diencephalo pituitarx disturbance xxith undescended 
testicle to their fate or ultimately to the surgeon without 
any attempt at early correction bx means of general con- 
stitutional treatment mcluding endoermotherapx The 

disquieting possibilities of hormone treatment men- 
tioned bx Mr Denis Browne do not exist xxhen treatment 
IS planned and gtxen bx skilful clinicians but tragic 
certainties assuredly make their appearance xxhen such 
constitutional disturbances are not sought discoxered and 
corrected in the early years of life I am the first to 
protest against abuse of hormone trea'ment but the method 
IS undeniably efficacious proxided that the injected her 
mones are mixed with the commodity used bx the great 
painter in the mingling of his colours — brains — I am etc , 

London \\ 1 Julj 22 A P CXXXXDIXS 

Cancer of Phannv and Larynx 

Sir — This subject selected for discussion at the recent 
Annual Meetmg of the British Medical Association xxas 
xxell chosen for as Mr Lionel Colledge mentions xxhen 
opening the discussion from the surgical aspect (Journal 
Julx 23 p 167) the intrcducuon of irradiation has 
rendered the problem of treatment in xarious situations 
infinitely more complicated This problem of treatment 
— namely ‘ surgery i ersus irradiation — is particularly 
difficult in those early cases of a small cancerous groxxah 
limited to the true x ocal cord the extremities of the cord 
being free of disease 

In an endeaxour to clarify the present position I 
recorded (J Otol Lorxng 193/, 52 -163) the results 
xxhich had been obtained at the Manchester Radium 
Institute foUoxxmg irradiation of intrinsic laryngeal cancer 
and contrasted them with those following surgical treat 
ment (larxngo fissure) in a similar series of cases collected 
from mx own records and those of mx Manchester col- 
leagues This comparatixe rexiexx xxas restricted to that 
type of intnnsic laryngeal cancer which xxas suitable either 
for surgical treatment or irradiation bx the Finzi Harmer 
technique For comparatixe purposes I adopted a three 



260 July 30, 1938 


CORRESPONDENCE 


year symptom-free rate, meaning thereby freedom from 
recurrence during a period of three years or longer 
The records showed that of eighteen patients treated by 
irradiation fourteen (77 8 per cent) were alive without disease 
(nine for three years two for four vears and three for five 
to SIX years) while recurrence or continuance of malignancy, 
occurred in four (22 2 per cent) There was no operative 
niortalitv In the surgical group (laivngo-fissure) sixteen 
patients were treated with an operative moitality of 12 “i per 
cent and a recurrence rate of 18 7 per cent while eleven 
(68 7 per cent) survived three years or longer (one for four- 
teen years one for thirteen vears two for eleven vears one 
for SIX years six for thiee to five years) 

On figures alone it would appear, therefoie that treat- 
ment by irradiation gives a lower mortality with a greater 
risk of continuance or recurrence of disease This how- 
ever, IS not ‘ all the picture, for there can be no doubt 
that the convalescence in patients treated by irradiation 
IS often most tedious and prolonged, and in my opinion 
the voice is never quite so good An operative mor- 
tality in the recorded surgical group of 12 5 per cent is, 
I think too high, as is shown by the fact that theie was 
only one post operative death in twelve of my own cases 
Mr Colledge in his present paper recalls two (8 7 per cent) 
deaths in twenty-three operations 

I think It can still be said that, given a case of limited 
laryngeal cancer surgery offers the better chance of 
success, with a slightly higher operative risk but with a 
quicker and happier convalescence In conclusion, may 
1 congratulate Mr Colledge on his excellent surgical 
results especially in those cases requiring pharyngotomy 
oi laryngectomy I feel certain it is to be assumed that 
the cases he records in Table II of his paper fall within 
the three-year survival rate as mentioned in Table I, 
though this is not stated May I suggest that confirma- 
tion of this point would be most valuable statistically — 
I am etc , 

Manchester July 2S F HOLT DiGGLr 

Chemotherapy of Gonorrhoea 

Sir — I n Colonel Harrison s letter (/oiiiiin/, July 9 p 90) 
reference is made to the disulphanilamide drug “ uleron ” 
and to the technique of its administration in gonorrhoea 
as practised in the German clinics 

Over one hundred Continental publications on this drug 
have appeared since last July, and these include reports 
from the leading German university clinics Since that 
time considerable improvements in end results have been 
obtained with the drug and it might therefore be of 
interest if (as an observer and not a clinician) I gave a 
brief outline of what the current practice of administration 
in Germany is, and of the views held in that country as 
to the advisability or otherwise of withholding this chemo- 
therapeutic — as recommended by Colonel Harrison — in 
the early stages of acute gonorrhoea This seems all the 
more necessary as there appear lO be wide differences 
between the technique of sulphanilamide therapy in 
England on the one hand and of uleron therapy in 
Germany on the other 

When the latter drug vvas first introduced immediate 
application vvas practised in the acute case and it vvas 
given for periods of ten days or more continuously 
Experience soon showed that gonorrhoea responds to 
uleron in a few days if it responds at all It vvas further 
observed that lengthy administration besides being unneces- 
sary could be harmful The so-called “ Stoss method 
ot treiiment was therefore adopted — that is, the drug 
w IS administered m a maximum of three short bouts of 
trLaiment lasting generilly, for three to four davs apiece 


The British 
Medical Joiy\a 

and separated by intervals of six days It is now believed 
that toxic effects — which reference to the literature sliowi 
to have included instances, happily rare, of a serious con 
dition (namely, polyneuritis) — can be avoided altogether 
if this Stoss method of interrupted treatment is 
employed At the present time the best results in Germany 
appear to have been obtained by the use of this ‘Stoss 
therapy supplemented by vaccine in certain cases As 
urethroscopic examinations suggested that many relapses 
may be due to inflammatory gland foci, urethral dilaia 
tion has recently been performed with marked success on 
the second, fourth and sixth day's after the beginning of 
uleron treatment In brief the rather complicated kch 
nique of administration which is now recommended b\ 
those responsible for the introduction of uleron into the 
Geiman clinics and which is based on results reported in 
publicTtions referred to above is as follows 

In the acute cases a three to four dav Stoss (tolallms 
12 grammes) is given at once K.MnO, or weak silver im>’3 
tions being started at the same time and continued throiichoui 
If at the end of this course smears arc negative for gono 
COCCI the Stoss is repeated after a six-dav pause as a kind 
of securitv measure If smears aie positive one can eilh i 
(fl) repeat the course once or if need be twice after the 
necessarv pause or (/>) (as practised b\ Schreiiss) give a 'iv 
day course of vaccine followed bv a second course of uleron 
Tests of cure are done ten to twelve davs after the last do 
of uleron has been given 

As regards the advisability of withholding uleron treat 
ment for three weeks, as advocated by Colonel Harrison 
opinion in Germany seems to be divided on this point 
At a recent meeting of the Berliner Medizinische Gewll 
schaft, SpiethofF, discussing this question, sponsored minx 
diate treatment and quoted as his supporters Schub rl 
Lohe Fuss, and also Bernhard, one reason for thu 
sy'stem being the likelihood of complications such as 
epididymitis and adnexitis occurring during the waiim* 
period On the other hand, Schreuss and Behring s clmx 
lecommend prepaiatory vaccine treatment prior to apph 
cation of chemotherapy The fomaer has stated that vvilh 
early vaccine therapy and uleron administered as from 
the tenth to the twelfth day he obtained results at kasl 
as good as those with the drug administered at the oubd 
Felke quoted by Colonel Harrison, has also emphasize 
the importance of waiting foi three weeks or more b'for' 
using the drug Opinion is thus divided the balano 
numerically, being in favour of immediate as opposed W 
delayed tieatment 

It IS almost trite to say that as treatment with 
— and even with sulphanilamide — is still in the very <-an) 
stage of development it is as yet impossible either to h) 
down haid-and-fast rules foi administration or to assv>i 
the end-results with any certainty — I am, etc , 

London, W 1 July 19 RtPLEV OoDIE. 

Sulphanilamide in Acute Maxillary Sintisihs 

Sir — I have just had experience of a use for sulpha''^ 
amide which I thought might be of interest as I hi'O 
seen it described so far My patient an adult 
developed acute pain in the antrum and an intense hM 
ache on the same side, following a short typical atlac 
influenza The sinusitis showed all the classical s)” 
toms, with an intermittent temperature of about I 
The condition vvas becoming unbearable and she ^ 
very reluctant to submit to surgical drainage so, all ^ 
the causative organisms vveie not identified, I stadi- 
on prontosil album After 4 grammes the 
pain had decreased 90 per cent and natural z** 
became established , she had 3 grammes for t"° 



J^JL^ 30. 193S 


CORRESPONDENCE 


following and then 1 5 grammes for another two da\s 
making a total of 13 grammes m fi'e da\s She e\pen- 
tncid slight nausea throughout but no other disadvan 
tages and she avoided surgical treatment which pleased 
her greatlv Drainage is still free but the discharge is 
decreasing steadilv, and the patient feels well and is about 
her household duties — 1 am, etc, 

Rangoon Jub IS J Shvnks LvurIE 

Sulphommide for Epilepsj 

Sir — ^T he following notes on the action of sulphon- 
amide in a case of old standing cpilepsv mav stimulate 
interest in trving out this drug 

\ bov aged Ilf vears phvsicallv sound with no familv 
historv of epilepsv at the age of vears had major fits 
once a month for si\ months He had no fits for two vears 
then a bad fit followed bv coma lasting one week He 
improved and had onlv occasional attacks of petit mal till 
four vears ago, when he came under m\ supervision For 
the last three vears he has averaged sic attacks of petit mat 
a dav and two to three major fits a week His mental develop 
ment was normal till 19^4 since when it has graduallv 
detenorated All sources of reflex irritation were dealt with 
and in December 19j7 he was completelv investigated in 
hospital \ entnculographv showed no focal damage 
Encephalograms showed enlargement of the ventricular 
svstem explained bv widespread cerebral atrophv 

Dunng the last four vears ketogenic diet prominal It-minal 
and bromides have been tned — prominal and luminal m small, 
moderate and large do'C' There was no improvement in the 
number of fits or in the deterioration of the mental condition 
In despair 74- grams of sulphonamide were given thnee 
dailj In three davs the bov ceased having either major or 
minor fits but was verv restless and had night terrors The 
sulphonamide was stopped at the end of a week and two davs 
later he had two major fits which recurred each dav Treat 
ment with sulphonamide (15 grains tds) was re instituted 
after a weeks intenal (and is suH being continued under 
observation for toxic svmptoms) The bov has had no fits 
of anv kind from two davs after re instituting the sulphon- 
amide treatment (fourteen davs ago) 

The bov s mental condition shows definite improvement 
He IS having no sedatives and is on a normal diet and 
regime After four vears of depressing results with 
cerebral sedatives the action of the sulphonamide appears 
nothing short of miraculous — I am etc 

J C Yeomxn mb BS 

Cullercoats Whiilej Bav Jul) 20 


Complicafions of Gold Therapv 

Sir — ^An\ who wish can prove for themselves the 
ruths contained m the letter from Dr H M'arren Crowe 
lournat Jul> 2, p 44) Since 1930 suitable cases of 
heuraatic disease have been treated at the Rojal Ports 
noulh Hospital with small doses of the vaccines advised 
vv Dr Warren Crowe and the claims advanced for this 
reatment have manv times been substantiated For the 
ist two vears or so vaccine resistant cases — a small 
ninoritv when correct doses are emploved and the doses 
ire properlv spaced — have been given jntramuscular m- 
ections of gold The doses have often been as small as 
hose given at the Charterhouse Clinic and the results 
leeminglv have run parallel with those of that clinic, 
10 toxic svmptoms have occurred Home exercises m- 
isted on from the first attendance are of the greatest 
alue MTien the disease has become less active phvsio- 
herapv and/or manipulation are combined with 
njection treatment 

Mv colleague Dr R S MacHardv treats cases of 
irlhritis, preferablv those of the rheumatoid tvpe, with 


The BjkinsH 
Mo CAE Jocjlsae 


261 


low voltage x ravs (60 to 90 kV) He gives a first do'e 
of 80 r units on not more than two joints His aim is to 
get a slight local reaction within fortv -eight hours as 
evidenced b> some increase of pain and heat in lho<e 
joints Should the reaction not appear he halves the 
dose at the next visit when the desired reaction is likelv 
to occur unless the dose is still too large This technique 
IS a further example of the value of small doses m the 
treatment of rheumatic disease Though quick local im- 
provement IS aimed at vvhen vaccines and gold are 
cmplojed rather than the slight local reaction which 
follows the use of the small doses of r ravs bodi 
methods produce a definite improvement m the patients 
general health in a short time — I am etc 
SoUtlKM, Jut) 11 H Fvrncovibe 

Sir — Our researches at the Charterhouse Rheumatism 
Clinic have demonstrated that the differential sedimenta- 
tion lest,' which IS an elaboration ot the blood «edimenla 
tion rale supplies just that method for which Dr J B 
Bennett (Journal Jul> 16 p 152) and his collaborators 
at Bath are searching From its indications we have 
been able to decide which cases are suitable tor go'd 
and, after the first determine the proper size of subse- 
quent doses Further, the test gives adequate warning 
of the approach of toxic reactions 
I gather that Dr Slot (Journal Julv 16 p 152) must 
have tried the small-dose method following a letter of 
mine m the Lancet (1937 2 990) but possiblv the last 
paragraph of that letter escaped his notice for here I 
ventured to claim that the direct result of gold was like 
that of vaccine — an immunitv response The two 
methods vaccine therapv and chrvsotherapv would thus 
be complcmentarv and not as Dr Slot savs, based on 
enlirelv different conceptions of therapv 
The opinion of Koppenhofer is that gold acts as a 
caialjtic stimulator to the reliculo-endothelial svstem 
He showed that when a colloidal gold salt is injected it 
finds Its wav immediatelv into the cells of an inflam 
matorj area where it is reduced to the metal or the 
simple sulphide If this view is correct there does not 
seem to be anv obvious neces'it) tor the more compli- 
cated gold salts Experience at the Charterhouse 
Rheumatism Clinic tends to confirm Koppenhofer s views 
of the action of gold, as at present we are using with 
quite appreciable success a simple colloid emulsion of 
gold sulphide, prepared for us bv British Colloids in 
doses up to a maximum of 2 5 mg 
I understand it to be a principle of the chemistrv of 
catal>sls that the optimum concentration is rarelv the 
largest tolerable and quite commonlj it is an extremelv 
small quantitv Since we find that we are able to 
obtain both the desired clinical and biochemical effecis 
which we seek bv using gold in these small doses at 
long intervals there seems no sound reason for lollovving 
blindl> the manufacturers posological tables into the 
regions of hundreds of milligrammes and toxic reactions 
It must be understood that we onlv use gold in that 
small proportion of cases which show extreme sensitive 
ness to vaccine but that is because in the majontv of 
cases vaccines give as good results as can be expected 
I do feel that it is extremelv important for the p'O- 
fession as a whole to decide vvheiher doses of gold a-e 
inadequate unless they are large enough to carrv the 
risk of toxic reactions Through these reactions ih s 
valuable method is rapidlv falhng into disrepute One 
often has the greatest difficultv m persuading an enlirelv 

Charterhome Rheumnusm CUntc Papers 19^7 1 xs 
^ Beit Klin Tuberk 19j5 80 5',9 



262 July 30, 1938 


MEDICO-LEGAL THE BOURNE CASE 


The British 
Mxdical JoUItVil 


suitable patient to agree to chrysotherapy The fact is 
that rheumatic patients are getting increasingly alarmed 
by the stones of severe illness,” of “terrible skin 
trouble ’ of ‘ gold ibscesses which fail to heal for 
months, and such like I am personally quite convinced 
that none of these is necessary and that in the great 
majority of suitable cases (those showing some degree of 
hyperergy) subtoxic doses at prolonged inters als are 
effective — I am etc , 

London, W1 July 2S H Warren CrOWE 

Keratoplasty 

Sir — ^Referring to the letter of Mr B W Rycroft 
in the Journal of July 2 (p 431 concerning my case of 
keratoplasty, I should like to point out that what is seen 
in the photograph is the apparent position of the nm of 
the pupil Under normal conditions the pupil dilates up 
to a diameter of 4 mm , whereas the trephine used to 
prepare the graft was 4 63 mm in diameter It is well 
known that the usual results of optical iridectomy afe 
disappointing Regarding the duration of the trans- 
parency of a graft I quoted in my paper the observa- 
tions of those who have had considerable experience m 
corneal grafting — for example, Filatov — I am, etc 

Bith Jqly 15 T H S TlZZARD 


Medico-Legal 


THE BOURNE CASE A LEGAL VIEWPOINT 
[Bv A Barrister] 

So far as the ethical and social aspects of the Bourne case 
were concerned probably everyone, except those who adopt 
the extreme view, on religious grounds that abortion is 
never justified, was glad that Mr Bourne was acquitted 
Looking at the matter, however, from a purely impersonal 
standpoint as a member of the legal profession, it is rather 
to be legretted that there was not a formal conviction and 
a nominal sentence of one day, in order that the law might 
be discussed in the Court of Criminal Appeal and possibly 
even in the House of Lords, if the Attorney-General s fiat 
could have been obtained to take the case there as in- 
volving ‘ a question of law of exceptional public impor- 
tance For It is no disrespect to the judge to say — and 
he would certainly admit it — that no summing-up to a 
jury, however careful, fair and accurate carries the same 
weight of authority as the deliberate pronouncement of 
an appellate tribunal Strictly speaking indeed the 
opinion expiessed in the summing-up is not binding on 
other judges of co-ordinate jurisdiction though they would 
be reluctant to differ from it But the fact remains that 
It IS still open to any other judge to say ‘ I have carefully 
considered the statement of the law by Mr Justice 
Macnaghten in Rex v Bourne, but with the utmost respect 
to the learned judge I do not agree with his view and 
am not prepared to follow it ’ And the rival view might 
be more rigid or more liberal than that of Mr Justice' 
Macnaghten Whereas if the case could have been taken 
higher the decision of the Court of Criminal Appeal would 
have bound all judges of first instance until either the 
House of Lords overruled it or Parliament dealt with the 
position bv statute 

Abortion, Lawful and Unlawful 

The general opinion of the legal profession seems to be 
that as the law stands Mr Justice Macnaghten s ruling was 
right erring if at all on the side of rigidity' No doubt 
exists that abortion to save the mothers life is lawful. 


few will doubt that it was coirect to extend that to Include 
the pievention of serious or permanent injury to her health , 
some would go further No definition these would say, 
has been laid down by Parliament of “lawful ’ or“un" 
lawful in this connexion The saving of life is admiUtdlj 
an example of that which is lawful, but is there any 
authority for saying that it is the sole and exclusive 
example md that there cannot be other circumstances of 
suflicient gravity to render abortion lawfuU Among such 
possible alternative grounds they would probably b. 
Willing to include the desii ability of terminating a preg 
nancy resulting from a criminal assault on a girl under 
the age of consent and possibly any pregnancy lesulling 
from a criminal assault whatever the age of the expectant 
- mother Such a view might well be based on the mtokr 
able position of a mother whose child, by its very exist 
ence was a continual remindeT of the ordeal to which 
she had been subjected, to say nothing of the undesirability 
of bringing her into further contact with the assailant 
over questions of maintenance, which would probably 
arise if the child vverc born As to this, one may observe 
m passing that, while something more than the expectant 
mothers mere assertion that she has been assaulted u 
obviously required something less than the conviction of 
the assailant ought to suffice, since there may well be 
cases where the fact of an assault is not in doubt but 
where the identity of the culprit is never established 
Apart from a conviction therefore, if this ground of abor 
tion were allowed adequate medical or other evidence 
should be accepted 

There is a certain amount of inferential evidence to 
support this more extended and liberal view of the law 
It IS only within recent years that Parliament has raised 
the minimum age of marriage to sixteen, from which one 
may conclude that it was thought that motherhood eien 
in wedlock ought not to be permitted below that age 
and that pregnancy m a girl under sixteen must always 
and in all cases result from a crime In the Infant Life 
(Preservation) Act, 1929 which created the specific offence 
of child destruction it was'' expressly enacted that to mH 
a child capable of being bom ali\e should be felony unless 
It was done for the purpose only of preserving the life 
of the mother This appears (n) to draw a distinction 
between abortion alter the child is viable and abortion 
at an earlier stage md (b) to imply that at the eariur 
stage some other causes may justify abortion for otner 
wise this express restriction with regard to the later since 
seems wholly superfluous 

DifficuUv in Framing a Definition 

When one considers possible reform of the hw to i^nfe 
more explicit the circumstances in which abortion shou 
be lawful, one is faced with the usual difficulty in uan'i 
a definition vvhich will not, on the one hand, let m ■ 
much and make abortion easy tor any unwilling euoti' 
or on the othei hand, shut out some cases which 
and conscientious surgeon would desire to include 
IS reliance on a second opinion even if it were gi 
statutory, as distinct from professional and custom f 
lecogmtion, a wholly satisfactory safeguard againsi 
proper interference with pregnancy . 

1 have more than once heard it stated — with "Ml tru 
your medical readers will be better able to judge ^jj 
that a woman provided with sufficient funds can 
get an illegal operation performed with all the (,( 
ances of respectability provided she goes to 
man (or men) The very existence of such a ^ 
may be apocryphal one would certainly not 
It IS widespread but the fact that it is obviously p j 
mmimtzes considerably the value of the protection a 
to the honest surgeon by a second or third opinion 

It has been suggested that a solution of tM P’'° 
might be found m legislation on the following ime ^ 

(nl Abortion to be an offence in anv f 

formed by anyone other than a registered medical pra 



Jll\ *^0 


MEDICO LEGAL 


TheEiitish 

•JtDtCAl. JCtH'JvL 


26 : 


ih) \n obMcinc bo'^ru of '\n '•cNcn eminent u\n^c\.o^ 
locivls to be vtt up The method of nomination of such a 
bo^rd IS obMousl\ a nnilcr for the medic il profesMon not 
for 1 to ^ucgc^t The botrd to ha\e power to act 

b\ a panel of not less than three (This provision is ntccs 
s<jrv to prevent the possibilftv of a memher being called on 
to adjudicate on a ease of his o'vn) It would probabK be 
nccessan to appoint regional boards in a num^r of large 
towns to prevent patients having to come lone distances for 
cxaminatjon 

(i) medical pnsiuioner to be at hbertv to refer to 
the board an\ case in which he considered that abortion 
oucht to be allowed on anv ground and the hoard after 
evamming the patient and convidenng <?// the circumstances 
of the case including the mothers health the p obabihu ot 
good or bad hereditv for the child and '‘nv special ethical 
or sotwial problems arising out of the case to have power to 
permit o- refuse abortion 

(f/) Abortion without the boards permit to be unlawful 
except in cases of immediate urgenev in which case a full 
report on the circumst-^nces should be furnished forthwith 
to the board b\ the surgeon 

(c) \ reasonable fee to be paid fo” the bojrd s examination 
tnd certificate bv those who can affoM it ho>pita! casc<; 
to be given it as part of the hospital service 

If such legislation were introduced the opperttmitt might 
perhaps be taken to overhaul and bring into line with 
modem thought and knowledge the whole criminal law 
with regard to sexual offences 

M A, BCL 


UNSLST\INED CHA.RGE OF VEGLIGENCE 

On JuU 21 without leaving the box ? '‘pccial jurv at Leeds 
Assizes returned a verdict for Dr Florence SLde in an 
acjion ngainst her for alleged negligence in the course of 
attendance upon a vounc married woman in her first preg 
nanev Mrs Isabella Marx Llovd Hughes sued to recover 
damages from Dr Slade and Trevor Llovd Hughes her 
husband of Headinglev an insurance otTicnl claimed for out 
of pocket expen cs incurred as a result of the allcced nech 
gence Dr Slade denied negligence and counter claimed for 
ner fees against the husband Mr G H B Streaifield kC 
fo” the phmtiffs submitted ih?i complications v^ere di covered 
bv another doctor after ome lap e ot time and the result 
was that Mrs Llovd Hughes had to undergo a much more 
Ncrious operation than othenvise would have been required 
The defence called Mr Carlton Oldfield consulting gvnaeco 
logical surgeon to the General Infirmarv at Leeds who said 
that there was no one svmplom in the case which should 
have induced Dr Slade to suppose that eventhme vvas not 
perfectlv normal Judgment vvas entered for the defendant 
with costs on both the claim and the counier-cLiim for fee 


The Services 


DE'\THS IN THE SERVICES 
Colonel Alewsder Fr.vser Rlssell CMG late R A MC 
died at a nurMng home in Edinburch on June 12 aged 
SI He was bom at kilmodan Argvllchirc on December 21 
1856 and was educated at Edinburgh Lmiver^itv where he 
craduated MA in 1877 and MB CM m 1^81 Entering 
the Arniv as a surceon on Februarv 5 1882 he attained the 
rank of colonel on November 2 191 1 and retired on December 
21 1913 He served throughout the South Afncan \\ar of 
1899 to 1902 when he took part in the relief of Kimbcrlev 
and in operations m the Transvaal Orange Tree State Zulu- 
Jand and Cape Colonv and was present m the actions at 
Paardeberg Poplar Grove Dreifoniein karee Siding Zand 
River Johannesburg Pretoria and Diamond liill He vvas 
mentioned in dispatcher* m the London Gozetn of April 16 
1901 and •eceived the Queens Medal with six clasp« the 
kings Medal with two clasps and the CMG He rejoined 
for service during the war of 1^14-1^ throughout which he 
served as A D M S on Salisbiirv Plain 


Obituary 


CHARLES H H HAROLD OBE MD DPR 
Ltcutcnatit-Colociel RAMC uet \ Dirtxtoc ot Waiec 
Ex*imination Metropolitan Vater Board • 

We announce with great regret the sudden death on 
JuK 18 oC Colonel Charles Harold «ho succeeded the 
late Sir Alexander Houston as Director ot Water Exam na 
tion Metropolitan Water Board in March 1914 OnK 
a fortnight ago at PUmouth he was re elected for the 
third lime to represent the Rotal Arms Medical Co ps 
upon the Council of the British Medical Association 
Charles Henr\ Hasler Harold vvas bom on Januarv 1 
ISSi and studied medicine at Liverpool Lniversitj 
graduating MB Ch B with honours m 1907 alter which 
he spent two ^ears m house appointments at the Liverpool 
Roval Infirmarv He was 
elected Holt Fellow of the 
Universitv in 1909 and m 
the lollowing 'ear took his 
M D degree and joined the 
R A M C as a lieutenanL 
Winning theTuIIoch Memorial 
Medal and the Ranald 
Marten Medal After several 
'ears service in India he 
Was promoted captain in 
1914 while at Dagshai 
During the war he served 
With the Indian Expedi 
iionarv Force in Mesopo- 
tamia and with the Mam 
Punitive Expedition in 1918 , 
for ns services in East 
Persia and Afghanistan 1918-20 he was mentioned m 
dispatches and promoted brevet major He had been 
D A D M SiSan 1 of the 3rd Lahore Division and on the 
Lines of Communication East Persia and sanitari adviser 
to the Forces in Transcaspia In 1921 he was made 
instructor at the Armv School of Hvgiene Aldershot and 
five vears later Assistant Director ot Hvgiene and Patho- 
logv Northern Command India His last railiiarv post 
was that of Assistant Director of Hvgiene Southern 
Command England and he retired from ihe Service in 
1924 with the rank of brevet lieutenant-colonel on taking 
up the important dutj of watching over the puritv of the 
Water suppK of the Metropolis Colonel Harold s 
presence in London gave the British Medical Association 
an opportunitv to profit bv his knowledge and sound 
judgment at headquarters In 1935 he was appointed to 
the Naval and Militarv Committee and elected to the 
Council as representative of the RAMC he was also 
a member of the Subcommittee on Terms and Conditions 
of Service of Civilian Medical Practice 

After graduation at Liverpool he published jointiv in 
the Journal of Plnstolog\ a paper on the influence of the 
presence and position of various radicles of adrenaline 
on Its phvsiological aclivitj he also wrole on his war 
experiences with tick fever in East Persia on the breeding 
of Anopheles maenUpenms in captivitv and on mosquito 
bionomics A contribution to the Journal of Stare 
Medicine in 1925 on sterilization of water bv chlorine 
and some of its compounds had been preceded bv a 
paper on the chloramine treatment of water in the field 
and these foreshadowed the nature of his future line 
of work The iwo annual reoorts bearing Harolds 




2« hA , ^0 I93S 


OBITUARY 


Thc B^rtuH 

MfDtCAl. 


siniliirc on tin. of chemical and b icteriological 

c' irnin iiion ol the London %vaters %\cre lucid and in- 
form iloc documents licking onK the piclurcique toich 
in I reid^rs hid lool cd tor vear b> jear in the writings 
o! \l(.\indvr Houston Lnder Harold the high standard 
Ol purity of thc \satcr supplied b% thc M W B was full> 
III ini'intd it IS sid to think that death has presented 
h tn Irom continuing his s iluable career m the large new 
cn.mictl ind bacteriological laboratories at New River 
Held He w IS I mm of the most kindh and approach- 
ib’c disposition 

nil. piuitoci ipti reproduced ii bs Lafi>eiie London] 

Tile death of Dr Andress William Thomson of 
J im lie 1 S’ hich occurred on Mas 30 ssas mourned through- 
out the p Irish ot C larendon Born on December 29, 
LSbS he pursued his medical studies at thc University of 
\bcrdctn gr idu iting MB CM in 1892 md returning 
home entered the Gosernment Medical Sersice in the same 
seir His first ippointment svas acting district medical 
olheer at May Pen in the ptnsh of Clarendon Soon 
hos ever he w is tr msferred to Stonv Hill ind later to 
1 limouth ind it sv is not until 1902 that he returned to 
C larendon sshere is district medical ofitcer at Chapelion 
he was to serve the community faithfully until his death 
J or forty six ycirs Dr Thomson svas in ictive member 
of the Jim lie i Brinch of the British Medical Association, 
md in 1932 his colic igiies showed their esteem by electing 
him to thc oflicc of president In more recent sears he 
w IS forced b\ ill health to curtail his activities but his 
interest in Brinch iffairs never abated In municipal life 
my scheme for thc improvement of the lot ot the working 
m in w IS issurcd of his whole hearted support and despite 
the continuous pressure of i very large practice he still 
found It possible to give much time even in his busiest 
veirs to this cuisc Loyal to his colleagues sympathetic 
with his piticms and courteous to all he won the esteem 
md iffcction of ill with whom he came in contict Thc 
profession is the poorer for his passing 

Ihc dc iih ol Dr Dvmd Lvirfsci Tvir which 
cNcurtcd e irlv in June robbed the pirish ol St James 
J im uc i ol one ot its oiitsl mding personalities Although 

his he ilih h 111 been t iiling tor some time hts sudden 

dc iili c line IS I slunk to his many triends throughout 

the is! md He studied medicine it G1 isgow graduating 

MB thBGlis in 190f, md taking the F R C S Ed in 
I'llb A verv iblc surgeon md keenlv interested in his 
piolcssion L lurciice Tile vv is mcapibie ot sparing 
iiimsclf His c iriy yeirs m the Government Medical 
Svivicc Were sp,.nt m the pirish of St Marv whence he 
w IS tr inslcrrcd to Montego Biv where as district medical 
otlNer he Served ^e ilouslv until his retirement a few 
Veils igo In I'tos !u becime a member of the British 
Medic d \ssoei ition md to the end he maintained a 
hvelv mie.est in the leliviiies of the Jamaica Branch 
p iriieiil irlv in medico politic il problems To his sorrow 
ini vvidovv md d iiighlers the Branch lenders its sincere 
sympithv 

Dr Wtiitwi CivKWtros Dot ot ass who died it 
St tnmore Sliddlesex on Julv 7 vv is tor many vears a 
keen wo ker in electrotherapy and r-rav diagnosis He 
stud'ed medicine It St B utholomcw s Hospital and quah- 
tied MRC S LRt P in 1900 During the war he 

itt lined itic r ink ot mijor R \ M C and won the Military 

Cross He hid been ehnieal issistant m the r rav and 
cl.eirother ipeiiiie dep irtnients It St Bartholomews 
in.d e il svip^rinlendenl ot Clare H ill small pox hospital 
md iiudu il director ot the Comelv B ink electro 
'!u ipeii'ie elm e It \\ ilih imsto'v He obtained the 

( tinbuhe DMRr in PUb md in recent vears held 

'V pssis o* issisijnt niedie il olhcer in the rriv and 
c' el o 1 a qui 'u d.pirtn'ent oi the Metropolitan Hospital 
n -d ,i! oOuft m eh I'gc ol ihc eCetrothcr ipeiitic md 
e px 'men V It th. Connuight Hospital Wal'ham 


*stow Dr Douglass published a small work Thc EUmuu 
of Medical High hreqtieiic\ and Diathennx m 1930 and 
wrote several papers on his specialty He had b.en a 
member of the Idarrovv Division of the British Medical 
Association for the past ten years 

Dr Charles R Dicrson who introduced v ra\v 
to the Toronto General Hospital and. after losing hn 
sight through exposure to the rays founded in 1914 the 
Canadian Institute for the Blind, died at Toronto on 
July 9 


Universities and Colleges 


UNIVERSITY OF CAMBRIDGE 
The following candidates have been approved at thc evam 
inaiions indicated 

Diplomv i\ Medical Radiologv and Elcctroloov —Fun I 
J C A Liddy Fart // S J H Douglas, Heather D Do»lir 
Kathleen M Henderson F B Kicmander Mary C Lcohmii 
K. Lumsden, J K Muir R S Pidaki C N Pulverlaft S J R 
Revnolds Alice M Ross A Smcrasiifi, S E D H E Tjoaii 
L WerbelolT M A A Zohdy 

UNIVERSITY OF LONDON 
At a meeting of the Senate held on July 20 the folloviii 
titles were conferred m respect of posts held at the Schook 
of the Universitv Piofessor of Anatonn Mr E P Slib(“ 
(king s College) Rciuhi in Clinical Pntlwlog\ Dr M Maud 
(Universitv College Hospital) 

Dr C k Meek and Professor W M MacMilhn vieu 
appointed Heath Clark Lecturers for 1938-9 


Umversiti Collcgc 

Thc following iwards have been made in the Faeuliy o 
Medical Sciences Bncknill Entrance Scholanlnp S M Cha< 
Lntrunie Exhibitions D B Griffiths Leslev M M Seaton 
Entunne Siliolarship H E Thom is Aiwlonn (Senio 
Course gold medal) Gwendoline R Briggs, (BSc) Sclio’’f 
ship D G Lamblev Practical Anatomx (Suckling Memom! 
Prire) S D V Weller Phx xiologx (Senior Course gold nieh! 
and iB Sc ) Scholarship), Gwendoline R Briggs (Schaler Ptud 
R ■k Gregorv 


UMVLRsirv College Hospital Medicai School 
The following scholarships exhibitions and prites I'l't 
been ivvarded at Universitv College Hospital Medical School 
Ga/ilMiiid Entrance Scholarships E Emanuel " 

Shrimplon Coldsnnil Eitirance Exhibilioii W D M 
rdliitr Entrain e Sciminrsliip in Pailiolog) Angela E Ri J' ^ 
Aulnson Scholarship Jo^ephlne Barnes Atkinson Slorkl, Scr' ' 
ship J D N Nabarro Macraih Scholarship J I " ■'■‘2 , 
J D N Nabarro Eillner Exhibiiion and Alexander Brii e uc 
Medal A Hargreaves Liston Gold Medals J C Font K / 
Harries Erichseii Pruc J C Ford Eelloiies CoM "r' 

R N Hoiilding Elizabeth Toplcy Fellowcs Siher Slehn 1 r 
Squire A G Spencer Take Sdxer Medal Elizabeth Tor ’ 
Junior Clinical Snrgen Prices, E Neumark D Lpu , 
Eerrtere Scholarship Annie E Walker Poslcradiiale ai' 
Leshi Pearce Gould Scholarship Margaret D Baber 


London Hospital Medical CoLtrer 
Thc Price Scholarship in Anatomv and PhvsioioC' cr 
to students of the Universities of Oxford and Camhri^e 
been divided between A H Ferguson of Wadham COj 
Oxford and F H Hovvarth of Corpus Chrivti 
C imhridgc 


UNIVERSITY OF MANCHESTER 
The tollowing appointments were made on Julv I4 ^ 
Lecturer in Medicine for Dental Sindenis Dr C , 

Lecturer in Surgical Paihologx Mr A H Southam ’ c 
Operame Surgery Mr R L Newell Special Lccinrer a 
log! Dr R VC Fairbrother Denwnstralor in Anatatm 
Bat! 

UNIVERSITY OF DUBI IN 
School or Piivsic Trinitv Coilfci 
ml,,- f,^llncc,nf, ennUifl-ifes h ivr been aonrovcd at thc ev 


tione indicated 

M D— VV B Roanirce C G S vin Hcvnmecn , 

FINCI XttDK VL LXAVlISAriON — Part / ‘J *' 

Tleapenites Pathology and Bactertolo^x *L Soloni 


Jin '0 I'J s 


l M\ I KSnil S AND COI I I GPS 


C J {it ^ O Nilcn 1 n Cj n U’cnncrh l^ c!t 

J 1 Citi’ipc \ M I \ctt D I Huhiu on M A 

•'I K MC M«v o J M lixicr I) K N! t uill\ 

K J S !! J S n tli ! M \!t Ci I f 

KcJ% \ \ li-f‘v ! J K HoU W M Wmn tv^bcl M 

WvVX’^i t I Cl N\ I Ml C 1 Tt - li n I K V>T( TTi *1 

\ I linVI r H k U>i r 1) C \! ! ^ u jt M<Hn\ I Kawcnu 

n MV G l N'>,| tj n C M l‘•ln U \ l •»« on 

K 1 B.- V.J ^ Iv.i'' a M n ' pi n ♦ s V\i l t H \ I") iij m 

K NV I I") I '' 'l ! It tV !i N! Rrr 

ivs rah Ii' N' r U R 1 *>' K J Cir>\r\Miir W Nti.<»nth 
K WtU'- \U T-1 U I J W ! S I \\rtN 1 W 

Iv Clo Via > C CO’*’tn J R \1i’ n O K Vte^itl It il\ 

1 1 I H ! C. 1) n I W K }h Ic n K T Dv\’n 

M I \ S alien Wee vvt I) I VIcJ c- V! I C Hilntcr 

J W ta an O M K \U n K J 11 Vc J C <’ R Sur^r 

I \ s J r Co- - Rr/ Cl 1 '^CM II \ 

IXip-r R 1 R rC l 11 Uun tlvaSMt M l> m n 

W C Gw! *R Vtn-c *J C tV R V; pi J C»r "c 

W»uc M> B Inl Ihilx-'j I J K'-n I M C%»-i»tn 

R J R V! dxV W W Vl-CiatJi J G W tupM 

Muncl t t 13 M R Bari^ I> Bey -i R W Ic^r'^ 

C M LLj'>tt W \ J 1 iVc 1 D I Verde 1 W Bi Hex 

I W R II Vc I J 1 Spe d ! M-in C Con’ n G O v cten n 

h •< O SvXj I llernar *I S Icm-x''! ^Ivthe’h Vf 

D'‘*-n-n Vlarv \ Ct-'’- ham \ 1 Wii„i'*t< J I H*.nde*m>n 

B kcrr'i'’^ J R Via’ i - I li aVth VI Rc^i Sx’xii VI ! j /Cir tUl 

W Sard OTd L U Ban Vr I Cni n I K T HoBm W B 

Wc’p > r R 1 vie’ 'I*' 1 Ct Vli’ ar II J ! Hra*^ n I !i aK* It 
1 ) Kx:an Roxalern d* C VKor’' V O D P Harr 

Direvtv ix. CoNiii <k a km» ^ — p VI B e^om 

A I \ I JJTawj’ VJ VJt‘/lj S C Wf^b O k khtBal 

A Thom_v W N t^aii \ V ’ ^x G B kahmj 

Oirioxt* IS IiMj IlixiTti— r t tt W A Gil’e r«e 

I kca-e •C'^arJote I PAc tl xeleen VI H t 1B I I 
B-nnex 1G H B Ri Velx ♦R A Heallcx A Do 

• Flrx -vlavs ho-v jfv t ^ ond-x.lax\ 1 onours 

The foBouiPc hv>c hern ‘tw^rded ^ 

fpi uf Trs\r n* Fn f B rniri ur\ • '/ ^ Pft r r/ 

H . u- *?<f rt G 'x VtaUatbnc MB 

Ft k Si^'^^^'hr T I l^JAxon V( B \frji il Schojr 

ahrs An.\i'»mx a"d Phxxit. n"> \\ L OC C lowcll 0»emK rx 
Phxxjcx Bo anx arJ 7oo’ C S Cumrr -xx Or f/rnrt 
If }(hii ** Stei^^ri \tf{ ’ S( f ^*ihps Anato***x and Phx^iolofx 
Elujhcth D L S no" 'n Ch*m' n Phxnj s Botanx nnd 

Zoo np T S S n ''p D f{<f \ Ifn ct n S r^^utt Scl t *orsf ip 

I : Kfrr Piir m J F Cil -* r f B Jof i efrVe/ Funfr 

Mcil ' VlaLd-* I 1 B rrr J-tfn Cttrr**tatk^tfi Sfrni >r if 

* r J Pn f ri jK*{h D I Si'^'X'On Dr ken » Centr- r\ 

Pn r Lxelecn Vf M See I VI B -Ic/ui'a / fi T i e I Solomon 

II I ber it Smttf Pn e Vlan k VfeCarlhx Ct to ft Vom n 
\1ci* ! in ^frn ’ Diir^irs H A Dourm 


NATION \L LNUTRSm OF IKII AND 

LsiMRX'm Comer, Covk 

The folloxvinp medical dcprccs and diplomi^ xxerc conferred 
on Juh 9 

VI D — O T D Loup’ ran IPO Connor 
VI B B Cff BjVO — R A VfacCarlhx Dlcn Vturp’ x W J 
Tv.chip R G Barrx A S Beare VI I BeeVeB C J Clohexxx 
VI M Cc-ran Vfan Co V Vf Crenjn G R CuhiB P I irrcll 
J nixGcrald L kc'lx M3r> Ijiuion J Lucex D J R 
McConxcH Jo<erhire C Murphx N Nrwman C I O Connell 
I O rixm P (3 keefe Marx r O Lenrv J G Paton I deen L 
Oumlan M 1 Rc''3xnc R M Walxon 
DPH— \ J Dillon T P P ORiordan 
B> PH— T P P ORiordan 


RO^AL COLLCGC OF SURGFONS OF LNGI AND 

A quaricrh Council mccimp of the RoNal College of Surgeons 
of England \xa«i held on JuK N with the Prexident Sir 
Cuthbert Wallace m the chair 

Mr Hugh I ett wax elected Prcxjdeni Profexxor G Grex 
Turner wax re-elected Vice Prexident and Mr K F kclU 
wix elected \ ice Prexident for the cnxumg xear 

Mr Nieto- Bonnex Mr R C FImxlic and Sir William 
Girling Ball were readmitted nnd Mr I F C Norburx 
wax admitted to the Counnl 

Dr Mahmud Baxumi Bc\ (Cairo) xxas admitted to the 
Fcllovsxhip of the College haxing been elected in April Jaxt 
The congratulations of the Council were exprexxed to Mr 
Cecil P G WaVelex and Profexxor A St G HuRgelt who 
ha\c been awarded the Insignia of OBiccr of the Order of the 
Nile (Tliird Claxsl and to Mr Horace H Rew Director of 
Examinations of the College who had been awarded the 
Insignia of Ofiiccr of the Order of the Nile (fourth Class) 
after (he Primirv Examination for the Fellowship conducted 
in January of this scar 


Tut PiiTisr '’FS 
stimcAL loi.»s*L 


I nIurcrK 

I he lollo'MMg IcGurcrx were appointed for the cn nine 
xcir 

Unit n »i Injt^sirs — Vfr Citorpc Armiligt one IclIiitc ta 
G\xu opc Oh crxalionx on the llcnlinp ot ChroniL Oixirie 
1 1 or VIjxx Dorolli) J Collier one Icvturc on Fav-nl pTralw^ 

md itx Operative Ircilmcni Vfr A I d Abreu one Iceturc on 

Congcnitil C' tx of the I um and I Icura Vlr } R Ldward< one 
!-'».titrc on Sliuhc in I xpenmental I nctirnoncctomx ind the 
Dcxeltpmnt of a Ixxosnpc Opentjon for the Remox il of a 
While I uap Vfr A J (jardhim one Iceturc on Surgerx of 
C luinimi <l the Vto ilh and the Tongue Vfr I J S Oiwar ore 
Ic fuTc o\ Iulmonir> I clxe tonu 1 oxt-opcratixc ComplKitions 

ar d th If Picxcniun A Cliai at ind I spennicnn! Irut tipiiion 

Atf C \ Joll one leutiiic on the latholo^'x Diapno i and Treat 
menl tf Ixnp'tadcnod Ootre (Hashmioto I xanphogr-nulom i 
Vtr J H VIlIx lax oae l'*Llurc on Oiffcrcntniioa in the 

Vtc^.’’ n xm Sxmp omatologx I ilhologx and Ircaimcnt ot the 
lx»o Ixpcs of 1 xophthalmos axxtyuted uith Graxesx Dixca c and 
a V ort Acvount of th ir IrohaMe Pithogcnc is Vfr D W G 
Vfurrax one lecture on Mep-arm la Thrombosis Vfr E W Rithcx 
oae le tufc la Ilxdfoacpltrosis Tic RexuUx of Coaxerxatisc 
Tinlnient ProVs nr ) Pi cf'on Rns^ one Ic lure on the EfTctix 
of Radium i pxx 1 Cartiaonn of the Breax Vfr II T Simmons 
c-'* I (lire 0 1 Reljpxc follmxmg Sxmp ithcttomx 

Artti r> { (t t r Lrtrtiirer J< hn Iteatti'* three lectures oa 
stlj-«,!x fclatnp to Human Anatomx and Ihxxiolop 

ft tMii II ih< - Dn nn\trat n — Vfr R St I Bro\.Vman one 
d'^monxtratK a la Some Inflammalofs I cxionx of the Alimcntarx 
Cuul Vfr R Dasiex-Coffcs one demon rranon on fhe Pttho 
logi *31 Contents of the Vfuscum Vfr I W Proper four demon 
tfpti as oa the Pjtho’o-i'-al Contents of the Vfuscum 

Arn i!i Dri^omtrctrr — Vfr A J I Case xj\ demonstrations 

0 I the Con entx of the Vluxeura 

The Hallctl Pri/e ssax awarded to How ird Hadficld Fddev 
of the Uniscrxitv of Vfclbournc and the ninth M-xcloghlin 
Si^hohrxhip to 1 ranL Bailcx of Oldham Hulmc Grammar 
Svhool 

The rew regulations for the I iccncc in Dental Siirgen 
which will hctomc efTewtixc pr'^dualls as from October 1 
Were approved and the Council agreed'' to a rccommenda 
lion that a Poxigraduaic Diploma in Dental Surgerx should 
be instituted 

The Council ippointed Profex or R J S McDowall 
(Bha lologat and Professor R Bramble Green (An items) to 
act IX I V iminers for the Priman I vaminalion for the 
Icllowxhip to be held carK m P 39 in I ahorc (India) and 
Cairo (Fgapl) 

The following rcappoin(mcnts for the ensuing sear were 
approved Mr 1 W Proper Piiholopical Curator of the 
Ahi'cum Sir Irani CoUcr Honorarv Curator of the 
Odoniological Collection (on the nomination of the Roval 
Soviets of Vlcdicinc) Mr CIS Thompson Honcrarv 
Cif'^ior of the Historical Collection 

Mr George kent Harrison (Toronto) was appointed a 

1 cxcrluilmc Scholar for one >car from October I and Dr 
David Slomc was reappointed a Vlackcnzic MacTinnon 
Re carch I cllow 

Dipionias 

\ Diploma of Membership was granted to Chcllnh 
Ponnambalam (Ccvlon) and Diplomas of Fellowship were 
granted lo Edward Philemon Connolh and I ouis Julius Horn 
both of Svdnc) 

Diplomas were granted jomlls with the Roval College of 
Phvxicians of I ondon as follows 

Diiiomv is AyvtsntETics — W Bourne S M Campbell A L 
Ilcmnimg P V Francis S Johnston H J Shields C C Stewart 

DiPioxfs IS Plblic Heaiti! — R H Barrett C Crowlex F R 
Glover J C Hogarth N D karani Suxan VfacVlahon A W 
VtcRoric J Marshall B Roberts C Seelex C G k Thompson 
I W \ ilain 

Diri^oxii IS PsaoiOLOGiCAL VICDICISX — M J BrooTe?. B FinTle 
man J F R Goodhd R K Grossart C R Harns C Holmes 
A A Huxe A Lcitch J P McGuinness R L Moedx R B 
Vtorton E k Vfuhnder J E SaviIIc S Sharman A Stoller 
\ H Tomplins Betty Vf Zeal 

DiPLOxtv IS LvRa-scoLOGY ASD OiOLOCv — R H B Betungton 
B K kapur k Vf Mayall D G Phillips I M Robertson 
R A Sxed R Tliomas 

RON AL COLLEGE OF PHYSICIANS OF EDINBURGH 

The Dr Jessie Maegregor Prize in Medical Science has 
been awarded lo Dr Susanne Jean Paterson for her work on 
the therapeutic uses of progesterone The value of the prize 
15 £50 



/ 


](^^ ■?() 


TstEDKAL NOTES IN PARLIAMENT 


Tite Bm^sk 
Medical Joehsm 


BPnisH coi I roF of obstetricians and 
OT N \ECOI OGISTS 

At tlic qiitrtciK n ectint. of the Council held in the College 
llni ".r I ondon \S on ]ul\ 23 '■'■ith the President Sir Ewen 
'll. km in the ehnir the foUoEMnc ofTtscrs were elected to 
I tc ofhec tl ihc Oetoher mcetmg of the Council 
PnMi'iti Professor \% Fletcher Sh iw I ice Presuletus 
I'rntcs or R W Johnstonc Professor Miles H Phillips 
Ih": ir,ir In, Mini Mr Eirdlev L Holland Honorarx 
I P rtiruit, Mr f rcdcricls Roques Honorarx Suntan Mr 
< I ( Ciiht -rd 

Ihc foilowin. were idmitted to the Fellowship 
M M li Bulmin NorwKh I G Phillips Condon 
The following were idmittcd to the Membership (i/t 
uln, 111111) 

I (i Mctiuinness Winnipeg O J Strean Montreal 
The lollowini, were clccltd to the Membership 
\ < ti liKid New Zeilind Muriel S Blander Indii W M 
< ipp- ' it I iiii I' Cl Chjrlewood Indi i J C Coetzec South Africa 
(tliilv S {. 11 iniivh im Chini J B Dew ir Edinburch 3 Edis M>ers 
I uli> I I M 1 Jv uds 1 ondon A B Esans London J G Gallagher 
Dulilin Ann ! Iktring Dundee R E Hirson Manchester 
I) 1 I ivss in Au irilij T F Lennon Liicrpool Mar) H 
'livi-iit I ondon C R Morison Harrogate H A Rippmer 
111 1 Uind Doroiln A Sliupc London P V VenLitswami India 
It S W lit I s Indi 1 


Medical Notes in Parliament 


llolli Houses of Pirliamcnt were occupied this wccL in 
ck inttg iw 1 ) irrcirs of business before the Recess which 
w IS dm. to heyn on Ittlv 2') On the previous day a 
dch lie w IS irr ingcd in the House of Commons on health 
idmmistraiion The P uhamcnlary Medical Committee 
ilso irr ingcd to meet before the Recess 

Tsso members of the Pirhamentiry Medical Commitlcc 
Sir 1 r vncis 1 remantie ind Dr Haden Guest were able 
to leeept the insit ition of the Council of the British 
Medieil Sssoei ition to mend the Annual Representative 
Meeting it Plemotilh 

On lul\ 12 fise members of the Parliamentary Medical 
( ommiiiee ind two miner M Ps were rcceieed by Captain 
t mot sh ink Secret irv tor Mines ind Sir Alfred Faulkner 
to discuss rheum itism imong coalminers and its treit- 
niint The Minister m idc it plain that his Department 
wouk! not be interested in i scheme for the general health 
>1 the people or with mereh experimental work but said 
III It (t propos ils to be submitted could be shown to be 
toi ihe Ire ituient of conditions pcculi irly alTeclmg miners 
ill. Miners Wclf ire Committee might then be able to 
tnte est Itself m them He suggested ih it in the first 
rust rnee the Miners He ilth Rcsetrch Bo ird should be 
ippioiehed Sir 1 r meis f rent mile undertook to convey 
(Ills smiesiion to the Empire Rheumatism Council with 
whom he IS now in touch 

the N itional He ilth Insur ince (Medical Benefits) 
Keiiilitions iSivotlanili I'Jts Were laid on the table of the 
House of t omnions on Juls 

Ih Report ot the Boiril ot Control for 1937 Part I 
' IS p escnted to Pirliinient on JiiU 26 

lord IlonlEr on Quack Med cine Trade 

In p e Hois, of lords on Juh 26 lord Horto R called 
o cniion US it " enormous growth in the qinck medicine trade 

0 d lo i! c in.esneniits of cverei'inp no control over the 
0* e eruus cPcets o! such trade upon health it a time when 

1 setis’iis el o I w IS heme m vde to unprosc nationd fitness 

H' aKsi roved tor pipers He said he had been told th it 
i' f e 1 I'o IS raised this qicstion he ssoidd he charged 
s I li tsin. 'o e cits i monopssls for his ovsn profession ind 
' ' 1 d.p isiaa t* c psssster el vsscs of cheap cures t{ there 

wis I r s "s'^sst n las in his si.w wuh the tr idc that 

( o p e ^ lO s,:;s(,mpo<a o t'OOOOPpO a vear— rearlv 

> ' v- as O toil sp. r on all oi r hospiia! services He 

3 - o I est up a lormid ib'e ind larvclv on 


scrupulous monopol) which judging from the exclusion of 
patent and propnetarv medicines and foods from the Food 
and Drugs Bill successive Governments seemed almost to co 
out of their wav to gviard If the doctor thought onh m 
terms of hard cash he would benefit from this unprincip'!.J 
trade which eventualh brought him more patients, ultimauh 
even the undertaker benefited sooner and ofiener than h- 
need Onlv now was there something better to put m th* 
place of these dubious specifics We had the finest health 
services in the world The slogan “Use vour Health Service 
was one of the most intelligent he had heard His roam 
Tcaeon for pressing the matter at this time was his concern lor 
the success of the national fitness movement For even £1M 
the Government spent in making the people health-conscious 
the quack medicine mongers paid £1,000 in making them 
disease conscious A few patented and propneian things 
were good and the claims made for them reasonable a greit 
manv did little good or harm and were sold at fantasliv 
prices and now and again something was sold that diJ 
definite harm There were an enormous number of prepara 
tions that were fraudulent m varving degree The creit 
increase in advertising media was capable of appalling reviilu 
in Its mass suggestion on the countrv s health and moral 
The advertisements had become a graver danger than 
the medicines thev served ^ 

The debate was continued bv Lord Addison 


Viscount Gage satd that investigation had borne out ih' 
fact that improper use of substances in themselves Inrmlew 
was a distinct danger to the health of the countrv and hinili 
capped the work of the medical profession He vvas reailv w 
agree that it might constitute an obstacle to national fitnt" 
The problem of the dangerous drug had been solved cvcepi 
possibly for new drugs which were being put on the market 
it had been said that the public were being used as a guinea 
pig by unscrupulous manufacturers He was informed ihai 
there was no method of foretelling the effect of some con. 
pounds and that the effects on the human bodv could onh fe 
ascertained by experiment That constituted a posilvve ilan<'vr 
but It vvas difliciili to pul absolute restriction on new inven 
tions The majoritj of the substances were made b\ In'" 
of Ihe highest repute which in their own interests saw ihilit' 
prcciutions taken were very complete 
The real difficiiliv arose from products and substances vvhiv’i 
were not in themselves harmful but the improper use of "I" I' 
constituted a danger Aspinn used properlt provided ml' ‘ 
from a number of minor ailments but used lo eveess it war 
not beneficial The inherent dtfficullv in dealing with ccrtaii' 
substances was that the real fault lav with the individual wl'ij 
Used them If people did not use the immense State assiU i 
medical schemes and preferred to dngnose and treat iht 
own complaints it vvas largelv their own responsibilitv it 'he 
suffered in consequence Thej were encouraged to do so f 
verv carefullv worded advertisements In theon there "a' 
a case for controlling the advertisements but it was not cw 
lo design forms of words which could not be evaded 
was not attempting to exclude the possibilitv of some led' 
lion on certain lines suggested but it vvas difficult to guaran t 
that It would be effective Repression alone was one of '' 
most dubious of all lines of progress The Minisief o 
Health would ex imine what Lord Hordcr had said and 
if anv thing could be done to incorporate in the cdticit'i^ ^ 
side of the national fitness movement some warning again'l 
abuses of drugs generallv Perhaps Lord Hordcr might 
he unconvinced bv bis rcplv If so possiblv he would 
to have a trv at legislating himself In regard to 
m liters the Government would be pleased lo place all 
resources at Lord Horder s disposal but on medical 
thev had no higher sources of information than Lord Ik"' 
him'-elf commanded The Governments attitude must lo m’ 
extent at anv rate be dictated bv public opinion besa 
these matters the public must have the last word 
Government were perfeetK prepared to lav anv papef' 
which Lord Hordcr might wish 

lord Hordi B asked leave to withdraw hiv mono'’ 
pipers and this was acrccd to 



Jin '0 19 A 


Ml OIC\I NOTCS IN P\RUAMENT 


The Durnnr 

/■ftDICAL JOLTISAL 


267 


Mnrtion nrd III" lj« 

Sir Hiski Morris Josi ■■ on JiiK 2^ asVciI the Minister 
of Hcallli ivliethcr his ntlcnlion Ind teen dircsted to the 
recent leqnittal it the hinds of the jnn of Mr Aleck Millnm 
Bourne who wis chirped it the Old Biilci with unhwfiilK 
U'inc an insmiment with intent to pri'snre the mi eiirnpc of 
a pirl of Is \cirs ind whether is this wis i test cisc he 
intended introducing lepishnon to elinfc or imend the liw 
deihnc with siidi ollenc'cs 

Dr Emor ^cs Sir M\ attention his been dnwn to 
this CISC I mi not in i position to make ins stiicment 
pendinc the issi c of i report hs the Inlcrdepirlnicnt il 
Committee which is insesnpitinp this ind other nutters 
ccincemmc ihortion 

Sir Hi SRI Morris Josns asked if Dr Elliot was iwnre 
that during the heinnp of this cisc the defendint stitcd in 
csidenx heforc the court thil had the subject of the opcntion 
been n entilh defcc tse he would not hate operated ind wis 
not dc‘'ecti\c mentilits a case of citreme ill health also"* 

■No answer was poen to this question 

On Jtili 2' Mr Msrssi asked the Minister of Heiltli if 
he was prepared to bring in a reeiihtion requinnc ill members 
of the r^edical and mirsnp p'ofessions to ccrtifs and notifs 
to the medical olTiecrs of health all opentions for abortion in 
Slew of the fact that such operations dilTered from others m 
that the life of another ssns insolsed 

Dr Eliiot This is imonc the matters which are under 
consideration b' the Interdepartmental Committee on \bor 
tion and I an timble to make an\ statement it the present 
tine 

Mr Msrssi In view of the prase concern throughout 
the countrs on this matter will the nuht hon gentlemin 
take care to make representations to the committee to show 
clearls that this sot of thing is not i private misdemeanour 
but a deadh national crime'’ 

Dr Eu-ior An inHuentnl committee has been considering 
this for some time and I have no doubt it will talc ill these 
matters into consideration 

Mr Loess I take it that no recommendation will alter 
the law with recird to murder and the taking of life’’ 

Progress of Bills 

The Roval Assent was given on Julv P to the Street Plav 
grounds \cl the Housing (Agricultural Population) (Scotland) 
Act the Children and 'Aounp Persons Act the Baking Industrj 
(Hours of A\ork) Act the MennI Defiaenev Act the In 
hcnlance (Familv Provision) Act and other Acts 

The Recistration of Stillbirths (Scotland) Bill vvis read a 
third time in the House of Lords on Julv 20 

On Julj 21 the House of Lords igrccd to the Commons 
amendments to the Eood and Drugs Bill 

The Milk (Extension and Amendment) Bill and the Einancc 
Bill were read the third time and passed in the House of 
Lords on Julv 2^ 

The following dav the Commons amendments to the A oung 
Persons (Emplovmcnt) Bill were agreed to and the Hohdavs 
with Pav Bill passed through Committee 

The Annual Report of the Chief Inspector of E^clories ind 
AVorl shops for 1937 was presented to the House of Commons 
on Julv 15 

A Prohibition of Vivisection on Dogs (Scotland) Bill wis 
introduced into the House of Commons bj Mr Mathers on 
Julv 26 and was read a first time 

Health and Education Services in Scotland 

Estimates for the Department of Health Scotland were 
debated bv the Hou e of Commons on Julv 20 Mr 
Colville said the period he had to review fell cntirclj 
Within the term of office of Dr Elliot The House knew 
the keen interest which Dr Elliot as Secretarj of Stile for 
Scotland took in health matters These estimitcs included 
a new item of £-10 000 for grants under the Matcrnitj Services 


Act pissed list veir In public health Scotland was going 
forw ird It hid m the spring the worst influenza epidemic 
since 1929 vet the pcnenl dcith rate had remained practicallv 
the same Infant mortilitv fell from S2 j to 80 per I 000 
and the figures for the first quarter of 1938 were still better 
Most welcome of ill wis the fall in the maternil mortalitv 
me from 3 6 per 1 000 registered births m 1936 to 4 8 per 

I (XHl in 1937 The 1937 figure was the lowest recorded in 
Scotlind tilts ccnlurv These figures should be in incentive to 
further effort in which the Matcrnitv Services (Scotland) Act 
would Ic of great help The local authorities were pushing 
on with the prcpintion of schemes and he hoped that soon 
cverv mother in Scotlind could secure the services of midwife 
do tor and if nccevsarv consiilnnt The school health 
service w is working the conception of health into the whole 
of school life ind the 90 000 children who left school vearlv 
in Scotlind were fitter thin previous generations were The 
Instirince Act passed list jear hid enabled the Department 
to link up the school heilth service with the insurance medical 
service and links were being cstiblishcd with the indu'tnal 
health service under tic Eactorics Act This medicil service 
WIS given in Scotlind bv about 2 (X)0 doctors who under a 
new scheme organized bv the Department received oppor 
(unities for postgraduitc courses Under the Insurance Act 

II hid been found that about two fifths of the total sickness 
among insured persons wis accounted for bv those who were 
ill for more thin a vear The Depirtmcnl of Health with the 
CO opcntion of insurance doctors and of the approved societies 
had begun an investigation of this chronic sickness in such 
a W 1 V as to bring the services of the regional medical officer 
and the specialist to bear on individual cases In that vvav 
ihcv hoped to help the individual case ind to discover facts 
on the handling of chronic sickness gcncnllv Other services 
contributed to the whole health effort For example tuber 
culm tested cows in Scotland had increased from 204X9 to 
'0002 Since the postwar housing effort beean 290 000 
houses of working class Ivpe hid been built in Scotland 
23X(X)0 of them with Stitc ltd but 250 000 houses were still 
needed In the first hilf of 1937 local authorities com 
plctcd 5 973 houses in the first half of 1938 9 095 houses 
Since I93X the Department hid refused to approve the 
building of houses with less than three apirtments hut he 
proposed to luthorize the erection of (wo roomed houses up 
to the number ascertained to be necessarv for old people 

Air Tom Joiis<nos moved i reduction of the vote remarking 
that 00 OCX) households in the burghs had no Iivatorv 
accommodation Sir Arciiiiivld Sivclmr said a grant of 
£50 000 vearlv in aid of the stitutorj heilth services in the 
Highlands ind Islands had been recommended bv the Depart 
mental Committee on the Scottish Health Services and should 
be implemented 

Mr Liossrd spoke of dental defects among school children 
and suggested tint these could be abated bv greater attentic* 
to the diet of prcgmnt mothers and voungcr children He was 
advised that the Notification of Births Act 1915 would 
permit local luthorities to pav attention to this 

After further debate on housing and on water supplv Mr 
AAi nncRBLRs- replied for the Department and the motion to 
reduce the A'otc was defeated bv 162 to III 

A/cf/icfl/ rxamtntUtons of School Chililrgn 

On Julv 21 Mr AA'i ddlrblr.s moved a A’ote for Public 
Education in Scotlind He said that the vear 1939-40 would 
find education authontics gencrallv prepared to make effective 
provision for the children between 14 and 15 who after 
September I 1939 would continue at school There must 
then be additional accommodation for phvsical education 
Considerable progress hid been made in providing gjmnasia 
swimming pools and phving fields Continuation classes in 
phjsical education were expanding Keep fit classes 
chieflv for women were successful 

In moving a reduction of the Vote Mr AA’estvvood said 
the school health service had largelv fulfilled its purpose of 
becoming one of the mam preventive health services At 
present children were examined as i routine thrice during 
school hfe at entrj at age 5, at age 9 and before leaving 



26'! Jen to I93S 


MEDICAL NOTES IN PARLIAMENT 


The Bxmss 
Medical io ilml 


school— about age It Novs th it health and education aiithori 
lies s ere usualK the same age “i had no special significance 
and the routine medical examinations could be cut down to 
tv o It igc 7 md age It This would release some of the 
medical staff for a pre school medical examination to discoxer 
defects which should be remedied before the children entered 
school Mr Tom Joiixstov said Mr Colville was for the 
first lime civ me monctarv grints to two Universities — Edin- 
burgh ind Olisgow — out of the Education (Scotland) Fund 

Mr Con It It sud 27 per cent of 180 482 children in 
Olisgow schools received milk free on March 31 1938 It 
w IS not ncccssirv that a child should have a medical certificate 
ih It It w IS in need of food before food was provided Manx 
children were provided with food on the report of the head 
m istcr or teacher 

I he motion to reduce the Vote was defeated bv 171 to 102 
ind the House went on to discuss the Vote for the Scottish 
Ollice On this Mr Colmlie give an account of work done 
under the N itional Fitness Council He mentioned the 
expenditure on juvenile welfare and said that he desired to 
extend the sjsiem of probation for adult and juvenile offenders 
in Scotland 

C irlifualtoii of Ciiiiiincil Lunatics 

Mr Neil MAtitvN moved a reduction of the Vote and 
pointed out that in a recent rcplj to i question in the House it 
hid been stated that i lunatic had been eertified b) two 
medic 1 1 officers of the Department Mr Maclean contended 
tint this w IS against the intention of an amendment made 
to the Act passed for the building ^of a new criminal lunatic 
prison in Scotland The amendment proposed that one of the 
persons ccrtifving should not be from the Department but 
someone from outside prefcrablv a medical man who knew 
somcfhing of the familj historv of the individual being certi 
Tied I h it proposil hid been accepted bv the Government 
ind the House but he was now told that it onlj applied to 
persons likelv to be committed to the new Scottish criminal 
lull itic prison It C irstairs which was not vet completed 

Mr C xssM I s Slid he had been shocked to be told in repiv 
to 1 question th it no instructions had been issued to courts 
in Seotl iiid concerning the examin ition of juvenile delm 
qi cuts bv psvcho inilvsts He had merclv been told that on 
cverv occ isioti where there vv is a suspicion of defect or abnor- 
Mi ililv III ex imin ition vv is to be made 

Mr 1 Dili mil UN rcplvmg to the point raised b> Mr 

M idem slid th It It Barlmnie and Perth prisons certificates of 
irisinilv were norm illv given bv two prison doctors emplo)ed 
it those prisons At Fdinbiirgh prison the certificates were 
noriiiillv given bv the prison doctor and bv the medical 
adviser to the Prisons Department At all other prisons the 
eeriifie Ition vv is norm illv bv the prison doctor and a 
ckKlor independent of the prison service When the Criminal 
I un Hies (Seotl iiidl Net cimc into operation on a date to be 
ippoinled bv the Scerel irv of St itc it would rem un competent 
to leniove i person from prison to the new criminal lunatic 
.svluiii on the eerliticitcs of two doctors in the cmplojment 
of itie prison lulhoriiics but it would be open to that person 
vsr to someone on his behalf to dem ind that he be examined 
bv in independent doctor Sccondiv no person could be 
vlel lined in the eriminal lunatic asvlum after expirv of his 
sentence unless i medical ccrtificalc was granted bv a doctor 
vvtio vv IS not a siliricd officer of the Prisons Department 

I he motion for reduction of the Vole w is rejected bv 
1 '7 to 9S 

Divorce in Scotland Bill 

The Divorce (Seotl indl Bill was read i third time bj 77 
to 1') in the House of Commons on Julv 12 Earlier in the 
sittiiie it the elo e of the Report stage the words and nullitv 
ot II irriice were deleted from the title of the Bill 

In the House of lords on Julv 19 the Commons amend- 
n’erits to the Bill were agreed to In regard to the deletion of 
( 1 ji ■-4 vvhieh dealt with niilhtv Lord \Incss said there was 
A s loni fccline in the Svoiiish Grand Committee against the 
tv -n loa o! the eliuse lis deletion would not affect the main 
t Mss e o' lb- U,U ssliuh was lo reform the 1 ivv of divorce 


Maternal Morlalitv Rales 

On Julj 12 Mr Sanders asked the Minister of Htalih 
the names of the countries with a lovver maternal mortaluv 
rate than that of Great Britain Dr Elliot m circulatin' 
this tabulated statement said that the figures in it exvept 
where otherwise shown were for 1933 The coniparabilii) 
of the published rates ot matern il mortalitv was however 
affected b> manv factors (for example differences in methods 
of classification and in completeness of national arrangements 
for the collection of vital statistics) 

Mnleinal Morinlili All Causes Rates per I 000 Lae Birth 


Great Britain 

43 

Iceland (1934) 

'1 

England and Wales 

4 1 

Italy 

>0 

Bbigium 

42 

Japan (1934) 


Denmark 

40 

Netherlands 

30 

Spam 

34 

New Zealand 


Estonia (1934) 

34 

Norway (1934) 

■") 

Finland (1974) 

2 7 

Sweden (1933) 

31 

France 

23 

Uruguay (1934) 

23 

Hungarv (1974) 

38 




Cost of Health Insurance for Dependants 

Dr Elliot on Julv 14 (old Mr Graham White (hit tn 
the assumption that the term dependants was restricted lo 
wives and to children up to the school leaving age the cost 
of providing medical benefit to the dependants of insured 
persons would be about £10 000 000 a year if the anniiil 
charge per head were the same as that now applicable lo 
insured persons themselves 

Medical Examining Bodies 

Mr Sorensen on July 14 asked whether, in view of 
the multiplicity of examinations and examining bodies rclaliie 
to the training and professional status of medical practi 
ttoners Dr Elliot vxould consult with the British Mednl 
Association and other medical and surgical organizaliori 
about the co ordination and simplification of such trainw 
with a view to considering the institution of a Stale mednal 
examination and establishment of a State medical trainmt 
hospital Dr Elliot replying for the Lord President of if 
Council said there was no present prospect of the mlrodis 
tion of legislation which would be necessary for this piirpox 

Medical Refugees 

In a reply to Mr Riley on July 14 Sir Samuel HovRt sid 
It had always been recognized that a policy of unrcdndc 
admission to this country for qualified doctors or dcnlii’> 
would be out of the question Only a small number 
foreign practitioners could be absorbed into the medical 
dental professions It would be necessary to select this nuin 
with care To assist him in making this selection it * 
proposed that applications should be examined by a commit ^ 
on which there would be representatives of the mcdinl - 
dental professions and of the refugee organizations nc 
not informed that there was a shortage of medical pm'* 
tioncrs in this countrv 

Mr Mmhers isked if Sir Samuel had received intina^'^ ^ 
of the concern of doctors practising in this counir) k ' 
the numbers alreadv admitted to practice 

Sir Samuel Hovre said he had had discussions with 
senlatives of the principal medical organizations who ac ^ 
with him that discrimination must be exercised The ' 
Office would be able to admit a limited number ao 
maintain effective discrimination 

Repiv ing to Sir Hlnrv Morris Jones who asked abojU 
idmission of medical practitioners of Austrian 
Sir SvxiLEL said he had agreed with representatives 
medical profession that the number of Austrian < 

could be absorbed into the profession was limited 
deciding on a precise figure he would await 
tumtv of ascertaining how manv of the applicants p 
special qualificalions or special claims to considcraii ^ 
rev lew mi, applications the Home Office would consi 



Ji.L\ 0 i>ns 


MEDICAL NOTES IN PARLIAMENT TucErtthh 

MIDICjU. JOLR.S<L “ 


^rnnccmcni*: the npplif\nt propo cJ for iLqinrinu the ncccs 
Mf\ •qinhfjcinon for pnciiMni, in Ihi*. countrs md in whiC 
pirt of the LounttA he propo cd to citlc It mu i fxkc into 
acvouni that av Sir licnr\ Morris Jones pointed out nnn> of 
the forvicn practitioners avcrc able to pravUsc in this coiinlr\ 
•'fter a «.hort period of sii d\ bir Samuel added that ujlh co 
cpcnlion between the mctiKil profession the rcfupec oruani 
rations and the Home CfiKC he bclic\c\l that rehipc could 
bv alTordeil to a nuinber of refugees without Poodinc the 
profession m this counir\ with doctor^ who were not required 
Dr Si MMiJi'vXiLL said manv doctors in this countr\ 
bchcNcd that the Austrian doctors could make a helpful con 
tnbution to medicil knovsledcc here 

Sir SiMtrL Hoiri s^id that was the fact and showed how 
nccc<sarv U was to deal with the applications case b\ ctse 
on their merits 

On JuU 20 Mr Hu»gs. pul a question which asserted that 
medical practitioners were \er\ concerned at the intention of 
the Home Onicc to admit further alien doctors into this 
coimin and allow them to practise here Mr KiRm on the 
srrrc da\ asserted that the medical profession stroncK 
re ents their entn and consequent compelilion with them on 
a lower standard of iraininp than is required here 

Lord \\ivnRTOS referred the questioners to replies pre- 
MoiisK giscn to Sir Henrs Morns Jones and oilers 

Ans-wermc a general qt/e tton hi Mr Rilei on Jtih Str 
SsMiEL Hosre said traditional bo piialit\ would be extended 
far as was compatible with our social and economic con- 
ditions to persons obliged to lease their ow*n countries on 
political raaal or religious grounds but indisiduals who 
came here must be carcfulls selected 

Nursing Homes Registration in Scotland 

Lord Alness m the House of Lords on Jul> 14 mo\cd 
the second readme of the Nursing Homes Registration (Scot 
land) Bill which had he said been piloted through the House 
of Commons b\ Sir Doughs Thonson Its purpose was to 
require esers nursing home in Scotland to be registered and 
to make it an ofTcnce in that countra to canrs on a nursing 
home without registration In Scotland maiemitv homes had 
been 'Cgistrable since 1927 but nursing homes had not been 
The Bill proposed to repeal the Act of 1927 and to make all 
nursing homes m Scotland subject to one code as in England 
to-da\ This would bring the law of the two countries into 
complete harmons 

The Bill was read a second time without a diMsion -v 
On Jul\ 19 the Bill was considered in committee \n 
amendment b\ Lord Alness to make it dear that a qualified 
nurse might act as an officer authorized b> a local authonU 
to inspect a nursing home was aerced to 

Lord Alness mo\ed a new clause gising power to the 
Department of Health for Scotland to exempt ans nursing 
home earned on m accordance with the practice and principles 
of Christian Science from the requirement that the home 
should be in charge of either a recistcrcd medical practitioner 
or a qualified nurse who was or would be resident in the 
home He s^jd that the clause mcrch echoed the correspond- 
int. proMsion in the English Statute of 1927 which wus 
re-enacted in the Public Health Act The new clause 

was drafted in the Department of Health for Scotland and 
came before the House with their sanction The dau<c did 
not exempt these nursing homes from am of the structural 
or sanitarx requirements which the Board of Health might 
impose and mcrcU rulatcd to the requirements about doctors 
and nurses The English Act had worJed smoothh and well 
The new clause was agreed to and the Bill passed through 
committee 

The Bill was read a third time and passed on Jul> 25 

/mrni/ntzalion aQai/isf Diphtheria in Scotland— On Julv 12 
Sir Thomas Moore asked the Sccretarx of Stale for Scotland 
what assistance was pro\ided b\ his department for the 
immunization of school children against diphtheria and 
wheiher in \ieu of the danger of epidemics of this disease. 


progress in this matter could be accelerated Mr Colville 
said that the Department of Health had laid stress in heir 
annual reports on the value of immunization of children 
against diphthcrn A number of local authorities with the 
cncoungcmcnl of the Department had proceeded with the 
formulation of schemes for securing such immunization and 
the Department s medical officers had co operated with rredical 
ollicers of health to that end 

Recall of Patient on Licence — On Jul> 12 Mr Loexs asked 
the Minister of Health whv a man named Thomas Fisher 
after being out of Calderslones Institution for five ve^rs was 
recalled and if he was aware that the doctor said he could 
be considered for release if he had a permanent job 

Mr B/rnx\s said that the au^ho^Ilc^ at Calderslones re 
called the patient bccau‘-c questions had arisen as to the 
suitibihtv of the occupation and the adequaev of the super 
Vision available at his home The Board of Control how 
ever on June 21 last asked the committee to reconsider the 
matter and to furnish their observations on the suitabilitv of 
Mr Fisher for discharge As a result it had been decided to 
discharge the patient Mr Bernavs added that the Minister 
of Health appreciated Mr Logans anxictv that patients on 
licence should not be recalled unnecessarilv The Board of 
Control had m f''ct issued a circular and the Minister was in 
communication wiih the authorities concerned 

Somtufainc Anreoju in Dementia — Dr Elliot stated on 
June 14 in replj to Mr Sorensen that it was not proposed 
to issue a report on the treatment of dementia bv somnifainc 
narcosis The report on cardiazol treatment would b^ 
published shortlv 

Braqt; Paul Rtspirator — Answering a question on Julv 14 
Dr Elliot said he knew that a broadcast on Julv 8 asked 
listeners whether ihev knew where a Bragg Paul respirator 
or iron lung could be found to save the life of a child 
He regretted a respirator could not be found in this ease 
A certain number of respirators were alrcadv available at 
hospiiil centres and his medical officers in their Msits of 
inspection were prepared to advise local auihoniies upon the 
question of providing them in suitable centres Under the 
circumstances and having regard to the infrequent occasions 
on which these appliances were required provision b> 
Government funds of a number of such appliances would not 
be justified In a supplcmcntin question an assertion was 
made that there were eighteen such respirators in Great 
Britain 

Rhcumain, Pexer on a Traininq Ship — There have been 
Ibirtv one fresh cases of rheumatic fever amongst the trairces 
in the Caledonia at Rosvih since April 1 last a ratio of 
approximaielv 18 per I 000 strength The sewage arrange- 
ments both on board the Caledonia and on shore have 
teen under continuous observation bv the departments con 
cerned and except for one lemporarv breakdown against 
the recurrence of which steps have been taken no deficienc> 
has been reported 

Ai/omc ScrMcer lnquir\ — The interdepartmental com 
mitlcc on the nursing sen ices hopes to make an intenm 
report before the end of the vear It is still hearing 
cv idence 

Notes m Brief 

A report from the departmental committee on the use of 
celluloid m the manufacture of tovs fanc> goods etc was 
presented to Parliament on Julv 6 

Correspondence relating to the welfare of women m tropical 
\frica was presented to Parliament on Jul> 5 

Replving to Dr Summerskill Sir Samuel Hoare savs the 
removal of women from Hollowav Prison to a modern prison 
outside of London is under consideration 

The Scottish Office has recommended to all courts in 
Scotland that on everv occasion where there is suspicion of 
defect or abnormalitv a medical and menial examination 
should be conducted b> the most skilful specialist available 



EPlDEXriOLOGY SECTION 


T«e BRirtiK 
Medical Souwi 


270 Juu 30, 193S 


INFECTIOUS DISEASES AND VITAL STATISTICS 

We print bclovs j summtry of infectious Dist-jsts and Vital Statistics in the British Jsies during the iveek ended Julv 16 19 iS 

Figures of Prmcipil Notifiable Diseases for the week and those for (he corresponding week last year, for (a) England and SVak, 
(London included) (b) London (administrative county) (c) Scotland (d) Eire (e) Northern Ireland Median values for ihi. Iw 
9 vcirs for (a) and (b) 

rigiires of Birtln and Death and of Death lecordtd under each tiiftctious disease aiefoi (a) The 126 great towns (124 in 193)) 

in England ind Wales (including London) (b) London (administrative county) (c) The 16 principal towns in Scotland (d)Ttn. 

1 3 principal towns in Eire (e) The 10 principal towns (9 in 1917) in Northern Ireland 

A dash — denotes no cases a blank space denotes disease not notifiable or no return available 


Disease 

1938 

1937 (Corresponding Week) 

1929-37 (MedunValu 
Corresponding Weeks) 

(a) 

(b) 

(0 

(d) 

(e) 

(a) 

(b) 

(0 

(d) 

(e) 

(a) 

(b) 

Cerebrospinal fever 

20 

2 

9 

2 

— 

22 

2 

6 

1 

— 



Deaths 


— 

1 




1 

3 





Diphthen i 

1,075 

153 

121 

58 

24 

979 

125 

145 

36 

19 

912 

bS 

Dciths 

26 

3 

2 

4 

— 

17 

1 

3 

2 

— 



Dysentery 

39 

16 

25 


— 

21 

4 

8 

1 

1 



Dc iths 




— 

— 




1 

— 



r nccphalitis lethargica acute 

3 

— 

— 


— 

2 

— 

— 

1 




Deaths 


— 





1 






Enteric (typhoid ind pantyphoid) fever 

26 

5 

3 

1 

2 

45 

5 

4 

7 

— 

54 


De iths ^ 

2 

— 

— 

— 

— 

3 

— 

— 

— 




Ervsipelas 



58 

9 

I 



70 

1 

4 



Deaths 


I 





1 






Inltetive enteritis or di irrhoea under 2 yeirs 













Dc Iths 

61 

17 

14 

5 

— 

39 

12 

9 

3 

3 



Me tsits 



109 


4 



63 





De Iths 

5 

I 

1 

_ 

2 

15 

— 

1 

1 

— 



Ophthalmia neonatorum 

94 

12 

39 




104 

5 

35 






Dciths 













Pnctimonii influen/ilj; 

52S 

37 

9 

1 

8 

blO 

47 

3 

1 

1 

533 

■D 

De Iths (from infliicnra) 

23 

1 

3 

— 

1 

10 

4 

— 

— 

— 



Pneumonia pnmarv 



143 

17 




105 

7 




Dciths 


11 


13 

8 


7 


1 

6 



Polio cnceph thus iciile 

1 






1 

— 






Dc iths 


— 





~ 







Pohomychlis icule 

8 

1 

3 



8 


1 





Dc Iths 


— 





— 







Pucrpcril feier 

6* 

6 

7 


1 

32 

4 

17 

I 





Dc Iths 


— 





It 






Pucrpcril pyrevia 

195 

22 

13 



132 

14 

42 





Dc Uhs 












- 

Rti ipsing fever 







— — 



.... 





Dc Iths 














Scarlet fever 

1,740 

168 

310 

73 

56 

1,665 

184 

334 

69 

43 

1,673 

247 

Dc nils 

3 

— 


~ 

— 

3 

1 


1 

~ 




Smill pox 


W-. 

__ 



— 




-- 



Deaths 

__ 

— 


— 

— 

— 

— 


— 

— 




Tvphus fever 










.. , 

_ 






De Iths 






— 




— 

— 




Whoopi ni, eoiigh 



25 


3 



42 


4 



Dc uhs 

6 

2 

1 

1 

— 

13 

4 

3 

2 

— 



Deaths (0 1 veir) 

290 

44 

42 

15 

24 

296 

58 

57 

24 

17 

■II 


Infint mortahtv rate (per 1 000 live births) 

48 

36 




50 

48 





- 

De Iths (excluding stillbirths) 

3 S56 

686 

553 

la2 

12! 

3 747 

705 

534 

163 

115 



Annual death rite (per 1 000 persons living) 

95 

87 

M 3 

10 2 

10 7 

93 

89 

109 

11 I 

110 




Live births 

6 907!i 285 

876 

430 

229 

6 780 

1,244 

911 

343 

240 



Annu il rue per 1 (X)0 persons living 

170 

164 

178 

29 1 

20 3 

168 

15 7 

18 6 

23 4 

23 0 


- 

Stillbirths 

2y4 

32 




29^ 

41 






Rsitt. per 1 (XK) tota! births (ins.!udmt> stillborn) 

35 

24 




41 

32 







* f'-'" “•*’ " ii'ijMc <wl> m (he .Includes primarv form m figures for EriBlund and "a’'* 

t Dei i fruni tnitpcl/ja (idminisltaluc counljJ and Norihern Irelind 



Jin ’0 19^^ 


EPIDEMIOLOGY SECTION 


Tire Bxmsi/ 

MXDICAI. JotFS^L 


271 


EPIDEMIOLOGIC VL ^O^rs* 

\n O Mlircnk of roIiom\cIitis 

\ '*nnll outbrciV of polionncliiiv in I c\ u-\s reported to 
the Mini^irv of Health enrU h'^i week ind i under m\e ti 
pition b\ one ct the mcdicnl oPKcrN of the Mini irv m con 
jurdion With the lo al medicnl oOKcrv of health Lp to 
Jii1\ 27 hiNc ci>nic to notice il in Hal teid Kural 

DiMrict ' in Braintree ind •* in Di nmou Ri ral District 
There has been one death Four of the ca cs base occurred 
in a boarding si^hcol for bos^ The ives of the per on 
alTccied ranee from ^ \eirv to idolesccrce One ca e has 
oexurred m an adult of 26 \cars of age I he loc-il hc*.!ih 
authontics arc takinc all necc sara precaution' and the counts 
nr'dical otTi^er of hedlh for b'sex is cooperating with the 
medical oniccrv of hc'^llh concerned Dr Norman Smith a 
medical ofliccr of the Ministrv of Health i' a" 'ting the local 
health authoniics and is M'liinc the aPe^ted dt tn-ts Small 
outbreaks of this disease arc not uncommon in this counin 
and an ascracc ni mber of 10 or 12 cases a week ire notified 
\ memoranaun of the Mmi'trs of Health on acute polio 
maclitis whch includes ad\i e on prccautionars measures 
again t infection can be obtained from H M Stationers 
OHicc pnee 2d 

Diph hcri3 ard Scarlet Ecser 
Notifications oi oiphthcna m Encland and Wales dunne the 
week under rcsiess ro'c from I 001 to 1 07^ and in London 
froni 127 to 1^ There was a decided decrease in the notifi 
cations for Scotland — 121 as acain<t 1^1 recorded m the 
previous week — but in Eire and Northern Irchnd there were 
small ncrea es — ^8 compared with and 2t compared s'lih 
21 rcspcciisch Death' from diphtheria in the 126 Great 
Towns of Encland and Wales ro'c from 22 to 26 and in 
London from 2 to ^ Of the 26 deaths recorded in the 126 
Great Towr< ^ (1) Ocairred in Lncrpcol ‘ (1) in South 
Shields and 2 each in Che ter (0) and Shcflicld U) There 
were 2 deaths from diphthcru in the 16 pnn^ipal towns of 
See land during the week i ndcr review — I c ich in Glasgow 
and Edinburgh There vv-is -j slichi decrease in the number 
of notifications of ‘carlci fever in Encland and W dcs during 
the wcel — 17*^0 compared with 1 7>1 — but in I ordon an 
increase was noted — If^S (1^7) In England and Wales the 
figures were in excess of the median value for the last nine 
xears hut in London thev were convidcrabh Ic" There ' ere 
3 deaths from scarlet fever in the 126 Great Towns of 
England and Wales during the wee! under review compared 
xMtVi 2 in the previous week Notifications of scarlet fever in 
Scoitard ro«c from 29^ to 310 with I death (in Greenock) 
In Eire thev remained at 7 vvhilc in Northern Ireland thev 
fell from 71 lo ^6 in the week under review 

Pnman and Innuenzal Pneumonia 
There was a rise in the notifications of primarx and 
influenzal pneumonia in England and W'alcs during the week 
under review — *^00 lo ^28 — but in London the figures dropped 
from 42 lo 37 both these figures arc below the median 
Values for the h't nine vear< 

Measles and Whooping-cough 
The incidence of measles in England and Wales conlinuo to 
decline Deaths m the 126 Great Towns have fallen from 
7 to ^ during the week under review one of them being in 
London The number of cases reported in the LCC 
' elemenliir> schools during the week was 176 compared with 
2^0 m the previous week while the average dailv admissions 
to the LCC fever hospitals fell from 12 to 9 for the week 
under review Notifications dropped in nine of the metro 
poliian boroughs in which measles is notifiable and ro«e in 
Fulham — 10 as against 9 in the previous week — and Green 
vvich — 22 as against 19 In Scotland the figures for measles 
rose during the week from 91 to 109 of these 54 (19) were in 
Kirkcaldv 22 (18) in Falkirk and 8 (23) in Dunfermline 
There have been more deaths from wh ooping<ough than from 

• Except v^herc otherwise nicniioncd figures in parentheses refer 
I to the v^ee*. preceding the one under f-»icw 


measles during the week — 6 for England and Wale as against 
^ for measles and 2 for London as against 1 for measles 
in Scotland there was 1 death each from both diseases in 
Ghscow and Dundee rcspcctivelv 

Giolcra 

^ con idcrablc increase in the incidence of cholera has 
been repor cd in China durmc the week For the week ended 
Julv 16 in Shanghai there were 418 cases with 152 deaths 
compared v\iih 22'' cases m the previous week m Hong kong 
tn the same week there were 60 ca'cs. with 53 deaths com 
pared with 4j ca«cs and 32 deaths in the previous v eek The 
Chinese Hevlih \dmini'iration which has been working m 
close CO ope ation with the I caguc of Nation has a'ked the 

1 cacuc for 6 000(X)0 doscs of cholera vaccine In respon e 
lo the appeal Australi i and Ccvlon have each ent ^00 090 
docs the \mcrican Red Cross '(XK)000 does Turkev and 
Rumania each 1(X>0 000 docs ^ ucoslavia and the Pasteur 
Irsiituie it H noi c'^ch ^00 000 doses Smaller amount have 
al o been received from the Scrum Institute at Copenhagen 
the Eevptian Ministrv of Health and the Institute of Bactcrio 
locv It Buenos \ircs In British India cholera has been 
declining in recent weeks with the exception of Berar with 

2 *^25 (I 950) cn es and Madras 43^ (414) cases 

Small pD\ 

A review of the epidemic of small pox at Hong Kong has 
revealed that nearU 2 (X)0 persons lost their lives this vear 
The total figures were 2 284 bv the end of Mav and 1920 
patients died (case faialitv 84 1 per cent ) Over 75 per cent 
of the fatal eases occurred among children The epidemic 
reached its peak m the middle of March when an average of 
40 ca es dailv were recorded but for the last few weeks onlv 
ore or two case^ have been reported 


Medical News 


Tbe House of the Britisli Medical Association including the 
I ibrarx will be clo'ci from 5 pm lo-dav (Endav Julv 29) 
to 9 a m on Tuesdav kugusi 2 (Librarv 10 a m ) 

Ml who contemplate attending the third international con 
gresv for microbiologv New ^ork Citv September 2-9 I9a9 
arc asked to 'end their names to Dr R St John Brooks 
sccrciarv of the British National Committee (Lister Institute 
Chcl ca Carden London SW 1) Some knowledge of the 
numbcr^ likcK to make the joumev vvdl greatlv facilitate 
arrancements for securing advantageous terms of transport 
from shippmc companies 

The first number has been published this week of the 
Bnttih Joiirr al of Rhctimafism edited bv Dr M B Rav and 
dc cribed m the subtitle as an independent review mainlv 
devoted lo the practical and clinical aspects of rheumati m 
Lord Herder writes a short send off Dr Foriescue Fox 
follow*, vith a foreword and there is an cditonaJ outlining 
the aims of the new quarierlv publication (price I2s 6d per 
inniim sinclc copies 3^ 6d > 

The issue of Parts Micittal for Julv 16 which is devoted to 
psvchiatrv contains the proceedings of the seven eenth inter 
national neurological reunion held in Pans on Mav 3] and 
June I 

During the State vi it of the king and Queen to Pans last 
week Her Majcsiv accompanied bv the Duchess of 
Northumberland inspected the Hertford Bntish Hospital 
This institution with foru beds js in the Rue de Villiers 
Founded in 1877 bv Sir Richard Wallace it was made over 
to the British Government bv deed of gift in 1892 Its object 
IS to give medical care and relief to needs men and women 
fiom am part of the British Empire but the original endow- 
ment onlv suffices now for one third of the annual expendi- 
ture The chairman of the hospital Sir Alfred S B Tebbitt 
presented members of the Committee of Management and the 
French vjsnmg phvsicians and surgeons headed bv Dr 
Charles Flandin to the Queen before she made a tour of the 
wards 



272 Ji/u 30 I93S 


Tjie BfmsH 
MtDlCAiJo 


LETTERS, NOTES AND ANSWERS 


Letters, Notes, and Answers 


AH tommunic itions in retard to editornl business should be 
iddrtsscd to Fill FDITOR Briiish Medical Journvl BMA 
Hoi SI rASisrotf. Sqlare WCl 
ORIOI\Al ARTICLES and LETTERS forwarded for publication 
jrc undersuiod to be ofTered to the Briinli Medical Joiiinal alone 
iinlt-ss the contrjr> be silted Correspondents Atho «ish notice 
to be laLtn of their communic itions should authenticate them 
witli their n imts not neccssanl) for publication 
Aulhots dLsirint, REPRINTS of their articles published m the 
Briinh Mcdntil Jnurntd must communicate Avith the Secretary 
HMA House TiaimocI. Square WCl on receipt of proofs 
Authors oAcrsc is should indicate on MSS if reprints arc 
requited as proofs ire not sent abroad 
All communic ilions with reference to ADVERTISEMENTS should 
be iddrcsscd to the AdAcrtiscmcnt Manager Orders for copies 
ol the Jiiiirmil and communications Avith reference to subscrip 
lions should be iddrcssed lo the Secretary BMA House 
I uisiock Squire WC 1 

fhc fiiiiuosi Nlmiier of the British Medical Association and 
Ific hnliili Midual Journal is EUSTON 2111 
I he ItiKRAPiiK Addri SSFS arc 
1 DU OR Ol IHL BRITISH MTDICAL JOURNAL Ailiulo^i 
II riKC/il London 

SICK! rAR\ Mcdnrira IPeitrent London 
The iddicss of ihc BMA Scottish Oflice is 7 Drumsheugh 
Giidcns Edinburgh (telegrams Aisocnire Edinburgh tele- 
phone 24161 Edinburgh) and of the Office of the Irish Free 
SlUc Medical Union (IMA and BMA) 18 Kildare Street, 
Dublin (Iclcgrims Bacillus Dtihlin telephone 62^50 Dublin) 


QUEUIES AND ANSWERS 

Mnmmao Cancer and the Menopause 

Dr R Andi RSON (Birmingham) Avntes For a long time I base 
been under the impression that Avomen Avho suffer much 
from the flushings of the menopause are not so prone to 
breast cincer is those Asho don t Yestcrda> 1 sa\A a Avoman 
AAho IS suffering from a secondary groAAth after excision 
of the bre isi three years ago She told me that she had 
hid AcrA fcAA flushings and that her mother Avho died of 
breisi t inccr ilso had Acr\ fcAv Judging by the treatment 
noAA icUiscd for post menopausal symptoms I suppose it 
IS liken IS proAcd that these are due to a diminution or 
lisk of ocstrone m the sAstem It would be interesting 
to knoAA AAhcther those AAomen Avho do not suffer to any 
extent from flushings htve an excess of ocstrone Dr W E 
Gac ijniirtiol March 12 p 8S1) states that ocstrone injected 
into mice causes tumour formation not at the site of injcc 
non hut in the mamma Ocstrone is eMdentlv one of the 
f iciors concerned in the production of breast cancer and 
I think therefore that a great deal of caution should be 
Used in c'Aing it 1 vvould like lo know whether anv other 
reader Ins formed the same impression about the incidence 
of breast cancer 


or farm workers, one was a braceman cmploved on nti\ 
sew'erage construction and one was a laboratory techniem 
engaged in the actual studv' of the fever itself The repot 
describes at some length the clinical features of the du^ie 
and the results of laboratory investigation The problem ot 
leptospirosis was studied by the mobile unit attached lo 
the Laboratory' of Pathology and Microbiology and it 
appears to be established that a mild leptospirosis is a not 
uncommon cause of illness in South Queensland previouli 
diagnosed as coastal fever influenza or dengue An 
appendix to the report is devoted to the hookworm 
campaign 

Parturition with Albuminuria and Raised Blood Pressure 

Dr C Dysant (Bromley Kent) writes The following o e 
may perhaps be of interest A muitigraxida aged 40 five 
previous confinements began labour at 12 noon and Aia> 
delivered at 130 pm one and a half hours later of a 
15 Ib male baby She had been confined to bed for three 
weeks with albuminuria and blood pressure up lo 
174 mm Hg systolic 110 diastolic The aibuminum 

cleared up but the blood pressure varied and was 1/0 
mm Hg systolic 90 diastolic before confinement Thea 
was no shock and both mother and child are doidg well 

Epsom College 

Major W L Giffard OBE Secretary of the Royal Mednl 
Foundation of Epsom College, writes At the annual general 
meeting of the Governors of Epsom College held hd 
month after reference had been made to the kindneis of 
the Editor of the Bitlish Medical Journal in publiihin’ 
articles and notices about the Roval Medical Foundatioi 
and Its aims a resolution as under was unanimou h 
passed by the meeting That the Annual General \fcetin, 
desires to place on record its appreciation of the kmdn > 
of the Editor of the British Medical Journal for his readi 
ness at all times to publish notices regarding Epsom Collt ' 
and Us Roval Medical Foundation’ 

Artificial Respiration Apparatus 

Dr D Edge (Medical Superintendent LadAvvell Sanatorufl 
and Isolation Hospital) writes In view of the demand to' 
the artificial respiration apparatus miscalled iron lung 
mav 1 be permitted lo point out that there is one avaibh 
at Ladvwell Sanatorium and Isolation Hospital Eccles N ’ 
Road Salford 5 Lancs 

An aulhontative letter on the Bragg Paul puKalorh 
Sir William Bragg appears this week at page 2‘!4 

Sterilization of Syringes 

Dr A E Finckh (Sydney NSW) writes I haveb-eni 
practice as a clinical pathologist for over thirty years dune 
which lime I have made thousands of senupiindv^ 
Needles and syringes have always been subjected to 
being placed in cold water and brought to the had ‘ 
once have 1 experienced a mishap 


Hormone Tlicrapy of Prostatic Hvpertrophx 

\i At II (Cornwill) would like advice from anx reader who 
h IS had personal experience of the treatment of prostatic 
liApcrlrophA with injections of testicular hormones What 
dosice should be administered and at what intcrAalsi 


LETTERS, NOTES, ETC 

" Q ” Fever m Queensland 

Tla innuil report for 1916-7 of the Health and Medical 
SsrAiAA-s of the St itc of Queensland shows Mial statistics 
whish compare favourablv with those of the other States of 
the CorinionwL ilih The crude birth rate was 19 7 and the 
death rate STS the infant mortality rate was 16 20 per 
thoiisind Tfic respective figures for the CommonvveaUh of 
\usirihi as i whole were 17 11 943 and 4116 The 
report states thit work on the unclassified fevers of the 
coast it districts of South Queensland proceeded steadily 
ihrouchoiit the scar with special concentration upon the 
prohlcnis involved in two fever tvpcs Q fever and seven 
dis feser Ihc laticr is die jo a leptospira of mild 

occurred in men 

ii Ie,c\ sccic emp’oved in an abattoir some were farmers 


Medical Golf 

Dr A Keith Forbes and Dr A J Buchan each "Of F’ 
of the five events held by the Scottish Medical Oo ^ 
Society at us meeting on Princes course (Sandwicn) 
week end Keith Forbes (16) won the boge) ooroN" ^ 
with a return of one up and the Silver Haggis (bc 
64 net while Buchan (7) took the stroke oompetil'on 
76 net aYid the Captains Prize with 72 net The fou ^ ^ 
event against bogev went to Drs G Gilchrist (o) 
Norman Fleming (14) with a return of 9 up 

Corrigenda 

A printing error which it is important to correct 
Dr F G Hodson s article on Measles in the ■'O" 

July 23 (p 174) Owing to a misplaced line the m co, _ 
under Table V was without meaning It s 

100 per cent infected 0 per cent escaped no > 
tions 22 protected cases all had attenuated allac 

Our recent notice of The Diet for rxpcclant and M/ ^ 
Mothers published by the Food T 

erroneously named Afiss J Halford as the aii , i 
little book IS the worl of the Society and i 
contributed a foreword 



Jui-\ '0 t9^S 


TirE BumsH 
Midical Jovtrn^l 


33 


KEY TO CURRENT MEDICAL LITERATURE 

GENERAL JOURNALS 


Cmadnn Medical V<;socntion Journal 

3S 'tj) JO''' 

At-* rruJ Ii-i I nnc cl C n Sevre rj N!«hari -t a P MbV F-ct t 
m Path rc'C' s cf Peri LT cr — B P BaHin 
P-i ’«> B x\.Joi ar.4 Safe llacn^hv\lcvtcn> — E P Poivtran 
Krau^-Hi Ln,Vi''ak;a ard Pni'^tus \i %ac TTc-tnert bv Roctti n c( 
Scrwr> Senes c{ Pcri'*cu'n — H L ber and ^ D Canrbdl 
\sn bo'^aic^ CK iu"i — G S Trer h 
Ca c-T>-~a cl A’T’'- b cf N atcr — -L G M Cabe 
AmrrJi'i.br Co’ — O t Ro*xrtv.n 
Arre-'d * 1 . ar c i — A Br«.^n 

Verercal Drtca c in Rcbti>n to Prec’'anc> —J C Ccvdwir 
Tfcaf^c^i o' \r"<bi Dj^n crj •— P Bercfif* G Kw 
L^c cl Ir'-hn In Lrii-ana— \\ R Caten 
Dc^tbs n Tcanus Phcnv'^cr n of Tcxin relca c — P B H 11 
E^ect on Dooon of Repeated LtT ted B Lo*' — E Cadham 
RadethcrapJ cf Cancer cf B'cajt — P B oJeu 
C-r nvna of O^c'-hanP ~F R S^ett 
Ca«c cf Pelbr^ — \I L At L Pa’ner 

Sr "al C«.Td Injun ^nbm E^^ cf Ira rure cr D s’ovat cn t \ciieb al 
Cc unrj — B Plewes 

I ri, ual APceti n c E>e jn Lcular**ij — E A 
A’"e«'bic D nerterj Aicthot-' cf Dacn-nrt — P Berec TGd 
A’cbxl cf Adnirtsiranon cf Ant pf'eu'ncvov.cal Sen.'" -~*0 Cannon a^d 
H E»art 

Ircatneni cf Ac"e — D E H Oe'c’ "d 

Apr led Pbinjo! o cfTbjTCtl GLnJ — J E P* inKctt 

^ ciienal Diseasi in Prevnm c\ — ^Thc inadea^e of s\philis 
and gonorrhoea m pregnanca would appear to be decreasing 
as the result of education of the public xenercal disease control 
methods and adequate facilities for and improved methods 
of treatment livamination for these diseases includmc 
Wasserroann and Kahn Jests should form an integral p’rt of 
everv pre nauil routine \nti svphihtic treatment is safe 
provided the dosage of arscnicals is moderate and the patient 
is hept under close observation for cvidensc of toxic mantfesta 
lions Routine plans for the treatment of prenatal svphilis 
and gonorrhoea are fuliv described in this article bv Goodvvin 

Insulin in Lriicaria — ^Two cases of urticaria arc reported 
which showed remarl able improvement after the admmistr’ 
tion of 'mall doses of protamine zinc insulin One of these 
was associated waih sensitivitv to wheat egc' and mill and the 
other was of unknown ongin 

Blood Donors — In order to obtain convalescent 'crum for 
the treatment of poliomvehtis during an epidemic in 1936 
Cadham had occasion to withdraw frequent small amounts 
of blood xarving from 65 to 140 esm from 125 donors 
None of the donors reported anv ill cfTccts On the conlrarx 
manv of them staled that Ihcv were dcfinitclv improved in 
general health Points noted were an improvement in appetite 
disappearance of acne cessation of attacks of urticaria and 
increase of weight Cadham sugeesis that under certain cir 
cumstances the withdrawal of limited amounts of blood at 
regular intervals mav prove of decided therapeutic value 


Deutsche Medizmische Mochcnschnft 

Her n vol 64 May .0 19<S 

Iptroduaion lo Rhithn Research— A Joici 

Rh>ibm in the \csctablc Ktnedcm — A klcirhconie 
J hjih'Tj of Eunctions of Liver — E ForvRrci 
Lnrr Rhjthn srd Fat Resorption — H HolmRrc’i 
ltvcri> four hour Rhjihtn of Duress — F Gemtzen 
SvphHts Treaxrocfii ^nd Sercloj -al Findin-n — J Richter 

Surpn ins Ds-overj by Tomosrarhy of a Fo eifin Bodj Jn a B on bus — 
Ai Darien and K Creincder 
Ca! isansum m Treatment of Asthma — H Minibec*. 

LcuVichtan n Treatment of Su'iburn — E NS Dorffe! 

'V'hat Must the General Pract tion'T Knon of Efc'irocardiosraph )'* — G 
'Budrimann 

Mryh Court Mcdico-lepal Judyments in 19^" — Pacvh and rrembiir 
Khacn Lulas &.hcnJem Founder cf the Berlin S hool — E H G Atirotu 


Journal of the American Medical Association 

Chwaso vol 110 A'ay .1 193a 
Prcrtcmtnial Ter Jen — S L Israel 

Erc' urc on Bra h al r*csus cau c* Simula it. n cf Coronary D ca c — M D 
Had 

IIC..J Irauna— N Gcttcn 

Tv cr lonal RcQuircmen of Irsulm and Sa r Sc’uticn in Di».bet Com.. — 
U E Roct and J E E Ri cn*an 
Cert n N n ct as a Therapeutic Ar rt — R L Sjitkn 
Ecmafe Perircun — R J Pien 

Seed of Rcdctcrmnrc S<h ck ner'iivcncss n School Chi dren — A B Schvs nz 
arJ E R Janrej 

Oems^ cf A I amn \ and SuNtan cs bavins a \itamin A Effect —L. S 
Pa *rer 

Prcimn*tnial Tension — The svndromc of premcn trual 
tenMon include> '.\mploms irritabihiA restlessness cr\ing 
spells hcad’iches \enigo insomnia painful turgidii\ of the 
brcisis and nvmphomania It arises during the height of 
corpus Juicum acinii\ and is aggravated bv oeslrocen iherapv 
Israel studv mg fourteen cases found that substitutional therapv 
With progesfin and low dose irradiation of the pituitan. and 
ovaries relieved the svmptoms 

Geniutn 1 lo/ct— Sutton strongK recommends the use of 
gcninn Molet m dermatological conditions due to such Gram 
positive organisms as Staphslococcus aureus the gonococcus 
nnd C diphthcnac and in those due to monilia and to a less 
extent to trichophvton cpidermophvton torula and saccharo 
mvccs The mam disadv-mlage is the conspicuous colour 
which can however be removed from linens etc bv repealed 
washings wnh water and alcohol or bleaching with chlorine 
\pplications of a 1 to 2 per cent tqueous solution are best 
Gentian violet is non toxic and hvpersensmve sKin reactions to 
It arc unknown 

Klmischc >\och“nschriri 

B rlin vol 17 May 21 jOjS 

A-Ificy 3rd Rr^iMai c to Tuber m cAis — VV Scitcrt 
Dc'crmi'ution of V it n n C Bal-n c in Afan — G G chtrenv 
T peal \-riain.r$ tn Renal Fur tnn Dctcrmred b> Pc^iure m Hcalihy and 
Eat CbiJdren ard Childrc*! w ih Card ac Cb-ng« — H Hun erbrd 
Arcxacruj of C-rdiac Afjvcie n rarovjtmal Tachycardoi and Rfoiratcry 
ImuP icp'v — K Voii and G I—ndcv 
Acid Cover of Skin and Antibacterial Protection II — A. Alarchtoa m 
R Svhmidt apd J Ktcfcf 

C imn..ticn of Elav res in Lrme. — L Arr'c'itaro E. B Haiz w^d S 
RusznyJk 

Is Eurun-uoi.s an Allerc ^ Condition'* — C Pchl 

Bioosiml DifTcrence between Od and Bovin* Tubermlta hown b> Schulz 
Dale Test — P W S^hri di and B Bau«ch 
Id Atfnjon of O to Nacsrii — W GIccr Afejer 

j4nn bacterial Prottction of Further CApenments with 

culture^ taken from various parts of the skin which had been 
painted vviih an emulsion of B prodigiosus proved that an 
acid reaction of the surface of the skin definitelv inhibited fhe 
growth of this bacillus and of the usual skm flora 


Lancet 

London 'c! 234 Afaj 21 I9^S 

Bo'osi'al Thoucht and Oi*rivca! Thought — G HorUns 
Pboiodjiumic Aam of Care no* n «. Aecnts — J C Aicttran and I Doru.ch 
Simulation of Acjic Abdorren in Carbo'i Tetrachlonde Po seeing — 
VV H Graham 

Haemerrbase and lme«tinal Obstrumon due to Aleckri s D veni-njlura — 
B H Pa^e 

Effect of Testosterone Prcpion-tc on Tcsti'niJir Fu'Ktion m Aforkev^ — 
S Zu kerman 

Simple Electrical Dcvi't. for Fojnh EIcctrocartJio*raph u Lead — A Schott. 

272 A 



34 Jbu 30 193S 


KEY TO CURRENT MEDICAL LITERATURE 


TncBRmm 

MtDICXlJoLTlNU 


Medi7inischc K!mik 

Berlin \oI 34 20 

I) caNi. proJuccO bi nxn.'i'iiNe: SmokinR — R Schmidt 
P(0orn>clnt> — \S Hollminn 

Pftn ipK of Gnc tnd Tike in Edutition of Children — f Himbiirter 
Fti.dtn« of Bibics wiih riill Cream Acid Ntilk — J SeharfT 
\u m \riificiallv Healed Rooms — F G NUicr 

SnuiUincous Appearance of Prostaiic H>Pcrirophi in Unio\ular Tvon — O 
K ufmann 

f c o muon of \\ ilfiil Simvil luon of Chronic Poisonmc — P Kc«.k/ch 
N ifu Gi c iscs in Germany — H H Siemens 

Mcdi/inisclie Welt 

Berlin \ol 12 Maj 2\ 195S 

f hujcicr nd Trtiimcni ol H>ncrtmcMs Orwidarum — T Hejntmann 
IrvatriLni of \bornon m Hoi*pual and Pri\ iic Pricticc — G HascUior t 
Rc'itf il I on in Child! irih - \\ Holtnun 

Dturmin iiion ol Dale of Delivery in Pincl Practice — t Oldcmcycr 
Trciimcni of \ icmal Plor i cspccullv 1 ricUomona'i Infection — W Lu-kc 
licitmcnt of P cudoncuristh'’ma krtenosekrouca with Jo ipial — \ 
Ki liter 


Munclicncr Mcditmischc Wochenschrjft 

Munich \ol 85 May 20 193s 

lljcmorrhaRc from Smallest Blood Vessels in Circulation — C Jorgensen 
Inir iihoracie Di placement of Air — H \S enderoth 
fnnreon in over 1 300 Gjn iceolopic il Cases — H krantann 
Compovinon of Alkaloid Mixrurc in ndladonna Root — A kuhn anti G 
Sell ifer 

tnierv olie rptdcmic caused bv DifTerciu Speeihe Oreimtn m One fimily 
— G Russo 

irciimeni of Insommi — L R Muller 
Drv Wipptc rrcitmcnt in Pucrperium — E Lcin?iu«ec 
Praetie il Oro nasal Proiccie>r — C Hopmann 
Dry Blood Test in Elimmation of Syphilis — R Muller 
Leki! Cvtinnlieui of Infiniicidc — H Cumnierslncli 


Nature 

London vol 141 M iv 21 I9t'< 

loxieity vf Ntcreiify \apour to Insects — H C Gough 
Bind Groups ind Pipment ition — M A MieConaiU 

feiiili Htpliid Sttiors by Pirinl Mcrogonj in Nfo/aie's of Droutphtht piffuto 
th\ii4Ki—\ A F Crew ind Reawtna Linn 
lienue il Ideniifte ill m of Gestrone tn Huntut Mdc Urine —L Dmgeman c 

1 I uuieiir ind O Muhibock 

London vol 141 May »8 1938 

N e irhieeii in Plain md Anim d Tissues — B C Guhv ind P N Sen Gupta 
Veil m of \nol and its Dcrivatists on Nipple of Guinea pig — H E Fieri 
U Jadisohn E UchliuKer and R Monnier 

New Engl ind Journal of Medicine 

Boston vol 218 May 19 193 n 

S nv Stwer \ peels of the \leohol Problem — V Leary 
Ncphriin. loxicmias of 1 iic PrcRnancy — L Phantuf inJ M Bel on 

Vip/irific —Careful intcmtil MiperiiMOn his 

i,reiU\ iinproicd the results in nephritic toMeniui of prcgnmci 
In stxcntcen icirs it the Cirnei Hospitil there were 6 909 
Jells cries with eight! eight ciscs of hte nephritic tOMcniia an 
iiieKleuec of 1 ' per Cent Si\ women in the senes hid con 
Milsions or eclinipsii in incidence of 0 1 per cent 

Nordisk Mcdicinsk Tidsknff 

Sto\.kholm sol 15 May 21 Iht-t 
C h\.ni iherapcuti Essays m Gonorrhoci — C A Falk 

J n nv. with Triehlt reihylcne sMih Spctnl Ucfefcnee to Chemical Cleaning 
Uifks — F H Sehtnl/ 

C li( r<;/n o/ Coiiorrhocti — ^Thc idminislntion of i 
Swedish prepirition of sulphiml imide it the St Goran Hos 
pitat m Stockholm m cases of gonorrhoea his been \er> sue 
ei'siiii The best resiilis were obt lined in old ind compliciled 
s I'cs T liouch no serious scquclic were obsersed after the 
u!Inlnt^t^ Ition of si\tecn t ibtcls cich of OJl grimme bv the 

2 72 II 


mouth diilv for four da\ s and i smiller lolil d ul\ dosc for 
the ne\t eight to ten dies Filk considers thit this irciimem 
should IS 1 rule he given onh in hospital ind lint the ptibE 
should not he free to purchase this drug 

Polidinieo 

Rome 'Ol 45 May If 19 S {Sc/ ) rat ) 

V 

Green Urine in Spiroctneiosis H icmorrlngica — G Gtusio 
Marcim m Treatment of Undu{atu I e'er — P limpano 
Myomeetomy m Tifih Month of Prej.ninC' for Neerobioov — f Tonuu 


Presse Mcdicalc 

Pins 'Ol 46 May 18 19jSl 

\jriaiions m Retieulpcy tosiv n Course of Acute Non lubtrcuUaiu lurj 
dilions — Jean Minet and E Houeke 
*Siiphyloeoccal Anatovine in I urunculosis — M R Lacassic 
LoelBer s Syndrome Trmsient Pulmonary InhUntions with Eountphilu- 
Rcn6 Cohen 

riiiiiiKiilosis — The author discusses the ictiologs of funtn 
ciilosts and other staphs lococcil nnmfestittons ami com s 
to the conclusion tint (hej arc due to tinderlsing diijssiin 
disoiders and pirliciihrl> to hepatic disfunction 

Ptris vol 4G Ml' 21 I93i> 

Ihvmeciomy ind Piralhyroidcciomy for Disturbinee of Growth and Ocfia l* 
i/cd Caluinosis Result after Eighteen Months — R Len he and \ Jj t 
Syphihtte Gumma of Lung — Michel LiJon kindlurg md G Lapme 
’Slo" Progressive Eroding Canecr of Stomach —Rene A Giitmann yi 
Ivan Bertrand 

lethmque tnd Immediuc Results of rxtriplcural Pneumothorax —r err 
Bourgeois and Matio Lcbcl 

\(.ntrtcuHr fibnUition ind Ultra fraction jJ SysioJts*— R LuicmMthCf 

•Told Pn umoncctomv for Bronchtt lists — P Sants md Marcel DenrJ 
Bactericidal Power of Blood Its Measurement md Clinical Impotnr'ct- 
H fnjerman and L Van Dimnse 

Gasiiic CniLiiioDia — ^Ihe aulhois gue an lecount of a 
hitherto undcscribed tnd quite distinct \aricl\ of cancer of tii 
stomach which iflecis onli the mucosa and docs not intol't 
the hmph glands 

hutimoiULioiin — he uilhois describe a tiisi. of WM 
chicclasis of the left lung in a girl igcd 10 Total pneimwnw 
, tom% w IS undci taken with sucecss 

Schwcizcrisclte Mcdizinischc VN'oclicnsclirift 

time \ol GS Miy Cl Ittts 

PcoLnosis of OldvtindmR Fracture of Seaphoid — \ Brunner 
Differential Cercbrospin il I Imd Pressure m Brmn Injuries— P ffa^cr 
Treatment of rracinre of Paitlli — M Dubois 

Siereoseopic Radiographs — E Hagenbach j 

M issage of W alls of \ eins ind Surroundinp Ti sues aftvr Phke' '* 

Thrombophlebitis — C Hcnschen and F Becker ^ 

•Non puerperal Osteomalacia treated by Ov iricetomy — ^ Jcntmff * 
2Vcjencth 

Treatment of Protrusion of Lower Jaw — C JuiPard 
Gunshot Wound of Heart with Ligature Infarctusn — H Mam 
Review of riasiic Opcruions in Children — E Monnier 
Spinvf Cord Surgery — T Nacgcli 

I ost operuive Malady — J H OUramare Puf 

Jnirafocal and Hypodermie Auto pyolher ip> of Cif um ctil 
Effusions — H Paschoiid 
Experiences with C-algut — A Ritter 
O icoKenie Function of Hehoihcrapy —A Rollicr 
♦Experiences in Ircaimeni of Surgical Tuberculosis — F 
Four Cases of Polyneuritis following F'lpan Anacsth . p 

Dt'clopmtni of Sarcoma m Pigcts Disease — O Sehureh and 
Diasnosis md Treatment of Renal Cirbunclc— F Sutcr 
Treitmeni of Injuries of Veins and Arteries in Cluical Kevum 
and R Monlant 

Oiatiectonn tn Non~pittrpcra} ulj' ' 

hold til'll the clinic'tl picture of osteomthti t ctn c 

b\ simple senile oslcoporosts fibrous osteitis ? 

exogenous ctiis'ition Tnd P'lgcl s distist 
on!\ possible b\ biopsv of t bone n portion oi >■ ^ 
crcsi WTS nken in the c'tse here described The 
38 hsd h'ld no prcgn'inc> for fourteen 
findint^s -ire illustrated in dct'ul before snd > 
Ircitment b> ONaricciomi 



Jiu '0 IQ'S 


Kl:^ TO CURRLN'T \ILD1CAL LITERATURE 


Tilt BKITlaH 

MtDJCAl. JotRS^L 


■?5 


Ttil <nulo\i ^ — In n tcnNulcniion ot llic rcNultv of 
^unliplU \nd ctimitu trcitmcni of Miriiuil tiibtrtnIoMs in llic 
Upr^r bncidtne Kupi intitr icporl*. ton^pKiioiis ucttss in 
Oi of the vpinc vnero ilnt joint vhouUlcr 'vml uriM 
viiri.K'i! mc'ivxirc'v 'in. ton'^tdered often prcfcrxblc in idvintcd 
tubtaulo IS of the cIbov\ ind in tuberculous disc isc of the 
kn'‘c or fool the jreqient occurrence of trllinlis dcformins 
-i^tcr the con en iii\c ircitnent of the foot is pointed out 
Ruppanner h^s found tuberculous disci c of one or both 

kidncvs in one third of his ciscs ol tuberculosis of the 

lumbir spine The pirls plixcd l\ hcliothcnpv md b\ 

ionviIlectom\ m tubcrculo is ot the ccrxicil Umph ^linds ire 
di cussed Good results ire iisinl in pcntonctl tuberculosis 
In tuberculosis of the cpididvmis loc d hehoihcr\p\ is u dc s 
ind excision i rcc'ommcnded 

Science 

Xi'tV w " t'^"‘ 

C r»r> f Vt** Rat ur cT Ic'al C i r —I Xt r Viet »nJ 

r D r a c 

Ccf T Drltj X ta In F'nh^tj n it TTcrarSsi* Rojlts— I 1 June 

C >TV.’cnfirtTv'-i ard Pinf'^usn cf O-Llcn Tu*" or 1 Aren —A CUn-f 
r arruic cJ KealJ»c D U ^ir art * TchJi i» XI ^k. 

\iry r*i cia — X L rr3u’"rt>n arJ It Sciraih 
J. ton l>r X\ ctcXt anJ SX-.*v cf Xfr»s, k, X irL< 1 r tc o — M A I t '*<•# 

Scs X Tl. ' 1 17 xtJ' 

R/4.rrru in Dh l LiJcn — X C ^.^xh^c d 

Ifn'rimi/atK 1 train i Lqu nc Ln TrXat'^islm % ith C^ 1. rnbf> Xa n 
J X\ Peard It finlcl ton \\ C Scab a-d R W C W >cl IT 

South \fncan Stcdical Journal 

Carctu«n ss’ 12 xtj> |4 19^8 

Lim uij n —It r Bell XXallcr 

rmmao H'm nes and iheir Thc-apeutK. Xrrl ai n — P Krei 

L^r'crt fcT ibe Booc Xtedi-sl — L S WTur-s 

7''m:*s In cr Out"— P A Lcmai 

IfTirrcs cf Xmen-ar 'led me— It L llcinarn 

Sc“TC cf RadiMberap) — H H Vasid 

Sdffs en 1. e of Th^rt *0 Endot ■'tcid \ aceme — K M sersic n 

Ugcsknft for Laeger 

Ccpcntufcn ul iCO 'I y !*» tV* 

T»cnt 5 -ci«hl Ca cs of Br» n h c^a i\ sinpcvtci of Tuber “u — J 2 »i«urd n 

P lyneunm pro cVed b^ Llcrin • — C Ccldbicft Hansen 3 'kI k H krabbe 
Tfcstrocri »ith D ryt cf IrH-cpcr tuc Rctcrtin cf Lmc— S Bnmbctc 
Plcuntt Prcbler*^ — O Th 'ruaf'cn 

Case of QuincVc ^ Oederru urated *»ith Irtra^rncus Inicrt r cf Clueal m 
Leo — O O\ocn 

BronchttLifJsis and Tuhcrciilosis — This js a bronchopnphic 
siud\ freeU illustrated xMih skntr^ni cirned out at the 
Spangsbjerg Sanatonum in Denmnrk 

SPECIAL 


AcU Qiinirgica Scandinaxica 
S ts.kh Im lI si May I I9’s 
Condiuen of Tenjic n Dch^dran r — E *xm kirk 

Irtcstiful IrtmMrNCcp 1 n< (ir-'Ijdjna nc Rermrk n I { p«»» \ if Small 
B<ncl> — ^Icrstcn B rkroth 

Dinib c kidney of Diacnos^i fntefo*t — Ben 1 Barer 
In^uer'o of Diktat on of Sromacb on Circn! run — Hern n Wahren 
LlccirocardiofTaphtc Exarnm in.rs of Opcrati n Pjuent — S H Df*d r en 
ImixrrarKc cf Elcerrocardi r*iy for Jud-micnt tf Ri k in Thyrodcct mi-s 
and Thcr-*ccpa ties — H Tr Hnrbit/ arJ X Jer^ II 
IniWiraucn of Imponan c cf Pre-oper-tne El *ctrocardiOTrarby — O R m ke 
L bectemy and Prcu'no'*ccti.riy for Bren h i. la rd Br n bial Sicnox — . 
Jib n Hcl t 

Tenant in Deindralion — ^The author finds thit drsness of 
the longue is not rchted to dchvdntion of the blood \ 
definite relationship ho«e\er 'ms ob erxed between the 
ippemnce of the tongue and the degree of miestiml moior 
actiMU 

Pri opiratiM CUctrocardioprapfn — In three articles this 
problem is discussed In all about 800 pitients were sub 
JDitled to pre operafnc electrocardiographic in\esii£:atton The 


Dory ! — Post opcraine and picrperal retention of urine 
re lets satisf icionls to the subcutaneous injection of dorxl 
which IS a c irb immoxlchohnc chloride — a derualne of aceivl 
chohne 

^^lcnc^ Khnischc \\ ochenschrift 

X icnnj \ it 5T Xl > '1 I9^S 

S t n 1 s •v 1 m trd V r t — T I rnk pf 
s*c^ Cl cs f f I n W r — T Leipcrl 

IrPifr c Sp rat Nr m I Cs n In im 1 Orrir jnU L\r i u n if Life — 
() Sir eke 

fi hi n t n ph ‘’cru a^d S -artet f r n N i nra — O % kepeuky 
Irc-tmcnt « f I ru %» ih Ethyl Ch! r ue — j Mel cf and k T h fen 
Cr lex Dee snJ X k tatnc Scrviu S> icn — k P Ir r 
S iddcn D-aih d irfns CbilJbinh — f Bcrnhjn 
fnporiancc f Ci cuL.tl''n In XhtlimiCJl Sar^cry — R Fr dr h 
licaincrt « f X'*acrtai— \X Bo b N.k 

'»cs Xfcih X. tn ly iTcrerfi- 1 D~fnv«i f Blx^d D scj o — I! Rci hha kcr 
In *khn \X ay h d Cen f I I ra r fi ncr dr v. tp Sfcdi-al Repin — 
\ W crknrrrcr 

Sudden Di(:h tn Cliihlhirfh — The possibililx ol sudden 
dcith occurring dUrinc partiiniion must be borne in mind b\ 
the ob letnciin Bcrnharl classifies the cau«^es as (I) birth 
inumas including po t parium haemorrhage rupture of the 
iiienis and other complicniions associated with partuntion 
(2) consfifutiopal anomalies and individual indispositions — for 
example stjius ihv molv mphaliciis and diseases of the heart 
lungs and endocrine glands and ( ) toxaemias of pregnancx 
afTctling the h\er kidncvs sLin or nervous sxstem 


Wiener Medizimsche Wochcnschnft 

X.cnn V 1 tt Xf4) .1 19 S 
tiaenjiuna — C Lauda 

Xiumtn fcrdtns <1 Car cr Celts f t Redu mn f Xfjlijnapo — T Orthrer 
Clursci «f Xcj e n D m,* ex if Larynx —E XXexsel) 

rrnJcffiv Ser c Me- rctii and jt Rclauin is X ru D es ei of Cential 
Sen s-j^ c stem —11 Sihreiwcr 

\'otctr Chijitus — Thexe are caused bv (ul changes in the 
nnicou membrane (h) dixeases of the musculature (t) dis 
orders in innervation and (d) affections of the cnco arxienoid 
joint and iiv snrroundincs Anx of these max give rise to 
dxsphonta or in extreme cases aphonia Proper diagnosis 
IS not pc' ibic from the chance of xoice alone If hoarsene s 
graduillv appears and if it persists for more than four weeks 
a local examination is essential ^ number of causes are dis 
cu sed rancmg from simple catarrh tumours tuberculosis and 
sxphilis to pohpus pachvdermia and penchondniis Infec 
tious causcv as m diphtheria or the ulcerations in tuberculosis 
sepsis or ixphoid fever max also be responsible as max 
hx stern or paresis of the recurrent nerxe 

JOURNALS 

authors arc unanimous m reaching the conclusion that no 
useful procnostic information can he gained from this pro 
ccdiirc 

\mcrican Heart Journal 

ie Leu 111 15 Arril 193S 

C^o ex f 13 J li m Patient n th Cert exit Heart Fatlure — R ff W Vutv 
ard J Rai-cy 

S me Pf b t- in Du-n jxt' Pr v*n •»'t> ^nd Treatment of X utc Xricna 
O'vlii' n — H E Ryken -rJ Dun-an Graham 
Flsrir F am of Card a Mir^le 11 1 ennhx of St ex of Xtu t> —A Garr^ru 
M_cl x’ 

Xcriri »! r Dcnciii n in Xfj af fnfaraion — J G Xf H nrdt n -n- 
Ian Nyb icr 

C'mparaii c Eflcis if XXatiT Baih and Xlu tard Bath at Xaryintt Tempir- 
lur'x on Kate cf Perirheral Bl lod n v in M n — J X killian ..f*d 
C X o cii 

Elecirocardi cr phi Ch»r ex fiund in licniy t i C^ ex cf Carbon Monoside 
flltuminaiinc Ca ) P oning — W H Steam C k Dnnkcr and 
T J Shaushnex \ 

B x. Pf'x ure arJ Sre cf Caruu-c Inf rn — I Traiitl H Geld and 
X\ MxJdl 

Coronary Xaxxinin t r ^^IC'n cf Fcrci n Speciex B x>d — L S kaU 
\X XX m Tc n ard k J -xhim 


272 r 



36 JUL\ 30, 1938 KEY TO CURRENT MEDICAL LITERATURE 


TiieBmtuh 


‘Occlusion of Coronary Arlenes b> HTcmorrhuc into ilieir \\ Ols n 
Wirtman 

Study of EkctncTl AciiMiy m Auricles —D J Abr mison N M I cnlthcl 
and C ShookhofT 

Conccninl Transposition of OrcTl Arttrnl Trunks ■ — D W InLlimi ind 1 A 
Willlus 

Acute Aitena} Occlimon — ^Thc cinr ictcristics of the puns 
which accompTnv embolism of the hrge penpher il arteries 
are descnbccl The results of certain forms of irLaimcnt ire 
given and the authors suggest that a combination of \uioiis 
non operatI^c methods is best 


I nnu Atsecss— J 1) UUc U C Milor nni S A Kormno 
Cirtinomi of Siomith Toni OiMrccinmy — A \V Allen 
DKcrUctifi of JcUimim — iohn C A Ocr^icr 

C>mplkiUnR rffcclA of nUcriiculitiA upon Abdommit Surscry—V C DinJ 
iml K K OUchrlU 

SurklcTl IrcTtmcni of IntnciiMc Chronic lJUentUe CohtN ~llcnry V Cave 

Uclroptntoncil Appendix — \V H M^rburv 

Umlociihr C>st of llscr— I It Ochsner 

Plowed Spleen ivith lorslon of Icdiclc— F If Adkins 

Compirison of Three TyptH of ffvstcrcclomv — C H Tyrone 

*Sm»plt. Method of Consiru linr t Vapim — L II Winrton 

lourto Virlnal llcrnn — NV r tUicV. 

\ temd Cy^ts — K L Sanders 


Hac/fjorrJioQC tuto Cojoij{n\ A}tii\ W uH — C iscs ire 
described demonstrating the complete occluMon of the 
coronirv arter\ b\ haemonhige into the ilheromatous wall 
Thrombosis within the \esscl itian or ma\ not be present 
When It IS It IS probabJ\ a second ir\ cITccl An inf irct 
was not present m all cases but de ilh was attributed to the 
coronau lesion m ever\ one 

American Journal of Siirgcrs 

Ness vvd tt Mas IHIS 

llcml Rickeis or Hcnal Dwarlism — 1 Icon llovsird 

“Diniculiics in Urcihnl CathctcruTUon — John L Cmnuu 

Jruimalic LcMons of KKlnty — J t PricMRy ind f Pilchur pm 

Measurement of Kidney I uneiiun durine I rcun mey — Mbcri W llolnun 

Tr inspcriioncal Exclusion C lesare in Seetion — I hlIi T frost 

luUTsenous Annesthesn in Obsielnes — r A K isselMduu md M J Si.hrt.il er 

Suroical TrcTimeiu of SsrinRomycln — L J Adelstein 

Common Duel Obstruction — W S Sirpeni 

Lipation of Cssiie \ csscls in Subscrous Cholecy iccionu t 1 Wlntikef 
EnieroRcnous Cyst — ll bhcrs'in 
Carbuncle —J K Hermin 

rhysicloRied Uisis for Ligalion of Great Sapl cnou Vein— 1 ll Neal uul 
B Van Werden 

Rationale of SufRical Tcehnique in Cireinoma of Uecuim — J M lyinh and 
G J Hamilton 

Elecirosurtcrt in Prociolocs — K \ Gorsch 
Lons Rack Pain —A 1 Buk i 
rracuircs of Hip-joint — I r ineeso Mocasero 
1 cmoral Herniorrhaphy — S J Burross 

Carcinoid Tumour of Meekel s DueUicuUmi — D ( Colhn t K Colhn 
and V L Vndresss 

Cirolid Body Tumours — ll K Shos m »nd C \ Owen 
ChromarRentafTinc Tumours of Appendix — A M Gnassi 
Jejunal Ulcer follONsinB Gastro enteroMcniy —P K S uier 
Multiple Vesical CaleuU — E K Moraan and C Nf Stone 
Repeated Eciopic PrcRnancs — Harrs M in/ 

Pcrfonteel Appendicitis — Calsm B Uentschlcr 
Total Rcmosal of Patella — Addison II Bi sell 

* 

Ccilluiciiziitioii — This piper presents to the pi iclitioner in 
cxplination bised upon amtomical considcnlions of the 
common diflicuUies encounteicd m cithetcri/ntion Simple 
technical meisiires to oxercome these diflicultics ne described 
The choice of suitable instruments md the cire of the in 
dwelling euheter ire also deilt with 

Ancsthcsic ct Analgesic 

*Pans sol 4 April lOtS 

Penpher ll Element m Pun — A Daudouin 

Some Criticisms of Cs iluation of Actisity of Locil Anac ihciie b\ Meisiiremeiu 
of Chronaxic of Isnl iied Ntr\e Some Improsemenix m Tcehmciiie — 
J Reenicr md A Ouc\au\iller 
Lo a! Anacsthesn — A V^ Vichncwky 

Recent Comparaii\e Siidies on Aciisiiy of Various SjUs of Morphine 
administered in N anoux \\ ass Urinars Ehmiiniion — J UeBmer md 
S I ambin 


Annals of Surgerx 

I’hilndclphn \ol 107 Mw 19's 

’'linr itranul Xncurysm ot Inicrnal Carotid Artcrv — XV iUli E O ind\ 
*AnLur>vnis of Ihc Circle of U dlis — RuJolpli Mrns 
Bnin Ali'^eci.s due to Gia forminn Spore bcariPR Anaerobes — C B irIcs jun 
Use of Fasen and Ribbon CaiRiiI in Repair of CIcfl Palate and Hire lip — 
A G Brcnizer 

*7 r ictico oesopliaReal Fistula — H A Gamble 

Se ileiius Nciiroeircidatory Compression — R Glen SputlmR md F Ktilli 
Bradford 

C iremonia of Breast m Ncero — Isidore Cohn 
Careinoma of Breast — HurIi H Iroiu 
Simple Ircalmcnt for Empyema in Cliddnn— B C XVdIis 
Hioraeonlasiy m Treatment of Pulmonary Tuberculosis — L XX 1 r ink and 
P Turner 

272 D 


IniKKniniiil Caroiitl Anciirwni — This is i description of a 
CISC of i liter ll incurxsm of the intcrnil cirotid cured bj 
occlusion of Its connecting st ill. It is the first of this bird 
to be rccorelcd 

Atutn i sni\ <>j Circh oj II ///ft — ^Tlie ciolution of the sureical 
trutmcnt of miner imil inciirxsm is reviewed The prohlenu 
in dnpnosis md trcitmcnt of incurjsms of the circle as 
opposed to inciirxsnt of the interml carotid, ire dixcusteiJ 

Frm III o ociopluiveiil I isliiln — A new method of sure cal 
trcitmcnt is described Ihc stomich is divided 'tnnsxcrseli 
the distil portion being mide the site of gistroslomj while 
the upper segment provides free ocsoplngci! dnimge to tin 
exterior Siibveqnenlh Ihc fistuli is itticked dirceth 

Pltniii I iiLiiiti — The spice between the rectum ind bfaiMe; 
IS dissected md in idcqii itc civitv is kept open bv i vacmal 
mould R ipit! cpilheIiiIi 7 iiion occurs from the surface o! 
Ihc rudimcniirv viiim Successful cises ire described 

Archives dcs Mahdics tin Ccriir ct dcs Vni'sciux 

lati Mil 31 Aplll l''JS 

Itrnimjl InfiCUM EnJpcartliln contpli Jtme Oil Uhtumapt. EntlocarJn - 
\ Diimn*. 

•\ »hi of Cett iin ClKvt 1 1 , icl m Dnwnpsi of Nfyi cxrtliaMnf ircbon of Tj T'*^ 

—I Don/tUn md M Kiic/ 

I Ldiinhcilion of J »rsr Sum d — C Inn and ) 3 NSihi 
Llcctrocirdu ct iphr Studv of the CTfoiid Smux luntx — Jcxn LcfikSte 

/, T\/>t Infnntioii — Clinical dclail' at'l 

clectroc irdiogr iphs arc given of eight cises with infirswn 
of the interior tv pc to show ihit the ipicil chest lead ihb 
rcvcil ch inctcnstic ch inges more mirked thin thOsC of If 
limb Jcids md tint in the chest leids these chinces niav 
ippeir before ind also oiithst those in the limb lends 

Arcliiv fur GvniKologie 

Berlin \o1 1D7 Miy 2-1 

Di pi icN.mcnl of White Blood Corpiixclcs in Norm'll aiU Toxi rresnin J 
llcinrith Sicdcntopf . 

Criiicil Considtr iiion of Best Trcitmcnt for Plxccnti IracNU—D Lifp^f 
I hysioloky of V^iRinil Muxcul iturc in RTbbii^ — H Dworzak 
Coimtxion between Poctnl Membranes nnd Pliccntal Vascular Pmorn m 

PttRnancy — B Srcndi unmen- 

1 ate of Glutathione and us Lnd products m Blood of Pregnant ^ 

H Sicdetironf tnd W Htricl fia— " 

Influence of Iron contauunp I lachmootes on Sterility of 

Stir7c\yxkt . .| 

Ntyy Method of \ Ray Cil^uhllon of Size of foetal Hiad~I ^ 
runeiional Condition ot N^icinal Mucosa followinR Operations on r 
E Murray md K rkrrnbLrRtr 

Endomctropathia Hypcrphsuci — A Honcrmcicr Thvrp'J" 

RcRUiuion of Uterine I unction by Oyanin Hormones acfiOR via the 

P Grumbrcchl and A Locser practRO-' 

Determination of Stages of Ovuhtion bv Serunl nocciuation 
M Taknta 

Ossiritaiion in Os Capilatum as Sipn ot Post maturity — K 

Pulse Volume m PrcRnancy — H R Schmidt CImendorfT C U ‘• 

\V Borcard 

Physiolokv of V^atmal Mucosa in Newborn — M Alcxiu 


Archives of Internal Medicine 


Chicado \ol 01 M'vJ 

AT\y.Unod\c\yly and us MeUicM CompUcations — P H Futcficr 
Souihworth 

Heart in Acromcpalj — C Courvillc and V R Mason d^ttcr 

Cholesterol Content _of Blood m Heart Disease — C A 
Bruner 


anii 

anJ 



Ji,n 'H) 10 s 


The Britisu 
Medical Jolrs^l 


kL> TO C URRl NT MI DICAl I ITER \TURE 


37 


11 fvjl V I -A ( Kcvp Ml 1 '‘I l\r« I n In'’ 1 n c t) ». \ir Hunccr 

nrJ D ■'r ^ r xti nJ bx J^b j1 I cti t t S rtn il S b -vt iml 

n Ti ic~t « th Ilf 11 r> c — ) \ 1 fcxn jnJ I \\ S n n 
n cvl urtr'in r !l c^-t i I lli r ! I p ib h ni MclhM ( \ vxv ( 

7>»r ir N N irx Cl -» I Ir-’ f U k, n irJ V 

rMiiTtjl VxTct tx 1 ; T T f H t- n I'm r fh 1 t il t up — 

i M MOi “an D L S p- r anJ C J S jlt in 

I px fx-u I viJt'u ^ ih Chi’~'lc^ \ f fr nil n hxmjl i H».p« 

JW-j c~l Nt lk>J mJ W I C rn 1 
''ti.x* ■^ 1 r tr'i T-a III ^v^lt IJ -vib t rr^'u — \V J T»> r r 

C a rK "x 'Tcl n n Nlin O'^cixa* ~ n ITcvt In i t i f 

Hrxi — c a’v! 0-1 If r pni \x.h h uf a — I Vb TCI) rmann jnJ 
1 Tab! 

CjU, ^ IK. <> cr tx". C"ir jI anJ IJ-Mrx—rJ e r“ -I B iV 

anil Af n pcP-u n 

iVvci TV r jm I Can bet D ca < C c Rcr» l - S a-nl W Che i t 

Ti nrr'v tn Ir ctral M-vlxinc Dr^ra of ibc He t lu x» T ini V 
Gmxb I a-vil P O \\hic 

C\t<rf(i! Sartiion of Puficrtd^ — Oh-xcmlions curicxl oul 
on a man with a pancrcaii*. fiMuIi arc rci.ordcd root!“ 
Actrtiin acid ^\alcr mccholvl and rhwosncminc incrca cd the 
rale of Accretion bile miUa bicarbonate mipneMiim Milphatt 
adrenaline •atropine and hiAtamine dtminivhed (he <ecfc(ion 
Qiialilatiie without neccAvrinh quanlilati\c \ariations in 
Accretion were ^cen in rcAponAe to \*‘noiis stimuli 
Coht^i Srcfoiii- — Fouriccn ca-vCx of this condition 

•’re reMeued and il is concluded that it is now possihfc to 
make thiA diacnosiA in the liNinc Signs of aortic inAufluiencv 
\ssociaied with electrocardiographic evidence of nuocardial 
dt'ea^e in the abAcncc of svphilis and b itleria! cndotirditi 
MicgCAt the diagnosis \ rav exammadon will confirm or 
refute thi5 imprcAAton Cardiac failure occurs late in the 
diAca^c but svneope and sudden death arc not infrequent 

Arcimes of Pcdtifncs 

\ 

Sen "istV \ ) 5S Ma> I9TS 

Pr rhltivi f C rnn< n C 'n*'“LP at cl) ca o <'f Cb ’x-h vxl —I H I r 
Xruena in Di-oU'c D^csvc' cf Cbil-fcn— I \ Ktre 
trvJi'sn C-veret n in Nc«Sxn— H Sb_rl t 
lr\'*uciu^I Xter "t itv — R !l ^oun* arJ C 'I'sfe 

1 ubcicu' ^ Me" " I's fcver"t irt Djb^iK C v“nj —1. R Kt f h V joJ 
L B S’ “oc) 

A'rnc'is pf ibe LL'nff — J V> ard C D 1*.’*!?^ 

Cave cf Suifiu "Jil O-dc— a — H L »cr“ufr -xpd \ B X!i t 
r incicnal Sna "• tn O v.rcn — J Cr'ien 

Xlerrbcfi 1 Boraic ^nd S- rH^n amide m Ttpru'^r* <3* R'l mxcl i —) x 
Teyvney ard W S laka-x 

rc» Sl-cjches on r-edL-!n*s and rv>c*io’>S) —J Zsh 'f Vi 

Lni» rctccrv Dcliieri m Refatum to Afcntal Dcti •“CO — f Watrer 

Infhuruol Mtnini,iiis — According to oung and Moort this 
vondition is more common than is usuallv thought espccialU 
in children under the age of ^ Oscasionallv the diagnosis 
IS not made because of the pleomorphic appearance of the 
organisms Prognosis is not uniformU bid provided adequate 
treatment is earned out with anti influenzal serum toccihcr 
with sulphanilamide The authors report a case treated in 
this wav with remarkable success and suggest that this com 
bined treatment should be gencralh adopted 

Archives of Surgen 

Oiicato Aol 36 May 19^ 

tnua-abdomnal Xroplcyi —C B M non 
Acute Rctrocaccal XrrcDdicitrt — D C C< Ihnv 
FfC'h Fracturr cf Ov Cain — G W Gnfl 
CclJeCtKn of Xir in Rijhl Subd-aphraymaTK Space — b C Svhen V 
Mcvhan-s of STnr c Intmiina! Ob<!UKU'n — L Spcfl nr 
Intevtirul 0''vtruaion — H G Scott 
OviccEcnK: Sarcoma — Ga ten A Carlucci 
Ouxas cn Curabi t> cf Infi-mnuti m — C C Mctilcr 
ParTial Chdeci-vTcctomy — U L E^tes 

Fractures of Both Bones of Lee — G i Corr> and C Stewart Tavlor 
Sorruntne Irtratboracic Thi-roidnts — I D Kirvhbaum and X H Jlovcrblu n 
Pebovton Fibrous DisrLxia — L Lichten icin 

Froernn of Os Cnicis — ^Thc methods reported in the 
literature for the treatment of os calcis fractures are mgeni 
ouslv summarized b\ a pictorial review Fight cases treated 
b\ immediate reduction bv moulding with a clamp and 
blocks and subsequent plaster fixation are described 
MeLhanici of Intestino! Obstruction — This is an expert 
menial studv of the effects of increased intra enteric pre sure 


in simple oh triiLtion of the lower ileum The resulting 
changes m the length and weiuht of the bowel wall are noted" 
The influence -ol encmaia on intestinal tone secretion and 
absorption and the transpentoncal passage of dves are 
recorded Increased eerciion and diminished absorption are 
shown to produce a pro£.rcssive distension leading to venous 
stasi hacmorrhacc mfarciion necrosis and perforation of 
(he gut Impaired vnhihtv is followed bv the passage of toxic 
milcrtai into the peritoneum Death results from trans 

penioncil ab orption of toxic substances or from peritonitis 

PohoMotu I ihrotis *D\\p}a\ui — The author describes a 

uroup ot eases characterized hv multiple fibrous foci in the 
hafts of lorn. I ones frequenth unilateral and sometimes 
assoLiatcd with similar chances m the skull and with a 
tendenev to patholouical fracture Scrum c'alcium readings 
ire usuallv above the norm tllcvcl No evidence of pirathvroid 
tumour has been foiiriL 

Vuslnlnn nnd New Zealand Journal of Surgen 

Mel*' rr I 7 Xpril l‘>as 

Xans X ci'^v jrJ ih ir C r p "atj " — D R bb 

Xtt f IhKncriar OrM m — H C xcrdulc 

s. Ir nf ti — C V! Cfcrn tie 
Xn-c* hcti» t irev a il t pi " i — G c 

Ifratmcri t Ilet w ih Keferen^ t i C ni pt u* it inj h X piranofl rd 
Xfa \c Intr xc/ t Irfi n— I J W sxJ 

liumt/utu L\p}osuni \ — This is a review of the phvsical 
factors coninhiiiin^ to aniestheiic fires and explosions with 
some general conclusions as to the optimum design of a 

modern opcratini. theatre 

British Journal of Radiologx 

Inn \ 1 11 Mai 

RadK n L>rst cr n \f*ir u r pbx — E Ljsbolm 
L X r Nc fnJt »n c \ Ra> rberap “J T Brorplex 
A!icr<arc i Paijcnt jITcnns frcxrj Brea t Can*cf — F Hertuman J hn 'n 
Cjvc i M^fbl B< nfv — J g X cr i. 

P £C S rrx f r In ef ti Rsdem Thcrapi Part H Phx “t A rwt — 
Jl Nf P-fkc 

t cfttrHitloi.ntp/i \ — The authors experience is based upon 
b06 xcntriculogriphics in cases of verified cerebral lesions 
of which were supratentorial and 163 subtentorial Bv 
using a special technique and taking both sagittal and lateral 
views It w^s possible to'localizc the lesion in nearh all the 
cases examined The size of the tumour generallv corre 
sponded to the amount of ventricular displacement except in 
eases with marked cerebral oedema 

/<M» i\iiir A Ra\ T/icrap \ — The strict 

localization of the r rav beam both in width and in depth is an 
advantage m numerous situations Full dosage accuratelx 
measured is essential At least 6 000 r must be given to 
carcinomatous tumours For rodent ulcer the doses maj be 
smaller Multiple small fields are in general more efficient 
than single large fields Occasionallv however — as for 
example m rodent ulcer of the canthus of the eve — a small 
single field js permissible 

Bruns Beitngc Zur Kltnischen Chirurgie 

B r in so? 167 June 1 I9«S 

Olliers Grtxvih Dix<rdcr — VV SiarV 

Kcsctk n of Curularc lo ihc Penctr ihcrm — G SaeV 

1 trs xlcvft \c'J*ac Fdlcac Sun n-al Inxc^tiEat on of Po<t monem Maienal — 
T Ahtin 

Trcatnteni ^f Ccniral Etivan n of Hip-) ni — B KanixV> 

L*pcrMneni3l JnxcvHran n n XxndanT of Pctvi-< rtranxe Adhevi oS Jn 
XbJxminal Ca ii\ — VX Inthvn 
Xccic OicoTi'clui — XX Inih m 

Proenj-dai p-tvm n cf Cbo}ex.s ixi'Di anJ irs Rout at the FranVfurt Oio 
— H Gci vc*«J rfer 

FoTTnation if Clefts anc Fro Bn Sh dox > in Ant ular Pro-cv es of 
Lumbar Vert bra! C tiimn — k Resx'«borfcr 

Luttthar Clefts and Frit Bone Shadows — Eighteen such 
cases showing the e radiological changes were found bx the 
author on looking through 2 000 x rav films of patients com 
plaining of pain in the back A developmental and a 
tr'»umaiic group can be differentiated 


272 E 



38 JUL\ 30, 1938 


Endocriiiolog> 

Boston ^oI 22 Mi' 

Role o[ Hypophysis m Cnnlal Ostconuchii Pctroslns md Siniis InftCi^ons — 
G Lcvchc L r Johnson K Nt Lourmn incl I O W twmt. 

Uclition of Iodine Toler incc lo Thyroid 1 unction — I Nf \\ ntson 
Inducncc of Tl'vroid md Ovary on Mcinbolism of Iodine — H i Perkin 
and B R Brown 

Dvnmiic Tests in Tlivroioxicosis — W BariJcti jnn 

Metabolic Cardiovascular and Biochcmicd Chanets \s ociaud with 1 xpcri 
mentally Induced Hyperthyroidism in Schi?ophrenia — L H Cohen »nd 
J H Herman 

Experimental Induction of Oestrus m the DoRti-J 1 1 Leathern 
Inhibition of Gonadotropic Aciivitv bv Sex HormoiKs in I anbionc H'^t' — 
E CntuK and Z C Cufuly 

Electrical Excitability (Chronaxtc) of Rats Uterus ihrotichcmt Oestrus Cvclc — 
r C Katzenstem 

Potency of Ccriiin Commcrcnl Hormone Preparations — \ I t) Amour and 
M C D Amour 

Gonadotropic Poiencv of Hypophysis m Wild Mile Rodent with Annud Rtit — 
L J W'cUs 

rcminization in Male Adult with Carcinonn of \drcinl Cortex ■ — S L 
Simpson and C A JoU 
Pituitary Emaciation — R H Kunstadicr 

Occurrence of Coitus induced Ovulation m Adren dcctomized R ibt it — C SfcC 
Brooks and S W' Paec 

Keratodcrmias of Hands and Feet and Thyroid DcHcicncv — J M Cervino 
A Bcriohnl and R A L Hclgucn 
Dysostosis Multiplex — W A Rcillv 

Eugenics RcMcn 

Leichworth vol 30 April 
Medicine and Cugcnics — J A Rvlc 

Some Anthropological Characteristics of Hybrid lopulitionN — J C Itevor 
declining Birth Rale and Cost of Education — G G Lcybotirnc 
Danish Law on Abortion 

Population Problems in the Bniivh Commonwcilth — G E MeClcjfv 

Folia Hacniatologica 

Berlin vol 53 April lOvH Heft f t 

•Relationship between Lcucocytosi and Leak icnu i —S Oliver »nd B Kat/man 
•Methodical Essentials for Quantitative Use of Stern d Punctures —S Gfxd 
Re ults of Stcrnil Puncture in Eosinophil Infiltntion of Luncs — U Stahcl 
Lcukatmic Infiltration of Stomach Wall in Lvntphatte Leukaemu — W 
Steinbrinck 

Genesis of Lcucocytosis and Lcucopenia — f fafudi 
•Human Lymph Glands containing Blood — O Carere Conics 
Bibliography of American Hasmatological Literature of 19^0 — O P Jones 
Bibliography of Dutch HaematoloticaJ Literature of IV'4 to 1946 — O W illhach 

Lcucoc\tosis aful Leukocfnta — -Mice weic injected with 
sodium nucleimte sodium caseinate md bile sails While 
the first two compounds caused leucocvtosis bile salts pio 
duced leukaemn like changes in the blood and tissues This 
can perhaps be explained b) the chemical structure of the bile 
salts which IS similar to that of carcinogenic substances 
Sternal PiiiHtiiie — -In sternal punctures the normal content 
of nucleated red blood cells is between 4^000 tnd isOOOO 
per c mm in leucopenia the figure is usiialh under 41 000 
and in leucoct tosu, over 150 000 The margin of error is from 
0 4 per cent to 14 4 per cent the average being 6 54 per cent 
Less than 0 1c cm should be taken and the first drop onh 
should be counted is this giies the highest and the most 
reliable results 

L\niph Glands conlainini. Blood — Blood is formed in the 
tissue of some human hmph glands especialh m pre 
\ertebial glands and in those of the splenic lulus Diapedesis 
through the wall of the \enous capillaries is the most frequent 
cause There are usualh other signs of a haemorrhagic 
diathesis The existence of haemolj mph glands like those 
in lununating animals can be excluded in human beings 

Journal of Bacteriologv 

BaUtmorc vol 35 April 19 x 
DnicI HcndriLks Bcfgcy 1S60-19 7 

Xfuosis like Aciiviiy in Bacillus Sp Pfclimmary Report — H L Chance 
VsL of Chorio all inioic Membrane of Developing Chick Embryo as a Medium 
m Siudy of \ irus Myxomaiosum — R E Hoffsiadt and K S Pilchtr 
HTtki of Lh and Sodium Chloride Conccniration on Physiology of Halophihc 
BvLiexn — L S Sivnu and L H James 
EiRct of Sodium Chlond on Eh ot Proioeenous Media — L S Siiiari and 
L H 1 \mcs 

272 F 


TiicIiRmjJi 

' fCOlCAL J 0 IT.SAL 

Sifict Anacrolcs in Slime and Intestines of HadJo k (Cnduj nrx/rfnwO- 
— J M Shewan 

I iTvLiv of Suffice Unsion md Osmotic 1 fc>MJrc on Gross Morpho'ozy of 
Ccfi on I iihoLcnit fingi— J \V W illnms 
fyrosinisc Reaction of S tinomyce cs *— C I Skinner 
ScroloLical Idtniihcailon of (occin ^xniosenn with ih Ian rf ’J 

Croup — I) I R Smith C I Niven and J M Sherman 
Experiments on Nutrition of Strcptocotci — S H llutncr 
I kutrophorctic Mnniion \clecitv of hschrrichn co}i ''firr Cultna i a ca 
Media of \ utoiis Cnmposmnn H Ohxcfvaiions (oUmvine Chaoia n 
ImafK miL Conviiiui.nis — R P Iittslcr inJ G I Betfy 

Joiirinl of IniEstriil Ihgicnc md Toxicologr 

Ihllimofc \()J 20 May 194S 

•Chrome Lime Onnscs m I Ictlric \rc Welders — N Enref and 0 A SaMtr 
•Kolition of Miner »l Dust tn I unts and Sputum — N Sandiix and A B) ’cn 
Conipifium of Toxicity of Carbon Tetrachloride and Trichlorcthy enc—H M 
Barrett D I NlicLtm and J G Ciinninghim 
Ikalih Hazard in Mel »1 spraying —H ) Miller ion G M Harra E C J 
Urban and Philip Drinker 

I lint, Cliant.ts in Ilidric Arc If cldtrs — Iron oxide u 
deposited in the lungs to a marked extent onh^nhen tk 
work IS \cr\ confined The resulting nodulation goes rtaj 
ippcatawctts simihr \o those of silicosis T unctional iropai 
mcni of the lungs ippears to be lacking howcicr as lo botli 
the dcxclopmcnt of clinical sxmpioms and of susccptibiliti 
lo infection 

holalion of Dust in I uni.s — ^Thc merits and dements of 
different methods of quantitatixc determination of mineral 
deposits of xanoiis kinds in lung tissue arc discussed Th 
authors fatour the use of perhtdrol (Merck) with 10 percent 
Indrogen peroxide added to decompose the lung tissue Th 
small amount of acid formed during the proccss'docs nol ailed 
the result unless carbonates arc present in the lung tissue to a 
marked degree Iron ore dust was removed unchanged and 
confusion with the iron content of blood avoided Where lbs 
method was not applicable (asbestos carbonates) fine gralmcof 
the tissue and centrifuging from a hcavv fluid facets Icnc teira 
bromide diluted with bcnrcnc) was cmplojcd 

Journal of Laboratorx and Clinical Medicine 

St Louis vol 23 Apnt I91S 

InadcqiMcv of Conjuncliial Smcirs in DiiRnoM of Slight Vitamm A D 
m AOuUx— J B ^oumanx M B Coflctic M G Corlcih 
H Prank 

Trichinosts Divtnhution of TnehmW/a \ptrtihi m Pork Produsts soJ w 
rhUulclpIui — '\ Dickntan 

Corrcluion of Cfiniwal Dtigno is mJ Postmortem PmclmBs m Trich — 
M M Schapiro B 1 Croxbv and M M Sickle 
Jmpoiinct. of Conccmruion Prcpiriiionx of Leucocytes in Study of Lcua>- 
pennx — R L Haden 

Relationship bcu\ci.n ChiundLs and NitroRtnous Waste Products m 
M TtitcJbaiim 

Mkthod of Siudyinp Some Phvsjological Actions of Benzedrine Sulrh^te*" 
E DaviUofT and E C Rciftnstcin 

Choksicrolysis in the. Blood Phsma of Normal Man — P G Schubc N K* 
and I Campbell 

Pcntollnl SiudiLS wuh Spcciil F^cRruncc to Elcclrocirdiopram — R 
and L Lcdircr 

laboratory Diagnosis in Chronic Gonorrhoea of I cmalcs — T Jacob vn H 
M won and L Arnold 

Concentration of Tubercle Baeilh from Sputum by Chemical Elix ubt'k''’ 
Method — J H Hulks H I Clark and H Exldmin 
Use of Index of Hatmolvsis in expressing rngihtv of try thro y tea 
W'aiigfi and E G Ashtrman 

Method for Colkction of Peripheral Blood Samples — M I Andrcscn ^ 
Colour Photography and its Application in Medical Teaching — H 
W M Hull 

Intndvrnnl Antuitrin S in Children — I P Bronstcin 
Sttriluaiion of Sodium Bicirbonatt, Solution for Intravenous Use in AciJo'n 
r E Holmes and G E Culkn 

Reaction of Stra of Different Animals to Kahn Khne Ide EaR’^ ^ . 
Laughten Tests — R A Greene H B Harding W T Hud>pct 
W J Pistor 


Journal of Pediatrics 

St Louis vol 12 May 1938 

Focal Infection and Metabolism — J A Johnston and 3 W Mafoth 
Immunological Rea«.nons for Undulant Fever in Apparently Health) a 
Tuberculous Children — J R Lcwin and P Gersh 
Effects of Tannic Acid Nasal Spnys on Incidence of Upper R^f* 
Jnfeettons — M H MeKee 

Hwxlcr s Syndrome fGatsoylvstiW '—R. 3 Krcxslct nnd E. E Ac&crtcr 
Ehlers Danlos Svndromc — A C Rambar 


KEY TO CURRENT MEDICAL LITERATURE 



Jun "<0 1*5^^ 


Nur ar'c I MV<ilc^cn - I \ \\ >« 

C-rc 4 f SV n 4 f Nc'^K rn Jnf ri — H Vnifh 
t rani 1 v>ti rcr ^ n1 H\rcTlct xm >» f t 
r K Mrcn arM R r I fSr^ 

I C t Vi ^^■»r Jfr Jf in C n viv al Inf xi 
J \ Jin-4 arvj S C v- r^cr'c 
5vj'riMirc4xr» r at r»! P »\tHl rhthcr i P-r^f rtram. Pir {> i titatcd K 
'Mc\h n al Rcxp rat f unH Kfv \rt% — ^ II ScfT n nj S M WfhiV 

^ 1 \C l-i-n •'-a t atain t Pcfi »» th I rr rJ \ aix rc ML IP it 

I I cM'^ a''J I 1 '«'“arr 

\ n Cxtkc Ct ccn S fjf I) r c— '1 I I • O C I irc arj S M 
r y n 

\ rtv I a c np K.ainJ V ni i. Ih '*'NyM rvt l^ rr la .«nj < arttcnc 

\ \ St>c"CT and \N Nk I y.V» yxl 

In'* crsTc f 1,-t r> IL. r s-kI it Itm f P t 4ft4 n Prcn' t rc M nt !\ 
r \x Nfoc 

of tit \cHl' 0 rn — One of the chief rrohicms of 
malcmiis ho pitiU }< the prcxention of \Vtn infctlion*- in 
neNvbom infants Different methods of prc\cntion 'ire 
dcxcnbcd The author hov\c\cr '■uj.pc^ ^ tint the b'lbx should 
not be clcined in an\ wav ^o that the vemiv CT^eo a iv not 
removed The infinty ylm p neither oiled nor bithed and 
onlv wtimi wntcr i> u^ed to clem the buttock' It is believed 
th''t the preat advantape is that there is less handhnp of the 
skin and so Ic s chance of infection 

Siilpliof i!< — This driip was tned m a larpc senes of 

Lbtidren suffering from \ulvo v^pinitis with no pood result 
coniran, to what has been reported b\ manv venters 

Journal of Phamiacolojy. ind Hapcnmcntal Tlienpcufics 

flj J rr re ' fi |9lv 

I «l S "t *1 t I) j ».•*• O yj VI |( Ir* t' n Ip cf' b c 

Water L — M C PafS»' r and L f Rt c 

V ^pT p 1 \>oi> It fjp'c atJ Im tu 1 a ct'rd pc i f) refrni fh nre 
f \(.r“ -'«*r I r ~-P J M p/ I S J Lch*^ n arJ V P R ^ ^ 

i -It r )ed V ( L" ars Dm " oJ V h v— p 1 C creral E^cct — P I M -u k 

3n« K J Lch— n 

I Tc a c'' li ""J h after Ip rsn v-u’ r Inka s f v s ni*t J t\rsr r*cpt I 
^rJ C ri*al Kr- h — P J II r k \ J lc^•^an arvJ A P R hard 'n 
I sir —irn -r In n - of S ^ -i t VN rr i '' and D tnW ti •> f p muth 
— P / Ha"? V J Lc^•"-Jn a-'J APR ‘tard n 
If a ' Pf r— n Airr’'-‘nM“pnS-u‘i HfiVehRR 
L- CT A G I n-N 

R- f f jPe Vcc vl S V ni n <.*11 n I) o - R I Ren *ui* 
D Creep a-d M Z-'T 

An n f Veer>l b'fa rnetht ti »' Cf fi4,e I'le h f I> n Se i ep I) 

U r •y.o if l^e Lfp f* P d^er ih j N n Mcxl ir r* f S- j| 
yk -P M to n 

Ir^’acna f O ^r-ifv » - c n ra i n S futes- e — 1 C ttc 

Rebtw n rf Aeet n J anw <1 r-r I) ~4 i Vr ro m Vf kc> P k h 


Joumjl of Plivsiolo^ 

Lr-’i. n % J 5*1 Sfji 14 n " 

I renrneruf Ir u—jfy VSyk— i R Cc/f A Sf Clafl ryj I) f 

Cl-^^*y^vv n 

O wntu-i c D-ta on jnli I t n f O xtru hi 1 t htit ^ Pr '»i r c nd 

Certan 0*hcr Cemr x--kIs — I Vf Rev *ti 

S nc I an n ir'*a \ cn ; Prvx jrc m M n D i,re R A Krjn u» 

^nd S R S" y* av 

Art y-n hcfuccn Pr^-C't r -i and the S nthei, Ooir e n !> V jr c 
Tfir't " I fct*’ c-'C — J Vl P<^n 

LlTcci if Vdap^ti n in D 'Tcrc- lal BrikSfre D f-nnat.p— k J W Oak 

A T n f H TwCr r C •~'p» an »vn Cent 1 s^ct u S) ti — \ S.^14 x/cr 
a-'d i V\ n ht 

Rc'pratKT «pd MeiaKIt **1 of Suhn 1 arj d nJ I u f C-i — W D tiiM,h 
nd H S Rarer 

IFcxi of Laryc D iso f Jr J n n J yial S^crn and Gix I -K Pw rr >» 
and H Seb — _inn 

C urhin- uJ cd Vfran f I Rat Cr m i riarSv -k J frank n rd 
R JanVer 


Joumil dc Radiolojjit cl d Elcctrolo^ic 

I r I f *‘2 Vla4 19 

1 uryjjfpcnt 1 Pi ry. p' x f K d tber r> n In'! r-m t r> C4»rJ i n — 

W sea W icvcr 

Radi v^aphu. Vnib u) f L ft Viifi I within Carda Shadow — R H 

dc Bal'ac 

C r fjjtal Hjpcrtriphr f Left L «cf LifJ h Rem le Rc'hJi f Jrr-d^u o 
of Er'r‘t^’^1 Cam co d inpc Aitne Period if On th — P D sai t 
CclJcclne R d o-photiVTarl — ' dc Abreu ^ 

Irtcmaticnal Radi Jcyi al C n fr- in Chi-afi SeptemKr 19V — J B lot 

CoIltLiixt Rtuhn photo rapln —The ndiotnrhic evamina 
tion of the ihorax becomes expensive when m'lnv such ex'im 


THcBanisH 30 
VfEOtCAl. JotHNii. 

imiions ifL undertikcn in the course of a campaign against 
tuberculosis The nulhor has therefore adopted the principle 
of indirect photognphv of the radioscopic image The image 
the chest IS projected on to the radioscopic screen which 
Is then photographed b\ means of a miniature camera The 
principle is not unlike that used in t ra> cinematographv 
except tint onlv one view of the chest is obtained 


lonmnl of Tropical Medicine and Hvgicne 

Irrtl n % I 41 Vlav 2 19»« 

Ire m ao ^ tc rn Tiarta m Cc>l n 19^6- — VV L P Da4s3ra)kc 
I rcrirtcnta! PeParra in M nkevs (llamadoad Eabeyns) at 2 ilrtical Gary n 
Catr — Alfred Clark 

I be ett al Cenesrs rf O a rb'crscil jn T r^t Three Si rdard Lead t 
I < If yard rram —R It Bj>Ic> 


Polichnico 

K c I 45 V!4> I< |9ts tSc/ Ojir ) 

PU t Ke n tr 1 n f Lir mertum Teres in C me mial 1 jtaii n< nd 
Sib Hat* r f H p — C Art nusxi 
IfTci f Spjf» hn Sene Rcsccvi n n Rena! Pun t n — A CalS 
Ca f f Cat in r'j f Smill Intest re inirhinc Abd ninal Will — A Co- ni 
n*arr »»i and Treatr* ri tf C trs-tcjurvi. I*, fttufj f I wine Ga tro- 
erter »si w > — M Mj r 

Lij^t ftu litnm Tens — \flcr describing the anatomical varta 
lions of the ligament Anlonucci proposes in congenital hrxa 
lions and subluvations of the hip to replace it b\ 1 band denved 
from fiscn hla and the aponeurosis of the vastus extermi 
He tunnels the femoral head neck and trochanter as vvell as 
the ilium The openiion in the cadaver is illustrated 

Public Health 

I y n » 1 51 Mat l9 s 

II r III I 4 tn Re 1 n tr Pf rntre Med nc — A M o J 

Ice n 

floxpitai Pt>!n \ —This is a review of recent alterations in 
the lundions ol the general hospital and the part it plavs 
in relation to the hcilih of the communiiv The passing 
the volunlarv hospital is commented upon and a policv 
of oft-anirmc hospiii! crviccs upon a regional basis is 
idumbratcd 

Radiologv 

M pjtl M nnc-cT % t 33 Ma> tyt 

I I <0 I t n l \ Ra ul \ ers Shan VV j c Icnsth — W D C lidc \ 

C I t^ti n jrd IK if vail n rf kidnc> Hcmc f Lit r ti r jrd Rer rt 

of Ca "4 - V E Cl J ten and B S Aboh lu c 
It x-n crnl *• al S cd> cf Pncal Dricrtaii n It C nparr n f Gr 

Pr r n nj! Meth d tn Pro cn Ca o f Bra n Tim ur — W W Fra> 

S d r Ti ti D wax- and P dati n EfTm n Opcra‘*Ie C»r cr f Brea t 
treated b> Cimbmatm of Prc-oncraiitc Irradiation nd R d al Vfastc 
I ry\ — b r Adatf E L FrazcM and E H Qt-^nbi 
I*' n cal A peer 43 f Calciri^ttion ard O. 'ittn n in V-ri j 4 ByJ> Tt tics — 
E P W»drr-inn H V\ tVtrun and H Freed 
K KTitrren rherapt of Dupujtren Cvi^tr crnrc — !> R Beatt> 

Cal ulatun tf P-rtcniacc Depth D-^cs — C Pa kard 

l-ncsnan'c ol itaicncni of Tumour D'we in Rad oJtcfap> — J R Nuiiall 
rit r x^lo raph New 'lethctd for Examinin- T rcet of RccnTgcn-ra> Tube — 
£ K Ked and L F B'ack 

Bj V-^aiier and it Eff*ei o« Di^aec Mea urement — R S Landaiier 
V niy fa to-s in'luenctns Di tnfcutimt cf Rad^tion u n" Tw vobliqi c F»cJy 
Techno c — Vt C Renhard and F V| ers 
\ Ra> D en » f C ndmon of Th>‘mu Gland m Cb dren — H A Judven 

Ditpiisirin s Conintitiirt — Afier briefl\ de cribing ihe 

ituolog' ind pathoIogN of this condition the author relates 
his evpencnce "ith v rav treatment in ten ca e The folio" 
ing technique "as used 100 TV s mA 30 cm fsd filtra 
tion ihrou-h I to 2 mm of aluminium single doses of 100 
to 200 r (in air) gnen at "eekh intervals for three to four 
"eeks Several such senes mav be given at intervals of six to 
eight weeks according to progre s Seven out of the ten cases 
improved under this treatment 


Kn TO CURRENT MEDICAL I ITLRATURE 

•> anl M Sweet 
nc Silpha lam dc Therapy - 
A m Ch yfcn — I W 11 me 


272 G 



40 July 30 1938 

Enliiiged TInnms — The •wilhoi pomVs ovh Jhc difliculU \ntl 
unrelnbilitx of the ndiognphic diagnosis of enliigcd thjmiis 
in childien He questions the snlue of the ndiothcr ipeiitic 
test and in \ie\v of dangers fiom osci e\posnic to \ ri\s he 
adsises moderile doses in the tieitment of the condition he 
also doubts the value of pre-operative radiographic CMinini 
tion lor enlargement of the thjmus in chiklien 


Revue Frangaise de Gvnecologie ct d Obsttlrique 

Pins ^ol 33 April lavS 

Gonorrhoea m the rtmMc G nerM Considerations — I- rn.rft 
ConsuUmR room Dut nosis of Gonorrhoea — P nirhcltion 
L iboraiori Dncnosis of Gonococcal Infection in the ferndv—Ch O 
Ginllaumm 

Clinical Anatcmital Suid\ of Gonorrhoc'i in Women — J liktrcHa and \ 
Donnett 

Complications and Aftereffects of Conorrhoea in Women — L M TicCfi ind 
G Carlandc 


Surgerj 

St Loins sol 3 May 19 S 

Biclcrioloty of SprcadinR PcruoniUs complicatinR Acute Ptrforal»\c AppcnJi 
cius — J BoNscr J Rums and H Mcnglc 
C ilcihcd Fuccahih in Appendix — H SheUcy 

Smgical Treatment of Complieatcd Duodcnit Ulecr — W otfson and U 

Rothenberg 

Primary Carcinoma of Biliary System — R D Aunoy M Osden and B Hatpin 

Fspcnmcntal Study of BchaMOur of Free Fat Tratisplinis — C Gurney 

Method of Constant Suction applied to T csine Tube — C Welch 

Partial Gas rectomy in Trcitmcnt of Peptic Ulcer — F Connell 

♦Hacmangiomx and us Treatment — W Pevton and N Leten 

Operative Treatment of Hypospadias -—C Crecw 

Treatment of Dislocation of Shoulder — H Milch 

Conscnital and Developmental Coxa Vara — G Dunctn 

Cancer of Breast m Male — J Sarnoff 

MoJtl to Illustrate Mechanics of Rcspiriion «nd Movcnicms of Mcdiasiimim 
with and without Various Kinds and D*.grvc of Brom-hi il Steoo » — L 
Elocsser ind A Freeman 

Haciiuiiiciioma — This is -v comprehensive sludv of the capil 
hij vnd cavernous forms of angioma with the nvanv varu 
tions of each of these ivpes There arc mans methods of 
treatment such as eacision the injection of hot water or 
alcohol vaccination for small lesions irradiation and the 
injection of ‘odium morrhuate These methods are discussed 
and the cases for which thev aie found most suitable aic 
desci ibed 

Tubercle 

Loudon vol 19 Miv I9ts 

CruiLvl Review Modern Outlook on Tuberculin — 11 J P»ri>h 
* \ctioloRy of Bronchiccnsis — W E Adams iind L EsciiUcro 
De ensuizaiion m Treatment of Tubcrtulous Guinea pigs — } D Ihiver 

Bioiicliiectasii — E\peuments were canted out in dogs Two 
factors were found necessarv for the production of bronchi 
ectvsis — incomplete bronchial obstruction and contamination 
of the bronchial tree Its development did not depend upon 
an> particulai organism it was produced b\ both aerobic 
and anaerobic pvogenic organisms, by the tubercle bacillus 
and b> distemper organisms In no case did hronchiectacis 
develop if the obstruction of the bronchus was complete 
Increased intrapleural negative pressure was impoitant as 
a caiisitive factor onh in so fat as the seventv of the patho 
logical ch inges was conceined bronchiectasis developed to 
a somewhat more marked extent when an incieased negative 
piessure was present 


Wiener Archiv fur Innere Medium 

Vienn 1 vol 32 April I9tS 

*Oln.cuvc Ctusls of Hunger ind of Sen Ttion of Svtl^flCllpn of \ppvUIl — > 
J Men turn 

HvpophvM jnd W ittr Metibolivm — P Werner 

anti /Jppc/ilt — R idiographic recoids ot the motor 
aclwitv of the stomach weie compared with a blood siigai 
272 n 


Tiicimniiii 

Mtnic*!. JOCTSAl 

curve t ikcn \t the stnvc time Different types of paiicnK were 
observed and there vv is i corrclalion between llic blood 
siigai curve ind the tune when the siomich was emptied 

Zcitschrifl fur HvRicnc tinil Inrcktionskraiiklicilcn 

Berlin vol 120 lone I9li? 

''Uicicru.iU il Properly of R iw Honey — Milvn Inca 

llunoRnphlc DcmoiiMniion of Droplet Inltciion— F Weyrauh aJ J 
U/ymkovvskI 

•C'vuvcx of Rc tnin nc FfTcci of SaliVT on Growth of Cap ubted nicifro- 
A Berk 

Nomenclature of xocillcd STlmoncIlT Gniip — Hors; Hnhs • 
Ol*icfvations on Scirlct Fever T pulcmle In Pinncbcrg (lODj Cernin Anrjul 
f xptnmcnis in Rclitum thereto — Dtto Boyksen 
HvRicnc of Uuril W'orkers Dwcllinss — J MrusowvVy 
I urthu \ -vccinTiion Results with Smll pox Irotcctivc lymph from Culium 
on Alivntols Mcmbrine of Chicken I mhryiA ^W Mihcr Ichniann 
Kc«.cn Icslx of Ffllticy of DiphlhcrU Anatoxin Prcciplnic SingK Injection 
— 1 rntTRiS 

Epidemic Hcpaiiiis m Dosscnhcim near Hcfdclbcrc —Hcrhcri Dem-w 
Invcsiie vtion of W' forms obtained by Pissasc of \ type Typhus Bacilli ibrouth 
Chimhcrl'ind filters — Ciuho Ruonomini 
Minim »! Infection with Tubctwlc Racilh — B lust 

Raw Hones — Following the researches of Dold Du and 
Dzito, who found an inhihitorv factor (inhibinc) in raw honq 
the author shows tint this propertv is not due to the uoriml 
icid content of n iliiral honev ind slill less to ils sugar con 
ccivtration but to a secretion product of the bee The sub 
stincc IS filterable tliermohbilc, sensitive to increased acidih 
ind ilmosl insensitive to dilfiiscd dav light It is slronsh 
bacicricidil to boili Grim positive and Gram necatiie 
bactcri i 

S«/iui — flic lulhor follows up previous research by DoW 
and Olliers (cilcdl upon in ‘ inliibine in saliva, Dolds 
results in cert iin respccls ire confirmed Aclivilv is luoie 
mvrkcd when excess of biclcria is present heating renden 
the saliva inaclivc and its properties arc not regained bv addin" 
ficslv saliva 

Zcitschnft fur Krcbsforschung 

Ilulm vol 47 Mi> 21 lavs 

SUuoc UvniUomt »ntl Slioos Cuemonvv Spontvncous ind Cvp umviiial Ttm 
formutoiv of PTpillDnvv into C mccr — J Hdri 
I xpcnmcniil Invcviikationx on Modihcntion of Irinspbnicd liimoiirk— fr R 
Koch 

Mctiplvsuc Bone lormuion 'I'vxcvkMicd with Lpilhclnl rrolifcraiion p^dtRC 
m Uitrus of Rabbits by Follisuhn — H Pierson 
•Production of Tumours in Rabbits by I 2 ben pyrene— J KhnVe 
•Produeiion of Intrvmuscuhr M iliknini Growths m Mice anJ ' 

1 2 benzpyrene — J KUnkc 

Fuithcr Invcsna »t one on I robicm of Tumour Resi nnec — H Au' ^ ^ 

W SchilhnR 

Sanonuila poni ] 2 binzpsnne — Khnke pre'ioush 
recorded the production of sarconiaii in rabbits by inieclioin 
of 1 2-benzj>y rene T hree -additional sarconiala have 
developed after long latent periods In the second paF' 
Klmkt describes similai experiments vvilli rats and nine 
Saiconaat i resulted in a larger proportion of aniniih m 
shoitei lime ind with smaller doses of benzpvrenc than 
rabbits The tumours icsulting from intramuscular 
did not oiiginite from muscle cells It is concluded 
tumour production bv highly carcinogenic substances reqiw > 
a suitable animal species and i responsive tissue 

Zcitschnft fur Urologic 

Leipzig vol 32 Hcfl 5 

^lvnsllKm^ from HvpcrpHstic kulntv to \ Trnntb in Conrikiim^''''’ 
Collecting Cilyx in RndiogrTphs — K Huttcr 
Ucml Stvsig xs-iocnicd wiih Doisil Cour^iL of Ureter — F hfi> 

Ucuury Cnlcull TnnspTTi.ni tb \ Rays — H Kunstimnn 
Bilncology nnd Distvscs of Unmry Orgins — Adolf Czech 2 a 

Polycystic DcBLncntion of kidneys ChnicTt Svmptoms niiJ Si?nii 
lUrcditnrv Disctsc — O Wcidncr 
Plnstic Opcniions on Rcnnl Ptlvis — Hcyn 

Sotirci. of Error in \ Rny EximinTtions of kidnev — O Pfit-tonus ^ 

C vremoran tn Blxctdcr DncrticuUun wuh in Obscrvuion on 
Foimiiion in Kidncj — B Ibbiis 


KEY TO CURRENT MEDICAL LITERATURE 



THi: BRITISH Ml DICAI JOURNAL 


Jin IV s 



MENF 
TABL 

to reverse 
menopausal changes 

“There are, of course, certain more 
severe sequelae of the menopause which 
demand much higher doses Pruritis, 

Kraurosis, Leukoplakia vulvae, fall into 
this class and, provided sufficiently high 
doses are given, the results are little 
short of miraculous ” 

PROC ROY SOC MED JULY 1936 p 1094 
Tablets of 1000 3 000 10 000 lU each 

Somp/es and liicroturc gladly sent on request 

ORGANON LABORATORIES 

Standardised btcfogical products 

77 NEWMAN STREET, LONDON, W I 

Xthtrens trfc men fic ^ Lc d n Telepfxre Mustum 2SS7 (3 I nes) 

I Inda Jcr’ Sentje e$(lrdo) ltd A^itre a F H Feutd rg & Co Ltd 

PO Bs 2SS B m cr ^ , 

S Afr ca Her'^t f a hew Ltd F O Wew Ztd^d Dom n n De cJ 

Bex 242 Cc^t Tcnn es Ltd 





THE BRITISH MEDICAL JOURNAL 


Juu 30, 1938 


This cookeiy hook is based on the latest scientific standaids 
Medical pi actitionei s can paiticulaily lecommend it to those 
of then patients who have to get a full pennyworth of food 
value fiom eveiy penny of then outlay 



DOCTORS 






21 Menus and 82 Recipes for Family Meals 


21 PAGES OF PHOTOGRAPHS 


PUBLISHED BY THE BRITISH MEDICAL ASSOCIATION 
OhtaniabU from cll booKtellerSi net s as^ntfj Smtth sbookstaUs,Grd Co^cperatne Societies 
iniutrits to th DM t , Taiisto h Squurtp London, \X Cj 



HEALTH BREAD 
ROLLS 
CRACKNELS 

HYGIENIC PACKING 


I ROTCIN 
42 00 


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(REEVE) 

Picsci ibeil Ii} Ifie Aledical Profession in 
lilt Irenlinenl of all SKIN DISEASES 
716 pci lb 

Siimple sent on reqursj utfiouJ rJiargi 

Orders lo wholesalers or lo 
HEEVES REMEDIES LTD 
Monurocturing Chcmisls Rirmingham 


ch«r«cfcrJn 
• lr«s5.-tBrajnze- 


Send lor lltmiiaied Brochure and Price List 

FR H ALL A rn **^5 Cross Rd S E 14 
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NAME PLATES 

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Tlie mXE BUOXZE Co ‘■^r,5-o\"nn'I''’ 



CARBOHYDRATCb 
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Simple Die! Plans Analysis Frceonrequesty 


KirD xii\br MNRk 


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IRONZB 'STAINLESS STEEL- BRASS 
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SELL HIRE KIREPUR Tables and Chairs 

CHASE, EXCHANCE p.. 

BUY and REPAIR ALL ,004 
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lating Machines THE 

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or Phonc-IIoIborn 3793 rhe be t portable U nlcr 
BUY A BIJOU FOR Lomplctc in Iriveihug 
15/ a Month Ciso £14 14s 

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JE ■-■w.-.v--.". 


IN BRONZE Tree Sketch \ 

ENAMEL a»d Booklet 1 

OR BRASS "'ll he sent • 

Phone «> 'cccipt of ^ 

Clcrkenwell 2441 dctnilo l 

S J & A Herd, so Clerkcm *)II Rtl E C 1 


FREQUENT MICTURITION 

“iBUET” •iBSOKBENT BiGS 

Male Uaj paitcm }*•! 

New Model Female da> pattern 4 , 

" DUPLEX ” B\GS 

Male or Female da> and night /O 

» SANITUBE " 

For hclplc'vs bedridden patients <0 

Our baRs catch all IcakaEC casing mind 
Invisible under clothing and ca ily cf^hti*^ ‘ 
worn world wide Special patterns tor t" 
and aviators 

Diagrams etc on reQiiesl from 
H1LLI\RD i:, Doiishs StrcctQlj^f^^J^ 

A OENTUEMAN ALWAYS LOOKS 
DRESSED IN SAVILE ROW . 

J NEW LIGHT onRCOtK 
lounge dress SPORTSSl « 

ciL h> all eminent , , 

Seholie Lcslci L Robau M'E 
el^ OUR PRICES 3 to ® •' 
Allcratwrts on Eteninft 

regent onESj ^'i 

’nd Floor Piccadillj M>"' 
SInfteiburj A\ II 

\V 1 (Next Cafe Monico) utK 

-I ladies dept on 1st 


NAMEPLAraSIS.’”-' 

REDUCED PRI® 

Send for List in to the IrinsI ’ ^ 

F OSBO R N E & Co , Ltd Tel W''"" 
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7 Ml IJMT/SH MI'DICAL JOURNAL 


Ji 0 l'> S 


FENS'! \NTON, 

CIIKISTCniHCH IvO\n 
Str< ilinnt Hill 

^ To ate n “te f f the Care arJ Treat 'icn 

a 1 "T tevJ r **71^ » f I *- o th 'ten jj ai J 

Nrt^> Ovre-cfN CenreJ 'r ''t t' atxJ 

atA r«li rt fccc ev! I *rtc 'lar^ ^ 

'Ki h I fC' if trou'*J <'<e 'f i. 

P r t r !1 ! \rr Rcv^fc^l If in 
r Tt » c H I I'l 


BVILBROOK HOUSE 
B VTH 

I r r fr m Ser^ n a'*v. 'ten I O 

rri, IN wi h n- »>i h It ern al-^ 

TF ^ n r> t III ate\J >n h sx. cU 

fT nw ft -rcx »i h rtai" 'cri \n*ik f 
l*“c Cl arj l^c ^ on Vat- <Ve 'f r c/ 
P I r-re - ) 

f ler—A a~'N> \ Ciitt it M \ I) 

PCh npM Krvv.c-t r**> u.n 
Te -h n R- a - 


ST. ANDREW’S HOSPITAL 

1 on 'MENTAi nisonni ns 

NORTHAMPTON 


K)It Till IIIIR 'MIDDI r CI^AS‘*Ks ONL^ 


r / liii M 1 Ho'. im VfAROl I vs Of I \l II R (M< SDC 


tf c \ r rrn 0 / In I \ lisstsf M I) M I< C f DP H O P S! 


IP He* ic rtl If 1 I (u (ctJ in I «> ren f r rW anj rtc fc Cf un.. \ riarj r-Ji cr 
»il jie 'termi, If -n tr t'nent mental c order rr %»i ti i pre cm rcvur cni att.. k f o' nt I 
tf icmpx f r> fui ente art! tcrtiftcd r ticn ef h« th eex arc 'c cned f r ircatfn**nt Car f 1 

1 I P Ktcr* h.. ten real ard (^alhl > tw I C'apiinjti >0 I ate r'xm w S pc al n 
r*j e r fcf~ r n ihc If *'r I f n nc f i‘’e ri mcrinje \i a n iP tt m. f the jr f- r c> 
an he c ruc 1 

\! tNTtGi: HOLSE 


HEIGH tM HVLL NORWICH 

A PRIXATE MrVTKL HOMI titiutcd n f) 
rc' of vclriLx-ed r~ If and 

Cent mm •Te^-' fr im Vcf o *% or Sf -tal 
Iltno \ » ar) Patient Ic—rv- O Paten 

-rd Pat CT t n.,rf Cen h ..tc are sl.'*' tted f 
»rcat"~ent Peex fr"“n 4 r r a »tceV tni^ard 
2 vo"t-i t{ r*\, I m'- A fexk e csrvrten e\ i 
fir l-u ce and C -time*) i rce-a ed feen on t‘*e 
rr 'n--n'*v..at "n ef the Pa ktI o^r Ph x an 
Arnl% to r>f I A f ii Tr cr‘’o*‘e v r»tvh 
Ternary S'^afl d Norm h 


TYKEFORD ABBEY, 

NEHTORT r\GNELU ni.CK‘. 

HMTION^I M:«^OIsDI ORUITT'* 'll III! (1 
VMl MIWALP'-CINT 

The Hcr“c » a 'Ian ion cf llc-torxal irtcrcit 
land nc tn 1^ ae.f“n cf tarJen and noire. 

• rvJ h Latcd 14 ri c> fron Non‘‘anrttn 

are. I rm'en Irom Bcufo d n ihe n_in London 
I Npnhanricn Road nfie r-i c» fro«^ Lend n 
F ih texet arc a ar"’not~Jtctl Ps h>-tSeTs 
rcut Trcat"*eri t> ir><d cttenvi e' n jitah’e 
cs.'CN Pad art Heat \-ra) anj I Itra \ 1 e 
Ltth Dalhcrrr and Pcan B-dt R'^ ure. 
lent etv. 

Arrh Dr D E M DOLCLsS-MORRIS 
Tc er'* ne Ve«ro^ P ere I I I 


HILL END HOSPITAL AND CLINIC 

ion Till Pnt%L'VTION VMl TnilT'IIM 
<11 'IFNTvL VMl MRVdl" Ul^OHniif' 

ISO I il fnim Lon lool 

L.«d cs sj'fennt fron all foms tf MEnPvL 
ILLVESS are recci cd t r irr* mere on r'ceern 
I cs a VoJj'*t3r> Ter'*Xfarr or Cen I'nJ 
Priea e Pauents .1 the HtH Frd Ho r*i al 
C '’ealcv.-rri rr mi’d ca r» on he trea cd in 
dc* MIul ecj to r-ar on xeith ex cn ec 
fTovrd Frown ti 

HIGIxFILLD II 

itua c .-Nxii 3 me awa) from the H >-r jil 
I EES TWO TO THREE GLISEAS PEP V\ EEK 
For f -ihcr renrmUrj j'~rl> 10 the VfeeJeraJ 
Siir U J T Kietxci L R C P D P V! 
ST ALB4\S HEFTS 


BARNWOOD HOUSE 

GLOtCESTER 

A REGISTERED HOSPITAL for the CARE and 
lREAlA!ENTOFUADIESar>dCEVn.EVEN»urer 
ns from NERVOIS and MENTAL DISORDERS 
Within two mtJri cf the G W Railwaj and L 'I A 
S RaPway S atione at Clou*mer the Hcwntal re 
ex H acco iHe tre rail trcri Lrn.-on and all rar 
of the Lr ted Kiord^'m It ts beautifull) siiiuted at 
Ih* f -lOt cf the Coixe»o*d HtIH and xtaOw m n own 
rrctjnds of o cr *00 acres Voljrtarr Patierle of 
Kth CTCS are al<o re^ctxed for treatment Special 
cccrro'cxlation for Lad) Vctuntar> Patients ts a’so 
rroxid-d at tV MANOR HOLSE whrch has its oun 
rrtsatc fTcn.nds arJ ts entirel) cnaratc from the 
Vlan Herntal For particulars as to terms etc 
^rrj to GW T H FLF_MING MRCS 
L R C P D P M Medical Supt 
Te epheme No 6 O’’ Barnwood 


Ih I « kc cn n II '>p f I in t. t hed *roe ne, with a cpir tc trira c t v.! h r„T cn 1 

K je-mtici. It t <u rnd w h a! t e arr-ftt 1 r the mrxi m x.crn ire rmcni of M r a! mJ 

NefMu D r n- I tl a pc 1 . 1 e.er fimemt f r hid the ps h ri i methx. ir I s. n" 

It V> h ■*'4 Rl n ha h the p I nree. n hath V he O h S ch Di u he EJcc*r a! 

Kifh rj ’rrNcres tfcarf"cni ct There n an fl-'cratin fheatre D r aJ S irr r an \ ra» r<x m n 

L lira % H *t A*''*afa i jrJ a l)erartf-*cni f r IJ therm ar« H th Free, c»* > trcifir ni Ii I rt 

LaNratencx f r h x.t rr I h cm t aJ ard path J remrar h 

MOLLTON PARK 

Iw m rv If <m ihe V jm H p I theft a c cr I hran h e i-l J hrren ard It IL led n a 

parV. nd farm e f r i> fev M tV me t ft 1 1 ard erctah m arc si rr et, 10 the H 'xr tal from the f rm 

r rder ard or hard of M 'u t n larV Occur-ai» n Iherap' a feat re of iho bran h arnj p t cris 

are t m eser I ci t> f r osci p) nt them I rv in farrripr rarden nc rd ft 11 rr w re 

BRA.VA-NEL'ADD HALL 

The ca v-c h um. t f St Aodr w Hi>'''ia1 o hcauiifull) t laied n a r-rl I 0 -ro L nf fc h n 

.nits, t the frexi Kcn rs n Ncnh W m On the N rth West sice i f the E tate a mile I e« r. » 

offT the hour.arv Pa c" r^a) t ihi Brar h f r a sh ft ca tc <h n e or f r lo" cr pcnrx. 
The H ->*• tal ha its own pri at ha hr**, h -•'c cn the e. h re There »' trout f hin- in th parV 

At aU t*'e br*plm f the Hmpta) 1*1 re arc srKket frouni. f o hall ami hoeVo rr i— u ! nn 

' PC' n trra and h tu c urt ) cfoc et rr J-d prif coi'^m and Kwlms s ee** L.d ex J»*d 

*cp en* n hase thci own tarcers and fa iJ t cn ate pro ded I'f har^durafis su-h carp^rtr ct 
fer tern ard f nher pan ar appl ti the 'fed al Superirtencen (Telcph n» No t n ipj <" 
N thj»-rt n) wh can h- <cn in Ls c n hv apps n r'enr 


COURT' HALL, KENTON, near EXETER, 

for the* lr<ntm*'nt of tijrht I*.i<llpw voIimfTrv temporarv or certified pitunlw 
1>nr{;< fnrdtn.s ind own dairv 

CLIFI DFN TEIGNMOUTH for carl\ and Lonvdlcsucnt A well ppointed 

hou e wnh ^paciou** bakonie^i ind c\tenM\e views of ihc South Devon const 
Sub tropical gardens own dun in 2^ acre Privaie road to beach 

Telephones 

Dk, .. « BERTH \ M MULLS MD BS Snrerovs 19 

Rc idem Ph% MCI ln^ \NNE S MtIFS MRCS I RCP Tei^nmoulh 2S9 


THE COPPICE, NOTTINGHAM 

itosriTAi, ron mcntal diseases 

This Institution is cvtlusivcU for the reception of a limited number of Private P iicnts 
of both ‘^cves of the Upper ind Middle Clas cs at moderate ratei, of pavmenl It is 
bcauttfiillv situated in its own crounds on an eminence a short disiince from Nolling 
ham and from its smcularlv hcalthv position and comfomble arrangements ■affords 
cverv faciittv for Ihc relief and cure of those mcnlallv afllicied Occupational 
Thenpv Voluntarv and Temporarv Patients received 

Trl f>4II“ Frf le t elc aprh t if e d aJ S e n en f t 


HAYDOCK LODGE 


LAN C ASHIBi: 

Tt! K Street A hipn n Maierheld PI me A-hton-in-MaVerheld “ II 

For the reeePtiOT and uc imeti cf PRIVATE PATIENTS cf both s«es of the LPPER AND 
MIDDLE CLASSES suaemjr fr*m rrenul and nerteux d xea e< either clunu-fx temporaril) 
under Cenifi-are Patients are cla ificd in sepjnuc huild ncs . 

Situ ted n park and jrrourds of •» 0 .mcs 
ji-licnts are erxcoirared to *>. niD) themscl es 
tcfTT * 


^E^^TO^ IE-^^IIIOMS 

Sirect A htpn n Maierheld 

■RIVATE PATIENTS cf both 

fi1 .•*nrr r>*nr<iK d xe3 C* Cltf 

.c c dine to their rrcnial cond tion 
Self upponed b> m own farm .nd gardens m v h-vh 
tterv laei ity fer UK.ocr and uidoor recreation F r 
rrn^rcctu elc applJ VIEOICaL SLPERINTLNDENT 


STRETTON HOUSE, 

Church St-etton Shropshire 

A private HOVtE for the ifeatm-nt of 
Gemlcmen ufrenr*j from Vtertal and Nenoux 
ll n*^s tn ludint the allied dj-orden of 
Akohe txm ard the D*AJit Habit All types of 
emly Men.al and Nersous cases arc rcccned 
wtihci t cenificajes as V oluotary Patients under 
tie rrosrtjorK of the VIcntal Treatment Act 
l9to Br.cict b 11 ccunify See Met/ raj 
Pie tcry p 2y S — Arr > to the vied cal Super 
mtendem ITjore 10 PO Chur h Strction 


NORTHUMBERLAND HOUSE, 

GREEN LANES FINSBURV PARK N4 
A PRIVATE HOSPITAL for the trcatnenlof mental and nervous illnesses Convenienllv 
situated and cn^tv of access from all parts Si\ acres of ground highlv situated facing 
Finsburv Park Voluntarv and Temporarv Patients received without certification 
Occupational Thcrapv Psvchothcrapv and other rrodern forms of treatment 

Telephone ST AMFORD HILL Tcicprar- SLBjIDJARV LONDON 

CcnTalcxcem Home KE.ARSNEV COURT DOVER- For further parunjlars arrJ) to the Mmlicai Sip 








2S 


THE BRITISH MEDICAL JOURNAI. 


Juu 10, I91S 


The MUNDESLEY SANATORIUM 


The centnl biitlchng nnkes 
the Miindesle\ Stnttoriuiii 
the best equipped building 
in Enghnd tor the cure ot 
Tuberculosis All the bed 
looms ln\c hot nnd cold 
uinniiig uatcr clcctiic light 
and wireless headphones The 
public rooms aie spacious 
ind comfort ibic 


RiMtknt Vli\\icitm\ 

S VCRC REXRSON 
MD (Cantab) MRCtMlond), 
C C WT NNC EDWARDS 
MB (Cant lb) ERCSd'din) 
CrOROCH DA^, 

M D (C intah ) 


f or ill informTijoM *ipp!> 
llK StCKtUV 

THE SANATOniUM, MUNDESLEY 
NORFOLK 

liliphotti i\hf/ult \h \ 94 (///(/ 9^ 
(2 hncs\ 


s 

) 

Ihc buildings face SSW I 

and arc sheltered from the j 

sc t b\ 1 pine clad ndcc i 

T he sunshine record md dr\ ( 

iir complete a perfect site f 

T he medical equipment is of | 

the l.atcst kind and there is S 

1 dat ind night nursing \ 

St ill ) 


lEKMS rUOM 7i GL1M1VS \1EEKIT 


THE CORNISH RIVIERA SANATORIUM 

KOSDiniT rnN/ANCD 

For the (icntmciit of pnfionis siifTering from tiihereiilosis 

The Sanatorium stands in its own grounds of 11 acres of garden liwn and woodland and is well sheltered from cold winJ^ 
The Climate is mild in wintci cool in summer Artificiil pnciimoihoras and other modern forms of treatment arc ainhbk 
Das and night nursing staff Electric light Wiieless in all looms 

Medical Supt rrnncis Chossn M B Lend DPH Consulting Plnsician (htc \Icd Supt) Cornwall Counts Sanatciriimi 
Terms “i to 7 guineas ssecKls 'I’lioiu rinzniue 'iOS 


THE COTSWOLD SANATORIUM 

Eiist opened in 1898 and icbuilt in I92s On Ihc Cotsssold Hills scscn miles fiom Cheltenham for the treitnicnt of Piilnionin 
and all othci forms ol [uberculosis Aspect SSM sheltered Irom North md Cast cics ilion 800 feet Pure bnems air 
Specml Trcrlment b> Aitificial PuciimoUiorav (\ ras controlled) Tnbertnlms and Elirn-slolet Knss arc isailiblc sshen 
necessary without cMra charge N-ris plant Etills equipped Den! li Depirtment Eleelne light Radi ilors, hot and coM 
basins and Wireless in all looms Up to due mun diimigc 

full thN md niRhl Nursinj, SntT Term " pn*- n» "3 pn n v.rfk intlu Ur 

Mfrt Stipt GJOrJ UC^ A noUMNN 11 \ MU I C Dub T/im M NRC NRM \ UVRRISOS Mil II S 1 mHi f uhotoriU n)G\K> 

DN\E\ MO OCh CofiKult Uinttcoio^iu C^SS^D^ DC W CilBB THCSldm Cvnutliitti: Drum' Siuc (»rOR(.! \ SMNDCUS LOi 

U C S LonU \ppK Hu C n luilU Suukuium Cnnlum GUnuiMvr 7 / si uui s. WjmiMiu llonvuv 



HiU rtMv* f Ihtlr j ill»l fn iiiinti (n tiuUtU I 
tfitc f iUth luikl )> lilt) III in) III \K nil I 
\ tolls b mlr Ml )1 nilirrr* lititnifiit '•tinli 

Ihur Ik'ciiK III liIliH n f r Uitli nn) Unr 

MNU i] I iMs l»K Itiiihiit ilrnl infri ti t 

I i>,h( \rtifltli) Niiiibk.lit b VfN n«il ))lcli ms 

1*1 itherms bnuluim llilli 's- iilr I iiii lUih fk 
i uUiPl milk bum sMifnrm I nri XMnttit mltn 
t>rs nu I Njuxiil n i\i I >n r >r Im iHil Mvl t Mli n<l 
lit Osit iX) lii(ii('il 'III nnJ ItJiTlt. NiU'sf 
'1 » purs \ttcmlnni cii 

Terms IV to 18/6 per ih> inclusive boird 
lllustntcd Brocliurc M J on request 
RiStdent Pinslaans 
G C R NOON ' - -'r' 

(R U I ) ' > C M 

Phone A Marhck 


MONTANA HALL, Montana, Switzeiland 

OPCN \LL IHL \C^R 

THE O^L^ S\N\TOKIUM IN SWHZbRLXND UNDER BRUISH OWNLHSHIR 
\ND CONTROL AND WITH \ AND NIGHl M \l T 0\ BRUISH Ul MNLD 

NURSING SISTLUS 

INCLUSIVE TERMS— from 7 kuincTA (Ntcrhni.) per wttk 


Mtd SiJpr HILXRV ROCHC MDlMtlb) MRCIMLond) ItibircuUnis Din U»p(\\ lie's) 


PRIVATE NERVOUS AND 
MENTAL PATIENTS 


LONDON COUNTS COUNCIL Atcommod ) 
b m for Mite piiitnis sulTcnnk from Nenouv md 
irttnul Otbordcr (lokiniarj tcmponr^ or ccrtiticd) 

» proMded m tlK prmte section of CLAVBURA 
HOSPll \L Woodford Bridce Esst.v Terms 
txvlusot of cloihinc inU spvcn! luxuries 49 n 
iiicck for London tiscs I t week for others 
Tk'r pmitubrs ipplj to the MtUicnl SupcnnicnJem 
At tiu Hospinl or to the Chief OtlKtr Mvntil 
rU^PUiI Depiumcnt Shell Mex House Stnnd 


SPRINGFIELD HOUSE 

Neai BlEDrORD (’Plione 3417 ) 

I or Mcnint Disorder xiith or > Ithnnt CrrlHic’iicn 
Resident rii'Mcnn CLDIUC \V BOWER 
Onllnjr) Itrius FHt Culnenn per % erk 
(Including Stptntc Bedrooms where suinble ) 
Inlerxicws in London b> \ppomtmcm 

CIT^ 01 LONDON MINTVL IIOSPH U 
DVnilORD, MM 

Lxdics nnd Ocntkmcn received for trcitmcnt 
under ccctificucs 'ind without cerbhCTtlon ns 
either \OLUN1 Ain orlLMrORAin PAT 11 N 1 S 
ni a wtekh let of TWO CUINCVS nnd upwirUs 


THE MAUDSLEY HOSPITAL, 

D1 NM\BK inn " 

Tclerhenc RODnev ^S4I 

/f CllMC imniuted tn the Loft<hn Ci 

Coumtl for uralment o! Arruin oU Cn-^f 

Mental Pitorder I oHtmart paiienii tnrufJ 
New Out p Dients — Mfs Mond vs 
di>x 2 pm WoMis lue'sd'ijs md Dwjw 
2 P ni CmiDRis Mond*>i nnd I rid')' 

In pTbcntx (n> bcd> tloih xexe'x) In 
scpiritc ro *ms jneludins beds m i vurJ p 
Kirks Cexllese llospHTl which in 
teniror'D nnnexe of the M'ludsk) Hommi n 
peeiY) vvvrd imcluUmK some pdvitc 


those pTbems of cich sex who 'irt pt'n 


eost md 'irt otherwise suitiMt 
week but in CTxt of Psilums wiih t w 

in the Countj of London \ Rss sum tin* ht ciim 
neeordinv to meins ^ 

Terms include (with rift cweplansiau 
vd tredniLm for whieh there ire 
licilnles nx there is n stdT of CowsuRmt SiNv 
nnd the Centnl Libor uorv of A' 

MciUil Hospinls is iHiehext 
liunnries ol Fowikd Mviothir MD ‘ 

I R (2 S Medic il Superintendent 


1HL 

HOTEL GREAT CENTRAL 

Mars lebono Eoad, N )' I 

rhe Hotel Gieit Central ts wi;i|'Uhd 
minutes walk ol the I ondon Clmte 
Hulcs Sheet 

Special let ms for friends \isiline N 
Homes in sieliiits 
\pp U Managci Telephone PuW 

PiclimiiKU j EsJUiunalioii'’ 

I„e cdiLftL or“^rt'ioits IIJWJ,;::;, 
Im imry rsimimllon, for , Ccnn > 

simlLiils in Lmulon iml ‘/‘lU’cmi cr I', 

in Msrch June Svinsnibcr nnd 

Itcsnl Iiions innll lo ll's W C I 

I’r.nninn, Hkoimtniii Sqn itc London 




s 


TTic Spa» and 1 Irnllh Rr.ort^ of Oocho loMiVn \ lOi thnr ccnlunc cM tr-idilion of hnlinq mntorcrd b> the 
rxpcncncr and rr -archr^ of local xprcinlista inxilc >our onoux conxidrrnlion 
In addition to pficrs of x orld xxidc repute ruch ns 


PIbTANY 

(Pitstany) 

ST dOACHIMSTHAU 

(J^cliymov) 


CARLSBAD 

(Karlovy Vary) 

TEPLICE-SANOV 

(Tcpllti Schonnii) 


marienbad franzensbad 

(flarianshe Larne) (Frantisbovy Larne) 

LUHACOVICE SLIAC TRENCIANSKE-TEPLICE 


xxith their medicinal spriiit.s and mud bath* there are numerous sm dier spas and health resorts ndmirablx 
ertuipped for the treatment of manx diseases includint, those in the folloxxine j roups 

Anaemia and Chlorosis nssedoxr s Disease Bronchial Catarrh Constitutional Diseases 
Scrofula Rickets Direitixe Diseases Diseases of the Bladder and Urinary Oriians 
Diseases of the kidneys Diseases of the Nose and Throat Diseases of Women 
Disorders of Bones Muscles Leucaemia Nerxous Diseases 


itnd Joints Disorders of the 
Heirt. Disorders of Metn 
holism and Gout Gallstones 
The armreenents in the bitS e«t*hl: hmenti 
T/e liplodile in e\ery \ ihe elemlnr^i 
ard neitness proxerbnl the lemce 
?nd courteou 

II I accepted ih t a spi cure to be fulU here 
ficia) hculd proMde a ccmplele chmje of 
surround n»*s and a hre'>t \ ilh the patient s 
norm’ll e>er>d3> life 

Fttrlhef wfermahen frem cni e^'ce cf 

THOS COOK Sc SON, LTD 

and cthff tending Tc irtil Aficnocu 



Leucftemi') Nersous Diseases 
•\nd Post Hcmipleric Condi 
hons Tuberculosis of the 
Lunrs 

The Creclici Ir \ k bj rs fu fi! iFrs i'orp>‘e 
a»lr)jr>bl} crrrfrrfabJe hrt Is hrs! 

cl orchestras srd dance hrnds eserv 

f'^cilil} for port— lennrs <lf s' rmmine 
ndine fishing etc. 

71) ere 're aljo numerojs fulij up to drte hemes 
for ccn\ilecrnce arid ret cures 

snd At 

CZECHOSLOVAK TOURIST 
rNPORMATION OFFICES 
m London 21 Resent Strtel S V/ 1 - 


DOCTORS OWN SPA fok 

RHEUMATISM 


nwc rom Fjn 7 n paou reser er heme use S mptes; ssleit. 
rtf r->e»t ec^nom cal treatment may be enerLstetf to jnr pat ent 
Cost “Os cr"t5 treatr-ents. t. teratur^ on request. 

PISTANY AGENCY LTD.. 10 Pep nt St eet Lontfo V/ 1 Tef (A 



VOLCANIC- SULPHURIC 
frlUD SPRINGS 
in dctishtful surroundings 

2 B DAYS 

INCLUSIVE CURE 
Special facilities for doctors 
and their vvives 
St 6-vtJ Class Fare w m SIftce 
£1 18 0 retu n. 


PISTANY SPA BUREAU 25 Ccev* 


About the Harrogate CURE 


Harrogate tpcctiaijes in the Treatnicni of -Disorders of 
the Li\ cr— COT"ts I n cirrhosis jaundice chc cc>''ti is 
chc 'eltihiasis, and ircpi al Juer Also n Disc s^s of -tb“ 
Sljnjl^creraa p niu is the ccs.cal in^’cction of the sVn 
etc Th Chrc’'i Rhccm ti D scas-s—^rthnjs Fi^rp n»« 
Neuniis Gc^i H'T* rpiesu Mu ous Cchus Turcu n J 
D so dets cf ihe He ri Pelri Disorders cf Women 
Ct sal-scen'e from acute 1 Iress 

A tvide rar^c Su phur and Iren waters is a'ai!ab*e 
f r de^ i g m h th If" group o*" disorders ar^enable 
to Spi treatment Pres-^ib d di is to Spa patient 
can be cblained at hotels and boarding houses with jt 
extra ch rpe CompUmentars and reduced price 
facilities for the Cure AccornmoUalion and Amuse 


menis ore asallable for Members of ihe Medical 
Pro^e^slon 

I ull d ui’s < H-rr pjie for Cure a''d H hdj> wll b 
ent tree upon .''pli a i n t Spa Marugej In^ rmauoa 
Bu e u Harrogate 1 ^State i*" 3 ircd:,jl enquiry) 


IT’S QUICKER BY R\IL’* 

Cffaf rr tiuTit n left tp reyef / cm all u^ticni 

A n rreM'* ary day 


THE CLIIVIC 

20 Dcionsliirc Place 
Londnn, IV I 

Td n db'-r! U-14 {20 Imes) 


A MJRSING HOSIE FOR SLRGIC\L iMCDICVL 
Ai>D UATERMTt C4SES ^ 


Fees 10 pns to 18 jms per St- c R-rsie ed Nu-'es 

kcek I'-^ve.-ap- — 14 ims -Resider Medical Oncers 

8 Operating Theatres do ert igeraes) E" j 

Patient erd' recened under the supcMsion their own j J ft 
Med cal Pracutioncr v t_ 

DrLcsan-Dressingrsfreefo herlh-nPrepncu^ Art- Ir*'' 

Illu tra ed Brochure on appLcaticn to Secretar> 


fr h 

fj" ' 




30 


THC BRITISH MEDICAL JOURNAL 


JuL\ 30 I9’i( 


UrdBVERSSTY OF LONDON 

BRITISH POSTGRADUATE MEDICAL SCHOOL mn or p™ra, 

DIPLOMA IN CLINICAL PATHOLOGY 

A COURSE OF STUDY in the ncidcmic \CTr 19SS 9 «ill be held for this Diplonn commencing on October Vd 19.S 

The Course will occiips twelve cilendnr months The subjects cmbrnccd will be — 

HAEMATOLOGY AND CLINICAL PATIlOI OG^ B ACT LRIOLOG’l 

PATHOLOGICAL CHEMISTRY MORBID ANATOiND AND HISTOLOGY 

The Course will commence with Hienntologv ■ind Clinic il Piihologv which will occupv nbout si\ weeks ^nd will L 
followed bv the Course in Pathologicil Chemistrv which will occupv iboiit the s imi. time The Courses in BnctcriolOr,v and 
Morbid Anatomv and Histologv wiB run concurrenth tnd occupv about si\ months Tor the hst three months of tbeCour' 
Students will be occupied in the practice of routine "ork in the liboialoriL of the Departn ent and in revision work Tti 
number of places in the Course is limited and students will be selected shortlv before the Course is due to commence 

Fee fortv guineas 

In addition to the full Couisc it will probabh be possible to enrol i limited number of students for the subjeclv of 
Pathological Chemistrv and Clinical Pathologv and Hacmatologv, scpiratclv the Course in each subject lasting about siv 
weeks Fee foi cither Course nine guineas 

Further particulars mav be obtained fiom the Dean British Poslgr idiialc Medical School Ducanc Road Shepherd s BupIi 
L ondon W 12 








Jl L^ 0 l'> S 


THC BRITISH MLDICAL JOURN'AL 


51 



\rc \oii jirtpirni^ fur im 

MiDicvu srur.icM^ or 
ni'M VL I \ \'\H> \TION 


Said Coupon hclon for 
ciir valuable piiblicalicn 

“ Guide I 

to Medical 
Examinations ” i 

rKiscir^L coNrrvzs ' 

The Kxaminallon of tlic Conjoint \ 

Board i 

The ’ST Jl and M B llcRrees of all ‘ 

British T. ni\erNitiCN J 

lion to pa>s the m C S Exam 
The M-S Lond and other llipher 
Surjjlral Examinations ' 

The ’SLK CJ* 

The T) P II and hon to obtain It 
The Diploma in Tropical 'Mcdiolne 
Tlie Diploma In Ps^choU»;:ical Modi 
cine I 

The Diploma in Ophthalmoloy^ i 

The Diploma In I^r>nsolojr\ 

The Masteia of Mldnlfen { 

Do not fill to get a cop\ of this Hook j 

before commcncini. preparation for 
an\ taaminalion It contain<« a large 
amount of Naluablc information j 

Dental ENaminations in special dental 
guide 

Semi ftir >oiir cop\ now * 


rtiF s< »ijr 

CORREhl ONDENCL 
COLDTCE. ■ 

19 T\ elbeck Street Caaendish Sfjimre 
London W 1 

Sr— rroir* rrd nr j ccp cf rc/ CuiJr 
tc \l d cul lL\e n n tf n t'x refu n 

Nc -p 

A eu ^ 

Eicm nc an in ") 
f' nrr r\tfd ^ 


DirLO^L\ IN Pmuc HEAITII 

Tile Royal Insbtule of Public 
Health and Hygiene 

The Ccone of Imtaictjon can be commeiKcd 
«t »ny lane Special ^ro\^ on o made for 
I udems «bo can ttve only pan time to the 
i*crlL 

A pto?re«t« and funher panicular? can be 
cbtatred Item the Secretary 

TeJcrhoce Larrhara 2731 / 2 . 

S PcnlarKl Pb'x LorwJon N\ 1 


RITISH POSTCRADLATE MEDICAL 
' SCHOOL 


UNIVERSITY 

EXAMINATION 

POSTAL 

INSTITUTION 

17 RID I IDN lOMION \\ C 1 

I M snit> ts I s 

t> t V \\i\ t t III M Nfltrsl) 

V\C\1I0N CL\ShES 
Hill 111 Ik 1(1 (lining Aii^ii-'l 
f«>r I't Coiijoiiil iml 2ii(l 
iM R II S I Klltlotl ( \ IIIMII I- 

iKItl- 

WTXKLY CL^bhES 

for rill il ( <>iij<iiiil ini] I'm il 
AI B B S I oiidim ( \ mu i- 
tKiii" cmiiiiK iici Hill 

Full p^rtlculars of these cli^'es can 
he obtained from the Principal 

MI me M IHO^HFCTIS (47 pp ) 

COSTFSTS The rrcibc^ ..nO ihc < »'i < f eoiet 
IOC the Mo* jl Pf ■>fr‘ n ta t a In i t c f 
Ifrc, <-tff la ra cr P •'lal C« ofvo nd Oral 
Cf CA S rt-'flom ftr the Hir*^cT ^!ed -al 
l\7ininjii Surtr>nor^ for the 11 thrr Sir 

r 1 L» m n-it n Suree^it n for the S~'^i4l 
1) •I ma raarrifutt. \ Kefroher Coii'c* Oi-cn 
in“v ( t Wcfpcn H nta f r '‘f i ne ihcMr\ 

Meu -al If^^pcctm trat ^ ir- with I t of 
litin etc on arrl cat n to ihc I nncipal 
I” ReJ 1 It n Sq Lo»u.on M Cl liccrhonc 
M< S n » 


LONDON HOSPITAL 
MEDICAL COLLEGE AND 
DENTAL SCHOOL 

nil TtiNTfit ^,n p,„ „„ mom)v> 

ocroitfJt 3 ii 


Ihc Lond n Hi><ril 4 il cr>cs the LaM hn^, f 

{ Lind n iind iMih cirht hundred and ninct> bed is 
j ihc larccM Mluntary Ho^rital in Enc ar<J The 
fit t fviDcnt Dcpirifncnt wh ch deals »»ith a hurdf'-il 
j ih usand nc*" raticnts per annum rs exten c 
, u ed f r teachinc 

Ihc i/c of the ne'e tal nccc'^ itairs a lartc 

' number of rc'ii-cnt met! "at cfTcers L er> >c r 

J esents rev dent house rhj'snarw and ho c 
I rre r and ci hi> sj! ned rt n rev dent iir< 1 

ti i 1 nis arc arr< nicsl from amonj; rc cm > q< i 
' bed indents The op*‘v rtuniiics ishch the c 
arr< nimcnts ifTcr ft r s bt tn rjr clmic-l cxrcricr' c 
arc in aliiah c 

TTic Med -al Ct cre ts ana bed to the H -r ^-1 

and I tafTcd bx f f 'cv ors cf Anaiom> Foi i 

r> Baicnt try Chem cal Paihiloyy M rh d 
Anatimy rd Mcdi me of the Lnsci ity of 
Ll ndi i 

Spes I Coui cx in Arutt'my and Ph ( >r> t r 
Ihc I nmary f R C S and ad ar cd cour c> m 
S irterr f r the P mal f R C S Esamiruiit n and in 
1 Mrd ne for the M D and VI R C P Ex*rn r— 
j t t n -fc he d tisKC a year 

Lrirani.c S».holjr hips and pnres tf the tit I 
sal c <f arc awarded annaafly Reve r h 

Tuntj to the aiuc of £ 11 * COO perm t of nt 
anvc be rc * cn ir tt denis and £r..duaics enrret- 
tn med al rc'^arch 

The Met. -al Col cre contains a modern Mem 

0 P tho'ety arv 3 a Library p osidcd with all the 
current medical periodicals m charge of a full t me 

1 hranan There ts a! o an Athcnaci.rt Club and 
Dirinr Hall a Gymna mm a Fiscs Ctun and mo 
So 1 - b C Hjns tn the S tdents Hostel The Athlei 
Ground of II acre* at Ha e End is wiihtn ca > 
dr ance of the Hospital 

The Hospital ts only 0 minutes from Ch nrg 
Cro< and Baker Street Statu r> For thewc who 
HI h to lisc ir irrmediaic rroa mty to the U'spitd) 
there t av rnnodation f r s ir> tudents i" the 
S udemt Hov el 

Funher detail* r~ y be obtained from the Dean 
Dr A E rUfi Kennedy V! D FRCP 
Phy I u.n lo the Hospital and FcKo* of Corpu 
Cbroti C Here Cambridge who is alw y* p e '^d 
ti meet sti dent wihine to ee th Hosptal .inJ 
Col etc and ii whon *rr! 'ation ftr «dm n 
hoLlJ be made 

Turner Street Linu n Ll 


C OVCHISG rtRS(»S\LLT OR fi\ POST FOR 
fn 1 irti at ex n rations Fees rr ^.eraic 
— Addre-s So B Vt \ Hcioe T ifs.L 

Sju rc U C 1 


JyjLM 7 EALASO COV I RSMENT 

App Kation ate in utd ft m rcr rcred and 
Qualifed nedi-al rrco Ur appi mment lo the 
Vfenial Hospul Scr ice Salaric Ji nicr A is- 
lant Vfedtcal tJPi C's 1 t year 161 * nd year 
£nss fd year C*!' Sen < r A am Vfcdical 

Of ers Isx ytrr £ t' nd year I'-l ird year 
£• 0(11 pfirs an ..ll-iwance of £^0 if appointed 

Deputy Vfed cal % penn cn ent Med cal Super 
irien^cr s £l OO In acu ti n to salary quarter 
fucL and light are provided nd aic CNU-iatcd f r 
sup^rannii tt n rjrr 'se\ at £ 1*0 p-cr ann im vicdi 
Cal Ofneer* eon nbuie to the Supeiannuation 1 und 
Commencing salancs in ih imtan c svi I be octer 
min'd by qual ficaiiorts ..nJ prexicu expcricn e 
Appointees will rpeo c fr t-s.lt pa sarc u Sexv 
Zealand and hxlf salary from date of tmb-rVa 
Uon 

Application tt ing full particul rs res rdmg 
career and Qualibcau accemp rued by opio 
of icsliriona » xhculd rca h ibe High C nrmrs- 
lon r for Sew Zeal nd < 1 * Strand Lend n 
W not later than Aujru t ih HH** Ctn«i- 
dalps must supply their foil it-mes age ird 
lUtiorul ty and state whclhcr they arc married or 
ingle 


JJNIVERSITY OF BRISTOL 
DEPARTMENT OF PRE\ ENT 1 \ E MEDICINE 


THF KIRK DLNCANSON FELLOW SHIP 
FOR MEDIC \L RESEVRCH 


Ihc Ctun ll of ihc Royal Color of Phv n 
tf Ed nburgh will htnly a ard a rcni\i’p n 
the cand date who in the c^ir on f the Co i 1 t 
devenmg if the Fellow hip and wh-> furn hes 
s-lrsLcTory esid Hn* i f h s ability f r rcsea h The 
Fell will he required to devote hs v ht time 
to the tcnarrol the Fellow hip nJ hall rr> xvj h 
o i the consent of the C n il hold an o her 
Fellow hi"* Scho arship cr Fxhibi ion cr hod ..nv 
1 paid aprontrrent r unden ke ny rcmuncmii c 
work 

The value of the Fellow hip for the Hr t year will 
be £300 The Coun ! may rerew ihc tenure of the 
Fellow hp fir a cv.onJ or ut>equcnt >c r r 
years at in rca cd emolument 

Applicat or^ mu l b^ lodged with the Scuretarr 
Ro ai College of Phv ician Edmbur h not later 
than August Oih 193 ^ 

July tlh 19*9 



COACHING 


Bv VI D 

vfRCP FRCS in 

Stirgcrv 

and F*atholory for Con o ni VI B or 


Clas es or indi iduaity 

Addre-s 

No -6 6 

B VI A House Ta rstock 

Square 

\\ C 1 or 

Phone (momingsl K.EN 

^ 4*0 


App cations are invited from fu ly qualified 
ircdnral practmoners for the post of CASUALTY 
OFFICER to commence duty at the becmmnr 
vf Sep ember 19 *S 

The n meni is for six mv nih and norv 

residcm Salary i at the rate of £ 1*0 per 
annum and the post is special') uiicd to earidi- 
dates tudyiRg for higher quahn-ations 

Apr caners accompanied by copies of two 
imt mofxalx should be addres ed to ihc Dean 
Bfifsh Postgradjate Vfedtcal School Due- ne Road 
Shepberd » Binh London W I tc am e not 
later than the fit t poy on Tuesday Au ust 5 hh 
19*? 


amesded 

Applications are inviieU for a SENIOR 
BACTERIOLOGIST Salary £“00 to £?00 per 
annum according to qualihcatioRs and expericT'-e 
Appointment to date fremi Octvter Isi 19 *S 
Candidates must be fully qualifed and reg vtcred 
and have had considerable cxpericn c in a 
recogntred Pathology depanment 

Applications hould reach the undersigrcd from 
whom further particulars rray be -obtaired on cr 
before August * 0 th 1938 

\MNIFRED SFfAPLAVD 

Secretary jnd Regsir&r 


J^OT AL 


BERKSHIRE- HOSPITAL 
Readme f 3 8 Bed ] 


ASSISTANT RADIOLOGIST requir'd for fuB 
lirrc dut S«'ary £hO(V£ PO p a accordin' to 
qualifoiti n Candiualcs muvi be fully qua ified 
Vfcdical Pm titioners and have had Hospital ex 
penersce in Radio orv and Deep Therapy and 
p<»Ave the D M R E qu-Ufication 
Arpi-aiions together with not less than three 
copiev of leviin* r a s to be sent to the uod r 
signed on cr bef rc Ai gust *Pih 19*8 
H F R^AN 

Sccrciary ^nd Hoi c Cevernrr 





(/ 


( V 
, ,<(( 

, I 


( «'< 


> ^ 


( !>' 


I ll 


, V' 1 '' 

' .1 ’ 

o« I n 1 » 


3ULN 30 19 3S^y 

,_Af journal____^ — 

— ...riiPOHT I (J .riiirM OFFlCtR OF llEAUll 

Applic-vllon'i nrc °ot fhc'^aSc appomi 


I I 




it 


t 


^t 

<1 


■JS^SSSS" 


Ot 


,(,I Vl^ SoiUhr"” 1 Applic-v'lon-i nrc '"jor , he above appomv 

, .H- c.>»'’'> "‘''7 ncpriiv rcnl'lctcO pn«csr a n.ploma la 

^ 4 u! ‘ ^ r ihc P<’'* * ll I nfliccr \ IfJnt three vean cTpcti*^c 

‘,ppll a'l;"' 'j Vhool n^plpn'-' "I 1 rnWic Ilcil"' T'd ’’’"'^ph ^ ,?ccn\ ctpcnence in 

.rr.r., will be nub ,°,"'i,,h” 


s> 


..r ' '■"'’tcSi 

I ^ ^ . MH. i< 

',.• ", l b V i in 

.' ■ , : l.i'b ' , 

' ! f th'^" *‘'5, 1 'P 

., ;;,'A " T' 

>T? iribuli- ; 

wm 'b- ,'f;''',he c 1 U’u’n;' ,„ 1 nil lUbv illo^' , ^ 

^'vp'r; ’"r. r ."erci'vcn 

•:';,„itie.b- ..rNH:„.,"‘rCe'..n.l coiinnlt 

„;.roi«n,ri>ni 
CUn'i'y" 

MV:'nn .93S 


''(‘'V.o W"""""' "ill - niiblcc, ro «''r« will 

• 'V. 'nriiminicn. 


rue ,1 inetcmcn-’ >■• - i pannipml qinb'u^a 

:=^HE= in': —as-^is flls^ 

ihc'^'wliPlc “U '”,nc,\'"’?o 'live in ihe Borousli fl 
r !o cil^« 'in,^br-.c„rrncb« „„„ „ „ 

r.pvcrnmcni anil O'b" „nd.ilate ^ 

\<-t c\am»nation 

''rptn-nrMabn«^;;«^,^^^^^^ 
picncni abb‘"^";"'",cccnt ' 1 ”!"'“™ ^cr Una ,» 
copies iinJcrstRPC^ 1Q18 

"jlcahh « -lonhcation 


person •xpi’^* 

'H'K2:=>£S;5-»;£:sr 
SsErrsirissr.s 


icf'vnnoauiM. — . ticsimciu » 

,t^c dbt.noM«i ,cfr icUon sv 

,,ir.i7>f f 'asoiS'fSsnS; 

^s?’«£s 

S'%:S-3i:n2“» 

si::«.,SK.rAffC 

Town I'aii 
Souibpo'i „ 
jul) ;5ih IBIS 


cniiniei 

isoL\-no^°^''^^^ ^^(sidcnt 

iPPOisr ^ Ae '- o ^-^ 

AU«us« " '-r-NVVN 

cm Hb'' 

„if;* iBrs 


tempo'^'^'^' orFictib 

,nvncd from »f„'’'" 3 ‘'penorot 
Appl>ca>'°''^„J' .he above poai f 
ractipoo^*^* -niicants 

iK months given to m School 

Vrefctcncc >v>n J;*; ^ more cspcciany^^^^^ 

lad previous o*P Intani Experience 

?r.i.ra, Inspeeiioriv amcsthelies „vaminalion 


nre iH^^cd «-b-« AmM-* 

Applisalions »«p, ,he post 

telriciion ''0'|- per •'nmuu t 5^^ There 

Tbc .as ,o •< >”.’"eTn tot uavclli 


telriciion ''0'|- ^^pp pet •'nm«^ ' , j'-jp There 
^is it II' <“ •> "V'cTo for itavcllini: cv 

increments 01 ol £10 to 

ssr 

Eduevtion OfTiecs 

'’'ist’mebes''' 3 

July Sill >B3S 


July 

^ r ti or di:kb\ 

pFSlDENTblED'C'''' O' 

ASSlSrANP UESIDLN 

^fc invitcU lor ohosc 

Applieat'om ' omci.t '^Ji’^ipspnal provides 

Kss "" 

suri«y - tor a period o' 


desirable Tbe Welfare and W , „ 

MedUil "o l- Vo opportunities for espv 
«inil there 2!'- ueiUh none hv 

general f^OO per annuni 

IhC £2S to rm'“e"Vrt 

increments ot tct to nthcers Surh 

appointment and Other OBi«a^„j,ji« 

ihe Local Government VS^«tniM'"\ 

anntiation Act a medteal 

will be tvQUirv^d "j. Panties a"? *'^rti a('''’'"''iT 
particulatTs c*t _ «t tov-Cthef _ Gviiotrt^ 

X °hlun viral 

decent 'e'>>"’'’"‘,“'ue„«'’l5ib ^ divnu’"''”'' ” 

"’■b^inSm any 'o-m^YAND BOOTH^,,, 

Ti-vvvn Hall 


Town Hall 

Dcvvsburv 
July 26lh IB'S 


dicM ‘f cencral a"'*'’";; the cxsminauL.** 

,t br»mo| --Tbe^’Vr of no >0s 

Ilemuncration ohtaincd from the 

^roTmtof -P''"vrm"’" P'^^d"^ ^^^^I'porSy 

""" 

:um.r.'.b R r PB"Bt^„Vvn Clerl. 

Guildhall lovvii 

Shrewsbury 

July I'lb 


Candid itcs pionihv 

Thi’^ nPPP'"*™V"V ' ol'^ervnmvimj Pjpp'Vpihram 

r.=£,ss, - e. 7£ i-- » » -- 

;s»““rt ... .1 “» - — ” : 

"^ L “ em . pptBe ^ eeem ^ e ^^^^^^^ 

1iS?SSn,S«rW.b 

1 Derwent bucv.» _ 

Derby — — 


COUNTT 

^-' coumyorrr . tS ' f - 

exboNt, 40 yctrs ot jia J 

uonett. '{BO" in rublic JJ' „ai Publiv "' 
possess Dipiom pmics ocii Draim'V,hn 

vious evper eri Water Supr.. o.-nlws 

Wotl. Homms _ . .. 


Mous experience 

'w^t. Hoiisins 


;r Gcrieral n-'-, la 
Mous eaperieiivs S,”K?Siiprhv5 "“oa 

Work Hon5>mB nnd m*. , Supet^^at'^^ 

Rcuous Disenscs roo^„„„ „ncler 

S-;r!v''r.-;.rMn«s 
“S’C'S' 

July 23td 1938 


,1 M T Y COUNCIL 

,„OE°T5ru»TV, OENCSAV 

.....“SV''!--.*' 

RESlDENfTrSlSTANT MEDICAL 

inyale oTlT.i'v'el J'?, ‘S'n 

ihr'^rpirntmem wbieb n^v 

TP ‘ re ° “ PP'iio ' a ^ pomm'im m4 

n RP",:™' “irhom Teaching HospUalS y_, 

S^iriJin^i ^Vuun^-or la.er .ban 

''‘'S'V.ci:ial‘’V.rec. 

Chc^itcr 


junior MED.C^i J 0 „y equipped 

"""‘^'.wial Bitmmeham Ihe ,PPr,p,t instance 

Oik Hospim "’°""’s m tt jot a 

'f^SS’-srSS'l 

2U 1938 ^ ^ NV'DTSHlf^,„, 

The Council House 

Birmmsham JUiy 


. , roR® 

S A L > 

pt 1 T Y — TTcus IfOSPlTAE 

IN rECTlOUS D'jjS j,;p5 ) lUhlOR 

the post e'oNlCtS 

r’ee and laundry oh.a.neS 

:W?sSSiwsS» 

SfbBn^Ausu? f jj'^T^OMSON Town CU 



•(3 


Jll\ '0 10 '3 THC BRITISH MEDICAL JOURN \L 


ROYAL NAVAL MEDICAL SERVICL 

Vncnncics exist for Mcdicnl Officers in the Ro)nl Nnty ind applicitions are invited for entry 
in September, 193S 

t Candidates below the age of 2S jears are preferred, and they must be registered under the 
Medical Acts No axamination in professional subjects will be held but candidates will be 
required to attend for inters lew b) a Selection Board 

Selected candidates will be entered for Sen ice for a period of three years, which if desired is 
usualN axtended to fisc scars at the discretion of the Admiralty 

At the end of three years’ sersice, officers mas retire wath a gratuity of £400, but those who 
serse for fisc years will rcccisc £1 000 

At the end of fi\ c y cars’ Short Scrsacc, permanent commissions sv ill be gis en to selected officers 
who wash to make the Nasal Medical Sen icc their permanent career Officers transferred to the 
permanent list will rcccisc a gratuity of £1,000 (less Income Tax) 

Full opportunities axist for transfer to the permanent list and periods of unemployed or half 
pay are s ery rare The assistance of pris ate income is not necessary for the purpose of supplementing 
official pas and allosiances 

Opportunities arc as ailablc for officers on die permanent list for post graduate study, to specialise 
to take higher examinations and to obtain further qualifications 

Nasal nlcdical Officers arc included in the Scheme for Marriage Allosvancc under the same 
conditions as for other Naval Officers 

Copies of the regulations for entry and conditions of sersice, including rates of pay, allosvances 
and retired pay, may be obtained from the Medical Director General of the Nas^, Admiralty, S W 1, 
and from the Deans of all Medical Schools 

Applications for entry from intending candidates must be received not later than 
31st August, 193S 



Appoinlmenls foi Medical OJJjccn 
III I he HOYIL AW FOBCE 


Mtilanl men in iiiMliil to tpplx foi iii tin ]{ov il \n lout 

CoiulidiU'* mu ( 1)« n ,.1 Und und< r the M< clu il uu! he iioi inoit lli'iit 31 m 

of i_i on eiur\ 

I lie pci lod of MMiti I'* ^ \c in>— < \lendihh to 3 \e irv \ of V^00 oi 000 

!■* pii d)Ie It the t< I null moil of i oi ~y ic^P«<iim!\ PirmiiRiiI i ornnii'^-ion- iir 

iM ird( d 111 1 niiiiilx I of i i 1 Ik '•( olfei i pi ii'^ion d)le iiiiii witii tin oppoi tiini(> of 

< \tri lent on full p i\ for -pe*ei ili-*id **tud\ Vpplu int-^ ulio Iiolil— oi in liLtU to Iioltl 
— po^t «! idii lie ippointnicntv m ti\il liO'^pil iK m i\ on jotnin^ tin Ron d \ir Foitc Ik. 
'‘et'onded until tin (e i iiiin itiuti of llitii ip|KMiiliiu nlv (foi i pi riotl not one 

\eTi) \n inttditi of eoiiinm- ion up to IwcIm nionilt'> i*. iI14)\\mI foi ipjioinlnienlv hold 
it ijipiovid ho'>pil iK 

Fuller information can be obtained from The Director 
of Medical Sen ices iir Ministry, Kingsiia^ London 




34 


THE BRITISH MEDICAL JOURNAl. 


JuL\ 30 1938 


ITY OF PORTSMOUTH 


SAINT MARY'S MUNICIPAL HOSPITAL 
(1 050 Beds) 


ApplJCitJOrts ore mvjicd for ibc 'ippomimcni of 
1 SENIOR ASSJSfANr RLSIDENT MEDIC \L 
OFTICCR for the M'lttrnuj Department of ibe 
ibovc Ho'JpJt'j! AnpbtTnlb must be smj.lc ficnilt 
men duJjr qualified and rcRisicrcd not exceeding, 
jO years and must have had nt least one >tar s 
experience m a Maternbj Hospital The Depart 
ment has at present 'sOD births per annum arul 
Ante-natal and Post natal Climes arc conducted m 
connexion therewith There is a Hcsidcni Medic il 
Superintendent at the Hospital and a Consultant 
Obstetrician attends rcRularL and is on call for 
cmergencits Die appointment is one of \aluc to 
a medical man sped lizine in obstetrics who dc 
sires to take the M M or M C O G Diplomas 
ihc appointment includes scrtict at am In 
stJtution bclonginR to the Citv Council that 
be required md will be limited to a term not 
cxcccdinR two years Salary for the brst year 
£150 and for the second £375 wuh residential 
emoluments valued at £125 per annum and the 
appointment will be miUcci to one months notice 
on either ide 

Application forms may be obtained from ihd 
must be returned to the Medic il OlVicer of He lUh 
The Guildhall Portsmouth not later than 
Thursdav August 18th 1918 
Cantassirtg either directly or Indirectly will be a 
dtsquaitncation 

The Guildhall T J SPARKS 

Porismouih Town Clerk 

July 22nd 191S 


QITY or PORTSMOUTH 

SAINT MARY S MUNICIPAL HOSPITAL 
I UOSO Bcdsl 


Applications arc invited for the appointment of 
a JUNIOR ASSISI AM RCSlDCNf MLDICM 
OrriCER Appliv.ams must be single gtntKmtn 
duly qualified «nd rLi.Mt.rvd not vxcvvding u 
years and must luw hid at Ivast one years expen 
cnee of hospiiil \ ork experience in anicsthctlcs 
will be an additional qualilitation The appoint 
ment IS limned to a term ol fnc war and the 
salary will be £*.5o per annum with tl idvntial 
cmolvimcnls valued n £12^ pet nnnum The 
appointment incUi lex scrvic it any institution be 
longing to the City Council nnd wUl be subjcvi 
to termination ly one momh s notiw on either 
side A resident Mvdicil Suncnntcndvnt ia in 
attend nice 

Applicition forms may be obtained from and 
must bL rcttirntd to the Mcdival OfTiLcr of Health 
The Guildhall Porjsmuuth not later than Dints 
day August llth ]9aN 

Canvassing either dire tlv or indirccUv will Ic 
deemed a disquatifiLaiion 
The Oiiildhill r J SPARKS 

Partsmouth Town Clerk 

July ISih 1918 


L 


ON DON 


COUNTY COUNCIL 


App’ications invited from Medical Praciiiioncrs of 
at least one years standing to undermcntionLd 
positions Experience in a resident appointment in 
a general hospital for at least six months dcsinbK 
Married quarters not ivailablc 

Queen Marv s, Hospital for Children Carshalton 
Surrey (I 2b4 beds) Dverc arc special dtparimcnts 
for rheumatic and orihopavdic conditions for con 
gcniiil mal/orm mom md for nutritional diseases 
ASSISTANT MEDICAL omCERS (Grade H) 
(two positions) Salarv £2^0 n vear together with 
board lodging md washing Appointment for one 
war only m first insiimcc (renewable for i second 
Star under certain eondiiions) 

Application forms obtainable (stamped addressed 
foolscap envelope iicecssary) from Medical OiTiccr 
of Health Staff Division 2A County Hall S C I 
returnable by Aucusi 15fh 
Canvassing disquiUhcs 


L 


ON D ON 


CeJUNT Y 


COUNCIL 


Medical Practitioner required with appropriate 
qualifications for appointment as ASSISTANT 
PATHOLOGIST at Central Histologic il Lahora 
lory Archway Hospital Archway Road N 19 
Salarv t(50 by £25 to £800 Experience in nwKbid 
histology and post mortem work essential 

Forms of application and further particulars 
(st imped addressed foolscap envelope nccessarv) 
from Medical Officer of Health (Staff Division 2a) 
County Hall Westminster Bridge S L I returnable 
b\ August list 
Canvassing disquahhcs 


ECKENHAM HOSPITAL 

Beckenham Kent 


Applications are invited for the post of HOUSE 
OrriCEU (male) Svlary at the rate of £1''0 per 
annum with board residence and laundrv 
Appointment tenable for six months stibicct to 
renewal 

Appheatuns siaung age quahficitions and ex 
pcnencc with copies of recent testimonials to be 
iddrcsscd to the Sccrciarv and to reach him not 
later than August 20th 


gTArrORDSHlRC COUNTS COUNCll 

NkORDSLC^ I untie ASSIST ANCr 
INSTITUTION 


RESIDENT ASSISTXNF MFDICAL omCCR 


Applications »tc Invited from rcRivtcrcd medical 
pnctuioncrs (mile) for the post of Awtetini 
Medical OITiCer (Resident) at Wordsley I iiblic 
Assistance Insimuion near Stourbridge 
Salarv £300 per mnum with board residence 
and laundry Candidates should be unmarried 
Die appomimcni will be in the firai instance 
for a period of six months hut the successful 
candidate wilt be cliRible (or reappointment for a 
further penou of six months nnd if the engage 
ment IS so extended four weeks wiU be granted for 
holidays 

The Institution »s in process of conversion into 
a Hospital and faciluits will be available for 
gainina experience in medicine surRcry midwifery 
and diseases of children There will also be 
excellent opporiimitics (or studyinR for hlRhcr 
qualification 

Furihcr dctuls may he obtained on application 
to the County Medical Offiecr of Health 

Applications siatmR age qualifications and 
experience wuh copies of testimonials should he 
sent to the under ixni.d not later than Diursday 
Aurim Mill 191R 

H L UNDEUW ODD 
Clerk of Ihc County Council 
County Bmldings Siaflord July 2f>th 191S 


^Ot^T^ no ROUGH or REVDING 
IIATTLL HOSrn \L 


\rPOIMMINI or UrSlDLNT ASSIST \NT 
MEDIC \L ornCER 


Applications itc mviied from rcti tered medical 
pr iciiiiontrv for the anpoimmeni of Resident 
Assistant Mcdie il Oflicer tm»K) at the ibove 
Ho pital at a sdary of £ (K) per annum wuh 
board residence cte Candidates must Ic single 
and should not he more than 0 vears of irc 
I lic Selected candidate will he required to work 
under the direction of the Medic il Supermicndenl 
The ippoinimtm (which will he dclcrminabK by 
one months notice on culver side) will be (or a 
period of one year and preference will be Riven 
to candidates who are readme for higher quah 
fie tion 

Forms of pplwaiion max be obtained from and 
must be Tcuirned duly completed to the under 
signed wuh voMes of three rewnt testimonial 
not later than Thursday 4(h proximo Cainasstng 
either directh or tttdireelly will di qualify 
Town Hall C S JOHNSON 

Readme - lown Clerk 

Jiilv 2.nd 19 S 


^OUNTT BOROUGH OF ROCIIDME 
PUBLIC HCSLTH DEPSRTMENT 

Die Health Commiitcc invuc applications from 
fuilv qualified rcgl tered Medical Practitioners 
tunmatried) for the appomimcni of JUNIOR UCSl 
DENT MEDICAL OFFICER (male) at the Birch 
HiU Hospital (4?s Deds — Mcdicil Siirgicil Child 
Ten and Maiernuv) 

The ippomtment includes certain services n! ihc 
adjoining Public Assistance Invtuiuion and will 
be for a period of six months m the first insi incc 
and for a further period of six months at the 
option of the Town Conned but wiH not be re 
new able thereafter 

Salarv at the rate of £22^ per annum together 
with board residence and laundry 

Apphcuions must be made on the prescribed 
form which may be obtained on ippheation to the 
Medical OflTiecr of Health ind returned addressed 
to him at the I ublie Health Ofliccs Baillic Street 
Rochdale uoi later than luesdav August 9th 
1938 

Town Hill HARR\ BANN 

Rochdale Town Clerk 

July 15th I9 jS 


C * O T LEEDS 

PUBLIC HEALTH DLPXRTMFNT 


Sr MART S INFIRMART 
Armlcv Leeds 12 


\ RESIDENT MEDICAL OmCER is required 
for St Mary s Infirmary Leeds (‘*50 beds) The 
appointment is for twelve months Salary £250 
per annum with the usual residenttal emoluments 
and one months hohdav Cindidatcs must hive 
had experience in midwifery subscqucni to quah 
fyinj. The duties of the Officer include lecturing 
to the Nursing Staff and instruction of Pupil 
Midwiws 

Applications stating age qualifications etc 
together with comes of three tecem testimonials 
to be forwarded to the undersigned not later than 
10 a m on Saltirdav August I3th 1938 
J JOHNSTONE JERVIS 

Medical Officer of Health 
Public Health Department 
12 Mttket Dtuldmgs 
Vicar Lane Leeds t 


0OUNTY or HUNTINGDON 

ASSISTANT COUNTY MI 3ICAL OmCER OF 
iicsLTit and medical OEFICEP 
or HEALTH 


Applications nrc Invited for the jciint r^bolc 
tune appoinlmcnl of an Assistant County Medical 
Officer of Hcafih the Admimvtrativc County 
of Htiniingdon and Medical Officer of Health for 
the Borouch of Godmanchester the Urban Dmuos 
of Old f letton and Ramsey and the Rural Dwnt 
of Norman Cross in the said County at a sahry ot 
£V00 per mnum with a travclhnc afiowance of tlOO 
per annum The estimated total ropulatioo of 
the Sanitary D trtcls named ts 23 000 
Applicants who should not be over 45 years of 
ace must be duly quafifiedf medical practitiorcrs 
with vvholetimc experience in Public Health du!i'*s 
and must hold the Diplom i in Public Health ot 
Its equivalent The officer appointed will k 
rcqmrcd to reside at such place in the nonhem 
pan of the County as shall be approved Av 
Tcsards the duties of an Assistant County Medical 
Officer of Health (he officer will act under the 
control of th'' County hfcdical Officer of Health 
and wilf he cquircd to perform such duties t 
may be from time to tine prescribed As re td 
hi duties as District Medt al Officer of Hnli'i 
the officer will Ic the officer of (he Local Sv i 
tary Authoriti'*s 

The Joint appointment is subject to the aprtoval 
of the Minister of Health and the Board of Edj 
cation and also so far as the office of Distr t 
Medical Office! of Health is concerned to th rto- 
visions of the aniiaty Officers (Outsdc Lon^'al 
Rcgufations 1935 The yoint appointment will he 
one under the Local Government Supcrannuit ■'ft 
Act 1917 md the selected cand date will K 
required to pass '• medical examination 
The oini appoirtmcni will be dcjcrminab'e bj 
three months v ritten notice on either side su*'*cct 
so fir as the oPicc of the Di tnet Medical Of cr 
of He llth I concerned to the consent of ib 
Minister of Health 

Forms of application together with a list pf 
dimes m ly t c obtained from the undersigned aaJ 
nccompamed \ y copies of not more than three 
recent tCNiimonial should be teturned to h'a r 
later thm Aurum 5th 1918 

J D KELLY 
Clerk of the County Coins'll 
Counu Offices Huntingdon 
July lOth 1938 


C DUNn COUNCll or Tiir w EST niDiNO 

or loiii shire 

SCOTTON BSNkS SVNATOUIUM 

AEPOINTMrNT OP SI MOR 
MFDICAL OI nCCR and 

Ml DIC\L SUPERINTENDENT 

Tlic Coimn Council ot \hc ^^csl R"'|"l ?! 
SotLsIiirc inMIc mplicalions from ictuicw 
medic il practitioners for the appointment of aer 
\sslstant Medical Officer and Dtputy 
Superintendent (non resident) al the S ouon lun 
Siniionum near Knarcsborough for 
bed ) and children (KKt bed ) u m •»-) 

Candidates should have previously ^ am 
appomtmcnl as Houst 1 hvsitnn or Hoiwcaufpe 
Experience in Pulmonarv and Nonruimcnn 
Tuberculosis is essential nnd a knowicufe 
Anaesthetics will be an advantage 
Salary £600 per annum rising by annual 
crcmcnis of £25 to £700 ps-r annum 
Further particulars and forms of 
mav be had from the iindcrbigncd and j 
tions toReihcr vviih not more than three ' 
testimonial must be sent to me not itc 
Mondav AkuRUst 15ih 1918 ,t» 

CounlvHall J CHNRLES 
\\ aktficld Clerk of the County Couroi 

July 19 8 


kCRBTSHIRE COUNTT 




\PP01NTMCN'r or COUNTY 

LOGIST AND PATHOLOOIST 

Applications arc invited from tcRtstc^ r^my 
iciitioners* for the appointment ® .p-int 

Licnologisi and Pathologist at ^ c J^ 
ary of tToO per annum rising by bicnnwi 
ms of £a0 to £937 lOs per „ c n 

Ayvplicants must have 
r bactcrioioRv of water and milk an 
a PithoIoRica! Liboratory to dew’ff 

Die officer appointed will be require 
; whole of his lime to the pjctcri'' 

d will be m charge of the 
•ical Laboratory under the admino 
the County Medical Officer prij- 

Fhe appointment will be subject 

ions of the Local Government and 

pcranmifltion Act 1922 

tc will be required to nass a ntcjic^ r ^ rt 
Applications accompanied by the 

tn three recent testimonials gth }0J5 

ned not later than Monday Aupu^' 

\V M ASH , Oflicer 

bounty Offices (T^ounfy Af 

5i Mary s C »tc Derby 
lulv 20th 1938 






TH! BRITISH Ml DICAL JOURNAL 


T in CMKisni IKtMIfM \M> not] 

INMIIV n 
\\ th rr* n Mir I otcr 

t n ar n itcJ f m if r •'i f I I vr 

nisr ^^lnIc^L oriiciK i ir ni | 

tpI Ir tiuitc ( f c 1 **iih the K c ! 
l**<rar t> 'Mfi-'-rt t -i~*en t (M her j 

Sr'S. •*' m i ( t \ r* » ' if’C l r»i ir tin c I 
b t t' Trrcu '' 

M’ln at t** rale f 1 1 0 r i a i v.ri r> t5>t 
’cnee tp 'ate J e' N'^ru ct 
Ibc a^P^.'•r'J~'nt 'Tef an i\n. "t o*^ nun t 
f K.J - ™ ctr'-tc**"'- RjJ ' 'n irJ \ fa> 

'\bcvir> 

CanJwttcn rut hai baJ r’e" u-xj! rJ 

^ itthj cnr'CTt n e 

\rr >cat' ■*< at Pk acc o af k. t '• and 

pc ts orcTicni.1. t ' Nr rcxn'cJ b' I'* tindT 
^T>cd noi latT than Sc** ertber *>h 

riRO s GLV'iS 

ri-r n c** 'cm 


T nr CtFST HOSPITAL DlDLE'i 

tCciera! I ‘J Bet. ) 

The Re^Js5cT•t S a^ cnr<»' < of a KrtaJer Si fr» al 
ct ard t»f> !fo* tc Surfcont 

^rr’ -at c-*N a c »n\i cJ f ort rect tered Med ^1 
Pianti -ers f r the ro^t of RLMOINf 
SLRGICSL OfFlCFR tr-aJcl Dt.Jrcn tn cr^ 
r»r*vc Ai-m t I ih I'JK SaUn at Che rate of 
t— 0-£.'Ot per ann-'o. ax>*une to et*'encf> e 
with f r~ •i'nI a'*jnr**T N'Mrd ** 1 * taundr 
Care x-2icn r'^nt ha'c had expcncnxc In c***CTfno 
^urr-n and rtcfetc’n.c I be ci m to th"~-e 
hili.i**e t*'e Qua •'cv.ti no FRCS rr M^ 

^r** ca I **< «*«t nf ar qual '■can n< arJ 

orcrv~>ce aeoo-*fvsn cd H ct •* cn »f te^T r* _1 
to be icrt to the i.’v.en r**“t. 

H R MOSD IRTlSr 
Jl’ 1^ Heniv. G cfn>' and Seer tar^ 


T ilt GLEST HO^tplTSL- Dl DLE^ 
(Got ral Hcr’'tal 1 9 Bcu* 1 

The RcMdcpt SafT **'j xt c a Revdent Sureical 
OIT t ,.*>d t»o H t. e S rtciT* 

TASO HOtSfc surgeons (na1c'» rcQu red 
One t'> cn cr uisn h< duti-s ir—cdJtefj and 
the c*h f to crf—"en'c on ^uru tit'* 19 
S.>.> > at the r-tc of £l 0 -e a"*L*i 'Mtb fern diCw 
wparurc": board and Isu^'n Cari.Jac' r-u i 
be fu qual f fu a"i re? cfcd 

^r'*f‘C3tf*rs ati"« ae q sa *atj r' and 
e ner^a aceonna*}«d tn ct,* n of 
13 K 'e*’i I the urcer* ?rcd 

H RAYMOND HURST 
Ju > . eh I9XV H L»c G 'em ra-dSoercuf) 


T he dlchess or ^ork hospital ior 

BODIES MASCHESICR 


Acp cat on a e tn'iied for the pent f JUNIOR 
RESIDENT MEDICSL OFFICER f r vit no-th 
fiin Oao*XT 1 t 19t Salary C"' per arnun 
»ith bo^rd rcN derwe and laendo 
Ar''t*eatio'*«i t>««bcr «uh cor o of te^ti- 
mmuib to be ^ent to Lhe Scereiin bj \uru« 
I ih 19 S 

LOUISE BMLEA 

SecTct.ir) 


V ICTORIA HOSPITAL WORKSOP 
iS^ Beds) 

Ap'^ficatjo'* are i-’sucd for t^*.. pent of JUNIOR 
HOUSE SURGEON (ru e) 

The appoiriate**: rs for mo-ih^ from Ono- 
ber I t valaiT -i the ra c of fl-J per anra*n »ith 
board ressden e etc 

Ap-tijcatiorr %uh ccri“^ of three resent toti 
monul tanr* ape qualiT catjo-t and naticP' 
ahir 'hex: d be sent to the undcrvpncd 
P E- DICKINSON 

Secretar) Supenrtendent 


THE WINOFIELEbMORRIS ORTHOPAEDIC 
A HOSPFTAL HEADINCTON OXFORD 

THE LORD N*UrnELD SCHOLARSHIP IN 
ORTHOPAEDIC SURGERT 

MALE RESIDENT €-.00 p*n‘ anrum for two 
ptars f lornctJ br three month travel (ClOOf 
Kc'tdcr e to ccttiraesxe about Noscrober I ih 
Some Onh racd*^ rtpeneocc ens niial 

Inlor’Raticn can be o‘'tau*ed from and appl ca 
non before October "th hoold be made to 
Prcfes,or G R Gird!e<tone 


•J’HE GENERAL INFIRMARY AT LEEDS 

Am ications ate intned for the pent of SENIOR 
RESIDENT anaesthetic OFFICER 

Salarv ^149 per annum with the u'ual re>i 
centul allo'»‘ancc!' 

The anpcmtmeni i for tHtl e month' ubfcst 
to renewal Candidate^ mu't be full> poat hed 
and remtered ApplicaiKin' w th cop of icvti 
men at to |o once to the undervipned 

S CLACTON FR^ ERS 
Hoir*e G> ernor and Sesretary 


B IRMINrnVM \ND MIDI \ND Mb 
HOM 11 M- lIU Rev ) 

\rP> Jti n ati in' ted ft m d il> j i ! f cd 
'(cv af fraittt n r f r the r* f RLSfDfNl 
SI KC ICVL OIIICIR at tb ab 'c H<*'p ra! 
Sj ar\ £ tx> pi.r annum and tIO lairdry aP jr e 
Ihe Rc» vent Start c r t t' f a RmiJ ni 
Sufvi al O'*" «. and three If u Surcc n and in 
tht. i. ent f n rf th latter Nrins prom Mcd 
t I** pi ifi n RcvvC-t Si rn-al f>T cr appfi 

a r b «1J tale whether th > wil K w I! - t' 

-■\erJ am tmmt a H( I'C Sorpe n at a 1 r 

f tl 0 tn n n tbe end of u m nth jj 

fan r\ er' c t' £I It Pet annum 

Vr** at ** «uh tmtimor a < ard c i -»• e < f 
rcc ifat n m tbcreeiedrt later th^n 'f r» 
da> Aud t I th 

Ch trvh Street I W frsRCF 

B m rbam ' llmi c C err f 


LI INC S\NA1i»RU M HOLT NORIOLK 

Ibe C 'm*'* lice of Manaermerr t f the Kell nr 
Saratrr urn dc* re apM -an xi from 

Sfcd>s.al fVa n t ncf< with u table o lal fxit on 
f^ the rx"! «f Mf DICAL SI rFRINIlNOrN! 
at Kc( r** Vinai xurn H *i Sorf IK Of 9 bed 
meni Pfef'XcnvC will be »i en • a**p j"{ 

between the apct of ihin>*f» e ard fi ly why ba'C 
avm n trat \c c peneoer Kntmledre «f p*od-rn 
meth-xJ' f Sana! tr m treatme-t and T ray w vK 
Th piw ti-rt I open a fr^m rXt ber I i lotv 
viUry t^ry per ann m with « ccllent boi *e in 
Sanatorium pexinw' A S l•vran'*-lat^on Scheme t 
jn f fee 

Ar*'Iic3t{n ta re p jal ati n t aeth r 
with three fceerf tm '** x* .il h c IJ N. tent t 
the SxTctary Kd irp Sjui'fi m )| t N rfrIK 

b' Sep e*n*xrT ’rd ISXS 


K ent and sussen hospitm 

Roval Turbivt Well' ( H> R-d ) 

Vppt 'aiKvj arc in'Xed f r ib arpcrtmmi f 
nuLSE PinsiClAV <mjie» S-lary tl n mr 
a**r>.m R urv re>dm e ard I t rJry »n th 
H wp ul 

The Hcwpiul armoted b> the I ni'cr ly f 
Lc**i. n f f lb purpi*^ of M B etam ran - 
Si ex fol cand v-.te will K. required to uKe un 
dt ty <n Stpiem^'er 1 19 and a****! -ation 

atir pj4 -ationx I ether wih cert f ate if 
rer trati m aov crp o < f n t more than ih cc 
revent tex imonu ho M be xc-t t« the cover 
red bj Acti t <th 
. TOM 0 HSRRISON 

July ^tfd J9XS Sapcrin crvcn Secrewry 


L oughborough and district 

GENERAL HOSPITAL 

App! cst CM are litmtcd frem duly rttHxcred 
ca^dr-atei fmal* a**J urmarred) for 
a HOUSE SURGEON »a.arjr £1 0 per annum 
from Aunryt Ut 

» HOUaE PHTSICIAN taDry £l«5 per anrom 
(fcm IuIt 1st. 

The appontner $ are for ux montby ard tn lode 
apartmcnit beard ard laundry TTic Hou c 
Sar-om r*u'i be an cspcnerccd anaesihe*! i 

All apriica lo-$ jtatirat a?e el with cor *s 
of lest-'-onjls to be sort to ere at 0*u.q 
FRANK H TOONE. 

9 Le-ccner Read SeCTct.T 

Lcvrhborcoth 


T HF ClflfORFNS HOSPltAU SHU HELD 
tl5' Bed ) 

Applh;3i» n arc m iied f r the piwi t HOLSL 
PHTSICIAN 'acani Vpicmber IM 19XS 
The apnenntnent i for xit month Salary til'll 
per anmm with board residence and bundry 
Card daie« fmale and unnumedi who mu l 
pi'Hxe' rem tered goal i-ation houM f rward 
aprli'alion tatin? are national cy ere locethcT 
with cop ex of three rcveni to imonial to the 
undcTiiKned 

T H G GARTLAND 

Sarerini '’cent and Sei.ri.ury 

R o^al victoria hospital 

Belf-.'X 

RESIDLST MEDICAL OFFICER wanted for 
Gynaceolopcar Ward << bed I Appomiment for 
'le month' from Scpietnber I t Saury at ibe rate 
of £KH> per annum 

App ican-x must ha'C held a r-wd nt ppo nt 
ment ftr at lea i ooc year 

Apnl cation with three lesionor-al to reach 
Super ntendent not bier than Aumi't 6th 

(By Ofd f) F A HERON Hon So. 

R/fANCHESTER ROT At E\E HOSPITAL 


M ntKKSHiPE HOSniAl READING 

Tbe f M wine rex dent apii inim nt wi!l beecrre 
J ant on October It 19 S 
RfSIDFNT KfEDfCAL OmCER tmafcl at (he 
nt era c Branch Hr*ir Ul arx! A"i unt to the 
P lb I ! t ( ombtn'^ appoir merit) To rexide 
at rd ha c charsc of M beds at Bran h IIxpul 
and I wirK at A uri in the Patho’ -cal De 
rjrirrent t me mam Ifoxptial (Prcyioun etperi 
en e in Path t y rot cx'cntial ) 
j Fb- app intf-cn is fo in month' arsJ cardi- 
d te* tn f* be fully qual Ted and res 'tered 

Rer- n-rali n at the rate of €1 0 per anrum 
w th bt rd rexJence ard launofi 

Kp-t at n tat nx fc ard etlNrer e « th 
c me f t-xtimonu to N. ent to the urt.er 
coed n r befor I fuuy STtember Vth 19"* 
H F PY \N 

« ScvTcury arxl Houxe Go crrK.r 

R oy M BERKSHIRE HOSPITAL 
Rcadm- f Bed ) 

Kpp v-ii 1 r n'ltcd f >f the r wi f 

KFAIDFSI ANAISlHniST irra'c) wht h fall 
a art on Ki it 6th I9t 
Tbe app« ntnent i f r ' m mth in th tit i 
in la c Carx. daiex nut be fill) qual f cd ard 
resj tered and ha'c had or k-c^aMc apcntiw-e 
tr the admin-xtratrm f ararxibctfcx 

A eatary fC^opa wihb arv re* den ard 

laiirvry will be pi J t the c nv vjtc riw^cx me 
iiiub e qual -at ox f ir the p‘'’*t 
Sp-'lcatim tat t ate ard csrerier-e with 
c p “x of p It more than three fccct- text moruH 
I txe T»t I il u-vcrxiened a x<> n a r«>x it c 
H t RYAN 

Seireury and H uxe Co ern f 


R oy KL HAMPSHIRE COLNTY HOSPITAL 
W ir hr* CT Oh" Bed < Rex -crx OPiccrx ) 
Hfwpttal fee c"i/cd by the Roxal Co leec of 
Sur— " Ersland 

IIOLSE SURGEON 

Yr** -aiin are tn itnf frun fully gujIiheJ rrer 
f r the -N 'c p»*xi to uKe l** dmt-s a' oon a' 
pi" jM Sis r* - h arr^i-j**CPt SataD £1*^ 
per ar-um with N ard m -e'N.e and laundry 
CanJdatci wh r-u i be of Brrti h rait >nal ty 
tp r*aKe ar"l cation to the c^d-n r— d envlosths 
p ex of three ic'tj.‘“nnjl 

HERBERT MASLEN 

July Hth |9 w Seereury 


R oy m sus.sc\ couNn hospitkL 

Bn ht n I ' B*d I 

HOI M SLRCLON (rule) rniured erd of 
Kuruxt l9tK Charsc f bcu Salary £1 0 per 
annum with b'ard r'xiv rce and tau-do 

Canduatex r* rt hod ned aal ard urrml 
qua! fication of the Bfttrxh Empire and N. duly 
fe\ tered under tbe M -dical Act* 

Ibey mu t K. urmamed rd »bcn elected 
I nver Ih rty ycarx •> a 

Kppi -all Ox wiih cixpicx rf tmtimonu!' jhxild 
tx. «e*it I the urdcrxisned s «x n a* p<^ Me 
L L V. L ANC SETER-GAY E 

Seereury Supert- endenr 


R OTHER ff AM HOSP TSL 

( I ’0 Bed' ) 

CKSLMTY HOUSE SI RGEON 

Ypplcaii nx arc tn'Ued fnm aualified m n foi 
the poxi of Ca ualty H-xrre Siirscon Dutyex to 
c o m men c a xocn a' reixMblc will tn-lodc worlr 
tn the Ear N<wc and Throat DepafTmem Ex 
ccllent cepcrien c to be pained tn the treatment 
of fra-turex Salary £1*0 per annen with full 
board rcxidcfNc and laundry 

Application' with cortex of recent te'txm'»nul 
hould be cm to the Secretary G W Ro«f«T' 
b Kfoorpate Street Rotherham YorKs 


T orbay hospital 

tl6 Bed') 


jyjANCHESTER ROY At 


JUNIOR HOUSE SURGEON required Salary 
£1 0 per annum with residence board ere 
Appl canon.' (with copes of tcxxraooal ) 
endorsed House Sorpeon " to be addressed to 
the undermentioned 

H R NORTH 
Gen Sopf and Secretary 


HOUSE SURGEON (male) required for Se^ 
I -mbcT I'th Salary Cl"* per annum with b«ra 
rcxtderxre and laundry Candidaim nim be fully 
qualified retnxtcTcd and uranamed 

Appl* muons tat nff arre, naoonalitr CualiOca 
I tons and expenen'e with copic* of 

than three recent icxtimoncsl to be rccci ca oy 
the underx sned not later than AugM^^jh 

Jut iwh 19X9 Seereury 

R oy \L CORNWALL INHRMARY TRURO 
(e-* Bed* ) 

HOLSE SURGEON (male) requ red wiih e\ 
pcfjcncc of AnacsihctiN to omn'cnce dirties on 
Auiju t I t next Salary £1"0 per annum room 
board and wa fii^ 

Ypply with copies of three rctcni testimonials 
to the Secretary tf whom further panwailars may 

be obtained — 

Iniro W E- GRTNEELL 

J I' ^ih I 9 *« Hen Secreur* 







% 


THE BRlllSH MEDICAL lOURNAl. 


Jun 30 1938 


j^ANCHCSTCR R O 'i A L ^NnRMAR^ 

CHirr ASSISTANT TO MLDICAL NCURO 
LOGICAL UNIT (Non rLCiclcnl) 


Titc Bonrd of Mntiagcmcm TnpljCRiian’s for 

the abo\c Tppotntmcni 

Appiicints must be registered Medical Pntfi 
tioners Higher qualifications desirable 

The candidate nmU be required to attend on sc\cn 
baU 'Sessions per xscoK of which at IcaM four %stU 
be morninc sessions Duties wilt uKliidc work in 
the In patient and Out patient Dcpartmlnts and 
participation m teaching Tltc candidate will be 
expected to engage in Research work for which 
facilities wilt be provided 

Sdarj £300 per annum The appointment will 
fc for ortc 5 car m the first instance but mat be 
renewed for two further periods of orve ^car swh 
jcct to the provisions of the n> ivws as to notice # 
etc 

Candidates should forward fifteen Copies of their 
applications giving particulars of \cc experience, 
etc together with copies of recent tcsiinioniah not 
later than 9 am on Thursdaj August 4|h |93s 
to the undersigned from whom further »nfo»manon 
in iv be obtained 

By Order 

1 J CABLf 
General Supt and Sccrctar> 

Jul) 18 193R 


M 


ANCHCSTER R O A L lNnRM\RT 


JUNIOR ASSISTANT MEDIC \L OfflCER 
IN RADIOLOGICAL DEPARTMENT 


The Board of Manigemcni mtitc applications for 
the above whole time appointment Apphetnts 
must be registered and hold n Medical and Surgical 
qua ificaiion and the D M R E or equivalent 
The appointment (nonresident) Is for twelve 
months renewable for a further period of twelve 
n omhs subject to the provisions of the B> laws as 
to notice Salarv is at the rate of i'^0 per annum 
Applicants must state age and send fifteen CopR> 
■of their applications and testimonials to the under 
signed bi Thursdav August 4th 19 8 
By Order 

f J CABLE 

General Suoi and Sccrcnr> 

July 18 1938 


AfORD COUNTT AND CITT MENTVL 
' HOSPITAL 


SECOND ASSISTANT MEDIC \L 
OfflCER (MALE) 

Applications arc invited for the above mentioned 
position Applicants should be under 40 ycirs of 
IRC have had some previous Mental Hospital 
experience and possess the Diploma in Psveho 
logical NKdisine 

The Olliccr appointed must ic prtpared to assist 
it the Clinics (or the Out paucat Utatmetu of 
mental illnos in the City of Oxford 

Commcncini, salarv £a00 per innum (including 
£^0 for DPMI rising by four annual increments 
of £2^ to £600 ps.r annum together vsuh hoi]s<. 
light fuel and garden produce valued for super 
innuation purposus at £100 per annum 

The appointment is subject to the provisions ol 
the AsvUims OfTictrs Superannuation Act Tlu. 
successful candid vie will be required to pass a 
medical ex imination 

Applications accompanied bv copies of not more 
than two recent testimonials should be s».nt to 
the Medical Superintendent Liitlcmorc Hospital 
near Oxford before August Gth 193l> 


P 


RESrON AND COUNTT Of LANCNSFER 
QUEEN VICTORIA ROT AL 
INflRMARY 


RESIDENT OBSTETRlC\L OFI ICLR 


The Board of Management invite vppUcaiions 
from unmarried Medical Pnctitioncrs for the 
above po^>t wuh duuc^> vrv she Maternvfv 
Hospital (43 beds) under the direction of the 
Consulting Obvtetru.*al Surgeon CXandidatts 
should have hid cxpericnee in dealing with 
cn>ergcnc> ciscs and m conducting ante naul and 
post natal clinics Twelve months engagement 
from October 1st 1938 Salary £300 per annum 
with boird residence and washing 

Vpplications stating age quaUfications vnd 
experience iccompanied bv copies of recent 
testimonials to be forwarded to the undersigned 
on or before August ISih 193S 

JOHN GIBSON 
Superintendent and Sccrciarv 


A/TANCHESTER MCTORIA MEMORIAL 
I' I JEWISH HOSPITAL CHEETHAM 
(Non Sectarian) — 102 Beds 


\pplicaiions arc invited for the post of SUPER 
INIENDENT AND SECRET ART to the above 
Hospital Commencing salary £4*:0 per \nnum 
I rev ton Hospital experience necessary and poses 
Sion of the A H O \ Certificate a recommendation 
Applications stating uj.c and experience to 
geiher with copies of three recent lestvmonnl to 
be fsvrw » ded to the Chairman of the Hospinl 


^NCOVTS HOSPITAL MANCHISIIR 4 

HOUSE SURCrONS (Tn'o) required (lady or 
Gentleman) to commence dutv on September 1st 
Ont lor the Orthopvcdit DxpvTtmciit and one (or 
the (.ombmed post of House Surgeon to the I ar 
Nose and Ihroai Dcptrimcnt and House Physienn 
to one of the Honoratv Ihvsienns Sal iry at the 
rite of £100 per annum vvuh loard residence 
laimdiv etc Appointment for six months 

Apphciitotts stating ijt qinlificatlons cxpcri 
cnce if my ind full pirtieulars to he forw irdcd jo 
the undervign''d on or before Wednesday Atigiisi 
2ml with copjc of three recent icsiimonfals 
By Order of the Board 

HfUBfRT 3 DAUOUNE 

Gen Sup! md Secretary 


M 


ANCHrSTTR 

Crosvenor Square 


FAR Hosrn \l 
AH Saints 


The Board Invite applications for the follovvme 

posts — 

RlSIDfNT HOUSE SUROfOS Salary at the 
late of £120 per annum 

NONRfSfDENT UOUSf SURGfON Salary 
at the talc ol £1*^0 per annum and partial board 
\ppamtments six months Tlurty one beds 
Ciindidaics must be duly qualified md registered 
Applications with four copies of recent testl 
monivls to be forwarded to Sir Uceimld S 
Milford (Hon Secret »rv Mnnehester I ar Hcwpual) 
c'o Mr W J rilim 7 Brarenose Street Man 
chcsicr 2 


r'HESTERnrLD AND NORTH DERBT SHHU 
ROTAL JIOSPITAL 
(2-0 Surgted and Medic vl Beds) 


HOUSE SURGEON to Ophthalmic inJ far 
Noxc md Throat Depirtmcntv 

Appheationv arc invited from fully quihricd men 
for the vbove povt 
The appointment is for six month 
Salarv it the rate of per mnum 
Applications smlng acc together wuh eopi'^s of 
three recent tcsiimoniaK should be sent to the 
undcrMkncd as soon as possible 

M H BOON I 
Superintendent and Secretary 

Julv I8ih 1918 


K 


ETTCRING AND 
HOSPITAL 


DISnUCT GLSCRVL 
(10'^ Beds) 


Apphcaiions arc Invited for the post of HOUSE 
PinSfClAN 

Salarv £lso per annum with hoard tcsulcncc 
and laundry Candidates must be fully qualified 
and registered and he free to commence duties on 
Scpiemhcr 1st 1938 

Applications staling age nationality and qinli 
heationv toeether with copies of three te iimonnU 
to be sent to the undersigned before August 2nd 
I93S 

G \V JACKSOS 
Scerctary Supennicndcm 


g U I r Ef Q 5 f I T A L L U J O N 

HOUSE SURGEON (male) wanted to commence 
duties as voon as pox jbic Salarv 11^0 per annum 
vvuh board residence and laundry 

Applications stating age nationality and cxpcn 
cnee together wuh copicx ot not more than three 
recent testmtemial xhould be sent immediately to 
the Secret iry of the Medical Advoory Comrnuice 
u the Ho pud 

U r LINGVRD 

Secretary B\Uc Hospit il 


T he hautlepools hospital 

(95 Beds ) 


Applications lire invited for the position of 
HOUSE SURGEON at n salary of £150 pa plus 
board residence and laundry 
Appointment for six months stibicet to renewal 
md duties to commence immcdhicly 
Applications to be made to the undermentioned 
NORMAN O DEANS 

Sc'crctary 


gURlON ON TRENT GENERAL INflRMART 

Applications are mvued for the position of 
CASUALIT Ol nCCR AND HOUSE 
PHTSICITN Silaiy « the rue of £150 per 
annum with board residence and laundry 

Applications giving age quahhcations and 
nationahiv together with copies of testimonials to 
be sent to E \V Tiiornllv Secret ity 


jgCCLCS 


AND PVTRlCROrr HOSPITAL 
near Manchester 


JUNIOR RfSlDENT SURGEON required 
September 1st 1938 Appoinlmcm m first instance 
for MX months Good surt,tev( work Salitv at 
rate of £125 plus usual emoluments Apply wuh 
references to Secretary 


QObSH \M 


MEMORIAL HOSPITAL 
Kingswood Bristol 


Wanted an iddiUonat HONOR \R\ SURCEON 
for general Mirgicil work 

\pplv wuh full pariteiilirs to the Sccretars 


J^O-iAL llLItKSlIIRt IIOSPITM REVOISg 

nic ntnril ot M-imscmcni inmc arrlnn , 
for lire pon ot ASSISTANT SURC ICti 
HI Gist RAH ouia.m 

Cindidrici m»M lie Tcllows ol nne ol ih 
Rovil C ollccci of Siirtcnns ot lire nmoh Iroi 
or Suroicil Griduatc ot one ot the Umvcrwio. ot 
tin. Ilriti^h t moire nnd itiolr mmcv-omcred on jt, 
Nfcdical Register 

The ckcjcd Candidate will be appointed fo ih< 
pcDod ending nn the first Tuesday in March 1<) 5 
md wdl be eligible for re election 

Canvassing by or on behalf of a Cardidai e i 
disqu ilify 

Applications wlih copies of not more than f r 
tcxtimonnU must reach the Secretary m hu 
than 9 am on Triday September 2tul 19U 

TTvc I lection Will take place on TijcsLt 
S eptember 6ih l‘>j8 

H F RTAN 

Scwrctary and Home Govern t 


TIL BIRMINGHAM UNITED HOSHTtL 


The OULEN S HOSIITAI Rirmmcham H 


RECISTRXR to the E^r No<c anJ Thfxit 
Department required part time non rcstdcni 
The diittex arc in connection wuh th li- 
patient anJ Out Muent Departments 
The appointment iv for six rrontlis in the frsi 
in i vnee 

Candidates must be real tered nriici! 
practitioners and for rrcfcrcocc should hold hid r 
degrees 

Silvry will te at the rate of £H0 per ann n 
Applie uion wuh coptex of three tcvtimonak 
should reach the unJersigned not later thaa fry 
post on Vugiist 3Ht i‘>a^ 

r CROCKER 

July 20ih 1938 IIouxc Govtrp^r 


'^HC BIRMINCHVM UMTLD HOSHTU 

QUEENS HOSPITAL 
(Medical School) 


R 


Appheaiions arc invited for the post of RtSl 
DENT MLDICAL RtGlSTRVR vacant ahvji 
September 2(vh \938 

Salary £‘'P0 per annum wuh full board c( 
Candidates mu t send in their arpl'-ih'*’'* 
together wuh testimonial and evidence of 
tion to the undersigned (from whom all ^ 
panitularx can te obtained) bv NNcdr*'«) 
August tjm J9tg 

P CROCKER 

Julv :fith 1938 Houte GQ>«n t 

GT VL E T E TlOSriTAL 

^ Peven ev Road ta ibourne 

NO\ RESIDLST llGUSr SURGEON rcq>.j; J 
to commen^'c dutv tn Augu t The ariNtf* 

Will le for IX months tn the first Itwtan e 
Satats C\uo per annum and aUowan e m ii u c' 
board residence £175 per annum , 

Apph auons statiny. age qualifiritum 2 
ophthalmic experience together with * 

monnls should retch the undersigned as 
as po siMe . . 

Before engagement candidate have to « ‘ 
Mewed In the Hon Surgeon from whom lum 1 
partieiilars could be obtained in person 
H nVGRWC Hon Sccfcf^rr, 

M V.NCHCSTCR NORTHERN -JIOSFlTAl 
Chcctham Hill Road Manchester i 
(General Hospital — 113 Bedb) 

Applications are mvued for the post of 
DENT SURG1C\L Ol UCCR commencing 
Cjso per annum wuh board 304 resJc r 
appoinimetu is (or twelve months from mm 

Applications stating ngc ^uaiificitfom 
intlonalilv wuh copie'i» of not 
recent lestintonnls to be sent to ifj av’ 

Mr Jvvtrs C Danjfis 3S Barton Afvadc 
Chester 3 a s t>oon as possible — • 

OTKOUD genera! HOSPIT'! 
O Stroud Glov 

RESIDENT MEDIC 'L 
CnndW iti.': niii^i be fulh (unlincd ^ 

Six monihx ippomlmcnt *“ ""..m «ii'> 

xoon -11 po siblc SHnrj £-00 rxt a""'"” 
bpxre ina luimln (> 

Applixvtions viuinc nee >’ 

Rxthcr wuh copux ot fiilllit 

lu xxnt to ihx imttcP'Ktnct! Pfoot hP 
paruudars may K 

'T’HE BUCHANAN J’ (* * ^ ^ *^ 

T St Leonards on Sea (103 Dedj ) 

JUNIOR HOUSE SURGEON 
10 commence Junes Scptcml cr Isi ' „ t 

trom tlJs per innum Molin' 

CindiJMcs must be Jub SlJ In L 

mcuuuncrs md ipnlicitions "I"'-" te 
three eopics of recent icsiimonnb n 

O the UndePUSneJ Jvje .jenT 

t RANte 





Jun '0 


THH BRIIISH MCDICAL JOURNAL 


37 


APPOINTMENTS — ^Important Notice 

Mulii-il pnLtUioiii.r'. nrc n-qm.-tt.d nol lo apph fni nm ^ppf)lIltnlLnt rLfcrncI to in tliL following 
tililc without In ing fir^t lomnninicntcd with tin. S<.cutTr\ to the Britnli Mcdicil ocntion, B M A 
IfoU'-i., ln\ntoi.k ''qinrc, \\ C 1 (in the ci'-e of Scotti'h ipiiointnicnt'-, with the Scotti'-h Secrctirj, 
7 , Uninivhni^h (nukn--, Iklinhurj,!!) '■ 

(a) British Islands 


Town rr D tTHt 

T wn r D tret 

' Town or D (rxi 

CONTRACT PRACrriCC 

CONIRACr IRACllCI— (c niJi 

PUBLIC HEALTH 

ABCRTYSSAXG AfCDfCAL AID StXTIETY 
Ofrrfrcf Or-irr) 

AHD RHONDDA AifOfCAL AID St>CfrTA 

(A tant «fr 0 / D<* r ) 

col STY OF RONPLKCH 

4t I fani %trj at Of e of Ufa ih ) 

BLAENAAON AfEDICAL SOCIETY 
(CAirf Afru ewf O^wvrJ 

NTAHI AND DIMKlCr 
i%tfd •%,! A 1 4 1 VM/ n ) 

CILFACH roCH CL-AMOBrAV 
(11 o'kmm j \tr f Acirme) 

OTAtORE \ ALLFA n AAfORCAN 
(ll tr»/*-a»n TV// rer 'frd^u/ A f '/• V rf ) 

(K fttnffi 1 Afr at A t r f'f ) 

DISPCsS VR\ APPOINTMCSTS 

ELUY’NYriA CLYDACH A ALT i 

PENY CRAIG GL.AA 1 ORCAS- 

(fl <vA/rfn j AfeJ uf A here) 

LIMERICK cm 

(II A /e*y mr P rrnta r iff / ct Op^rft ) 

OAKDALF Ajr»N ' 

|Afr,frnf O^rrr f M <e/ ,4 / ( i wk n) ! 


(b) Oicrscas 

Mcdml pnctitioiK-rs, nre r^que^ted luit lo ippl' f"r in\ ipi>i)intnn.nt rtlt-md lo in iht. follow ing 
nhk without Innng fir^t coinnninmted with the Honorirv bt-Lnlirv of tin. Din-ion or Brineh 
innied in the 'icond column or with tin. Secret ir\ to Iht I’riinh Mtdml V'^otntion, BM \ Hou't 
TiM'tock Sqinre, C 1 


Town or Di ni j 

H n Sev of D »i 1 n . 
or Branch 

1 

' Town or P true 

l(< n Sev of D M ten 
*f Branvh 

i( Toati or D trh .1 

Hon Sev of Disisivn 
or Branch 

SOUTH 

ALES 

(411 T fnir 
^vim Attf 

ntfnti ) 1 

The MeJw 1 Seerctarv | 
New Soaih \\ ales j 
Pra*v.h l’< Ma 
ouatie S reel Sjc*Nn 

ssw 1 

1 

Y I C T 0 n I A 

[ (4U Jut tuff r 

'fr cat P rrn 

J iAf n ) 

i 

) 

1 

Ibe 1? n ran SowrctJty 

A ict •run Branch 

1 Rftrh 'ted "^1 V MV 

, vuti n A{ c d 1 c a 1 

Nxicty Ha 1 M^rt 
St r t Afe boi me 

\ Ktl tv 

i 

i! ’ 

I 

I M F«:tern 

AISTKAIIA 

I (C rf uCt cd 

:i L Jtf P OLt ft) 

II 

|l 

The H n See AAestem 
Auvtralian Branch 
Bmrh AfcdiOl As 0 
cution She I Hou e 

O' St George s Ter 
race Penh Uesfern 
At iralu 

Th-Hvi Sec 0 lecm- ! 
Dnd Bra-*h fl » rh * 
' cd> al A N^ti n 

B M A H( jNe 

AA ic k h a n Terrate 
Bft bane B I 

QrEENSLA>D j 

(Bri Sire At V’u/e 
fnflu Sfc ft fi \ 

Inst fa f ) 


luK 27 , 19 ti> B\ Ordtr ot tlcComnil C WDf.R'^OV Attn 'art 


L eicester roial ivnR'iARt 

< (V) IktJil 

Sur ■: n.S ’HP : C O Rci. Arjcih 
1 Res Rjd 

\AC\-VCIES rOR OCrOBCR I j 19’ 
HOLSE SERGEOV 

^kry rcT amjn Ar" *C3r r'jc h %«: 

bcK! a Resiucr Hevt’’ tal po** s ct 

rtricncc cf Henp- « xk 
Lrsucrtsful ci'3d dates miI be cen oc'cd i 
S.T r Ca ua t) OT-rr if ihcs o ir f^alc 
CASL\LT^ OFFICERS 
Ssokx Casualty OTcer Fe loss F p st nJard 
*v Ury per an n 

Junior Casualty er ClOl per arru^ 

MOLSF PinsiCIXNCIES ( ) 

Salan 1.^ per arnu-i Ap- icart nu i h_yc 
he d u Ro« dcr Hopital post of had s cs 
reneo e of Uc "td nerk 

RESIDENT ANAESTHETIST 
SjUrv at the rate of fl^O ref arrun f'*r first 
K rtentht, CNX) per annu-y for ecend sir 
morths C— 5 f r third ti riprths £_*0 fourth 
It noniH 

Apri'atoo h cc-' es of ihrp* rwtt 
rronia! to be forwarded to the H h-sc Goternor 
imJ Secretary not later than Autust 13lh 
Arpoift-tnent for stc mo-th w II be made on 
AiHTir't --Ith 
July J«th 19’3 


W EST RENT general HOSPITAL 

(Incorporated) Maidstone 
<H5 Beds) 

Arrlicaiions arc insttcd for the posi of HOLSE 
SLlRGEON who must be a male of Brtish 
nai nahty 

Sakry at the rate of £1 5 per _muin with 
Nxafd aranm rts and laundrv 
Candidates ma t penscss rcpKtetcd ai»l/icatians 
Archcations tatin,. oualu ~aiioa and erpen- 
erve tcJtether with copies of lesttmonial houM 
be sent to the undcis sned immediately 
IDWARDJ GREGG 
Hcir«c Cmem r and Sefctarc 


C ARDirr RO^ AL INFIRMARA 
(A oetated with the MclOi Naij rj) 

Seb x>l of 'lee. cin > 

Ar“hcntio~s arc ^r^ ted (o (‘■c r«.'*t cf 

RESIDENT MEDICAL orriCFR 
Dt ties will in uJc caie record Veep n* and 
teach n *rd 'fcx. nl w 'tV, iinccr l**c d cvti n of 
the Iknorary Sia'' 

Candidates r*o t N. D-v't r of M'div"e of 3 
Lnisanits of !*• Lnted Kipcd-im or Te’eas of 
me tf the Royal Cilleec* of Phy i un in the 
Lnted Kunedewn ard ni\t pres oosly he d 

~ Roidcm Hcsmui pc«t 
Th salary will tx at the rate o* f ’^1 txr annum 
with bcerd revd-r c and iaj*'d'> The rpo r 
mert n for on year ard the hok wil he eJisib'c 
to trply f r rcanpontr'crt a-d n y rcum cr-c 
for three con ectnne years 

Fonher panmlars rray be obtain'd frirn the 
AfedicaJ Sopemrendent to \ (tom appl ■afion 
(crdof>cd R M O ) with not rrere than three 
ic<imonjls (copes) nut be sc"t by n-wn cn 
AN edresday Aurast ’I t I9ys 
By Ord r of the Cooi-I 

K ARMSTRONG 

Medwal Suponri nu ni 


M erthsr general hospital 
(IIS Bed } 

RESIDENT HOLSE SLRGEON revuir d f r a 
per: id of sis m rths 

Salary at the rate of Cl 0 pet annum wiih 
Ivard and laundrv AppliuatK.n statir- afc 
nationalii) qualif -ations and a vnranicd bs three 
(copes onh) recent ic«.t monml should be 
addressed to the Secrct-.f> cf the Menhtr General 
Hospital 


W EST CORNWALL MINERS’ AND 
WOMENS HOSPITaU REDRLTH 

Wanted HOLSE SLRGEON Lad Sertenbef 
1st or October |s* 90 Bed £1 0 per anmmi 

with board and laundry 

Appf eaiiofK with testimonials to E POPE 
Hon Secretary 


RUl 


I N F I R A! A R Y 
fl-J BedJ ) 


(LANCS) 


APPmvTvic-vT nr Tvv n trnf ec cTTonrnxc 


A 'nnvics as abote arise on th Resident 
Alcd ~al Suit and app cati rs arc inuted fer the 
pCK s 

The Res v.ent S-afT con ms of R,S O a Hou e 
Phys 'i_n ard two House Sur—'ors 

The 3rn>.ntments arc for a term of sii morths 
and saijricn puyab c arc at the rate of £! 0 per 
annum with Nurd residetue and laundry th 
Salary ben? ipxcased to £1"^ per annum in the 
csent of reapno nimcnt to the same or some ether 
oPi c f r a penod of s x months 

Th- sem-cs of ho h House Sergeev wi I be 
requ red on er about August Sih 

Ar- *3tto-s statin a - auaUficatiorts ard 
rationality to-cther wnh cop es of three rcocni 
tesfi'-'onjfs arc to he forwarded to the tinder 
sijmed as soen as possible endorsed House 
Surge >n ~ 

Full parti *ulars of duties may be had 00 appitca 
Hon 

H WlLklNSON 

Sopennttxfeot 


'J’HE 


CENTRAL INFIRAfARY AT LEEDS 
(ST Beds ) 


Ap'^hoau ns arc invited for the post of a full 
tme DIRECTOR of the new Y-ray DtagnostK 
Der-runertw 

The comT-mns salary will be at the rate cl 
£1 POO per „finuTn 

(Zardidates must be duly Re titered Med cal 
Practition-Ts with spccul etpe'iencc la Radio- 
lomeal work and ntm ho’d the D M R E- quali- 
fi<atton 

Appl cation wccompanied by copes of recent 
testimonials s -tins ape qualiSeaitons etc shook 
be sent lo the ondcrsignrf not later ih-u Aomm 
-9tb 19’S 

S CLAYTON FRYERS 
- House GoveTDor and Secretary 


iAv[» ntmrnfi e«ir/ nued 
























38 


THE BRITISH MEDICAL JOURNAL 


Juu 30 1938 



CLASSIFIED The Minimum charge is 9s , which covers up to 30 
words Extra words are charged 1/6 for 5 or less 

Example 33 words would be charged as for 35 
Name and address should be included w'hcn 
counting words for cost 

If Box Niimbei is used, it should be reckoned as 5 
w'ords in tlu total 

Replies should be addressed separately to each 
Box No care of this oflicc 

Advertisements, accompanied by remittance, should reach 
this office not later than noon — ^TUI: sDA^, to insure 
INSERTION IN CURRENT ISSUE PleaSC write CLEARLY 

DISPLAYED Whole page £24, and pro rata to one-eighth page 
Special positions, dates and rates on application 


Every effort is made to ensure the accuracy of 
advertisements appearing in the Journal No 
recommendation is implied by acceptance and the 
British Medical Association reserves the right to 
refuse or interrupt the insertion of any advertisement 


ADVERTISEMENT MANAGER, BRITISH MEDICAL JOURNAL, 
B M A HOUSE, TAVISTOCK SQUARE, W C.l 
EUSton 2111 


NOT CLASSIFIED 


CIGARS (ENDCUT) ALL HAVANA 

rOBACCO GOOD SMOKES ii n low rrccc 
Qintuy Rinranctcd of 50 for 25/ poM free — 

Sole Manuhciurcrs J J Freiman S. Co Ltd 
90 PiccTclilIj London \V 1 (GRO 1^29) 


“BIZIM” CIGARETTES 

THESE luxurious* deliciously satisfying smolvcs ^0 s 
or 100 s at 6/3 per 100 5S/6 per 1 000 post 

free — Sole Manufaeturers J J Freeman ^ Co 
Ltd 90 Piccadilly London W 1 (GRO 1529 ) 


“ SOLACE CIRCLES ” TOBACCO 

THE finest combinition ever disco%ered of Choice 
Naiural Tobaccos Every pipeful an indescribable 
pleasure 12/6 per i lb tin post free — Sole 
M inufacturcrs J ) Frclman \ Co Ltd 
90 Piccadilly London W 1 (GRO 1*129) 


W ANTED MEDICAL STUDENT WORKING 
for final wishes to reside in medical mins 
house in or near London as PAYING GUEST 
for two or three months — Address No 7628 
BMA House Tavistock Square WCl 


F or all INCOME tax complications 
oi difficuliics consult or communicate with 
Mr C G C KILNER (laic H M Inspector of 
Taxes) 7 bi James Street Piccadilly London 
S W 1 Telephone Whitehall 9278 for appoinlnicnl 


N ational adoption socifty 4 baker 

STREET W I Telephone Welbeck 7211 
OFFERS ASSIST NNCE in the Icta! adoption of 
iIIcRiunnic and orphan babies into suitable 
family life Chairman The Lady Gwemth 
CVN FNDISH 



QFTERED IN DENONSHIRE TOR DELI 
X-/ cate child requiring individual care 
ACCOMMODATION in home of cxpcru.nccd 
medical p^vcholoptst \ oung familv Educational 
(acilitiLs Lovclv surroundings Terms by 
arrangement — Address No 7f34 T) M A Hoii e 
lav I toek Square WCl 


^DMINrSlRATl\C COUNTS OF ESSLX 
LABOR \K)R^ ARRANGEMENTS 


I he County Council of the Administrative 
County of Essex mviic quotations from Lnbori 
tones undertaking the cxaminition of pathological 
bacteriological and other specimens for the 
examination and submission of reports upon such 
Specimens from Essex Onoiitions should be sub 
muted for the carrying out of sueh cximinaiions 
during a period of twelve months and it is desired 
that the arrangements should if possible com 
mcncc on April Isi 1939 
Details of the Council s requirements may be 
obtained from the undersigned md qnoniions 
should be addressed to him and delivered at the 
Couniv Hall Chelmsford not later than 10 a m 
on Thursdav September 8th 1938 
County Hall E S HOLCROTT 
Chelmsford Clerk of the Couniv Council 

July 2*^th 19^8 


T YPEWRITING DUPLICATING TRANSLA 
-TIONS — Experts in Medical work TESTl 
MONIALS THESES etc accurately eopicd in 
style that commands attention — W'ouurn Burfau 
Drayton House Gordon Street London WCl 
(close BMA House) EUSton 1775 


T ypewriting— SPECIALISTS in typing 

Medical and scientific papers lectures 
theses md books Shorthand typists always 
available Proofreading Indexing — Marcvret 
W vTSON Ltd 16 Palace Chambers Bridge 
Street S W' I W'HIlchall 3838 v 


W HEN TOU COME TO LONDON STAY AT 
THE HAMPDEN RESIDENTIAL CLUB 
FOR GENTLLMEN Hampden Street N W 1 
Close King s Cross ami Euston 300 bedrooms 
15/ to 22/6 p \v includ baths attend ami bool 
cleaning All meals Y la carte in dining room 
Mod tariff Large chib rms reading rm study 

for students Ulus pros Sec Euston 2244/5 


ASSISTANCIES 

W ANTED MALE ASSISTANT (BI ITISH) 

from early September Country praeticc 
Fast Anglia Outdoor or indoor Salary £300 pa 
all founJ rising £28 annually Car allowance £60 
— Address No 7608 BMA House Tavistock 
Squart WCl 


W ANTED IMMEDIATTLY MARRIED 
ASSISTANT (RfltMi) for South \vS 
colliery practice with early view 30-15 Sibn 
1450 and eir allowance or car provided 
free unfurnished house— Apply with photo rarh 
Address No 7315 BMA House TamiKl 
Square W C 1 


W YNffD IMMEDIATTLY INDOOR A\D 
Outdoor ASSISTANTS for Town anJ 
Country Priciiccs with anJ without view to pao 
nership Good salaries offered State full mr 
ticuhrs — D kitish MrnirAi Burui ij Cros 
Street Manchester 2 


W ANTTf) IMMEDIATELY OUTDOOR 
ASSISTANT for general praaicc r*ar 
Illrmingh im Salary 14^0 p a plus £<0 car allow 
ince if own car Usual bond —Address N-* 
7(10 BMA House Tavistock Square WCl 


W ANTTD IMMEDIATELY OUTDOOR 

male ASSIS'IANT for colliery practice n 
Co Durham to reside at branch Salary £3*0 all 
found (including board) plus £^0 car all 0 Ran\ — 
Address No 7743 B M \ House Tavistcxk 
Square W C 1 


W ANTED END OF AUGUST YOUNG 

male indoor ASSISTANT Enehsh cr 
Scotch preferred for mixed practice m NorD 
London Time for reading Car pro\i-^*j 
Salary £300 — Address No 7307 BMA Houk 
Tavistock Square W C I 


W YNTED AT END OF YEAR WEU 
qualified and experienced ASSISTANT 
With view to Pirtncrship In good<lass muJ 
practice 8 miles west of Marble Arch — Apply »ii*i 
full particulars Address No 7611 BMA }!(?■< 
Tavistock Square WCl 


\1/ANTED OUTDOOR ASSISTANT IN 
* V good-class Manchester suburb Scotch or 
English Salary £400 pa plus LO car allowie 
Applicants should prcfernbly have held hcspitil 
appointments Parlncrship later lo suitable nun 
—Address No "(18 BMA House lavistcsV 
Square W C I 


W ANTED ASSISTANT OUTDOOR MUE 
single English or Scotch for induxirul anJ 
priwte praciicc Yorkshire Arc ^ 

Sihr) rniO incl all foiincJ wiih car allompt 
— Add^c■i^ No 7f. B M X House Tasui-cV 
Square W C I 


W VNTFD MALE ASSISTANT COUNTS 
practice Shropshire Indoor (tach l.r 
hoii chr <“ - - • 

accord ir 
sport 
House 


Salari £300- " 
man keen on 
7613 BMA 


W ANTED XSSISTVNT EXPERIENCED 

G P married Erec unhirnuhed 6oJX 
ESOO pa includlnR car allowance cneli It « 
Si.otc.h Calhohc preferred but not 
Mew InrRe mined practice Chesture Aooto 
No 7S:6 BMA House Tasistosk Square 


iXMNted experienced 

VV with n view to partnership In , 
uburbm practice with good surgical . 

n (Cheshire To reside m and Krp 

irca Preference given to \ 

jood sahry and car allowance Mftlil boin 

atisficd with parlncrship prospects —Auaro 

'309 BMA House Tavistock Square 

RANTED OUTDOOR MALE 
VV for panel and private b) 

loctor m the Midlands ^■''“'3 , Koik 
J sual bond -Address No 7SS2 DMA Hoik 
lavistock Square W' C 1 _ 

ASSISTANT WANTED LONDON r3SlU 
^ worked panel practice Salars i j,, 
eparate house Pirtncr hip soon , 

ZncrRctie soimc EnRiish Irish "f j ^ jl,„e 
irefcrrcd —Address No 7616 BMA 
[asislock Square WCl . 


TANT EITHER SEX 
ith Mess wanted 

Lnt Gsnac or J, SsoJ 

e not essential Rood p M s 

rs photo lo— 'ddress Uo 7<IH 
Tavistock Square WCl 


TOR ASSISTANT RLOHH'LjHj 'J, 
; preferabis married sn j , 

'rcc house cas and cloetrieU) _ 

man c Ncss‘aslleonT>nc 

No 763S BMA House 
,\ C 1 


iN DOCTOR "'pL'LJ/ 

.erics per sscck Espcrien C I 
















j(’u ^0 ms 


Tjn: RRITJSH MEDICAL JOURNAI 


39 


I ocint^ 


W AMin lociM wmi i\riKiisci 

T r I Ijr anJ Ihr II p tal Ip n 
c tr% N n*' rn ItcJapJ M J s\ t l J 
Vr rr'NcT H i\ i' * IVJ pcf ar^ 

pfi Tfc ^■ra't^x arranffmcnt At\ f n 

pt 1'K. 'vl a-vJ all inJ — Kcp t V Tmr> I > c 
Tar anj Ty C'. t H rt'l I ’*- fern fsyem 

Ircbr * 


E NPFRIENCLD IRACriTIOsrR <‘JC01S 

put) want KXTl'l w th h >>"■ a! > I r 
uif ar> iw wc\V in **-rtc^N*' n tar if 
rex, reJ — \u-rr« N t 1 n M ^ 11 l e 

laxt't xV V, arc V\ C 1 


H OLlD\^ LOCLMS \M) \SSIS1AMS - 
Cxpcncn cJ UJ o a^J pc^il 'nen a\a lab 
i-nnctlj cl> X r-ar ft-tuT -re in\ ex. r 
p'-n ca c ' lib— -Tiir ^llr*K i- \t!N'i I tn 'r 
5. t.th n S reel S ra-tJ \\ C 


H O^PirvLlT^ LOCIM— Docior NMLLisr 

t c'cb “n c'a alxii'ninre^t'^fr 
1 an pf bxixc in a p cavart iJe pace Sea rj 
ha f I f Au-nnt f i twx if i^fce we<l•^ p' 
TcryJ i« t a T-i-*nb N\il pri x. c^T a’'« aU 
I her cxpx.-xpN Epc ish ! \\ acii i ■^cO \ tit 
rraiMTc C pryTato — 

N "n B M \ Hcht'c la^*'fcxl. V-arc W C 1 


r DI\S DOCTOR QU VLiriFD 

LRCr LRCSiFi-nl rc> uirr Lr~v. n 
rcQurcs LOCLM r* ASSISTVNTSHIP Cl 
circTicnrc n-iritrul -**J; edf en r*^rt ct 
'e-J'Tjl tex 'nonul — AJ-fO' Nn “t ^ B \ 
House Taaa texL Square C t 


L \m DISH SSI R lUQlMKLS LfXTl'M 
WORK I xixrien cil c\ client referer c% 
M Nh VWccrini. and Dpev rittnu — Wdfe> No 
N t n M \ Hue Ini xxli. Sqi arc W C I 


T ill Ro\ sL \R\n MrniCAL corps 
\SSt)CI\IJON < Ec Jp'f n Sciarc 
S\\ 1 (Tel r'xt nc Xiicna <u"p1ie< 

Q al I ed 1) rep'en D oklkcercr* Lahtratory 

\i lant San nr> \ i tar < Mac Nur c< 
Men'll and Spcx. al Ircaf^c-t Oa.cfl es Dcr a1 
Cl il. O i-erlte* I tier Circtakcn ct wiibcui 
cSircu ti rf'^'pevt c mrlo^cfa 


VAiiTsj n^iuirs 


W VNllU 
*. rir^ 
- J S J rn ( 
c '•c s»n p 
U ’re N 
N} ri. W C 1 


PXKlNIKSini IN ILlSSNNl 
I wn •» 1 1 e nvJ IX f^«uwifcr> 

c e e ( ) ke n e*'crt i Sv n* n 
He »» n Sh re h t € 1 - ■< 
f n M \ H i r i r xS 


W ssrrn aiiik rRiiiMiNsRs vssis 

ISNIMHI I SRINI ksilir n V mf> pra 
t c in lj t hv M R C S L R C I 

naninJ af-xl » t( p lat ct*vr n e >c f\ 
C P Mn. nc pre erred SeJ c N f r 

B MS 11 n. I JM i xV S are W C 1 


W SNTCD ns OMORD CRSIM \U 
aex! n IT eJ 1 SPlNlUSHII m belter 
Jj pr t e in rr w c f wn IJ m n.il 
fa 1 t en nip al atadab — \cs-frs S i 
fl Sf S Hx»c Ta 1 t(xk S3 larc WCt 


P SRTNrRSMIP W \STED . 3 MOVniS 
rreltPtinar> \ i tanish p (in<Jx*r if pcrsiM ) 
SertemN.r EtHS Orihnraedic Casually Sur 
rc< n II >rs Mental Hospital appo niment 
Sin ChBlGla ) Catholic ^0 >r< Surjcical 
X. re— \ddfc< N« "61 > BMS Hnu e 
Ia\t texk S 3 ii 3 re W C I 


pVRTNrRSMIP OFFERED SIELDING £1200 
a Two ea'x r'> S Sc with ir lease later after 
h rt js tar > M ted cereral p’^eticc South 
C a t Nppl nnt rnu t b cnrcnenced B^in 
fXrtibcr Isi — VuJrcx No *11 DM \ Hou c 
Tail i xV. Set re W C I 


S I SSr\ -col MRS PSPINERSIMP SSER 
ape srr 1 1 ir rca ir P r J I it) 
Ho c i< rent £ d C x-vj rcichb mhryxJ and 
» h u Premium iw vfifih hare 'wt h in rca c 
later) I jetr r rha'C— Sddrc' Ns f. 

B S| \ Hue lasi "xk Square 'S C I 


T hird psrtnfr reoi iked mter s 

rrcl min f> a tan h p in ery r o-cr-ab* 
I bed pr err c ithifi **1) r"i m Lorx.'-'n Mir-t hasc 
I n scr tv u cr e m med ire iprcfcnM) Oion < r 
Cj**t b> and erpenen e n paiho m or rad niom 
rh di- in au- n h her f~es.s3l qua canons 
M xem b-' r tjl hie hoi et — SdJrcx 
N *1^ B M V Iliri c I ( xk Square W C I 


T hird isremp pfoiiked rspidls 

ir-rea "s p acti e renr Sian Hester *^*-arc 
on rb rd (I i'''X) I scar pur ha e tl 'd in- 
tJudin Nh k deb Great "x Lar- h v jn- 
estates immcuudc fntrxfut r> Ltx im Tcred 
II week — \£,<-rr* N f / BM S H xi c 
1 as I t xk Sq re SS C I 


L XOS DOCTOR LRCP \ND S LM 
D P H a-ojs sole charpc and d "sns ne 
cxperie^ cd desres LOCLSIS in Lend n S \\ 
free Sum t l*h— -Pbonc BtUersea £ (b<N c 
II an) or VdJrc?« Nr ""d DM N H^use 
Tat) texV Square SN C 1 


r OCLSf AtGU^ NEAR NOTTlNGHASf 
i-r S<sen-*ui-ea C'ne fumca t'a'^'Vft alow 
ance— Au»res No **!•• B Sl A Hcj e Faint >,k 
Square SS C I 


aiEDlCAL rOSTS DISPENSERS 

A L.ADS DISPENSER BOOKKEEPER SI P 
plied ir-mediate1s tn request qua fed 
ard wiJi practical exrwcr e In pniate rraakc 
aod t pcftsary wok al o traip-d m Bacteriolocx*aI 
Labcratorics of the LONDON COU-EGE OF 
PHSKMACS FOR SVOME.N Pre-annors for 
Exatrinaticn. — SS ntc wire or pSPn- (Daps 
water 09^9) Secretary 7 Wextboum- Park 
Poad S\^ 


A COURSE OF TRAINING IN DISPENSING 
and Pharmacy 15 rten at CORDON HALL 
SCHOOL or PHARMACY and Stfcrriary Dis- 
pensers can be up* led to Doc»c?5 Sessions 
January ApnT a**d Serto-ber — Arrif Pr ncipals 
Sehx-l cf Phama-y Drayton Hou>e Gordon 
Street W C 1 Phone Custon 39^0 


pHAtFFEUR OR CHAUFFELR SECRETARS 
^ O'er -0 years clean dnsTfic record carape 
work hon ard electrical ctpenertec all runnnt 
repafx bcxkxccpinp i pmr corTesporucnce 
killed in phttottraphy unm’sea hab’e refertn cs 
married — W u^t* -0 Hasunps Road Maidstone 


r^lSPENSlNG CAREER FOR YOUNG LADIES 
FLLL TRAINING for Ar*othecancs Hall 
Cenreatc Enrolments cicry three ntntbs — 
Apnly The Pnnmpal Central School cf Pnarmacy 
SfcrctOQ Street London S SS I Tcicphon* 

S t torj 1641 


T^ISPENSEP (HALL) AGED 3 * SEEKS POST 
-k-' »iih Doctor or Hospital 3 ill make h msclf 
ccnerally l eful collected dxrtcrs bill kept books 
Highest referen c< charamef suarantced by firm 
of solntors — AdJrcs No ‘ 0 * B '1 A House 
Tasntock Square W C I 


TNOCTORS REOLIRING QUALIFIED 
-k-' Do'^men Nurse>D pensmn Secrct-ry 
Di pen ers or ChaufTcinc-Dt pen ers arc muted 
to write wire Of phone Temple Bar *S<S Tar 
Dispcnser s BLTtEAi, 3 Lindsay House 1 "I 
Shaliesbury Asenue Loridoa W C 7 


T\0CT0R (LADS) REQLIRES SUPERIOR 
■k*^ CARETAKER for urgery in good residentul 
suburb near Biiminzham Conicnicnt ntxJcrn 
httr-c with accommcxiation for three adults 
Rent free for sem cs — Address No 614 B M A 
Heu c TaMstexk Square AS C 1 


^llllllllllllllllfllllilllflllllllllllllll^ 

S The Name-, and Addre^tes of S 
s: Adicrti cr\ u<ing IS 

I BOX NUMBERS | 

S arc held b\ us tn stncl con S 
— fidence Tfid m i\ noibcdncloscd 5 
S Applications sliould be S 
S *<paraicl\ endowed nnd clearly SS 
iddrc*>Acd 2 


AddrcM A'o 

BAf A House 
ToMstock Sqttcre H' C 1 

AH comm tti an r arc forwarded 
to uicrtiscrs m cr r’a n \cr 


=niiiiiiiiiiiiiiiifiiiiiiiigiiiiiiiiiiiniF 


\\/ANIED BS CAMBKIDCE GK ADI ATE 
aced J r*3med PARTNERSHIP m 
C luntry T wn in Ss'uthTO Tnclard Share to 
r^xlu c f f (ifV) ret » r more Own capital aiailab’c 
-Ad-res No «. B Al \ Houx< Tai»tx:k 
Square S' C I 


D eson cits — rsRTNiR wanted 

AN It Cl Oh at - ye rs pur ha c capital 
x%*.niial Adequate rca on f r d p>NaI Ihy eian 
aged abi lit ax rrefened Pinel ab e t I tPO — 
Addres Ni t B A| \ H<uc Tail texk 
Square AV C I 


J LNIOR PARTNER FNGLISH SCOTCH 
Irish Prctcstani want^ in bi> ( du tnal 
rartn r hip Nmh Ltndon Li c m during pre 
iim nary A i lant h p Star csscniial parti-ulars 

— Addres No 6<V B At A Hou c la'ivtoek 

Square AA C I 


L ondon —HAL i SHARE partnership is 

o Tcred m a non-dispcrlsir** r^racti'C tuated 
resiccnlial local tv Sit corner hsc aiailablc 
G rden garage Recapts £_ 00 £2 00 Small 
panel Prem h c and half-share tn PO ca h 
I or fi rthcr Ociaif apply The AIjdic i Apexo 
Ltd h- Southampton Street Strand A\ C 


P artnership yielding £! oo rising 

ofTcred aft r i nc years pr tirnimn a s lant 
hip in rrtv d practice in large Kentish town 0 
nil's fr m Lcruon mod rn house av^ilab e f r 
rent rig Appli'^nts mu i tx und r cl 

qualfed and v iih c md txrcncncc — Ann with 
full rortnilars and rceeni rh i gnph Audres 
No "hH B Af A Hiu e Iwvi tO(.k Sqiiir 
AA C 1 


W EST LANCS COl NTKY TOWN PARTNER 
SHIP In firm of three Sen or rcttn"t 
A lied pruaic par I (3 U t) av-rage receipts 
L5 *r0 Wcll<ujti^ed ph> xidn requ red Pox itJs 
tafl apfointn-ent m mary Fifth quarter hare 
two years p-trehase mclLdi"* druss bonk debts 
Central sur-enm aNn from r » ate rcMdcrce — 
Awfcsi No *6 BAIA Hou c Tavisiovk 
Sqi are AA C 1 


PKACTICES 


W AN I Li) lAlMEDlATELA PRACllCE, 
L “u n Ir me tl W upward Panel 
exsenful ArtrMe mpiul N aifcnt — Addrexx 
No w)* B A! A Hou e Taxi tock Square 
W C I 


W ANIFD CENERAL practice IN 
Lord n ir me about t- 0r''o per annum with a 
vuNtantial panel Prcftrablv N AA AA o S \\ 
Ca h wxailaMc —Address No 60 B A( a 
M ou c lavi ixk Square AA C I 


W ANTED PRACTICE £I 00 TO £1-00 IN 
South of Eng and A! ddlt cla with pane! 
Good garden S^hola ii fanlities e< cniial 

Capital immed aicU ava labic Simly c nfidcmial 
— Addrex No fiO** B Af A Hue T-vi txk 

Square AA C I 


W ANTED IN LONDON OR PROAINCES 
PRACTICES with in on's l *>■) to £ O'x) 
pa Many pur ha ers waiting and quick 
iransaettt r f r tmrrcdiatc a fi — Prscook sn 

Hidiey Lrn 6" t Chan->s Street Sir nd 
AA C- 


W ANTED PRACTICE PRIVATE AND 
Panel Apnl next Res den lal uburb of 
city North Enelard South SsotJanJ £ OO-tlOOO 
per annum (certifies.) Gsod h use garden 
garage cs cniiat Ca h aiatlablc No agent 
Addres No "6 4 BMA Hou c Taxi icxk 
Square AA C I 


A BERDEENSHIRE — GOOD GOING 

medical PRACTICE i iih n cay di tarce of 
Aberdeen for sale Not r-cessary to par base 
house The present house mas be rented —For 
part 'mlars apnly to Mfssks Hcxtz* ssd Go»dos 
A dvocates - - Lnion Street Aberdeen 


A NLAIBER OrSAIALL PRACTICES AT LOAA 
premium- LtccHcnt opponurutics for pra 
tiiioncrs wishing to get a practi e with *• — 

Appiv PEvroOi sND HiDiry Ltd 6" 6 n*. r. 

Street Strard AA C - 


E stablished ajedical practice for 

Sale m Aberdeen h re wuh Modern Hou e 
and Surgery Electn ity Garage etc Good 
c untrv par'd — Particulars from J AA Stihino 
S clH-Uor *0 Dxtgla Street Dunfermline 




































40 


THE BRITISH MEDICAL JOURNAL 


30, !93S 


F ashionable se coast kesoiu 

Present ouncfs hTnds 10 jctes 1600 p t 
neu 2 Ktrs purch'isc Six hedroomed liou<ic md 
c-^rden f rcchold £2 000 niusi be bousht — 
Address No 6620 BMA House Tasistock 
Sqtnrc W C I 


F or sale NORrHUMBEULAND OLD 
estabUshed country PRACTICE A\cnj.c 
income £1 120 Panel ncirly 700 Prcinium U 
iCTrs Commodious house ssiih ftrounds and fish 
me riRhts Sell or let ssith uUimTlc porch isc 
P'lrtical'irs— GAKroRTH Drur^ and Knichtino 
Solitiiors Newcastle upon l>nc ! 


F or s\le —woman s practice in 

crcasinR m (country) town within ^0 miles 
of London Sm ill Panel Educational T icUdics 
Premium £1 soo —Address No 774*^ DMA 
Hou c Tasistock Square W C 1 


L ancs — old established practice 

steadily increasing Panel 2 450 Gross re 
ccipts £2 JOfl fsso pood houses asailablc 
Premium luo \e^rs — Address No 7744 BMA 
House Tavistock Square W C 1 


L ondon —unopposed practice tor 

sale m grovving western suburb Incrcising 
panel of 7^0 Receipts for past year £MQ Rent 
£7'l pa Premium £kl0 cash — Address No 7620 
B M \ House Tavistock Square W C 1 


N ear holborn nv c — well estab 

hshed PRACTICE Receipts avcraj^c £l 000 
p a panel 1 104 Splendid surgery accommodation 
only Long introduction Premium £2 000 — 
Apply Pt ACOCK AND HADitv Ltd 67 /6S Chindos 
Street Strand U C 2 


N e^r putney sw— death vacancy 

Old established PRACIICC Rcvcipts iboiit 
£2 000 p a mcludtnR panel about I flOO Nice 
surgery premises rental Offers —I fACocK and 
Hsolfy Ltd 67/68 Chandos Street Suvnd 
\\ C 2 


O LD ESTABLISHED COUNTRY PRACT/CE 
for sale £600 n« good appointments and 
panel nice roomy houyc £60 und garden rates 
£1^ —Address No 7559 D M A House Tavistock 
Square W C I 


O PIUHAIMIC IN IMPORTYNT IUSIDIN 
tial and InduMrlal cjiy In South producing 
about £600 p a Considerable scope for expansion 
of PRACTICE Sun I U C S or D O M S 
Usual private consuUailon fees ind anroinimcnis 
Premium tl 225 — AUdrciss No 7615 BMA 
House r iMstock Square W C 1 


P RACTICE (NORTH I ONDON) ISTABLISIIED 
over thirty years rctcniJy taken panel 400 
Splendid scope for energetic able min 1 ailing 
htallh PrcmUim £600 or near — Address No 
7612 BMA House 1 iMstock Sqtnrc W C I 


W EST RIDING OLD rSTABl ISHCD PUAC 
Tier aver icing £1 400 Panel 2 200 m 
creasing Amplt scone Premium £2 500 
Pleasant house tennis freehold £1700— Addres 
No 76^1 BMA Hoiivt Tavistock Square 
W C 1 


HOUSES. CONSULTING ROQIMS 


For ata}}fth}f 

CONSUITl^G nOOAIS. 
PHOrLSSIONAL HOUSES A FLVTS 

In Harley Street and the medical 
area generally Including Mayfair 

LEY CLARK & PARTNERS, 

AUCTIONEERS SURVEYORS k VALUERS 
3a Wlmrolc Street Cavendish Square W 1 
Telephone Langham 1095 6-7 
Represented at Cannes Nice and Monte Carlo 


C ONSULTING ROOMS WITH USE Of 
fully equipped tray room service heat dee 
tricity fcvcptionlst provided exclusive Miyfair 
position reasonable rent — Addrc« No 7^02 
B M A House Tavistock Square W C 1 


D evonshircstrcit two doors prom 

Harky Street an cxcclknt CONSULTING 
SUITE of three good rooms in one of the fincvl 
professional houses 7<cnf only £250 pa or 
smgk rooms mvy be had at £100 pa with phie 
on the door and all services \acam Sept 29ih 
J91S — Address No 7610 DMA House 
Tavistock Square VV C t 


HARLEY STREET 

AND MEDICAL DISTRICT 

Pot nil lypcs ol aviilablc accommodation 

BERTRAM & CO., 

50, ConnauElU Street, W 2 Paddlnslon , 542 j 


, tf' T COVSULTING ROOMS are 

n\ nhbie tor lull tnd part time use at modtra 
rems Piriiculars on npniic-iiion -Etoooo ra 
Co to Henrietta Pince Cucndub Scout 
W I I^ng 260! 


PARK LANr-ADNPRTlSER SMSIlCS TO 
*- meet consultant with view to LETnVG 
ROOM Use wailing and ladles room alvosmll 
1 rays £155 pa Vacant lunc Refm o- 
Vddress No 76^2 B M A House Tai txl 
Squ ire U C I 


Q ueen annc street— only fw pa 

secures exceptionally fine CONSULTING 
ROOM for use when required with aucndince stid 
all services Residential accommodation aniljb’t 
— Address No 6355 BMA House Ttngcck 
Square \V C 1 


S T JAMES S— LARGE LIGHT COSSOLTIVG 
ROOM to let in good house Very raeden 
rent by arrangement Also others m all di tnas- 
Apply Taitii asd Eastmvn 21 Sackvallc 5r* 
VV ! Regent 7565 


1/: VVELBECk STREET Wl-IUXIRI 

furnWhed SERVICE SUITES to let Urr 
silling douhk bedroom bathroom grounJ w 
noor— Wcibcck C^65 or write Manageress 


W r^ END MAIN DOOR FLAT AT 
bargain price— In best part of Wesicf 
at 15 GIcncairn Crescent Edinburgh cpniair i 
2 public rooms 3 bedrooms and mads fW’ 
2 bathrooms kitchen pantry Being no« few 
stfucted in modem manner and will 
purchaser X own taste —Address No 7 n" B'lv 
ilouse Tavistock Square WCl 


SMALL ADY^ERTISEMENT FOR INSERTION IN 
BRITISH MEDICAL JOURNAL. 

The Minimum cinrge is 9s which covers up to '^0 words EMn words ^re chirgcd Is 6d 
for 5 or less Esimplc 13 words would be charged is for H Name and address should 
be included when counting words lor cost 
If Box Number is used it should be reckoned as 5 words in the lotil 
PLEASE W'RITC Cl EARI*V— ONE W'ORD IN 


1 







2 







3 







B 





— 


H 







H 





(30 words) 

91 

H 






!0li 

8 






121 

9 






13/6 

10 








Please insert m\ advertisement in 
dated 

I enclose remittance value f 


issues 


Name 
Add I css 

Date 
















THL BRITISH MPDIC \L JOURNAL 


s 


l Ml h f OK 
CMOOl 


S ccr *• af''- c p nt lif '0 tn"* t hath 

r yy*^ \-»'p f of* T' central hcatinc 
srWDINC IS \ri ROMM \1I L\ I \CRJS 
^v. ea f; "t aJja cri i and n entte 

I t nn (\l^V Irexh J 
j>«nvs C*v N\ «TmM 1<I 00 


MIDICM NRl \ 

T > nrSVM. MFCUSSICS iJR UVR H 
v«. t h In I r Kli rr« v c nxcnrvl C n 
sit ft Hyv< PVSIMISI ROOMS j let 1 « 
K Apof^ 0«T*cr — Jrty' S S «t 
It M \ II yj c la\t vV. S,s arc C I 


S MC ori>isr — DisrvL rrsniri 
nv^ e-vb s Sft *»> t !(-• S ^^ d u t 

«»3!tsic rtx*Ti w rV h n i y r cr c n 
i r*^r h xr- f cytah •>hed v- vi r irnl C ^ 
cl c— ^dv-tev N Nb nM\ II r 
la 1 xV V rr \\ C 1 


MI«?CEI U\M OU<; SMIS etc 


IMPORTANT 

lo ^11 MHl R*? of ihr 

^ii 01(^1 rHon>sioN 

CLOniLS or distinction for CENILIMIN 
f niSCRIMlNMlNG TaSIEL Spevull) Ci i 
ii red «rKl Moulded to r “h loJt »d I f r e 
mace frem Timt Qiul t> Maicn- and >n the 
B-xt Toy ih c S ' e cot ro trewe than r* 
rrsx.jnon ipjd> r^jce clirhm 

The m alcah e Practical Ccrcnrnce and ^cv c 
f oir 14 Ltpert W e^t Erd Cuttcrx and Titien 
»% af»a>x -t tojr dxps'x.l 

\U HVIJ^ONL r«l Hon are IIWU 
IIMylllD IN IMJR\ IUTMI- 

vrfCI »E Otftft 

J M M r A M >T On fcia k nr ere I Cl I 
Ini h^t ju I I \rt *' tin \ i x IV n M| 
*-onil MNO ^OlvTID THOI^III** C2 S 
Tie I I al '‘tilt f« Prvfm onal fu fnr cej 
I Ol Nt I '•I IT> to n r ure I m l< < 

OM! lOXTs ^ *. C* • 

UINM II M ITx cn H 

ni I**** l iTx f o CIO lo 

I 1 1 y I ni II st IT*> r Ot cr f 

Till ini M It fo C onir* n I rtJns V 


S MlOkl) K O N A L nosilTAl 

t r Bet ) 

^ppl am 1 an. Intucd fr m icci tcicd and 
d (nnic) f t 

KlSiniNl StRCICM OrriCER ftr !«che 
m sth (f yn O t l<r I t Sibr^ £ 00 per anmm 
HOI SC rinsiLiN'^ 

HOI SI SI RCIONS tlhrcel 
CSSI MIS noLSI SEKCrON 
Is r t » m nih ft --ti C> t >her Hi NaJart j I t 
per ann m 

I ym < f appl t n \ bta n Me ft ’t^ the i n cr 
tncvt 111 he ccliterrd tn n tyfcrc 

S r errher l rS next 

fb f) L f f tic B ^fd 

II n SHilSUUL 
C octal s p t» tend rl jp J Secret r> 

J Q h 1*J» 


S M.IORI) I OS SI HOMM VL 

1 * Pec I 

\p*' » n tc m i cd ft 1 d f» Ji 1 c J 

part «*cfx » r Ih P'^'t t f R MIlOl OCISf tr n 
fey u ^ * f r attet' n c e eh r- tn nr tS "v.., 
r rp 'cl a**-! at nh t m'-x a h ret; roJ 

N art ft per an m T»»cl e me “ h m 

r*c i ten laal e Ihe cv f »1 an t e n 1 he 

le^ cd I » tV ni.* f she per n ef the 
H x af\ Pa J > r 1 

\rr t t t c re rJ q af r - 

I whcf •> th * text m na ard eert f tc 

t 1 ter tfati n c he ac c yed at *“ c to the 

I Pw rn d If yn nh -nt II p. rt br m t he 

ht ?p d 

R Orcer t the IVufd 

H n Mift^vrLL 

ene af S re mend rt nil s^ tciart 
Ji t rd iJtH 


T he IMIS ciiiriirsiiK Hr>siiiM 

lit \e BncM >n 

( « I r ti n 1 Ncr\i j D «<a e 
no B-ct ) 

SENIOR HOLSI rilSSICIAN momanl re 
c I red St mentK apfy rtm nt fKO ryt ann n 
alt fe» nj \ luahlc openeftee f r I) pi m jn 
P eh ex*al Med me 

M o It NfOfC fm -y-anl at f < pet nn m 
Oyrmcft c end i f 1 ♦ 

Spr I ail n «iih text rprn t he e t t l‘•e 

SeereiJfn Sir P T Spryyrr M \\<xi s ffft 
B ht n 
Jjl> . th IQtc 


(Oil) Stnui nilMM ItfllKHIx r on. C. 

iHiUM n\iiiT'» c« n 

IHPIM MOOpn 3 

(OxnMIn ^ lOM COVT* « If r 

tNsoLicncn aepreciation 

I it rntl nl e al! mrdr-f rtrn n/ n Ir /o 
/ e * 4.1 fact on t jv cm e Ita. j lla!l Lid at 
/ r dc h > / far had / o ►» <1 rm f irx ^ 
\fc I / e heen f>f itCi m fit Cut erd Fir h 
iSrned) SJA Sl^ MB FRCPS 
PATTERNS POST FREE 


Pafcyt Eit Guaranteed from S nple Self ne re 
ment Term cr Paticm Carmertt 

S» ilo to Ion Ion an *>r<ler n I ft an 1 y 
xf>*y I Pall fi «oal I then L ut n I J e f I 
l'■tl nr CIoll n* uppi e I ft Miihonl I Inc n 

HARRY HALL. LTD 

Cotemnr D rector Haro Hall 
Till Co I Ifrrerl II bit an I (.o i n e 
‘‘pe ixli 1 

in oMonpcT^tt I 117 (iiKKr-iiiKi t . 

Tettph res 

CERrard x'AK -gOn and •V'l NATi nal h(9f " 
MaVc'x of Fipest Ouahi) Br'PoVe Civil Spv rt nr 
rd Huntinj Clcthet for Ladies and Certicnten 
lllel e t v..a ! ir ( ol I M I 1 
L I o If) ye 


INCOME TAX 

SOUR bu lea i OtTI bu Inm 
Ta xp^l 1 , ij,, profm Ion 

H\RD\ ^ 1L\RD\ • 

4» CIISNOJIS LANE. LONDON ST 02 
r I phone Ilolbom f t 
U rite to /reererrof Athice on Jrcomf Tc.^ 


APPOl N TMEN TS — Con t d 


E ssen counts hospital 

Col'hc<tcr tl''4 Beds) 

Npp! *al pns arc intttcd from duly rcf tered 
ren lemen for th pot of HONOR ARS ASSIS- 
TANT SURGEON Canva mr di<Qiialificy hut 
th Tty t p e< of app icatjon and three iccent 
rexT r~ rals nay be yent not later than Autu t I-th 
to the Sc fctary for circt I ti n to the Scle non 
C mTrntee 


R OCMDALL INIIRMARY and 
DJSP fNSNRS 

fllO Bed Three Rmdentt) 

The B.\ard of Manacement invitct appli ji ri 
f f iht Appointment of HOUSE PHSSICIAN 
imalrl The xabry attached to the app< intmcn 
I at the rale tf fl 0 per annum with board rexc 
d n e I undfy The d itic< include work n the 
O I J Mient Aural Ophthalmic etc department 
a well a In ibc ward The Hfxpittl enters 
a brpc industru! area md afTcrdt excellent 
"poftiin IV f r cxpcri-ncc 
Apr at om ratine arc nationality ei v» th 
thre Iccent icstimonal to he vent to the Sevre 
Tir> R Kjjdalc Irf rm ry 
Infrnary OTee W WSNNE 

P xhi, le Sccreia 


T ill N^||f»N\l SSNSIORII I 

B r neen Kent 

Ihe ( m il f the Sxi ral Safuirnt m S y 
I n in c apx i n for the pext of Hf>l.Sf 
I MS SICIAN 

S I rv il (t per n- n with board rc'Kitr 
rl I '»Jr> The J cc f I -rJid.. e « 1 b 

app I ted f<’*r a per xl J x month c 'mmen n 

Sc'* ember I t I *< 

( rj u lex nu I h-* f Ms coil Ecd and rev rcicvi 
Spp at! n atir- -x* tut rjahty qi fc 

t f n and c r^r n c tor- her » ith op ex 
Three re ent text —on d houlj he m. t i*'i 
"dcr rnexi n i bter tb n \t:n. t yth 

C r LNSSRINCE 

4 V\ ext II I c Hon Sevr t rx 

Oeam S rfc> 


R OS M SOI III MASTS A SOlTHAMnDN 
IIOSniM f H Bed) 


Npr <.*» 'f» le m ted for ihe f I winr 
pr< tment 

(He RISIOCNT NNAtSnriirnST for the 
roTKvi end n Dccrm>x*f tj i jq c at a salary I 
il (I per annum w th bo. rd lod m and I un^rv 
CarvJ daicx mo he ma’c rO unnamed 

Appl *atiPOV acc^fxaned bv r l m re tb n 
three i«xt r- jx h ni d be xent t) the ndcr 
rned inmecutelv 

s \\ r VRNLS 

Houxc C 'xernrr and SecTciary 


R ot \l alfasndrs iiospifal for sick 
CTIILDRCN 
Itr chion (I() Beds) 

HOUSE rinsiCIAN (ru el rcciii cd Sa! ry 
at the r tc of fHO per annum with Ixvard Ixlrmt 
and laundry No can a< mr at med The H xptal 
I rev* m red for the D C H D plorra 

ArpI*C3l ont lo wniinr a cctnpan -d bv icxii 
mo- al hould be ent to Sfr PrrO F St vtstt 
Sexrclan Dyke Ro d Onrhton 
July Ih 


W FAIMORLAND COUNT-k HOSPITAL 
Kendal Reds > 

HOUSE SURGEON (female) required Ser- 
temher fit Appo ntmcni tx for x mmth 
rrnev»abc for a tjnher it minrhs 

Sal ry £ W> ncr annum with hoard rcxH-cncc 
and I t ndr> 

^pplicat n taint arc nat cnality and quali- 
fc ii nx with copiex of three recent text n n al 
tn he accrctNcd to the Hon Sec J M Semer 
xrll net later th n Aumsi 4ih 


W MiNrioKo rrsrRNL 

I rxr- n-t xp Spa 


RrSfDtNE CASt SLFl OfFlCEr nu 
HOtSE SI RCION JO re f ih Hr rar 
s. rrc nt rccu red h» Atiru r Prh Su rr r h 
appr-rtneni S.,1 r» tl 0 per annum with h rd 
rd lau-ury 

Appl lion from qualif ed rert tered Sfccical 
I f.1 tit oner hen d N- xert I rether »vih three 
fcxcnf rpxt m nal to the un'^ctMtretf by At r t 
IHh l^itv 

ri>U \RD I u JRGMAN 

Hope Covtrnor and Secret r> 

J ) tjh lOK 


W Allf)KD ANr> DISTRFCr 

Mf lOklkL HOSPFTnL 


App aiun wt invited for the f IMwinv p. i 
I r a pentd tf x rrrnthx lo cofrmcri c ct ex 
ry n x pox iMe 

HOI SE SI RGLON (female) 

S bry I the rate of tl 0 per anmm u ih 
N rd xnd I mtfy 

Ap-xl ati n 1 t n- re rut rulity ?nd qu h 
t at t inrether w :h three text mon al i b 

f rx* rue I t lie nerr pr d forthwi h 
T H FLETCHER 

Secret rv 


T HF HOSPITAL FOR SICK CHILDREN 

Ne»ca tic upon Tyn- 

Vppl catK px arc in iied for the poxt el 
lUH sr PinSICIAN and HOI SE SI RCEONS 
im tc f fern le) f r ix months ax from -kurj t I t 
IRIS Stbry at the rate of flCO per nn im 
toretber wnh board res dctKc and laundry 

Applt aiicrtx latinr arc and qialfcaiicr to- 
rcihcT w th cv p ex of testimonials to be ent to 
the Secretary Sir Nfji D>ooie IS Cty R «ad 
Ncwcavile-upcrx-T) nc I 

T HL HOSPITAL FOR SHTK CHILDREN 

Newca ile-uporv-Tync 

The Bxxrd of Manarement has d .^cd - 
at- n > for the pc«<t of HONORARY OPHTHAL 
MIC SURGEON and n lies apphcaiiotU for tb 
arr inimert tatinc are and Quahficaticrts u ^ 
I I rw rded to the Stcrciary Mr Neil Erode fb 
City Ro. d Ncwca tle-ur^n-Tync I accomr-..ned 
[ vs th picx cf three recent testimonials 


R Ok AL SOUTH HANTS L SOUTHAMPTON 
HOSPITAL ( 56 Beds) 

Applcali'inx are invited for the ro<i of 
CLINICAL ASSISTANT lo the H merry \n3Cx 
then t Pann of auahrcaiio’tx and expener c 
hojid be xenr lo ihe Houe Go emor _r>d 
Secret rv not later than AujrvKt lijh from whtro 
any further infentiation may he obtained 


QHARING CROSS HOSPITAL. 

Appti-aiiors arc invited for the po<i cf 
CLINICAL ASSISTANT in the I ray and Eletro- 
iherapeutsTS Department Candidates should ha e 
by p cfcrcnce the qua! fication of D M R E 

Anph-ationx together with copies of three recent 
lotirronu x should be ent to the urdcrsiyncd not 
later ih«n Autrust rd 193^ Honoranum £_0 
per annum 

(Thannf Cross Hospital GEORGE J JONLS 
London CJ2 S-vicl ry 







42 


THE BRITISH MEDICAL JOURNAI. 


JuL^ 30 HIS 


W OKCESTER COUNTS AND CIT\ MENTAL 
HOSPITAL 

Powick near Worcester 


Appiitiiions 'ire m\iicd for the post of 
ASSISTANT MEDICAL omCER Apphemts 
must be male stoRlc under thirty five icars of 
nee Tnd duly qualified in medicine and surRcry 
Commencing salary £350 risinp by annual m 
crements of £2^ to a masimum salary of £4^0 per 
annum toRciher wiih furni hed apartments board 
laundrs and attendance A further £'50 per annum 
will be paid if the selected candidate holds or 
obtains a Diploma in PsNCholocical Medicine 
ExpcncPLc m Anaesthetics will be a recommenda 
lion The appointment is subject to the proMsions 
of the Asylums OfiTiccrs Superannuation Act 1900 
Applications siatine tpe and full pirticulars of 
quahhcalions and cvpcritncc iccompanicd b\ 
copies of three rcccm tcstmionuK to be forwirdcd 
to the Medical Superintendent not later thin 
\Vcdnesday August lOth lOtS 


S T PAULS HOSPHAL TOR UROLOGICVL 
AND SKIN DISEASES 
Ended Street London W C 2 

Appheations arc imued for the post of male 
HOUSE SURGEON Candidates must be qualified 
and registered Salarv £U1Q per annum with 
board residence The appointn cut is for three 
months in the first instance and the holder will 
later be ehcihlc for the post of Resident Nfcdical 
Ofiicer Durmj, his appointment as House Surgeon 
the duties mvolic work tn the surgical ward and 
in the out patient department 

Applications wuh topics of recent icsiimoniah 
to bt submitted not later than August Hih The 
successful candidate will be required to take up duty 
about September 14ih 

J P KET CHlSf ETT Secretary 


YORK CITT COUNCIt 
PUBLIC ASSISI \NCl COMMITTEE 


Applications ire inMted for the appoinimcnt of 
a DlSIRICr MEDICAL fimcCR for the North 
Medical Relief District of the city at an inclusive 
silar of £130 per innum The successful apph 
cant must reside wtihin the District is proiidcd 
bv the Ptibhe AssMance Order of fOto further 
particulirs as to the extent of the district tie 
mav be obtained at my ofltces 
Applications must be rcccutd by me not liter 
than September I2ih 193S 

1 Museum Street JAS S\ BARNES 
\ork Ptibhe Assistance Ofiicer 

July 2lst 193S 


E ast ham memorial hospital 

Shrcsvsbiiry Road C <104 Beds) 


Applications arc inMtcd for the post of HOUSE 
PHTSICIAN (male) The appointment is (or six 
months commencing September Ist 

Salary at the rate of £1^0 per annum with 
hoard residence and laundry 
Appheations stiting age nationality experience 
and full particulars ogethcr with tonics of three 
testimonial should reach the undersigned bv 
August I8th 

REGINNLD PERRY 
Secretary 


OLDEN SOUM<E THROAT NOSE AND 
EAR hospital 
L ondon NV l 


HOUSE SURGEON (mile) required to com 
menee duties September 1st Salars 1 100 per 
annum with board residence ind laundry 
Appheations staling age qiiahlications and ex 
pcncrct together with topics of three tcMi 
menials should be sent to the undersigned on or 
before August }2ih 

r P CARROLL 

Secretary Superintendent 


^ I N G S 


COLLEGE HOSPITAL 
London S E 5 


BKfCHEMIST (naale) required lo commence 
on October 1st Salary £500 per annum with 
opportunities for Pnxaie Practice Candidates 
must be medically qualified and have had special 
experience in Chemistry 

Applications should be sent by September Ist 
to the House Goxernor Kings College Hospital 
Denmark Hill S E 5 from whom full particulars 
of the post may be obtained 


B attersea GENERAL HOSPITAL London 

S\V 11 CS^ Beds) Applications are invited 
for the post of HOUSE SURGEON (male or 
female) Salary £U0 per annum To commence 
duties as soon as possible Other terms to be 
arranged on appointment Applications stating age 
qualifications md experience wjih copies of two 
revent te*Ntimonials should be sent to the under 
signed G L BENNETT Sccretirx 


j^T MARTS HOSIITAL lONDON W2 

EAR NOSE AND THROAT 
DEPARTMENT 


Appheiiions arc invited for the post of 
HONORARY RTGISIRAR to the Cir Nose and 
Throat Dcpirtmcnt 

Candidates must be a Pcllovv of the Royal 
College of Surgeons or a Graduate in Surgery 
of a British University A copy of the rcculi 
tions governing the post may be had on apphea 
tion 

The appointment will be In the first instance 
for a period of twelve months but the holder 
will be chRiblc for reappointment for a second 
ycir 

Applications for the post together with copies 
of three recent tcsimfonnh should Ic sent to 
the undersigned not liter than August I2lh 
W PAUKTS 

House Oovernor 


'HL QUIENS noSPITAl I OR CHILDREN 
Ilickncy Road London E2 
(160 Beds) 


HOUSE SURGEON required September Ist 

TU O CASU \LT\ OrriCLRS required Sepfem 
her lit 1939 

Six months apnoinimcnts Salary at the rate of 
£106 per tear with board lodging and Inmdry m 
each case 

Appheations must be made on forms to be ob 
tamed from ihc undersigned ind Ic sent in with 
copies of not mort. ih^n three ttslimonnls on or 
before August 12th I03S 

CHARLES H RCSSCLI 

July 19ih 1939 Secretary 


W 


f M n t E D O N 

Thurxtan Road 


I! O S P I r A L 
S AV 19 


Applications arc Invited fot the post of RCSl 
DENT MIDICAL Of flCf R male unmarried 
Duties to commence on October 1st The appoint 
ment IS for a period of six months The salary 
offered IS at the rite of £1^0 per annum with 
bo ird residence md laundry * 

Applicitions accompanfed by copies of three 
rccc t tcstimonlils should be sent to the Hon 
Secretary 

A B WARD 

Acting Hon Secretary 


g T T H O M A S S H O ST 1 T A L 
VACANCY 


The appomimcni of a PHASIC! AN and in the 
event of a Physician to Out I iticnts being pro 
moled to the NA ards the appointment of \ 
Physician with charge of OutPilicnts Candiditcs 
must be I tllows or Member^ of the Royal College 
of Pliysieuns 

Appheations with full details of academic career 
and copies of testimonials must be made on 
forms obtainable from the Clerk to the Governors 
ind sent in to him not later than August 3 1st I93g 
He will be pleased to give further inform ition 


gT JOHNS HOSPITAL I EWISHAM SCH 

Apphcvtions arc invited from registered medical 
practitioners to fill the office of CLINICAL 
ASSISTANT lo the Medical Officer in Charge of 
the Electrical ind Massage Department Tlie 
successful applicant will be required to attend the 
hospital on three half days a week at an honorarium 
of "^6 guineas per annum 
ApphiUJons should be received bv the under- 
signed who will be pleased to give further 
particulars 

J C GILBERT 

Secretary Superintendent 


JgT JOHNS HOSPITAL LEWISHAM SEI3 

Applications arc invited for the resident appoint 
ment of Casualty OrnCER (male) tenable 
for SIX months from September Isl 1939 at a 
rcmuncratton of 1100 p a 
Applications with copies of testimonials should 
reach the undersigned by August 20th 193S 
J C GILBERT 

Secretary Supctmiendcni 


’HE PRINCE or WALES S GENERAL 
HOSPITAL LONDON N 15 


Applications arc invited for the appointment of 
HONORARY CLINICAL ASSISTANT with 
special Psychiatric experience 

Applications should be xent to the undersigned 
on or before August 31st 193S 

J C BURDETT 
Director and House Governor 

July 20m I93S 



ASSISTANT RADIOLOGIST 


Anpiic iimni itc mviicd from fu!l> QualiSej jrJ 
rccisicfcd Medical Pracinioncri for the pmi „[ 
whole lime RadiolocM in the Deep Th nm 
Dcnrimcnl at the Mount Vernon Hmnul Noni, 
wood 

Candidates must possess a diploma m ncc^l 
radiology 

Salary to be arranj.cd according to iht quj), 
ficahons of the successful candidate (minimum li^) 
per annum) 

Applications together wuh full details of unth 
mg and cxpvntncc and accompanied by cop!^ pI 
not more than three tcsumonials should K 
received by the undersigned as soon as pon h« 
but not later than August 13ih 1939 

Del Ills concerning the duties etc may K 
ob lined on application 

T A GARNER 

! Hiding House Street Sccruao 

London W I 


TIC RADIUM INSTITUTE AND MOUNT 
VERNON HOSPITAL 


HONORARY NEUROLOGIST 


Applicitions arc Invited for the post of HosTf 
jry Neurologist at the Mount Nernon Hc», i’ 
Northwood 

Candidates must be rcHows or NJemben c! t*- 
Royal College of Phvsicians of London 

Applications together with copies of not rv 
than three tcsnmoniaK should be tcccucd h 
the undersigned not later than September l$t 19 
T A GARNER 

1 Riding House Street Seacury 

London W I 


T he RADIUM INSTITUTI AND MOUSf 
NEPNON HOSPITAL 
1 Hiding Hoii c Street London W t 

Here V ill vhoftiv be i vacancy for a HOIS 
SURGEON at the Mount Vernon Hospital Safi* 
V 00(1 The aprointment will be made fir 
months at a silarv it the rite of £t 0 per w 
with board ind rcviJcnci. 

Applic* tIon sho lid k ^ ni to the Secretary it 
the ahe VC adJfC s 


THE CENTURY 
INSURANCE COMPANY LTD 

7 LEADENHALL STREET 
LONDON E C 3 

18 CHARLOTTE SQUARE 
EDINBURGH 


Assists Doctors 

TO PURCHASE 
A PRACTICE 
OR 

partnership 

NO GUARANTORS REQUIRED 
repayments arranged 
BY EQUAL quartered 

instalments which do 

NOT VARY WITH TLUCTUA 
TIONS IN THE BANK RATE 


PIEASr W'lilTC rOR 

PARIICULAHS, ST Arm 


MENTION B M 5 













Jl'L^ '0 I 9 'S THF, BRITISH MPDICAL JOURNXL 


THE MEDICAL AGENCY, Ltd 

IlLIlIl^ Iiotsr 31^^ ‘SOLTHASIITON ST, STRAND C > 


PERCIVAL TURNER 

no 

MEDIC VL VGENCY 

I fo M vn^■. I ■■, 

;•> MMPLN r^VM::, STKVMl W CZ 

(Ccrr r c( PcxJf rJ ^uctO 
T t t r " Loftlow** 

rhf>ii« Temple n»r KH 1 (3 I n ) 

Mter cfK'c ho m %\ aito^ •vThjT'c^ p ^ 

A tar < a-J L^^***' rriMwfJ »» ficnt fee u 

rt •NH'sa * rractt*r» itsCNtijaifsl Ex V Veer t 
t>c*n Co ^ni-t<r ct 

MVMVIM INCtl'lM | OH 

IDNU ON •‘UJ OJ JUVfTin OH » 
^tlVtl fNCIt’'Hi Ol ltO( *•! IHOUnT) 

I O lALU ON lOOll^T 

I OH |>I'*I 

SL’SSLN CO\ST— £I <00 P \ SON 

r \N l L n n-c *'r I co "oi*' Iir^ »n ^ vt* 
Cixxl hNj>< t< t tc*t“ rt rrceh J r* r*!! 

Ic- —1 

lONDON \\N — \BOLa £5^0 P\ 

I -x! \ IN ts ^ f t *■ I'lCT’ ^can 

r f\N H x-Nc * hcvJ et i t re**! — ^ 

lONDON NW— SHNRi: Ol 0 \hR 

00 ra Pjo I oO>'' Arr <^ct tuvi rco 
. 6 to 10 6 Prem irarx pt- h i~al 1 nai 'n 

SOOTl’sSD (^ 1-COU^TR^ ON PR 
1 Of>' p » :r 1 r~ncl f f i'*t r a Nil tc 
' Pir- D PLT h- c r c"cr ( xxJ 

h reri ct <<lt 

MIDDLESEX— SOnURB £1 0 0 P \ 

Parcl nra r^ P M S ll'.’^i P-tr^ "t 

pars r~-T h-sc C ■*”! h t4 red 1 S< j r ct — * 

SUKREN SLBUKB— HNir SHAKE 
c* 1 (W pa O s^-ot incrca i t r*os,cn» 
r-TL.'^ aix! r rapf t 1 l Prrn L*n £t ro> — t 

DERB^ SHIRE — COUM R\ PK \C 

TICE K I r a roexJ c-i>^ '<levt ttxI n 
aca nr arJ ^ c** of h''^.NC Iren-r* I 

>rr* re i.ha'e — ' 

MIDDLESEX SLBURB — PARTNER 
SHIP ‘•a’r r oJ xj i <0 p a to cax— oe c to 
f* t I",* l*ra*t-s,e PnmiLn . p rvhj e —A 

NORTH NNTS — COUNT RA PR \C 
TICE c J<xt Vm r re t c Aboyt ‘‘I pa 
•"e pa*'«l xorth t'JiO pa * A— s Sj e hxr< 
fi f « e Ptc^ ftn 1 1 ) car r ruh-'^ — .Q 

H'^DE PARK NEAR — PH^SICO 

IHERAP^ PPACTICE a^c^t £I a«0 ra N\cl 
r^t pooe cj A A'"'* c a *ccr*"*oujtjoi jc«t I 
Prr- -t 'I 'CM— m 

I ANCSTOWN— OLD EST INCRLNS 

ISO lOfi pa Select r-nel cf l c^o n e 
{■w^c a-^r c at ^Virn n f' < 

rxl tfi cs Ow 4jr-cfx furn iLfc — -II 

KENT SLBURB— GOOD MIDDLE 

CL-ASS aN-t CO p3 mere-.' “ c ec: par 1 

II i' * h up surren < Nur Tuutr ho -se ( 

V- c r’itl't 1-t I'rcm u**t I >cafx rufwhae— I 

SOUTH COAST— Ol D EST NEXRL'^ 

pa l•^rre- r Fair rare! mi ct3 nid c 
J better ul Deta h-xj b xoc rare n arJ 
rarar- for sale pr rr *■ l-i prer' u-x — n 

COUNTA TO^\^ \MTHIN 100 MU ES 

Oh LONDON —PARTSERSMII in'tcafl Lecc' 

1 n I- LN T Prac*} c a*x'u £J j 0 pa a-x. 
r-xi-Mr* -us t 0 p a 1 cars pi rcha c Pur 
b trr he^iJd hase F R O' -c of hexive— 14 

DEN ON —UNOPPOSED COUNTRN 

o cr £I l(X) r a m rc-urr par 1 **c'rih £ d p a 
Ap" £t-0 pj P'cm tl '• o C\ i«h A, h •>€ ' 
2 '*' I - xm -arden ar^ irra c Iff <_ic t iKt 
A! 'tcjR arrarexi Prcmiix-i (' — 1 < 
BIRMINGHAM NEAR — NCARLA 

(.*1 p a rood sco*^ panel rcarlr CD dc cl *'• 
f*T area Hexj^c t rden tar re f sale ji i'* 0 
t tet ut -"s 6d r \A Prcniiin I (;>• K 

H NNTS — Ol D EST A\ ER NGC 

£1 lOi p a Par I 1 C M APTt' aN ut £|<0 p a Coou 
f r-ilN bOsTse tk-C tarden ard tarac" ti be eld 
nial nenta c arranx-u Pren um ll jear 
purchase — F* 

^ ORkSHlRE DALES — BFAUTIFUL 

Cl n o J-es: fM»X?pa Latte hen. c -nd 

tn ord rent oily tfO pa Su t lexiucTH patents 
^rul cf hc-se a\aitab e Panel "Cnh Ctan pa 
IrcTTium tl W — I® 

NEAR MCTORIX SW I —LOCK UP 

-.Kxj £.00 pa ir^eas -'t p^jnel “<0 tCHxJ scepe 
Amp e p c exx orjl aa:cp''”cualjon eri rcnial ..t t 0 
r- Prc~i-m I years pjr'ha<< — 19 

MIDDLESEX SUBURB — HAI F 

SHARE cf in rea in Praaice about t pa 
Panel dc'c’ ''in., area Chit e of f ou^c 

Prr^iu-t « sears pufcK_se — "'0 

NIIDLANDS— OLD EST NEAR INI 

PORT AST tCN»n vrese Vendor r«irmr About 
r Dpa Par 17^0 Prm - years pi rtha e Hoi e ^ 
Tcecr 6 bed rood Carden forsalccrmichi let ” I 
NO CHARGE TO PLRCIIASERS 

financial assistance arranged 

NSSISTANTS — VACANCIES IN 

Tewn and Country Indoor and O tc xr Lr t n 
re aticn 


Tf rphi et — tctnrle Par 1014 lOM 


HINOON V\ — I \RlNf RAIHP SittrbanCr 
rx H HE^e t rent Rcucipt rcarlv it W'O 
I ncJarrriT 4 •Jt'O One-I flh hare Iyer 
r r ha c sstth test to one th r<l hare 
MIDDIISIX t\\)— Cl ermine re tdcnii 1 

Ivalty Is clem ho tsc "ith UfCf r « nt 
c rd n Rtxcirts aprtt s C* VO land 1 (<' 
Ten y r up Ptem years n ruha e Free 
h d h-n c and Turn t re C'pro 
WISI cot NTRA iSea Je) - PaRTNEKSHIP 
fftxrM- ro rent on lease Receipt faref 

I \<0 I m V f IP One thit I hsrc Ij 

'ears p t ha e 

1()N|>{)N \A I — Ouoah CP m n r d 
N h c a lab e I cs,e pts >rprt v I tA’ 
Viet panel '>»’»■> I'rem >c r pur ha c 
'x pc T r f 1 I —e 

LONDON S U 1 — O d-niab bcsl nn-u c-vb 
Cp Rn ert 1 I Nr 1 ts larcch"^ e p ere. d 
r fuen Kcvc rt am » il •*' Ae evt panel 

MANA OTIII UN I OK N\ri 


r t rti urn I'f't 

PEACOCK & H4DLEY, Ltd, 

AIKDICAI TUANNFFU AGFNCT 
67 68 OiandosSl OedfordSi Strand W C 2 

Te?e»«n llcrbaru Lexju-rc Lcrcon 
T t rf ne Temp c Par W 
Ih o d-cstab hed ACCfxs netot ics the Sale 
cf PRACTICES and PaRTNEBSHIPS n re 'on- 
ib e etm shi h can be obt ned cn ip'-lr^tion 
LOCLM TENLNS and ASSISTANTS uppl ed free 
cf cha re tt "^nre pals 


CAVTENDISH iNURSES 

MALE AND FE3LALE 

“ Had OT5ce 

0^1 IlEU'IONT STBETT LONDON V. 1 
B anchff W4SC//f5rrK VS OkJo i Read 

GLASCOM H itrdtor Te ace t 

DIBLI\ ^ Lfipc Batt; t . 

T<1 rl ncs Lcnucn I- WcTecL f- Ires) 

Man^h-ster ArdwteV i 

Dublin 6 006 Glas 4““ Douslas j 

tritt cnis Taacir London Surcts^! G.a so" j 
Tactcar Manuhester Tactear Dublin I 


Csnb t'hed in lfc>3 by J A REssint. 


ncirly 4 0 Fee, 3 6 up Premiimi li >carx 
pur hi c cr near pfrer 

HI H IS tPcrdcf) — Middlexiast PRACTICE Rr« 
dcniial local ty Corner hou e carden rararc 
Receipt netfls £1 Oo Panel o'cr 300 Fees T/6 
up Prcmiinn - years purchase or n-ar oFcr 
lONDON N E —Midd!c-cl s GP Rcucipis 
arm ' £ Panel 1 00 Premium - years 

purchase or nar oTer 

AUDI ASDS — Middlcxla s CP Rodent 1 
hvatity nmr larye imso Recciris cxer f^OO 
Smtll panel Fees 4 up Su t boioc 
'saibb e Prert £9<y> r rctr pTcr 
I NSl \ —Semi rural pR aCTICE fTcred fn sale 
due rrtifcmcri Rcvcipts abt Panel MO 

I foN I up p med lloux to ten Irem 

II years purcha e r near cfTcf 
lONDOS N — \!K,dlc<Us GP Rc' ucn i 1 

iNcalt' Corner hte Sep ent si recry Cirden 
r rare Rcce pi fi tr > Panel oser bti 
Sc cral Arp Prem years purcha e 

nrTAIIN ON PFQLF.ST 


teteph -c WcIbccV “ '> 

Iclccrarr Assi ti co Lovpon 

NURSES 

MALE OR FEMALE 


TRAINED NLRSES FOR 
SIENTAL NIEDICNL SLRGICAL 
AND FENER CASES 

Sw ses e Jf on the p (m set cid ti e 
a o-lufi/e / tl gen ca’/t Duj a td S ef r 


THE NLESES ASSOCIATION 

In njun tion h the SI ALE NERSES’ 
ASSOCIATION ) 

20 lorkSf Baker St., London Ml 

Mrs MILLICENT HICKS 5urr 
\\ J HICKS Se relLJT 


THE \\ESTERN 
MEDICAL AGENCY 

r ONDON nnd nUTSTOI-. 

I>r K il PtssiiT and Dr U I 1 «i i -h 
t e ret •*-»! at *0 n ic c\tT\ t *“01 
r n n a 4iu i-ftr t Tu /u e » c-d « Cl rt 
ot y/e at in on r ant i 
UKTl MS \NI> ASSISTANIS M n I IE l> 
wiuion ciiAROL T<» rriNCiPAL-s 
I re I rsj e Nrcn..\ m c enrr i n i l O 

•ib h tr tix.es e ct tS *r < d e cepi h c rrP'*r »' 


I MIDLAND cm -Ste u h Inv c c I K AC 
Tier m ' tune ra*t A'er ce t »»o pa 
t£ la t year) Panel lOO We! c't N 

1 *‘cd Ptc'*'! m £< *0 H NO e m cssellent 

repair r Ke t t •) 

MIDLAND <ITT— Worran PKACUrC 
Ihr. T'u t c 'at c Is be am I roa ed » h 
the jN e and «(» es- a Part-ersh p if re 
t,j rm. V esc m a erare £NO pa t I i i I 

earl lanel S«»i OJ ex ab *'*0 CtxxJ 

xepe Premium ft (O Hue rent 
t SOMEKSrr coast — FAP3VLRSHIP n 
ttu irv tcs.n Ian I | 4i'« A'erate fit' ' 
pa <t* ( 1 la t ear) Th rd ••arc t m 
men e Premium c*r p rch e II r 
safe r ff-t 

4 DORSLT COAST -t r rr«»»'ed vc ih sa " 
rKACriCC P rel to A crare Cl t» 0 pu 
If UNC re*t 

f)L\ ON coast— S mall PKACllCt xith x x5 
X -x trt ceJ rhif I part C xxJ reax r ! r v le 
Re rtly es ab i hed Rapdl m rc n t 4i» 
ta t scar Ho e in br*t pan 
r LONDON —PR AClICr ssihtxV p rcr e^ 
to re” A'cratc fl F i pa larct I It > 
years p- * ha c 

WOMANS PKACflCI Rti I \ cn^ r rc 
I r nc Escellert v.om: f r in rc c Purcl f 
r t e” uf red Can be au Vt> itKrca^ed fl rr 
i t«t» p a F ri e tl 4 n f r Pr'cli e aru tt 
Imi! h Xj c 

b CO AS I — PK AC Tier in i> p al r u » n 
r ml i tt«f Aser re C- n p a f t iii>4. la j 
year) _ car pi r b c Hr nc rent 


22 CT AUF STRLFT BRISTOL 1 
7eey MmJ co Br-'t 1 Tef Pti tol t 
n BED! ORI> ST., STRAND \\ C.2 
Tef Temp’e Bur o 


j tsi etiMiiD IS~7 

LCE & MARTIN, LTD. 

Thf lUrmlnjjh'vm Medical Acrencs 
•1 TLAIIII ROM BIRMINGI1A.M 

Jelrttcmt Telephone 

loKum Birm r h ct *’ *>63 Mi I nd B h rn 

TKANsriR or iRvmcrs and 
lARTNincinrs akkinged 

VIWIVILM PLE LD ll cicli?! cr 
ri'lru.tcd lo m 

4r(DfSrV l\\ I STIC ATtl) tSD t\COMI 
TAX RClLRSS PREPARED 
kfLlABLE AND LFMCIENT LOCUMS btP 
ILIED \r SMOPT NOTICE al o ASSISTANTS 

II ASTcn TO Pt RCIUSE 
I BIKMINCMAAj (rr u h n 0 rr cs there f» — 
r x<J Miscd PRaCUCL u. h a Pan I o I u) 
cr anJ rcve pts f from tl <r u t two 
I R'ENTLV I rr;i IktD CAPITAL \N ML 
ABll 

R f OL IR FD — ( r <0 I nri h Su tti h Irr-h 
LOCL Sts I-s-. J j{ Pi^ts to (*'er A 
VSSISTANIS immm.iaje r<‘*'t li oPer eih 
nj «ki h t lex, (o Panrenhip 
fOR Ot^PO^AL 

1 £ LOl Crsil RSMIRL - Well cMjb bed 

nujlc anj x<fVi« <1 , PR VCTICF Re 
ri" ' i> <// po PiiP f I PC ync r 
m-rc e and t xxl him e "ith all cr'xm 
STAHS R Pel ir r« me m sed Pri le pu 
P reJ I R VCriCh Kecc pt la t car I t t 
I I ' er El eller h e al? r x 

t AIIDLANDS OIJ ab nbed tndusirul nJ 
mdJcx- I R \CTlCr Recert a'cfuri 

£|f*fV pa P rc! K- x. pe to to.rc-'O arJ 
cood hue 

4 SOUTH W ALT^ — W cl -oub hed m ud e uro 
isrrVmx-vla PRACTICE Reucipts i t ear 

t ro Pune! iro C XX- h u e 
' midlands— C intrs PRACTICE n fi i” 
di tfi t Re e nt ~ 0 Small r.-pel ard 
t xxJ h e 

f LONDON -oj-onPl led miicd and Pn t 

and Pane) PR ACT Ct Rcuc pt a '1 Op 

P nel Sf/i Ar>>p ^ pp.. t in'Te2'< -nd e xxl 
h me 

fINANCIAL assistance al i rded to ap-ro cu 
app I art f r tbe p jreba e of Pract cs cr Punr t 
h r*s ct scry rc n be terrm. Full p-arii u! 'i on 
app ‘anon 

RCLIABIF AND LFFICIENT LOCUMS 
SUPfLIED AT SHORffST NOTICE 




THE BRITISH MEDICAL JOURNAL 


JuL\ 30 1938 


•UilANCI 


FOR 


OHAl HEALTH 
TITIONERS 


The Insurance Acts Committee of the British Medical Association, 
after protracted negotiation, secured for all Insurance Practitioners 
an opportunity of entering a 

Pension and Insurance Scheme providing 

(a) Pension at age 65 

(b) Disablement Income 

(c) Family Protection 

at extraordinarily low rates which are available only until 

September, 1942 

Policies effected prior to that date will not be affected by 
any alteration made thereafter 


The scheme was made available also to members of the Association 
not engaged in National Health Insurance practice 

These policies are issued through the Medical Insurance Agency 
of B M A House, Tavistock Square, acting as agents of the Insurance 
Offices which adopted the scheme for the collection and receipt 
of quarterly premiums 

All other insurances. Motor, Household, Educational, Life and 
Endowment etc , are also available at specially favourable rates 


In this as m all else 

THE M.I.A. EXISTS TO PROTECT YOUR INTERESTS AND SAVE YOUR MONEY. 

Medical Insurance Agency Ltd. 

BRITISH MEDICAL ASSOCIATION HOUSE 
TAVISTOCK SQUARE, LONDON, WCl 

Telephone Euslon 1871 


JiL> '0 1«'<! 


THL BRITISH MCDICAI JOLRNAL 


BBITISII 


BUBEAU 


(The Scholastic, Clerical and Medical Association Ltd ) 

(FOUNDED leso) 

NOBTHEBN BBANCH 

33. CBOSS ST.. ]»IAiVCIIESTEK, 2. 


(Manchester - Blackfriars 3925 
(Manchester - Rusholme 2549 (AtrA/ Cc//i) 


Leeds 


Recommended with every 
confidence to the pro 
fession by the BRITISH 
MEDICAL ASSOCIATION 
as a thoroughly Lrust 
worthy medium for the 
transaction of all Medical 
Agency business 


TRANSFER OF PRACTICES AND 
PARTNERSHIPS INTRODUCTION 
OF RELIABLE ASSISTANTS AND 
LOCUM TENENS at Short Notice 
VALUATION and INVESTIGATION 
OF PRACTICES. Etc 

FOR dTsp'oFaL 

Feu T f fl / t rent 


Tel fremt 

Locum Manchester ** 


Practices and Partnerships 
wanted Large list of 
bona fide purchasers with 
ample capital available 
Enquiries invited from 
prospective vendors All 
information treated in 
strict confidence 


NORriilMntRUASD CO\Sl — O l-extib i^Snl PR \CTH I 

n x5e and R« ucnital l un n hjru Ca\hrTcer«* 

£1 400 p a Situ.’* p ncl f LvetUmt 2 freer* n ' t*ecr »> nv 

^ Pa ^ess -^na! rcy mv cara •e and r>cc parucn Premium — 1 1 purchj^ — 

Nn ll'l 

NP AR \!\NCHESTER — Ne V Vd rmdd a d be ic »* 

ul* s PRACTICE. Ca h free pi o tf £Z.^Wpa Panel I n\cr en 
vVa hed hfHAe, 2 rr —p h n 6 v'-r^ pjfapr a''d rarden *knh tern \c * 

P-*cr CPO Prc*“m— I* ra's — No 

NORTH E.\ST COAST —O d<s rrived Panel ard Pn a e PR \0 

TICE. Cash rwx pf Ls r-f £^lfO Panel 2 App^im men » uran e* 
-He) oser £»00pa. G v'J hoL*< 2 recer*« n 3_he<!rvfrv, ^ Pro -4 
f X ms, paraw -rd sma warden Prvee £ »X) Prem t.rr>— .{I \ear\ r ‘Xha*< — 

N 1044 

YOR KSH IRE R»— Od<^a^ rnJw «*vj pester ^1 

PRACTICE n Lrpe t wn. C-sh receipt •aS' '^4^ £l "A2. Pan^r (r > 
erwn u aeed) *^0 C »od h uve - reception 4 beJf y mi t ProfeiM --1 r >, m 
-ar*'^ forvate c mjvl^fc-ted Prem m— I, earn pu**ha'< — N |l4i 
NEAR MANOIF-STFR —PARTNERSHIP n o J-ei aM iheJ m m.-vla i 
Practice c« r" 10 d a h f seri>r panoer A er*ce "aih free p CI.4-.# p a 
iincreasrvL Pane 2.1X1 Ss.o'v fir m ea 
Gcix. h 10 re" 2 rncet » n ■» x hewffV'n 1 
X Pro evs r.a! rooms para*- and S'"a!l J"n. 

Pr'm un>— one ha’f sl-ire— I can pur ha^ — — VV \ 

N-v 1114 " 1 

NORTH AATST LANCS -Od m -N h- * #1 o c - 1 c*-i - a ..i -r-w 

nt\ed Panel a^'d Pnra c PR ACTICP in la » ASSISTANT^ 
t T»n C-sh rccerpts las. ear tl 102 Panel «Atr 

1000 Good hojie p'eaia J tuaied 2 recer Fnr lnitti«fli 

lion, < beo 00 ms, canp- and imaM ^-ar 1 n 
Premium — Pr^^^ce — 11 ie n pjrch-vs — 

N I10« 

CHESHIRE TOAA'N it« Manchml f — 4rnl\ ixiffi full r>.i 

DEATH VACANO n cj r>^ 

Pa A\ and Pniate PRACTICE Ca h rrcr -n 
LiS. ear £1 6^6 Panel TIN Sv pe E t cp 

cetach*d bcune On oun croundil rreert rxim iiud 4 hedrxm 
Pr fesi nal roorm parade « 1 ^ervam qua lem. and ga ucn f r val 
at a la I n Pre-n.j'n— Pr-ctr-e— bes flcr — N IP'' 

CHESHIRL—Od-e«aHn**eJ mixed Pj-<larJ Pr -te PR ACTICF m r ca n 
Cru"tr I wn A erace ca\h r— c mi £2" "pa Pane' 1 ''ll. Atira 11 

h oie reuep*! n, ^ bedroom pa ace and ar— p ru-n v» h ten \ jtx . 

Pre-'i m — 1 xears pa chaw —Nt li 0 

SOLTH AORKSHIRE^Small PRACTICE capaHc f prea ir reas Can 
rece r ' Cfp»0 Pane 4a7 C kkI houAe « ih -irpc lard n Ren £AJp j 
Premum — beit offer — S.-> 10 1 

NORTH AAEST COAST— Medsra AAomani PRACTICr iTerm wfca 
Caib ftctns Le” o hJ h use I rem a C ' ]iaj Pre-m m -bes 
r — N } I ^ 

MANOIESTFR— A cn od-es ab ihM m ieu-< a 1 PRACTICE n iSorhw 
«''ra-c=shr--erl'£l VOpa PanclSj'? G v d c rrvr house ^ h«J m 

1 Pro esi r.a nx rm caray* et 1 rcmium— -L \ears pur base o ne i Tr 

— No MS) 

NORTH AAALE.S COAST — CoaxI-c’jss PRACTICE in ee*t res 1 — it 
reson Cash r-ceipis Gs ear i90i No Par or apo nim t N 
' LCta b<d house H rth - -ru d acce mm* da lon para •"and yard n P e n o n — 
Pn-micr — 2 ears purchase N 11^2 

Lancs TOMN — partnership n d-ei ab ihcJ pram vC n wm r ra 
d ilixn Cash em pj oier £2 W"* Pa <> 2 COT and appo rtmcmi £1^3 o a 
G xh! h uie _ reception 1 bedrtx m\. ^-ram: and yard*n price £6^0 Prcrniiuii 
j — tb rd h- e— tl ~<0 Iio m,lude Kx *. d b )— No IM 
I MIDLAND SPA — PARTNERSHIP (after pr Iim nan An stantsh pJ n J 
es aHmhmJ Practice ( asn receipts ait \car £4 T’d Pare! I 0^ liuom ri, 
r nner mav cboos- n res derxe^ Pos ibi! J of HospiiaJ appnptm nt 
I cmi im — * - ih share — "* »-ars pur ha^e — Furtbef share n three sears. 
— N 1069 

1 m Id e and bmie v» rkm '1 
* RAl. iICF m p.e3->am si burKin d tr t m rresent han li ears. A era" 
c <h teve pt$ o er £ ono p a Pane! I ^ X C hx] s*. pe Gcuxl cr -er h a ,. 

- fc^ptton '•bedrvims Pr fes nairxms -ara^e and yarwen a* Ba-wi 
Su «r p emtscs P h ma K. ren ed n «risc P em uni— I lein ro ha - 

— N l|t'^ 


— Vi \NTED — 
ASSISTANTS and LOCUMS 

For IrnttK di»lr Fii"ar« nirul*. 


•ippl) yy lift full parltLuIrrs to H 4>yt tic*thtis 


ItMtUOOl- — Steau 1 itvrra r mixci -wJavi PR ACTICE in «u*’urbs Caih 
rreipti la i nr £“' Parel fN> Fsceler deta bed ho-mc 2 rreep nn 6 
beJf X mx parape arj yarden Pren lum — Practice— best n'^er —No 1036 
I fNCOLNSIIIRE.— A cf> od-establihed PR ACTICF m p'eaunt country 
I »n C-ih re*c p i laa 'car £-..471 Panel about 1 xm C ^ttayc HesprtaL 
C xx! h iw ^ l^eurcx ms. ma J garden Prem um— Pr— nee— 

£XI<0l f cuKtl sale — N > 11X2. 

TORKSHmt (\\ R > — Od-es aMiibeJ rived Pane, and Pn»a e PRACTICE 
m b" cr woflin <)asv and fu al d« r>ct Ca h rc^t pta I-at 'car £1 1S6 Parel 
I 3<*. Scone Coixl h ijw ** retepii’n ? bedroents, tnaid A room 3 Pr> 
feincrjl rs 1 iwp ra e en ranee* garden xith lennii court Rer £45 pa. 
Car*fe rented PrmniuTi— I* \eari purebaw — No M— 

MANCHI.STFR — S< UP 1 o*d<v abltibed PRACTICE to irdus rial dis rx.- 
Cash fcce p 1 laj car £-,2f*‘* Pj"cl 2,2.X0 S*.c"c House 4 bedroom-s, 
** Profes *u*fx>“w RertL*D pa Premunt— bci o”er— No KNI 
AtIDLANOS — Iix.rt .1 n m dJ tf arj Horkinf.<a" PRACTICE rn larp 
t wn Ca h rrtip 1 L 'cur £1 O^i) Panel o e 1.-0T SvO'V Evee "n 
iiodern b use - rreeptt r 4 b dr»x '**« carao- ard Lr"* card-^ Fi, \ ' 

I rectc * I rtrn uni— PraTh.'c— t-.OV* — .N 1 )|.3 

NF..AR MANCHLM'LR -Nerv oL-e tab ubeJ 

n dc a w wo wiP <!u" PRACTICE n rrm; 
—.p. per us t wn Aers suitabl for two fnerui in 

fc,|J — partrefsh p or ma be run b' one man and an 

A I *art Cash rtceipts la year £J -0 Pa-x-I 
_j I OOIIIVI^ 1 D'J Nicemx-ern h une recep ion •• bed 

wN/V/A^ieio ri<oms separate Profeinnal rooms, raracc and 

„ laftc garuen For val" a a’ua icn Prtm um 

'iisarr mrnix — best oPer — No Ha? 

SHROPSHIRE.— Old-eMablishcd unopposed 
Cou r\ PR ACTICE. Cash receipts last ear 
. , ,i £6>‘S Pane' 4*0 Mcs.ern bouse 2 recep 1 n. 

rry toCi4>yt ucurtis e bedrximi, X Profess ona! rooms, yarace ard 
Li pe garden E'ectrN, light Rent £ 0 p a, 
r rem um — bes oPer — No 10^6 

NORTH STAFFS — Acts d-establi b d better workmc ard midde-class 
I R ACTICE Cash re emti la i car £-431 Pare! 1—25 Ss.o"C aid r — 
J« e p ry E\..enc~t h use recepinn 4 bedr x>ms ma d rxim. wparate 
uryer prem wn cara-m and arjen F r sal frehud Prem um— Pra n>».e 

— I c rs rurc*'a'e rea fer — N ll-T 

AIANCIILSTI R — AAcll-estah sh d m \eJ Pa- and Pn ate PRACTICE m 
easa ubu bjroJ r t jJu n k n w H JS‘ Esia e Cash rex r..s 
ir'^’ov mate £I IW Pan | ah - ! 033 Ev— 'ei mud rn h uv. *’ re'e*'- 
1 n 4 beJf X ms -am arJ n -e ward n F r va r may b, rented Pen um 

— I ein ra chase — N 111* 

NORTH AIIDLANDS — O d-es;«b ish J m eJ Pare anJ Pmate PRAC 
I IC r n C unin, d stri i near la - t wn A era *c »jsh re xip $ £1 067 r a 
Pari-I t 0 and irans^crab' a-’m. irtm-nti - OO p - Fvaellent detached hous- 
re“ertion 6 bmlf xim Pro cssi nal rxims y-ra-e ard larc- y rden. Price 
I -*0 — Preimum — II cars rurchai- — N til 
NORTH LASTS— AORKhlllRE BORDER —Otdnstab' shed ^orro«d 
Ccuntrv PR \CTICE n prewn bard 0 carv Cash rtxe pii £1 ^ P a 
far ’ and apfx intrrerts approvimatel £4-0 p a A\el built hoi^ wihampe 
ax mn cxJai on central h-aiin,- e e~ n I yht ara and gi^den o _ - 
Reri£-*ra Prem um— £1.500 Aerd r ret r n- — No U 19 
M0N*A10LTHSHIRF-— O d established Con a t PR XCTICt C^n rex p^ 

Lit earl'»IU f«h«.h er £_ OCO is from contran work Esxle^hu 

rt imnc X re cption 4 bedr> ms - ma d ro caraee lor - cars. ^ 
r rden Rent £* pa n Ion le w Co<xi pr mrets of -m^caw in 1 w 'me 
I rm um — beii iff r — No 1 14-. on . r~-rtr it 

iiNCS TOAAN Aerv olJ-estab! hed mived P-n-1 and Pn ate PRACTICE. 

C- eepsLs ear £? j'_ Panel I 925 Good house 2 recep- 

ii n ”• bcslfcoms, X Pr fess i nal o m isepara e ertrarce) Prem um Pract 

— II ears purch-s No II I . 

DERBASHIRE—O d-cs ablu.heu PR ACTICE capable f creai itxTeaw C- h 
rece pt last vear *"'t0 tin rcau e* Parel 86- Excel em house 2 rec-p 1 n, 
4 bedroom X Pr fess nal r k. ms (wpara c entrance) carae* and cood yard -i. 
Prem um — Pra li'c -nd h us- £1 6C0— No 9S9 

NEAR I EEDS — Old-es abhs ed m ddle and workin xH-ss PRACTICE. 
Cadi rec-ipi a cr’ge £I 00 - a Par.el 900 Excel en d-ta hml bwuse 
recep* n bed ooms Pro^cssi ir-l roonvs (wp-ratc entrance) yara— and 
arden Prt c £I OOh Mortc-~e can be arranced. Premium — Pra•^xe— 

1 eur pur ha e or near o‘*er — No 1125 


rd to thi 


ich Manager BRITISH > EDIC/sL BUREAU 33 CROSS STREET MANCHESTER 2. 







THE BRITISH MEDICAL 30UPN\L 


Jou 10 19 S 


)I ASTIC, Cl KKICAI A MIAMCAL ASSOCIATlOiN I TO) Cf , 


(The SCHOI ASTIC, Cl KKICAI A MEDICAL ASSOCIATlOiN 

(lousoiu ISSO) 

Tele Address TAMhlOCK 11013SL >OUTII 

Triform, «esfcenl-Tomlot. TVMSTOOv SQU VllL, WCl 


Tele|)hniie Eiisfon i 


The Assocnlion his long been f.wounbl) known lo the members of the Medicil I’lofession is i thoroucliK 
triistworlhv ind siiclcssUiI igcnci for the irinsitlion ol evert description of iMcdieil Schohstic ind Accountincj 
business ind the BRITISH MEDICAL ASSOCIAIION his c\er> eonfidcncc in recommending its members 
to eonsiilt The Mamger in ill liansictions icqitiring the scrtiecs of i Medicil Agent ^ 

Members of the British Medici! Association miu tiilte idt uit igc of n rcdneid scale of charges ipphciblc 
to them ~ ~~ ~ ~~ 

RCDUCIION IN FCFS 

In cases wheic the L>uieau iie sole Agents the commission in 
lespect of ant sate of goodwill book delits, fiiinituic diugs 
fittings ind othoi effects (escludmg s lies of inj fiechold or lease 
hold piopeitj 01 of piicticcs, efleets etc outside Gieit Biltiin) 

IS limited to 1 minimum fee ot Fiftt Pounds 

FULL TERMS 0^ APPLICATIOA 


Practiecs iiitl Pirtnc-ships for IJisposnl 

1 SURREY — PARTNERSHIP (alter i pitlimimii 

Assistanlship) in growing iisidentul district iboui 10 miles 
iiom 1 ondoii C isli iLceipts nei igc ibout tso p i 
Pmel I 0‘'0 A three ciglillis slnit is foi disposil it two 
tears puicinsc 

2 LONDON N 7— Incieasmg PRACTICE of 
ncail> it 200 pa in thieklj populitcti distiict Pincl I tip 
Iicniises to lent Premum' £2 400 

3 LONDON, N W —Medical Worn m s PRACTICE 
otci £800 pi in glowing district P'nel 740 House foi 
silo Ol lent Premium 1] >ears purclnsc Appomimenis 
worth >240 pi iddiiionil possiblj tnnsfenblc 

4 SE COAST— PARTNERSHIP (with succession) 

111 non dispensing Pnetiee ibout £2 000 p i Vci> smill pmel 
Attraelne house lor site oi lent Premium 7/lOtlis slurc two 
jeiis puielnse Hospital ind possible \icine> foi phssitnii 
in two or thiec jeais 

-i SURREY— PARTNERSHIP in Prictice of about 

£4 000 pa m lesidentiil district Panel 630 Modern house 
(4 bedioonis) gai ige garden To lent Piefeicnec would 
be given to in F R C S One half sinre £4 000 

6 E ANGl lA — PARTNERSHIP in country Pric- 

tice of ibout £2,200 p i within cisj distinee of coast Pmel 

1 400 Well built house to icnt One third sinre two veils 
purchase with succession in five jeirs 

7 LONDON EC— PARTNERSHIP (with good 
scope foi piivite pncticc in i spccnlitj) lu Pi ictice mostiv 
derived from v iluible appointments Shire of £800 to £1 000 
It first It two jeirs purclnsc Pntnei must possess the 
MD Ol MRCP Ol ERCS and prcfei ibl) Inve Cilj 
coniieetions 

8 S WALES COUNTY TOWN —PARTNER- 
SHIP ill Practice £2 800 pi PincI over 1,000 Visits “'/ ■. 
to £1 Is medicine e\ti a One Inlf slnic on leasonable terms 
Paitnei must hold F R C S Eng Hospital and cscelicm 
opportunity foi suigieil scope ind appointment on staff 
Prthminii) Assist mtslnp 

9 ESSEX (Boideis ot Epping Foi est) —PARTNER 

SHIP m steadily mereising Pncticc ovci £3 600 "pa m 
glowing residential distiiet Panel I 700 House obtimible 
One lotirlli share at two yeats piiidiasc Cottige hospital 
Scope foi amcsthcl'Cs x. 

10 SE COAST— PARTNERSHIP in non dispens 
mg Pi letice about £4 400 p 1 Pmel I 400 One filth oi one 
fouith share at two yens puiehasc Pielimiiiaiy Assist int 
sliip Scotsman piefened 

11 LOf'IDON N 12 — Middle class increasing PRAC- 
TICE m giovsuig district Receipts pist yen, £420 Panel I6> 
Modern liboiii siving house loi sale or tent Premium £640 

12 S WALES — Contiact and small private panel 
PRACTICE ovci £1 900 p i in mdustnil distuct Pine! over 

2 too House with surgeiv premises to rent Prospect of 
appointni'-nt Premium £4 sOO 

1 3 S COAST HEALTH RESORT —OPHTHALMIC 

PRACTICE Receipts 1948 £1 600 House to rent Un 
limited scope Premium one ven s purshise 

14 LONDON SW— ELECTRO-THERA- 
PEUf IC^L PRACTICE Receipts 1947 £1 727 Laigc con 


29 KENT— PRACTICE in de' eloptng^^d'S'r 


12 miles fiom London Receipts past '^ar over _ - 
about 464 Housx (v bedrooms) to rent Amp 
Prcui'iim £740, to include drills etc 


ITill I’urtieiil ITS ‘.eiit free 

siiltinu room and Ireitmcnt room to rent Premium £ I 6(9, 
p'us ippanuis \ ilued ibout £750 

li LONDON N— LOCK-UP PRACTICE £490 

p I tun by medic it woman Panel 427 Rent at surest) 
24/ Weekly Good scope Premium H years piirclnse 

16 S COAST HEALTH R ESORT —Non dispens 
mg PRACTICE £1240 pi No pmel but miplc scop 
Commodious house for s ile Premium £2 400 

17 DEATH VACANCY— ESSEX SUBURB - 
Receipts ivcrtge £989 p i Panel 744 Well siltialed bouse 
foi silc Scope 

liS N WALES — Popiihr seaside resort Good class 
thicnv non dispensing PRACTICE ivcnging £870 pa 
No pmel L\ccllently situated Uct'cbed resiUenee for vale 
Good scope Premium two veirs puiehasc 

19 lONDON E— Cash ind pine! PRACTICE 
avenging £2 800 pi Pmel 4 40(1 House (4 bedroomO 
Relit £1)6 pa itopc Piemiiim two and i Inn )van 
pinch isc to inchnle drugs etc 

20 W MIDLANDS— PARTNERSHIP in Pnctice 
ivcnging £6 000 pi in nnrket town Pmel 4 400 One 
sixth slntc it first it two years purchase Ineomiiig partnu 
should be iged 28/40 md able to do general surgery aiw 
minor C N mill woik Hospil il Piclimiinry Assislantsliip 

21 N MIDLANDS— PRACTICE m residentn 
district near progressive town Receipts 1947 £770 rau! 
about 100 Choice of two houses (oi 'de Good 'cep 
Plemitim £800 

22 S OF ENGLAND —Well cstiblished SANA 

TORIUM for the open m treatni'-iil Receipts at prcscn 
It ntc of ibout £4 000 p i Piemiuiii £1,000 to incliw 
luiniiurc etc 

23 LONDON, SE— PRACTICE avenging £MW 
p 1 m populous suburb Pmel 800 Dctichcd double Imn 
house Puce of le isehold £1 250 Scope Premium £1 / 

24 FRENCH RIVIERA —Old-established PRAE 

TICE MD cssentid Vendor it present in CnUmd 

25 SW ENGLAND— Coiinti 5 PRACTICE ova 

£1400 in beiutiliil put Pmel ibout 1 l()0 

nice modem house stmding in oWn grounds for site m 
and sliooting Scope Premium two veirs purchase 

56 CENTRAL LONDON PRACTICE —Bolter ^ 

pin if comloi table West End faniilv fiat i^q 

bi inch 10 minutes distant Both incieasing 1 mn 
Receipts past year £1 698 (vvciage £1 460) 2 vears p' 

27 SE COAST— PARTNERSHIP 

ivciaging £4 100 p a , m growing resort Pmel I no .iip 
house (4 b"di corns) to rent One fiftli share it lirst 
veils pmclnse _ vnTlCr 

28 Consulting Ear Nose and Throat PRr'e. 

in indiislinl city Receipts average ft 340 p > (m j 

appointments woith about £840 P ' ), ^nd In'r 

house to rent Puichiser should hold E R C S and 
specialist cvpciicncc Picmium two yens purciia c 



Jl'u '0 I9’S 


TItC BRITISH MCDICNL JOURNAl 


47 


^ iTIir i-CHOI \ST1C f I 1 Hlf \I t MI !>I< M \-'SOtIMION I Til ) 1 

/ «l « IM ui U () 


THO vMrc.. T\MbI(»av MOUM SQL I H 

Triform Wt^tttnt — ■I-omloii XV^ISJOC 1\ 1 

1 rictiios nnt! I arlnrrxhlps for I)ispo'*'il (contlmiiil) 


Tilrnlionc I^itstoii 

* nw's 


:0B1RMINGH \M — \Udic il Wonnn s PKACTICn 

a\crj-.ini. p-i I inci ucnrls *>(>'> GooJ hone with 

— ingc ind jrarUen 1 ikc 1‘‘(X) lea chou! Svopc 1 itonuni 
one and ihrci qiurtcr %enrv purvhi'r 

M S \hRlC\— PARTNERSHIP in hicniixu 

Pnvticc m Njial Share \NOfth about £1 FOO p^t at hr t i 
one \cars puo.h <.c Apph-nni ^hou’d be LompeterM suiicon 
and preferabb an TRc S 

32 WEST END ncir Lord j» Criuktt Ground — 
PRXCTICL a\erap3np ibOLt £J 900 pj m idul roidtntnl 
pan Panel about l^XX) with prospects of pood inLic»'< 
Well buHi detach'd doub''* fronted hou\c with paripc ard 
ni e sized garden Good introduction Prennum 

"G \V MIDLANDS— P^RT^ERSHIP in non di<; 

pcnsins Practice about £o 7^0 pai in t.ounts town Ilou c 
to rent One founh share at two >ors purchisc Aped ibout 
0 with FRCS preferred Prtlimmars Assisimthip 

M MIDDLESEX— PARTNERSHIP in stcadiK 
m-rcasinp town Practice abs->ut £2 (XW pas Pircl I MK) 
House to rent Premium one half share two jenr^ pufshisc 
App’icant should be English or Scottish 
35 SURREY — Medical Woman s PRACTICE over 
£n00 pal m outbnrg suburban district Panel I 0 Hou e 
for sale or rent Scope Premium £ 00 
s6 S AFRICA — Medical Woman holding D O M S 
required m Ophth-lmiw Practice Pspcricn'-cd in ofvritnc 
work and not oser mO preferred SHARP ibout £1 000 oflcrcd 
after ASSISTANTSHIP 

37 SUSSEX — PARTNERSHIP in good-class Pric 

lice n-ar!v £ OOO m favour c rr-rket town I mcl about 
I^AO House to rent Share of £1 000 at two vtan pufchnsc 
Pfclifn.nr\ Assjsiantsnip 

"S S COAST -PARTNERSHIP in Practice over 
£3 (KK) pal in seaside resort Pan-I about 2 000 Scmi-dctncJ cJ 
house bcJroomsl for sale or rent Premium one hnlf dnre 
£ 000 Exec ent bo>rjtal and scope for surperj 
j9 midlands— C ountrs PR \CTICE over £I ^00 
pa in hunting di trut pcptl Goed hou i (< bd 

TooTns> ^rage and •’ood garden Mam w iter and clcciritiu 
Pnee £1 tOO ircchold Prtnmim l^^o vea*^ purtha t 

-.ONE ENGLAND— PARTNERSHIP m non panG 

Pr2i.lj.c done -boui £6 000 m one of (he chci! lo«ns 
Hou c n^aLbe One MVIh sInn. at two >c.irs putthlc 
Partner rhould be siireicdb incbncJ 

41 S COAST HEALTH RESORT— PARTNER 
SHIP m Practice about £1ACK) pj Panel oicr I ICO House to 
rent Prem ii-n (»o “iftlis shnre £' 2<0 to inO iilc druo etc 

42 N OF ENGLAND INLAND SPA —PARTNER 

SHIP in Practice about £l 900 pj Panel I^OO Excellent 
house for salt Premium one half share £I FOO 


43 S CO\ST— PARTNl RSHIP in non dispensing 

lrn.li t o%tf f4*0 p^i in 1 e-dih resort Pircl I tut ftsO 
Mure worth abt tit £9(‘0 it two vcirs purtlu c 
^4 WEST END 01 lONDON -Good cl iss non 

ill pen inp IRACnci hou £I 1^0 No p ncl I ngc 
hoiiNC to Knl Pfcitmini ki ^ ind prcticc f^(XK) 

4^ BUCkS — PRACTICE m growing town Receipts 

lis Mir £S94 line! ibout 7^J Houh. fit v. Ic. Well 
cutiippsd ho t>il il Pre rm m £1 *(X) 

*,0 LONDON U6' — Non dispensing PRACTICE 

tM‘0')pa I Icicint iiburb No pane! Hou^c I ^ bedroom ) 

} tt tpc md 4 ifikn I renmim house md praciiLC C2 ^00 

47 ESSEX —Cotinirv PRNCTICL abom l700 pa 

Pine! ilsoiit ■•'0 \crv gtsod liousc bctlrtKims) pjngc nnd 

gifdcn Rent £f' p4v Picmnirv £‘•00 

4S LONDON S W'— Medic'll W'omnn s PRACTICE 

iKsui tO^rO pj in ouilsinj: suburb No pvnci Suitable 
icwommoihtion available 1 rcmium £9'0 

49 SURREY — McdicaUVominsPRACTICE about 
£<00 jn developing distnwt No p ncl Rent of house £100 
pa Scope Premium £<00 

M) PARTNERSHIP m incrcismg Eir Nose 'tnd 

Throve Pr iclicc in pros men 1 town P inner must ho'd FRCS 

MIDDLESEX —rOLRTH PARTNER required 

in Practice ovtr £7 f»on p.«i in rcvidcniial disin t on the 
riurrcs Panel I fOvI IIoijsl (< bedroom ) to rent Scopt 
I fcmitim < ^Oiln sliirc £' 100 

^2 LONDON N W'— PARTNERSHIP in Practice 
iscr gine bout £^200 p.a Pincl ibout 6 000 Mat onetlc 
t2 b'*slfooniv etc ) to rent One ti ih share at fir l it two 
sc fs pur Jns«» 

N C CO \ST — Middle md btiltr working class 
PRACner over £1 1^0 p-i in s^iport town No pincl 
Pimte rcNidcnvC for silc Prtmiiim £7<0 to include furnish 
ngs cit of consuhinu rooms or near ofTtr 

54 lONDON \V9— PRACTICE doing between 

.^900 £9<0 pj in re uJcnlnl district Panel ibout (-0 but 
plcnu of cope Rem of maisoncUe W KdroornsV £-00 p v 
I icmium tl t>00 or ofitr 

55 LONDON N W' 4 —Middle class PRACTICE 

iboiil pj m developing part land ^fM) Hou c H 

bedroortvs) for siL or rent Scope Premium £I _'0 

56 HOME COUNTS —FOURTH PARTNER 

required in Practice in grownc town Panel ^000 Incoming 
pirtncr niu t be energetic ivcd ibout 0 (married preferred! 
With a kaning towards rncdicinc Inilnl shirt ibout £I 2<0 
p3 premium £^000 Prcliminarv Assistmt hip 
COIONTES— Number of Colonial PRACTICES 

Incomes nngc from ibout £7<0 pat upwirds 


Purchasers can ruse 'idditiona! caplfil for the purchase of approved practices or shares 
Particular^ V ill be forwarded on application 

_ All eonimtinicatloiis to Im» addressed to The Alnnagcr 


SCOTTISH BRANCH, 21, Alva Street, Edinburgh, 2 £J nbu jrft 

ron DisPosAU 

A S OF SCOTLAND —Coiinlr\ PRACTICE in E E. OF SCOTLAND —Counin town Receipts 

Io\eh distnet Receipts -tpproxinntcN £1000 Panel 700 last sear £6SS (appointments £' '7 paael fcs>-el^t 

Exceptionalb cons enieni house Price £7 000 Premium for house «nh jarape and garden Price £1 4so Prcmiuir^iwv 

practice one and a half sears purchase F N OF SCOTLAND — Countrj PRAClJCfc 

B S OF SCOTLAND— Countn PRACTICE hong established Receipts approt.maiels £ I 000 Panel 275 

Receipts approsimalelv £ I 600 Suitable house G WALES — PARTNERSHIP in country loWTi 

C SCOTLAND —Old-established Cits PRAC Receipts £1 200 Panel oser 1000 Suitable house Price 

TICE Receipts approximatels £2 400 Panel 2 500 House e4en 

pnee £900 Premium two vears purchase or near offer H EDINBURGH — PRACTICE doing £450 House 

D YORKSHIRE— Countrs PRACTICE Receipts 

£1^00 Panel s(X) Excellent house vMth garage Price £1*200 I EDINBURGH PRACTICE about £400 oUil 

freehold Premium one and three quarter vears purchase abc house to rent Reasonable oner considered 

For further details appl> The Manager 21 Alva Street Edinburgh 
Terms on which the busines<5 of the Branch transacted will be submitted on application to the Branch 
Manager to whom all communications should be addressed 

UELIABr-E LOCITMS and ASSISTANTS are CKGENT^l REQUIRED bv ALL OFFICES of the BUREAL 


; 


THE BRITISH MEDICAL JOURNAL 


48 


Juu to 1938 


INDEX TO ADVERTISEMENTS 


PUBLISHERS 

British Medical Associalioa 3 24 
Churchill J A Ltd 2 

Lewis H K ^Co Lid 2 3 


ASSURANCE & INSURANCE 

Ccnlur> Insurance Co 42 

Medic il Defence Union Ltd Supp i 
Medical Insurance Agenev 44 


BANKS &. HNANCE 

British Medic tl Ftnince Ltd*" 


CHEMISTS 

Bdl ^Cro>dcn Ltd Supp lu 

British Drut Houses Ltd U H 
British Felsol Co Ltd Co er ii 
Burroughs ellcome i Co 21 

Boots Pure Drug Co Ltd 14 

Carnnek G W Co Coscr w 

Coates ^ Cooper Ltd 9 

Dinneford &. Co Ltd 12 

Eh Lill> & Co Ltd 19 

£\ans Sons Lescher S. Webb Ltd Id 
Fairchild Bros S. Foster 9 

Gedeon Richter Laboratories 11 
Glaxo Laboratories Ltd 12 

Iron Jelloid Co Ltd 8 

KajleneLcd 16 

Organon L iboratoncs 21 

Parke DaMS & Co 1** 

Pearson E T & Co Ltd 9 

Peat Products Ltd 8 

Reeves Remedies Ltd 24 

Smith Marlin H &.Co 14 

Wander A Ltd 10 

Wnuht La>man 5. Umne> Ltd 

Supp n 


FOODS, BCVERAGCS 

Berwick George «SL Sons Ltd 6 

Genatosan Ltd IS 

Hovis Ltd 4*1 

Husband J K <SL Co Ltd S 

Pollcv k Co Ltd 24 

R\ vita Co Ltd (7 

Valentine s Me il Juice Co Cover ii 
Wander A Ltd 11 


MOTORS & ACCESSORIES 

Brooklands Motor *'upp i 

Hcnl) s S 

Lodsc Pines Ltd 2 


NAME PLATES, etc 

Cooke s Ltd 24 

Hall r B L Co 24 

Herd S J & A 24 

Osborne F Co Lid 24 

White Hroiuc Co 24 


PRINTING, TVPEWRncUS, 
etc 

Tavlor s Tvpcwnicf> 24 


SURGICAL APPARATUS 

Compri Vena Ltd 2 

Curtis H E & Son Ltd Supp iii 

Hanger J E A. Co Ltd 7 

Hilliard 24 

Leslie s Ltd 6 


Salt & Son Ltd 
Smith A Nephew T J 


Supp IV 


Ltd 


TAILORING & CLOTHING, 
etc 

Regent Dress Co 


24 


TOBACCO & CIGARLTTLS 

Wills s Three C istle- 4 


VACCINES & SERA 

Allen C Ilinhtirss Lltl 20 

Ilfitisli Drue Houses Ltd 10 


VRAVS iS. ELECTRO- 
MEDICAL 

Allen ^ llinburss Lid 
Port tide X Rtvs Lid 


HOMES & INST ITU HONS 

Ptucs 25 26 27 24 10 


HOUSE AGENTS 

Plee 


40 


HOSPITALS A CLINICS 

London Clinic 29 

Ruthin C istle 27 


SANATORIA 

Cornish Riviera Sinatorium 2S 

V Cotswold Sanatorium 2S 

Montana Hill 28 

Mundcsiev Sanatorium ^ 28 


SPAS, HEALTH RESORTS, 


& mOROS 

Czechoslovak! i 
Harrogate 
Pislanj Spa 
Smedle> s H>dro 


29 

29 

29 

2S 


MEDICAL SCHOOLS, 

1 UTORS, & LECTURERS 

Paucs ‘>3 0 31 


NURSING, etc 

Page 


TR \NSl ER AGENTS 

BovriLMedical Agenev Cover i 

Dnhsh Bureau 4$ i 

Lee A Marlin Ltd 
Medical \gcnc> Ltd “ 
Peacock L Hadley Ltd h 

Turner P Ltd 4 

NS tsiern Medital /Vccncy "I' 


CONTRACT PRACTICE 

Page 


HOSPITAL VACANCIES, eft 

Puces 71 32 37 74 3W6^ 


CLASSIFIED 

advtertisements- 

(VVanted e8, VocanI) 

n ” 3’ 

Piges 


GENERAL 

British Electrical Dev Assn 
White H Mfg Co Ltd 


v 


252 ADDED WHEAT GEBM 


BEST BAKERS BAKE IT 


AW clcjf ofd 



RICH IN VITAMIN B 



The hiffliVitaniiii 'B’ conlciii in HOVIS 
^ • • 1 
increases ils iiutritivfe powers aiici 

acts as an aid lo regularity. 


j’libltshctl bj the Proprietors the British Meclicnl Assocntion Tmslock Sqinrc London WC 1 ind printed b> E>rc nnd Spcd0s'^°°i, 
Limited List Hirdmg St Fleet St , London EC4 Printed m Gitnt Britain Entered ns Second Cl tss nt New V ork USA 



hi.\ '0 !«'<? 


THr BRITISH MEDICAL JOURNAL 


in 


BovRiL Medical Agency, Ltd. 

ALDINP JIOLSn 

ion RinroiiD siurLi, stkmnd, London wc 2 

Tclccnms ISOAMLnlCSU II SQl Mtl' 1 OMION Tcipplionc TEMPI E B\R IGIG (3 Lines) 

Chilrnnn mill Mtmplnjj Plretlor, Dr J Eli III II \I E 

The mTsimum commission pi\-nlilc on the snie of nns I mcllec or I’nrinershlp in Gmf Britain placed exclasnels 
in the hinds of this Arhics Is laO (lUtx pounds), nhich sum coxers ttoodixlli driiffs surcerx Dttmirs fixtures and 
furniture instruments and liool debts hut not house propertx Siliedule of Terms xxill he forxxnrded on application 


Sccountancx and Ictal services fumishcxl bx the \pcncx xihere desired at moderate inclusixc charges 
No chares is made to Principals for the introduction of locum lencnx or \ssisiants 


1 SOUTH rrt{«n'nar> 

au sunt ‘ ' ofd-s. ass Tra-tice S ijrc t 

prviik» ««*i arr f ■n ''if'i n!ati n 

Re- £'>Ora Prcr’i-’n 2 'tan Sa jr> uLfi-g ’’■>0 

a. MS a-.ih - at rate cf £WX> p a 

2 COUNTS TDW'N NMTIUN IN) MILI5 ULST OF LONDON — 

PARTNERSHIP— A HALF SHVRF tn s sl-cMi‘'»ish J pfvx! m »fd<Ia s 
Pranice rrcN.uc:-c a— s\ -na eh ini.li.Ji-s Ia»^c panel lees 

2 6 to Ltis eepensev Pi.rcHasr' can cb his <is»n b v-sc as Pra*i»cr 

jss*orkcJff n central SsXf*,crs Prrmiu'n I* 'ea-s purchavc Ip^ nspa'iner 
s*" _’J be expencnccJ and L-der -.n 

’ SLRRE\— WITHIN M MILES OF LONDON —PARTNCRSHtr — 
ONE HALF SHARE n sen pr*oJ r’iseJ<ass Practice viua cd m f 
resjJ n*ial dis m Gri'ns casJi rccei- ♦ a-p n\i— ately I3000pa s»rh 
sjNrartiaJ panel \cr\ r»ce h-usc »i h a 1 -i x.enct nsT-»ences a-d bcatnifui 
pa.u*nl2rcce’'t n 4 bixrx —l etuL Can be remed t r pur-haseJ P'eTPJi.m 
. sc-n puntbase 

4 LONDON SW— Od-esa'' sbed ni\ed<Liss PR \CTR t pivdiicin f* r 
l«s 12 tr r M £***0 itLlOs. ~g pa-el s f . O Fl-t can be fenced at £'*n p a 
Pre-Mu-n £1 .*0 

^ LONDON LASTT — Mid» and v-c»fVtnx,-d*ss PRACTICE pfcxluCi-g f)sef 
f'Dr a. sst h pvK* sc- nc Pan-l cf aKij* V» Fees frrri . Ten ftn rreJ 
c r-< bn..ve Pn'e f t lease 0 Prr-r -s f-OO to in..Uid- s-n^ps. \ 4 fpcrs 
f iir-s. « w anx* Ss— c fu-n u'e 

b ESStN COVST— PVRTNCRSHIP — \ t'-ru pa-tner rs requ red tn « J 
Cita^ .s'‘cJ P-a*t Su a‘' e ho-v asai’a^'’ Pre- it.'n scan pc »'as 
Fvn*'eT cc a $ cn a-’^ tc- in- 

“• DEN ON CONST —rOPLUVR HOLIONN RESORT — O'J-es a'' sW 
r nesne-Ss- PRACTRCase-a -? f r p » ) ea-s£I640pa i-kijv n- 
pa—l It Su b **. b a— e *ccv —T Nia I n Iree^tJCI ID 
c r '*'t r— t Pr-n t--! £.»'> Xi 

e NORTH WELSH COAST— Gvd n M <'j t rrnr -.-el PR NCTICT 
« <-a ni. aS, I r^X'pj * i N p vxJ sc> •>? D-ta-bcJ b-nnve s *-rI h ki— 
bea-i tl bas »jJi a * 0 — ^ S-vriffa kin..i. C »d vb v s 
P-e—id-t sesrj pur“b.-v. t ) h-a- b reason f r vile 

9 lines— MARKET TOWS— Od-esaMd'-d PR \CnCf ^ rf,>v-croiis 
d net r P-. ^-5'Dn. i-vLd — panel cf MS? Weiibct 

heus. (, r-ce-tin- "bp- x-o re t£*^pa Pre— i -j ti scars pvreb-.^ 
cr r-a. s '*ef f r v j k s-’ O vsj i r vJ in 

0 NORTHLMnERLNND— Cbtf'^s p- e PRNCnCE tn pmofCM. >e 
si-ff -•‘s. f'sS p cs. ji. 1 - ,.S t£l^V)pj Pa-elcf'M Nen east*) ^erkeo 
Sv ** e b .se pjic- £I GN' Pre— -n I* 'ears pv— base 

1 '\EST MIDLANDS— PkRTNERiHIP s»i b s.a.T-t n m 2 <»r J jears 

Misec<lass f*— **icejn-i ractne cs un.“\ town n sen peasa-t surroo-winev. 
A\era-e rece -ts f- las ) sear^ £M bp a P*nel of aSoti b<0 On 
* bcuv. asaj! - t recrp*K n, lir-e Im-pe had bil*i.rd 

nx— ' t^wfcH f-v. c*^ ewe* — Pra-tice ar* — m -s-ati n r tc cardo 
para c Prer- vri for h- f share £| 

w REDS— PNRTNLRSHIP— ONE third SHARE tn sien-e'tab i W 
r'ised<Iass Praricc £1 67< p a Pa-el , f -«} SjitabeKv'se 

easil c*’ui’ia*'*- Pre^iuni £I OOT Defmi c fc.cpe 

3 WELSH CONST— Well-cst 3 b)tv‘-d prvxJ nned PR \cnCC produvi-c 
cser £1.0X>ru., i-xl.v.i-'c panel of I 4<0 Si ita^-'- house suth a— *e 
a*co— r-x-j n, ptxKl F-'ven and paup- Re-t£<Opa Premiun £tk X) 
fir vjjA sa'e 

I SLRREb -RAPIDEN EXPANDING DISTRICT —PR^NCTICE at present 

p Xi-ees - ..u* £j A3 p a ba* ccj d be T^tsh i-creased Pa-el of 3 0 (v s- 
ci...u-ed) No r-iu^i^en Es-tleri b jse h all nrxem consrrencev 
Prer'i-n f r Pns-*i'c a-J bo,.se £3 n>3 

Rl5IpEN*TI\L COLNTRN DISTRICT— Cr-t 

PRACTICE r-oduCTri. £ Op a with pesj Oo e cf 

- bo-sea Mix. r e prcr’ii.— i 1 1 h^a h rt-von f r sal 
DEATH \'^C'\NCb— LONDON SW — O d-cstaMis»’cd PRACTICE 
ia:* J "S p.r-1 of I 00 Su tab c h as- on 
i^a at -to p 3 Pren „ sears purcb»^ 

’’ f'''"" =”'! 3r sfip m cTO- o-jll 


. -rr*.. cn n lo lu taxic -r-'Ii'ni 

■ ~ 4 £;S‘-'^D-rAXOl,RITE COXST TOXX N -UALf Sit ARC =Acr 

r cTcri'r. !-£»?.<£ Vr XT'” - Iciolci.— XIusl be expen-oee.* arj 
^ .rC-NT Pmiiu^ir xerrx ro-re-O-ie pan bx arrarfc 

'■^Cbxnrx rRXCIICEaxerapmeritWlpa 

'---j 1 - 1 . e-, H xcerx p. chx e 

;Nd PRACnCfc. ch«rv axh. Recei-» 
r-xn tv- ^ funcl and club prodir'ir- c s-er £-*00 pa 

pL^*use up Sniab e pre— ises a -ailabic Premium 2 sears 

ester DISTRICT — NtW EST \TC — Esab isVd a\x ui 
™ s £500 p a Pa-el of «0 P M S 0 paticnis. Tern 

Mf-rto*. Pi-rchasercan b ildo»nhtusc It is tel esed there 

increase 

rn S W — . residential DISTRICT — Good m»ddle-c»i« 

aboat £l -.00 rjv sndvdjng par-l cf NOO paticn s and 
ttrxrsi Hou e on renal Good sco*^ fsr erergetx 

SLRrps*^’^(^'“,? - PLrebase or i>ur o'^er 

^ -ncreasng PRACTICE situa ed in deselopmc 

— disim Grns cavb receipts ftr I st 12 m-mths about f^^OO 

of ..bout ^00 Sma'I compact freeho'd hous- Ptkc £SV 
pn on rsortca— or vovM rent at £s.^ p a Premium £I ^00 AmpI xipe 
for e-'eiT- »c worker 


4 GROWING RfSIDENTIAL DISTRICT WETHIN 10 MILES OF 
LONIK) *» — Rencnly e tablisbcd u^pcf and fridd’e<lass PRNCTICE 
p vIiKinc abt ut L^OO pji with t.c‘‘nitc s- f r o'crca e Sc’ected panel 
t f “'2 1 ees ' opwafLs Promnent ctrrer hous* with 2 re-^ption 5 bed 

rv>m^ Separate ertrarwe In Pn fessmrjl riv. mv NNcU laid out gard n 
If me on rertaf Prenjum IJ sears purchase 

^ SURREN —partnership— ONI II \LF SH ARE in dcselopirs midd e- 
anJ better *sofki"{ -s-Iass Pr*'**icc m fascuntc residential hospital town 
Gr »s cash reccip % f r last I. mn'*ihs £l ^00 Pane! of O') Low expenses. 
We I bu It hou e with 2 rrcepti n 4 beuroomr etc Reni£IOOpa In-oing 
rartrcf thouM be Cspc r-fved aged 25-»0 and ab’c to do torre surgerj 
Pirmitmi 1} scan purchase for qu» k vale 

:« iondon s u —within easa reach ofcita andwestend — 

Well-esi3»'*ts*'ed ch cT r-iJJ e r''d better-class PRACTICE w th surpjc 1 
set pe p sdix ng abi t £I 4^0 p 3 Selected par I of 45 Fees ^ 3 rd " 6 
Good sued f rst V'r flit «idi - I Cf '* c-«tr.ce$ pLrehaser shoo'd be able to 
ds turpcT 4nd ! R CS wnu J be 3u.sapta>m us 

27 IONDON W C—Well-cs -! oh d PP ACTICFprxu m rarJ>£MOOpa 
\ e ape £14 0 Panel f 1 6^0 Soitab e mr ■»djtu n asail b ..''J 
sv"gen prem used as I'd. v" inrcrtal Pre-' um 2 sears p.-rch-x 

2 LONDON —WESTERN DITIRICT— O J-cstabfithcd no^-d spemms rn- 
pan I practice pfduving aN •• £ iMpa Ca*'a*' c of expa''S-'n 
cs'se-ia 1) if panel uork u*-oerTaVex Wei' s ua ed corner bn„se or ream 
road with ample aocomn'xXJ » >n. Prrm jm 1 ear s pi* d 3 c Pr* ni'C wojM 
be t J aran fn m h use if wj ''eJ 

2^ SOUTH W \LLS — O J<i jMi b 1 na n c " n PR ACTICC p 'v " 
Ln jear £*>.N>3 rf wb, h 0^ is frt -j c -tf n ' fk a J par I Su a*- e 
hoc c 3 S 3 a*' •* Fo « re pfmp-vts are '•lorJtabeenc r a$p**ssirki 
ha c fr*er is be-n erected n th d iirut Prcf” tm £3 '<» 

30 LADA IXKTORS I R NCnCF — IllRMINCHAM — O x.-%s 3 b , i 

PR ACTICL pf uxing lait sear i sc £( -.fvt pa m aK at £-'^0 from 

pan 1 Fees' i.r*a i-a- Nl»x.wi rs i s*a* 'p r as aN ut I .Oc-snpjj 
bu tab e h *se asaila*' Pterrium 1 * > rs pur I a*., c wc-Mtai C. OW 
c«sN f r c •- sale 

31 MNT COAST— I AAOLRITF SF-ASIDL RESORT— O d-es -‘'Iisb J 

uJlc-dass PR ACTICI rnxtKin- «S ut £6 n pa S-rall panel -N) 
pati '•I Act g oJ h uv. n hes erJ if the *wn ss» h s'— ’c a-xcmnxa 
II 1 I reeh-s'd 3 31 ab - Prrm n £].2C0 Lrrmer Iv sui at • f r retired 
artev c'*ver wis** n- to auprse-t pe'^si n < r th e 1 $ s i p* ftr >Dun,*r r*— n 

'2 bUSSl \— I WOLRni COAST ?OW S — Old estab is^'ed PRACnCF 
pf xa mg eb -1 £^ 0 ii p a iPwluwir pare! whi h brm n in about £ 1*0 p a 
(/<*«'d h i te on two P K^rs 2 fr'cpf r n 4 beurfVJ'ns er Freeh 'd f sa^" 
Pre*~ irm 2 can pjn:^-ie 

3A SOUlhl CONSr SEAPORT -PARTNERSHIP -ONE THIRD SHARE 
a*3«abe in c?w<s s'* I'eJ and rapid irxrca me Pra ti-c which la t e^r 
rr«xj,.*ed ap- sirutcJ) £A 3^' irvlj- ns a par^l of over I 6^0 pati rts 
IN baser can <1 -Ksse h s own residc-ncc ITa*ticc 1 $ cordu-ned front ctrtral 
jurpers a"!! the expetves arc not high 

34 LADA DOCTORS PRACTICES —Smrr-1 asaiLb’- Fu'l deui's on 
application 

3' NORTH ANTS — ASSIST VNTSMIP »nh view to Partnership in «n old 
esta***i Vd courts Pratiite with pos'd fuiu^ prospects Initial sa’aD 
£*4X)pj».. incluuing car aUowarce the assrs ant to live out Full detals on 
aTlxaii >n 

•t midlands — FAAOURITE COUNTS TDW'N — SLRGICAL 
OPENING — A QU ARTER SHARF (after pr I mirjrs assistartship of 
3 mo''ihs) IS ofTcr^ in tld-establ«hcd ir> reasirg Practi-e producin'* ap^roxi 
rtatcly £3 XK)pa Panel of about ...*00 Ore ap'X'intmerx worth abo-t 
£1-5 px Fees ' 10 )0 No disncrum'* Suitab'c h use with garu n 

and carar-* Rent £65 pji recmium 2 j'cars purchase part b> aiTar'*crreri 
fruom^. pamcr should be under " cs'^rier^ed -rdab c to do some sjrg-rv 

3 - SOUTH or ENGLAND— COAST TOW N — P \RTNERSHIP — A HALF 
SHARE in pood rnixed-class Praa e established over ICO years, asentgin'* 
apmosimatclv fJOfWpa with substariial panel ApNjnin'e'iis worm 
aboui£ OOpa Suiiab ehomeonren alatCIOOp a Prcmium2sears purchase 
^ MIDDLESEX —partnership— ONE HALF SHARE in incrcas n 
Ir’livc produ..inb. approsinxieh £. 000 p a P..rcl of 600 and inne-asinc. 
Houv. with 2 rccepH n 3 bedrooms etc Rent £100 pa Premium 2 ears 
purch- e 

)9 LONDON SC. — 0'd-e5fabfts*’ed chfe/T» mdd e-elass PR ACT7CE producing 
f f last 12 mo**ih5 £l.2b4 p a Parclcr6«' Suit-ble house on rental Prcrriuni 
2 Can purchase m»mir offer 

-0 SOUTH AFRICA —PARTNERSHIP— Good surgical openir- Preset 
rece pts about £2,TO0 pa w ith am" c scope for esparsion w iih aid of suitable 
partner Fulld tails on appli'-ation 

41 SOUTH WELSH CO VST — PARTNTRSHIP — ONE HALF SHA^ in 
old-estaHrthcd miudle and workins-cliM Pra-ice prxJixing o er £I OOOpa. 
Panel cf 2 AOO Good house wmh ample a-nrommodation Large garden 
Freehold for sale Premium £' *00 part by arr3n«,em rt 

4 • riixed<Ia 5 s PRACTICE producing re-r’ 

•s 3 6 to 10 6 D-*t-"-hed house with good 
Jil rert Premium £I *00 

43 > NTRY DISTRICT— PARTNERSHIP — 

stablished mixed-class Pranicc producing 
< ood scope Parel brino in about £700 p a 

Rent £50 pa Aery reasonable premium 

for quiA sal* 

^ SOUTH MIDLANDS— PARTNERSHIP— A H ALF SHARE in oM 
O' ablished good<lass coumr' Practr'C m beautiful dis rict Gross casa 
receipts approximatclv £3 000 p a., including panel of about 2,000 A erv ri "c 
house with garden and garag* Freehold for sale A erv good hurtn^ 

I shooting and other sport Premium 2 vears purchase 


je ■%eencv has made arrangemenfs for «ipecinl facilities, on verv favourable terms, to be afforded to apjiroved pur 
lasers, for the advance of part of the premium for anv suitable pracDce or partnership Full details on npphcation* 



THE BRITISH MEDICAL JOURNAL 


tV’ 






Tn^ IT 






H 

jiLi 


KJ' 






OVARIAN FOLLICULAR HORMONE 


o 

A standardized preparation of 
the ovarian follicular hormone 
for intensive ovarian therapy 
by hypodermic “ injection. 

j- 

Indicated in the treatment of 
scanty menstrual flow, amenor- 
rhoea and the vasomotor and 
nervous symptoms of the meno- 
pause. 

Boxes of 6 1-cc. ampoules. 2,000 
international units in oil. 


G, W. GARNRIGK GO. 

20 Mt. Pleasant Ave., Newark, N J., U S A 
DISTRIBUTORS 

BROOKS & WARBURTON, LTD 
240 Vauxhall Bridge Road, London, S W. 1 



BRITISH 

MEDICAL JOURNAL 


JOURNAL OF THE 



ASSOCIATION 

SATURDAY AUGUST 6 1938 


PRINCl 

Physiological Approach to 
Fitness 

Skiagraphy of the Chest 

Cl Welchii Infection following 
Abortion 

Phases in Life History of the 
Polymorph Leucocyte 

Chemotherapy in Gonorrhoea 

X-Ray Pelvimetry 


PAL 

CONTENTS 


P 273 

Leading Articles 

p 291 

276 

Scientific Sections at Plymouth 

301 

Correspondence 

315 

279 

Surgery in General Practice. 



Forearm Bone Fractures 

296 

281 

Reviews 

288 

283 

Epidemic Situation in China 

300 

284 

Psychotherapy Congress 

298 


WITH SUPPLEMENT AND EPITOME 

LONDON 

BRITISH MEDICAL ASSOCIATION 

TAVISTOCK SQUARE 


No 4048 ^\EEKL■\ PRICE 1/3 


Copyright 


REGISTERED AS A NEWSPAPER 



71 


THE BRITISH MEDICAL JOURNAL 


August 6 l93g 


No 14b 



in the treatment 


varicose ulcers 




This technique is one of many shown in detail in the sectionahsed film, “ The Use ot 
‘ Elastoplast ’ in Modern Surgery ” If youw^ould care to see it, please communicate with 
T y S}mth £f Nephew, Ltd , Dept B I2y Hull, for details of its evhibition 

B M A BRANCH Secretaries are invited to write for available dates for projections 







THE MODERN SURGICAL DRESSING 


ELASTIC ADHESIVE BANDAGES, PLASTERS, DRESSINGS 



BRITISH 


MEDICAL JOURNAL 

VLGLST 6 1938 


TABLE OF CONTENTS 


VDDRTSSLS \>D PVPLRS 
The Plu^iologicnl \pproach to 
Fitness E P Catiic \ri \i o 
D F r s 273 

Skneraphs of the Cl est Ciorct 
JtRSFL D M 276 

Tlircc Cases of Cl sielchii 
Infection followma Abortion 
R ^ Dswbsrs md and Rrs \s 
\V ILUSMS SI D r R C.S td 2"9 

Phases in the Lifc-histon of the 
Pohmorph Leucocslc C J Boso 
FRC^ 7SI 

Chemothcraps in Gonorrhoea 
F J T Bo\me m n 283 

VRas Pclvimctn A Orles 'id 294 


CLIMC\L MEMOR^^DV 

pneumococcal Meningitis treated 
"Uh SulphaniUmide Recoserv 
Fpeio' \oeso sib 286 

PoUneuntis "Uh Oedema simu 
lating Benberi E B Garpltt 
M B 257 


nEVIE\3S 

CeUub Redi'i'us 
Orcanic Chemistrs 
ISecrops' on a Gonlla 
Defence of the Ego 
Diet and Blood Pressure 
Gastro-inteslinal Pain 
Notes on Books 


288 

288 

288 

289 

289 

289 

290 


SERGICAL SERIES 
Fractures of Shafts of Forearm 
Bones E 3\ Hes Groses 
T rcjs 296 


LEVDING ARHCirS 
Pth ic McTsurcments 
Quack Medicines -and OSctiranlism 292 


VNNOTVTIONS 

SoLiolOi-tcal VshlcIn of a Derelict 
Area 29' 

The Corpus LuUtni 294 

Chcmothtrap\ in Gonorrhoea 294 

Inlcrdtririm ntal Commiiitc on 
\boruon 29-' 

Blood Chinee in Expcrirrcnla! 

TuKrwulo Is 2^^. 

E r H irrison and Gas Defence 29' 


SUPPLEMENT 

PROCEFDINGS OF CObNCIL 


Oicrsca Conference 


Annual Meeting Notes 


CoRREsrosorscc 
Postcr'de'TE News 
Disks or Socinirs 
MEEriscs OF Dimsions 
N'WL MILIT'RF asd 
Forci ArroivrsiESTs 
Associalion Notices \ acancics 
and Appointments Diars 


Ajp 


THE SERVICES 

Nasal Medical Compassionate Fund 20 
Deaths in the Sersices 320 


GENERAL ARTICLES AND 
NE3\S 

Psschothcraps Congress at Osford 298 
Epidemic Situation in China 300 

No>a et A etcra 

Annals of Medical Histon ^01 

PREPAPs.AT!ONS ^SD APPLIANCES 290 

Medical Notes in Pakliamlne 322 

Lmaepsities and Colleges 321 

Medical Nfaas "'0 


LETTERS VND ANSWERS 


Green StooK at 74 

3s0 

Finger pnnts of Twins 

3 0 

S\phihs in South Africa 

'jO 

The Medical Direclorv 

'jO 

Protest from \a1halla 

3^0 

Unilateral NAstagmus 

bbO 


EPIDEMIOLOGT SECTION 
Ei iDEAtiOLOGiCAL Notes 328 

Table of KrEcriots Diseases and 
\ iTAL Statistics 29 


CORRESPONDENCE 

\boriJon and the Law F M R 

\\ ALsnr AID 31 s 

Canecr o*' the Lunu \fRNnN C 
Tiioah son r p t n 316 

Injeetion Ria^a E W Haaaaafd 
r p c s id 317 

Sulp’unil imidc for Mf’nTnj.CvOucal 
Meningitis F J OMeara d 317 
I ehio ruble Cstcechondritis 
G D F McFadden frcs 317 

Lndescended Testicle Denis 
B fow^t FRCS John Honford 
F p c N 318 

]rr'>diaiion or SurgerA for Cancer‘s 
ERG pAS^F FRCN 318 

Horrronc TherapA in Mastitis and 
-Breast Cancer \ A Loeser 
L R c 319 

Placenta Pne\i3 H R Pearson 
MB 319 

PsAchoAomatic !llne>s Charles 
Bfpc md 319 

Treatment of Carbuncle^ P k 
Banfujef mb 320 

ThrombocMopenic Purpura from 
Sedormid F E LoEwa vi d >20 
EfTcclsof Smoking E SAkOsCHASskA 
M R c s '20 

Brace Paul Pulsator Robert M 
Pall ai i e e 320 


THE SECTIONS 
SummarA of Proceedings 

Medicine 301 

SurgerA 302 

ObMelnCi \Mth Public Health ji03 

Orthopaedics \Ailh PhAAtcal Medi 
cine 304 

Diseases of Children 305 

NeurologA and PsAchological Medi 
ane 306 

PaihologA and Bacteno’ogA 307 

RadiologA 30S 

PharmacoIogA 310 

PhAsiologA and Biochemistr\ 311 

Tuberculo is 312 

OphthalmoIocA 313 

ObstetricA 313 


REPORTS OF SOCIETIES 

Roa al Socifn OF Tropical Medi 
CINE Nulntional MacrocMic 
Anaemia m Macedonia ■'14 


A kE\ TO CURRENT MEDICAL LITERATURE amII be found at the end of the JOURNAL 




2 


THE BRITISH MEDICAL JOURNAL 


August 6, 1938 


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Ai'CU'^t 6 19'(S 


THr BRITISH MEDICAL JOURNAL 


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THE BRITISH MEDICAL JOURNAL 


August 6 1918 


Bw im@H0goe 


The lUustrahon below shows a retailer's 
cottage premises m the httle village of i 
Coclcfield, Suffolk Player’s Navy Cut ' 
Cigarettes can be purchased here, as in 
many similar picturesque and remote 
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- A 
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Numerous letters from smokers tell of 
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MEDIUMi 




PLAYER’S NAVY CUT aCARETTES ■« MEDIUM ” OR ■ MILD •• PLAIN OR CORK-TIPPED • 10 FOB 6° 20 


\H M t> 


THE BRITISH MEDIC \L JObRNAL 


THE 


Tampax Stand 


AT THE 

BRITISH MEDICAL ASSOCIATION EXHIBITION 


At the recent B M \ E\luj inn intc c he uc of t’lc h ncn'^il aper uru \v nild cau^e 

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M^tnneance o* thi> adapn ion o‘ the \ uinal tjnr<^ to ,.t I inpa\, ■> c her \ i h i o dtr ^ \in^ ^'inre de ail 

men ruil h\ricic Di p rs >u ui h am a t t wkU onrqucaoT mri\I d i c Bo’ton reef Lo-d in U i 

T ampa\ mmini c:> nA ot iniecion and com 
p]t eh tlimna cs JaHjal irnti ion It con t* 
freedom and peace o‘ mind 

lanpa\ i made bu hired ^ur^ical 
CO on utx>l uhich ha bet enU d aid 
hishU C0Tnprc>«cd Lach tampon has n 
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indi\idu~lh scaled \m hm its oun applici o 
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the CO ton b^ an c\clusi\e Kchinij proces 
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Tampav mav toihdcn h b" recommended 
In ph\ icnns tor use In married nenen 
dunn» noTnal men trua ion Its u c In un 
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THE BRITISH MEDICAL JOURNAL 


August 6, 1938 


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\icust6 19'S 


THE BRITISH MEDICAL JOURNAL 


OXYGEN AND NITROUS OXIDE 


an important announcement 



to physicians, anaesthetists and hospital authonties . . * . 


O WING to the increasing demand for ns Medical Gas Products, especially 
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According to ihe consumpiion of ihe user and ihe 
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THE BRITISH MEDICAL JOURNAL 


August 6, 1938 





\ 

by members of the 
Medical Profession 

Read what a doctor says — 

“ I think ‘ Ty phoo ’ is Monderful for sufferers from 
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'*1 Write to 

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(This ofTtr applies only to the British Isles Wc regret that \sc cannot send Typhoo tea abroad) 


^ Over 
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THC BRITISH MEDICAL JOURNAL 


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Auclsi 


THE BRITISH MEDICAL JOURNAL 


A Mucilaginous Laxative with natural 
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THE BRITISH MEDICAL JOURNAL 


August 6 I918 



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PICKETT-THOMSON RESEARCH LABORATORY 


Genatosan Limited wish to inform members of the Medical 
Profession that they will cease to distribute the Vaccine 
Products, prepared m the Pickett-Thomson Research 
Laboratory, after August 31st, 1938 

These products will, in future, be marketed by RESEARCH 
PRODUCTS, LTD , NAN CLARKS LANE, LONDON, N W 7^ 
together with other preparations manufactured m the Pickett- 
Thomson Research Laboratory 

GENATOSAN LIMITED 


Manufacturing Chemists 


LOUGHBOROUGH, LEICESTERSHIRE 




Alglst 6 19"^^ 


THE BRITISH MEDICAL JOURNAL 


13 



A mong the man\ and 

divtr^c an3lccMC<i ^^h^ch 
ha\ c been c\ ol\ cd b\ mexJern 
chemical rc«icarch accul ^alic\lic 
acid retains reputation as one of the 
vife>t and most cffectiNC Its tendcnc\ 
to liberate ^alic\lic acid — the irritant 
properties* of \\hich arc well known to 
ph\MCians — has howc\cr caused man\ to 
hesitate to cmploN it as widels as it dc*^cr^cs 
ExhaustiNc tnal in ho pml and pnsaic practice 
pro\cs that Alasd dchnitcU solves the 
problem of administering acctvl salicvlic acid in 
an elTectivc form bcinc free from the risk of 
irniatinc the stomach or bowels or of caiismc 
general reactions 

A supply for clmical trial nith 
full dcscrtptn c literature sent 
free on request 



In Alasil the desirable 
therapeutic effects of aceivl 
sahcvlic acid arc well exhibited 
b\ Its calcium aceivl salic>!2le 
moieiN whilctheprc'enceof Mocol 
(Colloid'll Hidroxide of Aluminum) a 
powerful gastnc sedative and antacid 
obvnte^ anv tendenev to gastnc irritation 
The superior absorbabililv of Alasil over 
ordmarv salicvlatc compounds and its freedom 
from the risk of hbcriting free salicvlic acid in 
the stomach have been well proved bv careful 
cxpcrimcntition Alasil can be prescribed 
with perfect safciv to patients of all aces 
and in larLcr doses than ordmarv salicvlaie 
compounds 

A MANDER I td^ Manufacturing Chemists 
181 Queens Gate Tendon SM 7 

Lcf-oratortits enJ li orl’i KING 5 LANGLEY HERTS 





ALOCOL 

C3o(£oiclxx( Ti/i^dMxxaude of ^Alu/rrwm/j/rn. 

Effective in Nervous Dyspepsia 

H VTE\ FR lit the lundnment il cau^e ot ntrvou" d\''pcp>ii u t'. 
W 'tcKnouled^cci that alleviation ot the giMric svmptoms i-> an 
important part oi cfttciivt trtalment 

Nervous connotc> Inicrs^-Crctioii Tin cau cs fl iiultnct sour stomach 

uiscc^niort and j rhip> jmn \locol provides the ideal gasinc sedative since 
it^ action IS promi I and lasting and ciitirtlv tree from liarnmil effect 

acts b\ adsorbing excess ot tree hvdroclilonc lud in the stomach torming 
a cwloidal jcllv which pas es ihrouch into th inltstmcs and i finallv evacuated 
Alocol thcretore actuallv removes irom the s\5icm the cau atue radicle (Cl) 
instead ot merdv temfKiranlv neutralizing il \loco! doe*' not intcriere with 
normal digestion nor doc u dctcmire anv unpleasant secondarv reactions It 
1 sued in tablet and powder lorm 


Complete c r I /"t t r- cf rtlo oJ n// c n •* icirt cit u j/ 
re*'cr*s arj si ['l\ f r iriv./ s >t Jrt to ex 



A WANDER LTD , Manufacturing Chemists, 
184, Queen s Gate, London, S W 7 

V rhs KINGS LANCLE\ HEI TFOPD^HIKE. 


Irdi OJ 
5»rax*r ti 

tl I ra 
(12 “• r r ir\) 



I2i3 









14 


THE BRITISH MEDICAL JOURNAL 


August 6 I9'.s 



SUGAR-FREE GINGER ALE . . . . 
SUGAR-FREE TONIC WATER. . . 
SUGAR-FREE SPARKLING LIME 

Approved ky the Imtitute of Hygtaie and the Diabetic Association 


These boerages haTc been analysed by the Institute of H)giene and 
found “ free from sugar and metallic contaminants ” The analTscs 
shoTTn haTe been accepted by the Medical Advisory Council of The 
Diabetic Association and recommended for diabetic and obese subjects 


ANALYSIS SHOWED THE FOLLOWING RESULTS 


Scliacppev Si/gar-EiiL Ordinary Diy 
Dry Gutter Ale Ginger Ale 
C^rbohyd^ates absent 6 2 ”o 

Protein absent absent 

Fat absent absent 


Sell eppis Sitgar-Frct Ordinary 

Tonic n atcr Tonic ICntfr 
Carbohjdntes absent 91% 

Protein absent absent 

Fat absent absent 


Sell icppLS Susar-Frce Ordiuiry 
Sparkling Ltnii. Sparklm’ bin 


Carbohj drates 

absent 


Protein 

absent 

ab'ent 

Fat 

absent 

absent 


FOR TREE SAMPLES WRITE TO MESSRS SCHWEPPES LTD , i CONNAUGHT PLA,CE, LONDONAT’ 



Many cases of anaemia improve more rapidly upon a com- 
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One tablespoonful represents ] lb of whole liver and contains 
1' grains of iron, chiefly in the ferrous state Most patients 
like the taste 


\aLI 0081% 


8-oz. Bottles tvs 


^&£oitior) 


Sample aatl hUraturL on rt quest from the Bntuh 
Dtsinbuiors 

Butler 8e Crispe, 

PO/84 Clerkenwell Road LONDON. EC1 


LIVER EXTRACT VA LE N T I N E ^ 



Algust 6 19'^'! 


THh BRITISH MEDICAL JOLRNAL 


★ Crcmi of 
(Mi'tun IH- 

droMdi BP L S P \ ) 
P-ittin--on > Bniid con 
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H\dro\ide m i stnle 
ot nlino't pcrtcct ‘;ii' 
pcn-ion in pure uilcr 


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-k It 1-. prcpircd In nn 
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ot rci,ulTr coinpo'ition, 
wlnKl \i'cO'il\ enn lie 
\ nrini to -uit cmtomci ■■ 
requirement'' 


★ In nddition to it=; 
\1rtuc5 an antacid 
Pattin'on'e Brand 
Cream of Magnesia can 
be U'cd a'' a mild Ia\a- 
ti\t It al'O makes an 
excellent mouth wash 
and liquid dentrifice 


★ It Is supplied 
m carbois and 
in one gajlon 
bottles A 
12-07 sample 
bottle \ ill be 
sent tree on 
request 


WASHINGTON CHEMICAL COMPANY 

BRANCH OF TURNER & NEV/ALL LTD 

H xfi y rt fr Cc Ott f- n 

f r I" I II il (it Ch rr-i f» f' X rt j (• r 5 1 r 



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Write for 
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THE SACCHARIN CORPORATION LTD, 72, Oxford Street, London, W 1 

Telegrams SACARINO Ri^TH LONDON Telephone MUSEUM 8096 

Australian Agents J L BRO\X N & CO New Zealand Agents THE DENTAL & MEDICAL SUPPLY CO LTD 


271 Moreland Road Moreland N 13 Melbourne 


128 V^aPefield Street Wellington 


16 


THE BRITISH MEDICAL lODRNAL 


August 6 19IS 



ELITYRAN' 
in OBESITY 




ISSi teAYERj tSjS 

r lA! MACIUTICAl 
T' ODUOS 


BAYER PRODUCTS LTD., 

AFRICA HOUSE, KINGSWAY, LONDON, WC2 

Noithern Office BLACKPRIARS HOUSE, PARSONAGE, MANCHESTER 
Dublin Office MOLESWORTH HOUSE, SOUTH FREDERICK STREET, DUBLIN 



Aucii'rr 6 191S 


THE BRITISH MEDICAL JOURNAL 


17 



fllHllF 


^ //ir f/rirr/jfc 

I /Ic 


\dministered onlH rcctallj or in 
emergencies mini enou'h iScmbutal 
exerts an extremeh rapid but brief 
h\pnotic and a pronouneed sedative 
aelion from a dosipe onlv about one- 
half that required with most other 
powerful barbiturates This small do- 
age reduces the recoverv period al-o 
bv about one-half and bv Icssemng 
the amount of the drug to be chmi 
nated makes IScmbutal clinicallv 
one of the safest of the barbiturate- 
• Safetv rapiditv and brevitv of action 
recommend IScmbutal for use not onl\ 
as a pre anT-thctic sedative m major 
and minor surgerv but also in the treat- 
ment of in'omnia hvsteria seasick- 
ness mu-ca from anv cau-e cclamp-ia 


delirium tremen- convulsions from 
stnchninc or other poisoning and in 
obstetrics — vvath or without morphine 
and scopolamine 'Scmbutal has also 
licen Used vnth much success as i sup- 
plement to morphine m conlroUmg the 
pain of earlv cancer • "Scmbutal is 
available tlirough pharmacies in a wade 
V arictv of form- the most widclv em 
plov cd of vv Inch are the * > grain and 




IJ >-graincapsuIcfororaluse Literature 
and a Inal sample of Ivcmbutal 
grain Cap-ules wall be sent upon request 
The coupon is for vour convemence 

ABBOTT LABORATORIES 

iE\Gh 1 ^i>) LIMITED 
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18 


THE BRITISH MEDICAL JOURNAL 


August 6 , 1938 


INDICATIONS FOR 'SANATOGEN' 


No 8 


TOE m\ 


OF ANAMIA 


“A conditioned dejiciency 




A distinguished physician, addicssing the Exeter branch of the BMA, recently 
emphasised “ the close relationship between anxmia and disturbances of gastro 
intestinal function , since abnormalities in food intake, digestion and absorption must 
result in a deficiency of hicmopoietic principles ” 

Nearly always, anaemia is secondary — a symptomatic manifestation of some primary 
disease The first procedure must obviously take the form of replacement therap) 
The administration either of iron or, in the case of pernicious anaemia, of a hjemo- 
poietically active preparation of hog’s stomach or liver is specific 

But, generally, the digestive and absorptive faculties are deranged, and the nerv'ous 
system is impaired Both these conditions call for treatment if the specific therapy is 
to be effective Here ‘ SANATOGEN ’ has been found of great value 

‘SANATOGEN’, consisting of 95% Milk casein, with 5% Glycerophosphate of 

sodium, IS rapidly absorbed and utilised It is non 
irritative, and, in addition to its high direct nutritive 
value, it stimulates gastric functioning, increases appe- 
tites, and promotes the digestion and absorption of 
other foods taken with it 


I tried Sanatogen in a female 
patient mth extreme ncr\ous debil- 
ity partly due to anasmia and 
excessive indulgence m tobacco 
after haMng previouslj used Nervine 
SedatiNes The general tome effect 
%\as satisfactory and sound sleep 
\Mthout the use of anv other drugs 
^^as attained^ a stead> but slow 
return to normal health bang 
rendered possible The preparation 
seems to Ailfil all the desiderata of a. 
good tome food — B ^ B Ch 


I have to say that I ha\e had 
most satisfactory results inch the ard 
of Sanatogen in the treatment of 
anaimia and weakness in a case of a 
young girl of 15 , suffering from 
epistaxis — OH, L R C P & 
S I 

The case of anarmia followmg 
the loss of a large amount of blood 
after an operation, recovered xery 
well with the administration of 
Sanatogen onlj ’ — L R C P & S 


Sanatogen 

(Trade Jlfark) 

A brand of Casnn and Soditfm Glycerophosphate 

Sold by all chemists price 3}3 io 1919 




DOSAGE For children and adults 
iwo teaspoonsful three times daily or 
ac'‘ 0 tding to arcumstances For infants 
i- teaspoonful added to each bottle feed 


The einl SAVATOGI N » '''? L”,’,' '"I'rLol 
icnitosan I t.l ml <1™'" X '''Xi V 
of II mil S 1 liimi Clj ceo ph ' ,, 

V f I NATOSAN P""'"" '"w'eSenh re 
G1 NA rOSAV I t(l ‘ 


Clinical samples and literature available on request to 

GENATOSAN LTD., LOUGHBOROUGH, LEICESTERSHIRE 



August 6 1 93b 


THE BRITISH MEDICAL JOURNAL 


19 


'"'TABLOID’ 

SULPHONAMIDE-P 

(SULPHANILAMIDE) 

Action on Hcemolytic Streptococci 
in the Human Blood 


At the B M A Exhibition at 
Pl\ mouth, |uh, 193S, Burroiig'lis 
Wellcome S. Co dcmonstritid 
the eflect of ‘T\bloid 
Sl LPHOx \MiDE- P on Hum-in 
Blood in ha,mol\ tic infections 
Coloured reproductions of nctinl 
blood-smears under big’ll 
magnification were shown 

A Normal blood 

B Twelve-hour growth of hasmolytic streptococci in blood broth inoculated from 
a plate culture Note complete haemolysis of the blood 
C Streptococci from same plate culture incubated for twelve hours and showing 
as many streptococci as B ‘Tabloid’ Sulphonamide-P (Sulphanilamide) added 
Smear examined five hours later shows only slight htemolysis, a few streptococci 
only and some in course of destruction (Gram -negative) 

D Smear from same specimen twenty-four hours after addition of ‘ Tabloid ’ 
Sulphonanude-P shows almost complete destruction of streptococci and absence 
of haemolysis 

Literature and details of packings on request 




Associated H 
Nev York 
H 363*’ 


Burroughs Wellcome & Co , London 

iddrfss for cof Jfr’ intcatiofs SNOW Hill BUILDINGS EC 1 
Exftbtuor Galttriei lO Henrietta Place Cavendish Square W l 

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COPYRIGHT 



20 


THE BRITISH MEDICAL JOURNAL 


August 6, 1938 



The new princtples of vaccine therapy established by Dissolved Vaccines G L bring 
to Cold prophylaxis the assurance of majority success For although the primary infecting agent in 
the common cold still remains a subject for research, enough has been discovered about the 
secondary invaders to produce an effective vaccine for prophylaxis and treatment 


Inoculation with Cold Dissolved Vaccine G L releases, for^immediate utilisation, 
the antigens of those organisms which are responsible for the acute secondary stage of the cold 
The retention of full antigenic power excites a rapid and potent response from the bodys 
defence mechanism 


Moreover, detoxication (which is simultaneously effected by the solvent — sodium 
lauryl sulphate) enables a maximum dose ({ — ^Icc) to be given from the first without fear of 
Undesirable reactions Immunity is developed rapidly, three injections at intervals of a week usually 
being sufficient for the whole of the winter The injections should be started in the early autumn 
Finally, with the Dissolved Vaccine G L , antibody production is sufficiently speedy to shorten an 
actual attack if injections are started when the first symptoms appear 


COMPOSITION of Cold 
Dissolved Vaccine G L Each 
cc contains in solution and de 
toxicated the antigens of 

million 


B pneumonias (Fnedlander) 25 
M catarrhalis 25 

Pneumococcus 150 

Streptococcus (respiratory) 150 
Staphylococcus 100 

C coryzas 25 

H Influenzae 100 


COLD BBSSiU-VCP 

vficci^4M 


Jn rubber-capped bottles 5 cc, 7/6 10 cc , 10/9, 25 cc, 17/6 Less usual professional discou-il 


GLAVO LABORATORIES LTD, GREENFORI), MIDDLESEX 






BRITISH 


MEDICAL JOURNAL 

LONDON SVTLRDVN AL'GLST 6 1938 


THE PHYSIOLOGICAL APPROACH TO FITNESS* 

E P CVTHCARl, C B E . r R S 

Rct;ttts Profesior of Ph\swlo''\ Lti\crut\ of Gfoii:OH 


Thi question which I ha\c b^Ln ashed to approach from 
th. phxsiological point of \n.w is one of tiindamental 
importanci. — the basis of national filness I suppose most 
ot us will base our own id^as as to the exact connotation 
of the word fitness The exact meaning we attach to the 
phrase will largeh be conditioned b\ th. question Fitness 
lor what’ ObxiousU a man max b^ pcrfectlx fit to carrx 
on some occupation and xet be unfit phxsicallx or psxchi 
callx for some other trade occupation or proless on 
Are XX e to confine our interpretation to mere phxsical 
fitness"’ Or is the xxord fitness as it xxell max b. used 
s mplx as a sxnonxm for perfect health"’ Or as a xariant 
to connote a state of well being or of good nutrition 
ot eutrophx"’ What are we looking for"* What are xxc 
trxing to attain"’ Personallx mx own reaction to and 
interpretation of the phrase national fitness is the 
building up of heallhx human beings well balanced 
phxsicallx and mentallx and emotionallx who xxill be 
capable of all ncccssarx adjustments to their immediate 
enxironmcnt be it of xxork or plax 

The approach to this state of fitness which at the 
moment seems to be most in the public cxe is that ot 
phxsical training of some kind The fact is there is no 
single line of attack Manx factors besides phxsical 
actixitx are concerned The proxision of a diet adequate 
in both quantitx and qualitx is of course one of the 
essentials but again diet alone no matter how perfect 
XX ill not achiexe the desired end Other factors such as 
an adequate supplx of fresh air opportunities for suffi 
cient sleep and for recreation contentment of spirit all 
plax important parts 1 shall confine mx attention to the 
phxsical actixitj and dietarx aspects of the problem 

The Aim of the Present Campaign 

The aim 1 behexe of the present campaign for phxsical 
fitness IS to dexelop and perfect the potentialities xxhich 
exist m all for the integration of the sexeral bodilx 
sxstems As a result of this integration it is hoped to 
achiexe a harmonx of motion a grace of carriage a pride 
of bodx a mental concentration and quickness of reac 
tion and a happiness and contentment xxhich characterize 
the reallx fit 

And this training as it has to take place in the leisure 
time of all those oxer school age must be attractixe 
; it must trulx gixe a sense of re creation It it xxere onlx 
concerned xxith ph>sical recreation it might be regarded 
as a relatixi.|x simpl e problem but the need of rebuilding 

• Pcad in opening a ctixcu ion in the Seclion of Phxsii.al Medicine 
and Phxsi~at Edu-ation at the Annual Xteeting of the British 
/ Xti-Jrat Asso''taIion Plx-moulh 19 3 


for the morroxx max b> as much psxchical as physcal 
In fact It might be said to dax that xxith the cxcr increasing 
climinition of heaxx manuil work from industrx and the 
extr increasing specialization of men to single operations 
the n^ed for the re creation of the spirit is greater than 
that for the bodx Further I do not think it is empha 
sized sufficientlx in these daxs xxhen the sense of rights 
seems to transcend the sense of dutx that phxsical 
training and indeed mans forms of recreation properlx 
carried out dexelop a true sense of discipline 

When xxe realize that inexitablx a xerx large proportion 
of those xxho will be trained or are being trained will 
enter on industrial work it is obxiois that it is our dutx 
to think m terms of allexiation It is probablx true that 
the man or xxomin who had xxell dexeloped muscles and 
xxho could use them was m greatest demand noi so long 
ago To dax xxhen machine minding becomes cxer more 
prominent xxe realize that although man max not xet 
haxe b.come and xxe hope nexer will the machine 
tickling aphid enxisaged bx Butler in Erewhon some 
thing more is required than mere brute force The 
qualities on xxhich there is a premium to dax are quick 
ness alertness quick reaction time intelligence 

No Short Cut to Perfection 

There is no short cut to this desirable state ot phjsical 
and mental perfection To attain it no amount of help 
no amount of direction no amount of guidance xxill suffice 
unless the xxilhng co operation of the trainee is obtained 
People must xxant to be fit Thex must be prepared to 
pa> the price The price that so manx are unxxilhng to 
pax IS steadfastness and discipline It is relatixelj easj 
to get Tom Dick and Harrx and still more easx to 
attract Marx Jane and Ann to start but it is difficult lo 
get them to continue in xxell doing So manj xxant the 
final result xxithout the necessar> effort Thex xxant the 
balance of posture the perfection of rhxthm xxithout the 
labour xxhich goes to the building up of smooth reflex 
moxement The onlx exercises in the end xxhich xxill be 
of xalue m retaining the performers are those xxhich are 
creatixe xxhich either alloxx the performer to express 
something innate bx xxax of limb moxements or gixe rise 
to the real belief that the sxstematic practice is creating 
a nexx bodx a nexx control The difficultx is to dexise 
a suitable s>stem Ot one thing xxe max be certain — 
that no one sxstem will suffice for all There must be 
exercises for the immature and the mature for t‘'e 
xigorous and the non xigorous alike So far as '' e 
children are concerned I am satisfied that the sxstem 
carried out under the Board of Education is sound Biu 

404S 



274 August 6, 1938 


PHYSIOLOGICAL APPROACH TO FITNESS 


TnrBRriBH 
MroJCAL JoiILVU 


what have wt to offer the adolescent and the adult of 
all ages^ Recently the Board of Education has issued 
(wo suggestive handbooks Obviously the many exercises 
contained therein must be chosen with care by leadeis, 
courses must be suitably adjusted from them This 
demands skilled and discerning leaders It is perhaps not 
within my province to discuss the nature of the exercises, 
but I should say that free standing exercises with a fair 
amount of apparatus work would be best for the male 
from post-school age to, sav, 30 or 35, the amount of 
apparatus work being i educed for the majority as age 
advances In the case of young women, unless thev so 
desire — and a certain number do exhibit a preference for 
apparatus work — the exercises should be all of the free- 
standing and floor-agihty type For both sexes after the 
age of 30 to 35 the exercises should be confined to the 
free-standing type Generally speaking, I would endorse 
the classification of Lindhard as a guide to training, 
particularly of the ‘ keep-fit ’ type His classification is 

1 Exercises the chief object of which is to discipline, to 
rouse, to educate in the general sense of the word 

(i) Order exercises 

(ii) Exercises of deportment 

(ill) Walking exercises 

2 Exercises the chief object of which is a sjstcmatic 
training of muscles and joints 

Corrective exercises Head and neck, Inink, arm, 
and leg exercises 

3 Exercises the chief object of which is the development 
of nervous co ordination Balance exercises 

4 Exercises that aim in (he first place at developing 
strength, endurance and resolution 

Marching running, jumping, games, and sports 

Lindhard’s Scheme as a Basts 

I feel convinced myself that if this scheme of Lind- 
hard be adopted as a basis, the necessary choice of exer- 
cises being made from the books issued by the Board 
of Education and adapted to the age and the vigour of 
the pupil whether of 16 or 60, a course could be de- 
veloped which in a relatively short time might simply 
transform the appearance of the average citizen I would 
lay special stress on the corrective exercises It falls to 
the lot of very few to carry out their several avocations 
in such a way as not to distort to some degree their 
physical frame Keeping fit does not merelv mean the 
retention of health and vigour in any kind ot framework 
The ideal is to get the frame, as well as the organs it 
contains and the muscles which bind it, as nearly balanced 
as possible The child at school, despite the provision of 
anatomically correct equipment, tends to adopt bad 
posture , the clerk at his desk, the worker at his machine, 
the labourer in the field, everywhere we turn — often, from 
the very necessity of the case, even the fact (hat the 
majority are right handed and not ambidextious en- 
courages wrong position — bad posture and unilateral 
development are the rule The bad posture tends to 
become permanent Surely one of the main purposes of 
(he whole “keep fit’ and physical training movement is 
to correct by suitable exercises such faulty developments 
and to restore to the frame whilst still pliable the resiliency 
and the beauty that are its right and proper heritage 

Posture and Carriage 

There IS no question about the physiological gam to 
c obtained by the healthy organism from muscular 


activity, but I do not propose to deal with its effects m 
detail These may be found in, for example, Bambridces 
Ph\ biology of MtiKiilar Excrasc Very few of our com 
plicated muscular movements arc inborn , they arc ih^ 
result of practice We assume too often that wl haw 
good contiol of our muscles until we try some new form 
of activity Most have passed through the humiliations 
of golf When v;e see a master of the game play it all 
looks so effortless and easy — till we try it We rcalue 
the same is true of any game, any art — for evample, 
singirtg piano playing, or even of dealing cards at bridge- 
vvhich demands exact co-ordination of muscle The 
obvious gain from constant exercise of muscles is a 
greater range of rhythmic movement, of better balaii,e, 
of more accurate judgment, a greater resiliency ot the 
body as a whole, a better carriage, better posture Our 
initial judgment of our fellow men is most often b) th ir 
posture or carnage To quote from Lindhard s book on 
the lliLOty of G}miiastics “It seems as if on sctinga 
person with a good carnage we do not expect tb find in 
him good physical qualities merely, but also good psjthical 
ones bravery, courage, energy, firmness, well proven, 3 
noble mind It is as if it shows us the free manu 
opposed to the cowed bent slave ’ And on the ivhol 1 
think It true to say that we do find some, if not all, 
of these extra attributes in individuals with good carriage 
It should be emphasized, however, that there is no 
standard posture for all ages and both sexes The stvle 
of normal posture vanes with the change in bodv build 
from babyhood to old age Still, there is a tvpe of niali 
posture at rest which should be aimed at where ft 
whole figure, vvhile not being stiff and rigid, should ‘bet' 
the stamp of controlled force ’ In the case of woir 
the stance should be lighter but vvell poised and sho '1 
suggest repose in oneself Far too many of the attilud'' 
assumed as correct posture contain too much of lb 
costly static effort In everyday life m common "iili 
all our other bodily activities our posture and niovs 
ments are subject to emotional control We do rvi-O'' 
nize that “ the ringing step of confidence, the halting psw 
of fear, (he expansiveness of joy, the drooping air of end 
serve to remind us of the pervasive quality of emotion 


Plivsiological Effect of Muscle Activitv 

But muscular exercise docs more than build up 
nerve muscle control Probably the niajont) of ft 
capillaries which exist in our tissues arc onlv, so to sptu > 
potential capillaries which open up to full activilv wL"' 
for instance, the muscles are used Krogh has givsi 
dramatic example of this state of affairs As he points 
out, m a piece of muscle no thicker than a P'” 
are some 700 capillaries and 200 muscle fibres >' 
the muscle is at rest there is, however, conipariim-l 
little blood flowing through it, there arc Lw 
capillaries, but as soon as it is active the laten ^ 
potential capillaries come into action to meet the enliant 
needs The increased metabolism of active mui^^ 
demands an increased oxygen supply, and at Ih^ 
time there is the need for more rapid removal of 
materials, including increased heal loss Moreover, ^ 
the increase in skeletal muscle activity there is> 
necessary result, increased cardiac activity, 
respiratory rate It comes to this that even a^ 


limited form of exercise^ brings about a 
refreshing of the whole organism 


It is perhaps not commonly appreciated that 
all forms of muscular activity three separate p 


almn^i 


effort may be recognized positive, negative. 


and sialic 


\(-CLiT 6 I9'S 


PHYSIOl OGICAL APPRO \C H TO FITNESS 


Tice B^rrt h 
IeD cal JOLPSiL 




(. ich dilTt.ring in <.n(.rg\ co>;t lo llit orginism \\liLn we 
lor txampli. throw up an irni wt p^rlorm positi\c work 
agimst grr\it\ whLO wc lut it fill again back to our side 
this IS ni.gati\(. work If Wi, ccast. mo\<,mi.nt sa\ in thc 
iipward swin^ and hold out the arm "iteidih from tht, 
bad\ this IS called Halic effort It is the degree to which 
the static component enters into all ispes of muscle effort 
which determines its seserits in regard to the organism 
as a whole Hence it follows that an\ tspe of muscle 
work can made more ease or more seSere iccording 
to the amount of the static elTorl permitted to enter in 
It on the other hand hosseser the static clement b^ 
reduced too miieh rhsthmie cvereises for eaample mas 
degenerate into mere dangling of the limbs Also the 
seseritv can be increased or diminished according to 
sshether the displacement of the centre of grasps ot llu 
bods as a whole is marked or not 

Medical Supcnision 

Th^re IS no question in ms mind about the propriets 
of medical supers ision in some form But sshat arc the 
standards to be since the tspe of phs steal csereis^s 
isailable are so sers sariablc’ Apart from gross lesions 
how ire sse to decide sshelh.r an indisidual shou'd or 
should not participate m some form of cscrcise'* There 
Is the further ditbcults that it a formal medical oserhaul 
Is made a smt qua i on before permission to participate 
esen in the rclaiisels simple I ecp fit cscrcises this 
mas act as a deterrent — so mans people fear a medical 
oserhaul If a medical csamination were instituted the 
ultimate saltie might be e'en greater than that which 
accrued direc from the actual phs steal training There 
ssould ba the further adsanlage that as the result of such 
a medical esamination some indication might b, gisen to 
ih. esammee regarding ih. tspe of more strenuous exercise 
tor which he would be fitted It a single test of fitness 
has 10 be adopted it seems to nie that some form of ih. 
heart tolerance test would be the best We are far too 
apt to assume that the aserage pulse rate and blood 
pressure are normal rates and pressures and that 
thes plas no part in or afford no guidance to the tspe of 
exercise for which an indisidual is suited According to 
the potentialities of a particular phssique for particular 
exercises there seems so to speal to be the appropriate 
cardiosasciilar equipment In a studs of Olsmpic 
athletes made bs BramwcII and Ellis these differences 
(aserage saluesi are sen clearls cspeeialls with regard 
to the pulse rate demonstrated in the case of runn<.rs 


1 

1 

As- 

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(i-lf’S) 

' PlIx , 

' 1 

I n XTd Prtssjfc 


Sas o t 

D ajioli * 

^ Pre 5 rf 

1 

S-s " -5 

"1 


1 “1 

1 i 


i 1 

1 

MiJ d star™ j 

23* 

64-63 j 

1 


II&-II9 j 

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3^-40 

I-O'' -dl5 2'yc j 

2-*) 

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61j 

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at j 

60 j 


1 

U j 

i 

•*5 


As in other forms of long sustained strenuous effort so 
in marathon races the sounger men seem to lack the 
necessars stamina for feats of endurance 

The cardioiascular equipment of weight lifters was 
interesting Nine out of fifteen examined had resting 
pulse rates of oser 80 per minute Thes had high ssstolic 
pressures fise out of fifteen had diastolic pressures of 
oser 100 (the aserage for the whole group ssas 90) and 
SIX had pulse pressures of 60 and oser 


TIic Question of kthlelics for Girls and Aoung Women 

Rcfercncu must I fe.l be made to the constanllv 
debated question as to the extent to sshich girls and soung 
ssomen should b_ encouraged or permitted to take part 
in the more athletic tjpcs of exercise either in the gsm- 
nasiiim or in the sports field especialls in forms ot 
exercise which insoisc more o" less hcass landing on 
their fe^l A great mans opinions base been expressed 
but serj little if ans real esidence has been produced 
to show that such acti'ilics do gise rise to uterine dis- 
placements So far as I am aware the b-st paper on the 
subiecl IS that of \lcClos The conclusion reached bs 
this writer IS that the anatomical evidence would point 
to there b_mg no real reason whs girls or women whote 
pehii floors an iimniiirtil ami is ho base no petstc 
infiiiioii should not jump Fhc shock of landing is 
for the pcKic organs negligible Obsiousis phssical 
education departments should see that those taking part 
in such aclisilies are adequatcis sup.rsised 

This question as to wh-thcr or no girls and soung 
women should b. p-rmitled to jump is quite apart from 
the question as to sshether thes should paruapatc m 
athletic eSercisc during th. menstrual period Here ot 
course opinions have b— n mans and varied — from the 
recomnundation that no abstention from sport should 
lake place to the recommendation that no form of 
aettsits should be indulged in throughout the period 
Probabls the no media of abstention during the first dav 
of the flow IS to be preferred h is a question which 
It IS impossible to dogmatize about as the effect ot the 
period varies so grealK in different individuals Too often 
It Seems to b^ forgotten that menstruation is a normal 
phssiological process Such evidence as exists would 
point to the sicw that the influence of normal menstrua- 
tion IS not greater than other influences of an accidental 
nature which might have affected the performance of the 
various tests at other times It is well to make it clear 
howeser that in some women the menstrual period mas 
apparenti' bring about greater efficienci— j result prob 
abls ot purels psschological origin 

The Dietars Aspect 

I shall now turn to a sers brief consideration of the 
diet irs aspect of this problem of fitness The spolhghl 
IS focused at the moment on diet not altogether to its 
advantage Too mans seem to imagine that if onK this 
or that be added lo ihe diet all will be well that the 
root cause of malnutrition is poserts and lack of proper 
food No doubt these are potent factors but thes a-e 
Certain!' not the onh ones Emerson who has made 
a most intensi'c stud' of the problem of malnutrition 
in children cites in his book \iiiriiion am! Gross Ih in 
Children Ihe causal factors in their order of importance 
The) are (I) phjsical defects especialK nasopharengeal 
obstructions (2) lack of home controls (3) oserfatigue 
(4) improper diet and faults food habits (5) faults heallh 
habits It "ill be noted that in Emersons opinion diet 
occupies onl\ Ihe fourth place in order of importance 

IS SIE.ST ESSENTISL'’ 

Of course it is perfectly true and perfecll' ob'ious that 
anyone who is going to reap Ihe full benefit of training 
must be adequate!' fed But adequate feeding does not 
mean elaborate feeding So far as our knowledge goes at 
the moment a diet consisting of brown bread milk butler 
cheese fresh fruit and salad could pro'ide all Ihe essen- 
tials As howe'er we are in part at least concerned 



276 August 6, 1938 


PHYSIOLOGICAL APPROACH TO FITNESS 


TiTtBumsH 
Medical Jonva 


with physical training the inevitable question arises as to 
whether meat is an essential constituent There is no 
scientific evidence to show that meat is essential The 
breakdown of the protein containing tissues particularly 
of muscle, during the performance of muscle work, pro- 
vided there is an adequate supply of fat and carbohydrate 
or, in other words, of the energy-giving foodstuffs, is 
negligible Yet if one examines the great majority of 
training diets meat is a prominent constituent Practically 
all of the athletes at the Berlin Olympic games were large 
consumers of meat Evidently the appetite or tradition 
or a real pica demands the presence of meat Why this 
demand if there be no marked breakdown of muscle to 
repair^ The explanation may in part he in the fact that 
the extractives of meat are stimulating and have a definite 
and to many an attractive flavour The presence of the 
flavour may help in the consumption of larger amounts 
of the, on the whole, flavourless fats and carbohydrates 
which are required for energy production On the other 
hand, it must not be forgotten that strict xegetarians ha\e 
shown themselves to be record-breakers jn sport and to 
be capable of immense endurance I think the conclusion 
to be reached must be that the presence of meat is not 
essential 

FATS AND CARBOHYDRATES 

The protein problem has, it is true, aroused most dis- 
cussion, but some very interesting facts are available re- 
garding the consumption of fat As long ago as 1866 
Frankland had noted that men engaged in really laborious 
work consumed for preference fat-rich diets “ thick slices 
of bread surmounted with massive blocks of bacon in 
which mere streaks of lean were visible ’ Lavonius, who 
studied the food intake of professional Finnish wrestlers, 
found that calories derived from fat formed about 45 per 
cent of the total intake, whereas those from protein only 
accounted for about 17 per cent It has also been noted 
that in the diets of lumbermen and others engaged in 
hard work under severe environmental conditions the 
consumption of fat is high If other lines regarding the 
need for fat be followed it is becoming increasingly evident 
that fat, or at least certain fatty acids, play a more 
important part than mere sources of energy 

There is no question about carbohydrate being the most 
readily available source of energy for the performance of 
muscle work But, contrary to general belief, the recent 
work of Krogh et al shows that there is no evidence during 
an hour s observation that glucose given during work, 
although It may cause a prompt rise in the blood-sugar 
level, well above resting level, is utilized Apparently the 
carbohydrate has first to be converted into glycogen Thus 
these authors maintain that in sporting events there ought 
to be about two days’ rest before the contest, " to secure a 
complete filling up of the glycogen stores , and it appears 
that this cannot be done by taking large amounts of carbo- 
hydrate just prior to work ” 

I have cited some of the work relating to protein, fat, 
and carbohydrate simply as examples of the profundity of 
our Ignorance of the whys and wherefores of somatic 
chemistry If we know relatively little about the funda- 
mental problem of the three energy-giving materials which 
have been intensively studied for many decades, we know 
considerably less, both quantitatively and qualitatively, 
about the action of mineral salts and vitamins 

Diet Not the Only Factor in Malnutrition 

It may be thought that I am overslressing the negative 
^ Side of the importance of food, that I am not giving 
It the importance which it so manifestly demands If that 


be so 1 desire most categorically to deny the interpret’ 
tion that I undcr-cstimate its value 1 have worked far 
too long at the problem But I do most emphaticallj 
desire to bring home the point of view that d'el 
alone is not the only factor involved in malnutntion 
Far too many people take the path of least resistance 
Seizing on the very fact that diet is important, thej 'hut 
their eyes to all other possible factors or, if they do nC 
wholly Ignore them, they belittle them or do not evp'ore 
their potentialities There would possibly be no hami 
done if they stopped at the proclamation of their appre 
ciation of an adequate dietarv, but when they go on to 
promise all sorts of miracles which will happen if and 
when the average diet is altered in this way or ttol 
a very real danger arises The majority of these miradcs 
cannot and will not happen The faith of the “ man m 
the-street ’ — the man we all wish to help — in scienci. and 
the scientific worker will be undermined 

Conclusion 

We require to keep a broad and open mind on i 
problem of how best to achieve fitness Just as lh\eL 
no one cause of unfitness, so there is no one solution 1 
IS a problem of many facets with as many lines of allal 
It will not be achieved merely by the satisfaction of tf 
somatic needs Malnutrition of the spirit is quiV ss 
common as malnutrition of the body The one reacts 
upon the other In these days when the raucous enunvU 
tion of rights threatens to extinguish the still small VO'S 
of duty, it should not be forgotten that fitness demand' 
discipline Discipline is essential for right living Rf’'' 
living means health As Amiel said ‘ Health is the fir' 
of all liberties, and happiness gives us the energv "hd 
IS the basis of health ” 


SKUGRAPHY OF THE CHEST* 


BY 


GEORGE JESSEL, M A , D M., D P H 

Consiiltniit Tubcrcnlosn Officer Lancashire Connie 
Council Visiting Medical Superintendent Peel 
Hall Piilmoiiar} Hospital 


{ well b 


cf 


The use of skiagrams as an aid to diagnosis may 
regarded as the greatest advance in medicine during i 
present century, worthy to rank with the discoierv e 
antiseptics and anaesthetics Skiagraphy of the chest ns 
become a most important and, indeed an indispcn'3 
adjunct in diagnosis Its routine application has o 
enabled a diagnosis of pulmonary disease to be nia ^ 
even when the symptoms were referred to some 
organ — for example, cases of so-called indigestion 
gastritis or suspected appendicitis 

In the training of medical students it has Ions 
customary to emphasize the importance of a careful e 
ination of patients, based upon history, symptoms, 
the routine use of the standard methods of physical ev 
ination By such means the careful and expenc^ 
practitioner can accurately diagnose a fair proporiio 
the diseases of the chest from which his palien 
suffering, while the consultants wider experience ® 
ticular conditions will raise the standard of 
further Indeed, some experienced phj'sicians 
the past, by clinical methods alone, achieved a 
degree of accuracy in diagnosis Their ciinica J _ 

* Read in opening a discussion in tlic Section b 

the Annual Meeting of the British Medical Assoent 
1938 



VirusT (y )9^S 


SMAGRAPH'i or THE CuEST 


vhich \M. now know lo be cIo';eI\ relTled to i thorough 
ind careful detaded examination of each patient coupled 
with an exceptional facilitx in recalling similar or related 
cases has sometimes been little short of uncanns bn 
tortunatels the number of such gifted men at ins one time 
Is relatisels few 

■Naluc of the Older Methods 

It IS ssell knossn that more mist ikes in di ignosis are due 
to failure to make a thorough examination of the patient 
than to lack of knowledge The increasing popul irits 
of skiagriphs, based on a growing appreciitien ot ns 
xalue in the elucidation of diflicult cases ought not to 
p-rmit ans relaxation in the thoroughness with xshich the 
older methods of examination are cmplosed It is ssell 
known as Sampson and Lawrason Brown (1931) and 
others ha\e shown that radiographs frequenth rcseal the 
existence of pulmonarx disease in the apparent absence of 
anx phxsical signs exen xxhen the patient is carcfull> 
examined bx an experienced phjsician but there arc like 
xxisc manx cases xxhere skiagraphic examination alone 
in the absence of information derixed from a careful 
historx and phxsical examination ma> proxide informa- 
tion that IS equixocal or misleading Accurate diagnosis 
depends upon a careful appraisement of all the axailable 
exidence including historx and clinical laboratorx and 
radiological examinations Skiagraphj should be regarded 
as an additional xxeapon m our diagnostic armotirj but 
xxe cannot afford to ignore the information derixed from 
interrogation cxe hand and ear As Sir Arthur 
MacNaltx (1937) has recentlx said pulmonarx tuber 
ctilosis still rexeals itself bx phxsical signs and sxmploms 
in other xxords inspection palpation percussion and 
aviscultation are not displaced but reinforced bx a 
skiagram of the chest 

The Dcxelopmcnt of Skiagnplix 

The National Health Insurance Act had as one of its 
objects the encouragement of insured persons to consult 
a doctor at an earlx stage of'their illness and thus oxer 
come the natural tendencx of the sick to defer medical 
examination until sxmptoms became too obxioiis or 
painful to be further ignored The xast increase m the 
amount of work thus thrown upon the bus> doctor has 
not infrcquentl) rendered a thorough and detailed exam 
tnation impossible Furthermore recent adxances in 
medical kno xledge haxe placed increasing responsibilities 
upon the oxerworked practitioner Often some method 
XX as needed that xxould furnish greater precision in diag 
nosis than could be proxided by ordinarx phjsical exam 
ination alone and at the same time introduce some objcclixe 
means of checking conclusions prexiouslj reached The 
dexelopment of skiagraphj xxas thus timelx In particular 
Its use in doubtful chest conditions espcciall} in the 
diagnosis of pulmonarx tuberculosis has been of m 
calculable x-alue It is imfortunatelx true that progress 
has been sloxx and unexen Indeed until xxell after the 
great xxar the use of skiagrams exen bx the enlightened 
xxas irregular and spasmodic m large centres patients 
xxere sometimes sent to radiologists attached to general 
hospitals but elsexxhere little or nothing in this direction 
xxas practicable Those xxere the da>s xxhen an r rax 
diagnosis of hilum tuberculosis or peribronchial 
fibrosis xxas fashionable Improxtments in technique 
and increased experience haxe resulted in a reliable 
standard of diagnosis bx competent radiologists and 
ample facilities for the production of first class skiagrams 
of the chest haxe existed in man> areas for a number of 


The Bum ti 'I77 
Medical JoLiLML “ 


xears Unfortimatelx howexer outside the big centres 
and cspcciallx m the smaller urban and rural districts 
these facilities are still patch) and irregular It is the 
dun of the councils of counties and count) boroughs to 
make proxision for the specialist diagnosis of tuberculosis 
ixailable for the xxhole population but some local authori- 
ties are still 1 iggards m this respect It is thus not stir 
prising that exen in 1937 pleas xxere still being made for 
an increase in the use of skiagrams in the diagnosis of 
chest diseases in gcncril and of tuberculosis in particular 
(Daxies 1937) On the other hand although there is 
good reason to belicxe that a steadilx increasing number 
of medical practitioners realize the xalue and importance 
of skiacraphx there are still far too man) xxho fail to make 
enough use of the facilities noxx axailable 

Its Use in Diagnosis of Pulmonar) Tuberculosis 

It IS arguable that skiagraphs of the chest need onlx 
be emploxed on occasions more or less frequent depend 
ing upon the person il factor xxhen the phxsician finds 
that ordinarx clinical methods are insufiicient to enable 
him 'o make i firm diignosis There are it is true a 
number of xxell marked cases of pulmonarx tuberculosis 
xxith tubercle bacilli in the sputum, xxhere v rax examina 
non IS unnccessarx On the other hand there are a large 
number of cases xxhere oxxing to the failure to make use 
of skiagraphs earl) tuberculosis has been missed until the 
disease has become exident exen to the hits 

In 1933 I wrote as follows (Jessel 1933) 

Diagno'is has of recent xears become much more preci e 
as the result of the intelligent use of good t rax apparatus 
In cases of suspect d fracture failure lo use 'uch facililicx 
ranee as negligence and I think the time is not far distant 
xxhen a similar xicw will be taken in cases where there arc 
reasonable grounds for suspecting tuberculosis 

This xicw has reccixed striking confirmation bx a recent 
decision of- the Court of Appeal (Connollx x Rubra) 
According lo the reports of the case Lord Justice Greet 
(1957) remarked 

Tuberculosis is one of manx diseases with which a general 
practilioner commonlx has to deal If the doctor has anx 
doubt xxhethcr or no there arc signs of tuberculosis it is hi 
obxious dulx to make further examination to resolxe that 
doubt and to make it clear that nothing further could be done 
for the patient A doctor xxho is not oxer confident of his 
oxxn judgment xxill xxhen he finds himself in a difficultx call 
an expert and decide according to the experts adxice To 
enable the experts opinon to be of xalue it is not enough lo 
do xxhat Dr Rubra did at a later date — namelx to take one 
specimen of sputum and be content with that if the result is 
negatue he musr lake manx specimens of sputum and in 
addition he ought to haxe an t rax examination and lo 
xxalcli the patient to see xxhelher he is progressing or going 
back as time goes on 

The disadxantages resulting from dela) in the use of 
skiagraphs are (1) the longer time that is usiiall) needed 
to ruach a diagnosis and (2) the tendencx to plax for 
safetx and to diagnose i non existent tuberculosis I 
refer specificallx to tuberculosis because being an infec 
tious disease it is most important that it should be diag 
nosed as earl) as possible in order that remedial and 
prcxentixe measures max be taken xviihout dela) Pul- 
monarx tuberculosis should be regarded as at least a 
possibilit) and skiagraphs be employed m the folloxxing 
circumstances 

1 In cases proxisionallx diagnosed ^as bronchitis oi 

bronchial catarrh xxhich do not clear up xxithin foui 

xxecks 

2 xxhere patients complain of indigeslion and dxspcp-n 
Manx so called gastnc or duodenal ulcers are reallx mam 
feslations of tuberculous toxaemia 



278 August 6 1938 


SKIAGRAPHY OF THE CHEST 


TiitBrniiH 
Medical loiiva 


3 In cases of alleged haemoptysis 

4 In young persons with symptoms of debility or anicmn 

5 In cases of chronic hoarseness 

6 In cases of ischio rectal abscess 

o 7 In all cases where there is a clear histoiy of tubciculosis 
in some member of the immediate family oi household 

8 Where theie is a histoiy of some othei close association 
with a case of pulmonarv tuberculosis — for example fiicnd 
or workmate in oflice oi factory 

9 Where a case of tuberculous meningitis or other form 
of non pulmonary tubeiculosis is found attention should be 
directed to adult members of the household, even if stated to 
be in good health in order to discover a possible source of 
infection 

When a diagnosis of pulmonaiy tuberculosis has been 
naade skiagraphy is olten of great value 

1 To deteimine the extent and nature of the disease — 
foi example unilateral or bilateral, piesence of cavities 
fibrosis calcification etc The information thciebv obt lined 
IS often of great assistance in deciding the nature of treatment 

2 During the course of treatment serial skiagraphs is essen 
iial in artificial pneumothoiax and whenever sdrgieal meisures 
are contemplated — for eximple phrenic operations division 
of adhesions and thoiacoplastv 

3 Serial skiagraphy also gives gieal service in en ibling the 
progress of the disease to be readily ascertained, is well as 
in providing opportunities for the study of living pilliology 

Skiagraphy in Differential Diagnosis 

Apdit lioui the question of tuberculosis, skiagiaphy of 
the chest is important in the diffeicntiation of pulmonary 
disease Assuming that tuberculosis can be definitely 
excluded, skiagraphy may clearly indicate oi suggest 
chronic bronchitis, bionchiectasis (especially when used 
in conjunction with lipiodol), pleuiisy, pneumonias 
ibscess, malignant disease, silicosis Unsuspected morbus 
cordis may likewise be discovered Caution must, how- 
ever, be exetcised in the interpi elation of skiagranisf as the 
tppearances — tor example, in cancer, tuberculosis or 
silicosis — mav at times be indistinguishable An opacity 
may be due to fluid thickened pleura, consolidation 
ueleciasis, abscess, or underlying new growth Con- 
sistently accurate dngnos s is only possible when 
skiugraphy is con elated with clinical evidence It 
demands judgment and experience Indeed, skiagi iphy 
may easily lead to misunderstanding and confusion 
shadows of bronchi and blood vessels seen in their various 
aspects and angles may be misinterpieted as evidence ol 
disease It is not impossible by skiagiaphy, is bv oldci 
methods of clinical examination to diagnose non existent 
tuberculosis which is almost as seiious as failing to detect 
tubeiculosis when it is present 

Skiagiaphv of the chest is a specialty within a speciiltv 
The taking of a good skiagram and its mteipietation are 
by no means easv The well to do aie in geneial, 
adequately catered for in this respect oy radiologists, and 
there are also a tew consultants and geneial piactilioneis 
who can produce excellent skiagrams The cost, how- 
ever, is undoubtedlv a deteiient, but fortunately skia 
giaphy IS obtainable at or m connexion with many tubci- 
culosis dispensaries and the chest clinics attached to some 
laige hospitals This provision needs to be extended so 
as to make chest skiagraphy readily available for every 
citizen The presence of a rav appaiatus at or in close 
issDciation with a tuberculosis dispensaiy or chest clinic 
aflords an ideal solution of the problem 

Routine m a Lancashire Area 

This is not the occasion to deal with technical details, 
which in. ni uiilv of inteiesi to those prictising ladiologv 


It IS, however, desirable to illuslratc what his been said 
ibove by a brief description of what obtains in theLann 
shire area with which I am associated The population c! 
the irea is about 370,000, and is mainly urban in chancter 
It contains five tubeiculosis dispensaries, as well as a small 
hospital ol fifty seven beds for adult male pulmonm 
cises The medical staff consists of three tuberculosis 
officers wot king as a team one of whom (in this case 
mvself) acts as radiologist at the central dispensary, ukrc 
the v-ray apparatus is situated Early in 1923 1 used a 
gtstube apparatus but since 1932 an all British single 
valve unit that has given complete satisfaction Exposures 
of one tenth of a second at four feet distance have ken 
found to give good results Two afternoon sessions ate 
held weekly Nearly all the patients, who are referred 
to the dispensaries or ire seen at home in consultation 
with the insurance practitioner or private doctor, aticrd 
one ol these sessions by appointment Bed cases, it nol 
too ill ate bt ought by imbulance, and by this mans 
acute non-tubciciilous conditions can be identified and 
studied On the same ifternoons an artificial pneunio- 
thor \\ refill clinic is held elsewhere in the buildin' h 
another tuberculosis officer, and these patients are sere d 
at the beginning of the session Screenings for diaKnc' 
ire seldom done, as the infoimation to be derived fieri 
them IS regarded as of lar less value than a skivrani 
which provides a permanent record to be examined and 
discussed at any subsequent time In difiicull cases 
oblique and lateral, also postero anterior flat films 
icgularly liken Non-pulmonary as well as pulmomn 
ciscs are deiU with, tnd the total volume of worldoK 
may be gauged by the f ict that 1,339 skiagrams vwretaUr 
and 557 screenings done during 1937 It is necessanii 
emphasize the point that the skiagrams are all talfi 
a tubeiculosis officer who has before him the clird 
notes made by himsell or by one of his two colka'^’' 
Dining each v-iay session two medical officers 
conjunction, one is a clinician ladiologist, tlie othir ri'iii 
useful help m chest throat, ind other examinak' 
Cases definitely’ tuberculous ire dealt with at once I t 
patient interviewed ind the necessary treatment arran'ev 
Other pitienls aic referred to the dispensary nearest 1 1 

homes tor ie-e\amination at i later date, but mostw'^ 
ire definitely dtagnosable bv this combined clinico ra i 
logical method within a loitnight On the 
following each v-iay session the three tuberculosis o w 
meet as a boatd to examine the films 
clinical dossiet of eich case The position is anaW 
to that of a bench of magistrites weighing 
the available evidence derived fiom various 
examination, including skiagiaphy md re idling n 
elusion based upon the different findings taken scpa^^ ^ 
and in conjunction It is obviouslv adv intageous 
able to bring the ctinici in and the radiologist so c ^ 
togethei, especially when it is noted that ,|. 

whole-time ladiologists admit that by skiagraphy a 
differential diagnosis of pulmonary conditions i 
impossible indeed, the inimber of such cises 
placed as high as 40 per cent Moieover i 
who has no clinical experience or is not 
in clinical work is olten greatly handicapped in 
ing to mterpiet what he sees This disa , "uu''’ 
however be overcome to some extent if the ra i 
clinician actually meet and discuss cases of sp 
culty or interest ^ si 

Finally as soon as i diagnosis is made a ^ fjj 

to the patient s doctor, and, if of snflicicnt i , 

days laid a reduced punt of the s'"'' 

icvson to believe that these prints are app 



The B?rnsii 


279 


Skr \GR \PHY or THC CHEST 


\i rusT 6 193S 

tulp lo tncoiini,!, the iKc of our ridiologieil clinic This 
in brief illustnlcs the proecdiire I Iitnc ndopted for oser 
fit teen scirs 

Conclusion 

Mcdienl pnctitumers ire cndinlK re^ogni/ini, the help 
tint chest skngriph> enn gise but the\ sometimes ha\e 
ditltcults in obtaining n patient s consent to undergo e\am 
imtion This reluctance is Usinlls related to the popular 
idea that tuberculosis is nccessariK incurable The wise 
and tactful practitioner mil caplain tint the object of 
shitgraphs IS to make sure that the pitient is all right 
or at least onh sulTering from disease in an carh stage 
Drmng and other tests arc becoming more common 
among the general public and a fen minutes simple 
esplanalion mil oft.n reassure a timid patient 

Skiagraphs of the chest is so important for acciirite 
diagnosis that it can seldom be omitted ssiih safels It 
s the most saluable single factor in the diagnosis of 
aiilmonars disease 

RtF01I,SCTS 

aasi G Isor (1^171 Tubercle 18 jso It 4s2 
jrc^r Lord Ju li'C (in 71 Lancet 1 1(V)' 

c s 1 G (t9 S) Lancs Coimiv Coon"ii Annual Repsrt of 
Ccnlrat Tuberculosis Odiarr p SS 
I cNalis Sir \rihur (t9r7) Itrit J Tttheri 31 tlf 
inpson H L and Broun L (19 I) Aiier J Roeut t 25 
;()9 


HREE CASES OF CL 'VN ELCHH INFECTION 
FOLLOWING ABORTION 

B1 

R T DAWBkR^. MD. 

Paiholof St n altflft flo^pifal 
ASO 

Qn\ AMLLUAIS M D , M C O G , F R C S Fd 

Sei tor Assistant i\Je(hcal Officer J* alton liospitoi 

his condiiion appears to be uncommon or at anv rale 
ifrcquenlU recognized, and \Ae hop?, therefore that it 
ia> be of ^aIue lo record three more cases In his \er\ 
lorough re\ie\s of the whole question of postabortal 
-id puerperal gas gangrene Hill (1936) was able to find 
nl> eighlT four cases described in the literature to which 
e added a further senes of thirt\ cases of his own 
The interest to us has been twofold first as regards 
le differential diagnosis and secondlv b\ reason of the 
tpidh fatal course of the illness In both of the cases 
septicaemia the onset was so sudden and the mani- 
siaitons were so dramatic that chemical poisoning was 
ispectcd These suspicions were strengthened b\ the 
ict that both patients had been taking large doses of 
Hs presumabh with the object of procuring abortion 
^e record the more recent of these two cases first because 
le diagnosis was confirmed bacteriologicallj The other 
\se occurred in 1934 and though we feel sure now of 
le diagnosis bacteriological confirmation is lacking The 
ird case also ran a fulminating course although the 
inical picture was different and the diagnosis was made 
>on after the admission of the patient to hospital 

Case I 

A married woman aged “^0 was admitted to alton Hospital 
2 30 p m on December n 19^7 Her three prcMous preg 
incies had been normal Her last menstrual period was on 
clober 20 During the previous week she had been taking 


pills of iron and docs twenlv in all At 2 a m on the da\ of 
admission she wa> <ej7cd with severe lower abdominal pam and 
\oniitinc At II am there was considerable vaginal bleeding 

On admission the patient showed sicns of severe shock and 
her pulse was feeble Her temperature was 97 pul e 96 
and respirations 26 The lower abdomen was exlremelv tender 
and ncid There was slight vaginal bleeding and on exam 
ination the cervix was closed and the uterus enlarged to about 
the size of a sixteen weeks precnanev There was general 
pcUic tcpdcmcss A provisional diagnosis of either septic 
abortion with pelvic pcritonuis or of ectopic precnanev was 
made 

At 6 pm her genera! condition appeared to have improved 
sluhlh The lower abdomen and face had become flushed 
\bout 2 cem of thick dark brown urine was wiihdrav n b\ 
a catheter microscopicallv this showed no intact red blood 
cell Bv 8 p m however her condition had become much 
Worse There was now an extensive bluish flush on the 
abdomen and face On vacmal examination the uterus seemed 
to be larecr Further catheterization produced onlv a few 
drops of ilmo t black urine Blood taken from a vein 
showed evidence of hacmolvsis ihe plasma being the colour of 
burcundv Deain occurred at 10 pm or within even 
hours of admission and just over nirctcen hours afie- tbe 
illne s began ShoriU before death a eracklinc sensation was 
elicited on palpation of the lower abdomen 

POST MOkTFM EWXUNVTIOS 

The surface of the bodv showed a duskv bronzed hue mo>t 
marked on the face and abdomen The deeper parts were 
verv da k and slight crepitation was noticed on culling through 
the tissues of the neck and uterus The lungs were ven 
conccstcd There was hacmohlic staining of the blood vessels 
and endocardium The kidnevs weighing 6 and 61- oz. were 
almost black The spleen was about twice the normal size 
and was tense and ncirlv Mack Froth\ fluid exuded from 
the cut surface The liver showed cloudv swelling with a little 
gas under the capsule The stomach revealed no sign of 
chemical poisoning The inicitines were pink and were not 
ulcerated The uterus was grc\i5»h blac) bv 3-1 inches and 
\cr\ shghtiv crepitant A little blood and necrotic ma crial 
was found in the uterus and was kept for section No cvi 
dcncc of mechanical injurv was found The peritoneum con 
tamed dark -coloured fluid A corpus Iiiteum was pre ent in 
the nchi ovarv 

Films made direcilv from the peritoneal fluid and spltnic 
pihp showed great number of Gram positive bacilli resem 
blinc Ct Milc/in Cultures were made from the spleen 
anacrobicallv and a good crowth of Cl ucicini was obtained 
which gave a characterisiic slormv rLaction in milk after 
incubation overnight 

Sections were cut of Ihe uterus and its contents the liver 
and kidnev and were stained bv haemalum and eosin and 
bv Grams method The uterine contents consisted of necrotic 
decidua blood manv Gram positive bacilli and other 
organisms No placental vilh were found The uterine wall 
showed evidence of infection and there were manv dilated 
vessels containing infected clot The muscle took the siain 
badh and parts appeared to be almost necrotic Numerous 
Gram positive bacilli were seen throughout especiallv in the 
blood vessels The appearance of the kidnev was suggestive 
of advanced post mortem change although the necropsv was 
performed well within twentv four hours of death In some 
areas the nuclei remained quite unstained and there was 
marked degeneration of the glomeruli and cells lining the 
tubules In addition to this manv of the tubules were filled 
with brownish material which was evidentlv derived from the 
blood as a result of the hacmolvsis The liver celK showed 
extreme degeneration in manv parts amounting to necrosis 
The stain for organisms-^howed Gram po itive bacilli in both 
liver and kidnev 

Case II 

The tollowing notes are lalen from the records of V altoa 
Hospital One of Ui saw this patient before she died and 



280 August 6, 1938 CL WELCHTI INFECTION FOLLOWING ABORTION 


, TiiEBmini 
Medical louMi, 


ilso reported on pieces ot tissue removed it necropsv for 
histological examimtion 

A married woman aged 23 was admitted to Walton Hospital 
at 5 20 a m on August 25, 1934 She had had two previous 
pregnancies Her last menstrual period was on June 24 
The patient admitted having taken pills to bring on an abor 
tion but denied the use of any other method Vaginal bleeding 
had begun at 5 p m the previous da\ followed b> abdominal 
pain at 1 1 p m On admission she complained of constant and 
severe lower abdominal pain The abdominal wall was held 
rigid Her temperature was 101 ", pulse 96 and respirations 
28 On vaginal examination some bleeding was noted, and 
the uterus seemed enlarged to about the size of a ten weeks 
pregnanev but was difficult to feel On catheterization about 
1 diachm of very daik mine was obtained This contained 
albumin and haemoglobin but no red blood cells Increasing 
jaundice and cvanosis were noted up to the time of death 
which occurred at 1 50 p m or eight and a half hours aftei 
admission and less than twenty one hours after the beginning 
of symptoms It was then thought that death might have 
been due to some chemical poisoning pioducing hacmolvsis, 
such as potassium chlorate 

I’OST-MORrrM LXAMINAIION 

The suiface ol the body showed a duskv led colour with 
minv small red spots mainlv on the face and the backs of 
the aims and legs The pleuial, peiicaidial and peritoneil 
cavities contained dark ' blood stained fluid The external 
appearance of the liver was noimal but the cut surface 

showed a yellowish brown colour The kidnevs were both 
of normal size but were intensely congested and evaoosed 
so that they looked almost uniformly black The spleen was 
of noimal size and consistencv but was daikei than normal 
The pelvic retiopentoneal tissues were deeply blood stained 
but there was no haematoma The uteius was about the size 
oLan eight weeks pregnanev There were no signs of injuiv 
to the vagina or cervix the latter was slightly open Theic 
vv\s no foetus in the uteius but a well marked decidual 

reaction was noted The right ovarv contained a corpus 
luteum The ahmentaiy canal showed no evidence of coirosive 
poisoning Samples of various organs were sent to the 
Liverpool City analyst to be examined for poisons 

In the sections of the kidnevs the tubules and Bowmans 
cipsules were choked with haemoiysed blood The hvci 
showed cloudy swelling and ciams stun revealed a few 

Giam positive bacilli In thei uterus no placental vilh were 
to be seen there was ev fence of infection and manv 

dilated blood spaces Exa'fnation foi organisms showed 
many Gram positive bacilli j some being inside the blood 
vessels "j 

Unfortunately the bacti 'ological repoit on the blood 
culture which was taken adoring life is incomplete It 
merely states that Gram poVtive spore-bearing bacilli were 
grown and the culture was Vot an anaerobic one 

The Liverpool City analysiVoond^no evidence of chemical 
poisoning, and the only diaiV®^'® could be made at 
the time was that the patient X^d died from some haemo- 
lytic toxin of unknown nature\ Although the matter was 
left doubtful the possibility of ^aerobic septicaemia was 
considered when the histological ^tions were being exam 
ined Owing to the fact that no^as was noticed in the 
liver or other tissues at the necrop^ was thought then 
that the presence of Gram-positive ^cilli in the sections 
vv IS a post mortem phenomenon anv\ the spore-bearing 
bacilli in the blood culture were looiKd upon as con- 
t iminants The last- assumption may haw’s been correct 
in any case it is unlikely that the orgmism's in the blood 
culture were true C/ ue/c/iii 

On the other hand in spite of the lack ol bacteriological 
evidence on looking back we are convinced that thn> vvas 
ilso 1 case of an verobtc septicaemia, and we base our 
dngnosis on the lollovving facts (1) the sudden onset of 
ihc illness in associrtion with in abortion the ibdominal 


pain, the ictero cyanosis, and the haemolysis m \no arc 
typical of an acute ‘ anaerobic septicaemia ” as described 
by Hill , (2) the lack of evidence of chemical poisomu", 

(3) the striking similarity of this case with the first one 

(4) the presence of Gram-positive bacilli m the post 
mortem sections The absence of gas from the tissue 
had origin illy appeared to provide a reison against tb 
diagnosts of ‘ anaerobic septicaemia, but this now appears 
to be invalid, as in Hill s series of cases it vvas iinmiial 
to detect gas in the tissues before death 

Case III 

A widow iged 27 vvas admitted to Walton Hospiiil at 
10 30 am on April 1 1938 Her two previous pregnanuev 

had been normal Her last menstrual period vvas on 

November 6 1937 She denied that any interference h d 

been earned out but admitted having taken salts bv moiilti 
Two davs before admission vaginal bleeding followed bv 
vbdonainal p un had slaclcd and a small foetus had appar 
cnllv been pissed shortlv before admission The patient wav 
verv‘ coll ipsed when admitted her pulse vvas 65 her tempera 
tuie 96“ and respirations 20 The blood pressure could nol 
be icgistered On abdominal examination the fundus U 
ilmosl the height and feel of a full time fundus after dcbvtrv 
A small cord vvas seen at the vulva On pressure on lie 
fundus 1 slight offensise loss of dark blood together with 
gas vvas observed which at once raised the suspicion of a 
C/ wddin infection A direct smear of this showed coliform 
bacilli streptoeoeci and large Gram positive bacilli similar m 
appeaiance to Cl ^\clcllll Aftei intravenous giinigluco'S 
saline her condition improved shghllv There vvas no fnrlbn 
bleeding At 8 p m the same evening however she becamt 
much worse and crepitation of the fundus was now felt Th 
idvisability of hvsterectomv vvas considered but this oper’ 
tion was held to be unjustifiable owing to her poor condiiv 
It vvas thought however that removal of the placenta n 
improve her chance of recovery by emptying the uttnt 
cavitv of dead tissue and bv decreasing the absorption d 
toxins and organisms This vvas therefore carried out I't'- 
ether anaesthesia The placenta vvas adherent but there "i 
no undue bleeding In spue however of blood Innsfun 
and the injection of prontosil soluble and gas gangrene serif' 
the patient died at 3 10 im the following dav or "ilM 
seventeen hours of idmission and three days after the 'W 
of the abortion Blood culture before death showed 8 o' 
only but Cl ii < It hit vvas cultured from the locliial discbiref 

I OSa MOKlrM hXAMINATION 

Post mortem examination revealed some blood stained tli"! 
in the peritoneal cavitv The uterus vvas large | * ^ 1 , 
of pregnancy and vvas dark red and covered with 
Us walls crackled owing to the presence of gas No 
any injury of the vagina or cervix were seen There 
some bubbles of gas in the letroperitoneal tissues 
wise no gas was noted in the liver or elsewhere Apnr 
some slight staining of the aorta with blood piton^" 
weie no other gross changes or signs of haemolysis 
of the placenta and uteiine wall showed manv Gram po 
bacilli lesembling Cl tteldiii 

This third case presents some points of contras ^ 
the other two cases, although its course "hile 
observation in hospital vvas almost as fulmimlias^^ 
diagnosis ,\vas more obvious during life giving 
presence of gas in the vaginal loss and the fin 
smears, of organisms morphologically simu'''' _ 
welcliii In addition however, the previous 
ol the first of these three cases had directed our a 
to this kind of infection Moreover, the infection 
first localized to the uterus as shown by the a 
Cl wekliii from blood cultures taken during 
haemolysis vvas found to be almost completely 
the post-mortem examination Strains o( Cl >'e 


August 6 I93S Cl \\"ELCHII INTECTION FOLLOWING ABORTION TircBRmsH 281 


m their CTpTcil} to produce haenioljtic and other to\in<i 
In the first two ctsls the ripidit\ of the haenioijsts was 
such as to suggest chemical poisoning whereas in the 
third the production of gas was the most obsious feature 
and more readih suggested the diagnosis 

In the two cases of septicaemia the infection was of a 
particularls fulminating nature the patients d\ing nine 
teen and twents one hours respectiseU from the onset of 
sjmptoms Hill describes one case in which death 
occurred within sixteen hours after interference but in 
most of his cases the duration of life in those that were 
fatal was considcrabK longer It seems probable from 
our experience that m some of these fatal cases the correct 
diagnosis is not made and that some other factor such 
as shock or chemical poisoning is held responsible for the 
patient s condition 

In none of the three cases was the mode of infection 
determined In e\er\ instance the pregnanes ssas an 
unwanted one and all patients admitted having taken 
drugs with the object of procuring abortion so that it 
seems probable that instrumental interference had aKo 
been attempted 

The treatment of this tjpe of infection has b-cn dis 
cussed m some detail b\ Hill but it seems unhkclv that 
anv method would have been successful in these fulminat 
ing cases at the time thej first came under observation 

Summan 

Th'ee fatal cases of infection with C/ wcicliit following 
abortion are described In two of these the infection 
vvas a fulminating one in which the mam feature vvas 
the occurrence of haemolvsis and a correct diagnosis was 
not made before death the condition being attributed to 
chemical poisoning The third case was one of a rapidiv 
fatal infection of the uterus 

We should like to express our thanks to Dr H H 
MacWilliam medical supcnntendcni of 3\allon Hospital and 
Mr St George Milson consulting ohstetncian and gvnaeco 
losisi for permission to record these cases 

Reference 

Hill Arthur M (19^61 / Obsiei G\taec Bric Etup 43 201 


The eiehth conference of militarj medicine and pharmac) 
in Luxemburg was distinguished bv a verv detailed discussion 
of svslematic radioscopv in land forces inaugurated bv the 
Belgian French and Swiss delegates. It was decided that 
the administration of the International Committee of the 
Congresses of Aviation and Health should henceforth pass inio 
the control of the conference of mililarv medicine and 
pharmaev M ilh regard to the statutes of the permanent 
committee of the congress it was apparent that now that the 
sixteenth International Red Cross Conference was to discuss 
the revision of the Conventions of Geneva and The Hague in 
respect of the sick and wounded of armies in the field and 
that the proposals of the International Committee of Militarv 
Medicine and Pharmaev had been referred to diplomatic dis 
cussion these two objectives had been achieved This success 
which vvas announced with great enthusiasm would now 
permit the International Committee to devote its activities to 
Its pnmarv purpose — namelv the science of militarv medicine 
The commission of medical junsprudence might have been 
accordinglv dissolved its work having thus been crowned 
with success But the problem of the protection of civil 
populations was still the focal point of discussion throughout 
the world and it was agreed that this subject might still 
preferablv occupv the attention of the- commission indepen 
denllv of the International Committee 


ON CERTAIN PHASES IN THE LIFE 
HISTORY OF THE POLYMORPH 
LEUCOCYTE 

THE INFLUENCC OF CELL ACTTN'm ON THE 
NUMBER AND \RRANGEMENT OF THE 
NUCLEVR LOBES 

BV 

C J BOND. C M G , F R C S 

Arncth fl904) Scbilling (1929) and other observers have 
attributed the multilobular condition of the polv morph 
nucleus to increasing age of the cell while others — for 
example Price Jones (1933) — have not accepted this con 
elusion In the following communication I shall hope to 
show that previous aclivitv on the part of the cel) as 
represented bv amoeboid movement and phagocvtosis 
mai be an important factor in determining the number 
of nuclear lobes or in other words the shift to the right 
in the Arneth count 

Chart I 

This curve gives a count of the total number of nuclear 
lobes in 100 polv morph leuccevtes taken from the blood 
of the same individual at the same time but under different 
conditions (n) the normal blood film (/>) the same blood 
after incubation (c) the same pol> morph cells when re- 
incubalcd after standing at room temperature for six hours 

Ir h!-i (a) the n a! nj-ib-r of p»r IM c*n5 271 

This rise m the numb.r of nuclear lobes in 100 cells 
represents a considerabli. shift of the Arneth eount to 
the right It suggests that the increased work done b> 
the ineubated eells over that of the resting blood cells 
and the still greater activiiv of the rtincubated cells after 
a period ol rest are responsible for the rise in the number 
of nuclear lobes in the activated and reactivated cells 



CllvRT I — (at Normal blood film 271 lobei. in 100 edt 
(&) Incubated blood film OT lobes in 100 cell (cl Re 
incubated blood film V94 lobes in 100 cells 

Chart II 

This gives the total number of nuclear lobes in 100 
po!> morph cells in two cases of pernicious anaemia In 
Case 1 the polv morphs constituted 31 per cent and haemo- 
globin 55 per cent and in Case 2 thej were 50 per cent 
and 72 per cent respectivel> Marked leucopenia vvas 
present in both cases The number of nuclear lobes per 
100 cells was 472 in Case 1 and 455 m Case 2 -In both 
Cases this marked increase in the number of nuclear 


2S2 August 6, 1938 


LIFE HISTORY OF POLYMORPH LEUCOCYTE 


Tift BHITLII 
Medical Joumi 


lobes pel cell coexisted with a considenble i eduction in 
the total leucocyte blood count 

The question arises whether this shilt to the tight in the 
Arneth count was due to the greiter demand on the 
ictivity of the reduced number of cells or whethei it 
depended on the circumstance that fewer young poly 
morphs — that is, cells with the average number ot two 
01 three lobes — were being discharged into the blood 
streim from the bone marrow It is a significant tact 
ih It in both cases of the disease a numbei ol cells 
cont lined as many as six or seven nuclear lobes 



Chart It — Pernicious uiacnin Case 1 polymoiphs It pci 
cent hiemoglobin 55 per cent 472 lobes in 100 cells 
Cisc 2 polymorphs 50 per cent h tcmoglobin 72 pei cent , 
•455 lobes in 100 cells 


Chart III 


This chart gives the total numbei ot nucleai lobes in 
100 polymorph cells in (a) a blood film (b) an incubated 
pus film , (c) a reincubated pus film The films weie all 
I tken from a patient with cerebiospinal meningitis, and 
the pus was obtained from the cerebiospinal fluid by 
puncture 

Film («) tises a loni of 273 lobes in 100 cells 
(6) 335 

(c) 422 

Here again the film from the pus cells — that is, cells 
which have emigrated from the blood vessels into the 
cerebrospinal fluid — shows a greatei numbei of nuclear 
lobes than the corresponding cells circulating in the blood 
stream while the reincubated pus cells after standing at 
loom temperature show a still greater incicise in the 
number of lobes 



CiURi III — Cerebrospinal meningitis (ol Blood smeii 
273 lobes in 100 cells (b) Pus smear 335 lobes in 100 cells 
(() Pus rcincubilcd 422 lobes in 100 cells 

Cell Emigration 

Now the liMng pus cell is a polymorph leucocyte 
3\hich his pissed through the capillary wall into the tissue 
sp lees or into i serous civiiy or on to the surl ice of i 
gi inuliting wound or as in this case into the cerebro 
spin il fluid To en ible it to carry out this migratory 
journey the cell must become plastic The nuclcir mass 


yvhich in the resting cell consists of tyvo or three lobes 
iggiegated together in the centre of the cell, undergoes 
marked changes in shape The nuclear lobes beconit 
thinner and more yvidely separated, like a string of 
sausages yvhen pulled apart, yvithin the common eniclopine 
skin In some actively moving cells the fine strand of 
chiomatin, oi nuclear material connecting one lobe mih 
mother, may break, and one lobe may thus become dis 
connected from its felloyv, though still eny eloped by the 
same cytoplasmic covering Metchnikoff (1893) has drawn 
attention to the segmental character of the polymorph 
nucleus as in aid to diapedesis and emigration 
It IS also historically inteiesting to note that T Wharton 
Jones (1853, 1884, 1887) stienuously rejected the emigra 
lion theory put toryvaid by Cohnheim, both in his writini’s 
and m his lectures, one of yvhich, given at Uniiersiti 
College, London, in 1878, 1 attended Wharton Jonts 
regarded the nucleus ol the polymorph cell as compostd 
ol a single mass, and he looked upon the miiltilohiihr 
form — yvhich, for instance, is rey'ealed by treatment of (fir 
cell yvith diluted acetic acid — as an artefact Probahh 
this misconception m regaid to the shape of the nornul 
polymorph nucleus may have made it difficult for WTiaiion 
Jones to accept the possibility of diapedesis and eniim 
tion through the capillary yvall 
The changes in shape of the nucleus yvhich occur diirinc 
emigration in the living body cm also be demonstrated 
expeiimentally as taking place outside the body (C J 
Bond, 1924) Thus, if a drop or tyvo of blood drawn 
Irom the finger be incubated in t Ponders chamber, llie 
cells yvhich emigrate from the red clot and settle on the 
ghss floor yvill shoyv similai changes in shape ot ih 
nucleus If, fuither, these activated cells are allowed if 
stand in the closed chamber at room temperature fci» 
short time the string of nuclear lobes tends to aggrtciHi 
or even in some cases to fuse into two or three lobes aw 
the cell resumes the rounded shape of the “resting 
But It must be lemembered that not only the resin i 
but the (kcie/ polymorph aie both round (ills The laiKt 
like the dead pus cell, can, however, be distinguished f(0>’' 
the living lestmg cell by their reluctance to take up slams 
like Janus green and by inability to reassiimc amocboi 
movement or phagocytosis yvhen stimulated 


Rltlrcnces 

Ainclh J (1904) Dii luiiiiopliilen iimjc/i Bhilkoii’ochin ^ 
Bond, C J (1924) Tin Ltiicocjle in Henllli mill L 

Jones, T Wlni ton (1853) Aftil Clin Trans London 36, 
(1884) Lancet 2, 630 

(1887) Ibid , 1, 164 , , 

MtIchnikolT E (1893) The Coinpaialiii Pallwlot,! ‘>1 
lion Eng trans , p 185 London 
Puce Jones C (1933) Blood Picliiics An Inlroiliicnon a 
Hacnialolof,i Bristol 

Schillint,, V (1929) Tin Blood Piclnii and ils Clamnl 
lance Eng Inns , London 


E Gieyelink [Thisi Pans 1938 No 24) who 
cises in unmarried y\omen, aged 32 and 38 with a re 
the literature states that feyerish attacks which nn) |ft 
oyanan feyer occur in the female sex between puberty 
menopause The most frequent are premenstrual f 
the evening temperature hardly eyer exceeds 100 or 
The commonest symptoms are asthenia, cardio \isei 
turbances, and various neryous or psychical trouh 
attacks cease with the natural or artificial 
pitients must be examined for the presence of a ’ y 
culm syndrome yyhich often occurs and 165013*^5 O'*- 
a hormone yyhich neutralizes the excess of cr ' 

an extract of the corpus luteum or mammary t 
testicular extract In one of Greyelink s cases t ic . ^ 
dispelled bi slimiihlion of the osirics or mammary 
diathermy 




Aiclst 6 19-!'^ CHCMOTHCRAP’^ IN GONORRHOEA 


CHEMOTHERVPY GONORRHOEA 

V rRCLnilNARI REPORT ON THE USE 
or 2-(r-\MINOREN7ENESULPHON 
AAIIDOIPI RIDINE AJ i B 693 

BY 

r J T BO^^IL, AI n ChB.DPH 

Chef \ enereol Otsci^es Of^uer Piihic Health 
Drrurimrrl -tl erdcca 

One of the most intriguing diaracti-ristics of medical 
research work lies in the possibilitv that overnight n 
remedv of unbelievable therapeutic potenev ma> be pro 
dueed and that the millennium of gonorrhoea control 
mav be close at hand Thus writes Parran (1937) m 
respect of what mav emerge from sulphanilamidc in the 
control of gonorrhoea 

The introduction of 2 (p aminobcnzenesu'phonamido) 
pvridinc \I anu B 693 ^ an cveat which bids fair to 
produce a notable advance in the attick on the gono 
coccus Reference has alrcadv b.en made to some of its 
results in e\p.rimcntal work in mice bv 3Vhitb> (193S) 
m pneumonia bv Telling and Oliver (I93S) and Evans 
and Gaisford (I9'’'v3 I93''b) and in the treatment of 

gonorrhoea bv Llovd Erskinc and Johnson (1938) The 
following report, css^ntiallv ot a prehminarv character 
supports the findings published at a simil ir stage of 
evperimcntal treatment bv Llovd it at and is of con 
sidcrab'e interest in ns clinical bearings 

Anah'sis of Cases Treated 

Through the courtesv of Messrs Ma> and Baker Ltd 
who are kindl> maintaining a supplv of M ind B 693 
It IS now possible to give some details of thirtv one cases 
of gonorrhoea treated orallv bv the drug thirlv b-ing 
male patients and one a female case of gonococcal oph 
thalmia neonatorum Of the thirtv male cases tvvcniv 
seven were of acute anterior urethritis and three of 
urethritis and prostatitis twentv three of the anterior and 
one of the proslatic tvpes were fresh untreated cases the 
other four and two respeetivelv having resisted previous 
treatment b) urethral lavage benzvl sulphanilamidc and or 
sulphanilamidc and in one case bj gonococcus antitomn 
Taking the fresh cases first (twentv-three of acute 
urethritis and one of additional prostatitis) the results wen. 
as follows SIX cases were gonococcus negative in one 
da> ten in two davs six in three da>s one in eight davs 
One patient showed gonococci up to the seventeenth dav 
but in his case there was reason to believe that he was 
not taking his M and B 693 regularlv Of the six 
previouslv treated (four of urethritis and two of prostatitis) 
five were gonococcus negative in two da>s and one in 
three davs Thus of thirtv cases six were negative in one 
d3> fifteen in two dajs seven in three davs one in 
eight davs and one in seventeen da)S (These figures 
err if an) thing in favour of the gonococcus if such an 
expression mav be used as the seven cases given as being 
negative in three d3)s were not seen till that period of 
treatment had elapsed and mav have been negative before 
but for purposes of these notes are given as three-da> 
results) The cases were controlled b) direct staining 
and/or culture of pus and urethral secretion at or up to 
the periods stated If such pus or secretion was not 
available as occurred in a number of cases ver) rapidlv 
a centrifuged urinar) deposit was investigated bv similar 
methods Gonococcus negative means the absence of 
gonococci b) an) of these methods of examination 


The 

AIeoical Joujlnal ^ 


While these negative results were observed and while 
most patients when asked would answer that their dis 
charge had disappeared in one dav or two da)S var)ing 
degrees of muco pus or mucus from the urethra and 
threads in the urine were noted for periods differing 
from three to even eighteen da)S and showing pus cells up 
to that time In most cases however it was with diffi- 
ciiltv that anv urethral discharge or secretion could be 
found after a week Though final tests of cure have 
not vet been applied none of the thirtv cases has shown 
either clinical or bacteriological signs of relapse in the 
two to tour weeks during which thev have been under 
observation since cessation of treatment It is worth) 
of note that so far is could be ascertained not one of 
the anterior cases has developed anv invasion of the 
posterior urethra The prostatic cases III ewise did not 
result III further complications 

Tic Dosage Used 

The dosage of 'I and B 693 in twentv three patients 
was a grammes dailv for four to seven davs then I 5 
grammes diilv for a similar period m most cas_s At 
first a few Wtre treated for a longer period probabl) 
quite unnecessarilv \ tri il of la grimmes dailv from 
the commencement of treatment was made in seven cases 
Of these five weri. gonococcus negative in two davs one 
in eight davs and one not till the seventeenth dav The 
total dosage varied actuallv from 42 to 14 grammes 
The avenge amount necessarv is vet undecided but it 
would appear that anvthing Irom 15 to 25 grammes 
suffices and the suggestion is made that the initial dcse 
should not b. less than 3 grammes dailv Tlie follow ng 
dosage IS to be tried in uncomplicated cases of urethril s 
first da) 4 grammes second and third davs 3 grammes 
p.r dav fourth to seventh dav inclusive I 5 grammes 
dail) Urethral lavage (potassium permanganate I in 
S0()0) was given to twentv four cases mainlv for psvcho 
logical reasons but of six patients who did not have 
anvthing other than M and B 693 five were gonococcus- 
ncgative in two davs and one in three days The dura- 
tion of infection — vvhich varied from thirteen weeks to 
one da) — prior to treatment did not seem to have an) 
influence on the result of M and B 693 

Toxic results were noted in seven of the thirt) patients 
nausea in two dizziness m two headache and lassitude 
m one drowsiness in one and breathlessness in one All 
were slight The last mentioned showed some methaemo- 
globinaemia and in this patient onl) was it deemed 
advisable to withdraw the drug when his breathlessness 
promptlv ceased Bv this time however the desired 
effect upon his infection had been accomplished Cyanosis 
was not seen in an) case 

A Case of Gonococcal Ophthalmia Neonatorum 

A case of gonococcal ophthalmia neonatorum remains 
to be mentioned and for permission to include it thanks 
arc due to Dr Michie senior resident medical officer 
at the Citv Hospital Aberdeen A female infant in- 
fected in one eve had been treated activelv with boric 
lavage and silver nitrate and had also received prontosil 
At the end of seventeen davs the notes read Making 
verv slow progress needs intensive treatment She 
was then given 0 25 gramme M and B 693 thrice daily 
for three davs The notes then read Sudden almost 
dramatic improvement Conjunctiva clear and onlv 
minimal pus This occurred m forty-eight hours A 
culture and smear examined one dav after the cessation 



284 August 6, 1938 


CHEMOTHERAPY IN GONORRHOEA 


Medical Jovuva 


ol {reatment were free from gonococci and Irom pus cells 
The child was discharged three days later 

Comment 

It IS not intended to make any comment meantime 
othei than that, of three preparations — benzyl-sulphanil- 
amide, sulphanilamide, and M and B 693 the first and 
second having been tried extensively in the Aberdeen 
clinic — the last is the swiftest in action So far it would 
ippear to be a highly efficient and comparatively safe 
drug in the doses which appaiently suffice to deal with 
the gonococcus But out of this very efficiency there 
may arise the necessity, foi obvious reasons of stiict 
control in the sale and distribution of such i prepaiation 
It IS hoped that at some futuie date a moie detailed 
rcpoit may be made on the use of M tnd B 693 in 
the treatment of gonorrhoea 

RertRCNccs 

Cmiis G M iml Giisford W T (19t8i) Laiud 1 1305 

(I9t8b) Ibid, 2 14 / 

Ltosd V E Eiskinc D and Johnson A G (t938) Ibid 1 130S 
Pairin T (I937I Anici J S^ph 21 475 
Telling M ind Olner W A (19181 Liiiicii 1 1191 
Whitby L E H (1938) Ibid 1 1210 


X-RAY PELVIMETRY 

A SIMPLE METHOD FOR MEASURING THE 
PELVIC BRIM 

BY 

A. ORLEY, M.D., F.B.A.R. 

Extern il pelvimetry is still practised by obsteti ici ms and 
general piactitioners, but probably more as a mtUer of 
routine than from the conviction that an accuiate know- 
ledge of the inteinal pelvic measurements will be gained 
Even internal pelsimetrv is unreliable Besides, it is 
not easv to apply, and it is often painful or disagreeable 
to the patient 

In a recent article on the true conjugate and pelvimetry 
J Howkins (1938) arrives at the conclusion that the 
clinic il measurement of the true conjugate is eithci 
impossible in practice or inaccurite when measured in 
ill but cases ot severe pelvic contiaction , that a genuine 
ittempt to measure it in a primipara demands a full 
maesthetic that the location of the sacral promontory 
requires practice ind skill, and is valueless unless per- 
formed bv one tamiliar with pelvic examination and 
thu the meTsurement, when tiuthfullv obtained, is open 
to considerable experimental error, in addition to errors 
dm. to the pirticular anatomy of a given patient such as 
the depth and inclination of the s>mphysis pubis 

It IS mainly lor the aboxe reasons that radiologists 
hue strixen since the early days of the \ ray era to 
111 ikc use of radiography for measuring the pehic brim 
The first ridiogriphy of the pehis (of a corpse) was per- 
tornii-d in 1896 by V irnier and Chappuis and required 
in exposure ot three hours In 1897, at the twelfth 
Intern itiond Congress of Medicine irt Moscow, Professor 
Budin shosved in excellent radiograph of an oblique 
Pl1\is ot Naegcle this required an exposure of three- 
qu irter-, ot in hour At the same congress Professors 
Pin ird ind V irnier reported results of the radiological 
insLstigitions ot the female pehis It is possible, they 
Slid accuritcl) to diagnose in doubtful cases the sym- 
mstrx or isvmmctn of the pehis the site and degree 


of the asymmetiy, the presence or absence of atroph) of 
the saci um or of sacro iliac ankylosis ’ They estimikd 
the various diameters of the pelvic brim by comparing the 
obtained radiograph with standard radiographs of dried 
pelves ' 

Since then the evolution of \ ray pelvimeirx his 
followed a very devious and complicated path (Orlci, 
1933) Most ingenious devices and methods for 
measuring the pelvic brim have been invented, and then 
discarded because they were too complicated, too ei 
pensive, or unreliable This paper deals with cm. 
method of v ray pelvimetry only — namely, that which was 
originally suggested in 1897 by Albert, was rediscmered 
thirty years later by R E Roberts (1927) of Lixerpool 
and simplified by H Thoms 

Description of Method 

The technique descubed latei differs somewhat from 
that suggested by Thoms The principle, however, is thi 
same Briefly speaking, the method consists in placin" 
the patient on the ladiographic couch in such a was a< 
10 bung the pi me of the pelvic brim parallel to the plin 
ol the radiographic film For this purpose the lip of 
the fourth lumbar spine is marked on the skin wilh a 
dermographic pencil or by a strip ol adhesive piaster 
The patient is then seated on the a-iay couch m a stffli 
reclining position, so adjusted that the tip of the spine 
of the fourth lumbai vertebra is at the same horiiontal 
level as the upper bolder of the symphysis pubis This 
is carried out in the following way one leg of a pair 
of callipers is placed on the top ot the \ ray couch in 
front of the symphysis pubis between the patient s Ihi"!!' 
and the callipers are spread until the tip of the othu 
leg of the calliper is at the level of the upper borf'i 
of the symphysis pubis The inclination ot the palicois 
spine IS then so adjusted that the distance between il’ 
top ot the couch and the skin mark correspondme 
the tip of the fourth lumbai spine is equal to the spre3“ 
ot the callipers 



join;, the two pisses through the promontoi> 

Some woikers dispense altogether with tin- 
the Up of the fourth lumbar spine and instead ^ 
only the distance of the upper border of the s) ^ 
pubis to the lop of the table, placing the P 
such a way that her spine forms an angle of 
with the plane of the \-rav couch The pe 



\i.rbST 6 I9'?S 


\ RA^ PELVIMETRY 


The Bwrmi 
MiOJCXL /OLILNAt 


2S5 


'.liould tliLn pinllLl with the top of the t n> couch 
\ ndiograph of the pchis tikcn m this position shows the 
piojsstion ot the peUiL brim sliglitls lirger than intunl 
size 


c 



Pig 2 — Diaerammaii^ rcprcscnlaiion of ilic anicro poslcnor 
diinctcr of the pcliic bnm AH of its ndiottraphiu projeciion 
ah and of the central raj Cd 

The radiographic projection ab of the true conjiigalc 
diameter is larger than the actual diameter AB owing to 
the distortion of the radiographic image caused b\ the 
spread of the r ra\ beam It is obsious that an> object 
placed in the imagtnarv plane of the pehic brim would 
undergo the same degree of radiographic distortion as the 
brim Itself Therefore if after basing radiographed 
the pelsie brim we remove the patient from the r r3> 
couch and leasing the tube in the same position sub 
stitutc for the imaginars plane of the pelvic brim a 
perforated sheet of lead supported on two adjustable 
supports and give a flash exposure we shall obtain on 
the r ras film a number of black dots corresponding to 
the perforations in the sheet of lead If these perfora 
tions sserc 1 cm apart the distance between each two 
adjoining dots on the film would correspond to I cm — 
in other ssords the distance between two adjoining dots 
on the film corresponds to a corrected centimetre and 
ans pelvic diameter can be read directlj on the film 
b\ counting the number of corrected centimetres 
corresponding to this diameter 
The perforated lead sheet can be made at home A 
sheet of lead 12 bv 12 inches and 2 mm thick is ruled 
out in square centimetres and fine perforations are 
drii'ed at each intersection of the transverse and vertical 
lines The sheet is then mounted on a piece of pljwood 
in order to keep it firm A flash exposure given through 
It results m a number of small black dots on the film 


Fig a — ^Th“ perforated sheet of lead 

For measuring the distance between the tip of the fourth 
lumbar spine (or of the upper border of the sjunphjsis 


pubis) and the lop of the t ray couch i pair of ordinarv 
internal callipers arc us»d These can be obtained from 
>nv ironmonger for a few shillings 



Tile adjustable supports on which the perforated 
lead sheet rests can also be easily made bv a local 
mechanic Roughly speaking c ich support consists of an 
iron base 3 bv 4 inches and about half an inch thick 
from the centre of which rises an iron rod about S 
inches long On this rod a horizontallv placed piece ot 
angle iron slides by means of a collar provided with a 
Set screw 



Pic 5 — \djustabls supports for the sheet ot lead 


After the pelvis has been exposed the distance between 
the horizontal piece of angle iron of each support and 
the lop of the table is adjusted to correspond to the 
spread of the callipers and the perforated sheet of lead 
IS placed on the horizontal angle irons in the imaginary 
plane of the pelvic bnm Bv using a focus film distance 
of 110 cm and bv centring the tube over the inner 
border of the svmphvsis pubis the maximum possible 
error in i ic measurements is reduced to about 3 mm 'or 
true conjugates of over 10 cm wide For smaller 
diameters the error is still smaller 


Commentary 

The method is extremely simple and can be carried 
out even with small r ray plants as radiographic speed 
IS not essential a Potter Bucky diaphragm however is 
indispensable The output of the plant may be as low as 
10 mA and provided the penetration is adequate (some 
where in the neighbourhood of 90 k\0 serviceable radio 
graphs can be obtained with exposures of thirty to fortv 
seconds In advanced pregnancy longer exposures may 
be required 

As with the patient sitting the thickness of the tissues 
IS much greater behind than m front of the abdomen 
the region of the pubis tends to be too dark on the 
radiograph This can easilv be remedied by shielding 
during part of the exposure the anterior half of the 
abdomen by means of a sheet of lead which is kept 
slightiv moving in order to prevent it casting a sharp 
shadow on the film 



286 August 6 1938 


X-RAY PELVIMETRY 


Tilt 

MtDtcja loix'.ii 


Y-ray pelvimetry can be earned out even during actual 
labour Where the head is in the pelvic brim the radio- 
graph also shows the relative sizes of the head and 
brim A number of obstetricians applv x-ray pelvimetry 
as a routine m all primiparae The expense and trouble 
are small in comparison with the saving of lives which 
might otherwise be lost through unnecessary or too-long- 
delayed Caesarean section in cases of suspected contracted 
pelvis, which constitutes the most important and most 
frequent indication for Caesarean section 



Fig 6 — Mrs M aged 28 Had Pott s disease of spine at 
age of 16 A fiat pelvis was diagnosed and first child was 
delivered by Caesarean section Now wants another child 
but not unless it were possible per \ias patmales Y-ray pehi- 
mctry shows A -P diameter 12 cm transierse diameter 
121 cm slight asymmetry of pelvis She was advised that 
there would be no need for Caesarean section for the next 
child 

The mortality from this operation according to a 
statistical analysis based on 3,686 cases (Banister, 1935) 
IS 6 6 per cent , as compared with a gross puerperal 
mortality of 0 45 per cent In other words, the mortality 
from Caesarean section is roughly fifteen times greater 
than the average mortality following childbirth But, 
apart from this, r ray pelvimetry, carried out as a routine, 
brings in an element of reassurance to both patient and 
doctor, a factor of no small importance in primiparae 

Bibliography 

Binisler J B (1935) British Medicnl Joinnal 2 H43 
Howhins J (1938) Ibid 1 278 

Jircho J (1931) G Miecological Roeiitaeiiologi Hoeber, New 
York 

Orlcy A (1933) Bril J Radiol NS, 6 345 (Includes extensive 
bibhogrnphy ) 

Roberts R E (1927) Ibid 32 11 

Thoms H (1935) Obstetric Pel) is Wood Baltimore 


R Debrc M Lam\ M Mignon and J J Welti (Pressc 
mid 1938 46 1011) who record two illustrative cases in a 
hov iged 1 1 and i girl aged 8, stale that whooping-cough is 
not mereh chanctenzed bv a slight catarrh of the upper 
respiratory tract but ts accompanied by a pulmonarv lesion 
In other words whooping cough is a disease of the lungs and 
runs a subicute course more often than is generallv supposed 
The pulmonarv lesions explain the frequency of certain find- 
ings even in the mildest attacks especialh the presence of fever 
cert rin ausLultatorv signs and the long duration of the disease 
as well as the frequenev and importance of radiological changes 
m the lung On the right side the usual appearance is that 
of 1 roughlv tnancular shadow m the sub hilar region while 
on ihe left the cardiac shadow i, blurred These changes 
which arc frequent in mild attacks and almost constant in 
severe whooping cough mav be riistaken for tuberculosis or 
abscess of the lung and diagnosis may not be possible without 
the assistance of lipiodol 


Clinical Memoranda 


Pneumococcal Meningitis treated niti 
Sulphamlamide : Recovery 

The number of recorded cases of pneumococcal menincitis 
which have recovered is still so small that the following 
case in which recovery followed treatment with sulphaml 
amide appears worth reporting 

Case Record 

A boy aged 5 years was admitted to the Roval Hospital 
Wolverhampton, on April 1, 1938, complaining of right sidM 
earache for one week there was no historv of preiious car 
disease An acute otitis media was found Mjnngotoni 
was performed, and this was followed bv a profuse discharc 
of pus The condition subsided, and the child was disch^'iitd 
on April 9 

He was readmitted on Apnl 14, complaining of 
frontal headache for two davs and vomiting the previous d 
On examination he was pale, listless, and verv drow" 
temperature 101° F pulse 130 There was slight neck 'iis 
ness, Kernigs sign was positive, and photophobia was p^^crt 
The right ear drum was retracted there was no ear di'ch’i'' 
and no mastoid tenderness The left ear was apparenili 
normal 

Lumbar puncture was performed and 20 cem of tuihd 
flvnd withdrawn, m the absence of a bacteriological dre 
nosis 10 cem of anti-menmgococcal serum was given inlra 
theealh , laboratorv' examination revealed a purulent fiud 
films showed abundant pus cells and Gram positive diplc- 
cocci Cultures vielded a pure growth of pneumo xx 
Globulin was found in excess, protein amounted to02-Sr 
per cent, chlorides to 0 66 per cent and sugar to OOlSp'' 
cent Ora! treatment with sulphamlamide was immedi”^ 
started, one tablet being giv en four-hourlv Lumbar pur k" 
was repealed once daih on the 15th, 16lh, and 17lh One i 
occasion pneumococci were grown on culture from the cetebo- 
spinal fluid but the turbiditv appeared to be decreasme Col 
counts were not made because of clot formation in the ccicf e" 
spinal fluid 

On the 16th — that is the third day of ircalment— t 
temperature fell bv crisis to 97 6° F The child was no lon« 
drowsy and was plaving with his toys On the ISth cisro ’ 
was jnst becoming evident and the sulphamlamide wav d 
continued Dosage to this point was twentv one tab; 
(10 5 grammes) The temperature rose sharplv to 101 
on the 20th, with recurrence of neck stiffness and 
Lumbar puncture xielded a clear fluid which was stcnle 
culture The sulphamlamide was restarted — one tablet bei ^ 
given four-hourh for three days, to the total of twelve la ^ 
(6 grammes) — stopped as the cyanosis had become m'e 
and then after an interval of two days given for a furl 
three days to a total for the last course of thirteen D 
(6 5 grammes) , 

The laboratorv reports on the cerebrospinal fluids obtair 
by subsequent lumbar punctures are as follows 
Apnl 24 — Clear colourless fluid cells 5 per emm 
show lymphocvles only , globulin in excess, protein, P ^ 
per cent chlorides 0 73 per cent , sugar, 0 043 pef 
No growth on culture 

April 27 — Clear colourless fluid cells 2 per c mm 
globulin in excess no growth on culture ^ 

April 29 — Clear colourless fluid, cells 2 per em 
globulin in excess no growth on culture ^ 

Afav 5 — Clear colourless fluid cells, 2 ^r 
lymphocvles no excess of globulin, no growth on ci 
The temperature fell on the 21st after discontinuance^ ^ 
sulphamlamide and except for an occasional rise 
thereafter remained normal In retrospect it appea 




VLtl'ST 6 I9'5S 


CLINICAL MEMORANDA 


The BRmsH 

MtOICAi JOtTlNtL 


2S7 


rivi. ot tcniperatnre on the 20lh \'is probihh rciclionan 
and dtic to the drug tint actinllv h\ lint time the infection 
had been niccc\sfoIh combated and that the further cour<ie\ 
of ^ulphamlanude were not realla necea^ara Erom the 
2'ath onwards the temperature remained normal and the piiNe 
rats tsil rapidh 

SuMMM a 

1 \ case ol pneumococcal m^ningilis is dLscribcd from 
which the organism w is recoacred on four difTtrcnl 
occasions 

2 Complstc rccoaer) folloaaed treatment aaitli siilphanil 
amide 

1 A total dosage of 2' grammes aaas giacn in thirteen 
daas aaith laao rest periods It is probable that infec 
tion aaas succcssfulla combated ba the first course of 
10 a grammes 

1 am indebled to Mr Hallchureh PROS for permis 
Sion to publish the notes of this case and to Dr S C Dale 
F R C P~ director of the pathological department of the 
ho pital for mueh aaluablc help and adaicc 

Freids Volsc M B 

Rosal \lo piaal Veitc Vsistant Paabologa a and 

Wolserhampion Resident Medical Oflicer 

Pol} neuritis ^^i(h Oedema simulating 
Bcnben 

Se^e^aI unusual pojnts occurring in this cast make it 
I think NNOrlh putting on record 

Case Record 

The patient is a girl rged 4 one of four children in a good 
middle-clasi famil\ ha\ing a normal mixed diet unlikclv to 
cauNe a Mtamm B dcfiacnc) PrcMoux medical hi<tor\ in 
clude> u hooping-cough chicken pox nnd measlex pneu 
monia all in tht. prcMous twclNc months but before September 
19 7 

Laxi December she suffered from an acute attack of bron 
chiUs Her temperature xaned bclxxcen 101 and 103 F 
with a pul^e rate of 120 for six da\5 The mucous membrane 
of her mouth xxas inflamed but there was no sore throat 
The quaniiu of muco puailenl cxpccioration was cxiraordinarx 
for a child of 4 Occasionallx the sputum was blood stained 
WTien she had been up two daxs she complained of pain 
m her thigh> and it xs-as then found that she could not xxilk 
properlx On examination she was unable to rare her legs 
from the bed but could moxe her ankles and iocs She 
could not turn oxer in bed Knee jerks and ankle reflexes 
were absent and the plantar reflexes were doubtful extensor 
Both leo xxere affected There xxas a slight exenmg tempera 
ture Her appetite remained good 

After a xxcek in bed the use began to return in her legs 
althouch she stijl complained of some pain in then and in 
her hands, 1 considered her case to be one of toxic neuritis 
follow ms the acme pulmonan infection of three weeks before 
After another week in bed U was noticed that her face xxas 
oedemaious more so on one side than the other The first 
thought was of nephritis but the unne contained no blood 
ca>ls or albumin Injections of adrenaline were tried in case 
it should proxe to be an angioneurotic oedema but without 
effect The oedema spread to her legs abdomen back and 
arm It was a hard oedema which pilled slightlx after steadx 
orebsurc There was a morbilliform rash on her hands and 
face Although her temperature did not rise oxer 99 F her 
puUe rate remained aboxe 140 Rctino copx shoxxed exudate 
in both retinae similar to albuminuric retinitis Unne excretion 
xxas reduced to about IS oz in the txxcntx four hours Rectal 
feeding had to be earned out for txxo daxs as sxx-alloxxing 
became difficult No paralxsis of the diaphragm xx’as noticed 
The blood pressure xvas 90/60 A blood count shoxxed oxer 
5 090 000 red cells per emm and a Ieucoc>t05is of 19000 


xxilh 79 per cent polxmorphs Blood cultures xvere sterile and 
the blood urea 20 me per 100 cem 

Parenteral xitamin Bj (beiaxan) 4 mg dailx xxas started 
on Jinuan 29 19^8 Four daxs later the unne excreted was 
ontx 11 oz. with a measured fluid intake of 20 oz so ixso 
small doses of salxrgan were gixen resulting in a temporarx 
increase of unne to 20 oz in the iwelxc hours folloxvmg 
each injection During these daxs her exenmg temperature 
rose to 102 and her pulse rate to oxer 150 After eichl da>s 
of the vitamin treatment there was definite reduction in the 
oedema in her face and legs Her temperature graduallx came 
down but the pulse rate remained above 1‘'0 The xiiamin 
w is reduced to 2 mg dailx 

On the eleventh dax the urine excretion suddenlx went up 
to oxer 30 oz. aIthom.h the intake w-as still reduced As the 
pulse rale did not drop in spite of the temperature being normal 
three dailx injections of 10 mg of vitamin Bi were given 
This treatment xsas followed on the dax of the third injection 
h\ a drop in the pulse rate to an average of lOS She was 
now able to move her legs and arms but the reflexes were 
still ab-vcnt The oedenx'' had graduallx cot less in the same 
order as it appeared Lnforiunatclx measurement of the 
limbs xsas not ihoucht of until the face and legs appeared 
normal The forearm then measured 91 inches Six daxs 
iMet the iorearm xwches and owe month later — 

that IS two months after the vitamin treatment was begun — 
onix 61 inches no trice of the oedema being observed 

Rccoxcrx was uneventful until March 10 when she con 
tracted a cold from another member of the famdx She 
became graxclx il) with pxrcxia of 103 F puj c rate oxer 
150 and a respiration rate oxer ^0 Apin the sputum was 
excessive There were fine crepitations at both bases and 
pneumonia was diacnosed On the sixth da\ she had the 
crisis with ncors and exanosjs From this time progress has 
been steadx The knee jerks relumed and the plantar response 
became flexor Now xi\ months after the beginning of the 
illness her pulse me axcraccs 84 she can walk well and 
she IS puUinc on wcichl In all 74 mg of xiiamin B were 
given intramuscularlx and since stopping the injections she 
has had the xiiamm b\ mouth in the form of r^zamm B 

COXlMnNTAR\ 

Apart from bcnben I can find \cr> hlile in the liieralure 
ihai resembles this case Macka> (1932) describes a case 
of peripheral neuritis as a complication of angioneurotic 
oedema while Boxd Campbell and Allison (1932) describe 
a case of pol> neuritis with urticaria Ford (1937) gi\e:» 
an account of acute febrile pol>neiirUis following acute 
pulmonars infection which closeK resembles this case 
except that oedema is not mentioned Price (1938) reports 
a case of alcoholic beriberi with polx neuritis and 
oedema 

In comparing the results of vitamin B, treatment in this 
case with the results in beriberi as described bx Straubs 
(1938) and Hawes Moniciro and Smith (1937) the most 
marked dififerences are the dc!a> in the reduction in the 
pulse rate and the delax m the diuresis These ma> have 
been due to inadequate dosage although this compares 
favourably II is for this reason that I doubt if the present 
case can be considered to be due to a xiiamin deficiency 

1 xxish to thank Dr J V C Brailhwaite and Professor L 
Parsons for their advice and for their interest in this case 

Lci"CNter ^ ^ Garrett MB B S 

References 

Campb"!! S B Boxd and Allison R S (1912) Lancet 2 2j 9 
Ford r R (19^7) Diseases of the ^'enous System in Infancy 
Childhood and Adolescence Springfield Illinois 
Hawes R B Monteiro E S and Smith C E (1937) J Ma!a\a 
Brer ch BM A 1 87 
Mackay W (1932) Uncet 1 777 
Price N L (193S) Ibid 1 831 
Strauss M B (I93S) J Amer nied Ass 110 953 



288 August 6, 1938 


REVIEWS 


TheBritish 

Medicai. 


Reviews 


CELSUS REDIVIVUS 

Dc Medicina By Celsus Volumes II ind III With an 
English Translation by W G Spencer, MS, F R C S 
The Loeb Classical Library (Pp 649 (both volumes) 

10s net each volume (leather 12s 6d net) 2 50 dollars 
each volume (leather 3 50 dollars) ) London W Heine- 
mann , Cambridge, Mass Harvard Unnersity Press 
1938 

Celsus IS coming into his own again From 1815 to 1858 
he was known and hated by every medical apprentice in 
England His treatise De Medicina was used by the 
Society of Apothecaries to test the knowledge of Latin in 
the examination for the L S A The examiners on the 
Court — like the Wheelers and the Rivmgtons — were 
scholars, and little mercy was shown to the more 
Ignorant candidates Various translations came into use, 
the best known being that by Dr G F Collier of the 
Academy of Leyden and of Magdalen Hall, Oxford 
These English versions, however, were of the nature of 
“ cribs,” designed to facilitate the passing of an ill- 
educated boy They are now finally superseded by the 
scholarly translation made by Mr W G Spencer, con- 
sulting surgeon to Westminster Hospital, and published 
in the Loeb Classical Series The Latin and English are 
printed on opposite pages, and it is thus easy to compare 
the translation with the original Mr Spencer has been 
successful , his version is crisp, accurate, idiomatic, and 
being himself a surgeon he has been able to elucidate 
various technical points The two volumes recently pub- 
lished complete the work They deal with Books V to 
VIII — that is to say, with drugs, external and internal 
remedies, and what may be called folk medicine Books 
VII and VIII treat of surgery, and tell of the operations 
in more common use in Rome in the first century of the 
Christian era, and of the treatment of fractures and dis- 
locations Read with intelligence and with a recognition 
of the limits of the time it shows that classical surgeons 
knew and ventured much more than they are usuallv given 
credit for In his second volume Mr Spencer gives a 
list of the remedies used by his author, and of the drugs, 
herbs, and other ingredients of his prescriptions — not a 
mere list but an account of each In the third volume 
there is an appendix on the meaning of the word “ cancer ” 
in Celsus and his reference to malignant disease, a list of 
pirallel passages in Hippocrates and Celsus, and a satis- 
factory index to the three volumes 

Mr Spencer -is to be congratulated very heartily on 
having brought several years of work to so successful an 
issue It shows that in England (he cultured surgeon is 
no more dead than the learned physician 

DA P 

ORGANIC CHEMISTRY 

Priiuiplcs of Organic Chtmntry B> H P Starck, 

M A Cantab (Pp 664 58 figures 7 tables 12s 6d 

nett London and Glasgow Blackie and Son 1938 

St irck s Principles of Organic Cficnusliy is well designed 
for the requirements of a beginner in the studv of the 
subject In his preface the author remarks that the diflt- 
ciiltN of mastering the first principles is increased by the 
introduction of complex compounds at an early stage 
bctorc their methods of preparation and characteristic 
properties ha\e been described This is a fact of out- 
siinding imporlancc and is one that has received scant 
recognition by writers of textbooks on organic chemistry 


Starck has followed the aim which he has set up and has 
produced a book m which (he principles are taught b\ 
reference to compounds of the simplest constitution He 
has recognized further that the best foundation for a 
knowledge of principles is only to be obtained by practice 
in the methods of production of compounds, for only bj 
this means can the properties of the compounds bv 
realistically revealed He has accordingly included e\cr 
cises m practical work which are suitably chosen and 
described in sufficient detail to enable the student to 
accomplish them successfully And further to enliven the 
student’s interest, and to induce him to exercise con 
structive thought, he has appended to each chapter a scries 
of questions, the answers to which will call for attenme 
consideration of what he has read Nothing seems to b 
omitted from the book that is required to give the student 
a comprehensive grasp of the subject It also includes 
important matters of a novel character, such as a descrip- 
tion of the Svedberg ultracentrifuge, which by its hish 
speed of 65,000 revolutions per minute has been used 
successfully to sort out particles of almost molecular 
magnitude 

NECROPSY ON A GORILLA 

Dcucht iibci das Ergcbins der Obdukuon dcs Gprilln 
Bobby des Zoologischen Gartens zn Berlin Bi Dr 
Walter Koch (Pp 36, 17 figures RM 2 50) Jena 
Gustav Fischer 1937 

Dr Walter Koch’s report on the post-mortem findina of 
the gorilla “ Bobby ” of the Zoological Gardens of Berlin 
consists of two parts The first is a very careful and 
thorough report on the necropsy of the ape, inciudin' 
exact measurements of different par[s of the body as "eff 
as the weight and size of all important internal orf 
The second part deals with the problem of the actual can-’ 
of death of this remarkable animal, which reached in bn 
and a half years a weight of 266 kg (=585 lb, w 
approximately 42 stone) and a height of about 5 ft 8 1 '' 
Necropsy revealed an appendicitis, oedema of the lun’S 
calcification of renal epithelia, and extreme obesity 
first It was impossible to decide which of these findm'S 
was responsible for the death Numerous bacteriology 
tests were carried out with material taken from the nasa 
cavities, pharynx, tonsils, trachea, bronchi, lungs, spleen 
and various parts of the intestinal tract, but the result "as 
practically negative The lungs showed slight adhesiom 
on the right upper lobe There was no fluid in the plenra 
cavity Most of the tissue of the lungs, especiallj * 
upper lobes, was full of air but oedematous ^ 

the oedema, the blood in the arteries and veins of the lu" 
contained a very great amount of leucocytes and aggW'^ 
ations of leucocytes in thrombi An actual lobar 
monia, however, did not exist, but some early foei 
consolidation were found No pathogenic bacteria 
COCCI were found, but putrefactive germs were nurnef®^ 
^The author therefore comes to the conclusion ina 
condition of the lungs is to be interpreted as a ternn ^ 
aspiration pneumonia which lasted probably only os’ 
two days .[,j[ 

The condition of the appendix was very similar 
in the case of human appendicitis the processus <■ 
formis was bent and adhered to the peritoneum o 
abdominal wall near the spine The peritoneum 
thicker than the normal and covered an abscess 
size of a large bean Inside the abscess was ^ 
extending into the submucosa of the appendix, m ^ 
with great probability a previous ulcerating 
kidneys showed slight signs of nephrotic degenera ( 
the already-mentioned calcification of renal tu u 




RE\ ILWS 


cxamimlion of iHl kitirn.\s wilh repnrd to niLlillic poison 
(corrosisc sublinnic) wns nei.nli\c 

7h; testicles sshich Ind i weight of onK 10 i grammes 
( = ab^tlt I/'^oz) Wert distinctls hspophstic There w is 
no spermitogenesis In conncvion with the ficl tint the 
cpiphsses were not completeh ossified ind thit the li\po 
phssis showed no interniednlc lobe but a persisting c>stic 
ci\it\ sepiriting the neiiro ind adeno hspophssis Dr 
Koch circiimstantialls discusses the problem whether the 
hspoplasia of the testes etc was primars or conditionil 
upon the alleged delased development of the h)poph)sis 

DEFENCE or THE EGO 

T/i** £eo orti the Afrr/iieiuiis of Dcfentr Os Anni 
Freud Translated from the Gcrnnn b\ Cecil Runes 
The International Psscho Anahtical 1 ibrarj Fdiied be 
Ernest Jones MD (Pp 196 9 net) I ondon Hccirlh 
Press 19j7 

There can be no question but thit psecho anal>sis is 
becoming more intelligible to the ordinarj reader Whether 
this IS because the ordinarj reader is becoming better 
educated in respect to psvcho inaljlic thought or because 
psvcho anahsis is becoming less esoteric it is diflicult to 
sa\ In an\ case the present volume will repaj the studj 
of a large public who owe no allegiance to the psjcho 
analvtic school 

The ego has got to defend itself against the id — that is 
the instinctual drives which demand direct and perhaps 
crude and conflicting expression Protection maj be 
need.d because these instincts arc inconvenient or because 
thev are too strong and threaten to overwhelm the ego 
altogether Or the defence mav b. required against the 
outs de world though this mav in the last analvsis be the 
same as the first since these outside objects Serve as 
stimuli to the instincts which are within the personalitj 
Thirdlv defence maj be needed against the tvrannv of 
the superego — the svstem of laws and ideals established 
within the personalitv largelv as a result of the dictates 
and examp'es of the child s parents and ciders In the 
present volume the mechanisms of such defence arc admir 
ablv described with illuminating clinical examples Still 
however the pansexualism is apt to strike a jarring note 
One wonders how the headmistress of a girls school 
devoted to athletics would receive the statement that a girl 
set herself to excel in drill and gjmnaslics as a substitute 
for the acrobatics of her brothers genitals ft mav be 
said that if she was Ihoroughlj up to date the headmistress 
would accept this as a simple statement of fact but the 
reviewer would regard the outraged susceptibilities of the 
old fashioned mistress with a certain degree of sjmpathj 

DIET AND BLOOD JPRESSURE 

Hi^li Blood Pressure Bv I Hams M D in collaboration 
with C N Aldred MD J T Ireland B Sc and G V 
Jam^ MSc (Pp 132 22 figures 10 6d net) 

London Humphrej Milford Oxford Univcrsitv Press 
19^7 

In this monograph Dr I Harris describes his researches 
into the causation of hvpertension These have been 
concerned with bodilj metabolism and relate largelj to 
the changes found in the blood and urine in high blood 
pressure The first chapter reviews the results of expert 
rnents designed to correlate blood pressure with the 
intake of protein in the diet Non protein nitrogen and 
urea values in the blood under high and low protein 
diets are considered in the second chapter while the third 
deals with the corresjKinding urinarv variations Further 
sections are devoted to analjses of metabolic exchanges 
and discussions of the results of these biochemical studies 


The Bumni aco 
Midtcal Iocrnal “ 


Dr Harris infers from them that the lower the protein 
intake the lower the iricrial pressure and that it is the 
qiiantitv and not the n iturc of the protein that matters 
On a fixed protein int ike he has found that the elimina 
tion of nitrogenous end products of metabolism t ikes 
place more quicklj when the blood pressure is higher 
Further in hvpertension the non protein nitrogen was 
found to be within normal limits except in verj advanced 
cases while urea clearance was retarded A diet rich in 
protein was observed not onlv to increase the blood 
pressure but also to augment the calcium and potassium 
content of the blood 

These ind manv other observations in this work are ot 
considerable interest and thej demonstrate the important 
part plajed bv diet and pirficularlv protein foods in 
the bodilj metabolism and in influencing blood pressure 
No one would dispute that there must be other contri 
biitorv causes of high blood pressure since manj people 
who take a high protein diet preserve normal blood 
pressures, while vegetarians arc not immune from hjper 
tension In this as in other departments of medic ne 
a broad view must be talcn when pathogenesis is under 
consideration As for hjpertension familial taint and 
endocrine imbalance are undoubtedly important in addition 
to diet while it is diflicult not to suspect that some dis 
turbance of the renal function underlies even so called 
essential hypertension Dr Harris s book deserves the 
attention of all who arc interested in the problem of high 
blood pressure 

GASTRO INTESTINAL PAIN 

Diccsiiie Trait Pain Diatu osis and Treatment Crperi 

mental Ohsenalions Bv Chester M Jones Nl D 

(Pp IS2 s figures 10 6d net) New 'J ork and 

I omJon The Macmillan Company 1938 

Dr Chester Jones has investigated digestive tract pain 
both experimentally and clinicallv he has confirmed some 
old observations and made some new ones which are 
both interesting and import int He recalls the original 
work of Ross (ISS7) which suggested that unexplained 
sensations from a diseased viscus would be perceived by 
the individual as cutaneous or subcutaneous sensations 
These observations laid the foundation for the modern 
conception of referred pain but in addition he recognized 
the existence of deep visceral pain Sir James Mackenzie 
and Sir Henrv Head (1893) subsequentlv elaborated these 
views (though we think Dr Chester Jones does rather 
scant justice to the letters contribution) but while both 
believed that the sympathetic did not carry painful s'^n 
sations Head did not deny the existence of direct visceral 
sensation The author quotes with approval J C Whites 
views (1935) that the large medullated fibres scantily 
present in the svmpathetic did unlike the non medullated 
ones convey sensation but surely this had already been 
advocated more than forty years ago by Edgeworth 
working under Gaskell s direction and was accepted as 
a satisfactory reconciliation of the discrepant views The 
matter took a fresh turn when Sir Arthur Hurst (1911) 
explained that the observations on the comparative in 
sensibilitv of visceral structures were due to the appli 
cation of an inappropriate stimulus For tubes containing 
plain muscle he maintained the effective stimulus was 
tension Thus the riddle was resolved of the causation 
of agonizing pain in structures that could hardly appre 
ciate the clean cut of a scalpel In the research before 
us the balloon method of expanding different portions of 
the alimentary tract was employed and not only wa' 
Hursts explanation confirmed but extensive studies in 
localization were earned out, and it was found that 


290 August 6, 193S 


REVIEWS 


^ Aie Bxmsji 
NtEDlCAl JoniMl 


suojective localization of the pain was most accurate where 
the structure involved was most fixed — for example, in 
the intestine over the appendix or at the hepatic and 
splenic flexures A very interesting study of the sen- 
sation of heartburn ” showed that it depended almost 
entirely on the degree of tension developed in the oeso- 
phagus ard not on the acidity or temperature of its 
contents 

Head regarded the cutaneous pain or hyperaesthesia 
referred from a visceral lesion as due to the ordinary 
stream of sensations from the skin falling into a segment 
of the spinal cord already irritated through its splanchnic 
supply Dr Chester Jones has confirmed this in an 
ingenious way He injected novocain into the skin area 
and found that this abolished the superficial pain while 
leaving the deeper pain unaltered His study of gastro- 
intestinal pain in “ functional disease ” is of much interest 


same clarity which is manifest throughout the preuoui 
sections The volume constitutes an excellent introdiiciion 
to the larger works on the subject, such as that o[ 
Buchanan and Fulmer It is published by E and S 
Livingstone of Edinburgh at I Os 6d (postage 6d) 

The second volume of the first series of the Nen Inicr 
national Clinic (J B Lippincott Company, four \ols 
50s ) contains fifteen original articles, including papers on 
epidemic encephalitis, heart surgery, brucellosis in Penn 
sylvanta, tuberculosis of the prostate, lymphogranuloim 
venereum, and a new treatment for acute infections 
(anthmco therapy), six clinical lectures deroted rtspci. 
lively to anaemias, cortical adrenal tumours, Brights 
disease, bilateral renal carbuncles, spontaneous hjpo- 
glycaemia, and surgical cases , and a review of regional 
ileitis 


Every clinician knows that such pain may apparently be 
as great as in any organic disease and, indeed, that 


Preparations and Appliances 


serious organic disease may evoke singularly little pain 
It IS all a question of the ‘ effective stimulus ’ a loss 
of balance between the sympathetic and parasvmpathetic 
IS capable of causing tensions which excite severe pain 
and which are demonstrable by v rays Dr F C Eve 
has written convincingly of such functional conditions 
under the engaging title of ‘ the blunders of plain 
muscle,” though we might suggest that if ‘ someone had 
blundered ’ it was the autonomic nervous system and 
not the unfortunate and suffering muscle' 

No one can read this stimulating book without gaining 
a fresher and more intelligent appreciation of a subject 
of real practical importance 


Notes on Books 

The second series of signed articles on the Management 
of Some Major Medical Disorders, which had appeared 
week by week in these columns in 1935-6, were republished 
in book form by Messrs H K Lewis and Co as Volume 
11 of Treatment in General Practice The fifty chapters 
\\ere grouped under diseases of the nervous system, 
diseases of the digestive system, diseases of the 
blood and blood-forming organs, rheumatic diseases, 
metabolic diseases, and diseases of the kidney A 
second edition has now been called for and is published 
at the same price (10s 6d ), each chapter having been 
submitted to its author for revision, except that by the 
late Dr Kinnier Wilson, which is revised by Dr 
Macdonald Cntchley The new edition of Volume I of 
1 riatment in General Practice (H K Lewis and Co, 
8s 6d ) was announced in our issue of July 16 

No great prescience is required to realize that the future 
progress of bacteriology lies mainly on biochemical lines 
Students of the science are bound to see moie and more 
biochemistry introduced into their subject and they will 
therefore find it a boon to have available the assistance of 
Dr C G Anderson s excellent httle textbook. An liitio- 
iliution to Bactei lological Chemistry obviouslv the work 
of an able teacher The specialized biochemistry of 
bacteria, yeasts, and moulds, comprising their nutritional 
requirements, metabolism, and by-products, is arranged to 
follow introductory chapters on underlying physico- 
chemical conceptions such as pH, oxidation-reduction 
potentials and the like Detailed attention is paid to 
alcoholic fermentation and to the basis of other industrial 
processes for which micro-organisms are used The author 
has i keen c\e for the recognition of what is important 
in the applied sense as well as in the academic and never 
fads to add where possible a point of special practical 
importance He concludes with a resiew of the funda- 
mentals of immunological chemistry, rendered with that 


A SIMPLE ARTIFICUL PNEUMOTHORAA 
INDUCTION NEEDLE 

Dr F G Chandler F R C P , senior phN sician to the Lcrioi 
Chest Hospital and phjsician to St Bartholomew s Ho'piUl 
w rites 

In 1925 I described' an improred artificial pneuraoihoiar 
refill needle with a trocar end which was made accordint 'o 
mv instructions by Messrs Allen and Hanburvs This was 'ut 
sequenth modified bv Dr Andrew Morland, who had i ''it 
made instead of a round aperture at the side of the reedli 
This had the advantage of allow mg air to pass more qmdf 
and a freer oscillation in the manometer, with an e'en 'nia'c 
diameter needle These advantages are often nullified 1 ' 
cser b> the slit filling with blood which practical!' r t 
happens with the original needle with the small round ho'ui 
the side The use of this type of needle is limited to c 
where a definite pneumothorax exists 
Later I asked the Genito Urinary Companj to makeantid^ 
With the hole in one of the facets of the trocar, as illu'in'e' 
the idea being that immediately the point of the trocar a*' 



through the parietal pleura the opening of the needle 
be there also A swing of the manometer would occur 
the admission of air could be allowed straight aw a' 

For about ten sears 1 base tested this needle and 
sinced of Us value It can make the induction of a pnc 
thorax in mans cases as eas\ as a refill The lumen ma' 
blocked with blood and this is the reason wh' it is not «' ^ ^ 
fill in all cases To fake the needle out, wash it i 

dn It mas seem to take too much time (though m rea 
takes only a few moments) it is desirable therefore o 
one or tsso spare needles m reserve If the o'l 

other tspes of refill needle may be employed I 
It the luckv dip method but now I am con'inee 
IS far more than a lucks dip ’ 

There is hardly need to describe the technique , 
absolutelv simple After anaesthetizing the 
parietal pleura — noting the distance of the ‘ 

from the skin by passing the needle slowly and gcu , 

the inscnsilise intercostal muscle until the P''’''i|' , ,, pu'tc' 
to feel the needle — the induction needle describe 
gentls through this anaesthetized track until ^ nuircff 
in the manometer There is no need for in. 

manipulations that are so frequently demanded 

and cannula tspe of induction nc£t[|b 

' Lancet August 22 1925 



\ltrvsT 6 I9^S PELVIC MEASUREMENTS vJlSijSS'K.L ^91 

m order that it may be proved to her beyond any 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDA\ AUGUST 6 I'JtS 


ARE PELVIC MEASUREMC^TS AN'ORTH 
TAKING •> 

The dimensions of the pelt is and the meins of 
their determination have for generations been re 
garded as the fundamentals of obstetric know ledge 
It IS therefore remarkable that simultnncouslv with 
the development of precise methods of mensuration 
many obstetricians arc now to be found who ignore 
the inch rule and insist that the intelligent use of 
the fingers m palpation and the exercise of the 
clinical sense ’ are the onlv safe guides in fore- 
telling the outcome of labour One evidence of 
this tendency is the increasing use now made of 
‘ trial labour in the treatment of supposed dis- 
proportion between foetus and pelvis Premature 
induction of labour m the pnmigravid woman for 
contracted pelvis has been completely abandoned 
in many clinics patients with grave pelvic con- 
traction are treated by Caesarean section while 
those showing minor degrees of pelvic contraction 
are allowed to go into spontaneous labour and 
onlv if evidence accumulates that the natural forces 
are unable to overcome obstruction is a lower- 
segment Caesarean section undertaken There is 
a twofold advantage m this policy on the one 
hand numerous inductions of labour are avoided 
with consequent improvement m sepsis and infant 
mortality rates and on the other hand the 
Caesarean operation itself is more rarely performed 
because the forces of labour so often prove success 
ful in overcoming supposed pelvic obstruction 
There is however another side to this question 
It IS sometimes very difficult to say whether a 
foetal head which is still barely engaged in the 
pelvic brim after several hours of “ trial of labour” 
will m fact pass through the remainder of the pelvis 
— and pass in undamaged condition Great re 
sponsibihty is thus thrown on the medical atten- 
dant and there is an unfortunate tendency for the 
important decision to be postponed from hour to 
hour with the result that Caesarean section 
should this finally become necessary, is a more 
dangerous operation than it would have been if 
performed at the time of election The humani 
tarian aspects also demand attention It is no 
triumph of medical art to subject a woman to a 
prolonged test of physical and mental endurance 


doubt tint her pelv’is can or cannot accommodate 
a foetus of such and such a size 

This subject has been vigorously discussed of 
1 ite in the pages of the Lancet Its wider aspects 
need not concern us here but the fact that such 
discussion can now take place is a clear proof of 
a change of heart in obstetricians Gone are the 
days in which the treatment of contracted pielvis 
vv is governed bv rigid rules concerning the indica 
tions for Cacsarc in section and the induction of 
premature labour There is no doubt that the 
present position has been reached because of the 
conipirativc failure of clinical measurements of 
the pelvis as hitherto obtained to provide a means 
of foretelling the case or difficulty of the pending 
labour More and more the truth of Barbours 
dictum IS being recognized — The foetal head is 
the best pelvimeter This is to the good but 
the pelvimeter whether it be the callipers or the 
foetal held itself cannot indicate the manner m 
which the presenting part will engage nor forecast 
the frequency and strength of uterine contractions 
Lc.ist of all can it measure the patient s mental 
make up the colonel s lady and Judy O Grady ’ 
may be sisters under the skin but this family re 
semblance has a tendenev to fade as the hands of 
the labour ward clock make their slow repeated 
round Here then are reasons for the distrust of 
precise measurements and the reliance on ‘ clinical 
sense But sound judgment is given to few and 
only as the reward of many years of patient observa- 
tion TTie experienced obstetrician may instinc- 
tively recognize the feel of a disproportionately 
small pelvis and be able to sense the difficulty 
which IS likely to ensue but the younger worker 
must perforce seek more tangible evidence of pelvic 
and foetal abnormality in order that he may deal 
intcUigcnlly with his patient On both scientific 
and practical grounds there is we believe good 
reason to continue to employ the more reliable of 
the methods of pelvimetry and cephalometry 
External pelvimetry has its uses in showing 
certain deviations from the normal type of pelvis 
but as a means of accurately determining the 
internal diameters it has long been discredited 
Serious contraction of the true conjugate may be 
present with a normal external measurement of 
Baudelocque and conversely small external 
measurements are no certain indication of a corre- 
sponding diminution of jaelvic capacity Internal 
palpation of the pelvis is of great value and the 
determination of the diagonal conjugate (from 
which the true conjugate may be estimated) is 
generally regarded as the most useful single pelvic 
measurement which can be taken at the patient s 
bedside But even this long-established obstetrical 



292 August 6, 3938 


PELVIC MEASUREMENTS 


TiieEhujji 
fillDICAL J(9l. RAIL 


procedure has not escaped criticism Mr J 
Howkms‘ has declared that it is only m cases of 
extreme rarity that the promontory of the sacrum 
can be reached by the examining finger and he 
describes many errors which the inexperienced 
worker may make His conclusion that “ the 
clinical measurement of the true conjugate is 
either impossible in practice or is inaccurate when 
measured, in all but cases of severe pelvic con- 
traction, and a genuine attempt to measure it 
demands in the primipara a full anaesthetic ” may 
be surprising, but it is also perhaps significant that 
no reader has yet replied to this challenging state- 
ment No doubt the ease with which the pro- 
montory IS reached depends to a large extent on the 
length of the obstetrician’s fingers, but equally im- 
portant is the metlrod of examination, for it is 
certain that unless the perineum is well depressed 
by the knuckles the tip of the middle finger will 
seldom reach the promontory Moreover, adequate 
pelvic examination is not possible till the later 
weeks of pregnancy for only then does the vagina 
become sufficiently soft and elastic to yield to the 
examining finger The statement that a promon- 
tory which is easily palpated is an indication of a 
contracted pelvis will meet with general approval , 
but the implication that measurement of the 
diagonal conjugate is m general beset with so many 
difficulties that the attempt to take it need scarcely 
be made may well form a topic for further 
discussion 

In our present issue there appears at page 284 
a paper on the merits of i-ray pelvimetry by Dr 
A Orley There is no question that several of 
the modern methods of radiological examination 
of the pelvis give exceedingly accurate information 
and for some of them it is claimed that the 
diameters of the brim can be estimated to within 
0 2 cm of the true measurement Dr Orley s 
method is to superimpose the shadow of a lead 
plate perforated at 1-cm intervals on to the shadow 
of the patient’s pelvis It is a modification of the 
methods used by Jarcho and Thoms m America 
and by Roberts and Rowden in this country it 
has the merit of simplicity and does not require 
elaborate apparatus Measurement of the foetal 
head is not discussed by Dr Orley but this equally 
necessary information can be readily obtained by 
various well-known procedures notably by Reece s 
technique- or by lateral pelvimetry as recently 
advocated by Thoms ^ Generations of obstet- 
ricians have sought a perfect method of pelvic and 
foetal mensuration, and it is fair to say that 
radiologists can now make good claim to hav’e 

British Medical Journal 1918 1 27S 

* Rcctt L N (191'i) Proc ro\ Soc Med 2 8 489 

’Tlioms 11, and Wilson H M (19381 } ole J bwl Med 

10 437 


answered the call How useful are these new 
methods'^ Time alone can tell Meanwhile, 
thoiough and patient trial is necessary Extreme 
opinions are too often expressed on this subject 
The statement that every woman who is about to 
be married ought to have her pelvis radiographed 
and the measurements engraved on her wedding 
ring gives as false an impression as does the state 
ment that the proper place for obstetrical callipus 
is m the medical museum Both opinions stress 
one aspect only of a very complex problem, and 
both are equally misleading 


QUACK MEDICINES AND OBSCURAMISM 

Lord Horder added another to Lis many sen ices 
as a public man by his speech in the House of 
Lords on quack medicines, summarized in hd 
week’s issue of the Journal and fully reported in 
our Pdrhamentaiy Notes this week The spetch 
was characteristically courageous and outspoUn 
While admitting that^some of the profusely adwt 
tised preparations are useful, and the claims madi. 
for some reasonable, when he went on to say that 
most did little good or harm but were sold at 
fantastic prices and some were fraudulent LonI 
Horder said what is known to every student oflli' 
problem The most telling part of his spisA 
was devoted to the incongruous position of a 
Government which makes no effort to regulate tins 
traffic while spending 'money and energy w 
advocating greater national fitness The Goum 
ment spokesman, Lord Gage, was obviously an 
comfortable when he replied, as he might well fce 
There was the usual admission of many of the cn s 
of the traffic, with the usual suggestion that IK 
Government was helpless Lord Gage threw 1 5 
mam blame on the individuals who were so fo^' 
as to be gulled by quack advertisements lais 
really will not do m face of the vast amoun! o 
legislation designed to protect the ignorant 
unwary against those who prey on them 
course Lord Gage promised to consider any s«^ 
gestions made for dealing with the problem, 
hinted that Lord Horder might try his han a 
Bill We should doubt if Lord Horder will ^ 
tempted to take all the trouble involved m 
a step when he recollects the fate of the very mo ^ 
Bill debated in the House of Commons on i 
27, 1936," and talked out with no protest on wr 
of the Government With all the evidence m 
possession of the Ministry of Health, inclu m^ 
damnatory report of the Select Committee o 
together with Lord Horder’s recent ^ 

the able summary of the present pos iJ__^ 

■ See Bnush Medical Journal April 4 1936 P - 



\LrtsT G I 9 ^s 


The Bumsa 

M-WCAi JOt/RNAL 


29j 


QUACk MEDICINES AND OBSCURANTISM 


Professor A J Cl irks Iitlle book - ilie Ministry 
cannot escape fins dilemni i Ii must either 
proceed to action with full Government support or 
continue to labour under the suspicion tint it is 
afraid of the enormous vested interests concerned 
in this tralTic 

In his Convv i\ Memon il Lccliiic three months 
ago Lord Herder discussed obscurantism in some 
of Its manv forms ^ Hw noted that in m itters of 
heilth and disease the influence of obscurantism 
has been and still is marked We have onlj 
quite recentlj become inlLrested in health as 
distinct from disease Tracing the emergence 
of organized medicine of to-dav from the trammels 
of magic and theologv he showed how man the 
sufferer lags far behind medicine and its exponent 
the doctor The mvstenous which is the 
obscurant often makes a greater appeal than does 
the plain statement of how the high road of plusio 
logical rectitude has been departed from and how 
to regain it What is the secret of the quack s 
success’ In replv to this question Lord Horder 
said that the argument such as it is runs thus in 
the mind of the patient He is not trained and he 
IS not recognized bv law how clever he must be 
bv nature ' therefore to be able to cure people' 
His power is a direct and supernatural gifr a power 
which on that account must clcarlj be superior to 
even the highest skill which comes from a long and 
painstaking studj on the part of the registered 
practitioner Tlie same holds good of the quack s 
indirect appeal to creduhtv through the artifices of 
advertisement experts in fnghtcnmg and per- 
suading the public bv means of the pnnted word 
An obscurant according to the dictionarv is one 
who opposes inquiry enlightenment and reform 
The Ministry of Health cannot be charced with 
opposing inquirj and enlightenment But will it 
passively obstruct reform of the law in relation to 
quack remedies’ Or will Dr Walter Elliot 
summon up courage and with his Department 
behind him insist on a Government Bill in the near 
future'’ 


SOCIOLOGICAL ASPECTS OE A DERELICT AREA 

An mteresung and unusual feature of the Section of 
Medical Sociologj at the Annual Meeting at Plymouth 
was an exposiuon bv the local schoolmas cr of socio 
logical changes in a derehet mining area in Cornwall 
followed the next dav bv a visit paid bv members of he 
Section and others to the centre in question The 
derelici. ’ village is St Dav in the pansh of Gwennap 
two mdes from Redruth with a populauon of between 
1 100 and lotX) a little pocket of people typical of 

, . '■ledmnes B\ A J Clark. M D F K S Fact 

MoPihl) Monoeraph No 14 19 Gamck Street ^\ C 2 Pnee 

^ Medfci! Journal JuiK 4 19jS p 1213 

Obscuranfum B) Lord Hordtr London \\ati»and Co 2> 


at least twelve pockets m the old Cornish mining 
country This was formerly a copper-mining district 
with an industrial history going back into the Middle 
Ages Its greatest prospenu was dunng the first half 
of the last century In ISOl the population of the 
distnet was 4 000 bv 1841 it had bceome 11 000 now 
il IS hick at 4 000 again The mining industry came 
t£ an end with the closing of the last mine which 
had employed 1000 persons in 1 870 The effects of 
the ensuing depression however were not felt imme 
dntelv because successive emigrations from the parish 
took place the emigrations of course taking awav the 
more adventurous independent and fearless of the stock 
Therefore ilthough the industrial disaster occurred 
fin illv m 1870 these emigrauons and later the demand 
for war service masked the decay and the full harvest 
of poverty has not b..en reaped until the third generation 
Tile schoolmaster Mr R R Blewett gave a void 
picture of a community where watei is still carried 
through the staets and sold from a can where street 
lighting was u iknown until four sears ago where over 
10 p^r Cent of the msure-d workers are unemploved 
yvhere fewer than ten houses have been built in the last 
fiftv vears where free milk IS ^iven lo more than one 
half of the school children (as eompared with a quarter 
of the school children in Merthvr T'dhI) where more 
than half the 268 men emploved work in surrounding 
towns and villiges iravellmg 170000 workers miles m 
the vear and where the Methodist chapels with their 
accommodation for main hundreds speak of a flourish 
mg past and with their handful of members of a 
verv thin present Mr Bleweit mentioned that in 1°27 
the school medical inspector reported the presence in 
St Dav of an unusual number of subnormals In the 
hovs school there were found seventeen serious cas-s 
and twenlv cases less Serious the former showing a 
retardation of from four to seven vears and the latter 
a retardation of from two to four vears Of the total 
of 108 children who might be described as educationallv 
defective thirtv three lived in a verv bad environment 
thirtv nine in a poor environment and tweniv seven in 
an environment which was good Mr Blewett had also 
endeavoured to studv the intclliLence and character of 
the parents of these particular children The parents 
of IS per Cent of them appeared to be normal not 
enough was known of 19 per cent to form anv judgment 
and one or both of the parents of 63 per cent appeared 
deficient or backward In his school 136 families were 
represented These families included in all 581 children 
an average of 4 05 per familv Twentv one families had 
seven or more children with a total of 195 and an 
average of 9 3 per familv At the other end of tne 
scale there were fortv four fanuhes with onlv one or 
two children The fathers of fifty three of the families 
whose members attended his school were unemploved 
and their children at school numbered 127 He had 
found no relation between the unemplovment of the 
father and the intelligence or backwardness of the 
children Some children from' the smallest famihes were 
the lowest in intelligence Among the bigger families 
the intelligence level did not appear to be so low As 
to physical charactenstics for what thev were worth 



296 August 6, 1938 


FRACTURES OF SHAFTS OF FOREARM BONES 


THcBamsH 
^lEDtCAL lomVAl 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

This IS one of a senes of ai deles contributed by invitation 


FRACTURES OF THE SHAFTS OF 
THE FOREARM BONES 

BY 

E. M . HEY GROVES, M.S , F R C S. 

General Consideralions 

In no class of fracture is it more important to be able 
to recognize the distinction between the simple case in 
which mere leposition and splinting will give a good result 
and the difficnb case m wVncVi a special kind ot arac'nori 
must be applied or a well-planned operation performed 
This IS because the integrity of the forearm bones is 
essential for the skilled movements of the hand Recog- 
nition of the difficult case requiring special treatment 
should be made earlj — that is within a week of the 
injury — because if once maliimon or non-union has taken 
place It will be a much harder problem to restore the hmb 
to usefulness, and operative treatment will be a rnuch 
more difficult and uncertain remedy To re-establish 
perfect function it is necessary not only to obtain correct 
length and proper alignment of both bones, but also to 
restore the outward bowing of the radius This outward 
curve ol the radius is necessary to enable the bone to be 
rotated round the ulna in the movements of supination 
and promtion The fact that the supination muscles, 
of which the biceps is of much the most consequence, 
are all attached to the upper part of the radius makes 
It important to put up the forearm either in full supina- 
tion or midway between pronation and supination This 
IS because the upper part of the radius will always be 
held in a supinated position by the biceps, and it is there- 
fore necessary to bring the lower part of the bone into the 
same position of rotation Throughout the whole stage 
of fixation the joints proximal and distal to the arm 
should be immobilized, but the muscle should be 
regularly and systematically exercised daily The fingers 
and thumb must be left free, and also the shoulder The 
digits must be exercised by active grasping movements 
and the shoulder bv abduction and rotation 

Careful supervision is necessary during the period of 
immobilization While it is true that in easy cases in 
voung patients consolidation may take place within four 
weeks if often happens that when there has been gross 
displacement originallv and especiallv in older patients, 
bony union is slow, and if the retentive cast is left off 
It the end of a month angulation and pronation may 
recur Therefore it is wise to keep some form of retentive 
splint lor a further period After the first five or six 
weeks the complete plaster cast may be removed and 
rcpl iced by a single slab of plaster extending from the 
palm of the hand up to the level of the deltoid, on the 
flexor aspect of the limb This is removed daily for 
leave movements of flexion and extension of the elbow 
ind roi ition of the forearm It will be worn for a further 
period ot iboiil SIX weeks 

Grecnstick Fractures in Children 

In these fractures there is angulation of both bones, 
which arc broken at the same level about the mid-pomt 


of the shafts, but there is no actual separation of ik 
fragments, which are held together by the envelope of 
periosteum Treatment consists m manual straighlenms 
of the forearm and m applying two plaster slabs (1) from 
the knuckles to the mid-pomt of the upper arm on the 
extensor aspect, and (2) from the palm of the hand to 
the mid point of the upper arm on the flexor aspect 
The plaster slabs are united by the turns of a roller 
plaster bandage The elbow is flexed at a right anele, 
and the hand is midway between pronation and supination 
and IS slightly dorsiflexed The fingers and shoulder are 
exercised daily.^ and the plaster ts removed in one month 

Fneture of Both Shafts without Much Displacement 

In the typical case the ulna is broken in its lo'u> 
third and the radius in its upper third, or if the forearm 
has been broken by direct violence both fractures ate 
at the same level, about the middle However obumis 
the fracture may be, a radiograph should be taken lo 
show the exact relation of the fragments and the evistence 
of any comminution If for any reason the final mampu 
lation and fixation cannot be done at once, a temporal) 
splint should be applied This is conveniently made h) 
a piece of Cramer wire splint bent to a right angle and 
extending from the insertion of the deltoid to the pata 
of the hand, the elbow being at a right angle and t 
forearm supinated Merely hanging the forearm in* 
sling across the chest is apt to increase the displacenxni 
A general anaesthetic should be given when the fracim* 
IS put up Local anaesthesia is not easy in this frad® 
because the bones lie deep in the soft parts and in« 
solution will be diffused along the connective tissue phnc' 
The method of reduction and fixation consists m iracwa 
on the hand and the application of a plaster cast h 
most useful to have a portable x ray viewing box, "'1 
which it can be seen in what position the bones assume 
the best line and also whether the upper and lower irae 
ments of the radius are locked sufficiently to 
together when the hand is rotated Counter-traction i 
made on the bent elbow by one assistant while ano 
pulls on the hand, which is held almost conipee 
supinated Two slabs of plaster are prepared so as ^ 
he one along the flexor and one along the extensor 
of the arm and long enough to reach from the j 
the hand or the knuckles to the insertion of the 
These are applied direct to the skin without 
and then joined together by circular turns of P ^ 
bandages A gap of about a quarter of an men s^^ 
be left between the outer margin of the slabs so < 
facilitate the splitting of the cast For the first '' 
four hours a careful watch should be kept 
evidence of swelling or ischaemia For this reaso 
patient ought to remain m hospital or certainly - 
again within twelve hours Evidence of pjpra 

the circulation will be given by coldness or is 
fion of the fingers or by increasing pam O” 
appearance of cither of these signs there shou 
hesitation in splitting the plaster After the c.is ^ 
fortably settled, the patient should be insirucie , 
wA xegvv'av w.sy.ew.CT.te -af tlxe fiagecs and 
shoiilder The cast is removed at the end ol 
or rather less if the position is good 



\Lot-Si 6 IP'^S 


fRACTURES OF SHAFTS OF FOREARM BONES 197 

\fEnr-«r 


T\-pical Mid shafl Friclurcs flilli Gross Displacement 

TIicsl an. Incturcs which nn\ cvcrcisc the patience 
and vesouro. ciC the surgeon to the utmost The traction 
needed for reduction will hise to be much more powerful 
and sustained for a longer time thin in the list tspe 
considered and it mas base to be supplemented bs some 
other form of correctise force to keep the two bones 
trom sagging together Patience and perseseranee ire 
more essential to success than ans feat of legerdemain 
The portable t ras Slewing bo\ ssdl be of the greatest 
Use Traction mas be applied m sarious ssass but it 
IS essential that it should be maintained for a considerable 
period not onls in order to osercome the muscular 
resistance but also to keep the arm m good position sshile 
the plaster is being applied and is setting The losscr 
part of the arm abose the elbow is protected bs a sur- 
rounding cutT of adhcsisc felt four inches wide A long 
strip of four inch webbing is passed round the fell cufl 
and the two ends are fised to a staple in the ssall or to the 
pjist at the head of the bed A ssooden spreader is 
placed b^isveen the tsso limbs of this band so as to lease 



Fig I — Traaioa applied to forearm before appUmp the plaster 
ca I A = SSebbae band surroundine the arm aboic the elbow 
and attaehed to a *'sed pomi B = SSooden spreader to keep the 
ba-k of ihe arm free C = adhesise fell cuff round Ih- atm 
D = T/aclion hand atlachcd to thumb and ndes finger C = Trac 
non band aliachcd to the three inner fincers 

the back of the arm free this presides for fixed countcr- 
traction Traction on the hand should be arranged bs 
applsmg strips of adhcsisc plaster along the back and 
front of the hand and digits one strip doubled oser 
E fashion taking the thumb and index finger and 
another strip tal ing the other three fingers These strips 
extend about one inch abose the ssrist and are fixed bj 
Circular turns of adhesise plaster The ends of the 
longitudinal strips form projecting loops besond the 
fingertips each loop affords an efficient form of traction 
and moreoser Ihe amount of traction on the radius and 
the ulna can be controlled bs basing separate traction 
bands on the outer and inner parts of the forearm Nosv 
that both traction and counter traction arc presided for 
it cnij remains to applj these forces Either immediate 
traction mas be made under an anaesthetic or continuous 
traction mas be applied through the attachment of 
ss eights When the fluorescent screen shosss that the full 
length and proper position base been obtained the Irac 
tion bands on the fingers are tied b> cords in the loops 
to a post at the bottom of the operation table and the 
arm and forearm are encased in plaster If continuous 
traction is used the patient is kept in bed ssith the arm 
abducted at the shoulder and the elbosv bent to a right 
angle Traction is made on the forearm b> sveights and 
cords running oser pullejs At least 10 lb svill be neces- 
sars in the case of an adult — about 6 Ib on the radial 
and 4 Ib on the ulnar side of the arm 


This continuous traction is kept up for about twentj 
four hours after sshich the plaster is applied WTien this 
15 in position the ssrist must be kept in some dorsifiexion 
and the back of the hand is protected from pressure b> 

I pad of adhesise felt The sshole plaster cast is applied 
before Ihe traction or counter traction is remosed This 
reiuosal IS cfTecled b> cutting off the webbing abose the 
elhoss and the adhesive piaster from the fingers If there 
IS a decided tcndcncs for two bones to sag towards one 
another this ma> sometimes be corrected bs pressure 
between the middle of the shafts of the bones The 
cfifccliscness of this can be observed bs means of Ihe 
fluorescent screen using at first the lips of the fingers 
and thumb to produce the separation of the bone and 
then after the plaster slabs have been applied placing 
longitudinil wooden rods about four inches m length 
and one third of m inch wide along Ihe long axis of the 
plaster back ind front pressing them in and fixing them 
b) circular turns of a plaster bandage (Bohler) 

If the forearm has been pulled out for Ihe full length 
and the hand kept in almost full supination ssith dorsi- 
flcxion of the wrist a sers useful limb wall probablj 
result even though Ihe radiographs show some irregularits 
at the sue of fr icuire It ma> happen hosseser that 
sccondar> displacement occurs a few dajs after the 



I ir I —A Dusraninnti. section ot forearm surroupdetl by 
a constnclmc btniJape which ho pressed the two bones tocsiher 
B Forctrm fraciore wiiti plaster stab on Pexor and extensor 
aspects tic bones base been ssrarited from one another and this 
position mamlamed b) placinR two wooden rods front and back 
in tfic groosc b-lwcsn the bones and fitine these b> tb" lu ns 
of X bind IRC 

fraciuro has been pul up This is due to shrinkage of ihc 
hmb allowing of retraction ssithin the plaster Under 
these circumstances the plaster case has to be remosed 
and traction reapplied tsso stout K-irschner s wires must 
then be used to transfix two points (I) the ulna jUst 
below the olecranon and (2) the lower ends of the radius 
and ulna The plaster case is noss reapplied incor- 
porating the transfixion ssircs sshich are then cut short 

I base thought it ssell to indicate the possibilities of 
efficient treatment of difficult cases without operation but 
I think It should be slrongls urged that cases be sent 
to a fracture clinic of repute if the) should prose re 
fractor) In these cases timel) open operation b) an 
expert IS often Ihe simplest and best solution of the diffi 
colt) if if be done at an earl) dale Sometimes it is onI> 
nccessar) to make a simple exposure of the bone ends 
when the) can be accuratels interlocked otherwise 
plating wiring or pegging will be satisfaclor) when done 
b) an expert 

Fracture of Shaft of Ulna Onls 

As a rule this causes no difficults as the displacement 
IS so slight It should be treated b) traction and the 
application of a plaster cast the forearm being put up m 
a position of mid rotation But if it is complicated b) 
a simultaneous dislocation of Ihe head of the radius at 
the elbosv the matter is entirel) different This fracture 



298 August 6, 1938 


FRACTURES OF SHAFTS OF FOREARM BONES 


Tilt Bmuii 
Mcdicu laa\xi 


dislocation requires to be treated on the same lines as 
the fracture ot both bones with displacement — that is, 
by a special form ot traction with double transfixion 
I am very doubtful whether it is ever justifiable to allow 
such a case to be treated by elosed methods, especially 
if the patient is a skilled manual worker The ideal 
method, in my opinion, is first to reduce the fracture and 
dislocation by traction and then to operate, uniting the ulna 
by a plate or wire, and following on by exposing the head 
of the radius and repairing the torn orbicular ligament 
If conservative methods are used it is important to check 
the position by weekly x-ray examination, because of the 
great liability to secondarv displacement 

Fractures of the Radial Shaft Alone 

In many cases these present no special difficulty and the 
arm should be put up in a plaster case following traction 
But three special conditions require careful consideration 
They are 

(a) Fractures Above the Middle of the Shaft — ^These 
must be put up m full supination, because the upper 
fragment will be supinated by the biceps and the lower 
fragment must therefore also be supinated to be in correct 
rotary orientation 

{b) Fractures at the imd-shaft are very liable to non- 
union because the tendon of the pronator radii teres slips 
between the fragments If, therefore, after apparent 
reduction and splinting the radiograph (in two planes) 
shows there is a persistent gap between the ends of the 
radius the case ought to be submitted to an open operation 
before bone sclerosis takes place 

(c) III fracliiies at the junetton of the luiddle and lowei 
thirds there is a great tendency for the lower fragment to 
be pulled over towards the ulna by the action of the 
pronator quadratus and the thumb. muscles An attempt 
may be made to correct the displacement by pulling on 
the thumb and forefinger and by lateral deviation of the 
wrist towards the ulnar side But if this does not succeed 
It IS far better to operate without undue delay At an 
^arly stage, open reduction and fixation by a peg, plate, 
or wire is very simple and satisfactory 

Open Fractures of the Forearm 

In cases where there is only a slight wound this should 
be immediately excised and sutured and the fracture 
treated is above described In cases of severe crushing, 
such IS when the arm has been caught in machinery, 
immediate and efficient tieatment will be required if the 
limb IS to be saved If it is practicable to transport the 
piticnt to a reliable fracture clinic within a few hours 
this should be done The only circumstance which 
dcminds immediate treatment is haemorrhage, but this 
lb unusual in the ordinary type ot machinery accident 
Bleeding must be stopped and 500 units of anti-tetanic 
scrum injected md the decision then made as to whether 
the case is to be treated on the spot or be sent elsewhere 
If the latter is impossible the wound toilet must be made 
It is unnecessarj to give details of this The essentials 
arc the should be performed within six hours of 
the injury , all contaminated surfaces, including an eighth 
of an irKh of the skin edges and all dirt and foreign 
bodies should be removed swabbing over the surface 
Wit in 1,000 flavine solution and immediate suture of 

c skm edges with interrupted stitches of silkworm- 
gu The arm is placed m a plaster cast after as accurate 
1 reposition of the fractures is is possible, and windows 
are eiit m the plaster over the wound 

The most important consider u, on is the indication for 
uuputation In general terms, no arm, hand, or finger 


should be amputated if the circulation is siifTicient to 
maintain life Only if the mam vessel has been divided 
and the distal part of the limb is cold and piiiseicss 
should immediate amputation be done The occurrence 
of gas gangrene, indicated by swelling, crepitation, and a 
characteristic odour, may require amputation one or two 
days after the accident 


PSYCHOTHERAPY CONGRESS AT 
OXFORD 


The tenth International Medical Congress for Psvcho 
therapy was held at Oxford from July 29 to August 2 
On the first evening H M Government held a reception of 
delegates in Christ Church Hall, with Mr Robert Bermjs, 
M P , as host The congress sessions were held in the 
Taylorian Institution 


Presidential Address 


Professor C G Jong, the President, opened the pro 
ceedings on July 30 with an address m which he evplained 
the “ fourteen points ” of agreement between the variois 
conflicting schools which had been reached by the effoiis 
of the Swiss branch of the congress The motive behind 
this enterprise was, he said, lo lay a basis for praciica! 
work and to abandon futile discussion of theory Thi 
points were first, that psychotherapy used medical leifi 
nique for diagnosis it used a relation by the patient of 
his difficulties, together with a study of his symptoms 
Forms of illness were observed which had nothing to do 
with bodilv disturbances, but were only intelligible m terms 
of the psyche This method of diagnosis therefore 
focused on the general psychic disposition of the palient 
It considered all possible means of expression associj 
lions, fantasies, dreams, symptoms and demeanour ij 
found an aetiology reaching down into the depths of jP 
personality below the conscious mind Investigation 
first to the discovery of unconscious fixations on silu^®^ 
and persons significant in the patients childhood 
fixations had both a causal and a purposive aspect an 
set tasks for future fulfilment One of the 
psychotherapy was to illuminate the factors out of 'iW 
the illness developed and continued, and its method « 
the analysis and interpietation of all forms 
The therapeutic development of the patient depcndifl 
his relationship with the physician, and this was the tu > 
of his relationship with society It took the form o 
transference neurosis — the projection of unconscious e 
tents This neurosis was laid down in the iinconsc 
fixations of childhood, behind which collective tmconsci 
fixations were assumed The new contents y 
realized as parts of the personality because only so 
the patient feel his responsibility towards them 


Psychological Mechanisms m Childhood 

Dr A Grofneveid (Amsterdam), m a 
nldhood and some of its mechanisms, poinlcd ^ 

vtremes in the psvchic realitv of the child ’’PP , . jfj 
f concrete realities and a tendency towards imboi 
iffuse fantasy The chiid showed too easy 
npiric realitv , magic reactions such as premature “ 
f banal facts , and a tendency to homogenize a 
mflicts and thus to escape from unbearable r ? 
larched for increase of potentiality m 
osive relief ' He was inclined to catastrophe ,).j 

canons such •> 


losive 

ansition he was handicapped bv 




raving for symmetry, perfection, and 
armulae of homogeneitv and canonolropism rmp 
1 (he understanding of adult neurosis concef' 

Dr F Kunkee (Germany) introduced the basm 

We " as a suggested solution of education ' i 

he child was born into a ‘ Wc condiU 
I which he could not distinguish himsci 
ut every unfavourable experience of idui 



\c~asi 6 IPiS 


PS'iCHOTHERAP’i CONGRESS AT OXFORD 


The BRmsH ^gg 
'fpiCAl. JOUItSAE “ 


thiN orinml ^^c Mite The px\choilicnp>xt should there 
fore idopl i We -ccnlred nlhiudc nnd dnw the child into 
ii cduciimg hjm m the <imc ’imiudc ind then through him 
modifMnc the ccoccntnc attitude of the nether The new 
altitude of the child to the group he called the maturing 
^^c which included and acccptcil differences tn its members 
Dr H Niicsrtin tGcrmans) considered that this concept 
could not offer a complete solution unless it ga\c full weight 
to the dt'clopment ol the indiMdin! and allowed him to 
realize his essential diffcmncc from the We In the last 
resort the concept broke down when the group met another 
With which It could not be reconciled Dr J H ass oir 
Hooi (Holland) feared that the idea micht make psxcho 
th'“rap\ seem over simple and asoid the distinct problems 
presented b\ the man\ Wes — scsiial social and spirtlua! 

Plaj Thcrap\ 

Dr NfsRCSRFT LowFvrtLD dealing with the theorv and 
u e of pla\ in the psschothcrapx of childhood sjid that the 
chi’d s mind contained at first a tolahts of mechanisms which 
could not be anahsed a primara sastem and that this must 
be expres ed ba ana non aerbal means aahich proaed suit 
able It w-as incommunjcable in a codified set of sambols 
His secondan cocnitiac s>-stem grcaa up alongside it and 
could express itself to others. The primarx sastem had a 
stTxiclure but it v.*as different from that of the cogmtiac It 
contained a mass of combined matemi combined rationally 
but according to the bodila experience of the combiner If 
the child be ciaen plaa maicnal aahich avould enable him to 
externalize his pnmara sastem and then incorporate it again 
into himself he aaould get aacll and pass on to a proper centre 
of uraaiia in his secondara system 

Dr C Boenheim aaho also spoke on the scope of child 
psachoiherapa said that iherapa depended on the exact 
analasis of siniclurc The chances rcsuliinc from dcsclopmcnt 
demanded reserve in considennc the treatment and confidence 
in the curaiiae powers of nature Mxna neraous disorders 
were connected aaalh phvsiological deacloprrcni — for example 
anorexia and enuresis— ^r associated aaith disorders of mental 
development which should be treated ba educational ircihods 
Sutcestibiliia and plasticita should be used consctoiisla instead 
of unconsciouslv The child depended on his environment 
and «o his surroundincs must be inacsiigaled and modified 
It nccessara The parents might have to be treated Approaches 
varied (he object being to make unconscious contents con 
scious Play therapv word therapy drawing and dream 
inierprciaiion had useful application 

Dr C L C BLR.SS (Birmincham) spoke of the value of 
pla\ therapv as a communication between unconsaous and 
conscious the children spoke in the old language of fable 
parable and dream Dr W FCrstemieim (Frankfort) said that 
It vaas often difficult to distinguish between neurotic and 
neglected children Lone patience with plaa methods would 
usualla be rew*arded 

The Development of Personalities 

Dr J H \ as der Hoop gave an address on analatic and 
santhetic processes in the different phases of life He said 
that in the phases of stabihla analasis w*as called for but 
in a phase of flexibihla a santhetic technique was neccssara 
to complete the work as for example with childish patients 
and those with a psachopathic personaJita or genius Special 
forms of sanlhesis and cquilibnum were propagated bv ideals 
Spintual ideals expressed the total meaning of life Objcciiaiiv 
in treating santhetic problems of puberta or a crisis involving 
spiritual ideals meant an abihtv to sec the value of different 
social forms and of different solutions of major problems 
The creation of a svnthetic psychologv describing the meaning 
of different ideal values aa-as neccssara for treating problems 
inaolaing the formation of new ideals 

Professor H C RCvikE (Holland) expressed a caution against 
analasis with a view to partial disintegration even for patients 
in a well integrated phase In the latent penod of middle life 
ca e was particularly necessary to ascertain whether the 
/ symptoms were those of neurosis or negation for analysis of 


the latter might be harmful Dr H Schlltz Hencxf 
(G ermanv) pleaded for the retention of the term analasis 
for real dissection of p^vchic contents which formed only 
a small part of practical psachoiherapa It was indis 
criniinaicla applied also to the act of drawing the patients 
atlcntion to the significance of his matenal and pointing out 
faults of attitude— both cssenlialla santhetic processes It wa^ 
an ancilhra process— a medium between science and santhesis 
Dr Irx Wile (New ^ork) considered that eaera analatical 
situation aaas a santhetic situation and vice versa and to 
separate them was a neurotic procedure 

Dr J M RoainoLTs (Holland) spoke of psachoiherapa and 
the development of personahta He showed how wealnexs 
and retardation were at the basis of mans mental adaptation 
The psachie content of the orcanism followed an undulant 
line It represented the santhetic anal impersonal side and 
alwaas strove towards over compen ation The mental content 
was personal dctichcd and analviical striving along a straight 
line to an imacined object with as Iitt c adaptation as possible 
The two principles inentabh conflicted sometimes until 
apparent failure and breakdown but even then the psvche 
continued to work In the first part of life the task of 

psvchothcrapv was to prepare the individual for life with all 
Its diniciiliies and possibilities to sircncthen the courage and 
show the possibilities of fresh growth inherent in eaera dis 
appointment In the second part of life the patient should be 
helped to realize hts membership of the whole of mankind 
and the imivcrsc 

Ncuro*oRical Studs of Hasfena 

Dr r Ron yk (C/echosIoaakia) speaking on a neurological 
studv of hasiena said that p achosomativ disturbance might 
show Itself in tlie ocular mechanism The eve was a valve 
so to Speak through whi h psachosomatiL forces passed from 
one lead to another Hastcncal disturbances ot sight could 
be explained m anatomical and funwuonal terms Hastcncal 
disturbances of scnsihiliia did not follow anatomical rules 
and the distribution of the lesions bore no relation to the 
spinal innervation Focal disorders sometime produ(,ed 
ocular sampioms similar to those which had habitualh been 
ascribed to basteria but with no suspicion of w/sh lulfilrrent 
This hapolhesis panla explained the samptom of auto copa 
Darbitonc poisoning could produce quasi hasiencal samptom 
The phasical ind psaebic mechanisms were separated so to 
speak b\ a membrane like that which separated the blood 
from the cerebrospinal fluid The permeabilita had a certain 
normal value for the maintenance of balance but in disease 
It might be much decreased or increased In most pavcho 
ncurose such as obsession it was decreased in hastena it 
allowed free minclinc of the psachic and phasical contents 
Hastena folloased the rules of general organic neuroloca in 
(he sampfoms which were produced ba the resulting releases 
of cnerga Dr Poliak related the case of a counira girl who 
suffered from a lapical hasterica! anae Ihcsia of the nght side 
after an affraa on her farm Organic causation was eliminated 
A feav weeks later she showed a fulia established sarinco 
myelia of the right side of which the hastencal samptom 
had been a prediction 

Dr E iTTkoavFR gave an aevouni of some personal 
studies in ulcerali'c colitis on fortv-one unselected patients 
Sufferers from this disease he said frequenlla referred n to 
worry and seemed obaiousla mentally abnormal His patients 
could be classified m(o several groups but, except for the 
common factor of gross emotional disturbance of onset in 
more than half and of longstanding psachological abnor 
mahties and disorders in nearla all there w-as no constant 
aetiologa 

Problems of the Mature Personahtx 

On Jula 31 Dr ^\ILUx^l Brows spoke on psachological 
problems of the mature personahta He said that the ace 
of malurita for his purposes was the man aaho was happila 
married Marriage with its need for responsibilila and the 

binocular view of life might give nse to disturbances 
affectinc feeling and outlook The great danger at every stage 
of mature life was retrogression to a previously occupied 



300 August 6, 1938 


PSYCHOTHERAPY CONGRESS AT OXFORD 




TutBRnwii 


position Deep mental analysis helped the individinl to gain 
an insight into the persisting effects of his earlier experiences 
The danger of narcissism or self-admiralion or self pity was 
ever present It was often subtly continued by making the 
marriage into a mutual admiration society, or forcing the 
children into being parts of the parents personality A man 
less often chose a profession than was- chosen bv it, and in 
mature life he might turn back to earlier and more primitive 
ambitions with disastrous results Sublimation was one of 
the most fundamental problems of the mature personality a 
movement forward to the fuller development of the personality 
The individual must consent finally to the surrender of some 
personal ambitions for himself and find a philosophy to 
meet the needs of his advancing years Much help could be 
given here bv analysis m the building up of a supraternporal 
and dulv co ordinated system of values and a serene and 
courageous spiritual outlook The central problem was ethical 

Dr H VON Hattingbcrg (Berlin) remarked that the literature 
gave the impression that there was no problem of will This 
was wrong The good analjst in practice, taught the patient 
how to will The study of will was necessary to bring 
analysis into relation to the remainder of psychotherapy 
Dr Brown answered that anahsis gave great insight into the 
nature and control of will He declared vigorously that the 
study of values through philosophy was of the greatest impor 
tance to the psychotherapist 

Dr A Repond (Switzerland) delivered an address on “ Le 
Demon de Midi — psychological troubles of the fourth decade 
of life such as outbursts of emotion, irregular love affairs and 
religious conversions He had found that crises of this kind 
occurred nearly always in persons with a certain abnormal 
youthfulness of temperament and body, and •sought for an 
explanation in factors which had hindered the normal sexual 
development of puberty According to the epigenetic theory, 
the ovum contained primary centres of organization which 
induced the development of secondary centres Growth was 
thereafter the work of a series of relays, coming into opera- 
tion successivclv Their potentialities might be varied by 
factors of inhibition or excitation Dr Repond drew an 
analogy in the development of the psycho sexual function 
xvhen this was inhibited energy might be stored up, to be 
rele ised much later in life and to produce the functions they 
should have produced much earlier, to the disturbance of 
the patient s social adaptation 

Professor Rumke remarked that many of these persons 
would accurately picture their whole emotional life history 
in the changes of mood which they underwent in four weeks 
He thought these patterns had little or nothing to do x'lth 
endocrine changes 

Infantile Anxiety 

Dr Karin Stephen took as her subyect the development of 
infantile anxielv in relation to frustration, aggression, and fear 
This disorder she said was the outcome of an internal dead- 
lock in which desire rage, and fear became involved in a 
VICIOUS circle each augmenting the other and inhibiting its 
discharge Projection on to the environment merely per- 
petuated the VICIOUS circle If the circle were broken by 
reversing the flight reaction fear, rage and self-frustration 
might be reduced and a real solution of the problem achieved 

Dr Thlodorf FAnrHFtL declared that the subject was of 
pnmarv importance to the work of the whole conference 
Race and hate were part of the male personahtv anxiety 
was a female reaction and most often due to the masculinity 
of the mother or nurse It was unless fixated a normal 
expresMon of the feminine side of the self 

{To he cotwltidcd) 


tin the Occasion of the centenarv celebration of Dalhoiisic 
I nivcrsiiv Halifax Nova Scotia, the honorary degree of 
I I D IS to be bestowed on August 17 upon three representa- 
tives from Great Britain 1 ord Macmillan, Sir Walter 
1 lagdon Brown, and Professor Ernest Barker 


THE EPIDEMIC SITUATION IN CHINA 

That the continuafion of hostilities in China would ha\c 
extensive epidemiological repercussions was anticipiied 
when the League of Nations Units— referred (o in an 
article in the Bitlisli Medical Journal of July 2, 193S, 
p 33 — were dispatched from Europe The mass nioii.’ 
ments of refugees and of troops on an unprecedented scale, 
the flooding (hat followed the breaking of the dykes of the 
Yellow River, and the lowered resistance of a large section 
of the population, together with the great strain put on 
the local administration in many districts, have resulted as 
was expected, in a widespread epidemic of cholera, afleci 
mg particularly the central and south western parts o( 
the country To deal with this emergency the Chinese 
Government made great efforts, particularly in the dircv 
tion of preparing cholera vaccine, but in view of the 
urgency and the enormous quantities required it was 
compelled to seek help from outside 

Control of Cholera by Vaccine 

The Government therefore applied to the League for as'i t 
ance m obtaining as soon as possible six million doves c( 
cholera vaccine In these circumstances the League, sfe 
placing an order for immediate delivery of one million do-ei 
of vaccine at the nearest bacteriological institute, milled ibe 
collaboration of national institutes of countries participaline 
in the work of the League s Eastern Bureau at Singapore a> 
well as those of Europe and the United States To dale ibe 
Eastern Bureau reports gifts of half a million doses each 
f om Australia and Ceylon, and one million from tbe 
Philippines (Red Cross), the Pasteur Institute at Hanoi hwitij 
previously given 250,000 doses From Europe the Sia 
Serum Institute of Copenhagen'js sending 130,000 do'ev irt 
Cantacuzenc Institute of Biicarest one million doses tr 
School of Hygiene at Zagreb half a million doses, nmii 
Ministry of Public Health of Turkey one million doses D 
Egyptian Ministry of Health have dispatched 180,000 dew 
From South America the National Institute of Bacicrioio ' 
Buenos Aires offered 200 000 doses The United Slit 
Government has informed the League that the Amcricin Kt 
Cross are shipping immediately three million doses to Chins 

It is this work in connexion with the control of cholw 
xvhich is the immediate preoccupation of the three US 
Units attached to Chinese Health Units, one of whir 
working over areas relatively close to the Vcllow •'Wr' , 
North China with headquarters at Sian, one is m G'' 
China with headquarters at Changsha, and one in South 
China with headquarters at Nanning in the last fe" 
large quantities of material have been sent out for ‘he i ^ 
vision of laboratories equipped both for diagnosis au 
preparation of vaccine, saline apparatus, and syringes 
inoculations 

I 

General Measures against Infec!iou> Diseases 

Though m face of the existing conditions the 
League Units is concerned for the time being ehie > ^ , 
cholera control, the work already done m ^ 

public health generally and epidemiology is '“iry .,| 
able This has been directed particularly to p 

lasting results, and among the principal of th 
encouragement given to the Chinese 
extremely difficult work of protecting the heallli ot , ^ 

population The Government has created no ‘“"5^ [s a 
hundred health units to serve particularly in 
well as three large anti epidemic units each oomis ' h 
150 to 250 doctors and nurses to deal with 
in the Northern Central and Southern areas ot j , 

In addition to these units and their inlhrs to 

the National Government has granted 160000 ‘ 

League of Nations Epidemic Commission fof > 
activities 

Small-pox, Typhus, Malaria ^ ^ 

In regard to the more dircctiv technical wo ^ 
League Units mention should be made of Ino » 


Alcvst 6 19 iS 


CPIDENTIC SITUATION IN CHINA 


The Burnsn 
Mcdicjo. 


301 


of ^nnll pox Mccimlion cirricd out b\ ill ihrcc iinils in 
which hr^c qinntitics of both "cl Mccinc nndc lociU> ind 
dr\ Mccinc from Jim ln>c been utilized The control of 
l\phiiN his been done on in cxiensne ^cile pirticuhrl) bj 
the unit m the North through the use of \iccinc is well is 
b\ the CNtiblishmeni of dclousinc siitions the gencril super 
MMon of the vinitirx conditions of refugee cimps ind the 
initMtion of hospitil for infectious diseiscs Milini work 
his been undtrtiken on i wide scile cspecnlh in the Ccntnl 
ind Southern pirt of Chini no less thin two tons of quinine 
hiNing been sent out bs the I cicuc for this purpo c 

Ssphilis amonc the refugees his cillcd for speenl work is 
well as urgent nutritional conditions Considenble quantities 
of rabies Mccine hi\c been prepared in the labontorN of the 
Northern Unit and distnbuted widcl\ to hospiiils md mission 
stations FinalU the personnel ln\c cxlcnsneU cngipctl in 
sur\c\s m connexion with pariicuhr problems such is phpiic 
or general public health conditions cspecnlls in the refugee 
camps 

The reports received inviriabU cmplnsizc the incrcismc 
need for mcdicil work gencnlK md pirticulirU for the 
epidemic work on which the I cacuc Units ire encaged The 
Chinese Government his rcecntlv ipphed to the Lciguc for 
the contininiion of this collabontion for another finmciil 
sear (19^9) in order to consohditc the work of which the 
Leacue Units hive alreidv built the foundations 


ONE HUNDRED AND SIXTH ANNUAL 
MEETING 

of the 

British Medical Association 

HELD IS PLYMOUTH, JULA, 1938 


THE SECTIONS 


SUMMARY or PROCEEDINGS 


Dunnt, iht mxt jiw iiionlhx there Hill be published in the 
Briiisii Mpdic^l Joursal the opening papers coiiiniiini 
mud to lilt Siieniipt Sit lions oj the Animal Meeting at 
PhnioiilU Till n ports oj discussions continued from last 
mil (p 2501 art intindid to gne members ssho Here 
not prisint a geniral idea of the proceedings 


SECTION or MEDICINE 


Nova et Vetera 


\NNALS OF MCDICAL HlSTOR\ 

The Slav number of the Amuds <tf \fc(/icu/ History* opens 
with a biographical sketch of Linnaeus phvsicnn and botmist 
bv Dr H Larsson of Detroit who dedicates M to the 

rremon of that brave group of his countnmen who in the 
sear 16**S founded the Swedish settlement on the Dchw irc 
The frontispiece which like the portnil on the cover is 
different in each instalment is that of Johannes L flau'^ch 
(160^ 6^) a distinguished phvsieian who suffered from major 
trigeminal neuralgia and according to Dr Icwv was the first 
authentic case on record for whit the Arabian school 
described was reallv facial paralvsis the error being due to 
mistranslation Dr C Elgood formerlv of Teheran now of 
London presents the earliest account of svphilis in the Cast 
given in 1501 b> a little known author who«c onI> work was 
The Qmntessence of Experience That the author of eleven 
hundred pages on phvsiologv who used the southern illigator 
for his experiments should be so forgotten (hat the 
date of his death somewhere between 1866 and 1879 is 
unknown must be exceptional but this is the sad case of 
Bennett Dowler who according to Dr Meek was a contro 
versnlist not unaware of his own peculiar merit Edm ind 
Theo von Siorch reproduce the description given of cpilepsv 
in the thirteenth ccntur> bv Arnold of Villanova The hislorv 
of medicine in Southern California from a \cr> carh date 
in the sisth centurj is begun bj Dr Shuniin of Los Angeles 


Sir Philip Crampton Sm>!> who is credited vviih the iniro 
duciion of the laryngoscope to Ireland in 1860 vvis bom one 
hundred >ears ago He was President of the Ro>al College 
of Surgeons in Ireland and in musical circles he was 
honoured with the presidencv of the Hibernian Catch Club 
in Dublin He died in 1904 


‘ Annals of Medical History N3 Vol X ^o 3 Ma> 19^8 
Edited by Francis R Packard Nt D Nev% ^ork Paul B Hoeber 
Inc London Mcdicil Book Departmtni Harper and Brothers 
llluslraied SubNCriptjon for six number^ annuall) 10 dollars 
sinele numbers 2 so dollars 


Tliiirsclox Jnh 21 
Anxictv States 

With Dr Dosvld Himlr in the chair Dr T A Ro^s 
opcncil 1 di (.us'^ion on anxiclv slates in general ana industrial 
medicine Dr Ro^s s paper was published in the Journal of 
Julv ^0 (p 209) 

Sir Hi SRV lUsiirORD continume. the discussion with a paper 
on the anxictv factor in mdusirv spoke of his personal obser 
valionv over a period of thirtv vears as Chief Medical Onicvr 
to the Post Ofiice The cmplovces in this industry numbered 
270000 In some respects thev were a selected group as the> 
were admitted onK after inilul medical examination more 
over the prospcut of i pension and the sick pav available 
for fixed periods conduced to a sense of secuntv among these 
workers As in example of an anxieiv state among Post 
Office cmplovces he mentioned telegraphists cramp m a verv 
large proportion of these patients apprehension of error and 
distrust of the unseen critic contributed to the trouble This 
disturbance had praclicallv been abolished since the discon 
iinuance of Morse md the introduction of teleprinters and 
other machines On the basis of sickness certificates the 
sj>cakcr computed that among men onl> one lwenl> third of 
the total sick ab ence VMS due to nerves neurasthenia neurosis 
or similar states The proportion among women was approxi 
match double Ruliruments through sickness were more 
frequent among women this disparit> being due to the fact 
that the dislurbanccN of the menopause frequentlv coincided 
with the assumption of new or more serious responsibilities 
in their emplovmenl The chief of a department might 
cxerase great influence on the health of his subordinates an 
exigent or selfpilving attitude readil> inducing invalidism in 
the staff Sir Henrv emploved an initial thorough insurance 
tvpe of examination in such an investigation anxieties or 
clashes of temperament were frequenlljr brought to light 
This often indicated the line of treatment or management 
most hkcl} to help Regarding the frequency of neurosis he 
thought that the figures often given in the medical or lay 
press were loo high In a group of fifty five applicants for 
Post Office appointments a psvchological examination had 
been made one third were said to have senous psychological 
svmptoms but some vears later when iheir records were 
reviewed it was found that all except one had normal sickness 
records and Iheir character reports were excellent 

Dr K Shirlev Smith spoke on the cardiac aspects of the 
anxiety states In a senes of sixtv two patients suspiectcd of 
heart disease due to or aggravated by accident or strain he 



302 August 6 , 1938 


THE SECTIONS SUMMARY OF PROCEEDINGS 


found thit approximately two thirds must have had cardio- 
vascular disease before the accident In the remaining third 
disability was due to symptoms such as palpitation breathless- 
ness nervousness left mammary pain, and insomnia, but 
no evidence of organic disease could be found The symp- 
toms in the great majontv were undoubtedly genuine, and he 
regarded them as expressions of disorder in the autonomic 
nervous system At first at any rate, these ssmptoms were 
nothing to do with anxiety and the use of the term com- 
pensation neurosis’ was often a grave injustice Exactly com- 
parable conditions occurred after illnesses or accidents in 
which no question of compensation could arise At a later 
stage anxiety and compensation might colour the picture 
These patients usually became permanently unfitted for 
strenuous work contrary to frequent assertions, little, if any, 
benefit accrued from conclusion of litigation He would like 
to see a concerted effort made to rehabilitate these men, who 
were so often judged capable only of light work which in 
practice did not exist in the labour market Dr Shirley Smith 
considered that the cardiac neuroses formed a xer\ important 
proportion of cardiological practice Treatment must be 
founded upon a basis of moral support and reassurance , 
long periods of rest in bed undue solicitude continued medi- 
cation and frequent examinations were all undesirable 

Dr Elizabeth Casson (Bristol) emphasized the great value 
of occupational therapy Where rehabilitation centres had 
been organized they were producing very good results She 
felt It was important that the doctors advice should be 
obtained as to the type of work or craft best suited to the 
individual patient Schemes of this kind could be of great 
assistance to the psychologist 

Dr H F Bell Walker (Balfour, S Africa) said that he 
came from a part ot the world where neurosis scarcely existed 
The multiplicity of sensory impressions received in the course 
of life in a populous community must lead to continued 
‘ sense repression ’ This, and the limitation of occupation to 
some small field, must play a part in the production of 
neuroses He thought it was difficult to be mentally normal 
when living m a crowd 

Dr Margaret Martin commented on the frequency of 
neurosis in women at middle age Verv often a woman, 
after bringing up a family, felt at a loose end and that she 
was of little value to the community In consequence she 
was liable to concentrate upon trivial symptoms An interest 
outside the home in some occupation or craft was often 
extremely beneficial 

Dr J D Simpson (Cambridge) referred to a case in which 
an anginal attack had been succeeded bv an anxiety state, 
with the result that attacks of pain recurred thirty or forty 
times in the day He had never seen cardiac damage result 
from rowing except in one case in which the antra had 
subsequently been found to contain pus Contrary to general 
belief, anxiety and its consequences were very common among 
athletes 

Dr F A Roper (Exeter) agreed that it was undesirable to 
speak of a weak heart to a patient with a cardiac neurosis 
He advocated that an explanation should be made in terms 
of nervous regulation of the heart Dr W S Macdonald 
(Leeds) spoke of the causation of anxiety slates by head 
injuries and described two cases to illustrate this relationship 
He had noticed that the blood pressure was frequently low in 
patients with cardiac neurosis and inquired whether this was 
a general finding Dr Ellis Murihv (Brisbane Queensland) 
regarded discussions of this sort as very valuable to those 
who worked m outlving parts He did not agree that anxiety 
states did not exist in sparsely populated areas Boundary 
riders and others who might make no contact with humanity 
for three to six weeks at a time were prone to develop these 

► disorders He emphasized the importance of distinguishing 
between pnmarv anxietv states and those neuroses engrafted 
, upon organic disease Dr W E Lishman (Plymouth) thought 
that Dr Ross had placed the incidence of neurosis too high 
On the other hand Sir Henry Bashford s figures were too low, 
parlU because thev concerned picked lives who bad the addi- 
tional advantage of a sense of security He believed that the 


The Bmjii 
MtniCAiloitvu 


problem should be tackled in the earlier years and advocated 
the extension of child guidance The dccav of religion \\a> 
m part responsible for the increasing frequenev of nervous 
disorders 

Dr Donald Huntlr held that the outlook from the stvnd 
point of medical education in these matters was not so bad 
as Dr Ross feared There were onlv a few teachers in the 
hospitals who were failing to teach these aspects of general 
medicine The student undoubtedly imbibed a proper method 
of psychological approach from many with whom he caire 
into contact, including teachers, residents, and sisters 

Dr Ross concluded the debate with a reference to Dr 
Halhday s vvork in Scotland In this investigation evamra 
tion by specialists of 1 ,000 cases of certified organic dive-^e 
among workers revealed the fact that 33 per cent were avUialh 
free from organic disease He thought that this consideration 
reduced the value of Sir Henry Bashford s figures, since the'c 
depended upon certification of the same kind He acreed 
that child guidance helped in making the best of poor 
material and in aiding the belter 


SECTION OF SURGERY 
Thursday July 21 
Cancer of (he Breast 

With Professor John Morley (Manchester) Vice President of 
the Section, in the chair, Mr G Gordon Tavlor opened a 
discussion on cancer of the breast 

Mr Gordon-Tavlor spoke as one who had e'chened 
except for a verv short time, the method of post opcrati'e 
irradiation as a supplement to radical operation m ca‘es m" 
commonlv classified as Group 1, in which the dnew it 
clinicallv apparently confined to the breast, and Group II ” 
which the only clinically apparent spread is to the av 
glands He had aivvav s regarded radical surgery as the msd' 
of choice in almost everv patient belonging to tlic'e i"* 
categories, but paid a tribute -to his radiological collew* 
for their help with the Group 111 or advanced cases rw 
1908 to 1938 he had performed the radical operation m 
instances and had been successful in tracing the after k v 
in all but seven of these patients Of Group 1 cases ofcrJ 
upon up to 1928, 113 in number, ninetv five (841 per c*'' 
had survived ten vears of 204 Group H cases m the 
period there were sixty ten-vear survivals (294 per cen 
of the fortv-six Group 111 cases only three (6 5 per « 
had survived In another statistical table embracing I”',' 
operated upon up to 1933, the figures in the three 
five or more years survival were 85 9 per cent , 
and 9 8 per cent respectively He had had 155 
who had survived for more than fen years aftpr ^ , 

mastectomy , thirty three had lived for between j. 

twenty years six had survived for between twenty and w 
five vears, and eight had survived for twenty five 
actual operative mortality had been 1 3 per cent 
In an attempt to ascertain the value of pre and 
irradiation Mr Gordon Taylor said he had sent ou 
tionary to seventy two British colleagues i 

practice in Group I and Group II cases Of j 

interrogated 25 per cent made no use of irradn i 
supplement to radical operation 44 per cent 
form of irradiation for every radical masteclomv , - i ^ , 
used irradiation in Group II cases after radical 
2 per cent employed irradiation alone without 
There was undoubtediv a trend towards the ' 

use of irradiation, but there were no figures pi 
support the belief in its value He thought tha , 

possible to draw anv fair conclusions between ^ 
treatments unless thev were applied in parallel scr 
graded on a histological basis ^ v 

Mr Gfoterey Kevncs said he had wished j ' 

so radical and mutilating an operation as t,i ke 

he asserted that excellent results were to he o ci t 

operation reinforced bv efficient radiological r 



Avoi'si 6 I9^S 


Trie SECTIONS SUMMARY OF PROCEEDINGS 


TiieBuitoh ■?{! j 

MeDICAI JOUKNiL 


ndioloucn! ircatmcnt alone He did not think it necc'ism lo 
remoNc the 'vhcle breast and p^^oral muscles nor did he 
think It evscntial to dis-sect the axilla ^\hllc the xi/c of 
the rnman tumour nucht limit the %alue of radium vo that 
local cxci ion ''as nccc^saia the axilla could be satisfactonh 
irradiated b' means of interstitial needles His fne \car 
sur'i'al rates "tre 71 1 per cent ^0^ per cent and 1*)4 per 
cent in the three groups respccli'el' Tliesc fipurcs com 
parttl sera fa'ourablv with prcMOiish published statistics of 
radical operations but "ere not so pood as Mr Gordon 
Ta'lors in Group 1 Mr Gordon Taslor ho"c\cr repre 
sented the best m the exposition of breast snrgcn Ccriainlv 
others had fallen belo" his hiph standard Mr Kcvncs 
claimed no finahts for the particular method of infcrstitial 
irradiation he cmplo'cd It micht be that improved deep 
r n' therap' "oiild in time supplant it Mhile r n\s could 
be made, to cover a "ide area radium could be applied "ilh 
Greater local iniensitv Trom the ps'cholopica) point of view 
his conserxati'c methods were of creal 'alie Tlic actual 
pre^naiion of the breast "-as not the onh Ibinp to be 
considered m this connexion fear of (he radical operation 
made mans "omen a'crsc from examination before the 
di ea e had spread "ide1\ 

Mr Cfcil Rowsrmn supccstcd that both Mr Gordon 
Taslor and Mr Kc'nes laid ihcmseKcs open to cnticism 
b\ urcing standard treatments for a disease so saned in its 
s\mpiomatolog\ and so protean in its palholopical manifesta 
t on^ He thought that in the class of ease rccarded as 
op'^rablc a number of patients b\ reason of intcrcurrenl 
disease such as diabetes or tuberculosis "ere unfil for major 
surccrv Again the incidence of recurrence m voimp "omen 
"as so hich that there was no point in submitting a "oman 
tinder 30 to the radical operation In all ihc^e cases he 
empio'cd interstitial radium In the 'cn old metastasis "as 
so slo" (hat local excision "as sufTicicnt The site of the 
Growth "as of importance Growths at the extreme upper 
limit of the breast or at the sternal margin necessitated 
awksN'ard and bifTicuIi surgery and had a bad prognosis 
These cases also were best treated b' interstitial radium 
Retarding the remaining cases— the great majontv— he thougHT 
the condition of the axillarv glands was the guide as to what 
should be done Where these were hcasils in'oivcd he 
followed Mr kcvncs s technique In all other eases he 
divided the sternal portion of the pcctoralis major at an carh 
stage in a proposed radical operation If then he found 
involvement of the axillar> glands clmicallv not apparent or at 
least not verv advainced of such a degree that meticulous 
scraping of the upper axilla would be required he completed 
the operation in a minor kev dealing with the axilla bv 
irradiation otherwise the case w-as dealt with bv the radical 
operation 

Dr J H Douglss Websttir said that at the Middlesex 
Ho pital one half to two thirds of all patients with primarv 
cancer of the breast were alrcad> in an inoperable stage of 
the disease when first medicalU examined The numbers 
treated bv radiothcrapv alone were incrcasinc )earl> Advances 
in radiotherapeulic methods and technique were so great as 
compared vvnh five or ten >cars ago that as vet the results at 
five vears could not be properlv compared with surgical figures 
He emphasized the value of pre and post operative irradiation 
because of its influence on the outlving clinically undetectable 
cancer cells In Group I there would be 100 per cent of 
cures by operation and no necessilv for irradiation if it were 
possible lo group the cases on a pathological basis instead of 
on clinical grounds 

Mr W SsMRsos Hasdlev thought that Mr Gordon 
Tavlors figures had settled the argument at least for the lime 
being, in favour of radical operation In his opinion the 
internal mammary glands were involved just as rapidlv as 
the axillarv nodes He considered it dangerous to rely on 
irradiation alone in the treatment of the axilla and thought 
that interstitial radium was suitable onU in inoperable eases 
and for growths situated peripherally In addition operation 
facilitated the task of post operative irradiation Mr D C L 
FiTzvviLLiwis considered himself more unorthodox even than 
Mr Kevnes m his conservatism He thought it was possible 


to dngnoKc the disca<;c while it was still local but onlv bv 
transillummation Mr Cecil Joll wished to urge that cood 
as Xfr Gordon Taylor s resuhs were following radical opera 
lion there was room for improvement cspeciallv in Groups 
11 and 111 The results oblxined at the Royal Cancer Hospital 
veemed lo point to the ndvintagcs of combined methods over 
surccrv alone 

The Chxirm'in Professor Morlfv vvas afraid that the dis 
cusMon had left a vaguenc s as to the place of vanous methods 
He thoucht that other methods were onh complementary to 
surgerv and that there was a tendenev to turn away from 
ndium to post openli'c x rav iherapv He had seen severe 
ncuniis following intcrstitiil radiation He was not moved 
bv Mr kcvncs s plea for preservation of the breast on 
psvchological grounds the ultimate result w’as the all 
important thing 

At the conclusion of this discussion Mr H C Edw vrds 
(I ondon) gave a lantern slide demonstration on gastroscopy 


COMniNCD SrCTIONS OF OBSTETRICS AND 
PUBLIC HEVLTH 

Thurula\ Jiil\ 21 

Prevention and Control of Puerperal Sepsis 

With Of W \iux Dvifv President of the Section of Public 
Health and Hvgicnc in the chair a discussion on the preven 
tton and control of puerperal sepsjv including the medico 
local aspects was opened bv Profes or R W JoirssTOsc (Edin 
burgh) followed bv Dr Euill Cvssii (Birmingham) Dr A 
Mss'.lv trovcnirvi and Dr R M Frv H ondon) whose papers 
wiU be published m next week s Jourt al 

Dr R \\ Dirvsp who followed with a paptr on the legal 
aspects of puerperal •‘Cp is said that the legal responsibilities 
in retard to puerperal ^cpsis did not differ greailv from those 
»n other di eases In cverv case whatever the disease the 
doctor was required bv law to exercise reasonable care and 
skill To-dav il was the exception and not the rule for prach 
itoncfs to wear masks and gloves when aticndinc confinements 
a docior would not ncccssarilv be considered negligent because 
he did not do so U might "cU be however that in five or 
ten years lime the common practice would have so changed 
that to attend a confinement without wearing a mask and 
gloves would be considered an act of negligence U a doctor 
had not exercised that amount of care and skill which might 
rcasonablv be expected of him having regard to existing 
practice m similar circumstances he might be charged with 
malpractice If U was shown that it was or should have been 
wfthin his knowledge that potentiallv he might be carrying 
infection and had not taken sufficient precaution against trans 
rnitting it then it was certainh posMble that he might be held 
to have acted negUgcolly Dr Durand pointed out that doctors 
cmplovcd bv a hospital or other aulhontv were in the same 
position as private practitioners It was the dutv of a doctor 
in administrative charge of an institution to see that the con 
ditions were such that safe midwifcrv could be earned out 
there If advisable he must close the hospital or certain wards 
until such lime as danger of infection had pas«.ed and should 
acquaint other doctors concerned with the facts A medical 
officer of health who had issued specific instructions to a 
midwife could not be held resoonsible if she failed lo carrv 
them out but adequate supervision must be exercised Nurses 
and midwives were within the scope of their training responsible 
for their actions 

Dr J Greenwood Wilson (Cardiff) described the procedure 
adopted in the Municipal Hospital Cardiff There were two 
labour wards one for clear and normal cases and one for 
suspected cases of infection Both in the hospital and m 
domiciharv practice masks were worn Ail municipal midwives 
were insured against legal damages in respect of acts of 
omission or commission 

Dr W C W Nixon referring to the subject of masks 
asked why the anaesthetist should be privileged not to wear 



THE SECTIONS SUMMARY OF PROCEEDINGS 


304 August 6, 1938 


one and wh% with the delivery of the placenti the nurse 
should immediaiel) remove her mask He referred to the vtliie 
of dettol m the form of a 30 per cent cream for the hands 
and vulva, and said that his experience in the Far East con- 
firmed the vahditv of Colebrook s reports of the reduction in 
the incidence of infections due to haemolv tic streptococci He 
commented on the mvth that haemolv tic streptococci were 
not found in the Tropics and recorded that m 1936 the 
incidence of puerperal infections with these organisms in the 
Hong Kong Universitj Obstetric Clinic was almost the same 
as that found at Queen Charlotte s Hospital 

Sir Evven Maclevn (Cardiff! referred to the help the medical 
officer of health could give to the practising obstetrician He 
said that local authorities could have in large measure that 
reduction in maternal mortahti which they were willing to 
pay for Dame Louise McIlrov agreed with Professor 
Johnstone s views regarding the importance of raising the 
resistance of the patient, and emphasized the need for earlv 
and efficient ante natal supervision Too much stress was at 
times laid on pelvic measurements and not enough on the 
general condition of the patient herself Her experience was 
that the incidence of puerperal infection was not high in 
hospital practice M>- L Carnac Riveit said that every doctor 
attending an infectious case or dealing with cases of whitlow 
or otorrhoea should W'ear a mask and gloves In his opinion 
dental caries did not cause puerperal sepsis but pyorrhoea 
and gingivitis were of more importance than was generally' 
realized 

Mr James W G H Riddell (Plymouth) declared that small 
wards of one or two beds were safer than large wards He 
pointed out that in osteomvelitis if the bone was trephined 
a positive blood culture could be obtained in a few minutes 
Therefore, in maternity cases requiring instrumental or manual 
delivery or Caesarean section sulphanilamide should be given 
before operation so that at the moment of deliverv this drug 
was circulating m the blood Dr Letitu Fairfield considered 
that the statistics for normal booked cases should be shown 
separately from those for suspected emergenev cases, otherwise 
the records might be misleading She emphasized the impor- 
tance of removing every case of puerperal pyrexia from the 
maternity ward, as other patients might contract infection in 
the first few hours She considered that in the small hospitals 
an experienced doctor should be responsible for the control 
of cases of puerperal pvrexia or sepsis ft should not be left 
to the matron to deal with the problem Dr J Preston 
Maxvvfll (Pekin) said that for tvventx xears all maternity 
patients at the Peiping Union Medical College had had a 
stand up or shower bath on admission Tub baths were pro- 
hibited for three weeks before labour on account of the danger 
of septic fluid entering the xagina He agreed with Dame 
Louise McIlrov that ante natal work should begin when preg- 
nanev started Dr F E Camps (Chelmsford) commented on 
the danger in small country hospitals of the hospital runner ” 
carrying streptococcal infections from the medical or surgical 
ward to the maternity ward, and advised against the inter- 
change of nurses between these wards 

Dr Mabel Ramsey (Plvmouth), Dr F McLauchun and 
Dr E Lewis Lillex (Leicester) also took part in the 
discussion 


COMBINED SECTIONS OF ORTHOPAEDICS AND 
PHYSICAL MEDICINE 

Thursday, July 21 

Rheumatoid krthntis 

With Mr \V \V Rcntoul (Truro) m the chair. Dr Wilfrid 
Eix lcombe (Harrogate) opened a discussion on rheumatoid 
arthritis by saving that m the B M A report of five vears ago 
rheum itoid arthritis was classified as primarv or secondary , 
vci ihe onlv real distinction appeared to be whether or not a 
focus of infcciion vv^s discovered The infective origin of the 
proved and bacteria their toxins allcrgv, 
' c VITUS were still all incriminated Both the seed and 


TUtlUITai 

XllDtCU.)- 


the soil were neccssirv, in his view (or the onset ol b 
condition He stressed the value of the sedimcniation r • 
and the need for standardization of the methods of camt 
it out \ hvperthvroidic factor was unlikelv, but the e>iM 
of ovarian secretion vvas more possibly causative In irc , 
ment vaccines were tending to fall into disrepute hit 
the value of gold was becoming more and more reco'swei 
Spa treatment vvas of great value, more because of thepre rce 
of all facilities for treatment — ^including specialist medal 
service — in one place rather than on account of the spent 
effect of the particular “water ’ 

Mr Norman Capener (Exeter) pointed out the value of i 
orthopaedic hospital as a treatment centre for rheunWiJ 
arthritis, and then proceeded to explain the position of phi e- 
logical rest for various joints, giving a detailed schetn- fc. 
charting deformity and progress He advocated iheuccf 
plaster immobilization ii iih padding, and described a melhod 
of correcting flexion deformity of the knee by cumns b 
back and sides of the plaster at the level of the kncejomi’ i 
inserting wedges postenorlv to increase extension 

Dr K R Collis H allow es (Torquav) described t»e 
chronic cases in which there was dramatic recoverv "li 
operation for acute abdominal emergency (gall bladder <si 
appendix) although previoiish there had been no c\iv r-* 
of inira abdominal disease While deprecating the vih s' 
vaccines, he strongly advocated gold therapy not erh i 
rheumatoid arthritis but when this condition was ccifai 
vvilh osteo-arthrilis He made a plea for accuraev in b 
prescription of phy siotherapv and also for earlv expert tre ’ 
ment, if only for a short lime in order to start the p'' rt 
along the right lines He did not believe that a r n 
climate was prejudicial to treatment, but that rest in vteU 
surroundings vvas essential 

Dr G D Kersley (Bath) drew attention to the vak i' 
plister immobilization as an adjunct to phv siothcrapi 
hvdrotherapv in the treatment of rheumatoid artbnii' f" 
plaster had to be light strong, and capable of beinse^^ 
removed and replaced for treatment For tne wti't '1 g 
slabs vvere used, and for the knee the whole lec hip lob'' 
was encased the plaster being divided and removed 
half an hour dailv During this" time mud packs were aff * 
massage vvas given for the muscles above and below iHb ^ 
and movement vvas carried out for a few times onh, ww 
Its full range, in a hot pool Corrective serial ph'tzf' ^ 
said, vvere applied in the best position obtainable if delon' ' 
was already present Thev were removed dailv for nwwF 
tion in the hot pool Many knees could be straichtenea 
had been flexed for vears and this method appeared to P 
results superior to those of continuous traction 
Mr W D CoLTART made a plea for the earlier 
of orthopaedic principles, and also stressed the neid for 
CO operation on the part of the patient, vvho should na' ^ 
programme of treatment explained to him beforenan ^ 
stressed the dilficultv of carrying out manipulation ” ' 
active focus or raised sedimentation rate vvas prtsen 
shoulder vvas a particularh ' difficult’ joint, 
extreme pain vvas present any attempt at regainmc a “ ^ 
had to be postponed In some cases both v\ eight o' 
and manipulation, followed bv plaster, had to be ^ 
It vvas surprising how much could be done for fW 
when deformity had arisen The use of support m 
of a calliper and insoles vvas often invaluable 
Miss Forrester Brown (Bath) mentioned ’/’’[Afi 
of occupational therapy m impioving muscular 
joints, and also reminded the meeting that Sir \tf 

many years ago, vvas the originator of serial , i 

H J Seddon likened the problem of b- 

that of infantile paralvsis and tuberculosis and 1 ^ 

It should be a notifiable disease and that j v( 

should contribute to the expense of its trea ^ 

C M KrNNFDV (Plymouth) supported Mr ^ o' ' 

for help from local authorities He also drew ifp-s' 
gonorrhoea as of aetiological importance ff ^ ‘ 

rheumatoid arthritis Mr K 14 PRrotc 
that gonorrhoeal cases could be recognized by x 



Vlglst 6 I'T’S 


THE SECTIONS SUMMARY Of PROCEEDINGS 


THrBumsH 

MlO CAi 


non and iKo drc\\ \Hcntion lo !l»c \'\luc of '■tTr\ ition nnd 
colonic li>avc m taitmcnl Dr \\ SC CoitMw felt that 
the tcndcne\ lor the treilmcnl of rhcnnntiem to btuorre 
more orthopTedie hut Ihtl from the orthor'icdic Mdt the 
interest NltH pntKjp'ilU concentrated on the end result 

and on eTpcratiNC Mirj.cr\ rather th in the earher stawCN Medical 
orihopaeJjCs ms the outlook required b\ cverehojx who 
treated this croup of di et^c^i It w i*' the onK eea\ m which 
raliciral laatmcnl would bc».omc posable on an orfc.aniccd 
scale He stressed the important of follow up treatment 

Dr \ R \Lit(.sN (Droitwuhl spoke of the pre rheumatic 
state charaetenzed bi cireulatcre md seniors chances in the 
e\ircmities abno mahtics m the sweatine. mcehani m wastme 
ot muscles and fatigue and advised that sus.h eases should he 
watched carcfulh Mr S T Irwis (Bclfastl mentioned the 
difiicults of re«aminc cooJ quadneeps functuan after rcnosal 
of the patella and advocated active rather than passive move 
rrctu to aid mamtcnanec of muscle function Nfr \\ 
RfNTOix (Truro) doubted vvheihcr anv infective factor existed 
in menopausal arthritis and aKo acrccd with Mr C ipencr 
about the need for padding in plasters 

Dr NNilfrid Fdcicompi rcphinc said he thought iberc 
was a tendenev to lemporarv imp ovcmcni in rl cumaioiJ 
arthritis when precnanev ensued Manv patients benefited hv 
a chance m diet with rcduc ion in starcli and mcrcasc in 
proem, as manv had sulTcred an itnnetesxar> and hirmful 
restriction of the latter 


SECTION or DISE.VSES OF CHILDREN 
r/i»rjdav Jitl\ 2i 

Some Nulnlional Problems of Ouldhood 

At a meeting of the Section of Diseases of Children on 
Jul\ 21 with the President Dr I \f U Allls fBelfjsl) in 
the chair Protc-,^or L G Psr^oss (Birmmgharil dclivcreJ 
the Dawson ^^IIlIa^'S Memorial Lecture which was cniitLd 
“ Investicalions into some Nutritional Problems of Childhood 
Professor Parsons dealt pnncipillv with vvork on coeliac 
di case carried out in Birmingham bv himself ind an 
cpihus astic band of colleague^, and pointed out how manv 
deficiencv diseases might a'’ise m the course of cocliac disca e 
such as rickcii ictanv cataract scurvv nichi blindness 
pvodermia xerophthalmia atrophic tongue benben microcvtiw 
ard macro viic anaemia dLnial hvpopJasia and stumme of 
growth Soon after the war he continued in the course or 
treating a child wuh coeliac di cave he found that the patient 
developed rickets which was succcssfullv cured bv ultra 
Violet irradiation A subsequent inve'tication of ihccITeclive 
ness of the sunlight available in Birmingham showed that the 
penod of healing ravs was limited to about iwentv-cight weeks 
in the vear Another dcficicncv disorder met with in cocluc 
disease was anaemia and this was commonlv (he result of 
a straightforward deficiencv in iron Professor P'*r ons ex 
piained that some of the rarer tv pcs of blood changes indicated 
that the earliest phase in the iron deficiencv state was acluallv 
an increase in the number of the red cells but a decrease in 
their size Calcium deficiencv appeared to plav some indirect 
part in the anaemia of coeliac disease It vvas clear from the 
v\or\ which had been done (hat there was poo absorption riot 
oaU of fat but also of carbohvdratc in cocliac disea e It 
W'^s found that sugar tolerance could be crcatl> improved bv 
the administration of certain liver exira^'ts either bv mouth or 
b\ injection \ ilamin fas marmitc) was also now given 
as a routine measure in view of further work that had been 
done on carbohvdratc tolerance in cocliac disease. 

nmpvcma 

Miss Geptrlde M a HfcRZFELD fCdinburgh) % icc President 
0 ^ the Section then took the chair when Dr H L ll\cc 
(Edinburgh) opened a discussion on the treatment of empvcma 
in children He pointed out that this was cssenliallv a disease 
in which there should be close co-operation between phv ician 
and surgeon To avoid persona! preferences he based hi> 


remarks upon a general review ot the treatment of empvema 
Xn practised at the Roval Edinburgh Hospital for Sick Children 
durinq the past fifteen vears this composed 363 cascN of v hich 
fifteen dvinc wjthm foriv eight hours of admission were ex 

eluded Dr Wallace then reviewed the mortahlv rates and 

Itncih of lime in hospital for three age groups — under 2 vears 
2 «o ^ vears and > to 12 vears— fo- each of the following 
methods vof treatment repeated aspiration drainage bv 
Cannula a piratton drainace bv closed suction thoracotomv 
nd open dratnacu drain'‘gc h\ re cction of rib (do ed 
''nd open) RcLardmc the fir t three as conservative 
measure an 1 the last two as radical D" NVallace 

showed lint both as recard mortalitv and length of 

Slav m hospnal the outlook was better for those children 
treated radicalK the general mortahlv being Ic<s than half that 
of tho c ticati-d bv conserv ttivc measures Such measures 
WTcrc of \alic as a prchminarv to nore radical intervention 
but except when the amount of the pus was verv small the 
It emp lo cure empvema bv repealed aspiration alone for 
cximple mcrciv prolonccd the illnc > and might even endanger 
htc The immediate results of treatment were not signif’canilv 
influenced bv the nature of the infectinc organi m in his «cnes 
Mr K C Dpcx"! cntiwized the re ults bronchi fonvard bv 
Dr U ilhce on the cround (hat thev did not appear to tale 
Into consideration the varvmc mortalitv from the disease 
different periods Defining empvema as a localized collection 
of pus m the pleura he pointed out that the condition must 
be cirefullv difTcrcniiatcd tro'a diffuse intr^-pleural uppura 
lion often part of a general mtcction In Dr Wallaces 
senes he continued it appeared that a high p-oportion of the 
deaths were m fact a octated vMih general di ease He par 
luularlv wished lo deal with the as^essmvni of the correct 
time to drain Other aspects of treatment mvluded the pro 
Vision of adequate drainace and the decision when to stop 
It Among the factors which made for caution as regards 
drainace Mr Brock considered ace the ivpe of organism 
(s rcplococcal ca cs eallmu tor more dclav before radical 
measures) the historv oi previous illness the evidence of 
ccncral blood infection the cenen! condition ot the patient 
and the exact duration of the cmpvena as distinct from other 
parts of (he whole infective process Earh aspiration was 
desirable but inicreostal drainage m general was belter post 
poned for a full three weeks after the erd of the antecedent 
pneumonic process An empvema was never an emercenev 
calling for immediate operation If a chdd vvas acuteh ill 
\viih an empvema it vvas likelv that some ceneral infection 
or other area of suppuration was the cause of this rather than 
Ihc empvema and hence debv m radical local measure^ was 
undesirable The temperature chart must be carefulh studied 
&nd intercostal drainage onlv pe formed when it had definiteh 
chanced from the earh form associated with pneumonia to the 
xwincmg form of septic infection The character of the pus — 
that IS the thick tvpc — was also a useful guide as to when the 
lime had arrived for drainage Mr Brock was rather distrust 
ful of the too earlv use ot the intercostal catheter and 
cmploved it onh as a stop gap for two to three davs In his 
xiew resection of a nb for the provi ion of adequate drainage 
\v*as essential in most cases eventinllv hut should never be 
pari of the earh treatment in voung children 

Dr A Brixs Tsvlor (Birmingham) dealt more especiallv 
With the prevention of chronic emp'cmata and associated 
disorders such as bronchiectasis chrome sinu es and postural 
defects He suggested that instead of repeated aspirations m 
ibc earlier phases of the diseaNC it was better for the empvema 
and kinder for (he child lo insert earlv on an intercostal self 
retained catheter leading to under water drainage this allowed 
ihe toxic fluid "to dram awav as it formed and encouraged 
expansion of the lung. Thi> procedure could be earned out 
m even verv ill children in their beds After about a week 
there was le>s toxaemia the pus thiCKened and nb re ection 
could be earned out still with a water seal since this avoided 
frequent dressings and permitted gentle irrigation The lime 
to remove the tube was when the cavnv m the pleura wax 
obliterated not when drainage ceased and m deierminins thi' 
point the use of Iipiodol and r ravs w?s most valuable Dr 
Brian Ta) lor considered that the be>t po>ition for drainage 



306 August 6, 1938 


THE SECTIONS SUMMARY OF PROCEEDINGS 


Tut n>m«j 

MtDJC\L 


vas in the avilhry !inc .ibout the fifth or sixth space since 
this was the phssiological point of election and most comfort- 
able for the child Breathing exercises of the inspiratorv and 
postural t\pe should be begun as soon as temperititre and 
toxaemia had subsided 

Dr Lindsay A Dey (S)dne\) thought that bacteriological 
study of the pus was of the greatest importance he was loath 
to dram earU in cases of streptococcal origin But he agreed 
th it delay in drainage might be responsible for poor ultimate 
results 

Dr F M B Allen (Belfast) said that in tackling empyema 
he first satisfied himself as to the presence of piis m the 
chest and then determined the organism present The general 
condition of the child must also be most carefully considered, 
since empyema might be part of a general pyaemic state 

Mr OrFiCLR Brown (Melbourne) from an extensne review 
of empvema in childhood showed that the mortalitx oxer 2 
years of age was much lower than under that age and was about 
the same as for adults He thought this was explained b\ the 
large number of streptococci! cases in xoi/ng infartts and the 
complication of empvema in measles and whooping cough jn 
which a septicaemia was probably piesent In treating bv 
the method of closed drainage he fax cured the maintenance of 
a high negative pressure Cellulitis of the chest wall was an 
occasional cause of death and was possiblv due to the use of 
too many sutures 

Professor L G Parsons (Birmingham) thought that the 
use of the terms svnpneumonic and metapneumonic ’ 
empvema was questionable, is this focused alleniion too 
much on the possible pneumonia ind not enough on the fact 
that the verv ill child with empvema was probabh suffering 
from a septicaemia which explained the high mortahtv m 
voting infants 

Dr Burton Wood presumed that the list of considerations 
fulfilled by Mr Brock meant the use of the needle until 
operation appeared safe He thought that intercostal tube 
drainage was dcfimtelv valuable in the earlv stages although 
It was possible that the tube in some cases might lead to erosion 
of the nbs above and below and cause osteomyelitis 


SECTION OF NEUROLOGY AND PSYCHOLOGICAL 
MEDICINE 

Thiirsdav Jitlv 21 

States of Mental Depression 

With Dr W RbSbELL Brain Vice President of the Section, 
in the chair Dr Albrfy J Lewis opened the discussion 
upon stales of depression their clinical and aetiological 
differentiation Devoting his attention mainlv to the problem 
of cl issificaiion he inquired how far a separation of the 
depressed states could be based upon genetic factors on the 
one hand and clinical factors on the other The distinction 
between hereditarv and environmental influences was piirelv 
theoretical and could not in practice be maintained There 
was no reliable evidence as to the hereditv of so called psveho- 
genic depression and nothing had been proved for the other 
varieties On the other hand it appeared that all the tables 
and classifications in terms of symptoms were little more than 
attempts to distinguish between the acute and chronic the 
mild and sex ere The danger of the classification into manic 
depressixe and psychogenic txpes h> in the assumption that 
there xxas nothing to be done for the former and that psxcho- 
therapx xxas alone effectixe for the latter Dr Lexxis empha- 
sized the importance of ascertaining xxhether a depression 
might be due to organic disease or to hxstcncal obsessional 
or other psxchopathic trends Classifications should there 

( ore be axoidcd 

||Dr Desmond Clrran welcomed the views expressed bx 
Pr Lcxxis because thex demonstrated the dangers of faPe 
imphfKation The application of fundamental psxchiatnc 
principles liberated clinicians from diagnostic sir iil jackets, and 


represented an advance from the attitude adopted up to 
Within the prexious few years The term deprewne 
svndrome ’ was more clastic than the old conception of rifid 
and sharply defined disease entities The typical mank 
depressive existed, but was rarelv met m practice while 
patients exhibiting symptoms characteristic of two different 
entities were often encountered Dr Curran submitted that 
physical mental and conslifutiona! factors were ineutabli 
operative m everyone, not excluding patients The inter 
action of these factors was such that the chief one could 
neither be found nor reasonably be inferred Therefore ihe 
general position advocated bv Dr Lewis appeared indispiitab’e 
Yet It might be argued that for practical purposes the neurones 
could and should be differentiated from the psychoses Siiih 
a sharp distinction was not possible, and an attempt to malt 
It was harmful if it vvas^combined with equally ricid and 
untenable views on aetiology, prognosis, and treatment 

Dr E A Bennet drew attention to the association of deptes 
Sion with early malignant disease, and emphasized the impot 
tance of repeated physical examination of depressnes of Ih' 
middle and later decades He agreed with Dr Lewis that 
stales of depression were clinically separable on a quantibtnt 
estimation into acute or chronic, mild or severe But a quali 
tative concept of depressiveness was also required, and until 
the nature of depression was investigated clinicians were net 
in a position to assert that all depressive states were of 'imiht 
qualilx — m other words, that they had a simifar actiolo'’’ 
The clinical findings, hoxxever afforded no clinical basis fe 
such a distinction and the only method at present avaihblt 
for obtaining knowledge of the aetiologv was some form of 
analxsis Psxeho analysts were agreed that states of dcpits 
Sion differed qimnlitativelv but not qualitatively Their n" 
left unexplained the periodic swing of mood and lhi< D' 
Bennet suggested, was the crux of the matter This chance cf 
phase m mood was present in all men and in the mans 
depressive group exhibited a morbid intensification in e' 
psvchoneurotics there was also depression of a secondary tie 
periodic tv pc which might be called psvchoncurolic dcprewii 
Psvchoneurotic depression differed from the cndofcMJ 
depression of the manic depressive both in the absence « 
periodicity and qualitativ'elv Dr Bennet therefore 
from the conclusions of Dr Lewis and Dr Chirran tr' 
depressive stales differed merely m degree He emphaiu™ 
the distinction between the natural periodicity of mood 
became morbidly intensified in endogenous depressiic ''3C| 
and psychonciirotic depression the qualities and actiolo?) n 
which were not known 

Dr R G Gordon (Bath) speaking of the ncurolocio 
aspects of depression suggested that thev might arise 
changes in the cortico thalamic hypothalamic system 
change might be imposed from above in the 
group, or from below in cases m which toxic or 
logical factors were manifest Thus Mever had dc'cri 
cerebral neuritis in the deep layers of the 
inxoliUtonal melancholia Again, depression might c® ^ 
found in cases of Parkinsonism and in disseminated 'de 
Dr A E A Carver (Nuneaton) agreed with Dr 
stressing the importance of the periodic factor 
and drug addicts when treated continued to cvhibil r 
of depression, and on analysis, showed evidence ol ^ 
endogenous and neurotic factors The same 
elaborated bv Dr R Eager (Exeter), who f pf 
meeting that the old word lunatic” expressed the 
penodictiv 

Yerligo 

At the afternoon session, with Professor 
Vice President of the Section, in the chair, Dr Ws 
opened a discussion on xertigo, its ’ -jine'’ - 

circulatory, and surgical aspects He defined the e ^ 
the consciousness of disordered orientation ot , 

space Disorders in normal orientation migh ,i/' 

variety of different levels in the nervous ’ 

cortex downwards A corresponding classification ^ j. 
states could accordingly be made He , ,_,co t ' 

uon to Mdnicre’s syndrome, and emphasized tn 



Vlcust (y 19 'S 


THr SCCTIONS SUMMARY Or PROCCEDINGS 


o’* -sCtVmL for focnl infcctionN m ib«s condition The cfljCTc\ 
ot dch\dn3tion a*; i form of rre*jfm'*ni u dotibtjul ihhoiich 
in the light of the recent ol cmtions of C urns ind H iHpikc 
wntcr retention mi^ht well be i contributor\ Iitior 

Mr W M \foitisoN spoke of M.rtico w n s\mpiom to be 
cured b\ destniction of the Iib\rinlh \ criii .0 re>ulkd from 
n dtsitirbincc of the balance between the (wo h{\rmth 
CniwcN of such ctisiurbnncc hv in the middle cir m the 
interml eir or in the Ncsiibulir nerse nnd its ten rts \liddlc 
car sertiijO wns common ard micht be die to thine**'- ir 
prcvMirc in the futd in the internal car brought about b\ 
chances m the position o^ the stipes m the onl window In 
practice It re ulicd from middle-tir catarrh ctondan to 
Eustachian ob'in cticn In all cases of scrtigo with onesided 
deafness inflation ot the tube was csseninl to cxclud'' ob>tri c 
lion as the cause O «.as5onaUs scttico was cuiscd b\ wax 
in contact with the membrane but since aerugo m the e 
circumstances was rare it was evident that some prcdisposinc 
cause mils be pre cat Hallpucs recent bistoloc cal ob cr\n 
lions siiccested that chances m the internal car micht som** 
tir'cs accompana middle ear catarrh and be responsible for 
acrtico AhhoiiLh Mr NJoIhson had m a number of cases 
injected alcohol into the internal ct with good results in 
76 per cent he re*.ommerded section of the sesiibular root at 
tl c internal audiion meatus as the operation of choice onic 
decree of hearing micht then be presened 

Dr A Horr Gossc anahscd a series of Ctt^ imseJe^itd 
eases of cardio vascular di ease with plddIncs^ is a ssmpiom 
llic maximum ace incidence between 60 and 70 \car and 
rren wc'c affected nearh twi-t: as often as \ om'*n The 
blood pressure was abnormalh hu.h in 22 p'^r cent Heart 
disease based or? atheroma aceourted for two third oi tie 
whole group It was of interest that cxcessnc snolinc was 
recorded m onh 8 per cent Dr H G GirLssn ilctds^ 
expressed dotbl whether vertigo w-is caii«cd bv either lo-al 
sepsis or tobacco He inquired whether civanc up smokin^ 
had relieved samptoms m an\ instance 

Mr GLon-Rn JcFrxp'^o^ iManchcsttrl said that he had not 
b^en impressed wnh the results of dchvdration treatment 
perhaps he had expected too much In this connexion the 
histological observations ol Cairns and Hallpikc were of the 
greatest imponance In both of ibeir cases however cercHnl 
oedema had been prc'cni and Mr Jefferson thought that their 
ob ervation of hvdrops vestibuli should be control’cd in this 
respect His approach to the operative treatment of labv 
nmhine venigo was comervativc b'*causc in mans instances 
the attacks tended to subside He advocated division of the 
cephalad fibres of the vestibular portion of the nenc but 
doubled whether this operation would ever completels replace 
the alcohol in;eet/on method desenbed bv Mr Molh on Tin. 
latter was more suited to those who bv reason ob ace or 
infirmitv were unfit for the severer operation 
Profc>sor H Olivecsonv (Stockholm) divided examples of 
Meniere s disease into fl) true cases with tinnitus unilateral 
deafness and recurrent vertigo (hc>e had no certain ana 
tomical basis (2) Similar eases with an obvious can c su^h 
as a tumour in the posterior fossa or middle-car di ca c (3) 
Dandv s pseudo Meniurcs disease m vvhich the disorder tended 
to disappear and in which themfore conservative treain'cni 
should be adopted In some examples of the first class spon 
taneous rccoverv also tended to occur But when lUacks were 
incapacitating and frequent Professor Olivecrona advocated 
division of the vestibular nerve He had operated in about 
fortv cases and most of the patients had done well 
Dr H \ DickS found evidence from the opening paper 
that phvsicians and neurologists m particular recognized the 
importance of the psvchological aspects of disorders of adjust 
menl to the environment Of all cases of consciousness of 
disordered oncmauon m space the neurotic were the most 
common In the life of the unconscious as studied in the 
dream and m hallucinations and delusions there was a 
different space sense from that which normallv governed mans 
relation to the outer world These distortions of reahtv sense 
mieht rise to consciousness under the stimulus of anxietv and 
this provided a background for the neurotic t>pe of vertigo 


Dr ^ P A CvKvcR (Nuneaton) asked for information 
about the nature of the rh>lhmic pulsation perceived m the ear 
b\ manv sufferers from vertigo P ofessor Henri Cohen 
Slid that such i pulsating tinnitus could sorretimes be heard 
b\ in observer auscultating over the masicrJ of the patient 
He had il o found that attacks of vertigo might svnehronize 
With attacks of paroxv mal tachveardn The true Character 
Ol such labvnmhinc circulalorv di orders was however un 
known He had coivirccd him elf ot the value of chloretone 
in Mciitrcs disease but had been su'pnscd to find that no 
Qood rcstilitd from intravenous h\ pc ’■tonic saline or gluco e 
Dr Rissrir Bpms in replv sud that it was undoubtedh 
Inc that the di coven and treatment or focal sep i«, m vertigo 
h d sometimes resulted in cure Auscultation or the skull 
should alwavs fern part of the routine examination since 
this micbi lead to the recognition ot an arterio venous 
anciirvsm 


SECTION or PVTHOLOGA, BACTERIOLOG'i, 
VND IMMLNOLOGA 

Thursda Juh 21 

Tvphoid Paratvplioid \accjnation 

\%ilh the Prcsidc-nt Dr M H Gordon ir ibc ^h-ir Breve» 
1 icutcn~nt Co’onel J S K Bdvd R \MC read a paper on 
rccc''! dvarccs in the preparation o* p'^opbvLctiu tvphoid 
paratvpfotd sjci-ine a u'-d m the Bnti h \rmv He aid 
tb 1 the o ikinal vaccine used ir the \ms v 2 > prepared 
from the Rawlnus train of U ir o low viml-nee 

1 ue dout ts were rai cd recardinc the uitabil tv of this 
strain ard OrinrcH 'ho ed th-i vacwines prepared trom 
cccnt’v 1 o'ai'M smooth strain we c more crTedive in pro 
tcciin^ m u from test Jos- ot living orcani ms Perrv 
Iinuliv and Bensttd onlirr*ed Grinnell findne and bv 
wo kinu on the chan'^t produced in Bu t t\plonm bv nouse 
passavc Were able to produce a strain ot Ra» lings v hich 
pose td the same virulervc av the highh virulent strains 
of recent oncin Purthcr it was round that everal strains 
of Hoct np/fj/im oncinatire Irorr dirTere"i cases m an 
outbreak when used as vaccines aPorded a deeree o*" p o 
(Cction corrcspondirij, direcrh to fh-ir viru'cn-e A/nilence 
in /her nphoutm hid been shown bv Felix and h:s colleagues 
to be atiriburablc to the o the virulence or 

\i antigen and the cruiasn h^d bwCn made that vTiccmes 
killed and preserved in the usual wav must lo'c an\ antigen 
(hex posss-s ed so that no advantage was to be gained bv 
the u c o*" virulent strains In practice this cniicism was no 
sub>(anUoied Experimental inoculations in voluateers had 
shown thar>lhe reaction cau ed bv vaccines ol virulent strains 
was no more severe than that given bv the old vaccire \ 
vaccine of Ban tsphosum Bact paranphositm \ and Boct 
parat\phositm B of proved and tested virulence was thereto e 
brought into ccncral use in the British Armv m J93a The 
rcMiUs of this measure could best be studied bv following fbe 
incidence ot tvphoid tever in the British Armv in India where 
'0 000 to 60 000 men were scattered through a countrv m 
which enteric fevers were endemic among the civil population 
The curve ol incidence showed an upward trend until 1929 
The vaccine u ed was then changed to embodv ^0 per cent 
ol a smooth and recentiv isolated strain of considerable 
- vinilen^'c From 1929 a declire m incidence occurred, whrh 
was sharplv accentuated in follovving the introduction 

of the new vaccine It was worthv o note that there had 
been no corresponding decline m the incidence of other 
intestinal diseases which seemed to show that the improve- 
ment in the enteric figures could not be solelv attributed to 
an improvement m general sanitat on Prior to 1934 most 
cases of enteric fever occurred in voung soldiers of less than 
one xcafN service m India Since 19‘*4 the dustribuiion of 
such cases had been mo^e evenlv spread out over the different 
vears of service and the new arrival seemed to possess an 
immunitv equal to that of bus mere 'ea oned comrade It 
seemed probable that this was attributable to the more 
effective vaccine 



308 August 6, 1938 THE SECTIONS SUMMARY OF PROCEEDINGS 


Dr E Grasset (loVianncsburg) in a paper on txpVioni 
endoto\oid laccine, ga\e a renew of the results of pre 
ventive inoculation against Uphold fe\er in an inoculated 
population of 400 000 He said that U phoid endotoxoid 
\accine consisted of the deruatnes obtained b\ treating endo- 
toxin with formalin at incubator temperature the endotoxin 
was denied from killed emulsions of Vi ti phoid (or para- 
t> phoid) strains bj a process of repeated freezings The 
atoxic product retained the antigenic properties of the original 
emulsion and conferred a high protection, as eiidenced bv 
mouse tests Large scale immunization of a mixed population 
had shown that endotoxoid could be injected with safeti and 
in considerably higher doses than suspension laccines The 
preliminari application of the method took place in 1933 and 
rapidU spread Information from various sources had testified 
to the high immunizing properties of endotoxoid — a consider- 
able reduction in the incidence and mortalitv rates following 
Its introduction as compared with the statistics of previous 
vears during which TAB and oral immunization were 
employed Dr Grasset then gave a number of statistical 
examples in support of this contention Continuing he said 
that serological investigations had shown that H and O * 
agglutinins to an average titre of 1/800 and 1/220 respectively 
were produced in 90 per cent of the subjects in the month 
following endotoxoid inoculation It had been ascertained 
that a single injection of endotoxoid of high antigenic power 
was sufficient to produce agglutinin titres of 1/10,000 H ’ 
and 1/500 O’ in man Work on an insoluble alum pre- 
cipitated endotoxoid showed that the protection conferred 
was equal to that given by the original endotoxoid By 
alcohol precipitation a purified antigen was obtained which, 
redissolved and injected into mice and rabbits, conferred a 
high degree of immunitv and agglutination litre equal to that 
given bv the original endotoxoid With regard to the duration, 
of immunity appreciable H and O agglutinins were 
present one vear after administration of endotoxoid and a 
comparable degree of protective immunitv persisted at the 
end of two years 

Dr H H Brown (Worthing) suggested that the action 
of TA B vaccine was due to Ivsis of the bacteria at the site 
of injection, liberating endotoxoid which subsequentlv reached 
the reticuloendothelial svstem If anv of the bacteria were 
destroved bv phagocytosis this portion would not contribute 
to the effect Thus endotoxin given subcutaneouslv or 
bacterial suspension intravenously might produce a more last- 
ing effect than suspension subcutaneouslv 

Dr E WoRDLEX (Plv mouth) questioned the accuracy of 
incidence rates m typhoid statistics and referred to the diffi- 
cultv in diagnosing or even suspecting the mild cases that 
must so often occur m inoculated persons Dr W Lexx’in 
(Johannesburg) asked whether when the new vaccine was 
introduced in India any controls were inoculated with the 
old Rawlings vaccine and the incidence rates compared 
Referring to Dr Brown s remarks he suggested that f experi- 
ence with alum precipitated toxoid in diphtheria pr 9 phvlaxis, 
in which alum icted bv delaying absorption were hnv guide, 
it might be better to inoculate whole bacterial bodies together 
with substances that delaved absorption rather than to use 
rapidlv absorbed endotoxoid Dr D S Sutherland (Man- 
chesicl) questioned Colonel Bovds comparison of figures 
from the South African and great wars and pointed out the 
differing sanitarv conditions in the two cases Colonel E C 
Hodgson (Paignton) asked whether the comparison between 
TAB vaccine and endotoxoid in Dr Grasset s work was 
between the new virulent TAB or the old Rawlings vaccine 

Colonel Bovd in replv said he was fullv aware of the fallacies 
of great war statistics but did not think that diagnosis 
was either more or less efficient in the great war than in the 
South Xfrican War This fallacv was therefore a constant 
He thought that sanitarv conditions during the great war were 
■probablv belter than in the South African War but pointed 
F'ut the big fall in tv phoid incidence in the French ^rmv in 
the great war following the introduction of tvphoid v tccine 
1 here had not been much decreave in India in the mortalitv 
rite in recent vears among thocc who did contract enteric 
This suggested that during the e^rc''i war mild undiagnosed 


*Tit Bums I 

VlEDICXl lo iMi 


cases were probablv not the result of prophvlaelic motiiL 
tion It had not been possible to compare at the same lire 
persons inoculated with the new and with the old vaccircN 
With regard to Dr Grasset s work he thought that iiati! ihi 
were certain that a part of the antigenic complex of B a 
nphosum was the equal of the whole for prophvlaxw if i 
would continue the use of suspension vaccines in the Biitnh 
Army 

Dr Grasset in replv to Colonel Hodgson, said that tie 
TAB vaccine used before introduction of endotoxoid w s 
prepared from a smooth recently isolated Bact nplio’ur 
In replx to Colonel Boxd, he said that comparative mou'e 
immunization experiments with tvphoid suspension vacur 
and endotoxoid from the same strain showed a similar detee 
of protection when tested with a Vt tx phoid strain 

* 

Glucose Tolerance in Obesity 

Dr D Exibleton, m a paper on glucose tolerance curves m 
500 obese patients (242 males and 258 females) said that 
although the subjects were definitely obese no cases of trosS 
endocrine disturbance were included The senes prohahh 
did not represent a fait sampling of tne obese population of 
the country, but all obese cases examined during the r>'i 
fifteen xears had been included about whom sufficient debils 
were available The cases were mainly derived from Ihs 
better-off classes A relatively small proportion only cair 
because sugar had been found m the urine High glui-Oie- 
tolerance curves were obtained m 73 per cent obese males 1 1 
only in 35 per cent obese females at all ages The differerce 
between males and females was still more marked when the 
percentages of high curves were charted for the lano : 
decades Superimposed high glucose tolerance curves of otf J 
males showed that there was no marked difference beli'W 
those with or without svmptoms of diabetes The percenUK 
of ‘ overvveightness did not appear to make any flifleOTT 
to the percentage of high glucose tolerance curves obnmedi- 
eilher sex 

Dr S Silverman (Birmingham) asked whether aii\tl'«'* 
was known as to the nature of the disturbance of ihe hj 
metabolism m these cases Was there any constitunofi 
tendency to obesitv, and was it possible to treat such 
simply by controlling the calorie intake’’ 

Dr Embleton in replv, said that fat metaholimi 
obviously bound up with the question, but he was not vbl' 
say exactly how The patients had a limited abililv to 
with carbohydrate There was undoubtedly a constiiutioM^ 
factor, and somh endocrine disturbance, possibly involu^ 
insulin production Anyone could reduce weight b\ dan 
tion Bv putting them on a high protein diet and cum 
out carbohydrate patients with a high tolerance curve coi i- 
be reduced in weight 


SECTION OF RADIOLOGY 
Tliursda\, Jiih 21 

Treatment of Uterine Haemorrliage 

With Dr Ralston Paterson (Manchester) the , 

the Section in the chair, Mr B W Windever m the o ^ 
of Mr C S Lane Roberts opened a discussion on t c 
ment of uterine haemorrhage ^ 

Mr Windever stressed the importance of 
nosis in cases of abnormal utenne haemorrhage emp , 
the necessity for pelvic examination to 
disease It was generally agreed that the action o 
the treatment of non malignant utenne t., wr* 

fined to the ovaries in which the more mature fo i , 
highly radio sensitive In voung subjects; m , fb < 

the follicles were immature higher dosage was 
was some evidence that radium in the uterus a 
action on the endometrium In practice 
by the ovaries — between 500 and 1,000 r in m 



At.ci.st 6 19''S 


THI SECTIONS SUMMARY OF PROCEEDINGS 


THEBumnr 

Midicjo. 


should be ^ufTiacnl to cnu'c stcnbziiion 'ind this do’^tpe ui*; 
in fnci UMnlU followed b\ n enopiij^'il s\mptonu In tn^cs 
of irrcpulir hicmorrlnpc it or ibout the mcnopnuAC -ill the 
evidence 'showed that ndtoihenpv vva«; the treatment of choice 
Prehmmarj dilitaton and enrettape were cwential The 
morlaliU in a <cnes of *7 CK>0 cincs quoted bN 1 conird Phillips; 
was 0 25 per cent and the convalescent period wnv m.i.hciblc 
The onh contraindications were asso’^iatcv! prolap c or ccrvual 
laceration and pelvic innanimiiion The former could be 
LUTxd at the 'iamc lime as ibc rxdiothcrapv was carncvl out and 
the latter could be avoided bv care in irradiation treatment 
Of filtv nine eases treated b\ him at a hospital Mr Windever 
said fiftv seven were cured Fifiv four of these were treated 
b% radium in the form of a ^0 me lube with a M:Tccn of 
1 5 mm of platinum for fortv-cight hours The onlv com 
plication of note was a vvaterv ulenne discharge due no doubt 
to lOval dcstniction of the endometrium b\ reason of the 
dose contact of the radium tube \s retards choice of 

method he was in favour of r radiation because of ab cn e 
of complications because pelvic inflammation was not so 
dangerous and because it was possible in cases where an ics 
thesia was contraindicated In tlnphnd the dosage was usualh 
such as he had outlined In the bS \ it was less and in 
Trance irradiation was given throuch the lateral vaginil 
fornices In the case of r ravs manv successful techniques 
had been described Mr NNindcvcr said that he ii'cd 200 
V.dOM>\\s wi\b a \boracus bUci and*a ford s\m distance of 
50 cm Three fields 10 b\ 15 cm were treated and "tOO r 
were given to each field on three occasions resulting in a dose 
of 700 to r to the ovanes Ntenopaiisal svmploms did not 
differ from the natural or surgrcalU produced climactefK In 
casej) of fibroids radtolhcrapv was indicated m patients over 
-»0 but contraindicated in voung women unless the nsVs of 
surgerv were loo great The presence of pressure s\mptom^ 
or of csidcncv of degeneration was also a contraindication 
In the case of menorrhagia in women under hvsicrcctomv 
bad in the past been recarded as the method of choice There 
was howescr csidcnce to suggest that norma! mcnstniation 
could be restored in a hich percentage of eases and that the 
danger of abnormal children and monsters was small Treat 
ment b\ x ra\s seemed the better method because of the 
absence of effect on the endometrium 

Dr W M Lemtt read Mr Lane Roberts s paper Execs 
sue uterine haemorrhage might be due to local pelvic causes 
to general causes to endoenne dvsfunction or to over active 
ovanan function It could be dealt with hv hormone thcrapv 
medication r ravs and radium or bv surgery In dealing with 
treatment bv t ravs and radium a verv complete survev had 
been provided in 19^' and in J9^S bv the discussions of the 
Radiological Section of the Roval Socictv of Medicine 
Thorough general examination should be earned out including 
blood count, bimanual examination and dilatation and 
curettage The advantages of t n>s over radium were that 
the nsk was ml there vverc no complications the results were 
better and there was no danger in eases of pelvic mfiamm'i 
tion In addition hospitalization was not ncccssarv and no 
anaesthetic need be given in cases where it was coniraindtcxied 
Radium on the other hand was more suitable in eases where 
the red blood count was low cessation of haemorrhage was 
quicker and there was probablv less de<lruction of ovarian 
tissue It was also cheaper and simpler and could be inserted 
on the occasion of dilatation and curettage Cases not suit 
ab^e for irradiation required surgical treatment bv either the 
abdominal or the vapnal route allhouch the latter had a 
definite mortahtv \Iost fibroids called for surgical treatment 
but irradiation should be given to cases in which anaesthesia 
was contraindicated to patients over 40 in whom there were 
no signs of pressure and when the svmptoms were mamlv 
mcnorrhacia or irregular hacmorrhacc In eases of endo- 
melnoma irradiation might be the method of choice and should 
be given m castration dosage after exploralorv laparolomv 
had confirmed the diagnosis Endometnomata in the recto 
vaginal septum — ^25 per cent of Doucal s cases occurred at this 
— should be treated b> irradiation Intractable mcnor 
rhagia in voung women should onU be treated bv irradiation 
after hormone ihcrap} and curettage had failed 1^0 to “CO 


me hours should be given followed in three to six months bv 
^00 mg hours In one <cries of ca<es normal menstruation 
had been restored in 8S per cent of ca es 

Mis^ BtATRict: M NSilumott (Birmingham) said that she 
performed abdominal hvstcrectomv m cases with pronounced 
chronic cervicitis with large fibroids causing svmploms or 
With submucous fibroids Curettage and medical treatment 
were indicated in women who desired children In all other 
eases she used radium r ravs not being available A recent 
qucsiionarv sent to 226 patients treated for uterine haemor 
rlnge at the Birmingham and Midland Hospital for Worren 
showed that after radium treatment 94 per cent had complete 
amcnorrhoea Onh two patients complained of di charge under 
the heading 111 effects of treatment though 11 had some dis 
charcc for varvinc periods *’ per cent had pain lasting m 
some cases for three months Seventeen patients had meno 
ptusal svmptoms three noticed increa c m weight seven had 
headaches and fifteen complained of weakness and nerves 
Complete snisfiction with the result of treatment was 
expressed bv 92 ^ per cent The dosage in the e ca es had 
been in the region of 2 000 me hour** with a screen of I mm 
of platinum the treatment period being from twentv four to 
fortv eight hours Of 411 cases treated during the past four 
vears there was no death due to radium treatment and the 
results had been verv sati faclorv 

Dr r Ellis (Shcflitldt anaU cd the replies rcLCived from 
patients treated for uterine haemorrhage at the Icssop Hospml 
for Women Cases were eh sified into six group the largest 
being tho c of bemen vitcnnc haemorrhage m whi h curettage 
had failed to reveal a t-ausc and metropathia haemorrh'>ci''a 
Of cvcnlv five patients who replied and who had had more 
than I 800 me hours all hid amcnorrhoea Of eight p^'ticnis 
who had had less thin "^0 mg hours there were two failures 
both in women between 0 and tO The dangers of pre 
conceplional irradiation had not so far been adequaiclv 
assessed Lscfu! information micht be acquired if uniform 
do'cs could be civen to the whole erdometnum wiihoui 
inaciivaiinp the ovaries In such circumstances menopau al 
svmptoms might not occur 

Dr LtMTT thought that the sterilization does quoted bv 
Mr Windevtr were higher than were ncccssarv The large 
number of prclimman investigations advised bv Mr Lane 
Roberts were he thought unneccssan in most cases He 
ihoiichi that pelvic sepsis could be lighted up bv \ ravs He 
agreed vviih Mr Windever that even verv large fibroids were 
in the absence of svmploms suitable for r rav treatment 
Slcnh/ation hould be earned out in eases of endome*noma 
Dr F Ellis agreed with Dr Levitt that dosage lower than 
that urged bv Mr Windever was sufficient 

Dr R Boiltos M^lls (Worthing) said that it was often 
uneconomic to treat patients bv r ravs on nine consecutive 
davs and he would be glad of a scheme whcrcbv thev could 
be treated on two or three davs a week for two or three 
weeks 

Dr R S Mxchsrd\ (Soulhsea) said that occasional failures 
in the treatment of ulenne haemorrhage were due he thought 
to varving positions of the ovanes He had usuallv spread 
T ra> treatment over a period of three weeks and had found 
this better from the patients point of view 

Dr A CR-MO Moosxa (PI> mouth) said that he had lo treat 
patients in a single dav because manv of them travelled long 
distances and could not come dail> He thought it possible 
that in eases of fibroids there was some irradiation effect on 
the uterus itself 

Dr Ralston Paterson (Nfanchester) showed figures demon 
strating the probable cause of failure in the treatment of 
nineteen out of 139 cases of uterine haemorrhage In three 
of these it seemed due to the low age of the patient in one 
to low dosage m five to overdosage and subsequent 
telangiectasia in two to mtercurrent complications and in four 
lo the fact that vaginal irradiation onlv was emploved In two of* 
the cases the diagnosis w*as doubtful and in two mahgnancv 
was discovered later 

Mr W'iNDEiER in replv said that it was possible that he had 
been using higher dosage than was neccssarj but there had 



310 August 6, 1938 


THE SECTIONS SUMMARY OF PROCEEDINGS 


Ti^C rai 

Medical Joifv^i 


been no ill effects He thought that the action of radiation 
uas confined to the ovaries in cases of fibroids 

Dr Ralston Paterson said tint in the tieatment of meno- 
pausal haemorrhage irradiation methods were evidently the 
best There was sometimes a difference of opinion about the 
efficaev of irradiation as against endocrine therapy Suielv 
radiotherapy was in effect endocrinological tn the sense 
that it acted on the ovaries and thus induced changes in the 
endocrine system In the treatment of uterine haemorrhage 
under the age of 40 and of fibroids howeser, the choice was 
between irradiation and surgery and depended on many 
factors of which the blood count and the results of curettage 
weie the most important 


SECTION OF PHARMACOLOGY 
Tliursdai July 21 
Teaching of Anaesthesia 

With the President Professor A J Claru (Edinburgh) in the 
chair Dr E Falkner Hill (Manchester) opened a discussion 
on the teaching of anaesthesia 
Dr Hill said that the student should be taught the funda- 
mental principles upon which safe anaesthesia was based 
Administration of chloroform was valuable for instructional 
purposes because it required of the student concentrated 
attention and appreciation of slight changes in the patient s 
colour The interests of the student and the patient did not 
always coincide If the patient possessed a limited field of 
cardiac reserve the students interests must be ignored and the 
safely of the patient made the anaesthetist s first concern 
He had safely administered light chloroform anaesthesia to 
4()00 cases in an atmosphere rich in oxygen after premcdica 
tion with atropine It had been shown that oxygen to a gieat 
extent protected the Iner of animals anaesthetized with chloro 
form divinyl ether and diethvl ether and the breathing of 
an atmosphere containing only 15 per cent of oxygen was 
sufficient to induce degenerative hepatic changes 
Dr J Gulies (Edinburgh) said that advances in surgery 
had demanded increased mechanization of methods and 
increased skill on the part of the administrator There had 
been no commensurate increase however, in the facilities for 
the teaching of students The whole teaching of anaesthesia 
was at present inadequate and steps should be taken bv the 
various medical schools to give more and detailed instruction 
and far more practice Co ordination between the pharmaco 
legist research worker and clinician must be the basis of any 
wider schemes of instruction which might be formulated 
Dr J Urban Human referring to the stages of anaesthesia 
stated that the third stage, in which operations were under- 
taken could be divided into four planes and 99 per cent of 
all operations could be performed in the first two planes 
This stage could also be regarded as consisting of an upper 
zone of muscular tone and a lower zone of muscular relaxa- 
tion The character of respiration was a useful guide to the 
depth of anaesthesia but it did not help to distinguish between 
the upper and lower zones When the patient entered the third 
stage the pupils were contracted to almost pin point dimensions 
but they gradually dilated as anaesthesia proceeded The 
roving eyeball consisting cither of a flickering lateral or a 
downward movement indicated that thg patient was in the 
zone of muscular relaxation The corneal reflex should only 
be used in an emergency, but the chin reflex consisting of a 
downward movement of the thyroid cartilage and chin with 
eich inspiration served to demarcate the zone of muscular 
tone from that of muscular relaxation 

Dr J T Hunti r stated that a student should be taught to 
iidminisier anaesthetics bv the open method before graduating 
^ more complicated methods In view of the exigencies of 
operiting theatre it was difficult for the practising anacs- 
tlwlisi 10 carry out research Mr James Russell. (Glasgow) 
emphasized that the leaching of anaesthesia was largely a post 
opsriiivc problem He believed that the anaesthetist should 


be called into consultation before the anaesthetic Dr J k 
Hasler said that if the student was taught simple meihoJi 
he would be able to teach himself more advanced ones His 
experience was that even advanced anaesthetists were ofien 
inexpert m simpler anaesthetic technique o 

In reply Dr Hill, deprecated the use of cocaine m a raso- 
phary ngeal spray preparatory to the introduction of an into 
tracheal tube, while Dr Human stated that it was casi to 
pass the tube without the aid of local anaesthesia 


Carbohydrate Metabolism in Anaesthesia 

Dr C L G Pratt (Oxford) said that the administiiaon 
of ether or chloroform was accompanied bvxanous metafolk 
changes of which certain aspects of carbohy dratc metabolwn 
had lately received experimental attention The most slrilins 
of these was the hy pergly caemia produced bv ether, acetylene 
ethylene and nitrous oxide all raised the blood sugar kiel 
to a lesser extent but in general the barbiturates and avertin 
were without effect m this connexion Many explanations W 
been offered as to the mechanism involved in the produciioa 
of hy pergly caemia among them partial asphyxia aiigfflenhtioa 
in _the release of adren iline direct action upon the liver, anl 
influence upon the action of insulin It was generallv agreed 
that carbohv'drate oxidation was the onlv oxidative metabolism 
carried on bv nervous tissue, and this peculiarilj remlued 
nervous tissue especnlh susceptible to any agent interferin’ 
with carbohvdrale meiabolism One hypothesis wav tbit 
anaesthetic drugs produced anaesthesia hy diminishine tbe 
amount of available acetvlcholine as 'a result of cessation or 
diminution of carbohydrate oxidatioft, and so preycnline tbe 
transmission of impulses at synapses m the central nervom 
sysiem 

The President remarked that if acetylcholine was conccrnid 
in anaesthesia one would expect atropine to be a good inw 
thcfic agent 

Anaesthesia in Cardiac Surgery 

Dr J K Hasler described the^melhods he emplojedw 
produce anaesthesia for operations designed to relieve enrdoe 
ischaemia bv attachment of omental grafts to the cardiiv 
muscle The ev ening before the operation a draught of chlom 
and bromide w as given, and one and a half hours before tn' 
operation an injection of omnopon and scopolamine Hit 
an hour later H grams of nembutal i was administered vn 
this was repealed after half an hour if the patient "sv 
asleep General anaesthesia was induced with an ethvl cliloriot' 
ethei sequence on an open mask and later this was repiirc 
bv a Tiegal Henle apparatus which administered a niivii'utn 
ether and oxygen The expired gases were conveved to 
tube dipping into water so that the desired degree of 
pressure could be secured Dr Hasler had not found i 
necessary to introduce an endotracheal tube It was 
sary to use positive pressure until the pleural cauiv " 
opened and the left lung collapsed when the metal lube " 
lowered into water for 5 or 6 c cm It V'as usinliy luam 
tamed in this position until the operation was 
the pressure was incieised during closure of the 
During the operation the patient was supplied 
maximum quantity of oxygen and the left lung 
prevented from collapsing Occasionallv gas would pv^s 
the stomach, but this might be avoided hy pressure nrun 
oesophagus , , .j 

Dr Falkner Hill said that Dr Hasler s paper 
the importance of avoiding anoxaemia He used 
and atropine in preference to omnopon and scope a 
because the former combination was less depressant 
respiratory centre Dr J Urban Hum vN stated tint uj" ' 
and scopolamine should be used in the propor i 
2J3 grain of the former to 1M50 grain of the 
W Ethfrington Wilson (Torquay) expressed 
for omnopon-scopolamme Dr J Gili irs ( 
inquired if the Tiegal-Henle apparatus was csscnlia 
intratracheal tube would make administration easier 



Alglsi 6 I«'S THC SECTIONS SUMM^RY OT PROCEEDINGS TKiBwnia ,11 

MtDICJki JOLTN^t 


Vn'ieMhcsn m l"horicic SurRcn 

Dr J 1 Hi MIR thu in no other brm^.h of vurgerv 
wa*!; the amc'iheii'-t faced "Mh <.iich dinicirlJiCs ns m thoracic 
surgery U ysas impossible to sny that an\ one method yy^i^ 
suitible for all operations each case must be considered on its 
merits The preparation of the patient y\as the sthic as for 
any other operation of any macnitudc but m some cases i 
course of postural drainage \yas insaluablc Prcniedication 
should be of the hchlesi and no druu capable of apprcciabh 
diminishinv. the couch reflca si ould be employed Drucs 
\Mth a transient ''Ction sus,h as sodium cyipan and sodium 
pentothal were \cry yaliiablc High spmal analgesia had 
proyed excellent for lobectomy and ihoracoplasiv Rlecdinp 
yyas reduced to a minimum the cough reflex was undisturbed 
and respiration was unimpeded There yyas hoyscycr a 
tendency to post opcratiyc headache and there ysas n fall in 
blood pressure which could be treated by the use of ephedrinc 
and other measures Rcgardinc general anaesthesia ether on 
account of its irniatinc erect and chloroform except m 
minute do es were unsuitable Nitrous oxide yyas of con 
sidcrable yalue but it yyas diflicult to maintain a steady anacs 
Ihcsia yyiihout using snail quantities of chloroform or diyinvl 
ether Cyclopropane howeyer seemed in spue of a feyy 
disadyantaccs to be ycra suitable for thoracic surgery It 
■xiuld be giyen y\nh a high percentage of oxygen Respiratory 
moyemcni yyas reduced to a minimum and it yyas easy to 
maintain a cough reflex 


SECTION OF PmSIOLOGV AND BIOCHLMISTin 

T}u{rs{h\ Juh 21 

Light in Relation to Climate ard Health 

Uiih the President Profes or H E Royr (Liycrpool) in tie 
chair Dr W R G Atkissi (Plymouth! opened the discussion 
on IiLhi m relation to climate ard health 
Dr Atkins first presented some of the results of measure 
rrcnls of daylight — that is both sunlight and sVy light — so 
that a discussion of the physiological effects proper miuhi hayc 
a full quamitatiyc background His data showcej that the 
energy in the anii rachitic region of ultra Molci light (radia 
tions of yyasc length below 313 millimicrons) yyas a ycry 
small proportion of the total solar energy TTic yyholc ultra 
yiolet region cyen outside the earths atmosphere contained 
only about 7 per cent of that energy yyhcrcas m the yisiHc 
part of the spectrum there was *^2 per cent and m the infra 
red tl per cent. At the earths surface the ultra yiolet light 
yyas relaiiyeh much reduced It was therefore adyisablc to 
consider the possible physiological importance of the remainder 
of the solar energy and the site of absorption of yarious yyasc 
lengths The deep red and short infra red ra>s (about 07 to 
1 4 microns) had the greatest poiser of penetration Deep 
seated healing resulting from their absorption was possibly 
responsible for the stimulation of the tissues In heal stroke it 
yy^s the mechanism of heat regulation of the body that yyas 
inyoUcd and it seemed hkcl> that a well sunned skin in which 
the blood capillaries y\ere larger than in unexposed skins yyas 
better adapted for dealing yyith extremes of temperature In 
England bright summer day light might register up to 125 
kilolux and in the Tropics up to 1‘'0 kilolux Of light 
recci\ed dunng the year in Plymouth 1 5 per cent yvas 
received m December and 15 to IS per cent dunng the 
bnghtest month which might be- May June or JuK From 
three quarters to four fifths of the total light was received in 
the SIX summer months from Apnl to September 
Dr V F SooTHiLL (Norwich) who followed dealt with the 
problem as it appeared to a medical officer of health He 
pointed out that a large body of people in this country worked 
without any day light at all and asked if this were satisfactory 
There was he stated a general consensus of opinion that some 
daylight was csscnlnl He referred to certain experiments 
including tho^c of Niels Finscn on anaemia, yyhich supported 


that opinion but added that yen little accurate scientific work 
Ind been done compirmg the relative values of whole 
light and of artificial illumination Ordinary artificial 
illuminanis *;howed an inadequacy ai ihe blue end of the 
spectrum but more research was needed on the subject The 
new Factories Act ga\e the Home Secretary power to lay 
down a standard of lighting for factories but no power was 
given in the Shops Act 

Dr J V A SiMPsos (Torquay) said that it was onU in the 
la t two or three decades that the influence of sunlight on 
animal nulnlion had been studied The most biologicalU 
active rays were at a \ya\c length of about 3(X) im LMtr-' 
violet rays came from the skv as well as directly from the sun 
in addition the ravs were reflected from the sea as he him elf 
had proved at Torquay some ten years ago The measure 
ment of the ravs had been carried out bv the acetone- 
methylene blue gaucc at Torquay for eleven years and the 
average ranee was from 1 5 units a dav in winter to 14 units 
in summer He showed coloured charts giving the daffy 
mcleorolocical readings ihrouchout the year and revealing 
ho'v muth y^cakcr was the winter sun in ultraviolet ravs 
than was the summer sun Fven the winter sun on the south 
coast in clean atmospheres however was sufficient to prevent 
rickets in voung rats and chickens Fn ^nne there was a 
marked increase in effect owinc to the greater power of tie 
sun and the p'^nclralion of the shorter waves (Tonver e[\ it 
had been overwhclmmcU demonstrated that the smoke screen 
of large towns wuh mist and foe stopped the passage of 
the ravs and it was apparent that mans parls of the country 
suffered from a <enous deficiency of phv siolo..ical light 
especially in winter The effect of d^v light was creates! when 
It followed dirkncss — for example in the early mominu “’nd 
in the spnne Darkness was essential to the succe s of lichl 
therapy The wi<e u c of these stimuli would continue to 
show excellent results hut as Sir Leonard HiH had repeatedly 
cmphasircd there were other factors intermingled— '^or 
example the stimulating power of mo'ing air on metabolism 
It was for medical science to apply the knowledce now avail 
able and ensure the proper utilization of daviichl m the 
promotion of public health 

Mr B D H UsTTtRSs paper in his unavoidable ab ence 
was read bv the President This contribution to the discussion 
Stressed the need for some dosimeter which would measure 
the quantity of ultra violet energy actually received bv the 
patient The ivpc of instrument required as well as the 
standard of measurement ncccssan to satisfy clinical demands 
were abo discussed 

In the final paper before the subject was thrown open to 
general discussion Mr J W J M vl-SU cave his views as an 
cncinccr Rcgardinc the dav light factor he wished on 
behalf of himvclf and Dr Paterson to disclaim anv credit for 
the initiation of its use in order to cypress the natural lighting 
conditions in a budding actually it y\as first described bv 
workers in Germany The use of such a factor was neces 
sitated bv the great variability in the intensity of daylight 
There were several types of instruments now on the market 
bv means of which day light factors could be quickly measured 
and they were being employed bv public health departments 
in connexion with slum-clearance schemes and for other 
purposes Dr Atkins had previously stated that situations 
With a daylight factor of 1 per cent were adequately lighted 
but there were Mr Walsh said manv rooms m which work 
was earned on where the dav light factor over bv far the 
greater part of the working area was much less than I per 
cenU especially in the rooms on the lower stones of large 
office blocks It was probably not too much to sav That a 
large proportion of the urban population of this country spent 
the greater part of its davs in conditions of davlight which for 
at least six (o eight months of the year were miserably 
inadequate While this might be more or less unavoidable 
m certain cases there was no excuse for it m manv others 
Modem methods of construction had made it comparativelv 
easy to provide for more davlicht than was possible twenty 
fiye_years ago 

Opening the genera? discussion Professor W^ P Llnsfov 
(B aghdad) cited clinical evidence showing the beneficial effect 



310 August 6, 1938 


Tnr 


een r 
■ as cf 
Dr 

c t 

id’ 


/i// 




f 

1 i 


\jurtc /rf>«» 

' ,, /rf mtf 


rA'orcLO^^J__^ 

' , . rc-.u/nn "’'""''"“f Cases had p!a\ed an^ 
n the O'- ’"'‘','Lrt 5 emsat<on «as rarely refused if the poMiio 

'^‘ '! ,‘ulntion 10 ""C 

'""\n»>n i‘ "«• “/'' nviriiion the need to abolish bovine tuberculo.b ■- 

ond the importance of detecting the origirj 

"( 'r,f Iroff'ior » 

>rr>» ‘'’"Y 

am -"‘C 


t /' 1" 




health 


(/tuioiil/i) IJf 
,1/ 1 i/iic o 

nn /«.' „c on 

^nnn£: 


a f rcht.nc w 


inW I’c isccrlaincd from 

imdcrproimd train 
i/ic other To 


,,, ,. 7innd amf clues encountered 

' ‘w.nu t cepJ/cd "“Loo obstacle Professor 

f’f ' ! (),e sliifi '"'C”’ heiiier the sensut\it> 

„I n'cutt.mm (Hrisiol) u'q»";cd^,,„V had been m dark- 


if t* 


h J 
to bi-bl 
,ir" "to 
(etrih c 

if/untmafton 




'f ,nd<*idtia/s “'f of cvposurc to strong winds 

1' 't'^tbe skin m sptte of low 


l)'0 


•V>'’'c P;‘'"k'’'cooier (Pis mouth) related a 
wornai where on a etottdi dai lufh 


rnmaftou Norn as wncies... 

‘’ri/Ss acquired a deep sunburn 


^O sun he , “'nr ATKINS said that one of the objects 

in bis finai cepP ^ attention awas from ultra-violet light 
nr hi- P'PCP 'r\he soeetrum as a whole and also to create 
^nd direct it ^ 5 ,oiog> In regard to the influence of 

interest in i^opm ^^i^ effects (1) ervthema production and 
Jight there fjie capillaries which could persist for 

(2) the cn arge thought gradual training could 

quite •’ '"”d 


lone 


enlarge the capillaries and therebv alter the 


Thoirwood sTpPh io the skin 


, cotinin and the importance of detecting the 
Tarce of infection in a familv He did not believe in if 
iilut of the evammation of child contacts 
Or G S Todd (Midhurst) pointed out the madequaev c‘ 
the leaching of undergraduates so far as pulmonarv mh^ 
eulosis was concerned It should be compulsorv for them lo 
spend three months tn a chest hospital so as to fatmlnii;. 
themselves with the various aspects of the disease Onlj loo 
often had patients been seen with svmptoms suggestive cf 
pulmonarv tuberculosis months before thev eventuall> ieatl*i 
the sanatorium He deprecated the use of the terra lufe. 
culosis dispensarv , to call such a dispensarv a chest dim " 
would encourage more people to attend The public vfouM 
be educated to the belief thal tuberculosis was a curaf 
disease 

Dr G Jessel (Leigh, Lancs) believed that the ttamins of 
undergraduates in tuberculosis was adequate, at least in for. 
places He was surprised that Professor Dunlop had re 
referred to the importance of radiographs m the pieventio-i 
of tuberculosis Dr Jvmes Crocket (Glasgow) thoudii IH 
too much stress had been laid on the epidemiologv of tuk 
ciilosis The death rate from this disease had fallen becais 
of improved conditions of living and becau.e of the proiivo 
made for dealing with the disease Much could vet be do 
lo decrease the incidence and mortahtv of tuberculosw b\ 
prompt and thorough action In his experience, when a rtt 
case of pulmonarj tuberculosis vvas notified am thing Iron 
SIX lo twelve weeks elapsed before the local authotit> coi'd 
deal with the case, and during that time the patient vi' i 
progressiv elv down hill 


SECTION OF TUBERCULOSIS 
T/tiirsda), JttI} 21 
Prevenhon of Tuberculosis 

With Dr Ernest Ward the President m the chair Professor 
D M Dunlop (Edinburgh) opened a discussion on modem 
\iews on the prevention of tuberculosis * 

Professor Dunlop, referring to the factors that might 
account for the falling mortality from tuberculosis mentioned 
particularlv the possible existence of epidemic waves and the 
part played by anii-tuberculosis measures There vvas no 
reason to believe that an epidemiological curve could not 
be modified beneficially bv human effort He thought that 
adult tuberculosis usually occurred as a late visceral manifesta- 
tion of an earlier disease Efforts should be directed, there- 
fore, to the prevention of massive primarv infection in the 
voung child These endeavours he maintained must be 
directed along two mam channels children must be pre- 
vented from coming into close contact vvith cases of open 
tuberculosis and a clean milk supply most be provided As 
to the first of these it was probablv more satisfactorv to 
remove and treat the adult patient who vvas the potential 
source of infection More beds for this purpose were urgentlv 
needed It vvas doubtful if anv phvsician in the pufflic 
health service did hts dutv adequatelv unless he vvas being- 
a continual nuisance lo his committee in this respect Raising 
the resisiance of the individual bv improving certain environ 
mental conditions vvas important in prevention as was the 
idcquaie training of future practitioners in the diagnosis 
of carlv tuberculosis He concluded bv saving that some 
lulhorities had stressed the difficultv and impracticability of 
cvimming contacts vvhile others claimed that these examina- 
tions in the widest sense were among the most important 
Junctions of the tuberculosis dispensarv vviih the latter view 
jbe could not too stronglv agree 

F Dr I KNrsT Wvrd the President thought that up to 1915 
the 1 ill in the mortahtv from tuberculosis vvas due not to anti- 
ii bcrculoMs measures but mainlv to general public health 
nicisurcs ind the improved standard of living since 1915 


Dr F ] H CouTTS (Bournemouth) said that much no 
education of both the public and the medical profession vv" 
needed The general practitioner vvas often to blame for ri 
applying simple measures for the diagnosis of pulmonin 
tuberculosis Dr A Nex ille Cox (Brighton) referred to ih 
effect of war conditions on the mortahtv from tubcroilo' 
and lo the fact thal pulmonarv tuberculosis vvas often qci 
symptomless in the earlv stages 

Dr Grecorv Kavne (Staines) said that exogenous re inftv 
tion was possible — at all events when the dose was miS'we-' 
as was shown bv a case recentlv recorffed A medical n r 
whose tuberculin test vvas known lo be positive altemrtcdK 
commit suicide bv injecting into himself a culture of vinii 'i 
tubercle bacilli , in a verv short time he died front generator 
tuberculosis ft had now been shown that BCG vvas ir 
offensive but its protective effect vvas limited In 
circumstances its administration even in this country 
be of value in individual cases The removal of children he ^ 
households in which thev were exposed to the danger c 
infection should be necessarv onlv for short periods, and "a* 
he thought practicable The examination of child conu 
was of great xalue if performed propcrlv it should in 
Mantoux testing the taking of aniero posterior and lat'r’_ 
radiographs and an examination of the gastric contents i 
suspicious cases 

Black Spots in Tuberculosis Distribution 

Dr F J H CouTTs (Bournemouth) opened a discussion o 
black spots in tuberculosis distribution He indicated ^ 
regions of high mortahtv and discussed in some detail sc 
factors as race occupation (with special reference 
faring) housing and samtarv conditions overcrowding , 
gallon and migration For practical purposes the 
factor should be ignored in considering measures to cv 
against tuberculosis He laid stress on the j 

housing and samtan accommodation and above all 
stricter insistence on the segregation of infective cases 

Dr D A Powell (Cardiff) said that the whole ot 
was in a sense a black spot compared with ^ 

Scotland which themselves were black spots "I ^ in fi 
with Holland, Denmark New Zealand, and Canada 



LCUST 6 


THE SECTIONS SUMMARY OF PROCEEDINGS 


IHE BRrrSTI 
\* DtCAL JofX KL 


nj-c group from to 2*' vcnrs per cent of the dcuhs 
among nnlcs *\nd per cent of tho l imonc fern lies were 
due to tubcrculoM«i Tlic corre pondinn proportion', for thoNC 
per'-ons between 2^ rnJ were ”'1 nnd ts per cert \ high 
mortnlitN nmoni. \ounc ndult’^ wns howtNcr il o found m 
other eoiinirics In the twcnt\ fuc xeir** there Ind 

been 1 decline of '0 per cent in the niort'tlit\ from tul cr 
culoMs in Wilci IhiN f'\H wns much Ic'*'; thin in Enchnd or 
Scollind The three mitn o^-cupilions of the people of Wilc'i 
—^oal mining (e<pccnll\ of mthricitc) quirrMnu ind vci 
firinc — brouchl added ri‘>K' Other fictors were depopuliiion 
ind the intcn'^e con^eriituim of the voenl ind dorrevtic hibii'i 
ind the clo^cnci,s and lcnacit\ of the famih rebiionvlups in 
Viilc*; He did not thmV tint the ricnl fictor pliNcd in\ 
part but po^c^t\ was ccrtiinU of prime importance 

Dr C Rolix'^ton (Rutland! a^ked what wi*; the part 
pla^ed b\ ilcohoh^m m the problem under di<cu'.MOn Dr 
CotTis in hi^i reph considered tint ilcohol wk not of much 
importince Dr Powtil 'aid ihit ilcohoh'm wis ilmo i 
non eM'tcni in N\ lies 


SECTION or OPHTH \LMOI OG\ 

Tf untlt 2 \ Jtit\ 2! 

Co-operation in Cases of \ i«ual Loss 

^^llh Sir Sttw KRT Dlkf Eldlr in the chair Mr C B P 
Tiw (Plymouth) opened a di'cission on cooperation between 
ophihilmoloci't and physician in ccrtiin ca'C' of M'lnl lo ' 
He vaid that the ophthalmologist wis omciimcs the fir^t to 
'-cc 'igns of established general di'ea'c not beciu'c others 
hid o\crlooked them but becau c piticnis considered eye 
'ympioms as a 'eparatc entity from other bodih symptom' 
and al'o because (he ophihalmo'copc micht clcirK resell 
lesions that cl'cy^hcre could only be inferred — for example 
eye changes m chronic ncphnti' diabc’cs ind Inpcrpicsjs 
\ number of un'olycd problems iro'c in this connexion such 
as the clinical fact that there was no pirallclism between 
chances in the fundus and the scscrity of hypcrpicsis \ 
similar difl1culi\ was seen in a recurrent Mtreous hacmorrhace 
yyhich occurred in apparently healthy young iduUs Mr 
Tiyy referred to the good that could be done by re i m eases 
of thrombosis of i branch of i retinal yem and the diagnostic 
significance to be attached to diplopia from paralysis of 
the external rectus in hsperpicsis \ studs of field defects 
was most helpful in localizing cerebral lesions and in 
ascertaining progress sshilc ocular lesions in ipparcnils 
healed cases of head jnjun might 'how the true state of 
affairs Collaboration ssas possible m other directions in 
his e\penence at least two cases of neurasthenia were relieved 
by a timely operation for cataract 

Dr E McClllocii (Plymouth) said a better understanding 
cf eye diseases by general practitioners wis cs^cniial if un 
qualified practice m eye work yyas to dimmish He insimccd 
ca^es where the time factor was irnporiant as shoyyjng the 
need for collaboration 

Professor J A Nixon (Bristol) dress attention to the \iluc 
of perimetry in diacnosis and emphasized the disturbances 
caused by siiamin deficiency In vitamin A deficiency there 
was diminished dark adaptation in vitamin B, deficiency — 
for example m beriberi — rclinil haemorrhages yvcrc pre ent 
y'hile acute glaucoma hid been described in epidemic dropsv 
Collaboration between ophthalmologist and phy'icnn was 
most helpful in the toxic amblvopias Dr C M Hinps 
H oyyELL discussed a number of neurological conditions par- 
ticularly chiasmal syndromes caused by localized arachnoiditis 
Other subjects he discussed were the visual symptoms of 
tumours of the occipital lobe recovered meningitis with 
secondary optic atrophy amaurotic familial idiocv Schilders 
disease and cataract in dystrophn myotonica Dr R N 
Crmg (E-xeter) held that it yyas not beciuse the psychiatrist 
overlooked the significance of such an essential function is 
vision ihil he saw so small a number of patients with serious 
eve trouble The fact was thit the blind npidh adapted 
themsches In contrast with the deaf who become isolated. 


the blind rcccncd much sympathy Functional blindness was a 
defence mcchmism igainsi c\quiMlcI\ pimful memcncs of 
eventN issocnicd with seeing and this blmdress w^s generally 
issoented With amnesia 

fn the sub cquent discussion Profc sor A J ByLL^sTv^E 
(Glasgow) emphasized the tuberculous character of at lea t 
some cases of recurrent vitreous haemorrhage and pom ed 
out the hek of knowledge on the aetiology of hvp'^rten ive 
retinitis Mr Rvnsom Pickvrd (Exeter) instanced a case of 
iiniocuhr retrobulbar neuritis which after thirty years 
showed no sicns of disscmmited sclerosis He also related 
ihit Ncllleship held that a patient 'yho became completely 
deaf became as placid as one yyho y as completely blind Mr 
R L Bickirton drc\y attention to the pitfalls in the diagnosiii 
of migraine especially in relation to cerebral tumours Dr 
R M MfKisr (California) quoted American yyork indicating 
a deficiency of vitamin B and o^ calcium in a high proportion 
of patients sufTcring from eve and ear nose and throat 
afTcclions 

srenoN or obstetrics 

H /n/y 20 

TIic Oostcfncal riyinj; Squad ’ 

In a paper on the orginization and u es of the obstetrical 
fitinc sqind Professor H rvRQittiR MiRRvt said that the 
vqu d which was now m cs cntial part of a modem maicrnil 
scry lee yyas e pceially dcsiened to deal yyith iho e acute cn es 
Ihit might Owcur in the most carefully supervised ca es Cases 
most urgently in need ol ueh c erviee were tho c m whiwh 
there was shock and post partum or ante partum haemorrhage 
but e I'Cs of threatened or actual eclampsia difficult labour 
or failed forceps would also derive benefit A doctor faced 
with an emergency cn a mcssace to the maternity hospital 
givinc particulars of the case and the name of the consultant 
on the panel whom he wished to attend Since the inception 
of the crvicc in October 19’** there had been forty six calls 
\monc these y\cre nnn\ verv ill and dvinc women and 
vet there had been onh five deaths No major operative work 
wav earned out at the patient s home if this could be avoided 
Slime and Wood transfusions simple bipolar version repair 
of '’n\ badly tom perineum etc were performed 

Disciissjnu blood iransfucion in obstetrics Dr M Bt-SCk 
(GIjscow) said that the difficulty of secunng recipients serum 
had been overcome b\ the use of a special cylinder and piston 
designed b\ him in collaboration with Dr Sheehan A small 
quantity of the patients blood was placed in the cylinder and 
a stronc piston was scrc'vcd down and the blood squeezed 
against a Zcilz K filler the scrum was coPected from the 
end of the cylinder With this apparatus enough serum for 
testing against the red cells of several prospective donors could 
be obtained wiihm a few minutes From 600 to 1000 cem 
of blood were usually given over a period of fifteen to tv en v 
minutes The administration of a few drops of ether on an 
open ma«k at the becinning of a transfusion served to keep 
the patient quiet and had a useful stimulant effect 

Miss Lctitm FMRntLD congratulated Professor Farquhar 
Muirav on the excellent results of his emergenev unit It 
was pointed out that the high degree of efficiencv of the LCC 
ambulance services had not made the introduction of the 
emergency unit m London so pres mg There were however 
such units now m existence in the LCC area 


The Advisory Committee has recommended and the Trustees 
for the Leverhulme Research Fellowships have approved 
nineteen awards tenable for varying penods up to two years 
These include awards ot Fellowships to W Cule Davies D Sc 
Lecturer m Chemistry Dniversily College Cardiff (studies of 
(he organic compounds of nitrogen pho'^phorus and arsenic) 
\\ H S Jones Liti D Lecturer and President St Catherine s 
College Cambridge (Greek medicine and Greek thought from 
"*00 lo 300 BC) and O A Oeser M Sc PhD Lecturer in 
Experimental Psychology St Andrew s Unnersitv (the 
combined method m the social sciences) 



314 August 6. 1938 NUTRITIONAL MACROCYTIC ANAEMIA IN MACEDONIA 


rilEBUTKH 
MtDlCA,l. lOUSU 


\ 


Reports of Societies 


NUTRITIONAL MACROCYTIC ANAEMIA IN 
MACEDONIA 

At the annual general meeting of the Royal Society of 
Tropical Medicine and Hygiene, with the president, 
Lieutenant-Colonel S P James in the chair, a conjoint 
paper on nutritional macrocytic anaemia m Macedonia 
was read by Dr N Hamilton Fmrlea 

Dr Hamilton Fairley pointed out that in a paper read in 
association with R J Bromfield before the Society last year 
the prevalence in Macedonia of tropical macrocytic anaemia 
w is recorded in pregnancy as well as in male patients with 
malaria and black water fever journal, 1937 1 629) 
As this was the first time that a megalocytic anaemia of 
nutritional origin had been reported on a large scale m 
Europe they had returned to Macedonia eaily this year 
to study the situation in more detail in conjunction with 
Mr Henry Foy and Dr Athena Kondi at the League of 
Nations Malaria Research Laboratorv, Thessaloniki 
The present preliminary report was the outcome of their 
combined efforts to get a clearer insight into the 
megalocytic anaemias there 

General Considerations 

The patients were mainly Greek refugees from Asia 
Minoi, some 700,000 of whom had been settled in villages 
scattered throughout the plains and mountainous regions 
ol Macedonia Macedonia was an intensely malaiious 
countiy with a ‘ spleen rate approximating to 40 pei 
cent and varying from 70 to 90 per cent in some 
ol the villages from which the patients came In the 
lefugce villages poverty was rife meat, eggs and milk 
were little eaten and the diet generally was verj deficient 
in sources of animal protein as judged by European 
standards 

Though the syndrome commonly encountered m 
Macedonia was similar to that previously described by 
Fail ley Giglioli, and Napier in tropical patients, difficulty 
was experienced in naming it In the first place, the term 
‘ tropical seemed hardly applicable to a disease 
originating on a large scale in Europe In the second 

place though they were satisfied that the anaemia had a 
nutiitional basis, certain features generally present such 
as splenomegaly and reticulocvtosis and such evidence of 
haemolysis as hyperbilirubinaemia urobilinuria and 
bilious stools were absent in uncomplicated tropical 
macrocytic anemia as described bv Wills m man, or m 
the experimentallv induced deficiency in monkeys In 
then present Macedonian series three types of macrocytic 
anicmn hid been recognized (1) haemolytic, (2) non 
hiemolytic (31 aplastic For the reasons given above 
they proposed substituting for the name tropical macro- 
cytic anacmii that of nutritional macrocytic anaemia 
— i term which would include as subgroups the common 
haemohtic type the infrequent non-haemolytic type and 
possibly the rare aplastic type as well Microcytic hypo- 
chromic anaemia — so common in pregnant women in 
India — w IS only once encountered, and in this case there 
hid been a seiere post-partum haemorrhage some three 
Weeks presiously 

Clinical Findings 

The clinical picture in the haemolytic type was striking 
and resulted from a combination of factors including 
(I) pinmielopathy with megalocytic anaemia and its 
ttendint sNmptoms (2) haemolysis associated with 
knomegalv (3) mechanical disturbances caused by 
isciral enlargement and (4) cardiac decompensation 
IhonOi amcniia was intense and hiemolitic icterus often 
ssidsnt the general nutrition was iinexpcctedh good the 
n Ills and teeth being excellent and the usual lingual features 


absent The utenis as it extended upwards was often dh 
placed to the right by the enlarged hard spleen while the 
hver was not infrequently enlarged and tender from con 
gestive failure Pressure effects on the diaphragm \ure 
sometimes evident 

Subjectise symptoms included lassitude, weakness achine 
muscles, shortness of breath palpitations, giddiness, and 
syncopal attacks Anorexia, epigastric discomfort ahdomrojl 
pain and flatulence after meals were common Free acid 
was generally present, and in twenty consecutoc cases ihe 
gastric juice showed the presence of hydrochloric acid follwi 
ing histamine injection Diarrhoea was rare and, in contra 
distinction to sprue the glucose tolerance and faecal fat were 
both normal Dyspnoea and cough were frequent and upward 
displacement of the diaphragm tended to compress the base 
of the lungs The apex beat was occasionalh displaced 
upward and at times the right heart was obvioush dilated 
Signs of decompensation included jugular engorgement and 
pulsation enlargement and congestion of the Iwer, basal raky 
and oedema of the feet and dependent parts Albiimimna 
was not uncommon but casts were rarely found Utobdimira 
was the rule and the blood urea was commonly derated dw 
piobabh to blood destruction rather than to urea retention 
No definite evidence of subacute combined degeneration of 
the cold or neuritis was forthcoming 

Not uncommon was a secondary thrombocrtopeni. 
purpura manifested by skin haemorrhages bleeding from 
the nose and gums and sometimes from the other mums 
membranes as well The platelet counts in these cases v wed 
from 5 400 to 54,300 per c mm 

Hacmatological Findings 

The blood picture was that of a mcgalocrtic anaemia "illi 
increased mean corpuscular volume increased mean cor 
puscular haemoglobin and a colour index equal to or ct 
cecdtng ] 0 In these profound anaemias blood films fised 
and stained with Jenners stain often prosed unsmlable fot 
Price Jones measurements owing to rouleaux formation and 
excessne shrinkage of the erythrocytes With Lcishmin 
staining (svhen fixation svith methyl alcohol ssas of shoriu 
duration) the shrinkage was often less and in a number of 
instances typical megalocytic curses ssere obtained Nornto 
blasts and ery throblasts often appeared in peripheral b'ocu 
smears Smears from the sternal marrow shots ed considerable 
hsperplasia of the red cell senes, haemocytoblasts and erylbm 
blasts being generally present in large numbers EhiKO 
mcgaloblasts ssere demonstrable in most cases but it 
rare for their csloplasm to has'c ripened beyond the polj 
chromatic stage and it never stained a decisis c pmk 
striking feature svas the presence of atypical cells of t ' 
neutrophilic senes including pathological promjcloctic' 
mselocstes and nactamyelocstes 

The changes observed included precocious nuclear N' 
morphism atypical granulation of the cytoplasm cy'opn''”' 
sacuolation and perforation of the nucleus The urt^ 
palhologicallv altered stab forms described by Tcmpla 
Braun in pernicious anaemia were often evident 
cylic nuclei devoid of cvtoplasm were not infrequent a Im ' 
suggesting that these cells were also affected The 
reached svas that in nutritional macrocytic anaemia there 
a panmyelopathy of the bone marrow similar to that recin > 
described in pernicious anaemia 

Conclusions 

Both clinical and pathological findings pointed 
chronic malarial infection in thesd cases On Ine 
hand during the time they were under observation 
of malarial origin was infrequent and parasites ^ 

found in the peripheral blood or sternal marrow s 
In cases coming to necropsy the characteristic Ra 
chronic malaria were observed Active ,| 

increased phagocytic activity of the ^ "j jr-i 

elements were very evident in sections of ^ J’ ,.fon 
spleen m two cases studied by Professor G 
malaria pigment and haemosidcnn were also pre s 



\Lilsr 6 19 S NUTRITION \L M \CROCYTIC ANAEMIA IN MACEDONIA Tm BiLmsH 


THl conclusion rL'ichtd uns ihu nuiruionil dislurb 
m the bone nnrrou ktl to the production ol red 
cells which Were sonitVNhit ibnorni if md ihii the reticufo 
cndoihcliU s\siem alrcidv Inpcrtroplued is n result of 
chrome m'lhrn phiccestoscd thes^ non p irism^td cor 
pvivvlci» with the production of n superndded hiemolvlic 
nn'icmn Ml iMilible diii — elinicil piiholotic-il 

hacm'itologioil nnd biochemical — supported sueh i thesis 
Time did not permit full con«-ider'Hion of the h amnio 
response to ihenpv bin in ccncril n might be snid 
thni during pregnanej both nnrmiic ornlh ind loer c\ 
tmci b\ injection hnd to be cacn in n much hrger desnge 
than was custeman m tropica! microcviie irncmn in 
India to gel a maximal rcliculocMcsis even wlun this 
was attained subsequent increase m the red cell count 
w^s slow This was probibh due to the hacmoKtic 
factor which complicated dictir> dcfieicncv in the vast 
majoniv ol the Macedonian cases 

General Discussion 

Dr Liyx m openme the dacia ion said tint her 

work had been confined to the uncomplicated dt ca«-c {.crcralK 
known as tropical maerocMic anaemia but she agreed that 
m future n michi with advantage be called nutritional 
iracrocviic anaemia as 0r Tair/cv and fits coffcacees mic 
ce cd and that the name tropical macroevtic anaemia 
should be abandoned or be u^cd onl\ for tropical ca es as a 
su'^secuon of the general heading She had met crises smular 
to the Maetdoman ones in India but had provi<ionallv re 
garded them as cases of acholunc jaundice and unsurtaMe 
for therapeutic tcsimc She aUo had seen some of the Mace 
donian cases and vsas inclined to accept the view pul forward 
that there ^as a nutritional factor and aUo a hacmohiic 
fuctor dependent on reticuloendothelial hvpcrtrophv resulting 
from chrome malaria The amount of Incr and marmilc 
required to induce a rcticulocvic response and also the small 
rue in the red cell count sugcesicd that all the Macedonian 
cases were complicated It also had to be remembered that 
the curative factor both in these Macedonian cases and in the 
tropical ones seen in Combav might not be liver principle 
pure and simple hut some other factor distinct from liver 
Her espenence in regard to Price Jones curves acrced with 
that of Dr Fairlev Some prcliminarv cxpcnmcnls sucgcsicd 
ih'’i dilution of blood in the presence of an excess of bilirubin 
mght cause shnnkace of the cells on a smear but not m \/io 
Dr JxNET VsLCHVs said she was not prepared to accept 
the sucgesiion that the discrepancv between mean corpuscular 
volume and corpuscular measurement was due to an iricfaci 
or some abnormaliiv dependent on the method of suming 
s nee It was known m acholuric jaundice and had abo been 
seen in mild anaemias in pregnano where it was associated 
With increased cell thickness and increased fragililx The 
remarkable variation in the picture of marrow obtained hv 
sternal puncture described b\ Dr Fairlev vvas abo seen in 
cases with Addisonian anaemia and mans showed as definite 
a disturbance of white cell maturation as of red eel! matura 
tion — in this wav resembling nutritional macroevtic anaemia 
Addisonian pernicious anaemia however did not exhibit the 
purpunc manifestations described bv Dr Fairlev She inquired 
whether the diet m Macedonia was deficient in vitamin C 
Professor L E Isvpicr said he had been doing verv much 
the same t\pc of work in India and had just compiled an 
anahsjs of fiftv seven ca<es of anaemia in pregnanes His 
senes included a large group of microcviic anaemias The 
whole population had a microcviic blood picture and those 
films which elsewhere might be termed normocvtic were realb 
macroevtic Some factor existed which decreased the size 
of cells in the entire population The microcviic anaemia 
was due to dietetic dcficiencv or to ankvlostomnsis the 
macrocMie anaemia to dieiarv deficiencv and/or malaria In 
the latter respect his conclusions were verv much the same as 
tho^e of Dr Fairlej In regard to the suggestion of alteration 
in nomenclature he considered Macedonia was subtropical 
and thought that in the precent state of knowledge the name 
tropical macroevtic anaemia should stand 


Dr G Frx<;er pointed out that these severe and complicated 
tnicmias were common among labour forces on tea estates 
in \ss'ini There patients suffered from dietarv deficiencv 
malaria and hookworm but he did not consider hookworm 
to be more than a minor contnbutorv factor The majoniv 
of eases came from malarious estates with a spleen rate 
of ^0 per cent or more and practicallv none carre 
from estates with a spleen rale below 10 per cent 

Treatment was on the whole unsuccessful marmite treat- 
ment in doses of 24 grammes dailv was di appointing 
m late eases and canipolon even in doses of 5 cem 
dailv for ten davs often failed In cases after the seventh 
month of prccnancv wnh counts of under J 000 OCO 
red cells per c mm the position was desperate but a belter 
re ponsc might be obtained with the larger doses adopted bv 
Dr f iiricv In such eases blood transfusion was liable to be 
tollowcd bv grave reactions and induction of labour to prove 
fat il on account of shock 

In repK both Dr Fairlev and Dr N\ills pointed out that 
St med smears from mile patients with nutritional macroevtic 
anacmi 1 showed the same difiiculiv in regard to Pnee Jones 
mcasiircmcnls Dr Fairlev said he was ven interested m what 
Dr \ iughan hid sud in retard to increased fragiliiv Thev 
had failed to demonstrate increased fragihlv ol ihe red cells 
bv oualitativc methods tn six cases in their «enes of 
nutritional macroevtic aracmia He acrced however that the 
red cells were abnormal md thoucht that more delicate quan 
Illative methods mtchl vet reveal increased fnciliiv So f^r 
as could be asccrlatncd there was no evidence of viiarnm C 
dcficicncV in the diets of patients developinc purpura and 
the condition w i invarnMv asspci fed with 'crv low phic<cl 
counts 


Correspondence 


Abortion nnd the 

Sir — M ost of \our rtadtrs who ha\e studied the report 
of the ease to which \ou refer in ihe leading article 
entitled Therapeutic \bortion and the Law will prob* 
abl\ agree that the issue of widest importance to cur 
profession is the interpretation gnen in the case to Ihe 
csprcssions danger to life and presersing life and 
Ibis irrcsptciisc of an\ \iews the\ mas hold of the initial 
esent which led to this interpretation reccising the sanction 
of the law 

In commenting upon the result of the trial >ou Sir 
express Ihe siew that the law has been clarified from 
which It seems reasonable to conclude that sou regard 
these isso expressions as basing been gisen greater clarits 
and definition than thes formerls possessed, and Ihe pracli 
tioner as basing ailaincd in consequence some measure ot 
freedom and securits in a certain respect that he did 
not prcsiousls enjos under the lass I senture to submit 
that a logical case mas be made out for the siesv that 
nothing has in fact been clarified and (hat so far from 
receismg ans adsantage from this interpretation those 
ssho practise medicine m this counirs must noss be less 
certain of sshat protection thes mas expect from the lass 
in anj gisen case than thes ssere before it ssas sanctioned 

In considering this question it is essential to dismiss 
all irrelesant factors and of these the factor of rape is 
cerlainis one for the serdict did not gise the right to 
induce abortion for pregnanes ensuing upon ravishment 
nor did Mr Bourne ask for this The point upon which 
the case hung ssas clearl> the meaning to be attached to 
the expression danger to life Now this expression has 
nexer been and of Us nature can never be capable of 
exact definition At most it can but connote that order 



J!6 August 6 1938 


CORRESPONDENCE 


Tiitflunbii 
Mtoicu Jouvu 


of moral certainty that is all we can look foi in medical 
assessments But at any rate men could agree about Us 
meaning even if it left the precise expectation of the life 
of the imperilled person a matter of some uncertainty 
Perhaps the associated expression “ preserving life 
possessed an even higher degree of literalness in ordinary 
use whether by doctors or laymen 

A study of the case report makes it clear that there 
was nothing literal in the interpretation of these terms 
accepted during the hearing or by the jury at its end 
In the course of this hearing the judge expressed himself 
as unable to appreciate any essential difference between 
danger to health and danger to life and then proceeded 
to cite an instance where health was impaired but life 
not threatened But this is to admit that there may upon 
occasion be a profound difference between the two In 
other words to the aphorism “ life depends upon health 
the inference that danger to health necessarily connotes 
danger to life is a non sequttin Indeed, has not the 
native wit of our ancestors embodied the general recog- 
nition of the fact m the old saying that “ creaking gates 
hang the longest ? 

Thus It IS that the geneiahzation that there is no clear 
difference between danger to health and danger to life 
IS not one that can be regarded as useful to the doctor 
who in his practice has to deal not with categories but 
with individual sick persons For the doctor then, it is 
reasonable to hold that nothing has been clarified by this 
exegesis of the expression “ dangei to life, though it 
appears that he may in future be expected to make it a 
basis of action But this is not all, for not only has 
d inger to health been accepted as the equivalent of danger 
to life but two modes of health — physical and psycho- 
logical — are now proposed to us as capable of being 
sepaiately endangered that is to say ‘life is now 
threatened from two quarters In short psychological ill 
health mav now be equated with danger to life It follows 


While the two debated expressions do not belong soklj 
to the grammai of medicine yet they are familiar ckmuih 
in that grammar, and it is plainly desirable that— as vuih 
all other elements in any scientific or_technicil grammar- 
they should possess as clear meaning as we can give th m 
Can we now say, either as scientists or as practitioner^ 
of the art of medicine, that the new, extended, and virtuallj 
indefinable meanings now given them really enhance tlieir 
value to us‘> Has this legal interpretation rendered them 
more comprehensible elements in our medical grammar, or 
has it conferred upon us as practitioners a measure ol 
secure freedom we did not previously enjov’ 

1 submit that the answer to both these questions is plainlj 
in the negative, and m respect of the second question it 
would be easy to' emphasize the difficulties and iin 
certainties that now surround the problem you suppos 
to have been clarified' 

However, I am anxious not to stray beyond mv modist 
purpose of a defence of clarity and precision in medial 
terminology — that is, a defence of clear thinking m medi 
cine and a protest against the thesis implicit m jour 
article that facts may be altered by using different vvordi 
about them If it be said that all this is to make of a 
live issue a mere matter of words I may reply that if 
the words we use have no discoverable and definik mean 
ing vve cannot think clearly or act reasonably At a first 
glance the law, by this verdict may seem to have con 
fei red upon us an enlarged measure of freedom, but. at 
one who believes that medical terminology may be mote 
safely interpreted by doctors than by lawyers 1 pro 
foundly distrust this similitude of freedom, and "iih 
Laocoon — than whom I hope I may be more fortunate iti 
my intervention agiinst popular opinion— I say ‘ imw 
Danaos, ct dona ferentes ’ — I am, etc , 

London W I, July 30 F M R WaLSUE 


thit the expression preserving life has suftered a pro 
portionate loss of definition for it may now be lawfully 
taken to mean no moic than the averting of a possible 
(and problematical) neurosis So far have vve already 
travelled fiom reality' 

Now if (he expression danger to life in its old literal 
ness lacked the highest degree of exactness and lacked this 
bee uisc the ai i ol prognosis is beset with uncertainties 
bow much less exact has it now become' The inlel- 
kctuallv candid doctor will admit that forecasts of psycho 
logic il hedth are highlv speculative In this as yet 
impwrlectlv won field of medical knowledge such fore- 
cistb cannot be invested with any known or measuiable 
degree ot probability and the candid doctor will be 
c unions m making them, knowing as he does the ever- 
picscnt dmger of self deception, ot exaggeration and even 
ot gross error In short when vve come to equate danger 
to lite with danger to psychological health wc sec lhat 
the former term has alreadv become a pure figuie of 
speech ind h is ce ised to be in element in the grammar 
ol medicine Surely to speak of this as clarifying anything 
IN to be deceived by a play on words Some may indeed 
hold lb It legil sanction for the induction ot abortion with 
i view to iverting the development ot a psychoneurosis 
IS 1 goead thing but to miintain that this is equivalent 
in sense to the judge s ruling that the unborn child must 
^not h^ destroved except for the purpose of preserving the 
l^ei more preeioiis lite ot the mother is a teal of ratio 
w) iiion that 1 confess to finding quite bevond my powers 
^e! this is whu the verdict does in tact permit a doctor 
to in lint iin 


Cancer of the Lung 


Sir — Il is with some diffidence lhat I criticize )Wir 
excellent leading article on cancer of the lung in 
Journal of July 23 (p 184), but the statement ' Tlx 
usual operation is lobectomy, or even tola! pniu 
mectomy,” cannot be allowed to pass unchallenged i 
suggests that lobectomy is the operation of choice in 
carcinoma of the lung , if such a belief is mainliincd an 
practised the results can only lead to disappointnxn 
and hold up the progress of thoracic surgery 

It IS very rare to find a malignant growth of the "ni 
which IS technically amenable to lobectomy, c'*"' ’ 
were desirable It is just as important to plan a n *■ 
opeiation for carcinoma of the lung as it is for 
growths elsewhere in the body The lymphatic c 
munication between the lobes and at the htliis makes 
pneumonectomy with individual ligation of the 
and closure of the main bronchus near the bifurcata"' 
the trachea the only radical procedure 
Until some more rational treatment of caac'- ^ 
established this is the only form of attack on c 
of the lung that can be claimed to be anything 
than palliative With modern improved met ® 
diagnosis and operative technique there is no reis 
the results of surgery for carcinoma of the long 
not be at least as successful as those in jr-j 

stomach which is admittedly a poor standard to 
bears no paTticiilar justification for professiona P 


1 am etc , 

London, W 1, Jul> 29 


Vlunon C Tiiovti-S"-’ 



Aiglst 6 I9^S 


CORRESPONDENCE 


Injection Risks — V Case of G^s-g'^ng^cne 

Sir — Sour innoniion of \pril '^0 (p 9SS1 on injection 
risks so impressed me ili it 1 issued n circiil ir to dl the 
hospitils ind dispLnsirits tinder me wTrning them of 
the danger ol using lupodermic ssringes tint had been 
kept or c\cn sterilized in aleohol but idmittine that 
in p'actice 1 did not see how thc\ could boil c\cr\ 
saringc for ten minutes m 3 p^r Cent sodium bicarbonate 
lotion and ccrtainU autocl ts mg is out of the question 
Before reading tour article I regret I w is not iware of 
the danger referred to hut hate now Ind it brought heme 
to me most titidlj 

On June 16 a feeble man of -.0 tears s fi s m m height 
but onlv 6 St I' Ib in "eight was admitled to the Windham 
Hospital m Jodhpur for dssuria His blood pressure "as 
ICOifO blood urea ,P ng urine urea 2 per ccni Hb per 
eent„ and indigo-carminc cserclion from the righl ureteric 
onfice bclo" sp p^r cent of normal bin etccllcnl from the 
left side \s the bladder ssas sliubtls infcclttl he ssas at ro 
time submitted to ureteric calhcteriration and as stmieht 
a rass "ere conclusoc there "as no need to etpend int 
uro elcstan on him 

The diacnosis "as a phosphatic bladder stone and a stone 
in the nght kidnet \ t"o st gc operation "as dcsided on 
and so his bladder stone "as crushed under a caudal blOi.k 
anaesthesia on June 20 His condition improted after this 
and on Jub 1 under ether I did a right nephrectoms Ibe 
kidncv not being "orth sasine The operation "ns tin 
usuallj cast and the nett da\ his condition "as as pood as 
one could etpect He "as on a four hourlt inicclion of 
atropine ind stnchnine because he was still rather feeble 
On Jul\ 1 in the earb morninc he "as terv fit hut bt 
middle dat he "as complaining of pain in the right arm 
(inceps region) "here some at least of the injections had been 
gitcn and his pubc had shot up from ‘'b to 126 and his tern 
perature to 100 6 Localb there "as tenderness but nothing 
el e of note He "as treated as a case of abscess follossmg 
htpodermic injection The same eteninc ho"cser the con 
dition "as obMousb one of gas gangrene and b\ 7 pm he 
was hasang injections of serum inirascnousb intramiiscularb 
and localb He refused operation and despite all other 
elforts died on the morning of Jub s 

The cause of the infection must CertainU be attributed 
to an injection Whether that "as the one gisen bv 
the theatre staff before operation or one of the mans 
in the ward could not be traced as the doctor who first 
diagnosed the case at once had eserj thing that could 
passibb be infected cither dcstroted or properh sterilized 
and all the others of the fiftj-lwo surgical cases in the 
Ward who bad had injccttons which might base been 
from the same sjringe, were gisen prophjlaciic doses of 
serum and no other case has occurred Salisfaclors 
though this has been from the point of mcss of the 
patients it has presented me from ascertaining the source 
of the infection 

According to sour article there are tsso factors to 
be considered — ihe s>ringe and the patient In this 
countrs ossing to shortage of staff and equipment and 
Ihe conditions under sshich ssork must be done in the 
Milages the sjringc must alssajs remain a polential 
source of danger It cannot be autoclascd as a routine 
csen m Ihe biggust hospitals I imagine sshile in 
dislrict hospitals and dispensaries boiling for ten minutes 
IS scarcels likcls to be done, and on mans occasions I 
knoss I base m the past gisen and in the future shall 
base to gisc injections m mud huts m far ass as sillages 
with a sandstorm blossing from a ssringe sshich can onlj 
possibis be sterilized bj alcohol 


The British a 1 7 

MtOICAl. Jouxnal 


Ms patient ssho died svas in a bed to sshich access 
ss IS cisier to ihe right side than the left, so he mas base 
had most of his injections m the right arm But what 

a prospect — a man stands a nephrectomy sscU but cannot 
resist perhtps a dozen hypodermic injections' In future 
1 hisc arranged for all four hourly and si\ hourls injec- 
tions 10 be gisen in alternate arms the site of each being 
dills recorded m writing but this of course is poss ble 
onis in the Windham Hospital and not in smaller hos 
pit ils and dispensaries throughout the State svhere for- 
lun itcls injections arc gisen less frequently If boss 
eser one could guaranlee the sterility of ssringes this 
extra ssork for the nursing staff could be asoidcd 
Can anv of sour readers suggest a feasible method of 
ssringe sterilization for adoption sshere boiling is im 
practiciblc’ W'hat acids do Coiillhard and Sskes 
recommend sshere can I see their paper and is sub 
scqucni wishing out svith sterile ssaler necessars'’ A 
e isc like ms recent one may occur once onls m a million 
injeciioas but that docs not lessen the disappoinimeni at 
losing a life after a clean operation — f am etc 
Jotlhptir Initn Juls P ^ HsSSSSRD 

The relcrencc lo Ihe article meniioned in the last 
paragraph js Collthsrd C E and Sskes G (I9’6) 
PluiTiniHcut 1 137 79 — Ed BStJ 

Sulphanihmiclc for Meningococcal Mcningi'is 

Sir — M s medical experience includes two outbreaks of 
nscningoeoccal infection at Catlerick Camp Yorkshire 
during* Ihe period 1930 to 193a 1 therefore read the 

article bs Drs T C Morion and J D Ebsssorth on 
sulph mil inside thcraps m meningococcal meningitis in 
the Journal of June 2< (p 1362) with considerable interest 
The three cases reported suggest the tape of case seen in 
an csiaWishcd oiilbrcak In ms experience serum thcraps 
giscs a reasonable recosers rate in these cases 

The fulminaiing sporadic ispc of ihis disease is boss 
eser a much more seserc lest of a ness thcraps During 
the last SIX months 1 base encountered two such cases 
One ssas that of an English officer with a generalized 
haemorrhagic rash Scrum and prontosil soluble (Baser) 
were used frccls but death follossed the infection in six 
dass from the onset The second case ssas under ms 
care sshen ihc Journal of June 25 reached me An 
English soldier had a fesv pciechiac in the skin of his 
abdominal ssall and a lemperalure of 105 E he com 
plained of pam beloss his lell costal margin the clinical 
picture suggesting an attack of primary malignant malaria 
Next day his neck ssas painful and lumbar puncture gase 
scants semi digested polymorphonuclear cells and a fess 
meningococci He ssas treated ssilh serum and solusepla- 
sinc (Mas and Baker) Death occurred on the eighth das 
of his illness In each ease meningococci ssere demon- 
strated in the cerebrospinal fluid at an early stage in the 
illness a sulphamlaraide preparation ssas used freels but 
did not appear to influence the progress of the infection lo 
a fatal conclusion — I am etc , 

F J O Meara M D , F R CT' I 

Brilnh Milinrj Hospila) Kanikhct 
U P Indn July 22 

Ischio-pubtc Osteochondritis 

Sir — Ms note in the Journal of June IS (p 1309) has 
had the desired effect of drassing attention to this interesl- 
ing condilion As suggested in ms note the condition js 
esjdentls not so rare as the published cases ssould lead 



318 August 6, 1938 


one to infer Mr H A T Fairbank (July 16, p 148) 
has made a valuable contribution to the subject, but I 
think that his figures are probably too high Any 
degree of thickening, irrespective of rarefaction, at the 
ischio pubic area is apparently included, and the radio- 
graphs examined were those of pelves with a bony lesion 
that one would expect might be associated with an ischio- 
pubic osteochondritis A congenital dislocation of the 
hip joint throws undue strain upon the ischio-pubic area, 
and the reduction of the hip adds to the chances of the 
junction being traumatized Perthes s disease, or osteo- 
chondritis of the upper end of the femur — if it is 
admitted that trauma plays its part in the production of 
the pathological process — would also be expected to lead 
to affection of the ischio pubic junction 

The pathology of a condition that is ‘ self-terminated,’ 
and which only leads to a passing slight disability, will 
probably always be a matter of conjecture I am unable 
to agree with Mr G Edgar Church s suggestion (July 9, 
p 94) that It is due to a general condition, such as 
avitaminosis, general infection, etc Weie such the case 
other areas of growth should be affected In the re- 
ported cases the condition is localized, if we except an 
associated lesion, as m osteochondritis of the upper end 
of the femur Also, in those general conditions I have 
seen in which all the growing ends of long bones are 
affected the ischio-pubic area was not affected 

Lesions in the ischio-pubic area cannot be too closely 
compared with lesions at the upper end of the femur 
In the former two centres of ossification are approaching 
along a bar of cartilage and there is a good blood supply 
at either end In the latter, there is a proximal epiphysis 
which derives practically all its blood supply from the 
vessels piercing the epiphyseal plate — that is, from one 
end — so that, given a similar pathological process, the 
results will not necessarily be alike The period of patho- 
logical change will be shorter and of less intensity in the 
ischio pubic area with its blood supply from either end, 
and the clinical signs less marked for the same reasons 
and because no joint is involved 

The name osteochondritis has already been recognized 
for this condition, and one cannot with any certainty as 
I hive implied above deny that it is correct In attempts 
to name correctly what 1 consider to be a similar lesion 
at the upper end of the femur there have crept into the 
literature seven different names for the condition This 
multiplicity of names has not been of any help to the 
student — I am. etc , 

Belfi^t July 26 GeORGE D F McFaddEN 

Undescended Testicle 

Sir —I think the writer of the criticism in the annota- 
tion which accompanied my article on undescended 
testicle (July 23) has attacked a carefully prepared 
position a trifle over confidently 

For instance I wonder how many of your readers 
noticed that two of the arguments against me very neatly 
cincd out The first is that a testicle in the inguinal 
cinal can be felt because the tendon of the external 
oblique is not always tense The second is that it is 
impossible to tell on examination whether a suprapubic 
testis IS m the canal or in the subcutaneous tissues Now 
it the first statement were correct the changes in the 
pilpibiliiy of the testis with changes in the tension of the 
ibdominal muscles would very clearly show whether it 
w IS under the tendon or not In actual fact a testis that 
cm be felt at all in this position can be felt just as 
pi iinlv whether the child is resisting or is under an 


Tiic D^rruii 
M-DfCAL iOUNU 

anaesthetic Again, anyPne who reads the whole ol Hi 
paper must 'see tfiat the two categories of “emergent 
positions aic quite meaningless unless it is possibk lo 
distinguish readily and clearly between the testis whm it 
IS inside the canal and when it is outside it When ih 
gland pops in it is quite impossible to feel it , whm it 
emerges it is plainly lo be felt in the pouch or over ih 
pubis 

As to Dr A P Cawadias s letter (July 30, p 2v9) l 
feel that we are at cross-purposes rather than m disaerei. 
ment What I am pleading for is *as careful a diagnois 
on the material side as he demands on the vital I 
admit that my statement that pregnyl will never biin» 
down a testis that would not have descended m any cw 
IS a sweeping one and m opposition to the findings oi 
other workers on the subject But has he considered that 
the percentage of cures reported alter pregnyl treatm nt 
IS just about the same as the difference between the in 
cidence of “ iindescended testis in childhood and adult 
life when no treatment is given at all'^ As lo Ifi 
complete safety of such a substance I propose to wail 
another sixty years before pronouncing on it — I am eli, 

London, W I, July 29 DeNIS BrOVV?JE, 

Sir — I have read with interest Mr Denis BrowniS 
article on undescended testis in the Journal of Julj B 
(p 168) He does an important service when h’ 
emphasizes the necessity for distinguishing bclvvun a 
superficial inguinal ectopic testis and an undescendJ 
testis I am often surprised at the lack of knovvledgi. of 
postgraduates in a final Fellowship class on Ihis subjtci 
and their failure to recognize the superficial inguinal 
ectopic testis, which is much the commonest type of 
ectopic testis 

I should like to know if Mr Biovvne really means what 
he says when he states in more than one/ place in tin 
article that ‘ a testis [or testicle , he uses the terms more 
or less alternately] that is in the inguinal canal cannot b 
felt through the skin ’’ I would readily agree that som 
testes which are, in the inguinal canal are quite impilp 
able through the skin, but it has certainly not been ni) 
experience that every testis in the inguinal canal n 
impalpable The proof of their being in the inguinal 
canal has been the finding of them m that sitintion at 
operation — I am, etc , 

London, W 1 July SO HOSrORD 

Irradiation or Surgery for Cancer’ 

Sir — I n the Journal of June 4 (p 123!) I niadv coni 
parison between the results of radium treatment in carci 
noma of the mouth, published by the National "f 
Commission for 1936-7, and the resuits obtamc t 
surgery by Mr Norman Patterson r » u 

Mr George F Stebbing and Mr Anthony E C ^ 
from the National Radium Commission saw fit 1° 
in the Journal of June 18 (p 1333) that I had no 
the statement made in the seventh annua! report (P ^ 
that The results shown by the survival rates gi ^ 
picture of the average results of radium trcaimcn ^ 
very widely scattered group of hospitals and 
compared lightly either with the results of spccia 
or icir/i results based upon a picked serits of cases 
bs a highly skilled surgeon ’ (The italics arc (,f 

are right There arc no figures from scattered g 
surgeons that can be compared with the figures o 
therapists Therefore it would be futile 
work of any one skilled surgeon with that ol | 

Commission Report 


CORRESPONDENCE 



6 19'i. 


The Bumsn 
'•IrSICAL JOLVSAL 


'19 


CORRrSPONDEN’CE 


Mr Gcorcc r Stibbinj. incJ Mr An!hon\ E C Hiri. 
hue ho\vc\cr mi<;consIrin.d m\ Idler 1 wis nol con 
demn ng ndiiim in t wholesale manner — is thev ippeir 
to condemn surgen — bm mine is i plei th it i better 
bilancc and sense of proportion should be obtained in 
the right treatment of these e ises The surgeons one 
might sa\ have onh the interests of the pitient at heart 
and are not concerned with the development of an 
elaborate technique demanding a profound knowledge of 
the phvsics of radium md r ravs I desire to stimulate 
inquirv m the minds of persons using methods of irradia 
tion to b^ sure that the best interests of the pitient ire 
being served because mv studv of the present condition 
has led me to beheve that there evists i most unjust 
balance 1 am not at cross purposes but wish to join 
them in a reasonable inquirv Let us imagine that thev 
or 1 were suffering from malignant disease Should vve 
not desire whatever advice ind treatment were the most 
efficacious'’ — and in doing so I feel sure that we would all 
consult both surgical and radiological colleagues 

1 still put forward the plea that more cases should be 
treated bv surgerv and not hv scattered groups of radio 
therapists in scattered groups of hospitals all over the 
countrv Would it not be better if a”form of centrili/a 
tion were adopted wherebv all cases might be referred 
in the first instance to the proper surgeons who have 
become techmcallv cvpert in some special branch of 
surgerv'’ Then when approxiniatelv equal numbers (Mr 
George Stebbing suggests a thousand) were treated bv 
each means a just comparison could be made I am sure 
with no detriment to surgerj 

The reason whj comparisons arc made on such rela 
tivelv small surgical numbers is that methods of irradia 
tion have been talked about so freclv in the popular press 
that he number of eases referred to surgeons has become 
less and less Despite this lack of material the surgical 
mortalitv rate has decreased materiallj as the result of 
improved technique and the introduction of modern 
anaesthesia (as stated in mv letter) 

If Mr George Stebbing and Mr Anthonj Hare reallv 
bJicvc as thev state that the technique of radio 
therapv has vastiv improved and vve arc not aware that 
the same can be said of surgen then I feel thev must 
be like Olvmpus — alone m their thoughts — I am etc 

Loriioa W 1 Jut) 23 E. R G Psssi; 

Hormone Therap} in Alastitis and Breast Cancer 

StR — Mr \\ Sampson Handlej described in voiir issue 
of JuK 16 (p 113) a familv historj of five sisters suffering 
from chronic mastitis and cancer of the breast We know 
that a surplus of oestrin acts on the female breast and 
frequentlj causes chronic mastitis W'c can counteract 
the effect of oestrin bv the male hormone testosterone 
propionate as I described m the Lancet of Februarv 12 
and Mav 14 of this vear This is the reason whv I 
should recommend using testosterone propionate to in 
fluence chronic mastitis In three cases I succeeded m 
making the lumps m the breast disappear bv intramuscular 
injections of the male hormone Doses between 500 and 
I 000 mg must be given These doses inhibit the pro- 
duction of the gonadotropic hormone m the anterior 
pituitary and prevent the growth and the ripening of the 
follicles in the ovarv which in their turn do not produce 
the follicular hormone And the surplus of the follicular 
hormone is the cause of the chronic mastius I should 
advise treating cases of chronic mastitis once or twice 
ever} vear with testosterone propionate even if the chronic 
mastitis had disapjieared 


So far as cancer of the breast is concerned it is advis 
able to treat patients who have alreadv undergone a 
radical operation prophvhcticallv with high doses of male 
hormone everv vear In mv opinion this is a better method 
of avoiding a secondarv deposition than irradiation especi 
allv in lamilies in whom cancer is hereditarv I have 
done this in two cases of breast cancer — 1 am etc 

London W t Julv 2, ALFRED A LOESER. 

Placenta Praevta 

Sir — I most hcarlilj agree with Dr H G Oliver 
iJoitrnal Mav 14 p 1071) m his contention that Caesarean 
Section IS not to be lightlv undertaken especiallv alter 
vaginal cvammation Upon three occasions I successfullv 
sondiicled confinements emplojing a technique similar to 
that described bv Dr Oliver In 1929 however it 
occurred to me that the application of a vulsellum to the 
foetal scalp would be much freer from trauma to the 
Cirviv and freer from the danger of infection \ccord 
inclv taking a wide bite fwhieh can be done with onl> 
one finger dilatation of the cervix) I emploved an ordinarv 
uterine vulsellum forceps with happv results Credit is 
due to Dr WilJcIl (of whose work al that time J did not 
know) fo' designing a special forceps for this particular 
purpose 

If Dr Oliver or anv other general practitioner engaged 
in niidwiferv should encounter a case of marginal or 
lateral placenta praevia with onlv slight dilatation I would 
urge him to use the Uillctt forceps not to worn about 
version and not to dilate manuallv the cervix which mav 

tear like wet blotting paper and aho not to applv 
forceps until full dilatation has occurred In the absence 
of full dll tation the use of midwifen forceps m cases of 
placenta praevia is fraught with the greatest danger — 
danger of trauma and infection and of death from 
haemorrhage and sepsis Three further points about the 
Willett forceps are alwavs earn a pair tale a wide 
bite of the child s scalp and do not applv more ih^n 
I lb weight for traction I slip the forceps through a 
funnel of one inch rubber so that this rather than the 
forceps presses against the posterior vaginal wall and 
perineum — 1 am etc 

Pcrih Western Ausinlia June _0 HR PevrSON 

“ Psx chosomatic Illness” 

Sib — Dr E K Mackenzie (Journal Jul> 23, p 197) is 
cvidenllj in conflict as to whether he approves or dis 
approves of Dr James L Halhdav s articles on psveho- 
somalic illness I am interested to see that among the 
bouquets that he throws are concealed daggers and even 
an occasional bomb But what arrested mv attention was 
his statement that within the last few months he bad seen 

a case of carcinoma of the stomach at the age of 19 
vears two cases at the age of 22 jears and one case at 
the age of 27 jears The statement reads somewhat 
ambiguouslv and I should like to ask Dr Mackenzie 
whether he means that he encountered all four cases 
in general practice within the last few months If so 
I feel that he has had a most extraordinarv experience 
I was mvself m general practice for twelve vears seeing 
an average of over fiftj patients a dav Throughout this 
period 1 neither encountered nor missed one single case 
of carcinoma of the stomach in a voung person But 
I saw dailv manv dozens of cases of psvchosomatic illness 
or as I would prefer to call them cases of psvchogenic 
illness — I am, etc^ 

London W I Julv 23 CttvRLES Berg MX) , DX M 


320 August 6, 1938 


CORRESPONDENCE 


Treatment of Carbuncles 

Sir — I read with interest the note on the treatment of 
carbuncles by Mr A P Bertwistle in the Journal of 
June II (p 1284) Packs of saturated sodium sulphate 
may be left on for three days m cold countries like 
England as suggested by Mr Bertwistle, but rn the humid 
high temperatures of India it is very uncomfortable for 
the patient if the dressings are not changed at least every 
iwenty-tour hours 1 have had good results from the 
four-hourly application of compresses of a hot saturated 
soUition of magnesium sulphate Sometimes, in sensitive 
patients, the application of magnesium sulphate directly 
on to the wound is painful and irritating In these cases 
1 covei the actual wound with fine gauze soaked in 
he\yl-resorcmol and secure this by cross-strips of adhesive 
plaster This dressing is changed every twenty-four hours, 
while the four hourly magnesium sulphate compresses are 
applied over it This softens the necrotic tissue, which 
can be easily removed by scissors and forceps Along 
with this local treatment I give collosol manganese either 
orally or by injection — I am, etc , 

Agn, July 19 P K BanerJEE 

Thrombocytopenic Purpura from Sedormid 

Sir — I welcome the annotation on thrombocytopenic 
purpura from sedormid m your issue of July 30 (p 229), 
but I cannot agree that this at times so serious illness is 
‘ evidently a very uncommon side effect 

In November, 1931, when sedormid had hardly been 
introduced into this country, 1 was able to prove expeii- 
mcntally that a severe case of purpura had been caused 
by this drug and in the first paper on sedormid purpura 
in the Lancet of April 21 1934 (Thrombopenic Haemor- 
rhagic Purpura due to Idiosyncrasy towards the Hypnotic 
Sedoimid Allergotoxic Effect), I was already reporting 
thiee cases seen by me within little over two years In 
191S so far two new serious cases have been brought to 
my notice in London 

1 have reason to believe that frequently the causative 
connexion between purpura and sedormid has been missed 
bee uise the makers — a reputable firm — continued to praise 
the harmlessness of sedormid in their advertisements 
cwn after 1 had brought my experience and publication 
to their notice Only recently I have at last received the 
issui ince that purpura would be mentioned as a possible 
side effect but it will naturally take some time before the 
old packages haxe been replaced and I should like mean- 
while to emphasize the practical importance ot the 
subject —1 am etc 

London \V I JuK tO F E LOCWV 


Effects of Smoking 


Tire C^mSH 
Medical Jduml 


1933 1, 268) states that it is probable that in manvaduU 
who suffer from toxic amblyopia— the result of o\ r 
indulgence in tobacco or alcohol, or both— there is a 
disturbance of carbohydrate metabolism, and that a 
systematic estimation of the blood sugar may prove an 
important factor in both prognosis and treatment A fell 
investigation of this subject offers a promising field tor 
research Graybie! does not think that carbon monovid 
is usually absorbed in amounts capable of indiicine th, 
changes recorded Armstrong {Journal 1922, 1, 922) 
stated that quite an appreciable amount of carbon 
monoxide is present in smoke and is largely deletmind 
for example, in cigars, by the closeness of the packing and 
the rate of smoking He remarked that 1 cubic fool of 
ordinary coal gas contained an amount of carbon 
monoxide equal to that in the smoke from four cieari 
The proportion of carbon monoxide in South Metropolitan 
gas. It may be added, is about that of average cigar smoke 
It IS evident, therefore, that alterations in the blood 
pressure and the frequency of the heart beats due lo 
smoking are of a somewhat complex nature— I mi, etc 


Soiitharapton, July 23 E SAkOSCHANS!.! 


Bragg-Paul Pulsator 

Sir — With your permission, and with the concurren e 
of Sir William Bragg I should like to supplement Im 
story of the development of the pulsator, as given m 
his letter which you print m the Journal of Julj W 
(P 254) 

I have received valuable aid and advice, freely gi'sn 
from Dr P M T Kerridge, MRCP of Umvers'tj 
College, London, and from the Department of IndmimI 
Physiology at the London School of Hvgienc aal 
Tropical Medicine To (he former I ovv't suggesliem 
for the form and mode of application of the air b h 
which IS an essential part of the equipment In the call) 
stages of the work the measurements of venlililn'i' 
efficiency made at the latter gave me confidenct m 
introducing the Bragg-Paul pulsatoi to (he notice ol !b( 
medical profession, with the results already reporkJ-" 
I am, etc , 

London, W 14 July 30 ROBERT W PAtl 


The Services 


naval medical COMPASSIONATE FUND 
M the quarterly meeting of the directors of ihc ba'4 
Medical Compassionate Fund held on July 8 "dh Siir“ 

ViceAdmiialP T Nicholls Medical Director Gencn> w a 

Navy, in the chair, the sum of £“56 10s was distributed ani 
the several applicants 


Sir — I was much interested in the annotation m the 
Join nal o{ July 23 (p 187) on electrocardiographic changes 
due to smoking describing the experiments of Graybiel 
ind his CO workers In these experiments the smoke from 
i cigirctte was inhaled until toxic symptoms appeared or 
It w IS finished and in some cases two or three cigarettes, 
I pipe or a cigar were smoked In 1929 with the assist- 
ance of Mr C A Beck, B Sc 1 carried out very similar 
experiments to determine the effect of smoking on the 
sug ir content of the blood It was found that a reduction 
ot the blood sugar w vs the rule in non smokers and also 
imong smokers although m two cises there was a aery 
slic,lu increase m the blood siigir Maitland {Jouiiwl, 


DEATHS IN THE SERVICES 

Lieutenant Colonel James, Charles Gordov 
QBE RAMC (ret) died at Ewell Surrey 
He was born on October 28 1876 the son of the , i, 

J C G Carmichael I M S and was educated al wu' ^ 
University where he graduated MB Ch B , 'oowl 
took the Cambridge DPH m 1912 He fcrwr" 

Armx Medical Corps as lieutenant on January 31 , ,o!o i 

major on October 31 1914 and retired as j, 

on August 11 1925 After retirement he ' "Ivrr'’"’ 

at Ewell where he was honorarv physician 
and Ewell Cottage Hospital He served thro“8 ihe Ln'' ' 
of 1914-18 and was mentioned in dispatches in j,, r' 
Gazette of December 18 1917 He had been 
the British Medical Association since 1905 



Airt'sT 6 19 S 


Tirr BumsH 
Mtdical Jovtlval 


LN1\ ERSITinS AND COLLEGES 


-21 


Unnersitics and Colleges 


UMMRsm or c wiiiRinc.r 

T D D'i\ M MB R Chtr Ins been ippointcd 
in Re^enreh in Palhologv (Morbid \mlonn nnd HiMo!oc\) 
to the Rceui^ Pro*‘e^vor of rh\^ic for three \cirs trom October 
1 

The MamnduVe SheiUi <«chohrvhip has leen awarded to 
G J Romance R \ D J Ruier R \ ha«; been re elected 
to the Michael Fo ter Mudeniship m phv««iolop\ 

Diinnc June titles: of the decree*; of N1 R R Chir vvcrc con 
fcrrcd b\ diploma on Mpn F C 1 dvvard<; of Girtcn Conc 4 .e 

UNUPRSIT^ OnONDON 

The follo\Mnc cardidatc'* lave been appro^ed at tic c\ m 
ination indicated 

Mb — Src»- h I (Surreri'l K C Eden S 11 ^\a\< BroH} lit 
{Op} } E J Sor'T cl 

Acadimjc PosTC5»Dt^Ti Diuovu IS Midi Ru>inMK-> — 
E P Mica I \\ D BjII \ G S Centner N I C Hill 
D J Hurrell C W S Jerram O MaJeat R ^ Mina J G Nel 
S F Oo thuirca K M Rai P N \jus H H Winter ten 
GilIcNpi^ 

Aciots 1 C Po 2 »TtjR.\DtATL DIPLOMA IS Psacuo a — I %chnc M 
Ecebt J D Cepp tleano A Lattcll PhNlhs M I rcc'ton W Nf 
GojM G H Kjellberp Ixs W Langan Jeanme \KM McKmlax 
H S-mp<oa Rcfph Dona M Wdk R.JcIZaban P / / S C 
Amn \en D Deulz, S'bia C Mamet Pan II Norah C 
Mom on 

Losdos SotooL or Hacirst \vd Tropical Mrninvr 


B H Grcig C Gnmshaw -P L Gunn 

h ^ J J! Halcros^ G R Hales E S Hamau D J 

lUrnTan J R Hassan G Ha> P J Hclliuell MLR Hersc% 
fchzabcth G Htggins Marjory C Hogg R B Hunter A D 
mgram M Ismail R M Johnstone J S Kcr s Jean Vf Lardbu 

^ ^ G Linton A P Liitlosood 

J D L(WpL D Lonmer Isobel St M Macaulas D I M Callum 
G M M Cnckcn J M Garni> Agnes D M Harg L G M Iniosh 
^ ^ Mackav C M Mackenzie Marjorie L Mackinnon 
iJ G Macicod A S B M Ncil G H M Pherson D A C 

M Rac R Makm W J Maihcson D R S Milne J B M Milne 

r H Minors A M Morns R C Morton H B M Murph\ 

W H Murn> W D Oliver E Oppcnhcim D L Owen L M 

Owen T Parkin F H Patel W I Paterson H S Patterson 

1 P Paul D T Pjtt S L Pollock Iv\ F Proctor H S Pro\i 
k D G Reid L E ResnikofT DAW Ritio C G Robert on 
D M Robertson D S F Robertson F J Robertson R H 

Robertson 1 W Robson Elizabeth M Rose D E Ro s J M L 
Ro s R A Rutherford G Saivcsen Sarah C Siundcr G S 
S>^olt Jean M G Shaw J A S Shaw L J M Shearer (/n 
«7*vt*/f//j) If R Shcnl in D M Sheppard M Simenof J \I D 
Simp on T D M Sloan H J C C Smith M L Stem J 
Straton J Ta>lor L F lognen J K Toop W j Toop Jean L 
Turnbul! Ida F Twccdie Janet A Walker GBR Warncck 
W S Watson A C Watt ROM Wedderbum C D Wer 
R n C Welsh A Whitcwright Katherine Nf Witkie A R Wu on 
Leslcs M Wilson M L Winston 
B Sc PuHoioca F/rsf Class — tR M M Hunter 


DiPLo\f\ IS pLnic IlrvLTH — J Cooper Winifred M Demp'-ter 
J M I rsV ire ^ ounjs S B Lai D C I oean A M Durmtd 
J S Oliphan Kab IL A Purdr F Townsend 

DiIsO\!\ is TsOPICVL MlDICIST 4SD IhctE F ~H Ha tings 
E Maunp 

DinovtA IS PsMHUiRa — J K Grant J S Johnstore A 
I ucfson G R Pile b M G Prcndcrgist H Stalker 
DiPtOMi is Mldicvl Radiology — R J C Campbell D B 
r lulds M ^ Khan 


• Comnended for thesis Mighiv commended for the is 

t Passed with honours 


The following candidate? have been approved at the exam 
inaiion indicated 

AcAD'^MIC PoSTGRADlStt DiPlOMA IS PCRUC HIaLIH — 
S Am-rasnphe P M R Anderson Annie R Chalmers 
F C L B D Crawford P A Crow lev LDP Dlurmaratne 
C W Dixon R ^ Dunlop A C Gee I W Gilbert M G 
Hvder O G Llovd G A VUegrepor I M Maegregor 
M Markowe J S Minnclt F Noronha P \ O Dwver D F 
Parra A I l^ss A F H Stewart S Sivasanlara Pdlai J Ta>Ior 
Emils S O Thomson S C Thurai Rajah M Watkins Helen E 
Wight 

Academic Postcradlate Diploma is OACTERioLora — E Apius 
{\,P Andrews D R Bal ombe Brow-n Dharmcndra Winfred M 
Hill H D Holt W Lcwin H H Stroud J M Vincent 

• Mark of distinction 


UNUERSm OF DURHAM 

The honorarx degree of D C L will be conferred on the Pnmc 
Minister Mr iseville Chamberlain on the occasion of the 
opening of the new budding? of the Medical School at 
Newcastle upon Tvne on October 8 

King s College Newcastle has appointed 
^ J E Francis MB B S B Sc assistant demonstrator in the 
Department of Phvsiolog) 


UNIVERSITY OF EDINBURGH 

A graduation ceremonv was held in M Ewan Hail on Juh 20 
when the following degrees and diplomas were conferred 

coT' ^ “The Right Hon Walter Elhot Elhol D Sc MB 
F R S Minister of Health 

MD—D Bell *D S Cownie G Fraser K Cirgis J W D 
Goodall J L Henderson R Leo A D Macdonald A M 
Xlackcrme N Macmjchacl G R M Nab C dc C Manm 
R Scott E Townsend •H L Wallace • D Wjllie 
4 ^ Adam JAW Adams T M Adnams 

n ^ B H M Aldndgc J H Annan S N Appavoo 

R S G Arnott R B Baird tj M Barkla F C Barlow Olive B 
^mclson J Baxter D E H Beattie tManon B Bclhunc R W 
Biagi Margaret E Black A dc V Boorkc K Brauer J A C 
Brown J W Buchanan Joan Campsie Marv Canned J Camck 
Geraldine M H Carrington R Calhcnrt L J Charles J Cohen 
W P Collmcwood A E A Cordin W R S Cowc J Cowen 
^ I Doroth) Cunningham C H Davidson J S Davidson 

T K Davidson J G Davies P F de Caires D P Decenhardt 
p S Dii.k G W A Dick W Donaldson tA J M Drcnmn 
Ajm« D Ferguson J R P Finliv W Forbes D D A Fraser 
W R Js Fnel tJessie R MC Fulton Eileen M Gnvin W D 
Giuen W A Gordon A P Gracic M K Granger R G S 


The following prizes were presented 

C< Ttrron prt e nt Pricinal Thtrapeu ics Karl Lindstciner M D 
tVicnnU member of the Rockefeller Insutuie for Medical Research 
Sew %ork In recognition of his researches on isohacm-gMu \mrs 
nnd bltod groups and the influence of his discoveries on ih- pracn c 
of thernpcutiv blood transfusion Eu\cs Sclw^oTslup enid LaUe 
GoU* Mfdal Bianr\ Pri e in Aratontx and Snrgfry -iitnvda'c 
Cold Mfdid in CUmcil 5f^rcfr> and Murdoch BroM.n Sther McJnl 
tn CUittnd Mcdiane J M Barkla Scottish -tssoun ion fir 
Medical tduntion of B omen Prt e Manon B Bclhunc and 

Je SIC R M C I ulton (equal) Afoi/ar Scholars! ip m the Practue 
of Phxsti Manon B Bcthunc Buchanan Scho'arshtp tn Mtdn ftry 
and Uynaecilo}.\ G W A Dick James Scon Scholarship m 
Midntferx and Gxraecology and Doroihs'Gilfillan Memorial Pruc 
JesM- R MC Fulton Cot an Doyle Prue A C Wall Ro\cl 
I tesorta flospiial Tuberculosis Trust Gold Medal G R Hales 
Ho’Int'tn Pn e in Clinical \fed/rme J Cohen 5»me Sutcicil 
lelloMshtp D L C Bingham Sfarh Scholarship tn Clinical 
Medicine H Milne Redhead Vans Dunlop Scholarship tn Marena 
Medica and Medicine J innes ElUs Prue in Phxsiology Barbara 
Pcirov>kai3 Gunning 1 ictoria JubiUe Pn^e in Cheinisirx J L 
Bollnnd Gunning 1 ulorta Jubilee Pri^e in Materia Medica J C 
Lees Gunning Victoria Jubilee Prue tn Therapeutics H W 
Drverre and D WvIIic (equal) Gunning Victoria Jubilee Prue in 
the Practue of Phxstc J W D Goodall Gunmng Vu ona 
Jubdee Pri.r in Psschxatry W M Millar Lexus Camen n Post 
graiiiate Prue R Scolt Thomson Memorial Medal in Chud 
Life and Health J L Henderson Lex is Cameron [/ndergraduate 
Pn e tn Bacteriology G R Millar \fn lagan Prue m Forensic 
Medicine L S Cooke H cllcome Gold Medal and Prue in the 
J/istorx of Medicine H W Smith Wellcome Siher Medal ai i 
prue tn the History of Medicine H L dc Waal Cunmnglatn 
Memorial Medal and Prue in Anatomy J R Lauckner Prosime 
Accesstt Elizabeth C Hams B hiteside Bruce Biirsarx RTS 
Louttit 1 ans Dunlop Pri^e in Botany and Zoologx M S Fra cr 

An nddress wa? delivered to the new graduates bv the 
Chnnccllor Lord Twecdsmuir 

RO'iAL COLLEGE OF SURGEONS OF EDINBURGH 

At a meelinc of the Roval College of Surgeons of Edinburgh 
held on Juh'' 23 with Mr NV 3 Stuart President m the chair 
the following having passed the requisite examinations were 
admitted Fellows 

H Aitkcn M M Ali N F Babbage G K Bhidc Ida L 
Birchall R B Eaton J A Elliot C A Ha>smer R G Henderson 
S Henderson G W' A Keddj J S Kinnear S Klenot 
P Kohnsiamm L R Levv J LI Lewis R.A Lucas N M L Lund 
J S Mackav D E Mackenzie I Mackenzie J A Magnus D V 
Marshall DAO Reill> J F Philip D F Pnee D K Rao 
J B Shield D F Smith Anna Vareed P M Williams W W 
Wilson J Wolfowitz W A W right 



311 /UGUST 6, 1938 


MEDICAL NOTES IN PARLIAMENT 


Medical Notes in Parliament 


On July 28 Mr Hore-Behsha announced conditions of 
service, pay, and retirement for combatant officers of the 
Regular Army Sir Francis Fremantle asked whether 
an> corresponding advances would be given to the Royal 
Army Medical Corps or other technical corps Mr 
Horc-Belisha replied that each technical corps had its 
own manner of enlistment and recruitment which differed 
m each case but each one was being looked into 

Quack Medicine Trade 

[In these columns last week we gave a brief account of the 
debate on ihe quack medicine trade, which was opened bv 
Lord Horder in the House of Lords on July 26 The following 
IS a fuller report of this important discussion ] 

Lord Horder said it might be thought that his topic vv is 
rather a hardy annual but he assured them that the question 
of quack medicines in relation to the health of the public 
was not reallv so much a hardy annual as a pernicious growth 
When he suggested dealing with this subject the first objec- 
tion raised by his friends was that he would have vested interests 
heauh against him — the vested interests, that was of newspapers 
and their proprietors the large Press agencies and those who 
owned hoardings and posters It vvas becoming more and 
more obvious that the head and fount of the offence m the 
matter of quack medicines was the advertisements, so often 
grossly misleading if not actually fraudulent 

Far from any signs of opposition he had received both help 
and encouragement from the reputable members of the groups 
to which he had referred For very decency s sake and a sense 
of dutv these people were themselves taking steps to exercise 
a degree of control and censorship which in other countries 
responsible authorities imposed He had received assurances 
on this matter from the Proprietary Association of Great 
Britain the Newspaper Socielv the Advertising Association, 
the Periodical Proprietors Association and the Institute of 
Incorporated Practitioners m Advertising Seeking again for 
advice from all authorities m anv wav connected with this 
subject of course he was warned that 'they wilt sav that 
if you as a doctor raise this subject, you will be charged 
with Irving to create a monopoly for vour colleagues, you 
will be charged with depnving the poorer classes of cheap 
cures to the cfficacv of which they constantlv testify On 
this question of monopolv he believed it to be true that if 
there was a monopolv it lay with the trade which, at a cost 
of nearlv as much as the total monev spent on the whole of 
our hospital services bled the public to the tune of between 
£2^000 000 and £30 000 000 a vear He was seeking to break 
this unscrupulous monopolv a monopolv which successive 
Governments seemed almost to have gone out of their wav 
lealouslv to guard witness the exclusion of patent and pro- 
prict irv medicines and food from the otherwise excellent Food 
ind Drugs BilUwhich was about to become law 

DOCTORS BLNEEIT FROM QUACK MEDICINES 

Referring to the position of the doctor Lord Horder said 
he felt sure that Lord Dawson would agree with him that if 
the doctor thought onlv in terms of hard cash in this matter 
he would actualh benefit from this unprincipled trade The 
doctor had eventinlh more patients because of this, and not 
fewer Espectallv would the surgeon benefit for cases became 
serious in proportion as diagnosis and treatment were delaved 
U1 imatelv even the undertaker benefited sooner and oftener 
than he might In striving to cleanse this Augean stable he 
(Lord Horder) was not acting in the interests of doctors He 
Was acting in the interests of the public which vvas least able 
to St ind up against exploitation — poorer people who could less 
ifford to lose monev on health than anv other section of the 
nation and the straitened middle classes People who were 
Kltcr ofT hut perhaps not less foolish could afford to pav 
for inv damage which their adventures into quack medicines 
micht incur 


,, Jr Bursa 
VltDICAL Jo TXIt 


The third objection with which he would deal vvas exprerx-d 
by those who said, * It is all very well to be destriiclue K.' 
if the citizen does not send his coupon for his lung cure jrJ 
if he does not get his diagnosis bv post for hix Ldr' 
trouble and if he does not get his gastric ulcer healed «i v 
a patent powder what ts there for the poor citizen lo do' 
Now and perhaps only now we had something infiniteU Ki , 
to put in the place of these extremelv dubious specificv. he 
had now available to the poorest everv where one of the fr i 
health services in the world, and the slogan “Use vourlieaia 
services vvas one of the most 'intelligent slogans he had er?r 
heard Health services, constantlv expanding health itixup'''' 
services were what the Government could and mud roi 
encourage the people to put m the place of this niidi od 
w itch-doctormg 

There were clear and abundant reasons whv the ptex t 
chaolic state of the law in relation to quack medicines sfo ’i 
come to an end His mam reason for pressing the ito'ot 
for papers at this time was his deep concern for the wot 
of the concerted move we were making towards natieJ 
fitness Bv fitness he did not mean muscular supremaev f 
meant health as a basis for good citizenship and happir \ 
Men and women of all parties were convcrginc on 
objective Thev were all genuinely moved vvilh thedwret' 
help Anv thing directlv bearing on the basic hcallh a ' 
happiness of the people vvas outside partv politics Hclrr 
from the support he had received during the past few da\\ 
when it vvas known that he was going to put thi> silt'll 
before the House of Lords tint it was commonlv fclllhaii' 
the realm of partv politics there was no room for i’' 
question as lo how we should keep the nation fit 


INCONGRUOUS SITUATION 

The incongruilv to which he referred m his nono. na 
apparent to everv one On the one hand the Govemmcnl h ^ 
launched a campaign to improve the national phvsiqie M 
recruited all of them whose business it was to know ' 0 '"- 
thing about health had set aside subsidies for the piirre'-^ 
of education and demonstration in regard to fitnexs ard 
spent quite a lot of monev m health propaganda On 1 
other hand they had this campaign of quick mcdicintv J J 
food totallv uncombaTed so far bv the Government but! 
bv verv subtle and skilled generals bent on niamtim 
national ill health moral and phv steal in order to have a ic ^ 
market for their goods For everv £100 that the Gavemw 
spent on making people health conscious quack nicdn 
mongers spent £1 000 in making them disease convciouv 
were tning to teach people the meaning of nutrition ana 
monev they might spend on food thev were spendint r 
quack medicines or on verv poor substitutes for good 
Those were the considerations which led him m brws 
subject before the House We had recentlv witnes'cd « 
financial friends assured him vvas a most necesssn and 
thought creditably expeditious effort to limit the cul 
share-pushing It seemed to him that tf the State son ^ 
protected the propertv of its less wary citizens against jimr 
sharks It should not regard it as less important to take 
steps to protect thetr health from wanton damage ^ 

A famous group of patent and proprietarv medu-inc ve'i-L 
catering chieflv for nervous and digestive disorders nao 1 
bud-geted for nearly £1 000 000 for Press advertisements ^ 
during the current vear This particular group , j > 
sixteen preparations if one excluded shampoos and 
cat medicines He saw that it vvas about to buv the ^ 
of SIX to ten more preparations The profits on the e ^ ^ 
shares had risen from £40 000 to £280000 m -> 

vears In 1931 the price of the 5s shares ^ \ 
and in each of the past three vears these shares ha ^ 

- of tbv 


above £3 These figures gave some indication 


VU dLJ I K^Ul ^ 4 X ^ f th>‘ C 

nature of the concern and of the great expansion o ^ 
medicine trade No wonder that the board of I ^ i 

thought It a wise thing to make a large l, , 

the London hospitals He vvas unable to <• i' 

ships if the donation vvas earmarked for the i > 

patients who had doctored themselves with ' 

medicines 


^LCLbT 6 , 19'SS MLDICXL NOTES IN PARLIAMENT rmB.mm 3 '-; 

_ MlDlCAl. JOtTRSAt 


liu ft nifC \ ( t IM \ T IG 

•\ few p'ltLntCAl nnd propnctir% lhini.s were good thme 
nnd the cHims midc for them a*; cHmis went were not 
unrci'^omblc \ good nnnN ihinuN t!ni did Iiiilc or no good 
nud liiilc or no hnrm were '■old ’ll finPi'^tic pnccs Hut now 
and acim ^omclhmc wns sold ihil did infinite harm — not often 
bccaii'^e an inquest wa*; a thme that pul some of the c people 
out of business more quickh than ansthme cUc and for that 
reason danccrous drugs were as a rule a\oided \U the same 
there wns noihinc in law to prevent a vendor in this country 
from trading in son c new druc not as \ct on the Poisons 
Schedule and concerning which capcncncc of its action was 
required to di cover the dancer In other words the puhhc 
was made the cuinca pic as it were of the unserupiiloiis 
vendor 

But there were an enormous number of preparations vvlndi 
were fraudulent in the decree of the advertisement— fraudulent 
injhc claims ihcv made and verv fraudulent in the vsav m 
which those claims chanced without anv change in the nature 
of the specific The public v\-as slowlv becoming aware that 
certain disease^ like cancer and hernia were not cured bv 
dnics and the advertiser was quick to realize that So disease 
conditions which were for anv reason in the public mind 
were made the means of selling the same old goods Tor 
evamplc the subject of malnuiiaiion was topical novs and a 
number of preparations /ormerJv advertised to cure quite 
oifi'crcnt conditions were now advertised as a cure for mal 
nutntion A set of new preparations nrosc which claimed 
to do the same thine The subject of vitamins having become 
omewhal popular it would be found that quite t large pro 
portion of the quack medicine advertisements !o*dav chimed 
tbat thev conLained "all the vitamins ncccssarv for health 
Some people had reccntlv become rather anxious about the 
prevalence of rheumatic disease in this countrv and straicht 
wav the quack medicine vendors orientated their advertise 
rents m that direction Advertising had become a specnlizcd 
profession The maker of quack medicine need no loncer 
rack his own brains as to how best to overcome anv reluctance 
the public might have in spcndinc He handed the matter 
over to the advertising specialist together with a large sum 
which had been appropnated for thi> purpo e and the thine 
was put across the public as thev said There was a 
rake off for the manufacturer the advertising igcnt and 
the newspaper ^^hen thev remembered the enormous m 
crease in the media through which advertisement operated — 
revvspapers omnibuses hoardings wireless and acropi incs — 
ihcv becan to realize the appallinc results which this mass 
sucgestion must cvcntuallv have upon the countrv s health 
and morale The<c advertisements had become a much 
graver dancer than the medicines thev sold Fear was the 
chief emotion thev relied upon so that much of this trade 
was in effect a huge form of blackmail 

It was all verv well to vet the medicine and reject its 
advertisement if harmful which vvas cLimed bv some respon 
sible newspaper proprietors but there was poison in the 
*idv eriisemeni Nobodv seemed to vet the advertisements 
except a few papers and he paid them all credit for that 
A picture that he had was of an operating theatre with the 
surgeon and nurses m their masks and it said Buv our 
invaluable ointment and vou will escape operation and the 
result IS guaranteed There was another a picture of a strong 
acid burning a hole in the carpet which said Tins is what 
is happening inside vour stomach when it pains vou Take 
our tablets and vou can eat anvthmg TTien there was a 
diagram of a circle a verv considcnble part of which was 
coloured on the poster to represent the proportion of nourish 
rrent in a certain meat juice The representation was a )ic 
because the stuff w-as mainU extractives which were not 
nourishing salts and colouring matter and the actual food 
value vvas almost negligible Of course cvervone takes a 
laxative said one advertisement so whv not ours'^ And 
the wretched man who_did not take a laxative began to 
V onder if he could possiblv be well without it Four out of 
five have pvorrhoea — which vvas not true — said another adver 
ti emenl But the chances were so hcavilv loaded against the 
reader that the goods sold 


\ MLNVCE TO HEVLTII 

So he might go on almost endlesslv ll was perhaps becau e 
'omc of our Continental friends had been reading our adver 
tiM-mcnt pages that thev thought that Bnlain had become 
decadent This of course was in the language of the street 
a ramp It was not onl> demanding monev with menaces 
It WTs coining monev out of the fears of the people Not 
onlv the sick but the well were swindled for bv what other 
Word could thev rightlv sticmatize the deliberate promotion 
of crcdiilitv for the purpose of gain'’ In Continental counines 
exploitation was forbidden It was forbidden in the United 
Stales m Australia and Canada there were heaw penaJiics for 
making false and fraudulent claims and even in South Africa 
hvi vear a Bill vvas introduced based on the recommendations 
of the Select Committee of this countrv of 1914 It was 
humiliating to think that Great Bntain remained complacent 
in face of this menace to the health of her citizens 

The Government as well as the others got a rake off 
and It was sometimes thought that this fact prevented legisla 
lion He could not think that that was a verv powerful pre 
^cnllvc of legislation in this countrv because the Chancellor 
of (he nxchcqiicr onU netted £1000000 a vear out of this 
'ordid business Of course he could make much more the 
\Icdicine Tax Act of 1812 was being evaded m the grossest 
manner To quote onlv one anomalv taxes were levied on’v 
On druiTv id^trii^cd as a cure for ailments and «o eoutb 
medicines and pills for backache were taxed but che i 
mixlurcs and kidncv pills were exempt 

It was ncarlv fiftv vcar> since a Roval Commission t^ied 
that the India opium revenue was morallv indefensible and 
Within a month of the pre cntation of its report Parliament 
approved It \ci there was the report of the Select Com 
miticc on Patent Medicines a compendious dov.umcni whivh 
wa so ill fated as to be pnnicd on that tragic dav Aucust t 
1914 That was iweniv four >ears aco and the committees 
recommendations simple though thev were — recistraiion di 
closure and censorship of advertisements — had never be-n 
Implemented Whv were we so prompt to protect the China 
man and so dilalorv m protecting our own citizens'’ \ei his 
analocv was fairlv close because to paraphrase a fanou 
xavinc Quack medicines arc the opium of our people 
What was the remedv'’ \\ ith the best intentions for whch 
he gave the reputable newspapers cverv credit no cen or hip 
Of ihcir own would ever cfTcctuallv deal with this nuisance 
This voluniarv effort had been on trial for more than iweniv 
tears and things were now much wor e than before CenU'al 
Or Government control would lighten up the situation at once 
The people who might be expected to know — that was the 
owners of large newspaper combines — supported him in this 
Contention He had letters quite a number from noble 
Lords to this effect and thev agreed with him that the cmI 
must be attacked at its source These papers which were 
trving to dav but unsuccessfullv to control the grosser forms 
of exploitation of their readers would bj some central control 
be protected and not penalized as at present thev were 

GOVERN VIEVT ACTION REQUIRED 
Lord Southwood who was president of the British Adver 
tising Association had told him that an important department 
of that association devoted its efforts to the elimination of 
advertisements of undesirable products Act as an example 
of how impossible it was to carrv out this good mieniion m 
practice he had there that afternoon an advertisement of 
Aadil in that week s John BuU and it was fourteen vears ago 
that Aadil was so thoroughh exposed m three successive 
Issues of the Datl\ that its sale was entircl> stopped 

This vs-^s the stuff that did not contain ih^ harmless ingreaient 
Which it wTs alleged to contain but I per cent of formalin 
an intense irritant of which it made no mention True the 
figure 1935 appeared now in brackets after the name 
Aadil That might mean something or nothing The point 
Was that this monster was h>dra headed and it could onU 
be destroved bv being strangled at its birth 

It was onlv fair to admit that a few things had been done 
Since 1914 and thej were to the good The Aenereal Di^euscu 
Act made it an offence to advertise medicines for \cnert».l 



324 August 6, 1938 


MEDICAL NOTES IN PARLIAMENT 


disease, and the verv success of this teto showed that measures 
of this hind were both practicable and effective Then there 
were the Pharmac> and Poisons Act, the Dangerous Drugs 
Act and the Therapeutic Substances Act , but good though 
all these laws were taken together, thej did not touch the real 
problem he was presenting to the House In the Food and 
Drugs Bill there was a great opportunity of dealing with this 
pest Instead of that quack medicines were specifically 
exempted from any penalties under that measure — an exemp 
tion which renewed automatically the exemption made in the 
previous Food and Drugs Act of 1928 In Part I of the new 
Bill, Clause 4 dealt with defences available m proceedings 
t iken under the Bill Subsection (3) contained the words 
where the food or drug in question is the subject of a patent 
in force and Subsection (5) read that the article supplied 
was a proprietary medicine and was supplied m response to t 
demand for that medicine In short, no action could succeed 
under that measure if it were attempted 
A record of the Bills that had been introduced into the 
House of Lords and the House of Commons since 1920 made 
very gloomv reading They had generally died of that 
common disease lack of Parliamentary facilities, though in 
one or two cases a more accurate explanation of death would 
be felo de se On the last occasion the failure of the Bill 
in the House of Commons was attributed to its having had 
the bad luck to be introduced on the dav of the Grand 
National There appeared to be a ‘ hoodoo resting upon 
private Bills dealing with this matter He earnestly trusted 
tint the House would support him in his efforts to persuade 
the Government to tackle it by a Government measure The 
m ichinery would be easily forthcoming His friend and 
colleague who now had charge of the Ministry of Health 
must bv virtue of his training and experience, have excep- 
tional knowledge of the whole of this subject, and must be 
more fully alive perhaps than some of his predecessors in 
that responsible office to the importance of the matter He 
(Lord Horder) believed that the Minister would have the 
opinion of the country behind him and he had good reasons 
for believing that the Press as a whole would support him 
A Bill dealing with this would be a ‘‘most fitting corollarv to 
the efforts we were all making for national fitness It would 
demonstrate clearly to the world that the Government was 
redly serious in regard to their health campaign It would 
close a wide gap in our defences a gap which was increasing 
month bv month and through which at the moment the enemv 
was pouring and spreading havoc among our people Once 
behind the lines there was no limit to the damage which this 
particular enemy could do 

PUBLIC LDUCATION IN USr OP COMMON DRUGS 
Lord FxRiNf.DON in supporting the motion suggested that 
the recommendations of the 1914 Committee in one respect 
at inv rate did not go tar enough They suggested the regis 
tration of preparations and disclosure to a Government 
Department of their contents There was no reason why th.s 
disclosure should not he absoluteiv n; m - “((."suggested, in 
view of the experience we had now of the extraordinanlv 
abstruse and incomprehcisTble nature of disclosure of contents 
of secret re^eyJ-.Cs' which was made in many cases incidentally 
I2_'’^^5^fhc Government lax that there should be a legal 
obligation to make them in a form generallv accepted bv 
the medical profession so that there should not be anv mis 
undersi inding is to what was contained in anv preparation 
tint vv IS sold It would of course be said that that would 
not dfect i great manv of the public who would be unable 
even if thev knew the nature of the actual drugs in a pre- 
pirition to judge for themselves of their eflicacv That vvas 
true hut a purch istr would alvvavs be able to consult his 
medic il priclitioncr or the chemist from whom he bought 
IS lo the V line ol 1 particular drug Lord Horder had 
hiK repelled the suggestion that members of the medical 
ofcssion had anv personal or financial interest in the 
’^icp isMon of this trade The medical profession had, he 
tin I chi shown a rcallv admirable attitude since the eighteenth 
St I urv in forbidding to members of the profession the use 
o esret remedies and insisting on publication Nevertheless 


The Buna 
Medical Jocami 


something might be done by the medical profession itself m 
co-operation with education authorities He suggesteii to 
Lord Horder that perhaps it would be possible to give mot' 
public instruction in the use of household remedies In frt 
way people who had headaches would not buy some lird o' 
headache powder , they would know for example, that ’n 
ordinary aspirin vvas in any case the active drug m am ft^ 
paration which thev were likely to buy, and that it cojld 
be obtained in a purer form at a very much cheaper prw 
direct from the chemist That vvas naturallv only one of 
manv possible examples The general public in the inlerfcg 
of Its health, should be educated lo appreciate the use of 
common drugs 

Lord Addison said that Lord Horder had studiously urniet 
stated his case and had done it deliberately In 1920 or 19h 
he (Lord Addison) remembered as Minister of Health beint 
a partv lo the initiation of proceedings that led to a joir.i 
conference representative of all the various interests cor 
cerned including medical men and newspaper propnelc^^, 
which made recommendations This step did not go very fir 
It was a verv tentative and moderate approach to the malltr 
He onlv mentioned it to emphasize the certainty that if ib 
Government would remove what Lord Horder had describfil 
as the fear which beset private Bills and take on ihemsehe) 
the responsibihtv m this matter thev would be supponeii 
much more vigorously and widely than thev suspected Th 
general public would be glad to be protected against itia 
exploitation, which had been enormously increased durim lbs 
last few veais The modern advertiser had a technique m 
which he promoted what he called a suitable atmosphere srj 
this technique during late vears had been imported into Ibe 
advertisement of these various nostrums The tcchmqw 
played particularlv upon the fear of people and drove Itwn 
into that state of apprehension which Lord Horder had 
described as being so exceedingly dangerous to a vast niiilli 
Itide of sensitive and nervous people 


GOVERNMENT REI LY 

Viscount Gage said that he was sure the Minister "ouH 
wish that the speeches of Lord Horder and the other nobe 
Lords should command a wide attention It vvas perlecll) 
true that every investigation that had been made had bone 
out that the improper use of drugs and of substanvCv in 
themselves harmless was a distinct danger to health in iw 
counirv that it had handicapped the work of the medial 
profession and that thev were behind other countries m 
would be quite ready to agree with Lord Horder that it mabj 
constitute an obstacle to the national fitness which * 
wished to obtain The problem of the dangerous ’’’ 
largelv been solved, except possibh for the case mentioned v 
Lord Horder — namelv that of the new drugs that vverc wt 
tinuallv being put on the market by the enterprise of 
factoring chemists He thought that Lord Horder 
criticism to make on these new medicines He had said 
the public had been used as a guinea pig bv the unscrupv®^^ 
manufacturers He (Lord Gage) vvas informed that 
no real method of foretelling what the effect of some o 
new compounds vvas going to be It vvas true that then c 
on the human body could onlv be ascertained by , 

and he believed there had been fatal cases abroad » ■ 
these experiments had been incomplete This f. 

possible danger but it was one which vvas very 
guard against without putting an absolutely undue re 
on these verv valuable new inventions He understoo 
the majority of these substances vvere made by ° 
highest possible repute, which in their own interests saa 
the precautions which vvere taken were verv comple ^ 
believed that the dangers arising from that possible sou 


alh remote , 

The real difficulty as Lord Horder had pointed 
om drugs and substances which were not o 

irmful and which could not be scheduled as dang 
jisonous The improper use of these did consul^ a ^ 
id that danger arose in two ways Aspirin il « ' c' 

d provide a remedy or relief anyhow lor a 
Pesses , If used lo excess it was not beneficial it 



SiTUsr 6 I9^S 


^^LDICAL NOTES IN' PARLIAMENT 


Tiie Ewnsn 
\^ICAt JOLTUVAL 


^25 


\\n<; not iKid to cvccv' liit «i i!-.!.!) to iiire 'ome dinccrous 
tevcr then it did Innn hccm i it rmuht prc\cnt proper trcit 
nient King npphcd It « i' true tint if the e iinforliimtc 
lewUc could in c from the improper ii^c of Ihc'c rcpiinhle 
prodiKt'. idierti'Cd in i rcspcelible far «or c results 

could obMousU cost e from the improper ii c of other drugs 
presented to the piillic r'ltli far less regard to truth nnd with 
far less sei.unl\ of qinlitt 

The inherent dilhcults m dcihnv with the e substances was 
ibnt the real fnult h\ with the indisidinl ssho tool, them 
It wns sutch pist ns diflicult to stop people induking m the 
encessisc use ol drugs and medicines ns it wns to stop people 
from c,\ce srsc indulgence in drink It people did not ii c the 
immense State assisted medisnl schemes which had Ken pro 
sided for at least IstOtWCOO of the inhabitnnts and if people 
preferred to diagnose ard trent their own complaints it wns 
surds largcls their ossn rcsponsibihts if thes sulTcred in con 
sequence U ssnis true that thes micht K cncourngcd to do 
so bs cnrcfulls ssorded adscrtiscmcnls and he aerced m tbcors 
that there ssns a case for controlling thc<e adscrti'cnients 
but here acain he thought the re ources of the legal pro 
fcssicn could casils he turned to bad account nnd it wns scri 
eass to find forms of words which ci ided (he pen dues lh„t 
might K dcsiscd m kets of Parliament unless these \cts were 
so strict as to b-mg ssithin the meshes of (heir nets n number 
of perfcetls harmless and svclJ-csijibhshcd compounds that 
could at present be chcapls and ensiK procured It was not 
alssass eass to dcsoe forms of ssords sshieh could not K 
esaded He svas surprised to hear Lord Hordcr and Lord 
Farincdon sas boss ca'ils thes thought this control of adscr 
tisemcnis could be effected He was not attempting to 
cscludc the possibihts of some logishlion on the lines ‘Ug 
gested but it would be SC's difficult to guarantee that such 
legislation ssould be eftectise It had been succested that 
certain adscriisements relating to certain specified diseases 
should K prohibited altogether , this had Ken done so far 
as senereal disease was concerned A Private Members Bill 
was reeentlv introduced m the House of Commons to catend 
ihis prohibition to other diseases and if that Bill had gone 
anv wa) it would base received the svmpaihclic consider uion 
of the Government Mhat happened was that during the 
second reading the Hou'e w~is counted out and the Govern 
ment were unable to take anv action ssmpathetic or otherwise 
because the Bill was automaticalh dropped 
Parliamenlarv apalhs in these matters svas frequcnlls ca 
plained bs the phrase sc<ted interests to sshich Lord 
Horder had referred He appreciated the tone in sshich Lord 
Hordcr referred to that pressure but others of his colleagues 
had gone a long ssas further than he had gone He noticed 
that in an article Professor Clark had said that the obvious 
reason svhs Parliament has refused for a quarter of a centurs 
to attempt to remeds anv of the disgraceful abuses rescaled 
b\ the report of the Committee is that the Press controls the 
politicians and the secret remedies trade associations control 
ihe Press” — the argument being of course that sesicd 
interests represented bv advertisers in the Press were so strong 
that the Government were powerless against them Thev 
might be perfectlv certain that no major reform had ever been 
or was ever likelv to K effected in this countn except in 
the face of sesied interest of 'ome sort He thought tint 
Professor Clark was rather severe on the Press and he was 
glad that Lord Horder treated the matter in a different wav 
If he was asked to sav whv successive Governments had 
done so little in this matter he should first explain it bv the 
popular theorv that people had the right to make fools of 
themselves in their own wav provided thev did not do harm 
to other people That might perhaps sound a rather crude 
srgument but he put it to Lord Horder that surelv the point 
was to K considered whether there was no danger in weaken- 
ing the individual sense of responsibilitv in these matters 
SecondU thev could not legislate elfcclivelv without at least 
risking adding to the difficultv and expense of obtaining 
remedies which were in mans cases harmless and Kneficia! 
In saving that he was not trving to exclude the possibilitv of 
further repressive and restrictive legislation he said most 
emphaucallj that renre'sion alone was one of the nio«t 


dubious of nil lines of progress Lord Horder would agree 
that It was onlv education as to what health and fiine s meant 
that would rcallv induce people to refrain as the well known 
phrase went from pounng drugs of which thev know liltie 
into bodies of which thev know nothing The Minister of 
Health would tarefulK examine what Lord Horder had said 
and would sec whether anv thing could be done to incorpora e 
in the cducalional side of the national fitness movement some- 
thine of a warning nature against the misuse of drugs 
gcncrallv 

lie had tried to be frank in answering Lord Horder Lord 
Herder mighl not be convinced and if that were <o perhaps 
he would lile to have a trv at legislation himselt In spite of 
the fact that ibere was a great mass of public opinion behind 
him in this manor Ihe oalv explanation Lord Horder gave whv 
private legislation had failed was in Ihe perhaps somewhat 
tin cicntific phrase that there wns a hoodoo on pnvate 
Bills He assured Lord Horder that dn legal matters the 
Government would be verv pleased to place all their resources 
at hts disposal and on medical matters thev had no higher 
sources of mformalion than those which he himself could 
command The Governments own attitude must be to some 
extent at anv rate dictated bv public opinion because m 
these mailers the public must have the last word He was 
prepared to lav anv papers that Lord Horder hked but he 
hoped be bad met the main arguments to his saiisjatuon 
lord Horoir sjid he understood that he had free ..ccess m 
a private capaciiv and he would like to avail him elf of that 
Me a ked Live lo wiihdriw the motion 

The motion for pipers was withdrawn ..scordingU 

Uork of the Ministrx of Health 
When the House on Julv 2*! went into Committee on the 
Appropriation Bill D Clliot made a utemenl on the 
Minivtrv of Hc..lih L umaie lor 19s8 He said the net total 
of £22 7’2'"2 wa an increa e of i -2 206 over the figure 
for the preceding vcir This increase was mainK due to 
proertss in respect of housing, and under the Midvvives Act 
of 19 j 6 For the litter it was £24 s 000 After dealing with 
housing slum clearance planning atmospheric polluiion 
'ewerage and water supplies Dr Elliot turned to air raid 
casiiallics In air warfare it was impossible to forecast with 
ccriaintv where casualties would occur What was intended 
as a base hospital might be required to function as a casualtv 
clearing hospital The casualties occumng in a particular 
localitv might prove to be bevond its hospital resources even 
If us peace lime accommodation had Ken considerablv 
auemenled Thev must aim at pooling hospital resources over 
a wide area and making provision for addilional beds and 
equipment where this seemed to be necessarv Plans had 
to be worked out for moving as manv as possible of Ihe peace- 
time sick from the hospitals best suited lo deal with casualties 
and for transporting the casualties themselves from raided 
areas to hospitals in less vulnerable positions His Depart- 
ment was at work on these lines and would submit them as 
soon as possible to the local authonties and others concerned 
\ survev of hospital accommodation throughout the countrv 
had been in progress since earlv this vear Medical and other 
Dlficers of the Department had been assigned to various 
districts in (he countrv to maintain close contact with the 
local authorities and managers of volunlarv hospitals in 
working out schemes which could be put into operation 
immediatelv if required Co operation between Ihe municipal 
and xoluntarv hospitals was essenlial for the proper planning 
of this work In the London area a number of hospital 
experts presided over bv Sir Charles Wilson dean of St 
Man s Hospital had submitted provisional conclusions and 
he had conveved^lhem to the \oluntan Hospitals Committee 
for London as well as to the local authorities in the area 
The next step vvas for officers of the Department to work 
out the plan in greater detail for individual hospitals This 
was being done 

FMi Cs IKFXNT VND MXTERNVL XIORTaUTV R.VTES 
The vital statistics for the vear 1957 bore witness lo the 
improvement m Ihe public health which had been coniinuous 



326 August 6 , 1938 


MEDICAL NOTES IN PARLIAMENl 


MtOlCXl lOl-lNii 


in recent \ears The number of live births registered during 
the >ear was 610 557 corresponding to a rate of 14 9 per 
I 000 population The provisional figures available for 1938 
suggested that the rise was still continuing The increase in 
the birth rate since 1933 had been accompanied b> a fall in 
the infant mortalitv rate, which stood at 58 per 1,000 live 
births in 1937, the second lowest rate ever recorded com- 
pared with 64 in 1933 The crude death rate per 1 000 popu 
lalion last >ear was 12 4 This showed a rise of 0 3 per 1 000 
over 1936 Manv deaths were due to the prevalence of 
influenza and influenzal conditions during the earlier part of 
the >ear The crude death rate from all forms of tuber- 
culosis was 692 per million population in 1936 the lowest 
>ct recorded a rate which was practically maintained m 1937 
The exact figure was 695 per million 

The maternal mortality rate m 1937 fell to 3 13 per 1000 
total births the lowest rate recorded There was room for 
renewed efforts to secure a greater reduction, and measures 
alreadj taken appeared to be showing results 

The number of attendances of children at infant welfare 
centres expressed as a percentage of live births was 63 and 
the number of attendances of expectant mothers at ante-natal 
clinics similarl> expressed was 54 Both these figures were 
records During 1937 local authorities improved their 
miternity services on the lines recommended in recent reports 
on maternal mortalitv in England and Wales above all bv 
promoting cooperation between doctors health visitors and 
midwives which was essential Mr Norman Birketts com 
mitiee had investigated the question of abortion, and the 
report might be available before the end of the year 
1 hroughout England and Wales local authorities now ensured 
the employ ment of nearlv 7 500 midwives on an improved and 
permanent basis by engaging mid wives as their own servants 
and by making extensive use of those voluntary associations 
which had done such excellent service in the past and still 
continued to do so The establishment of the service had 
now been substantially achieved The Central Midwives 
Board had made rules embodying important alterations in 
tiainmg which would come into force by stages beginning 
in the autumn In the future trained nurses would undergo 
i veirs training instead of six months and other potential 
midwives two years instead of one year Practising mid 
wives would be required to take post certificate courses at 
least once every seven years By the payment of increased 
grants in aid of training the supply of fullv qualified prac 
tising midwives would be stimulated 

The scheme for the provision of certain additional items 
of diet to expectant mothers which with the aid of grants 
fiom the Commissioner for the Special Areas was begun bv 
the National Birthday Trust Fund, was now being carried out 
bv the Joint Midwifery Council It must be regarded as still 
in the experimental stage Local authorities made increasing 
use of their powers to supply milk free or cheap to expectant 
and nursing mothers and children under the age of 5 A Bill 
had passed both Houses which would enable a scheme to be 
brought into operation for securing a reduction in the price 
of liquid milk to local authorities for maternity and child 
vvelfire purposes Arrangements were under active con 
sidcraiion 

llOSI IT XL SERVICES OF THE COUNTRY 

In addition to specific services such as those for tuber- 
culosis and venereal disease the years since 1929 had seen 
remark ible developments in the general hospital services The 
increase in the number of beds had not been strikingly great 
but there had been a continuous improvement in the standard 
of treatment equipment and accommodation Whereas in 
19y2 88 000 beds in local authoritv hospitals were m Poor 
Law institutions and i8 000 in public health hospitals the 
corresponding figures for 1937 were 69 000 in public assistance 
institutions and 60 000 in public health hospitals Transfer 
flrom Poor Law to public health had not onlv given an oppor 
tunitv for an improved service but made possible and indeed 
eseiuiil elose cooperation between local authority hospitals 
ind voUintarv hospitals in manv areas co operation had 
been developed and there were signs of a growing recognition 


by those responsible that general hospital aceommodaiion, 
however provided should form a pool for use to the maMnwm 
advantage of the whole population It might be that ihti 
were on the eve of expansion and reform in the hoipml 
world 

Last autumn a campaign with the slogan ‘ Use your Health 
Services was inaugurated by the Pnme Minister with ih 
support of Lord Addison and others To draw attention to 
the health services was only a small part of health tducaiioi 
Much could be done to inculcate positive rules of hvgiepi 
and the healthy way of life especially by means of the film 
Good work vvTs alreadv done in this field, but there was 
room for more He hoped local authorities would suppoti 
the work of the Central Council for Health Education a 
co-ordinating and executive body on which the medical pra 
fession was represented 

MEDICAL RESEARCH 

Further progress had also been made m research s oi 
influenza The first widespread epidemic of influenza since 
the recent work on the transmission of the virus began n 
December 1936 The results obtained confirmed cvpin 
mental identification of the virus as the primary cause of it 
infection In remedial work the group of drugs of wtisli 
prontosil and sulphanilamide were members had been i'“ 
subject of much further study and application The levuli 
of the use of these agents were as good as anything that lid 
ever been shown in the earlv history of remedies— so gooi 
that thev must be treated vv ith caution and checked in th 
true scientific spirit 

In conclusion Dr Elliot said the nation could not afford to 
lose every year nearly 2 000 mothers and more than Jf CW 
children under the age of 1 year They could not view wiih 
complacency an_ annual death roll of nearly 30000 pcnai" 
from tuberculosis and nearly 70 000 from cancer, or lIi 
estimated loss of 5+ million weeks every year owing lo 
rheumatism a disease to which one sixth of indusirui 
invalidism was due They were beginning to realize lioi 
much could be done even in the ca,se of those at preiew 
considered normal and fit 


MEDICAL CRITICISM 

Dr Haden Guest asked Dr Elliot why, in the appoint 
ment of a committee which had been asked to advise on 1 
organization of hospitals in the London area under the a'l 
raid precautions arrangement, the British Medical AssovUti^ 
was not consulted Dr Elliot said this was a mallet 
material The British Medical Association had undertaken 
review of the personnel available and when these » 
inquiries were completed the 'Ministry would be able to r 
the two halves of the plan together 

Captain Elliston said that the Health Department of i 


Borough of Kensington reported that of the 500 women 


alierd 


ing an ante-natal clinic 100 admitted that at some 


time ff'' 


had tried to procure abortion In nineteen cases the) 
been successful and in ten admitted that they used me 
pills advertised in the less reputable newspapers The me 
officer of health for Kensington recommended 
attending clinics should be educated in the dangers o a 
facients that the sale of these should be prohibited ,^i 
there should be an extension of notification to ' 
termination of pregnancy Of these 100 women ii 
had used proprietary pills 

Mrs Tate said the report of the Board of 
1936 showed the number of persons m j.mi' 

disorder was about 155 000 and that the 
people under control were between 80,000 and . jj] t 

ill-health nearlv approximated to the "hole physic 
of the nation because in ordinary hospitals there « 

198 000 beds Some mental hospitals (OuM 

treatment but m a large number of hospitals nfl * 
said was that the sufferers were kept out of harms 
urged that the old turbulent lunatics should , (v'"'- 

the more old fashioned mental hospitals i 

date hospitals should be kept for cases in which 
chance of cure In regard to the recent case o 



\LGUbT 6 , I<>.S 


MEDIC \L NOTES IN PARLIAMENT 


The Burrisa 

MlDlCAi JOE'FSAI. 


327 


il \\“is time Pirlnnicni v,on«^K*crcil N^hcJhcr the ittion liken bj 
Dr Bourne «houM noi be pcrmiutj in of girls onU 

nboul l*t scirs whether the girls heilth wns m d-ingcr or not 
More inspection should be nndc of conaitions of higicnc in 
nursing homes 

Dr Edith Sim^ii kskhi spcikmu on miicrnil moriThu 
said the final report of the Departmental Commiltcc showed 
that of nolhers who died and should be s-wed ** per cent 
died from lack of facilities and 7 per cent through ncghcencc 
on the part of the patients that ^ per cent of the deaths 
were ouc to lack or failure of ante natal care or error of 
judgment Expert nudwifers w^s a factor of major impor 
tance and she reuretled that her profession did not fate up to 
It Six sears ago it was recommended that education m 
obstetnes for medical students should be improscd She 
qualified in P24 and was qualified in midwiferv simpK b\ 
l^inc in a room where iwcnti confinements were conducted 
thouch she ncser went near a bed or touched a patient She 
was lucks because her father svas a ccneral prictitioner and 
o she had been able to get expert tuition at home Never 
thcless <hc was sicned up and certified as beme qualified to 
corouct a confincmeni without havinc conducted one in a 
hospital In repU to Sir Henrx Morns Jones she said she 
did not attend one case outside hospital On November 1 
^ the licensing autho ities were going to be told that the 
edwciUorv s-WidewU \tv obs\ei.r\c^ wvwsx be vwvp roved She 
had a copv of the rccommend‘*tions and found to her horror 
that a student was snU to be sicncd up after twcnt> cases 
which need not present anv abnormaliiv That was a kind 
of confidence trick plaved on the mothers who believed that 
cverx docto- vvas fullv qualified 
She was glad to hear from the Minister that films and 
lectures vverc u<ed to make people health minded but she 
referred him to the speech made b\ the President of the 
Bntish Medical Association m the previous week when he 
said even child in clemeniarx schools should be instructed 
in anatoms and phvsiologv The icnorance of the average 
patient on the location of his organs when he went to see 
the doctor was equal to that of a native m darkest \frica 
Education was particularh recessan in the case of potential 
mothers. She pres ed upon the Ministrv the need to attend 
to the final recommendations of the Departmental Commiltcc 
on the Medical Staffing of Matcmitv Hospitals To>dav mans 
patients sent into matcmitv hospitals vs ere treated bv assistant 
medical officers who had not the knovs ledge pos cssed bv the 
doctors who sent them there 

LVHEXLTin xiovvsne Lire or s lvtsl hospitsl oiricrRS 
Sir Erntst Gr-xilwi Littll said it was difficult to obtain 
experience for students in materniiv ca cs and the svstem of 
training students adopted in London was cxccllcnih adapted 
to irect the position One branch of medical practice m 
which little improvement had been made was that of mental 
diseases The reason lav in the faults cducaiion that was 
ofTered and the faults provisions made for medical officers in 
menial hospitals This applied in the provinces and London 
A ca'ic in the coun of kings Bench last sear established 
that it was posable under the Lunaev Act of 1890 for a visit 
ing committee of a mental hospital to discharge an officer 
of the hospital without giving anv reason The onlv officer 
recognized at such a hospital vvas the medical superintendent 
who vs-as able to rule his communitv with an autocratic rule 
- In an asvlum which had been described to Sir Ernest no 
assistant medical officer could be ab'-cnl without the leave of 
the medical superintendent and could onlv get awav at all at 
the annual holidav He lived in the hospital was unable to 
marrv and remained there sometimes for iwcnlv vears m that 
unhealthv monastic condition In addition these assistant 
medical officers were inadequatclv paid 
Tbev were trving to improve the training of officers in 
menlwl hospitals bv instituting in everv univcrsitv an improved 
diploma in psvchological medicine The training for such a 
diploma required an ab«cnce of at least six months at a recog- 
nized hospital and it was difficult to persuade medical officers 
at mental hospitals to take this extra qualification at their own 
nsk Provision in the Minister of Healths Estimates for 


studv leave would repav itself manv times over Research 
had been stagnant in this department of medicine owins to 
the conditions in the hospitals manv of them were antiquated 
and inadequate to deal with the cases which thev took The 
chairman of the Mental Hospitals Committee of the London 
Countv Council had told him that for some time thev had 
insisted on the diploma in psjchological medicine but thev 
now further insisted that their medical officers should also 
take the membership of the Roval College of Phvsicians of 
I ondon — an onerous and difficult examination in which the 
failure rate vvas some 80 per cent The President of the 
Roval College deprecated the idea that this should be insisted 
on m the case of a menial hospital officer holding the diploma 
in psvchological medicine To take an examination of that 
kind while at the same time working in the hospital was 
bevonJ the requirements of the case it put an intolerable 
strain on the officer ^ et officers had been told thev could 
not hope for promotion in the London Counts Council menial 
hospitals unless thev had a good M D or M RCPj or both 
in addition to a diploma in psvchological medicine and the 
quahfKation which put them on the register Sir Emesl also 
said that considerable dangers had to be faced m regard to 
the pre cm position of the London Counts Council hospital' 
These had inadequate personnel as compared with voluntary 
hospitals One hospital with hOO beds had four assistant 
nicciica! ofliccrs no house surgeon no hou e phvsician and 
no students Since 1929 these hospitals took a number of 
acute ease ''nd one officer told him that in iwcniv months 
of service he was called upon to deal with cases of 
illness caused bv unskilled and dangerous attempted abortion 

7HL <ISLR.VL rRSCTITIOStR S PI-SCE IS THE HESLnt SXbTEM 

Sir pRsvcTS PRrvfssrLE said he would like to know the 
results of the mission which was sent out bv the Mmisirv of 
Health to Svandinavia to inquire into the treatment of 
svphilis in Scandinavian countries This disease would con 
iiruc to wreck the stamina of the nation unless it was tackled 
He hoped that Parliament would get to work on the dangers 
of the quack medicine trade the new Drugs \ci would enable 
them to deal not onlv with popular patent medicines which 
mcdiral men often prescribed themselves but with misleading 
advertisements m relation not onlv to medicines but to 
mstnimcnts \oluntarv hospitals were on the rocks and not 
lei't the leaching hospitals Easier conditions of service and 
better rewards for the nurses and doctors emploved in the 
hospitals would mean immense additional cost Thev 
muM obtain some co operation with the municipal hospital' 
which would retain what was good m the voluntarv hospital 
svstem and at the same time allow it to develop General 
practitioners should be the basis of the health svstem he 
hoped general practitioners united together as thev were in 
the British Medical Association for the benefit of the public 
would be more consulted bv the Government If from the 
first the doctors had been induced to work the Fitness Cam 
paign It would have made greater progress 

RESEXRCH GR.XSTS DISCREDETABLE POSITION 

Dr Hvden Glest said that what was lacking m the frontal 
attack upon disease was a proper staff organization On the 
purification of rivers £7 000 000 was spent on vvaier suppiv 
£4 500 000 on mental diseases £10 000 000 on patent medi 
cincs £^0 000000 annuallv but the grant in aid for medical 
research from the Government vvas £195 000 onlv It was dis 
creditable that the Medical Research Council had to go cap 
in hand to funds in charge of private individuals Monev 
from private research funds such as the Rockefeller Founda 
tion should be spent on pioneenng work Yet the Medical 
Research Council asked for monev from such sources for 
research on rheumatism cancer and malaria For medical 
research work in connexion with the Mimstrv of Health that 
>!inistrv should provide at least £I 000000 A private appeal 
had been launched to raise £^00 000 for work on rheumatism 
That mone> should certainlv be provided from Govemrrent 
funds 

Mr Bernvvs replving to the debate said the number of 
malermtv beds had increased in the last two jears bj 1000 



32S August 6, 1938 


EPIDEMIOLOGY SECTION 


Tire BtUGH 
Medical 


and pUns were under consideration to increase that number 
further Mrs Tate had proposed to redistribute incuiable 
mental patients to the old hospitals That was a council of 
despair The old hospitals should be brought up to date 
uhtch was in fact being done Of 101 menial hospitals fortt- 
five had separate admission units and fifu-five had separate 
convalescent units Each tear that figure was improted and 
m due time all hospitals would have these units He believed 
that progress in well being in this country had been so swift 
as to commend the records of the Ministry of Health to the 
w orld 

The Appropriation Bill was then read a third time 


EPIDEMIOLOGICAL NOTES* 

“ ^ Poltorajciitis 

A further case of infantile paralysis has occurred at 
Braintree, Essex, and 2 moie suspected cases have been 
reported at Halstead — the first to be noted for over torty- 
eight hours The total number of cases reported which 
includes suspected and confirmed cases, is now 21, of 
which I has been fatal 

The recent occurrence of this small outbreak of acute 
poliomyelitis in Essex, which appears to be on (he wane, 
exemplifies well the epidemiological behaviour of the 
disease in this country, in which no large epidemics have 
ever been recorded, although on the average about 640 
cases have been notified annually Within the last ten 

years the annual number has varied from 1,397 in 1936 
to 394 in 1931 and 700 in 1935 m the same period large 
epidemics have been reported m Australia, the United 
Stales of America and (i^anada, and to a less extent m 
Europe — notably in Denmark The low incidence of the 
disease m this country probably increases rather than 
lessens the administrative difficulties in connexion with its 
control It may be difficult to decide whether the par- 
ticular measures which have been adopted have exerted 
any influence on the course of the outbreak In outbreaks 
at Chicago m 1937 and in Manitoba in 1936 post- 
ponement of reopening of schools was regarded as the 
most important single measure in bringing the outbreak 
to an end and there is ample reason to believe that 
closure of day schools as has been carried out at 
Braintree is a desirable measiiie With regard to the 
disbanding of residential schools difference of opinion has 
been expressed by various authorities by placing such a 
closed community in strict quarantine the chances of 
spread to other areas are undoubtedly lessened, but the 
probability of infection among Us members may be 
increised The interest of everyone concerned would be 
idequately safeguarded provided that the contact goes to 
t home in which there are no young children and is kept 
under medic il supervision for a period of three weeks, 
when the likelihood of his developing the disease is remote 
Carriers and cases clinically so mild as to escape recog- 
nition may be responsible for spreading the disease but 
proof of iheir guilt in a given instance is rarely forth- 
coming For individuals who are intimately exposed, 
gargles and nasal douches with a solution of permanganate 
of potash 1 tn 5 000 m 0 8 per cent of sodium chloride, 
should be cmploved More drastic measures such as 
instill ition of alum tannic acid and picric acid have been 
advocated but their efficaev has not been established and 
the method IS probably not free from risk of damage 
to the epithelial surfaces Immune serum taken from 
individuals convalescent from poliomyelitis mav be used 
for p issue immiim?ation in special instances but it is 
not apphcible on a large scale in this countrv while 
^voliomveiitis remains r sporadic and compar ilivcly 
Ip nir e q iien t disease 

l WLpt wlure othcrwiM, mcmioned fi!,urc> in pirt.nlhe’>e> rtfer 
10 til. w ->. 1 . prvvcdine the one under rerievs 


Diphtheria and Scarlet Fever 

/ 

Notifications of diphtheria in England and yVaks di,®. 
the week under review fell from 1 075 to 1,031, but m Lorau 
they rose from 153 to 155 There was a slight use lecDdftJ 
in the notifications for Scotland — 123, as against 121 m if 
previous week — while in Eire there was a definite fall if 
figures for the week being 45 compared with 5S m iv 
previous week, m Northern Ireland a considerable nie Mi 
noted — 37 as against 24 Deaths from diphtheria in the 125 
Great Towns of England and Wales rose from 26 to 27, nhi' 
in London thev remained at 3 Of the 27 deaths lecordei m 
the 126 Great Towns 3 (5) occurred in Liverpool 2 each m 
Newcastle upon-Tvne (0), South Shields (3) Stanley (0) Th re 
were 8 deaths from diphtheria m the 16 principal towm d 
Scotland during the week under review — 3 (1) in Glasgoa anj 
1 each in Edinburgh (1) Paisley (0), Motherwell and Wishw 
(0) Hamilton (0) Ayr (0) There was an increase m iff 
number of notifications of scarlet fever in England and llsh 
during the week — I 791 compared with 1,740 — and in Loniioi 
— 191 tl683 In England and Wales the figures were coa 
sidenbly in excess of the median value for the last ninevtan 
There were 3 deaths from scarlet fever in the 126 Great Tosm 
of Engl ind and Wales during the week 

Primary and Influenzal Pneumonia 

There was a drop in the notifications of primar} and 
influenzal pneumonia in England and Wales during the luel 
under review — 528 to 493 — and in London'-37 to 31 if 
figure for England and Wales is above the median valiit !« 
the hst nine years, while shat for London is well below 

Typhoid Fever 

Eight cases of typhoid fever were notified in Essex "ti to 
July 30 The outbreak began m the Tilbury area a "ed 
previously 

Measles and Whooping-cough 

There were 6 deaths from measles in the 126 Great To 'ft 
of England and Wales during the week under renew com 
pared with 5 in the previous week of these 2 (1) occunel 
in London and 3 (0) in Stoke on-Trent The number of ci‘t' 
reported in the L C C elementary schools during 'ho w« 
yyas 119 compared yvith 176 m the previous iveel whik i 
average daily admissions to the LC(3 fever hospitals was 
as against 9 in the previous week Notifications dtoppeo i 
five of the metropolitan boroughs in which measles is noH' 
able remained the same m three and rose in three— 
n (9) Lambeth 26 (15) and Shoreditch 3 (1) In 
figures for measles rose during the week from 109 
these 46 (54) occurred in Kirkcaldy 36 (8) in Donfen’'' 
and 6 (6) in Edinburgh As recorded last week there 
been more deaths from whooping cough than from 
during the week in England and Wales — 7 deaths 
mg cough as against 6 deaths from measles — but in^ 
there was only I death from whooping cough while - , 

from measles were reported In Scotland there were 
from whooping cough (all in Glasgow) - 

Cholera 

During the week ended July 23 505 cases of j 

204 deaths were reported in Shanghai, and in Hone 
cases with 33 deaths A further increase of tw 
incidence was noted in the Central Provinces an 
3 648 cases with 1 785 deaths — and in Bombay rfC'i 
150 cases with 71 deaths in the United Proviflocs ^ 
other hand there is a decline in the nviinbcr of case 
—777 (I 682) with 388 deaths 

Small-pox 

During the week under review 2 cases of - 

notified m Wigan counts borough In the saw ^ ^ 
Shanghai there were 6 cases of small pox 
reported and in Hong Kong 2 cases with 2 deal > 



Vlci’sT 6 19 ^^ 


EPIDEMIOLOGY SECTION 


Tiit^Rmsir 
^fEDICAi JotTENAL 


No 29 

INFECTIOUS DISEASES AND VITAL STATISTICS 

Wt print K!ow i ‘•uniimrs of Infixtioin Di‘«asi.s md \ inl Sntistn^ in the Briti<h Isles during the weeh ended JuK 23 I9'S 
1 i-tirC' of Pnneipil Notitnbk Disci<cs for the ucik ind those for the corresponding week last >ear for (a) England and Wales 
(London meluded) (h) London (ndministntnc eountr ) (c)Seollind (d) Eire (c) Northern Ireland Median talues for the last 9 
\uirs fo n) and (b) 

/■(Ciisfs o/B rf/is n //)e«rf/it at it of Deaths ricorjid under eaih » ficnam arefur (a) The 126 great towns (124 in 1937) in 

Enchnd nnd Wiles (ireliidinc London) (b> London (adnnnistritni. counts) (c) The 16 printipal towns m Scotland (d) The 13 
pnneip-il towns in Dre (e) The 10 prineipal towns (9 in 1937) in Northern Ireland 

\ jssi, — denotes ro eases a Hank spaex denotes disc.isc not notifiable or no return asailable 


Dl<4.a'‘C 



19 S 



1937 

(Corresponding W cek) 

1929 (Median \ aluc 
Corfcspondinc \\ ceks) 












m 


M 

<d) 

ig 

Dl 


m 

(d) 

(c) 



Ceabrospinal fever 

19 

3 

12 

2 

1 


B 

3 

1 

— 

|||B||||B 


DLalh<; 


* 




■■ 

B 






Diphthcra 

1 Oil 

D5 

12j 

45 

*7 

906 

119 

124 

56 

13 

944 

163 

Dciihs 

27 


s 


— 

0 


3 

4 

— 



Dvsentem 

1 

7 

2 



B 

5 

s 

I 

_ 



Dusihs 




— 

— 

B 



— 

— 



Ensephahtis I-thargica acaile 

t 

I 

— 

I 

— 

B 

— 

1 


__ 



D-aths 


— 




B 

— 






Enienc (I'phcid and piraiNphoid) fc\tr 

19 


4 

6 

1 

2S 

2 

2 

12 

1 

<9 

— 

Deaths 

— 

— 

— 

— 

— 

1 

— 

— 

— 

““ 



Er\sipe!_s 



57 

6 

3 



46 

*> 

•> 



Dea hs 


— 





— 






Infeetive cntcntis or diarrhoea under 2 sears 













D-aihs 

57 

19 

n 

6 

5 

lO 

20 

10 

II 

1 



Measles 

■1 


EB 

■ 

12 



66 


2 



Deaths 

H 

2 

IbI 

B 

I 

9 

— 

1 

2 

— 



Ophthalmia neonatorum 

Deaths 

i 

s 

:o 


2 

117 

IS 

2S 

i 

i 



Pneumonia influcnraU 

49a 

m 

9 

1 

9 

445 

■Q 

■Q 

s 


477 

4j 

Deaths (from infiuenra) 

19 

■1 

3 

— 

— 

6 

B 

B 

B 

B 



Pneumonia piamarv 



115 

4 


■I 


120 

3 




Deaths 


14 


12 

9 

Bi 



9 

5 



Polio-enccphalilis acute 

10 

— 




H 

I 

■1 





Deaths 


— 




B 


B 





Polonvelms acuie 

19 



10 




IS 

3 







Deaths 


— 





I 

B 





Puerperal fcNxr 


■§ 

7 

4 



46 


19 


1 



Deaths 

■1 

■ 





B 





Puerperal pvreaia 

165 

S 

19 


7 

IIS 

14 

21 


1 


D^ths 













Rdap^ng fc\er 


















Deaths 













Scarlet fever 

1 791 

191 

282 

66 

67 

1 618 

159 

e02 

96 

v5 

1 619 

25^^ 

Deaths 


I 

*> 

— 

— 

5 

I 

2 

— 

2 



Sm„ll pox 

2 

. , 






■H 



_ 





D*^ihs 

— 

— 


— 

— 


— 


— 

— 



Tvphus fe\cr 

— 

— 




_ 









Deaths 




— 

— 

■n 



— 

— 



WTiooping-coueh 



16 


7 



42 





D^lhs 

7 

I 



I 

s 

J 

6 

— 

— 



Deaths (0-1 \ear) 



67 

19 

11 

252 

48 

55 

21 

8 



Infant monalitv rate (per I 000 live births) 

iQ 

43 




43 

40 






Deaths (excludmc stillbirths) 

3S53 

67S 

599 

163 

IIS 


713 

561 

143 

lOS 



Annual death rate (p^r I 000 persons lining) 

95 

86 

12 2 

n 0 

105 

B 

90 

II 5 

97 




Live births 

6979 

1 275 

89S 

400 

2S0 

a 627 

1 289 

931 

404 

280 



Annual rate per 1 000 persons li\ing 

17 I 

162 

18 3 

27 I 

24 8 

164 

162 

19 0 

27 5 

26 8 



Stillbirths 

25S 

42 




276 

56 






Rate per 1 000 total births (including stillborn) 

3fc 

^2 




40 

42 







ASter O''obcr I I*>3 puerperal fcier was made nouliaHe crl> in the Ir^.Iud'^ primarj form in figures for Enstaad and W^Ies Lorden 
njstrati>c ccuni of Lorden (atouotstrause countj) ard Iscnbcm Ireland. 

T Death from ru'-rreral sopsis. 































































































































330 August 6, 1938 


MEDICAL NEWS 


The Bsmsn 
MeoiceeJxemi 


Medical News 


The Roval College of Physicians of London is closed for 
cleaning etc and will reopen on Monday September 12 
At a special meeting of the goiernors of The Warneford, 
Oxford held at New College Oxford on July 28 Dr 
Robert Gow Meinnes MRCPEd DPM was appointed 
phjsician superintendent of the hospital 

A Royal Commission has been set up to investigate social 
and economic conditions in Jamaica Tnnidad British Guiana 
British Honduras Barbados and the Leeward and Windward 
Islands The chairman is Lord Moyne, and one of the 
members is Dr Mary BlacklocL, wife of Professor D B 
Blacklock of Liverpool She has been professor of pathology 
at Lady Hardinge College, Delhi and is now curator of the 
museum of the Liverpool School of Tropical Medicine and 
a member of the Colonial Advisorv Medical Committee 
An international balneological association has been founded 
in Budapest The first meeting will be held m Germany in 
1938 the next in 1940 in France and the third in Italy in 
1942 during the World Exhibition 

A meeting of the Osier Club of London “was held at the 
Langham Hotel on July 12 in honour of the eighty-ninth 
anniversary of the birth of Sir William Osier Dr Archibald 
Malloch delivered the eleventh Oslerian oration on Osier ’ 
recounting the story of his life and work in a happily personal 
way that made him live again Among those who spoke were 
Dr Harvey Cushing and Dr Charles Singer Thirty six 
members and friends sat down to dinner and honoured m 
silence the toast to the memory of Sir William Osier 


Letters, Notes, and Answers 


All communications in regard to editorial business should be 
addressed to The EDITOR British Medical Journal B M A 
House Tvvistock Square WCl 
ORIGINAL ARTICLES and LETTERS forwarded for pubficition 
aic understood to be offered to the Briiisli Medical Journal alone, 
unless the contrary be stated Correspondents who wish notice 
to be taken of their communications should authenticate them 
with their names not necessarily for publication 
Authors desiring REPRINTS of then articles published in the 
British Medical Journal must communicate with the Secretary, 
BMA House Tavistock Square WCl on receipt of proofs 
Authois oversets should indicate on MSS if reprints are 
rcquiied as proofs arc not sent abroad 
All communications with reference to ADVERTISEMENTS should 
be addressed to the Advertisement Manager Orders for copies 
of the Journal and communications with reference to subscrip 
tions sliould be addressed to the Secretary, BMA House 
Tivistock Square W C 1 

The Telephone Number of the British Medical Association and 
the Briiish Medical Journal is EUCTON 2111 
The TllicjRvphic Addresses are 

EDITOR OF THE BRITISH MEDICAL JOURNAL Ailiolot;y 
llEsrcdir London 

SECRETARY Mcdisecra W'eslceni London 
The address of the BMA Scottish Office is 7 Drumslicugh 
G irdens Edinburgh (telegrams Associate Edinburgh tele 
phone 24361 Edinburgh) and of the OfTicc of the Irish Free 
State Medic il Union (IMA and BMA) 18 Kildare Street, 
Dublin (telegrams Bacillus Dublin telephone 62‘iSO Dublin) 


QUERIES AND ANSWERS 

Green Stools at 74 

\ltvvi writes 1 have a patient aged 74 of active disposition 
but slightlv neurotic He has been passing green stools 
for the last two months The tongue is fairly clean though 
there are svmptoms of occasional gastntis notablv some 
I pain cspeciallv at night \ ray examination has shown 
some diverticulitis The diet has been curtailed and kept 
simple and there has been an improvement lately in the 
condition Can anyone tell me what is the cause of the 
trouble and whether any treatment is of real valued 


Finger-prmfs of Twins 

Dr L W La Chard (St Kitts Leeward Islands) writes Wnh 
reference to Dr R Gotten s (May 21 p 1142) note oi 
finger-prints of twins may 1 state that during the fiie years 
that 1 was occupied in inaugurating the finger print systen 
in Northein Nigeiia and was attached to'Scotland )arf 
to study the system as carried out in England 1 cameacrcw 
many sets from known twins hut never once did I see any 
that were identical One curious feature which 1 pomiej 
out in my Correlation of Finger prints and Racial Clmcla 
istics (1913) was that in the cases of twins the whorl type 
of impression -prevailed and the loop type was quite un 
common This incidentally is the mark of lower nciil 
standard the higher the race in the ethnological sca'c th 
less tlie proportion of whorls and the greater the propotlion 
of loops In monkeys several hundreds of whose dieitil 
impressions I recorded a loop is unknown It would setn 
that there is a field for research into atavistic possibilities 
and while I think there can be no doubt that finger pniib 
of twins differ just as others do it is worthy of inqmn ai 
to why^they are definitely characterized by the predominan e 
of the "racially inferior type of impression 

Syphilis in South Africa 

Dr E E Barnett (Sefhare Hospital Bechiianahnd Pro- 
tectorate) writes Here as in many parts of the Empire nt 
are faced with a population largely syphilitic and mub 
too poor to pay for treatment sufficient to cure the dueK 
Treatment is therefore undertaken by the Government or 
Mission Hospitals Because of the enormous cod ol 
adequate treatment even if it could be enforced Ik 
accepted aim in most areas like this is to stcnlize ih 
patient — that is to render him non infectious This is done 
by means of a short course of injections — for example sit 
graded injections of N A B and a further six of bismum 
In addition where necessary iodides are given bv month. 
What I am anxious about is this Are we not encoiiratn 
the pel sistence of a strain of arsenic resistant spirochieR 
bv this technique’’ If so is not our last state liken loK 
worse than our first when that minority of patients who 
are not rendered non infectious bv treatment have aton 
infected ^the population7 I should be grateful for intormi 
tion as to whether anv work has been done on this problem 
and, if so with what result 


LETTERS, NOTES, ETC 


The Medical Diicctory Uncommunicatcd Addresses 

The Editor of the Medical Directon 104 Gloucester PI'T 
Portman Square London W 1 desires to notifv j’’*-'" ‘ 
of the medical profession that ceitain of their ^ "i, 
not communicated to him their present addresses 
Ihnt the persons in question will kindly give the inform >■ 
without delay Otherwise the words {adilicss 
cated) will appear in lieu of an address in the form o 
1939 issue 

Protest from Vallialla 

Wc have received the following letter signed ‘ 
and written from The Golden Hind off Plyniomn 
1 anxiously scanned your account of the i,, 

Dinner at Plymouth in the hope that someone v'ou ^ 
recalled the fact that it was actually held on the J “ ,| 

versary of my fight with the Spanish Armada ,,,»i 

no one did I feel rather neglected especiallv is I 
a Sydenham as your great Thomas Svdenham was 
to remember 


Unilateral Nystagmus 


aged ’’’ 


Mr Sydney Tibbles (London W) writes A T -p- 

was sent to me complaining that her sight ii, |V 

results of the examination were as follows visi 
right eye 6/60 and Jaegei 6, not improved vi j 

left eye, 6/18 and Jaeger 1, with glass 6/6 an ^ 
Both eves had a fair amount of mixed 
right eve apart from a vertical nystagmus IT 

low degree of vision being the result of the njs 1’ „ , 
movements were fine and rapid The tvmptc"' 

good and the patient who had no other ncr' 
said she had always had this condition , ° occ ' 

textbooks denv the possibility of unilateral n) . I ( 
ring though Gordon Holmes mentions it 
nvstagmus in the Dictionary of Practical Men 



6 I‘>'S 


Tht B^njsj 

VltDICAL JotILSAt 




KEY TO CURRENT MEDICAL LITERATURE 

GEN'ERAL JOURNALS 


Deutsche Mcdmni<:cbc >\ochcnsclirifl 

Bert T %ol il May 1<J « 

Rar^J Tvcvtxcn al cf an IncvN-pa* *' c »1 Tran f n n — H Kam'^c'cr 
r r-unm after \c'n tMraii no! t c in— O I r 

txronr'cctal 3**d t-vKHC-Ncn » ih a Ncn B c Rcr-cJ»— ^ Matlcct 

n cvn \r Tr*~*..ruati-»n atat** i D '‘Mhma Xrtucxm ntre K ihe Scni»n 
a^tcr ireev. a n on 1 *> (Vea ui h D t ai'*J V'lJ — I- **N.hal 
'^i-r'* cvM-*- cf Mill S«Ttt cn a H rr* n — \ V \ ar-CA arnl f Ci mN 
V'' in— C ''tu'^''Ve 

Treater cf Gc c"^l•<a «Ji*i I Jeren M rath — I Ja c*' 

C^ACA cf \fal_m Ke^-rk j Lem Latm reri**- — R \ B c*'tcl 
El ct ocarvincrarh' »n G'nrral Pramce — <3 B •detnurn 
\a »,r cf Si_t tj*A Ba cd on Setc ed Cauven cf IVaih - k T *“ m 
Jf tH.A.Taft Gu J aA a C'^^atjac Bks ' x 'al Prxci i! ^tcci n— I a Leert 

If Lcnpat ble Blootl Trat sfuston — \ man aued 30 of Mood 
group B had ^ufTcred for about cichl v^ccks from a high 
reniitcni sepiicacmic fc\cr \\hcn he \va«; gixcn a tnn'^fu ion 
of blood ^uppo^cd to come from a group B donor The 
puUcnt reacted dunne the tran'ifuMon NMth ntu^ca pain 
Nomiling and collapse ^ rigor and a icmpcmturc of 
10^^ F follON^ed It transpired that the donors blood 
bc’onccd in reaht\ to group O The patient s temperature 
fell below normal next da\ and thereafter remained normal 
Complete recO\erv \ as still maintained cicht weeks after this 
innsfusion The possible reasons wh\ this blunder achiescd 
such T dramatic therapeutic success arc discussed 


Die Medmnhch' ^^cU 

B-rla ycJ V Sta> « |SIa 

Set f *3! B xxJ P'C'L e la L»ie 5 sen cf Sirttttw Itca '■t I — T 'S 

S-hm-di 

V -e Sf-Tcn* ^n E.ycrt^l TtirimN.rcnj — S Sfatl T 
T*ucc C«A« of Gloracrj **-^ 0 -a — K Bjin-witAc*i 
PjpMh lu Trcaj~ert of ACCJ cJ D feet c! Pila e — S Ehn Vc 
O-cunerwe if Aopccia PjoToidcs — H Heffnann 
Tn-naflaA Trcaincnt of Erj-cr^*^! i** Lci*urc:C3 — O BsCA 
Trea cf TcbcrculoiM Per ten t a w « h Go-d Sal i — T Srefc^or 
S -ni.'U^-.iicn «"d Gaur"? c' B ire** n Co c'lr-c'cr — L lie x-ytr anJ 
I T MutiUS 

Rer y ic Ess 3>'5 cf F Hols a"d A. E Rc^'o on Ultra au « Irradat n and 
C..r *er — H Ba h 

Trcatn*cr: cf Male Irtpitencc — P S^hThii 

Gold Salt Therapy of Tuberculous Ftriwniiis — In com 
p*inng a senes of twcnls eases of -tuberculous peritonitis 
treated with gold salts and eights four treated b\ other 
methods Sparchez found that the former group had a much 
higher proportion of cures He found that gold injections 
had not onh a local but a general effect A careful anahsis 
of indications and contraindications of the treatment is gnen 
and the prognosis in different forms of tuberculous peritonitis 
IS discussed 

Indian Medical Gazette 
C^’eutj Aol 73 Sla) i938 

Sosernu tn Pictnar-y A Hacmatolc^^l Oin cal and Statnttcal Miidj — 
S Choudhury and \ S SfanralTc 

Sc— 'c O meal A-mets of Anaemia in Presrumr m Indian \S omen lo Bcncat — 
H S Chailerjcc 

Ir jccn^e of RheunutJ Infection in India II — 1! Stott 
Sh t Note on Epidemic of Chicken-pox in Central Jail Cannanorc — P 
Kararochandam 

C- c of Adrenal Imufn no Sjnulatmc Ad.jni-StokcA Syndrome — E S 
Ph p<on 

Dictiry Habits of Some Commumtics Li int at Calcutta — D D Mttra 
Gu nea pit in Latoraiory D^cnosts of TubcrculoAts — R k Gcyal 
Speefi G'aA^tJ• cf Serum of Epidemic Dremy Patient — C Pastxha S I al 
and k S Malik 

Method of Antf4ar«al Oihrr for Ri era.— D Slanson 

Apha la and Complete Rithi Hemiplejia after Scorpion Bite — S il M-»djr 


Leif I^iAAcpti me in CTUu itrt t f the Arm — St L I athak 

Sr nal Tumour and its Diaenmis — St G kin ard P kevi ai»a-') 

Ca c of Staphyl -< 00:31 Pi yanh in — S! S! dy 
led led arJ I cnduJouA Lipoma of Perineum — A R D Sbreu 
Car f Ch part A Ampt-taiion after I iftecp \e^r — Sf Kmi rd P 
kcAtta warns 

I> et arJ Inciucn e tf D ea e n Irsdia — S C Seal 

Atuuniuis in /Vre/umrt — As the result of a sniistical 
surscs Choudhiin and Mancaltk found a ^6 per cent in 
cidence of anaemia m 2 400 confinements Of forts one 

cisc\ sshich sscrc studied cltnicalls and hacmatolocicnlh 
6^8 per cent were of the macrocMic ispc These cases were 
identic's! with tropical macrocslic anaemn as described bs 
Napier The microcsltc anaemns were due to an inadccuate 
iron intikc made worse b\ pregnanes and parturition There 
IS no evidence lo show that the anaemia of prccnant women 
IS different from that of non pregnant women or of men Thus 
the authors prefer the term anaemias in pregnanes to 
anaemia of pregnanes 


Journal of the Vmcncan Medical Association 

Ch 'ato Ac) 116 Sfa> < loif 

Ir ra ahv -m r^l Cryrii-n:h»d-*m treated »uh Crmadoi cpv. SoNt nN.e— G B 
D tff 

Ticatfpcnt of SScumJv mu ti'it from Deep Blisa — N p Bla r and L T 
Byan 

C rrscvcal Mennc ua — S F Branham R I! S! i hell a-d \\ Earn 
C ^ Pjn%h Prentatw RcACCtmn — J L Ef—^clt 
Treatmem cf AUcho’i pAy^KCAMth Ben/corire Sulphate —E C Re fen tem 
-nd E Davidn'T 

F tal tin fo5c-wt**e In ccticn Treatment of Hefnj — C J Perre 
Prr oci JA Seiual Dnccpm'*ni frim ,»n Anterior ptu r> hVe Pr r m e — 
SS O ThpmpA'n and k j Hrekel 
Renal Slo** ty — E Hcaa 
I ncneiua ty — \\ H RuboMiy and \\ Stph r 
\iurrMn f —II A Slati 1 


Klinischc Woch-nschnft 

Dfilin >ol 17 Slay .v 191R 

•Icfiy arxl Ke^t urve to Tu^-tcu "niA \ (Con luAcnl— SS hci'^cri 
Elleci of LiAcr Eatracis on CarN hydrate Sfeiabo! n of Lner — A SSiecman 
Sorar CtniCTt cf CcTcbrtxp nal Fluid dunne In jlin hock Ttcatmem if 
Si.hir •'hre'*ia — k TTi Dua ik 

Scid Cc»er of Sk n af>d Snti ba tcnal Proicctm HI — A si r h cr* ni ard 
R S>hm dt 

Value if Ch m therapy in Surcc'al Coecal InfeciionA — J Frankl 
FrcviA of A hypeniiamiroAji m Rais foloAiing Oral Su’<utare u nd 
Pcrcut-nc ja Adr* n siraticm cf Ccn*cniiatcd Siumin -S I — SS 
SScAlaw D SSr'inAki A SSrdtlewski ard B SSr hew ki 
LlTect of Conned — k 7 h el 

llydrcchlcn SciJ C illarcol Peacrion New Cerch oap nal Flu d IcM — 
C Ricbclins 

Effect cf Sexual Hormmes on Cocks Comb — J Mcratd-Sl^naro A S 
Alhneux and SS Buho 

Acid Co\er of Skin — The third part of this paper de enbes 
a glasN-bell method which allows the determination of the 
number and tspe of organisms on different parts of the <kin 
Inscstications bs this method have prosed that there are 
fewer organisms and fewer sanelics of organisms on the acid 
parts of the skin Thes have also prosed that the anti 
bactenal protection of the skin increases with the strengthening 
of the acid reaction as for example after sweating, when the 
sweat has been allowed lo drs on the skin 

Hydrochloric Acid-Collargol Reaction — The new test is 
particularls suitable for the diagnosis of general paralssis of 
the insane for the differentiation of sanous tspes of chron c 
ssphilitic affections of the central nervous sssiem and for the 
recognition of somatic ssphilis not imolsing the central 
nervous ssstem. 


3:0 s 



42 August 6, 1938 


KEY TO CURRENT MEDICAL LITERATURE 


TirtBimjH 

MtDlCAL 


Lancet 

London \ol 23(1 May 2R 19'^'? 

Chumoihcrapi oI PncumococcTl incl Other Infection'; \Mth 2 (p ammobcn 2 cnc 
su(plionamido) pynJinc — L E H Whitby 
Treatment of Acute Suppurative Otitis Media — A TumtrWin 
•} cmonl Thrombosis — R T Pone 

remoral Tliiomhosis — The term here means i chnical 
condition similar to that of puerperal white leg ” — with 
which indeed it began in thirty-nine of the eight} -five cases 
anahsed The causal factor in the remainder included some 
post operative state in seventeen, typhoid in twelve, and 
infections of the lung or pleura in sesen The sjmptoms and 
treatment in the acute and later stages are described in no 
case did the limb become normal and twentv-si\ cases pre- 
sented ulceration From the clinical evidence it is suggested 
that the primar> cause of manifest femoral thrombosis is a 
perivenous lymphangitis Pulmonary embolus is much less 
like!} to occur with manifest than with latent venous 
thrombosis 

Medical Journal of Australia 

Sidney vol 1 Mty 7 193S 

Trcaimcnt of Poliomyelitis — L Macdonald 

Earlj Treatment of Poliomycliiis — J Stcigrad 

Mild Leptospirosis in Southern Queensland — D W Johnson 

Lfltci of Auricuhr Fibrillation on Course of Hipcrtcnsion — L E llothstadt 

Sidney \ot 1 May 14 t9iS 

Critical Inquiry into Aetiology of Chronic Peptic Ulcer — H C R Darting 
PliiMcal Efficiency of Recruits for New Zealand Permanent Forces — F \ 
Dowe*bank 

rcriartcniis Nodosa — J B CIcland 

SiiptiMMon of Air Traffic from Oicrsos ind its Attendant Risks — P W A 
Ponsford 

Prehnunary Survey of Types ot Cortnebnetemnn diphiheiiae isolated at Metro 
poliian Infectious Diseases Hospital Northficld — M C Puckey 
Sonit Aspects of Maxillary Antrum Infection — R H Bcttington 

Medizmische Klinik 

Berlin vol 34 May 27 1933 
OiONcIcroMv ~0 Sicurcf 

Medico legal Proof of Poisoning oy Toxic Gases — A Torster 
♦Viluc of New Anil diphtheria Vaccines Ditokoid asid and At FT 
(Behring) — E H islcr 

SenKiolOsi of Duodenal Divcriiculosis — P Spcidel 

Truimeni of Haemorrhage from Acute Gastnc or Duodenal Ulcer — O Onh 
•Uleer Diet Rieh in Vitamins — R Euler and H Otto 
Cise of Selefodermia with Pernicious Anicmia — A Schncidcrbaur 
Uelition between Pylorus and Benign Polypi of Stomach — J G Knoflach 
Tieainieni of Itching Skin Affections with Ocunum — C Etlingcr 
Latest Publications on Health Insurance — P Horn 

iVi 11 Anil diphtheria Vaccines — Investigations of tvventy- 
si\ adults and thirteen children after the injection of 
ditovoid asid and of twenty-three adults after “AIFT 
hive proved that active immunization with these vaccines docs 
not afford protection against infection The vaccination 
however is advisable where there is danger of a diphtheria 
epidemic spreading but onh when it can be carried out at 
least four weeks before exposure is likely The vaccinated 
persons must be warned that the vaccination does not afford 
ibsolute protection 

Diet Rich in Vitamins — A diet rich in vitamins par 
liciilanv'Tn vitamin C has proved beneficial in cases of recent 
sastric ulcer The patient must receive at least 50 mg 
of vitamin C a dav 

Munchener Medizmische Wochcnschnft 

Mmich vol 35 M'ly 27 1938 

• Burvung Pro latic Ring —O Franck 

rmNcm of SuiaJc from the Medical Axpcct — G Sxkcr 

nicicncidal Effect on Blood and Diuretic Action of Quinmc Redoxon tnd 
Quinine Redoxon m Animal Experiment — \\ WuUncr 
Lohfcd Infection ot Sub’mgual Gland with Plaui \ mcent s Spirochacic — 
f Bock * 

following Infection of Infusion of \rnicT — H Schoncmann 
renilc UandUnc and Mcauirms of Newborn — H Hofwcbcr 
Treatment of B cob Infections of Urinary Tract with Mandclic Acid ~H 
Kunstmann 
B 


Successful Trcitmcm of Coronary Infircl with Ciipavcrmc — H 
WcUmann s Reaction m Rheumatic Diseases Simnhricaiion of Toh tj 
A Kcmcn 

Eugenic Measures introduced into Medical Jurisprudence m Latvia n I> cr'^t 
1937 — F V Neurcitcr 

Acute Mercury Vapour Poisoning in the Home— F Lickint 
Patients— Fools— Malingerers (Documents on Quackery) —Kessler 
Two Important Conditions for Good Quality of our Daily Bread— E Ed 

Bursting the Prostatic Ring — Frmck advocalcs iv 
separation_ of the lateral lobes of the prostate m all caici 
of prostatic hypertrophy The results are as good as ilox 
following enucleation for the lobes never reunite The pro 
cedure is short almost bloodless and without dantu o 
complications It is of equal value m earl) and htc cixi 
and IS recommended even m ‘ inoperable cases 

New England Journal of Medicine 

Boston vol 218 May 26" 1938 

Growth of Boston City Hospital from 1864 — M Moore 
Ascorbic Acid Requirements in Early Infancy — H Ingalls 
•EtTcct of Sulphanilamidc on Rheumatic Fever and Chorea— B 
T D Jones 

Early Diagnosis of Cancer of Cervix — W Scliillcr 
DisturJjanccs of Bladder Function in Pernicious Anaemia— C J E kkl* a 
and W C Moloney 

Foreign Bodies m Male Urethra — A Riley 

Sulphanilamidc in Rheumatic Fetcr and Clwrea—hhhH 
and Jones administered sulphamlamide to lift) eight pain s 
with rheumatic fever After two or more dajs of treaiirrt 
a toxic rash or fever developed in 53 per cent of the cis 
Patients ill with active rheumatic fever arc particulatlj pro'' 
to develop severe febrile reactions This fact together ml'i 
the lack of anv observed beneficial effects, conlramJivat i 
the use of sulphanilamidc in active rheumatic fever 

Nordisk Medicinsk Tidskrifl 

Stockholm vol 15 May 28 1938 

•Skeletal Discovcnca from Koribcinings Graves at Visby — B E 
Quantitative Chemical Dcicrnunations of Caroiinoids and Vitamin A in 
H Willstacdl and T k With 

skeletal Discoveries — This is an anthropological stud' o 
skeletons of Scandinavians who fell in battle in 1361 

Policlinico 

Rome vol i15 May 21 1!US (Scr Pral) 

Photovcnsibiiizvlion by Actidinic Substances — G Clitorazzo and 0 G 

Morphology of Anthrax Bacillus — R Lucena 

Latent Visceral Leishmaniasis during Typhoid Infection— A Piccin: i 

Presse Medicalc 

Pans vol 46 May 25 193S 

Inaugural Lecture on Morbid Anatom/ — Roger Lcroux 
•Picgnancy and Renal Fragility — A Powilcvvicz 
•Scnihtv and Chronic Arthritis of Hp — J G Duvernay 

Renal Fragility —The author makes a plea for Jh' 
diagnosis of what he terms latent renal ' 'nP, < 
means of Legueu s ‘ provocative shock test ' i' 

be tried either m early pregnancy or before incur 
risk of another pregnancy ^ 

Scnilits and Chrome Aithniis — The author s tli'CU^^ ^ 
the age incidence of chrome arthritis of the hip 'S ^ 
a review of 1 067 eases He points out the 
earlv diagnosis so that treatment may be institute 
IS still a reasonable hope of its being effective 

Pans VQl 46 Mm 28 1’^^ 

•RcMsnncc of ttoncs anti Sue of rracciirc of Lon? Hants 

Causes — H Rouvurc —Riel' 1' t * ^ 

•EpidcmiotoBicat Data on Epidemic Cnccphabus m , Petfat i ^ 

•V'ascular Spasm tn \ifro Expenmcntal Study of I'O? 

Blood Vessels — A Nfouecot 

f ”* 

Site of fracture of Long Bones H b' 

the various factors "which combine (o 



^ycusi 6 KCY TO CURRENT MEDICAL LITERATURE 


ihctr nornnl icMstmcc 1 hc\ include the amount of compact 
'ubvimcc (he ratio Iciwecn the Icnj^th and the circumference 
of (he ’shaft the shape of the shift and its cross section the 
ridges for muscle in ertions etc He then discusses the 
ctTevt of these \anous factors on the sue of fncimc ot the 
lone bones bN indirect Mokncc 

f fuVnut Imihiliin — The author gnes in iccount of in 
chboraie inscstigUion into the historv distribution mode of 
pread actiolocN ole ol this di ewe He sompircs it wuh 
epidemic cn^cphahtis in Furopc sihich \NOuId ippear to be 
quite different at an\ rate as rccirds the mortahti curat of 
the disease m furopc and in japan Inada intlme to the 
Mcw that the Japanc e \arict\ is spread b\ a mosquito but 
1 tes that this is not \ci dchmteh csiiMi hed 

5p/ 'u » — \ NJouccot dc cubes the action on 
i ohted sinp of blood \cs eK kept aloe b\ immersion in 
Ttrodcs solution of vanou chemical acents such as alk ih 
oxspen carbon dioxide splenic supraren d md piiiuiarv 
cvtracis barium chloride hi t imine atctsMiohnc pepsin 
etc The author '*tso micsttcatcd ten illcced inii pismodics 
bit found the onl\ •'Ctixc sp\ rnoUtic Im were the 

nitrites and carbon dioxide 


Schucizcnschc Mcdizinischc Wochcnschrift 
lb l€ S 1 fS X'3> S 

rufKtKnj.1 r;iih W> f B Tc Xtjrrt » — K Rr*5f 
laDiurhafi fs ct Rcew«ii n c| CsrK'nJ ji MeuS n — L LkIiiwu? 
iiHirsMi n t Ttcu.'r Tcrxi t <1 Ji ih -iSik ;inJ N tiu « S ts.t -mf — 
1 R O nil's 

Boat A/imni — The method of ex iniin ition of the marrou 
bs <(cmal puncture has marked a new era in clinical haema 
tologs from (he standpoints of both morpholOe-s and 
diagnosis The closure of the marrou \essels from the 
cencral circulation is confirmed and immature cells are 
thought to gain cxtramedullarx access to the blood—in the 
hscr spleen and hmph glands The different \icws held 
concerning the dcrclopmcnt and derivation of the various 
cehular blood elements m foetal and in normal stimulated 
or inhibited adult marrow arc discus cd As special examples 
of functional pathologv the mcdullarv functions in agranuloi^x 
tosis and during the liver trcatmeni of pernicious anaemia arc 
traced In an allusion to the function of the mcdullarv 
reticulum it is stated that the mcdullarv plasma cells ire 
regarded not as hmphatic derivatives but as coming from the 
reticulum and as responsible in normal and pathological con 
dmons — for example mvcioma — for the formition of complex 
protein substances 


TXEBiirmH 4 ^ 
XftDtCAL JOLRSiL 


UgcsKrif) for Laeger 

C pcnhjfcn »ol 100 Mas 6 19 iJ 

wen »»h<nc Tretfun > mini rw tlco rn f d x,ipixar dunnjr Pu^rrerjum 
— K Ou h 

Ncnriin fillcmnt tJerc n Trcurrjcn: — XI Bnin-P^d-ren ard T Dal ffaari. 
Nicl c« 

Irciimcni if Pneum nti uh xhin<a’ lum and Ouin nc-cal Tum tVefhanc 

— C C Ja i r->cn 

c r ffk VT S inn t f 4 fxxi C n — P Ur n 

Pr(i,iuii(\ -Hhtiiniininit — This paper coming from Pro 
fcssor Haiich s hospital in Copenhagen deaK with a follow 
up stiidv of ixi\ three women whose albuminuria did not 
dis,ippcar during the fir t ten davs of the puerpenum The 
iiidv IS iKo c tended to the fate ol the children of these 
mothers 

Wiener KUnischc Wochcnsclinfl 

\ t nna 51 M V is 

If .'t I l)» •''cf fthxa II K nn V r 

tPrfarci.n Vjluc IN y i Inf ii t m t cn f 1 M d nc — W I du 
jnd I I c"/ 

C cv Rcc rrest W h f c ' H 7 v-htn 
Xr I c tpefars S'” d 1 1 ur cmi C rj t a \ Ha cr 

t he"" MScfjp\ f C f c M I h inj \\ X 4 fk 

r* f f /' S'^c > w } \ 5 II r f 

Ihutnitii t ft irlii </ — fsanmiker ula sitie*' the 

cm c'' of dwincnorrhoc I t (ollow iH p m due to siretchini. 
bv nicnstruil hvpercmii ot a pithological uterine mucou 
niemhranc pam due io d imminc up ot blood and in 
cfcicd painful conirittion i"*) cotcuhiion of mensiru«l 
bloovJ due to piiholocivil c ui t ibnormallv painful 

uterine contractions due lo lowered thrc'^hold to pam i^i 
timuUtion of the pcKit pcrnoncum on jccOtni of rcirOj.rade 
tranportition ol MockI ihrouch the lubcN ih) hvper timula 
lion of the hspogwiric plexus The Utter cause is exircmclv 
common mJ cinnot be ircaleJ ucccssfuMv bv the ordinarx 
mcthovls KamniKcr recommends re edion of the presacnl 
rtrxc with or without tppcndiccctomv aniefixation of ihe 
uteni etc Ihe technique »nd indications are de'^enbed 
The results ire excellent 

Wiener Medizimschc Wochenschnft 

X*cnft I li xra\ ^ | 9 U 

Pt 4 i> 4 l I het j \ f L » frh <a - VV Ha ‘ ct 
I Ifhl irwi ehc Dcfl nc I B nh Bale ~0 M nOr». 

Inrsfunc? it BiMxl C r uUt n tn Siir*cf> I ANI men anJ Cond xr-n 
cfco rO ihcfctfo'D *— K fncdri h 

Sr<\ I OiarsCTtn ix-s <"( Spa Ire-irrmt m fUiJ* mn ard »n the Sfv 
II Ifa tcin — O C 7jmmcim rn 

Hxt X ttunt in ihc Ai i t » m Maiimim f iPe Lni\ffsM f \ xnna 
Mjj 14 ; 9 V^ 


SPECIAL JOURNALS 


^c'a Tuberculosa ScandinaMcat 

Cirerhafcn »oJ 1*» 1 v>, paNT 5 

H He f X a rr n C m pjih ct Tuber ilrn in Guino r»if* Ifcnj: ) — 

X. C- B rkhaue 

SiuJic^ on Tire* of TuKafe B-c rh i LicJ tr m Man X llnr)— R A 
Jensen ard t Kiccf 

Ccur e and Loha) :> cf Tubcrcilnt t DiT rent Ac PerroU ircr>— S 
Matnu M.n 

*cn Atciceta is wuh Roenfven Xrre rjrc Rerun rni I Bas^l Med linal 
P!cuTtc> «En«)— H Hall ndcr 

I tUtmm C — A significant hvpovllammo^lS C develops 
dunne progressive tuberculosis in the guinea pig and is demon 
sirablc b\ quantitative analvsw of the vitamin C content of 
the urine during life and of the suprarenal glands post 
, mortem The urine and suprarenal gland vitamin C deficit js 
mpidlv and adequate ly overcome duri ng the earlv tuber 

+ After the tide of each iriicle in ihi> journal an mdicntion is 
given of the language in which it is vsnltcn thus Gcr means 
r u the paper is m German Eng thal u i in English 


Ltilous infection bv a dviK oral administration of 10 me of 
/ascorbic acid Hv povitaminosis C renders the animal 
organism more vulrerablc to procre Mve tuberculosis 

T\pis o/ Tiihirclc BtuilU — In ivpc determinations in about 
^000 cxscc of tuberculosis from vanouc parts of Denmark the 
».uthors found fourteen case of so called mixed infections 
Eight cases were selected —that is thev were discovered bv 
carrying out serial examinations m patients in whom a bovine 
infection had previously been demonstrated The remaining 
SIX cases were discovered accidentally Of 100 patients — with 
pulmonary tuberculosis produced bv the bovine t)pe of 
tubercle bacillus — who were under observation up to one 
year onlv two were found to show a double infection but 
of seventeen observed for from one to four \ear'.'*no fewer 
than nine were found to have turned into a mixed or double 
infection. The authors conclude that the present methods of 
txpe determina ion are not swtficientlv accurate for the sure 
tpplicaiion of the term tvpe to the two mammalian bacilli 

T30 c 


44 August 6, 1938 


KEY TO CURRENT MEDICAL LITERATURE 


, TutSintsH 
MtDiaLJmnvH 


Amerjcan Journal of Cancer 

Lancaster vol 33 May 1938 


•Rote of the Ncun! Crests, m Embryonal Adenosarcomas of kidney — P 
Masson 

Inflammatory Carcinoma or Breast — G W Taylor and A Meltzer 
Chemical Compounos as CTrcinogemc Accnis First Supplement try Report 
Litenture of 1937— J \V Cook and E L Kennatvay 
Spontaneous Bone Tumours of Mice — F C Pybus ind E W Miller 
Tr insmissiblc LcukTcmii in A Strain of Mice — J H Lassrence and'W U 
Gardn'T 

Chromosomes in Man — E Schwaiz 

Embryona] Renal Adenosaiioinas — Misson studied com 
plex adenosarcomas of the kidney from three children, using 
neurological impregnation as well as the usual histological 
methods He describes nephrons in \arious stages of differ 
cntiatjon mesenchymatoiis elements which in part become 
muscuhr and sympathetic elements which form neuroblasts 
and ganglion cells All these seemed to develop from a single 
blastema which combined therefore the characteristics of the 
neural crests and the renal blastema It is suggested tint m 
normal embiyogenesis certain striated muscles and the nephro 
genic (issue onginatc from (he mesec(ocierm of (he neural 
crests If this IS true, the displacement and precocious 
neoplasia of some elements of this neuro epithelium may be 
the source of mixed tumours of the kidnes 

Chemical Compounds as Caicinogemc Aqcnis — In this 
valuable reneiv Cook and Kennauay summarize ISO papeis 
published during 1937 and concerned with the carcinogenic 
activity of chemical compounds It forms a continuation of 
the important review which the authors and their colleagues 
published m 1937 


American Journal of the Medical Sciences 

Phihdelphn >ol 195 Mav J938 

•Problems rthilns lo Ins'isivc ProperukS of H icmolytic Strcpiococti '\nd tluir 
Control by Siilphanilamidc — W 1 Lonwopc 
•’sludiks in Dnbetes Mcliuus VI Mortiltiy and lonccsiiv of Diabetics — 
L P Joslin L 1 Dublin and H H Marks 
Crcniinc Tolerance Test in Diflcrcninl Dnpnosis o( Grwess Discisc Tnd AUitd 
Conditions — A U Sohvnl F H Kipl nnd M Hcina 
CotsMcncc of Mvxocdcrm nnd PcllTgra m Same Patient — J A Greene 
Spccttosraphic Determination of Lead in Blood from Norm'll Human Sub vets 
*— C H Scott nnd J H McMiUcn 

AciiolORical Impornncc of FitiRuc '\nd ^roRno^lu. SiRnificancc of Monocytosis 
in Ncuiropcnn (Afinnulocytosis) — P ReznikofT 
Optic Atrophy in Pernicious AntcmiT — K H kampmcicr and E Jones 
Course of Hyptrtensue Hcnrt Disease in Relation to Gros Artcno'icltrosib — 
N Fhxman 

Specilic Dermatoses due to Vitamin \ DcficicncN — J B Youmans and M B 
Corlcitc 

1 criaricntis Nodosa Report of Case diagnosed Clinically and confirmed bv 
Necropsy — B P Sandler 

Hchtionsliip of Sydenham > Chorta lo Other Rhcum itic ManifcNlipons — 
L P Sutton and K G Dodge 

Blood CuUurci after Tonsillectomy — H Soutb\sorth and C G Flake 
0\ygcn Want and InitacTanial Ptes^iVitc Prebmmary Report — J Micbckcn and 
J \\ Tliompson 

Control of Gastric Ncidiiy in Peptic LDcer by Alkalunzcd Powdered Skimmed 
Milk Tablets —P H WoMka * 

SiH>c»t incous Emphtstma complicating Bronchial Asthma Report of i Cisc 
and \nalyM'> Sesenteen prcMoiisly Reported Casti, — L RoscnbcTR and 
J Rosenberg 

ln\asi\e Properties of Haiinohlit Slreploconi — The moi 
txhiv in blood sircnm infections due to haemolytic strepto 
COCCI varied in 166 patients from 53 6 per cent in cases of 
mastoiditis and otitis media to 85 7 per cent in ciysipehs ind 
ccUuhtis In cases with meningitis 95 per cent sviccvimb 
and in peritonitis the mortality is perhaps still higher The 
remarkable therapeutic effect of siilphanilamidc on haemo 
h tic streptococci is most pronounced in the carlv stages of 
these infections It mav f id to sterilize foci of latent infection 
in the tonsils Intoxications bv the drug especiallv the most 
senous tv pcs of these arc rare and arc probablv due to 
individual idiosvncrasies 

Moriiiliis and Loneculs of Diabetics — ^Thcrc has been i 
conlimioiis decline in the death rate of diabetics which in the 
period J936 lo 1939 was 75 per cent lower than that of Jg97 

5i0 D 


to 1913 The gams have been greatest m voung diabciicv. 
The decline m morlahtv became more rapid after the iniro 
duetton of insulin There ts a large increase m the cxreui 
tion of hfe, which at the age of 10 is held to be about ihim 
years and which becomes progressively less with adian i<m 
age The death rates for diabetics are still much m cveew of 
those for the general population 

Stibcitlaneons Einplissemn coiiiplicaiiiis; Bronchial Asilms- 
A case of widespread subcutaneous emphysema conipliaim, 
an attack of bronchial asthma in a girl aged 3 is dcvmW 
Although the condition presents tn alarming pictiin. it iisiulK 
has a good prognosis A senes of seventeen similir caio 
coUeclcd from the literature is analysed 

American Journal of Tropical Medicine 

^ Baltimore yol 18 Mav 19ob, 

‘ Eftccuvcucss of Catbarsonc a t Remedy for Amocbusis — -n G >UVjn55vy 
Scicnih Years Ob*>crvation on Malarn in Pammi — H C Clark and \\ 11 
Kemp 

Role of Some Common Anopbebne Mosquitos ot Panami m Tnn^mitstn rJ 
Hhhcfa — Lfoyd E kerLboatrt 

Miidies of ^rnrkrtiu/ It mamnnoidfs ind ^pnr/rntiiim prof/ferum —J T Mu'" 
Fu ihcr Obs rvitions on Incidence of /fepn/icofn (Copi/faria) Ou u 

Human Faeces — Vltrry E Wright 

Cai baisonc in Antoehiasis — Varied dosage was emp'ouvi 
from 0 5 gramme daily for four weeks to 16 gramme^ duh 
for ten days The only imtowcard reaction — mmcl) ivirfi 
and gUcosuna — occurred in a patient who had rcccivtd cuh 
0 5 gramme dailv for twenty davs The small doses m ciriici! 
mav clear the stools of E Instohiica cysts m twoortliw 
days but tail to cuie some although continued for foiiruccti 
the higest dose also failed in sonic cases In iciilc tlyvint rj 
the small doses mav not clear the stools or even control ih 
dvsenterv but the large doses relieve the symrloms and i 
some cases appear to eradicate the infection 

American Review of Tuberculosis 

Biltimorc xol 37 May 1938 

•Incidentc of Exinpulmonary Primary TubtrculoMs — H C 

W L M Mirtmscn , 

•Studies on Retrogressive Changes of Tubercles — H C 
TiUothon and V KoziclcK 

IubCTcuIosii> Dissemination during Therapeutic I’ncumoihorat — W 
Tuberculous Bacillncmia m Rabbits 1 Bacilhcnua m Non allcrgis on 

J P Ditchatnc a mS- 

Tubcrculoi^ Bacillicmia m Rabbits 11 Bacilhcmia In Allergic M’ 

J P Duchainc 

•notation Method of Sputum Examination — C R Smith iv m ss- 

Clinical ieniis Pob'ic Health Point of View in Treatment of ^ 

F M Poitcnger ^ 

Posiiivk, Intrapleural Pressure as an Aid lo Pneumothorax Tlierapy ^ 
Tubcrculoits Infection in Negro Colleges — P B Cornefy and E j 1 

Sttidy of Results of Treatment of Pulmonary Tubcrculosu In 
While Patients — F R Harper 
Tuberculosis Survey m Jamtica — -E W Flahiff 

Extrapidmomin Piiman Tnbeiciilosis — This 
the calcified foci in 132 necropsies made with Ihcobjcci o 
mining the percentage occurrence of each portal of cn 0 , 

community Jn 73 5 per cent the primary infection ' 
onK the lungs and hilar Ivmph glands This , 

79 when cases having multiple portils of entry "“^7 ’ 

In 8 3 per cent the gastro intestinal tract was the ^ 
of entry, it was the portal of entry in 12 9 jf 

the cases of multiple portals of entry were , ' 

'corresponding percentages were 18 and 4 5 c ’ > 

head primary lesions (considered together)^^ Ther ^ ^ ^ 
per cent pleural primaries 2 3 per cent '* [,, i 
in the liver or Ivmph glands with no dcmonstri ^ 
lesion 2 3 per cent doubtful cases and 5 3 pe ^ 
which no calcification was found In 306 per , 

cases primary hacmatogcnoiis calcifications weW 
the liver and spleen 

RetroercssiM Cliani.es of Tnberttes The chanf' ^ 
pi ice in the ageing of primary tubercles .f i *’ 

folJoiwng fictors auioJysjs or cnzvmatic digcstio 



\n I sr 6 


Tnr B*nr h 
NlrUICAL JoVKS^l. 


4> 


Kl:^ TO CURKLNT MEDICAL LITER \TURE 


ihit ln\t been ktllcti of tins dacsl mil the 

proMmiiv of Iht c clvmcms lo ihc i.jau!\tinu. fimiK of the 
hod\ '\hith rcrniii'* of rt>orpijon mj ovMtKniion 7 ht pcnc 
muon of the cirMik bN c^pdlnncs nu\ c\cntinlh t ui<c the 
rvmvvval of rcmnint’^ of cilvdad cons nutend ^nil pcrlnp\ 
even of bone 

notation Ml hum! — Npcrci.nl ol mcir ncuiloc vpccimens 
*.rd 19 per cent of vmcir ncciltvc persons \*.crc vhov^n to Inve 
Uibcalc bicilli b\ this method I lonijon 'mcirs showed in 
avenge of cichfv five times is nnni ncid fast 1 itdh as direct 
smears The idnnlipcs of fiotitim o\cr cedimenution pro 
ccdurc^ ire belter distribution of tubercle bicilli nnd tleiner 
mcarv 

Annalcs dc DcnraloIo^ic ct dc S\phil»jTiphic 

Pjm \ 8 c > l«H 

s '<iv» !»» arwJ M K xu 1 »TX 'nrs I '<*Trs 1 CrSll' >> I n i *n M n »l •• 

M uth Dr»« f) — \ R -khT t i tV t "s 
O itc D sfasf fRciA.-iibr rrw'crrJ T l vtrr-u I Ig r rvj s^i k» 

L r rKT»«i 

\nnals of Internal Medicine 

Lan(.« t rtn*^) ar-A s 11 Ms IviP 

Ihc 1 4jr II rt I the C e-^c (Pir*"- -t-il ^^! cs » - J It Me n 

S •* C.srs'Tir'crtal Data *in -I H ren n" a — c Res (i*'t 
Dn-rs »n Ticatmert ot Mean I>t ca c K t Lc>> 

I »< t ^fcm.ru.f s * D jrn — t t letf'cr 

s, r"c PubU Health A r*-ct cf I nCca-t t cic —H C 
Tt un iK'Zi-t T I" Dabc^rs — L. P '■* <'u th 
A oJix n I Sv-Ua. Nr ni*^ »< h li -r D rJ < — h S 1 njr 

Ror n c t Fcei! rt o Cot "fs CoJ In n xr*a a*-J l>rt leet c b c » 

Mea urcti b> a N ii r* n C Ls te r lot— T 1 M » arJ \ I 

rrtoJ’ian 

Pinv t.’’'cr Fffcci f AC- r \T3U Hc—l S lr*» n 

VI ^ Svb- Vet 

Eiac;^ To anU Electr s re rgfh n Vu».< tj Icvt e — M 1 

MscaJ 

e vt Ore K p fht [) r c a \*vuic\, % h -ui 

E* r''i s. P" - UT) — K r I1( uCfl It n 

C mr etc A rx’o*»r*rfKHj D'^ vi-r n tf c n D ut « jt S U'n 
CCtct xf OscTV>s.ye Ca e Refs i —T t D > «ra G A Kv’xIm.sc 

^Itrctirial Suppo^tioriis — Mercunn -^uppoMionev which 
are vaid to be identical with noMirit suppositories were 
u<ed on paiicnts^with Mninju depreev of cirdiac failure ind 
a satisfactorv diuresis v»av obtained m per cent Ammonium 
chtonde should be given m addition The treatment wav of 
Imle avail m two cases of hepatic cirrhosis with oedema and 
observations on cases with renal compliciiions suggest th t 
the mercurial compound mav be aciinllv harmful m these 
conditions 

Rfjpome to CtMtantic Aiul — ^Thc unnarv excretion of 
vitamin C in the three hours following the intravenous in/et 
lion of 100 mg of cevitamic acid was used as a measure of 
vitamin C deficiencv Normal subjects excrete about 40 per 
cent of the vitamin C thus administered while cases of scurw 
excrete onlv a trace Tests using larger doses of cevitamic 
ucid vvere found to possess no advantage Observations on 
the effect of prolonged administration of vitamin C showed 
1b it the amount required to raise the unnarv excretion to 
normal was proportional to the degree of deficiencv 

Bile i/j Peptic L'her — ^The effect of the administration of 
bile in eases of peptic ulcer was tried because of reports that 
interference with the normal flow of bile in man and 'inimafs 
IS ■’ soaaicd with legions of the gastric and duodena! mucosa 
Forlv patients with ulcer were treated with bi!e and carefoUv 
followed for periods up to two vears The results show 
tlearh jh^t bile has no beneficial effect in the disease 

Vrehn fur Dermatologic und Svpbihs 

B«il n wl 177 M > -w wv 

Rf^u'is cl b<(ics tf Ttsjs m C- cs cf f fcma — S t wnh tc 

X liK %f imrosin-* Rett nc ChccM in Sian<l-ril Senes if Ec/ema Tot 
in Dxnnaulc— real Pnticnu ~P Bennene 
N^iiire and Trcaincni f Ut llajer E 7env— Bur kharUL 
Cl n^rnc Victh xJx m IrJu trial EntetTn 3 Pi^ 'bl Causes of Io«J iru! 
Ctrenu — \V Sxhnluc 


l I r| t o W Cl •> i> Itrcmj— J M vr 

0 lou n 1 Milan Bre rr rp m — V nVcnncI 
Nin -*la> rrsiliclr-j aflrr s r-^n - VV Hr hltr 

1 r r’ ft f Pci s citt Irrnai n i ( SV n — G Hepf 

N iirt u p m fcsuMin fipni Th r r~u ic Irt rv ni i — Siuhrrcr 
I arh Uv> „nil Tftatttt nt pf M\«J ci V« eim^urri — J VV crdclbcrpcr 
Hrrm wUs and Tc V It c — F Dcrminh 

I) m anj rrcatfTtnt f O a ex l P rtrhcral Xnen I Crulati n wih 
Spcxiat Keferen c Vrtcr ki rh> — M Rai h n 
'( lb ' "t <f Win Chi Ie»^icrm in S b rrhixa — X Vfaf b nin 
( nr »'a I n f Kr*c-irch rt Ch nt trv f sVm — K Hihner 
Itirclirr CJPiciu if S c i GlanJ — K xh 

I jm nt f PrufjE n u t / ma b In^ircvt Sh rj W a — R Beicen)' 

s nd Clartdulaf Clnrjrf in Til r ini. Cm al flKcnatJons m Lc r 
\ii int m Winter 1 !*» > — L \r7l 

In iin I snl and S«i al Rclattnhip Nrtucen L a and Pcmphifu* — 

W Ifram apd Svh*i inbi Tr 

C c f kranuloou Inru r t h ih Vijii aJ Pr s and Taial J sue — 

fl luh and VV V I cl 

C r •* draun fr "n f ■*! ricen V cat tspeiict' t 1 XI ‘ana Trcaimcn 

I SspXi — Rcrinjr and Mcnmcshcmir 

H fl f Vr 'chafia rati i m An h I Cu lure — K xh 
I nher ( ipcnncnt in C c f ralhir n f 'f 1 r « xac c fcvt irt Sjphifw — 
i tiircbcrr 

f hf r MicI d t-cutacma *» h Chara ter ii Perrr t o* -al Simpfom — 
K»cM 

lift cr Hr*faf h n \ t n il I ibcnrcd O n Path f cn t r»n«» of bVm 
P VV !wb"'wl 

Ncti Htvt at r nir hui 1 t f r P h m — <) Gfuf/ 

Ire imeni f P f n jh S p »cr I I \it i — K h t 
Ml f n fxl I ream ^ I I Ixr > c K 

Mutinal Trtiiinun tS\phihs Henni, and Mtmmesheimcr 

Miminiri/e their evpenentes m ihe irciimcnt of I 4(M) ta e 
in wIvKh mdanil uciimcoi wt preceded bv injections o! 
bi miilh and followed b\ mjcclions ol alvarvan Over fO per 
cent of the k tsts were sub ccjucnilv loUowed With fuUv 
developed general pjr»lv is light improvement mav Okcur or 
the disci c miv rem on laiionirv In other vases there was 
however swift proerc *on In invipient paraUsi marked 
improvement often occurred even lo re toration ol workint 
vipibiltiv at intcnccUjj! pursuits although this might be 
preceded hv inn anf mcniil deterioration immcdntelv itier 
the mdifii In c lahh hed and incipient tabes dorsali 
vess4stion of progrcs ion micht result but ome crises did 
not real In both di c i cs improvement in the spmal fluul 
tests maht or mahi noi run panllcl with the dinicil chinges 
fn those cases with positive i.hin..c m the pmil fluid wuhoiii 
phvsical signs the rcscrvil of the c chance tollowing nialarnl 
treatment is almost invariable tnd in no ci c did pirdwi 
or tabes develop sub cquentlv 

Sptr Hhotui pulluld Ol -triifuiul Luhnft 7 he lulhor refers 
lo the interest which has been taken in the uhject oJ arti 
ficial cultivation of the spirochaete ot svphihs ince ihi 
orgtriism was discovered rn 190 and to the ah enve of satjs 
factors evidence that the disease his been produced in sus 
ccpiible animals bv the inoculation ol culture material His 
own expenments m this respect hive been negative His 
present work is based on the discoverv bv Marchionini that the 
^ptroefunfa paDuJa destrovv dusn j;c iermeni He describe 
the technique of his evpcnments which showed that spiro 
cbaeies from the svphilitic lesions of human subjects or 
animals dcstroved the ferment almost completefv whereas 
the culture maiena) produced onlv a slight effect He believe 
this cMdcncc taken in conjunction with previous work 
supports the prcviilinu opinion that these cultures do not 
contain true Spinnhntln pcillitla but other spirochaetes whivh 
arc probablv hirmless saprophvtes obtained from the 
genitxln 

Archtv fur Ophthalmologic 
B<riin cl 135 Xla> joif Hell « 

Miner N> ucmuv m ihc Star D-itri-t— O VV icder hcim 
Dari* XUaptaiion (lbvcr\«t!Or> nh New Self rcjri tenn Dv i c for TBroh M 
Xaliid — VV KincJe» 

Etpsn'ncnial Ol> rvaii n on Cinirj tiliiv il Len^ Fibres — P Ginc«cfi 
Xuamm C Content m Patient * ih Senil Catjr’ct — J Scefned 
Exopk. Dcmon-viraii m ot X dl v. Colour of Mj uJa Lutea — R ZuHcr 
Ocular Aspects ot End«r- to Op ncran -"H CcsctvX 
New XV a J of L itiR Achron ii Dtutc Ltn c« — E L IrecX 
TuKr ulosrt ot BulMr Conjumiva — J Svhm dt 

Iffcci of Evce^s of X itamin A on Rai E>c anJ Cotinter<ftcct ot \ itamm D — 
— X\ 3 KarubCin K» run 


330 E 



46 August 6, 1938 


KEY TO CURRENT MEDICAL LITERATURE 


' 1 Bmish 
'llDlCAl. Joi-LSi 


Ccntrol of Tension m Jus nilc GIau'*oma — W Mpusc nskt 
early Operations in Caustic Burns of E>c — O Tines 
taemus — J Ohm 

r<pcrimcntal Observations on OriRin of \ Ras Cataract — H Goldmann and 
A Licchti 

Contractility of Lens Fibies — A comprehensive re\iew is 
5 , 1 ' en of the literature on the subject After considering 
c\pcrimental observations with such substances as acetvl 
choline and histamine the author concludes that the lens 
behaves like striated muscle and takes an active part in 
cccommodation 

Vitnniin C and Senile Calaiact — After making observations 
on forty four patients with senile cataract the conclusion is 
reached that there is a disturbance not onlv in the metabolism 
of vitamin C in the lens in such cases but also in the bodv 
as a whole 

Ociilai Aspects of Cndaiigiitis Ohiiteians — The author gives 
a detailed report of the eve changes in a patient diagnosed 
at one time as suffering from choroiditis and at another as a 
case of disseminated sclerosis ultimatelv proved to be a case 
of endangiitis obliterans The multiplicitv of appear inces seen 
in this affection are discussed 


Archu fur Psjchiatrie und Nencnkranklieiten 

Berlin ^ol 108 Annl ’9 191S 

S>sicmaiic Atrophies a W ell tlchncd Group ot Hcrcdinr> Diseases of 
Central Nersous sisleni— H Spaiz 

* Endemic and Epidemic Disorders of Tliiroid Glitid and ihcir Relation to 

Soil and Climate — E VVolter 

Contnhiilion to rimctionil Orcaniration ol Corpus Genieulatum Lateralc of 
Man — A Juba 

•Stittsiiuil Contribution to Problen of Acute ind Chronic Epidemic Enceplia 
litis — H NsrcI 

Rapid Method of Imprei nation ot Connceiise Iissuc of Centril Nervous S> tern 
ot Espcci il Use for fumours — L BonS ild 
1 roblem of Chronic Poliomycliiis — it Lanse 
Chemistry and Psschiatric Shock Thcrapv — J Schuster 
System ilic Atrophy of Superior Olive — E VVeisschedcl 
I orms of Siipcrsiioon m Black Forest — K Berinser 

Ivvo Cises ot Tumour of rrmeminus with Mid brain Svmpionis — VV Birkmcvet 
ind J SilLcrpfcnnie 

riidenin and Cpidcniic TIimohI Disordeis — F Wolter pro 
vides an cvhuistive discussion of facts and theoiies relative 
to the actiologv of endemic goitre In his view the theorv 
of iodine deficiencv can no longer be maintained and the 
.iLtiologv IS to be sought in the nature of the soil deficiencv 
of sunlight and a largely windless atmosphere with increased 
ridio activitv of the air nearest the ground 

Acute and Chronic Lpidiiiiic Encephalitis — Nagel analysing 
the hospital figures of Munich finds two to every 

tern lie imong the chronic encephalitics The vt 918 and 
1919 provided more cises than anv other yeaijfihere has 
been a slight increise in acute enceph-^lis. Trice 1934 The 
disease his shown no change in chrracter In nearly half 
the ehronic eases there is^no definite history of previous 
encephalitis and in 14 per cent no history of anv definite 
illness^ Tfalf the eases had an inters il of about two and a 
years between the acute and chronic stages and 36 per 
eent showed no such interval 

Archives of Diseases in Childhood 

London \ol 13 March 19^s 

•Irciirntni of Rcml RkKcis — G Cnh'im and \S G OikIc> 

Caac ol rvnancritis Nodosa \Mth Subculancous LcMons Rcco>cr> — C U 
\ mine 

Cv iKcnital Stcaiorrhoci dui to Pancreatic Defect — Nt If Harper 

• VJtnimsiratnn of ThNroid Gland to Premature nibicb — \ MoncncfT 
LnJuljnt Icwr in Children — D H Pate son and C Hard>Mck 

St nd ud Intrascnoiis GIiucsc K Icrancc Test — 1 Cnv-ford 

Hciiat Ruhiis — Two patients with renal rickets were treated 
vviih •- iflicient alkali to restore the alkali reserve to wKhin 
■normal limits md U the same time with large doses of 
vitaminv \ ind D Thu lesion of the kidnev in rend rickets 

1 r psciili ir one and lends to procress verv slowK Complete 
3J0 f 


tests of the blood and urine in the cases are described mu’! 
mans radiographs The general condition of the chiUm 
improved , they grew in height and their weight increas'd 
The state of the -kidnev s also slightly improved as did' tb 
condition of the bones Many references are given 

TInioid Theraps of Pwiinfnn/v — The administration ot 
Ihv roid gland to premature infants appears to evert a benefiaal 
effect A large number of premature infants have been irtaltJ 
The dose is 1/20 grain per Ib body weight daih In a 
controlled investigation the mortality rate in a group lecem" 
thvroid was only one third of that in the control croup 
Reasons are given whv better gains in weight arc not oblairs) 
and the opinion of the nursing staff is mentioned as cniphiU 
allv in favour of thvroid administration as rendenne smill 
b ibies easier to manage as regards feeding and kccpinc ihm 
warm 

Archives des Maladies de J’AppareiJ Digestif et dcs 
Maladies de h Nutrition 

P-xris \ot 25 April 193S 

Ciccum Rccunauim ind Chronic SubhTSiiL Appendicm — F Trcnu''t\ 
A Bcrgcrci and A Maurice 
Studifs of MLiabotiim of Viiamin C — M Vanilicj 
GI>co wria nnd Diabcfc:, in Cance of Pancreas — J \ Grotl 


Archives dcs Maladies du Cttur ct des Vauscauv 

Pan^ \ol 31 1938 

Pcspiraion Varnuon> in Cardiac S>sioIc and \rtccial Tension —E Rif 
Parasjsiolt wnh Slow Rates and Nfcchanisn of Rh>thniic Ertraw'i’ 
Ld Doiimcr 

E'ceirocardioenm of the Htiman Foetus — M I Martel and J P E'd* ^ 
\nmihr PcrstaUic S>stolc — R 1 utcmbachcr 


Arch MO di Orfopedia 

Mihn vol 54 Matth 11 1918 

libcuulous Spontiylius Cliniual and Stativlicvl Siirvciv of Casfi i t 
iMituto Ratlmici from 1903 to 193? — \ Poh ^ 

ConRcnitaf Talipes Its Regional Distribution as* compared \Mifi 
Dislo ation of Hip and ConRcmtal Torticollis — \ Poll 
•Mtcfunical Treatment of Scoliosis — A Albsn'^c 
•Congenital Di lotation of Hip and Blood Groups— E Tranam^f^^y 
Cuneiform Ostcotpm> of Asiraftalus in Treatment of Dtfotmuics of * 

C Sthapira ^ 

Clinical and Statistical Studv ot 1 583 Cases of Pohomictiti — ■' Sfifrr*.' 
and r Vecchione 

Orthopaedic Apparatus for Correction of Prointed Forearm— I 

Mechanical Treatment of Scoliosis — ^This is a review bJ 
on 1 245 cases of the response of various componenb ol 
deformitv to gymnastic, phvsiolherapeiitic and nieclnnoi < 
peutic measures The last named include the use ^ ^ 
machines (here illustrated and brieflv described) lotf ' ^ 
b\ Professor Galeazzi 

Congenital Dislocation of the Hip and Blood Grourt ^ 
connexion is mooted between a vitium primac forim lO 
on the one hand (congenital dislocation of the hip 
c\ tmple) and constitutional disharmony of spcrmaW °'^ ^ 
origin on the other In seventy cases of congem J ^ ' 
deformity 20 per cent came from parents of the siirv 
80 per cent from parents of different blood group'^^ ^ 
corresponding proportions in controls were 72 and 
cent The biochemical racial indices in different PJ^^ ^ 
Italy arc summarized there is some evidence tint , ,, 
dislocation of the hip is commoner where the inocv n 


Bcitr ige zur Klimk dcr Tuberkulosc 


Berlin vo! 91 April 193S IJcfi "* 

r 

I >cho!oRicil Symptomatology of Piilmomry Tub fcolo ' 
N Erwin 

Ascorb c Acid (\ itamm C) in Trcitmcnt of Vu'rnonity *' 
Trautwem 

Bronchiccta^i in Viriii M\cerurn tn^enifs totaUi K ^ 

Inflammation of SerouN Mcmbrmc in Tub rtiilaa^ 3 * ' tr f 
Ctmifibuiion to Application of ! neumopentmeum U * 



^LCl>^T 6 I9'S KhY TO CURRENT MEDICAL LITERATURE The B»msH 47 


17 ini*. n ar rs libtut n frt pr oi fcirth kirt<^{ 

Tvtxrvlc m l.*r ,r \4 ric K C mut'ui n 

t^c ^rt^cm if TihcT L Imnn n —G )h-n rJ 
1 rxncrH-o •iih F cxtr " rr % in Trrurrcni f s ify ji Titxrvi —f 

\Vcrtr*CT 

^ 41 ifvjl Ci’T'iicrau f* •vn Li I — k WjM*. it 
T 1 ii~cM r r iJn 1 f> Ti hcfa ^ t I ttfjp ct r Pir rr i I Kef Krt 

/ / r/i r/ope rt/pr n/fu — ll rv Miifdcn lowcrinp 

of ihe inln iKlomiml pre Mire ifJcr p ruinijon touM be 
uoidcd b\ induLinp i pneiimorcriioncom This proccdiirc 
m «hl prc>cni cxtccrbilion of t ioc\ivJinp pnlmonirx uibcr 

I iipii\ — Tbi> piper dc N \Mfh F>-0 p t cnN *.ccn it iht 
Ibcshu Lnucrsilv vLm cfjnjc Ibe follouir^ f ictors uc 
cximmcd diMnbulion in ^cpl^d^ lO'\n or loiinirv tnd vex 
tie file of the patients from the point of sjciv of the ipc t 
N'v'ijvh the condition dcNclopcvl its p ithoi^crcvis \ in tors of 
n rmuiovis in the ftmih iiion of the lesion insohe 

m'‘nl of mucoi s menibnncs md tube tnlo is cl cuheic 

Over ^0 per cent of the p^itients m the Brcshit vhnic were 
vnred or muth impro'Ctl 


Brilivh JournDt of Radnfopx 

Lew \ JJ » I !► 

s Ik >> n the P'Hci> 1 V -v t 4 t Ilf 'r -> 

S *. in r ’•lO Vctv — K X K II ffvf 

X »«. m Crinucn — J L \ ( jj 
X So •H*' —4 X 

OccL*’^t 1 "Ji! Di^ cv t Lft in Xms.*' i XX V«i K I » >» 

K^t I'T'al tVn *• rjt »n I Pjin g I Oj r >>> rj h ( •> 

fu{ P'Os'Cvc'— / r Br f'‘\S 

Ttvi Rr‘*'iai'T> Cr 7 -vn a - 5 t'-c r f t i n *> h H ^ r i xrr 
ar'tv tn Lu'^jr^ — ! M K -V 

K d *ff*^-*5 iiLu -s rf C^“rr 'n rf O f' f t -r* - X I f 
K J Ir-Vtn .nj K C M Srih 
pj 7 rv -Bhi h D- FT - 1 fv f* -C I v « r 

Stluosis in Potftrs Workers — The confluent txpc of ilicO is 
t hirlv cotntron among po(icr\ worker but ii ma\ al o be 
found in 'tone worker' and in wo ker-. in the South \fri>. n 
nine There appears to be no tvpical picture for one ispe 
of worker and the esolution of the diseisi. probabK depends 
on the patients condition the tape of dust and the presence 
or absence of infection This ma\ account for the fast that 
men cmploscd at the same t\pe of work and for the s,imc 
length of time mas present comptctcK ditTcrcni pictures 

Oiciiralia/tal Liir „ Disemrs m A^riaiUiirul II orkrrj — 
Agncultural workers are liable to infection hv organic muter 
the micrdfungi bacteria and parasites which csist in segetahlc 
matter and in the excreta of farm animals \ irioiis it pc 
of ms colic infection of the lungs are described and the radio 
logical appearances illustrated The author is of the opinion 
that the common microfungi though u ualh innoctioiis mis 
become pathogenic under certain conditions 


Jnlemational Jourral of Psscho-analssis 

Lo-x4on vcl 19 Apfii l9tX 

L'nv rccicO Furnn n in Cental Vctvcuv S> icm X Oajr>n n f i i iTt w* »v 
b P<) ho >«»5 — P rcd«n 
Frev ^nd Xrhrod 1C —Xl Ru! m 

S»nc PaUcohjofottcal and Bkc-j hkal R TrvT n —M Rrnar-iMc 

Xrui) K c4 a Piacfn — G XX Pa :h rpe 

P'>tho-ana.i>tKaf F»rl nain n I Mi,.r« p'U —XX S Irir n 


Journal of Clinical Inicsli^lion 

Phi adcirhfa \oI 17 M > 19^* 

IHct f EtLimp B Hx3 uptn L/nary O i i and Bl sJ Pro uf f Human 
Rcctrient -L XX p pc 

S od cv in Ph> jol X I Art twnaJ 1 tier J Ch npo in D “nxI \ o ume »rd 
XXaicT Bwlarrc — J G Gibbon ard } Korr 
1 rieci of Ir»uJ n on Ctr leniration t I r»c X d in Bl>xJ — E f RoNenterp 
Xtudto- tf Cira iaijcn in Paiieni i ''ctior from Sr nan mjs Xf>s'icdcnia — 
H J Sif^an J E Dcitri X and N r Crarc 
Jfcat StrpVc Cl n al and ChemKjl Ol^cr a u nv on Poriv f ur Ca ev — E 8 
r<nt< ! n XI A BiarVcnhnn HXX Rhn tv ndGC Colkn 


Xfca uement »f Tuho jt Evcrctoiv Xfa Cfica »c Blo,>d Firm jrd Filfratf n 
Rale »n No m 1 Hum n Kidne> — H XX Smih XX Gcldc rz and H 
Cha 

I n -ct r Ak hr • 4 n XX aicr ard Eicvli 5>1c Bakn c tn ! rt — \X \I N»chol on 
rnd H X! lari r 

I I rnji n « f W rX tf ffcari duririR and tcu»ccn Alt X of Anmra Feet 'ch 
I St rr C J Camhlc I S Donat ard L H CcMinv 
C riH j 1 KerrarX < n Determ nan n of Lrinar> fcxcrci on of X cirti Acid ^ — 

Xf n FeXe cn ard Xf Hetnemarn 

Ct p «L re p »n B vod of ttitS Evpcnmcnial HiFtncmion rioc >s.cd 

P C r tr tirn of RenaJ Xnenev — C C Ch d 
I •*£ I f \ n D n Cai jum nd PPcbsEhi irt Met h n Stud on Four 
Pai m — f Xfhrtthi ^.id H XX S lXo«f h 
C 'mp ri n F**c I i \ T 10 <Dih>drru.ch icr i) arc \ iiam n D (rt 
Cj ijr and rh>»rho u< Xf uFo h"! n Hrm mrathrrtid m — F 
Xfhnrhi L P mhcfff T O jlc ard H X' SjIX '* rch 
i r » if r B V- XX icT n L^hir Prcum na -C K XrdcT n 
• t n r Set f ai Rciati rth p of X h>ij Ca tr-ca to Pern i « 

Xr cm_i \ M Rc'crih n cv Ftfi»*ecn Pf fc tti X tjtitj / N rrnal 
H m n C itK I n Cavetn n Sc tra S ci n ^nd X ii t f 

I tn I I r -r ff L rj>tH XV B Cate K \\ He and 
M X Xc m 

t 1 t n S rp’-it 'tar and in SjFrct w th Gf me u r phriu — 

JI f h n c H XX Sn ih 

I f*r 1 f I ^ S rrr-l*'r in n O tufrence f ShtxX irnm Haem rrhjye — 

S f It c^ijn S X A C ShcTff ard H E Hull ne 

/muhti (ifi * Blo< (• Irii ft /r/ — SuKttnncou iniection of 
! lo 2 oniiv ot inviihn per kilocnmme bodx weight camev 
I m tried f H in rhe fconcenirafion of uriu acid in human 
Mood Ih/ ff)) J mdcpcndcni ol the ippc ran^c of hxpo 
^.Ivckcmi t If owurv when bvpogixc lemi i j iDowed to 
dt'elop nd ) «' ''hen ii i prc'ented b\ the dmini irtiion ot 
c fboli d lie 

//< It Xf *t (.afd iv I dure or pcnpheri) orci IdOfx wOi 
iip c w noi C'iJcni m ibe m^jO ii' ol i^'c loru fi^or puiieniv 
tidied ind iht od um chloride onitnl ol ihe blood ' a rot 
ij.nifii.aniK tlicrcd There wj however i mtHJeruiu cvido i' 
nil h cnjtx con cniriiion The biLh bodx lemperaiure 
ppe rctJ 10 be ibe chid c tu c ol the mpiomv oi hext 
ifote Old \\.e dcvcncrtii't dj v- c and uvute tlcoholi^ni 
jfc imporiini coniribuiorx f tier »n bed virolc The on Cl 
w iv prccipiiiicd b J diminuiion or vc iiion ol swelling tn 
the nujOfii ot ptiieni bul the pnmarx vau cs of thi 
ebiO^e ire not ^nown Vie urc to loxvcr thv bodx icm 

per lure promptK tre mdic 'ltd ivc w dcr uibbin^ with 

nn i^c being the mo t ciTcclixc methovJ in ewre vi e 

/ iuptfttiiJ >t t i /^/i /' W hr in ! I m Pinmi n — The bodv 
wcitbi o! children sufTcring Irom lobtr pneumonn i tound 
to be jnvrcived The invcnsiblc wafer lo ihroue-h ihe km 
IV lev than ih t which uvinllx occur in ofher levers It 

Is di Ihe *imc level as that of the normtl km before the 

criMv ind If >v vrcatlx elevated onlv at ihc lime ol ihe cri i 
ificr which ll dccreiscs The lung viporiEition iv hi^he I 
during the febrile period The ^kin icmperaiure ri cv to corre 
vpond wiih the rccl»I tcmpcrauirc 

Journal of Larxngologj and Otologv 

L r p \cl 53 Xf s I ov 
ijM’friksi S n-puru cm ErcCphal 1 p — E Jcrland 

Ob««rvar vw n X rut» n tn Ifcarirt in O rr' erusi - iierhen iurtii 
Mcvvil Oerrr o Cj t pf S-kc occurnnt in T<*in B -v — F XXcb'Tcr F irn 
7» ispar m C« t f Lah/rinth Irrrrovcd xi-ih->0 f PiciuiatJin ~E XX Pcv* 

Ofogeifoffs CiKipfiahtts — Otogenous non purulent cncephal 
Ills IS a rirc condition usualh diagnoved as cerebral abscess 
Jcrland describes on.- ixpical case in which a radical mastoid 
operation was performed exploration of the cerebrum and 
cerebellum revealed nothing abnormal The sxmptoms slowlx 
disappeared and the patient made a complete recoxcrx after 
three months The existence of this condition must be borne 
in mind otherwise too free and dangerous incisions of the 
cerebrum and cerebellum max be practised in the hope of 
finding an ab«^ccs^ 

Oftfscitrosti — In following up the work of A A Graj on 
otosclerosis Suggu studied the effect on the hearing of 
the introduction of 2 lo 3 cem of normal saline into the 
middle car b\ wax of the Eustachian lube This was dene 
in clexen patients xxuh characlensltc sxmptoms and signs ol 

330 c 



48 August 6, 1938 KEY TO CURRENT MEDICAL LITERATURE theb^wr 

'fCDCU.icn>,>( 


oio'clerosis The results %\crc negative Although some of 
the pitients showed improvement critical examination failed 
to place the improvement in the hearing outside the limits 
of normal variation The variations m the hearing of oto 
sclerotic patients over periods of up to tvventv-tvvo months 
V ere studied in a further fifteen persons who did not receive 
inv treatment The hearing tests were made with the audio 
n cter and the results are given in the form of graphs repro 
duced in the text 

Journal of Tropical Medicine and Hvgiene 

I ondon \o\ 11 Mai 16 

•Ouibrcjk of PI iRiic m Nfistn/a Pcbruari to Jun** IQ'7 — ] MePh vil Campbell 
Miun/io Ascoli s Trcalmcm in I raciicc of a Malaria Control Station — 
Alcsi'inUro MiUctari ' 

Pliii’iK' — This IS a good summarv of the factors associated 
with the 1917 epidemic in Mvvanza and the steps taken to 
control It 

Medical Clinics of North America 

Phibdclpbn \ol 22 I9t8 

St on Nfiioiu atu( Menial Dt\ea\e\ 

Ncuroloffji, »1 Lximiniijon in Gi,ncril Practice — 7 ) I utn-im 
lust opci invc fMCbosis — S Cobb tnd N T McDcrnott 
DiicnoMS ind Treatment of Viscuhr Lesions m Brim — H \! rnif 
Jh tcria as t Problem in a General Hospii »1 — fc Lindtmann 
Oi Tbiltitcs in Spcikm^ and Ucadins — L M C!oc 
C lusts Dmgnos s tiU Piopcr H indlmp of Cotra — P Solomon 
DiiBnosis md Irtiimcm of loHncurms— M P Brossn 
I Tnnoid Psv<.hosJs in NTreolcpsi md Possible Danc«.c of B n/eJnn^ freai 
ricnt — D \ounR Tnd W B ScomUc 
I ftiimitic Neuroses — A Mserson 

LUtiriti* Injuries to Centnl Nervous S^^tem — L A.lt.Kandu 
•Mii,rnnc Syndrome — T i C son StorcU 
•Dnenosis ind Ireatmcm of Mcn«(.rc s Di^cisc — L C BsrttK 
•DilTtre nit'll Dnsnosj of Pu’monirs Tubcfculost — P T Lord 
Prot immc Ztnc Insulin — L P Josim "H f Boot I \\ hUt \ Marble 
md A P JosUn 

Upper Oasiro inte bn d lhcmorflnt,c — I H Mean 
Pick f “iin tn Gistfo intestinal Discisc — C M Jonc 
Vaunitis Sidsms met Cefv unis — ) V Meus 
C irdne Inncnond Tests - \ Omibiel and P D %\ Imk 
C cntf\li/cd V ic inn md Ec;cm\ V vccmitum- C P MeKInnn nnd H \ 
Boss 

Ir timent of Infinule Cczcni ■— 3 U Swartz 

Bi..o«nitton 'ind Trcttmcm of Adolescent I ndo r m. Disturb met. •. — P B 
Tnlboi 

) tcOioB in Newborn — 1 M Buy 

Minit.t.mcnl of Nuuiiiunil Disorders of Infancy — P M Smith 
C ynovosed Arthritis —C S Keefer 

ircitmeni of Ads m cd Cifdne Dceompens mon — B E Hamilton inJ C A 
Sehuck 

Mit.uiinc — When the four cardinil svmptoms — recurrent 
htmicrani il head iche visual divturbances, such is scintillating 
scotoma vomiting and nausea and a fimilv historv of 
migraine cpilepsv or allcrgv — are present the diagnosis is 
dclimtc Treatment of the attacks bv means of the parenteral 
idmimstration of 0 2s to 0 5 mg of crgotamine tartrite pre 
fcribl) during the prcmonitorv svmptoms gives rapid success 
the most npid response is obtained alter the intravenous 
injection of 0 25 mg Oral administration should be tried 
with 5 mg followed hv 2 mg each hour until a total of 
II mg has been given Two injections l2 mgl of 20 mg bv 
mouth mav be given each week for long periods Unpleasant 
svmptoms inausca etc! should not ilarni the p itient or the 
doctor Oastne svmptoms mu be ameliorated bv LT20 
grim of itropinc sulphate pains and p uacsthcsiae bv massage 
oi exercise 

Miiiuu \ Duiusc — Light patients were tre ited bv severins 
the vestibuhr part of the eighth cram il nerve or if deifness 
w IS present bv sectioning the entire eighth nerve There w is 
no niortiliiv and in seven c iscs complete allevution of the 
iliieks of vertigo was obtained Of eighteen patients trcited 
on tlu lines of Fcsicnbercs low sodium diet twelve lecovercd 
conipictelv 

/ iiliiii fiiirs rill /uwj —T he import iiiec of vriv c\im 

in iiion in tlit. tliffercntnl diaenosis ol piilmon irv tuhercii 
lo IS mil Ollier tune compl iints is cmphisircd This is especi 
0 u 


alK so in cases where the area of consolidation is smsij (, 
deepiv seated Other important signs and stnipiom^ jr 
a familv historv of tuberculosis, a sudden hacmoptwi, p j 
primary pleunsv with or without effusion Also impotiaol-. 
the examination of the sputum for tubercle bacilli the ph\ 
character of the sputum an absence of am leucocMoMs ■>rj 
a positive tuberculin test in earlv childhood Primarv mie, 
tion in the apical subapical or anv other part ol the h, 
is more common in children than m adults, and mav appear Si 
a lobar pneumonia or bronchopneumonia 

Piotamine Zinc Iiisiihn — Protamine zinc insulin has f «r 
used alone in thirtv one cases and together with ordiM, 
insulin in thirty four cases it acts slovvlv, but contimns ix 
action over a period of fortv eight hours This allows if 
number of injections lo be reduced to one a dav but it c a 
also produce hvpogivcaemia especiallv after phvsical cx«u 
or as the tolerance improves Even a severe attack of hipo 
glycaemia can easily be checked bv means of adrcnaliae arl 
intravenous glucose In order to avoid local skin complct 
tions the injections should be spread over a wide arct 

Surgical Clinics of North America 

Ncvi "Vork >ol 1S April 19 JS 

N 

on \tnruiation$ 

Ampuuuon — B Chew Smith 

Ampuiauon-s Gctrcral Consider ilions — R H Kennedy 
Traumatic AmputTtion'i of rinsers — W Lints and H S Hiih r 
Bactcriolosi of Amputations — r L MUenci 
Anaesthesia Preference for Anipui*ition of Extremities -~C A Roicnt 
Ampuniion of Lea for Arteriosclerotic Ganurcne — B Chc'A Snu h 
Amputations for Gangrene m Diabetes — W C White 
Amputations following Trauma and Infection — i G Lee 
Care of Diabetic Evircmuy Lesions— T OKanc and F U Ui/ufni 
Medical Ircatmcni of Dnbcics before and after AmpuniJon— L fb "'i 
Ampul ition for Tumours of Bone — B L Coles 
'Amputations in Thrombo-ancutis Obliterans ~S Si bert 
Arterial Embolism and Thrombosis of Extremities — V Cornell 
Amputation for Aneurysms — A H Bbketrorc 

Optimum Amputation Site m Lower Extremity Ampuiatior — F P 
" Oppcnhcimcr ' 

Amputations dvtring Childhood — Bcekman 
After c-irc of Amputation Stumps— 3 Z Milhs in 
Plastic Surgery m Amputations — J P Webster 
Plistic SurgLty for Amputated Arms^ — D A Mul'ihill 
Physical Thcripy m Treatment of Amputation Stumps— N h T»tu\ 
Surgical Correction of Atrophy m Oracna — A Wachvbcrscf 
Trauma m Oynaeco’osy — R T frank ^ 

Treatment of Incomplete Abortion in BcPcxaic Hospital —W E ^ 

Lsc of Colposcopc and Schiller Test m Diagnosis of Early or Latent Cic 
of Cervix — L K Farrar 

Cuemoma of Pharyngeal Portion of Tongue with Metasta is to Ccnr'a I' 
Node — W F MacFcc . „j. 

Eirly Grade I CarcinomT of Lowtr Lip with Metastasis lo Ccr'i*5l i 
Nodes — ^V' F Macfcc 

Surgical Treatment for Massive Haemorrhage m Ptptic Ulcer— i w II 
Acute Osicomyclms of Femur with Septic Arthritis —C M 1^^ 

Fut Cases illustraiing Surgicd Treatment of Gaviro duodenal arJ GWf*- 
Ulcers — U Lcwisohn 

Amputations in Tlirombo-angiitis Ohlitiiaiis 
given in this nrticle of the treatment of nearly "00 F" 
wjih thrombo angiitis obliterans It was found that wf , 
lion was rareU required and over 687 patients werv 
bv means of repeated intravenous injections of a „ 

sodium chloride solution The disease need not e r 
gressive if the use of tobacco is discontinued b' the 
Klajor amputations were reduced lo 64 per cent ” “ 
tion of the lower limb is neccssarv the knee should e ‘ 

Zcilschnft fur Tuberkulose 

Leiprin vol 80 t'Ul * 

'XlorbiU AnjioTU-al Studies relatinit (o Open auJ CIt'' *1 

Cattti Ilicrap> — O kash Ti’-m * 

An tstimiic o! ihc Value of Gold Thenpy tii Piilmon^o 
Martini and A Ro'^cnthal 

Open and Closed Hcaliiie of ^ v, 

of the beneficial effect on cavities of large ' .ije , 
closure of the draining bronchus The author co 
the slate of the draining bronchus is of r jy / 

as the tissue changes in the civil' for the fate ^ 
and for the effect on the cavitv of thcrapciific tnei' 



Aivom <i 19'S 


THC BRITISH MEDICAL JOURNAL 


A non toxic circulatory and respiratory stimulant for oral hypodermic 
intravenous and mtracardiac administration improves the pulse 
and blood pressure reinforces the contractions of the myocardium 

Increases the respiratory amplitude activates the ventilation of 
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IndiLOled in cof/ap'L coma accidcn(s ifiiiiiip naicons poisoning fij coal gas 
narcotics and harhitonu dcrnattiLS fatiCac phenomena etc 

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An.S 47 



THE BRITISH MEDICAL JOURNAL 


August 6 19B 



A Compreliensive Financial Service for Medical M 

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Ai c.usr 6 19 S 


THC BRITISH MEDICAL JOURNAL 


BECAUSE IT HAS REAL MERIT the Dr Deimel 
Underwear %vas awarded the Gold Medal at the Seventeenth 

World Congress of Medicine held in London It grows in • 

popularit) every year It is so comfortable so satisfactory 

that after a few days wear you realise you have settled the - 

' OEtMEUN 

underwear question for good OndmVeO/V 

Can be svashed in boiling water for sterilization without injury British \i\de 

Dr Dcimcl Vniervear is made in a complete ronCe of sizes and styles for Men JFomen and Children 

Please nrite for full particulars 

DEIMEL FABRIC COMPANY, 99, NEW BOND ST , LONDON, W 1 


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For upwards of thirty— five years largely 
prcscribecf for the local treatment of 






SCABIES and all SICII:^ PISEAI 




SULPHAQUA SOAP 


Relieve Pam and Intense Itching, Soothing and 
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SAMPLES AND UITERATURE ON REQUEST 


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^Ylactotfen so adequately fPlafes Breast Mif/c 

, / wu-wgen so feeding is deficient or impossa,^ 


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^ssiblc. Both the proportions of irs food elements and its phts>o1o;jical character arc practicall\ 
identical The homogcnisalion process reduces the fat {globules to a size c\cn smaller than 
those of breast milk. The curd IS lipht, nak\ and casilv digested The \iiamins remain 
practicalh unaltered, and the mineral salts arc presented in an assimilable form Tliat is ^^hJ 
oabics t\ho are dcpn>ed of their natural food thri\e so well on Lactogen 


LACTOGEN 


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detailed deictirti'c htcniurc will be ent to aaj rre^ber 
t>t the Mct-tcal Profci’s on upon request Laaoren Bureau 
Scstid s t Products Ltd tD-rt Z K *) Sr Gccrfics Hoj e 
6 t. 8 Eastchean Lordon E.C 3 



SPECIAL RESERVE (STILL) 

(as ad\erti 5 ed in The Diabehc Journal 


EXHIBITED AT THE BRITISH MEDICAL EXHIBITION PLIMOUTH) 

Tliiv brand of G VTMCU S C\DCR ha^ been rccoinnicndcd i*« **uil«ble for Diabetica, it contains onl> the barest 

trace of *nipar ( cc I'pical anals i**) 

Spcafic 09^ST Sugars 0129c 

Alcolio! In \olumc 646^c ^cidit\ 0^39e 

n^tract or <oh(N 1 X'h or Min'ral 0,259c 

Non-‘:ugar colitis I So 9c Original graMtt 104^ 

Calone< per pint 2.0 

Grams sugars per fluid oz 002 

Tlie extract eontainbi mcinboIi*«ablc organic acid** gLccrol and *‘Orbiiol Tlie mineral matter mostlj carbonate 

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rWZK S-WPLt: on rcccipt of medic vl card quoting bmj 

•WM GAYMER & SON, LTD, ATTLEBOROUGH, NORFOLK- 





THE BRITISH MEDICAL JOURNAL 


August fi 19 , ( 


non-irritant Toilet Preparations 
specially for prescription in Allergic cases 

Leaders of the profession have found these of great use as an alternalne 11 ■ I A I len e il 

to hcauty preparntions and cosmetics suspected of giving rise to mi|| ■IIIIW I ■■■ lOU oOUliiamptOI) Rgy 

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other Irritants Through any Chemist or direct from — m m mm m mm uonaon, nil 


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II you have any OVERDUE ACCOUNTS 

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2 & 4, VALENTINE STREET, NORWICH 

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for rcliabiliij and normal reaction 
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Guy s Hospii il London 

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(Medical Books), Ltd 
99, Gt KtisscII St, London, WCl 

T cl c phone T ete^rnnis 

MusruM 3946 SuNLOCKS London 


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in BRONZE Tnd ENAMEL or BRASS 
Send dciuN lor sketch or IltRci 
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EPI^JPSY 

Oaaing to extensions there arc at 
present a few Vacancies at the 

DAVID LEWIS COLONY 

for Ladies and Gentlemen who have 
Epilepsy, but arc of good intelligence 
and sound mind 

Colons life gives to most people who 
have cpilcpsx the best chance of 
happiness and contentment 
Apph lo the Director, 

The Da>id Lewis Colony, 
Warford, Alderley Edge 


“i I 'toiirniiTil, 


HOME FOR EPILEPTICS 

MAGHUIB (near I n EUrOOn 
FARMING nnd OPEN Ml. 
OCCUPATION for PATH Ms 

A fp.v % TC Ulrica In 1*1 nnil -nil Cla . lino 
LLLS Isi Class (men only) (ram £) r« ' 
WTrds 2nd Chss (men 'tnd women) )/ f» 

For iiiither pnrilcidars apph 

C EDGAR GRISEW’OOD, Aft 

Spcrcnrj,20 Lxclianpo Strppl Fail 1 1 


HALLirORD HOUSE, UPPER IHLH 
FORD, SHEPPERTON niaUiiWui ' 

riui handsome vccludcd residence ilinJ n i 
park of 36 acres siiinicd 16 tnilo from Lc 
jiccn cd for the retention of ^ limiicJ rir 
rnticms ot the upper nnd middle ch"« f 
from nervous ind mental ilTtctions 

Voluntary or certified cises rcvcnw ' 
modente Patients arc under the comiar 
cire of the Resident Mcdieil Siip^f ^ 
Dr R A Stewart from whom full 
be obtained • Tel SunbuponT^ 


WYE HOUSE, BUXTON. AND CH ' 

for the PRLVLNIION and TREATW'i^ 
NLRVOUS and MENTAL DISORDniS i 
sexes L^rgc country house "i Lni i 
its own grounds Croquet r- 

billnrds wireless mst’illuion ihroiipho 
ficihti for spcchliscd modern 
psvehoihcnpj occupitioml , 

light dnihcrm> Pruitc rooms wiih sr<J 
if required Volunnry T^emporah '•"J 
miicnis received — for icrms ^PPl> . . p 
Superintendent llrirN S L 

Nil Pel DO 

THE GRANGE, 

iiLiir ROTHERHAM 

A IIOUiL licensed for s ' 

lunhed number of Ladies suireiins j , 
and Menial Disorders Both “ .V, -a 
tars Piiienis rcccucd ^nproud , 

I'aiicnis Ihis is a line conn ) ^ , 

bciuliful grounds ind . p.< P' 

ShefTield Icl No K rS ^ 

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Gnngc I Tne L k. N F R^y — ^ 

ASHWOOD HOljSL 

KINGSWTNFOR D, &T AI I <1”’ 

An old cslabllslicd •’•MVATL j, n ''' 
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paiicnis arc rcccucd as "c" 
certified ,, ,i,,, 5 ffd 13 

The home Is beaullfully 
grounds of 40 acres c 

mil particulars as to j| O' 

be obtained fro m Ihe Ifesideni Men 

RUSSELLS^,,,, 

III MIL IIIMiaTFin I'" „ 

Tclpphonr ^ VTTO ^ 

A conviiesccnt home for •i’*- “ « a 

of mild md recoverable nervou co ^ t ^ 
sexes The houxe ^ ' r * 
of crounds 17 miles from „ - a 
non of the aiford b> pass ,,, , i 
In residence and •''o'’'" ” i ,r I 
Lees from ten suineis a wee ,y » 

Apply ntsii'f" " 














6 I'J 'S 


THE BRITISH MEDICAL JOURNAL 


25 


BMLBROOK HOUSE, 
B VTH 

r».r 5w'Tcrrr< fan Ncox'* < arJ Vtcr si Da 
onicn «n’i tr 'nn^c t cni fkam 

T>c i r r» u H tLjicd fn no«\„rd 

iru-d"vi< of Til STn with njcn f irrt \ cws • f 
the Ch arO l^c Awn NaUn <Vc Vr 
O rf 'if'o r*r* ' 

Fvr tc*^' '*r ’* \ Cl i«r um 'I ^ D 

B 0» D r M Rc'iJc-t lan 

TcV*‘’''’'C T ‘I 


ST. ANDREW’S HOSPITAL 

FOR aIE^T^lX DISORDERS 

NORTHAMPTON 


FOR THE I PIER AMJ ailDDLE CL4SSES OXIY 
r ril rni Tile Mi)« Hos nir MARQUESS OF EXETER CMC ADC 


HEIGH VM HALL NORNMCH 

A rRI\ NIL MLNTNL HOMl a- icJ tn 11 
acr^ cf •cIJ Hoouo. ra*- •>-.• lawn arJ 

On* -nn V. “Li~r f Ntn h. ir Me" al 
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Ta i-T s u”v.cT Cm i~3 * c aw"* tesS f r 

Fees t on 4 s re* a w'tV c'm u 
acerni -* to feet: c"— -ts A fo» xaca- W rxi t 
f r Lac cs a-J Cc"i’c-"n ai rn- ervJ ter* < n th 
rrcor'~'"n:_j I n of t*'c I'ai cnn twn n 

A""') to r>r J \ Svai N.n») *1 

TcltT' 'n Sov. I *0 V r»i»ch 


TYKEFORD ABBEY, 

VEHTORT riGVFLE Bl CHS 
n \CTio\ iL M <n V DivoRurii" mi jitciL 
\VD cow MT>OVr ev't^ 

Th» Hc* 3C ti a Mjrr -n pI JIp >n al i-lrrpil 
and rj n acm cf raofen 
OTki b la cJ 14 r* r» ff*n '»or':_’""*on 
arxl 1 r*t M from pf<2 d m iFc na n Loow n 
to Ncnhan-ioa Road r-'^rs foyn Lonci.T 

B h 5cm a t aTf>— nnea rd ISy h<Mhffa 
rcj^v Trc3J"C" tx men xtl> ir ^ .aV e 

eaxo Heat \ ny anc LI n N i ct 

Dal^e•rJ) a-d Foan Bat*t C J'ufc 

Tc"r-i et 

Ar-b Dr D n. M DOLGUNS-MORRIS 
Te!e~‘*o:>e 'oeutvxt P*tneU I I 


HILL END HOSPITAL AND CLINIC 
ron Till rnLM'>Tio\ nmi Yni nt^haf 
or MtATlL 4M) MJIUHV IM onoi 

fSO mile* from Leat/onI 
Laues w^cn."? f on al fw— t cf vtevTAL 
ILLNESS are receded f r trcajne-w. cn n-x-em 
It«s ay \PB- ry Tctrpcfary cr Cent cd 
rnxate PaticnM at tfc- Hi I ErJ Hnr ul 
CcaxaloctTi or r- d C3.c» can be tmteu n 
» dc It** ccj“ ry tsamion »Jtb mcr< >c 
Courcy Lo-*»ti a« 


HICliriLLD HALL, 

Ku..te Abctwi at** s»a> (ton tbe Hnrtal 

FEES TVNO TO THREE GUlSEAb rfP N\If K 
For funbcT fvn -uan ar*' » to th-- Med -al 
Sopl N\ J 1 KIM0CI L.K cr DPM 
ST ALBVNS HERTS 


CHISWICK HOUSE, 
PINNER, MIDDLESEX 

Telefhoae riNNER 231 


A Private Ho^^piia! for the Treatment 
Hid Care of \Jenlal and NerNOUs Illnesses 
in both 'exes 


■\ modem countn house 12 miles from 
viarblc Arch in beautiful occluded ground' 
Feesfrom lOguineaspcrwcek inclusive 
Cases under Certificate Voluntan, and 
Temporarv patients received forircatmcnt 
Douglas \Iacaubv M D DPM 


STRETTON HOUSE, 

* Stretton Shropshire 

A PR|\ \TE HOV1E fer the ireatmcri of 
ueniicjnen lu^cnnf ffc«m Nfen al and Nervous 
ibc alJ ed d orders of 
Hres of 

»i»y Mc-^l and Nenous eaxes arc teemed 
, J cntif'dtcs av Voluntary Paisenu under 

Nicnial Treaimcrt An 
Bractrs hiM couriry See Med cal 
p 23.^ __Apj.}y Mcdjcal Surer 

latcEdert Phont 10 p O Church Sirction 


FENSTANTON, 

CimiSTCHCRCH KO\D 
SIreatham Hill SVkJl 
Rniait Home tor lEe Care are Trearmem 
or a Umted ni.r"l-r o( tadi-a »itb Menial and 
^tnota Dsonirra Ccnilicd \Dlunlary and 
Paucnis rtceiicd Larcc 'tanion 
Iw acres of rrounds (See Vfedirol 
P 231**) ArrJ) Rmucnt Riysicun 
Tele h fe TufeHd!71SI 


Me tw Vure fe»t err Th'sjvs Tevscvt MD NfRCP DPH DPM 


Th Re* irtfd H Mriial w situated tn I 0 acres of patV and plex ure Rrcu"ds Nountaty rauenu 
»r are i cn"c fr m ir ir ent ncntal dt "»rders or »i.h to prevent rc^urrcni attacks cf m "ta! 
u I e tcr*Tx rats ratte^tv and certified r tieni oI roih etes are received for treatinert Careful 
c! " al h xhm al hy tm •> al and pithoJ rical ctamnan r< Private rexms nuh special nur cs 
rule or female n the H''rt‘il cr tn o e cf the nur*etojs vjllas tn the srounuv of the »ancus brar hes 
van he rr vtJed 

WANTAGE HOLSE 

Tht 1 A RfvcT I n limp tal in cetaehcil rriund* ivith a separate entrance to which CAiic''ts can 
he adrr tied It n eq imvd %*i h all t e ap^uratus for th ment mouern treatment of Mcnul and 
Nrrvocv l>\.Tjcrv Is co~ n '—cal ccrarr*rnt« f r hjdrotherapy h> vanous ncihods includ ne 
Tu krh and Ph tan hat tbe pr need i-*~*erM n hath Vi b) Dou he S*. n h Douche Dectneal 
hath ten ttea '"crt etc Ih tc is an (Wratirs Theatre a Derial Surcery an \ ray room an 

LJ»r*\»sei A^^iratit and a Derrriment lor Diaihemy and H h Freduef'cy ircaitrcni It also contairs 
LaKfait les f r h-xhe*'h.jl hvetefith cal and rc'carch 

MOULTON PARK 


Two r*! es f r"n the Mam If aJ ih fc are r era! bran h cstaM hn nts ard ifl_s situated n a 
ratk ard fam cl * o aircs Nlitk meat fruit and veretahev af" uppl ed to the H H’-ifal fr m the farm 
firuert arid <> iharui cl V! tv n lark (Xxo^jih o Therapy tv a le tore of fhr hr'n.h and pat ents 
aic B cn ever) la l l> f r os upyrny them el cs n farm m. c ruemne nd fr t crussir*. 


BRVN-\-NCL VDD HVLL 

The sex eh e I S NnJrrw Hxp a» is he -t I l r i aiol in a pjrk ft res L nf rf« han 
a*"s.yi Ih f n-st s erer> n S tih WaJm On the N rthVVc»i uc fl the Lt le ni’c ea ». t 
f r“s th K*- •‘i.afy late ts r"as i th Oran h f r sh ft *<j.s -c hat* c r I r ' r vr x. 
Tie II •sp al has it own pn ate hath khac ntc ruhre The c 'r ut ft hn m th park 

M all t c hran hes < I tn II •»" u th re are niieruw fxiPl anu h xkes nd Lnn 
tot X court (c*^ a 1 h u <o- t » tsuaet er v rw f emrse* arJ tnwir kree* L-c rd 
fr"ile**en hasp thr <wn ran- r a J I i u e* are pr i-eu for hard rafts h a va pen f> et 

Iti itrrm ar- lunher pxn u» r ap-'ty t the Med b rcnmcndcri ffcleph N ' c nd *<7 
NctvN4't“p*''n> wNn on be cen n L n b> arr* rt 


THE COPPICE, NOTTINGHAM 

HOSriT\L Fon MENTAL DIsEASEto 
Thiv Imtiiution iv cxcluvivch for ihc reccplion of a limited number ol Pn He Patients 
of both sexes of the Lpper and Middle Clares at moJcrTic rales of pavmeni It is 
bcautifullv situated m its own grounds on ^n eminence a short distance from Netting 
ham and from its singularh healihv po'iHon and uomfortablc arrangements affords 
cverv faciiitx for the relief and cure of thosu mcntallv afflicted Oucupaiionaf 
ITienpv Nolunnrv md Temporarv Patients received 

Tel 1411” Fer term re «.p > to ti e Med cal Superif eruent 


HAYDOCK LODGE 

^EMTO^ LE-MILLOMS LANCASHIFE 

Telrt Street Axhtor-ir siaVcrfelJ phone AxhiO'>-in Makcrficid *'311 

r<r the recept OT and trcairrcnt of PRIVATE PXTIESrs of fcvth exes of the UPPER VND 
VfIDDLC CLASSES suffermc from meml nerxen/s d*sca c< c Ji-r xolurury tmntmnly cr 

under Ccru j-ni e P-tien x arc clax ifed in separate huildtncs cco di e to their rrental rendition 

S tuated m park arJ trourd of jryy acres Self surroncO h> its own farm and ordcru in wheh 
ratserts -re encrurased to OwCup) them chc? Every I cility for mdoor ard outdoor recrcaiicn For 
terms rrevretus et arrti MEDICAL SLPERINTENOE.NT 


NORTHUMBERLAND HOUSE, 

GREEN L-^N'ES FI>SBLRY PARK N 4 
A PRIVATE HOSPITALforthclrcatmcntof mental and nenoub illnesses Convenientli 
situated and casv of access from ill parts Six acres of ground highh situated facing 
Finsburv Park Voluntarv and Temporarv Patients received without certification 
Occupational Therapv Ps>chotherapv and other modern forms of treatment 
Telerhcn" CTAMFORD KILL -6SS Telegrams SUBSIDIARY LONDON 

Convalescent Home KEARSNCY COURT DOVER- For further parueufars apply to the Medical Sjp 


COURT HALL, KENTON, near EXETER, 

for the trcatnicnt of ei^ht Eadies voluntarv, temporarv or certified patients 
Large gardens and owm dam 

CLIFFDEN TEIGNMObTH for earh and convalescent cases A well appointed 
house with 'pacious balconies and extensive views of the South Devon coast 
Sub tropical gardens own dairv in 25 acres Private road to beach 

Telephones 

Ree.rlent PhvMcian*: BERTHA M MULES MD BS Siarcro's 59 

Kesiaent inxsicians ANNE S MULES MR CS L-RCP Teignmouth 2S9 






26 


THE BRITISH MEDICAL JOURNAL 


August 6 19'^ 


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HARROW ON THE HILL 

Foi the lesidential lieatnieiit of Functional Nei\ous Disoideis 

No CISC under certificate nor under the M T A 

This home which was founded in 1911, is designed to proNide for ps\choneurotics a curatne environment asso 
ented with modern psvchological treatment modified to suit each individual patient The treatment is in the handv 
of three experienced ps>chotherapists and most patients lecene three hours of analvtical treatment per week 
Occupational therapv of manv varieties is available but not obligatorv Recreations include tennis badminton 
billiards etc 

On admission patients are examined bv the diagnostic phvsician who advises on all phjsical treatment As far as 
possible all necessarv pathological examinations are carried out bj the pathologist in the laboratorj on the premises 

STAFF 

H Crichton Miller MA MD MR CP {Seiiioi PInsiciaii) GrvceH Nicolie M A, MB {RauIciuPInsicwi) 
Alfred Torrie MA MB Ch B , DPM (Medical Siipeiiiiiciident) Marx Hvll MB B Ch (Patlwlm:isi) 


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□ BnBDDndDDCDBdDQBEIBdBBBBBDDBBBBBDEBBBaBBBBBBBBBBBBBBBBBBBBBBflflflflBBBBBBBaBIIIIIIIII 


CAMBERWELL HOUSE, 33, Peckham Road, 


Telegrams 
Is^ciioLiv London 


FOR THE TREATfltEiVT OF MENTAL DISORDERS 


London, S.E,\ 

7elf!<her 
Rodney 4 P i ! 


Also completelv detached villas for mild cases with private suites if desired Voluntarv patients received Twentv acres of groirh 
Hard and Grass Tennis Courts Putting Greens Bowls Croquet Squash Rackets Recreation Hall with Badminton Court ardj 
indoor amusements including Wireless and other Concerts Occupational Therapv Callisthenics and Dancing Classes \ rai ’ ' 
Actino thcrapj Prolonged Immersion Baths Operating Theatre Pathological Laboratory Dental Surgerj and Ophtlnlniii Di,! 
Chapel Senior Phv sician Dr Hubert Jamfs Norman assisted by three Medical Ofheers also resident and visitinc Consiiltirx 

\n lllustnlcd probpccius piMnu fees which nre sinctH modcntc nny be obtained upon application to the Secreiar> 

The Convalescent Branch is HOVE VILLA, BRIGHTON and is 200 feet above sea level 


PECKHAM HOUSE, 112, Peckham Road, London, S.E. 15. 

Telegr ims “Alleviated, London” Telephone Rodnej 20-11 2042 

The above House is for the care and treatment of persons suffering fiom mental diseases and nervous disorders Ceri'i * 
voluntarv and temporary patients are received Separate houses for tieatment and accommodation of special cxvcs aJ," 
the Institution Occupational therapv ph>sical drill and other forms of modern treatment There is a seaside branch Ktat f ^ 
Court near Dover to which patients mav be sent for treatment or on holiday Motor drives are arranged whenrequtw 
Tennis courts Entertainments dances and indoor amusements held throughout the year Terms from £3 's per vic 
lllustiated prospectus and further particulars can be obtained from the Medical Superintendent 


LAVERSTOCK HOUSE 

SALISBURY WILTS 

PRIVATE MENTAL HOME FOR LADIES AND GENTLEMEN 

Completelv up to date Lovelv house and grounds (18 acres) Certified and uncertified cases taken Facihlies for t 
to the seaside 

ESTABLISHED OVER 200 YEARS c.. m ’ I’ 

Appiv to Med Supt for illiistiated brochure Tol SvLis 


ol those of il’ 'r 


CHEADLE ROYAL HOSPITAL 

CHEAHLE. CHESHIRE 

Ihi^ KCGISILKED JIOSPITAL wich a SEAblDE BRANCH -ii Colwm Bi> N Wales is for the treatment and cite 
jnJ Middle CUsscN sunennR from MEVT \L and NEK\OUS DISEASES 

Ih HoNpiitl IS KO>crntd Iv a CommnieL appointed b> the TRUSTEES of the Manchester Ro\al Infirnurj oround 

In addition to the Main Buildins ihcrt art separate villas Extensoc erdonds Hard and grass tcnnii courts cricket and croquci » 
lir ladmmton There are aNo wireless installations Golf ma> be had within casj distance Occupational thcrap> 

VOLUNTARY IEMPOR\R’\ AND CERflFIED PATIENTS rcccocd 

The Hospital is nine mile from Manche ter *50 minutes b> rail from Li\erpooI ind 31 hours from London -t-urMT 

Ixr terms and further pariicul ir appl) to the Medical Supenmcndcnt v\ho maj be seen m MANCHESlFR b' APPOINT MLINi 

Telephone Gule^ 2231 (3 lines) 


and * 


THE OLD MANOR 
SALISBURY 

tsicnsivc grounds Detichcd \ iMa 

CONSALESCENT IIO'ME 
nt BOURNE MOLTH 


Chapel 


V Pi IV ale Hospital for llie 
Trealmeiil of those of both si't" 
from ME^T\L DISORDERS 

Terras v«> = 


Garden ind dair> produce from own farm 


Detached Villas standing in 1- acre's of ornamental trounciS "Rh ^ 
Voluntars Tcmporar> or Certified Patients ma> sisit by amnccrrcni 


cohf ' 


forhfi cf' 


llliislr'itctl Brochure on application (o the i>Ic(lical Superinlendent, The Old Manor Salisbury 


riione s-vllvhiir' 


CALDECOTE HALL 


NtNi:ATON 
W \ n I c K S H I K E 

( Ph nc Nwd ji p 41 1 


in t } 


.tint 


fr.* /r 


Result ntnl trcnlmcnf of 

FUNCTIONAL NERVOUS 

IncIiuhng^AIeohoI.sm ^ ^ 

Till b'aiilifu] mansion situated m the heart of the rJ ‘ ^ 

London b> L MS R ) and surrounded by charrning n t f ^ 

and outdoor oecupaiional the apy are a^’ad^b c i . r 

runcinnal Nervous Disorders by rsychoth rapeu ^ 

I E CirttllC UD or U rUjnfml Vrdfd ^uprrlntr 



\VGV'^T Cl 


THr BRITISH MCDICAL JOURNAL 


27 


MINERAL 



SPRINGS 


H arrogate specialises in the treatment 
of Disorders of the Liver— congestion 
cirrhosis Jaundice, cholecystitis 
cholelithiasis, and tropical liver Also In 
Diseases of the Skin — eczema, psoriasis the 
coccal infections of the skin etc Other types 
of cases suitable for Harrogate treatments 
arc — The Chronic Rheumatic Diseases — 
Arthritis Fibrositis Neuritis Gout 
Hypcrpicsis Mucous Colitis Functional Dis- 
orders of the Heart Pelvic Disorders of 
Women Convalescence from acute illness 
At Harrogate a svide range of Sulphur \/atcrs 
strong and mid and of Iron 
sra'^ers both saline and pure 
chalybeate is available for 


dealing with the large group of disorders 
amenable to Spa treatment The Royal Baths 
at Harrogate is one of the finest Spa establish- 
ments in Europe, and the Corporation has 
embarked upon still further extension at a 
cost of £66 000 

DIET Prescribed diets for Spa patients may be 
obtained at hotels and boarding houses v/ithout 
extra charge Complimentai'y a*'d reduced 
price facilities for the Cure, Accommoda- 
tibn, and Amusements arc available for 
Members of the Medical Profession 
Full details of Harrogate for Cure and Holiday 
nAii •> v/illbcsentfreeuponappli- 
'< IT’S QUICKER BY RAIL cation to Spa Manager Infor- 

V"'™:”"™ 5 " B.™,. h.,rosa.. I 


HAR 


Air 


TOR-NA-DEE SANATORIUM 

MURTLE DEESIDE ABERDEENSHIRE 

FOR THE DIAGNOSIS AND TREATMENT OF ALL FORMS OF TUBERCULOSIS 

SlanacItiE Director V\YlO LAM SON M-D, TJLS-El 

Southern aspeci. Lo» rainfall Bum hraang air Sheltered groups Beautiful 

for diagnosis and treaimenl ■"^'‘'d^^8^operaUng^h«|^c^^^o^ cjrtra 

Day and Mnht Nursing SlafI All bedrooms V“"r'.''S'"’^nd'mnVu'hhc rooms‘‘ 

(headphones) Comfortable and air) public rooms c-rreiaTS 

Medical Supennlendent J M JOHNSTON CU^tI 107°' “ prospectus apply to Secretary 




PENDYFFRYN HALL SANATORIUM 

PENMAENMAWR, NORTH WALES 


All Modern Melhods ol Trealmen) Available ^ 

Res dent tafw Dennf On ^P»c«rrin6_^ »» ‘-r 


Res dent P*i>s taw Otnnt On 

For panyuUT a^rly o the Secretary Pcndyflryn Hall Pcr*"^enira^T 


Phone 20 


/ 


THF COTS WOLD SANATORIUM 

First opened in I89S and rebuilt m 1925 On '^<1 /olsnold Hdls ’ eTesluon^'wlert ‘’"|■'u‘re fmaTS 

and all other forms of Tuberculosis Aspect S^ M sneltcred Irom and tBfra violet Bass are asailable when 

Special Trenlment In Arfincml Pnenmotho^ (\ ras coumped Denial Department Electnc light Radiators hot and cold 
ncccssari uilhoul extra charge N ray plant '‘t'nPP™ ^ 

basins and x.xnoaBtr s 

-Morn., eanr.- 




THE BRITISH MEDtCAL JOURNAL 


2S 


August 6 1^. 


THE CLIIVIC 

20 Devonsliire Place 
London, W.l 

Tel TTelhecJ 4444 {20 lints) 


A NURSING HOME FOR SURGICAL, MEDIC/VL 
AND MATERNITY CASES 

Fees 10 gns to i8 gns per 150 State Registered Nurses 
\Neck (Average — x4gns> 2 Resident iMedical Officers 
8 Operating Theatres (for emergcnacs) 

Patients onJv received under the supervision of their own 
Medical Practiuoner 

Drugs and Dressings free (otherthanPropnetarj Articles) 

Illustrated Brochure on application to Secrctar> 



NEW LODGE CLINIC, WINDSOR FOREST 

This Clinic was founded in 1921 in order to provide for the scientific investigation and treatment of disease bv a leam 
of physicians and sneciahsts 

All foims of non-infectious medical cases are admitted, special attention being paid to disorders of digeshon and 
metabolism arthnlis anaemias asthma heart and kidney disease, and functional and organic nervous disorders 
Particulars can be obtained on application to the Secretarv, New Lodge Chnic", Windsor Torcst, Berks 

Telephone 181 and 182 M mkfield Kovv 


CRICHTON ROYAL, DUMFRIES and secluded surroundings 

FOR Home for tlio Treatment o[ 


NERVOUS AND MENTAL DISORDERS 

This HovpitTl Ins every facihii for complete investigation of the above conditions and provides aU 
forms of modern ircitmcnt including psychotherapy phystotUcrapy occupational and recreational therapy 
Cases of alcotiohsm and drug addiction arc admitted The Phvsiothcrapy Depanmem has separate tmns 
fully cQuippcd for \ lay work hchoihcrapy shortwave therapy electrotherapy and hydrotherapy 
(swimming bath prolonged baths Scotch and \ichy douches Plombicrts treatment clcctnc and Turkish 
bath cabinets etc) There is a fully cQuippcd gymnasium under qtiahhed instructors Facihiies arc 
provided under special recreational therapists Cor all indoor ano omioor games including goU course 
encKci football and hockey grounds lawn tennis and squash courts croquet and bowling greens 
The Hospital his its own Cinema Library and Hairdressing Saloon Terms include regular motor drives 
Private rooms suites or villas are available and special nurses can he provided 

Tltc Hospital grounds cvtcnding to nearly I 000 acres arc situated m dcligltifttl country and iiKludc an 
extensive farm (FT herd) gardens and orchards 

As the Hospital is well endowed terms arc exceptionally moderate e c First Department ^ to 30 
guineas per week Sceond Department 2 and 2i guineas per week Vohmtarv and certified patients arc 
received Medical Certificates given anywhere in the British Kies are valid Cor admission of patients For 
prospceius necessary forms and further information apply to 

Physician Superintendent P K McCow vn J P M D FRCP D P M Barrister at Law 
July Isi Tel Dumfries 1119 


SHAFTESBURY HOUSE, ' 

Spetnlly built and licensed for the care and treatment of a Umued number of Lidics and 
( cnilemcn suffering from Nervous and Mental breakdown Voluntary and certthed patients received 
Ladles also admitted as Icmporary Patients without Ccrtihcatton Terms moderate 

Apply UfsmtNT PiiYSKUN who may be seen at ti Rodney Street Liverpool by appointment 

Tel No 8 Formby 



luU range >t Hvdn pAthtc 'Imlmpnt it» I urh UInI 
nihe< >( lUtlw Turkish ind Rii Ixti BuIh \lx and 
\khv Douches 'U 'LC Uinitnrr'b Irfilnvfju ‘^tudi 
Chair licktrlc ln'«nlbtioii hr uid nther 

Medtcrl l*urts> lionsinp Uidnnt Hk\t lufn n 1 
light td Mmtipht D Vr* nv d IDbIi Ircpicno 

Duthcmiv S'luhtnu Uuhs soa|lfs> lUllv vtt 

LcrUfiNl milk from own fnrm J sian V\intfre vrdvn 
Orchpsirv *5)>ctid JO vision Pr It V did Night Vtunl 
aiuc Orcr fO iriliicd aiilc md yemde Nurse 
aiasseurs Vuendvnts cU 

Terras 13/ to 18/6 per day tnclusac board 
Illustrated Brochure M J on request 
RiSidifit PJnsicians 

G C R H VRBINSON MB B Ch , B A O 
(U U I ) R MacLELLAND, M D CM 
Phone tso 17 Qrams Sntcdle \5 Moilock 




A SPA UNDER ONE ROOF 

In RocksuJe arc combined all the amenities 
of a modern spa including treatment rest and 
cnikct unment 

SHrtTfRLO SirCMION SPVCIOIS 
CROINDS HIGHLY QUALIFIFD STnFF 
The Baths and Trcaimcm Rooms occupy a 
spcvul winv. acv.cs\ibk by lift from all fioors 
anJ arc (wik equipped for every form of 
physKal ircatmcni mkluding the most raod'-rn 
hvdKdi^i ai and ckvin al methods massage 
and tkmedul cxcrkiscs dietetic and occupi 
O’lnil ihcrapv Urms 4S Od to £6 6S Qd 
In iimxc terms fv r consuhatKO fees treatment 
b svrd It iJcr e and aiicndantc from £6 6s 
Write (or I iruT to the Sc rciary 

'’tijJfi'Jc //oil laa 
C I L I SIK VNGr 

in nch 

It n' 1 M f C riL<.nJ ) - 



•MATLOeg 


ALCOHOLISM, 

OTHER DRUG HABITS, 
FUNCTIONAL NERVOUS 
DISORDERS, INSOMNIA 

Old HtU House Chislehursl (25 
mms from London) is charmingly 
situated in quiet secluded grounds 
Billiards and outdoor recreations 
Under new manacemcnl with added 
accommodation ladies and gentlemen 
-xrc admitted for treatment Fees, 6 
to 8 guineas Special terms for long 
p-riods For illustrated prospectus 
write to the Medical Superintendent 
or Matron Phone Chisichurst 45 i 

Old Hill House 


CHISLEHURST 


KENT 


WORRY AND NERVE STRAiH 

(Under Medical Suptrvadon) 

Lirge air> rooms— Studied diel3r)-F< 
pert cooking Plevsant garftn 
tennis court — Friendlj and chectv stw 
sphere — New emplnsis on Happiness 
the Home 

Terms from £3 5 0 per wmI 

Apply lo-D H C^oTvEN MD DfD 
D T M L H Surgeon Capiain R N ri ^ 
(late Resident f>fed(eat Supennie/tdenf h ' 

"GLENROY," 

16, Sumlridffe Avenue, Bronm.Wf 
Telephone R/it embome 


“ECCLESFIELD,” Staplchurst, k'' 

(Rcmovxd from Ashford 


PRIVATE HOME tor the CARP 
aCOHOLlC PATIENTS f p I 

;ion bcnuiitully siuratcd m O 

and Extensa c "“i"' f?'™ r,,,!; if i; 

Jndcr the tnanascmcnl ol inc Mr" ^ 
rood Shepherd Appb Rc» 
haplchurst 61 

SPRINGFIELD HOV^ 

Near BEOrOBD 

ror Menial Dl.ortirr. v.ilh Lfj 

Resident Phs'sician CtDRIC S' R 
Orillnary Term, FOe i ' 

(Indudinc Separate Bedtooras » 'r 
Inter, lew’s in London hy Arpon 


5 HOPSTO^E lIOUSI , 

select Private Mental '' 

Voluntary with s«PMate llnu'c’'''''’ 
nntary Boarders Under prt«.«l 
resident Mental Sncciahvt t 

hot Supt Dr } LsNonv't '"d"" 
lord 270S — 


TUI cnovr 

:iiu»cu STttrrros miiw^ _ 

I, ate Home lot the cate ci » 
limUcd mmibcr of ^ 

uniary and Temporary Pan 
:w Mcmit Treatment A« i 

Icdical Supctintcndcni i>r 

rv ot lOMlON SUNT'! 

IJVUIfOIIII hf'’ ^ ^ - 

; and Oentlcmcn "“''ft// a 
ccrtincates fOP U ' F"' 

:eeT.>"reTvwJv:rr4s^ 


Itvv" ^ f * < 

J rctccwmv /'I ruDUD » 

eroundv •♦Wl fi ^ 

vicnul’y afni;tcd , y , 

I s uionv fkcr^ V ' 

Livcrpooi St •' 






Ax-HiUST 6 191^ 


THL BRITISH MfcDlCAL JOURNAL 


29 


DOCTORS OWN SPA /oi 

RHEUMATISM 

M -• *rt 5 *n r iti'x)' rtJ'* ^or heme we S mpleit la^wt 
nd molt eecicmJa? treJtmc'tc rtif he c'xf'vtred to »»»r pit tni. 
Ce^t*‘\. Of **0 treJCmfMv X. lerjtu*^ on reeuttt* 



PJSTANY AGENCY LTD^ 3t0 Rcfent Street Ion on W 1 


42 4 


/ A » 

o PISTANYSPA DUREAU 


VOLCANIC-SULPHURIC 

MUD SPRINGS 

in delishtful surroundings 

m ©AYg 

INCL.USSVE CURE 
Special facilities for doctors 
and their ttntes 
S< end Clast Fare wn*i Sleeper 
£1“’ 16 0 return. 

?5 CockspurSc eet SW 1 Tel H?tehgi2094 


BARxW^OOD HOUSE, 

r nt c'^erru 

t t f f I e C^Rl arO 

^ l^t^L^!lNxJFeT 

uktu *.1 J TM. niSORDIRS 

U Ssh " Ua-o m -t o' t‘'e C NS Ta »nJ I \t t. 
S. RiPnar Su K'Tt *i n^jcm rr i''C H'n-u! n 

03 ; \ a~c^ 0 W ra 1 frrm lp~v. n *rj all r>-n^ 
•of the Ur cd Km'ni'w-^ !t o tv-twlL h ' loairu at 
fv' o' iV C tnU Hi' t a*si Man«\ n ii% r*An 
o c CT a~c< \o! •‘tan Tauer t of 
bc*S tjotes a o a V foe i»oa'mcrf 

ccof*"~x~. I"'" ( r \< jr TjU'-" > o a 

a th- 'f ^NOr HOI SL ntuc^’hJ mrmn 
rni3 0 rren-'nj anj jt c^t rlv sorarai f iHc 

>fjj3 Ho<'*ol For rart)m.3r» m trrr- tt 
a-^y to r W T H rUFMIsr MhCS 

V. R C-r D r M M£L..ca\ Surt 
lec^hc^ f'OT ruTr»r<^ 


TORQUAY 

GRESHAM COURT HOTEI 

RCCEKTL'i OPENED Lurunoiix 
comfort tomhincd "ith an earnest desire 
to r'east 

■Hit resident propnetors 'sil! he pleased 
to quote special terms to memhers o! the 
Medical profession on receipt of request for 
Illustrated Brochure “ M Tcu "6<8 


THE LONDON SCHOOL 

• St Johns HesDital ter 

^ Lft tf Street. Lexnt 

Co*x!.?-rf t th- Mo«o'af> Sia'^ of the 

tftcf *rth the Fh>V''urt in 

clurpc c' tPe tJcmsio o-ical D rortnen t of 
ihe London TC'c'imj: .U Lcciurm and 

DemoTsmon iw« d mr Ocio'-or 

and \d4cmNx AnJ a«n dun-2 J nu>f) a-iJ 
Fctnran and fur tnio» mcyX.I> dcrie^: M j 
GrreraJ Pra-i. jonm mJI be neJ omc o»xj^wa»l 
\o4*ott om r'CNcnjiion of ifttir C-rrfi Cl wily 
at - pjn 3 d 0 p m Sai-rdix 10 A ra rrJ> Thr 
y Lahoraton n mrti-uLr}» «e}J eqjif-evl ard 

Amn*tfa-n % cm be maLc f r cl 

i^ny’v.il I'^iruei.on o fir rcscarth wirk 
trcuincs The Dan Of Sceretiry of t'le S>.hx*l 


OF DERMATOLOGY 

Diseases cl the SUIn 
;er a- cart U C 


LONDON HOSPITAL 
MEDICAL^COLLEGE 

"primary fellowship 

exam^tion 

.ij!' or tSSTRUenOS tor 

The fee lor iho Course ts 15 tumces 

S'A '•s obtar.^ tma, _ 
^ A n. CI^RK KES'NEDY MJD, F R C P_ 
Don Turner Street tonJon E-t 


LONDON HOSPITAL 

, imedical^college 

FR.CS 


Irnuustion tor the FIVAl 
TSri?"^^"^ E-VAMI\AT10 S~»iU hom or 
T^*I- Sereemher in IS3S Feet focteite oi 
‘ rn^^'' ^Siseri) .5 curncaa Orcome Surttfy 
10 tuincii 

Ferrer c^rtieul-rt rt_y be otuuned from — 

“ Hwcital Medical Collese Tuttjei 
Lo-doa C.I 



\\li\ nol a<M om of (ht follow inj; fk^rccs or diplomas fo \our name'* 
Piploma In I m rliolocfonl ^fod/clnr DIpIomi in Tropical 'Medicine 
IJlploina in I.an. ncolojTN otc. Hiploma in Cluld IKalth 

Diploma In Ophth ilmolo;rN of Midwifcn 

Dlplom i In Kadlotojrx MCOC and D COG 

can c II> f'f any «.♦ the ah»>»e rr oi r C ur»ct cf Comhmed Penial O n cal sn<3 
PracinJl Jmirun n 


\\i •ipeclali'»e In I osf Gmchiali Coachlni; for all nxanitnations 
^fV\ul Pfcrural n I » all Wr-al Otlfal-i FRC** LNCL XVp T R C S miNBl RTH 
rhCSblKMAND MSLf)M>OS M f C XM XR XM> AIL Oil HJriHft SCKCICXL 

01 < KU S AMT DH LoMxS 

! u — rn L «• 5.. c h -I «r <J f /r-j s' / r >i f m at i 


MEDIC XL CORRESPONDENCE COLLEGE 


19 mtBifh '•TithiT rwtsrubU "QIlke, London mi 

Cm r*<H *’*» n pt J m f r ait tre N »c I ur* njit aiv iHc J'l rd led F r XI 0 

nStOVIMls 3 ^d aft fvff 1 r cfN OI M nd \ r f nt nt l ^ -u T«h Irple rd 

L_M ^-S K I) r II * 1 . an ab I -vj V i f)j n ct > M I> I n fn xi p ( P I nd n rd 
fiemf"! en M i> Ihm la J * r> mi e n ih rd C n » N i Den... tx..m rui n 



n Hr cY • e f r < u / tn Ifru ai f -nr - n’t t amt W “/j fa 
ft-m n. en > J c e < <f<i d a-I c rr;* IJ bp frJ r i tf<c b '» 


Medical Corrcspontlenro Collese 19 Uelhctl Street M 1. 


cm' OF LONDON M\TERNTTY HOSPITAL 

l/rr js cfrd f V RnulCiate) 

cm MMO rci 

The IlmpTal otter* faci J -* lo POSTCRADI X IXS f f oHer» n ihc » rh I ji Xni n lal 
r-ninaul and Derw CIrm «rJ ti »na)c MIDICAL STUDCNlS ‘and Pmi n-n eairne 
a kefrorer C«n,nc> a u Uvt »kecVs Mu^xlcry Cwij c (Ren-eraiaD N ..rit POO 
pali-n annja’Iy 

RVLMI n CN^VJNfS So. cur 


I UCS KNGUWD 
rnc^ rniNBUiiGii 
rates IKELrlND 
M3 LONTJON NIC C\XTAB 

• nil ail lilirher ^urpl at C attiloaflerr* 
FeJ patti'njlArs ot ihon Iniemirc Pcnwl 
and Oral Ro&ion Courses appljr SfCMCtAur 
Medi'a! CcfTwpondcrcc Col cte 19 \Xel 
heck Srreef " I 


STAMMERIHC SPEECH DEFECTS 

BEHNKt MITIIOD F tnh non } 

re idem treilrd m da t-arW Court bo , 
S V » and IT* teaidencr in fhe Summer no/i J 
dnTnnX Miss'. BiuvKfi si ou c on the Chihern« , 
I re'eruaml *rree in e<lu *t on anJ irc^inenl 
a" » T. x-li I ftel' — Tinic< 
rjn pl*n — > Laurel 
cortect Aod perfre ly 
rlccuie *- v*t Gateite. 

Slanitnannf Cleft Palalt Spttcli Lwpmg 

3 0 tf Ml s 59 Earl s Conrt Sq., S " 5 


A D\ ICC O'* the choice OF SUITABLE 

^ ino'i"' ^'x71 TUTORS 

' »jib prcnpcctu es of 

mil be men free 
Z are of pupti dc*- 
inct rftftrred ranre ol Ices and lypc of vrhool 
ttejoued 

J ^ J PATOV, 

143 Cannon Street Lordoo E C 4 
PoblnheTs of 

Paions Lm cf Schools ^ Tutors Post free S/S 


DIPLOMAS IN MEDICAL 
RADIOLOGY 


ST BARTHOLOMEW’S HOSPITAL, 

EC f 


A complete cour e of sludv for — 

(a) Tftc ACADEMIC DIPLOMA of 
MEDICAL RADIOLOGY Uw 

rersitf of Lom^on and 

(b) The DIPLOVA of MEDICAL 
RADIOLOGY Conjoint Board 

will be pxen bi St Barlholomc" s 
Hospital and College begnnmg Nfondaj 
3 rd October 1938 

Tuition Will be pronded for both Paris j 
and n of ihe aboxe 

ff accoramodafion is axailabfe. a limiled 
number of students mil also be accepted 
for a course of inslniction in Practical 
Rai^ologj for Part II of the D/pfoma m 
Afedicaf Radfclocj and Eleclrologj of 
Cambndge UmTersiljr 
Application hould be made lo the Dean 
of the Medical College, Si Bartholomcv. < 
Hospifal £,Cl 







30 


THE BRITISH MEDICAL JOURNAL 


August 6 19?n 


HOSPITAL ME DICAL COLL EGE & DENTAL SCHOOL 

THE WINTER SESSION t>iI1 Open on Monday, October 3rd 


The LOhDON HOSPITAL serves the E-ist End of London nnd with eight hundred and ninety beds is the hrscst \oluniar> Ho Piial m r 
The Outpatient Depirtment which deals uiih a hundred thousand new patients per annum is cxtensisclj used for teaching 

The st7c of the Hospital necessitates a large number of resident medical olhcers E\cr> year sc\cni> resident house physicians and hou've ejft t« 
iRhty salaried nonresident clinical assistants arc appointed from among reccntlv iQualificd students The opportunities which these appomin’cn 
obiaming clinical expcncncc is insaluable ^ 

The MEDICAL COLLEGE is attached to the Hospital and t\ stalled bi Professors of Anatomy Phystologi Bactcriofoge Chemical Path fio V-vt 
Anatomy and Medicine of the Uni\crsii> of London 

SPECIAL COURSES in Anatomy and Physiology for the Primarv FRCS and Advanced Courses m Surgery for the Final FRCS Liamiai ij 
in Medicine for the M D and M R C P Examinations arc held twice a vear 

ENTRANCE SCHOLARSHIPS AI^D PRIZES of the total value of £9^0 arc awarded annually Research Funds to the value of £in0''O V 
issistance being given to students and graduates engaged in medical research 

The MEDICAL COLLEGE contains a modern Museum of Pathology and a Librarv provided with all the current medical pcriodi aK m rtur? j 
full time Librarian There is also an Athenaeum Club and Dinmg Hall a Gymnasium a Fives Court and two Squash Courts m the Students p 
Aililclic Ground of H acres at Hale End is within easy distance of the Hospital 

The I OSPITAL is. '■■'ly _0 minutes from Charing Cross and Baker Street Stations For those who vvish to live in immediate proximuv tot'- H - 
there IS accommod non for sitiy students in the Students Hostel 

Further details may be obtained from the Dean Dr A E Clark Kcnscdv MD FRCP Phvsician to the Hospital and Fellow of Cnv.\ a 
College Cambridge who is always pleased to meet students wishing to sec the Hospital and College and to whom application for admission 'h uMhr 
Turner Street London C 1 



17 RED LION SQ, LONDON, WCl 


Founded in 1SS2 

by E S Weymouth M A (Lond ) 

POSTAL OR ORAL PREPARATION 
rOR ALL MEDICAL E\AHUN ATIONS 


SOME SUCCESSES 

MD(Loml) 190) 37 (! I Cold 
Medallls.s durine 1913 37) 
M S (Lond ) 1901 37 (iticludms 

4 Gold Medallists) 
M B , B S (Lond ) Final 1918 37 
(ConiDleicd Exam ) 


413 

24 

255 


TRCS (Eng ), 
1019 37 


Primary 

Final 


100 

194 

286 


M R C P (Lond ) 1919 37 

DPI! (Vatlous) 1906 37 

(Completed Exam ) 

FRCS (Edllt ) 1918 37 

MRCS.LRCP Final 1919 37 
(Completed Exam ) 

MD Various Dy Thesl:, Many suceesse 


348 

65 

606 


Preiaraiion for th- above also for Medical 
Preliminary and ah examinations leading up 
to M R C S L R C P or M B of various Uni 
vcrsuics also for M R C P (Edin ) D P M 
DO MS DTM H DLO DCH DA 

D M R E M M S A L M S S A D C O G and 

some exams ol Dominions Universities 


ORAL Cl ASSES 

M K C P M D Primary and Final FRCS 
I RCS(Edin) also Final MB BS and 
jisK C S L R C P Museum and Microscope 
W oiK'^jAh^Privajc^ujiion 

MEDICAL PROSPECTUS (47 pp ) 

( ()\TE\TS The method and the cost of enter 
inw the Medical Profession Pariictilars of all 
Medical Exarninadnm Postal Courses and Oral 
Classes Suggestions for the Higher Mcdi-al 
Examinations Suggestions for the Higher Sur 
gicjl Ex mmaiions Sugcestions for the Special 
Dipl 'ma Lxjminatioas Refresher Courses Open 
ln^^ for Women Hints for writing theses 

Mcdital Pro>pcctus grans along with list of 
Inters c! on appl cation to the Principal 
17 Red Lion Sq London WCl (Telephone 
lUut om ) 


B 


PlirSH POSrCRXDUkTE 
SCHOOL 


MEDICAL 


Nri I III nv arc in>ited from fully Qinlificd 
m (Ji jl pn iiiion rv L r ihc rot of C\SL\LT\ 
Ol I ICl P ta comm-ntt duty at the beginning 
tf i. picm'^cr iq S 

Ih- anpointnent iv for siv m-*nths and non 
Tc J ni Saltry u at the t^li, of £1^0 per 
am in inj ih- p st ts sp<.<.M ly suited to canJi 
J 1 J in f r h khcr qi al i an 

Xp- at r a r-ptn cd \ > colics of i\so 

11 ''s ai-J cN nl U the Dan 

S ^ i/ . ", Dnvtn Road 

' * ^ IrnJ n W I arrive not 

I n iK J iLodiy \i i t h 


COACHING 

By M D M R C P FRCS in Surgery 
and Pathology for Conjoint M B or 
Fv-llowsUip Classes or individually Address 
No 76^6 B M A House Tavistock Square 
W Cl or Phone (mornings) KEN 2450 


F.RCS (Edin.) 

EDINBURGH POST AL COURSES 1 

Full details of above and Oral Classes — I 
H C Okrin FRCS Surgeons Halt Edinburgh | 


NORTH-EAST LONDON 
POST-GRADUATE COLLEGE 

IRINCh OF WALESS GENERAL HOSPITAL 
N 15 

Tlic Practice of the Hospital is limned to 
Medical Practitioners Particulars from J 
Bkownno Alcxander MD Dean 


new 


ZEALAND GOVERNMENT 


Applications arc invited from registered and 
qualified medical men for appointment to the 
Nfcntal Hospital Service Salaries Junior Assis 
tant Medical Officers 1st year £615 2nd year 
£665 3rd year £715 Senior Assistant Medical 
Officers 1st year £765 2nd year £'115 3rd year 
£900 plus an allowance of £50 if appointed 
Deputy Medical Superintendent Medical Super 
incendents £l 200 In addition to salary quarters 
fuel and light arc provided and arc estimated for 
superannuation purposes at £150 per annum Mcdi 
cal Officers contribute to the Superannuation Fund 
Commencing salaries in this instance will be deter 
mined by qualifications and previous cxperitncc 
Appointees vvill receive firvl-class passage to New 
Zealand and half salary from date of embarka 
tion 

Applications giving full particulars regarding 
career and qualifications accompanied by copies 
of testimonials should reach the High Commis 
sioncr for New Zealand 415 Strand London 
W' C 2 not later than August 27th 1938 Candi 
dates must supply their full names age and 
nationality and state, whether thev arc married or 
single 


A PPLICATIONS ARE IN\ ITED IN W'RITING 
in the first instance for the EUNICE OAKES 
RESEARCH FELLOW'SHIP at the HOSPITAL 
FOR SICK CHILDREN Great Ormond Street 
London \V C 1 tenable from January Isi 1939 
Candidates must be medically qualified and fully 
equipped technically and by experience to con 
duct rcscarth work upon the prevention and cure 
of Children s Diseases They must be under 35 
years of age and the salary is to be not less than 
£700 per annum 

Apphcations which most give full particulars of 
the candidate and of the propoved line of rc'carch 
and bt accompanied by references and copies of 
rt-'cnl testimonials should be addressed to the 
imdcrsicncJ 

H r RUTHERFORD Secretary 
July 19 


pRIGHTON EDUCATION COMMITTFE 
ASSISTANT SCHOOL DENTIST 


Nrp ication for the above appo ntment arc In 
vitcd from Registered Dental Surgeons Inclu ivc 
annual siliry i-»^0 riving by annual increments of 
£.* to l^no sub ect to satisfactory sen ice The 
appotnrncnt i subject to the conditions of the 
Local Government anJ Other Officers Superan 
nuation \ct 1922 

Fo ms of arphcaiion and schedules of duties 
nav N* ob aincd on rcc'*ipi of a sf imped addressed 
enveUpe from the undersigned to whom all 
ap'^licati'sn must be rciiirn-d by Nu^uvi '’6th I9I 
Can' ass ng wi I he regarded as a di qualifi atioQ. 

S4 Old Stem- I IILPBERT Toy NE 
Briehian Education Officer 


T he king edward \!i wei^ 
national MhMORUL ASS0C1\TI0\ 


App ications arc invited from duh ri 
medical pratlilioncrs for the rovi cl 11\U 
TIME ASSISTANT TUBERCULOSIS OiriCTv' 
(three in n imber) to be attach d to Ci 
Newport and Pontypridd areas resrv*ti' i 
commencing duty on 0 loUr It r n 1 
appointments are limited to one year at a r - 
tion fo the war of £250 Dunn* i*' 
successful candidates will Ic cvpccicd t O 
during the other half of ihcir time the Ce \ ’ 
the Diploma in Tubercubsis Diseases I"j r 
the Tuberculosis Department \yclh '« 
School of Medicine and afterward s.i i e 
ammaiion PariicuLrs as to ftc» fir P t 
can be obtained from the Sccrciary We ‘iNi 
School of Medicine Cardiff 
Applicants must have held a house a \ “ 
in medicine or surgery at a gcncnl ho j 
least SIX months and must aho hue h c 
a post ns resident for a period of t« ‘f " 
m an msiitiition for the irtatmem of ti* 
(medical or surgical) or a peruxf cf * 
work accepted by the Stmte as cquiva** 
Applications stating jge qiialificat <''' 
cnee etc together with topics of > 
testimonials should reach the tinder itraJ rx 
than W ednesday August 24th 19iy 
D \ POWELL 
Prm ipal Mcdi*al P 

Memorial Offices 
Wcstgatc Street Cardiff 
August 1st 1938 


QLDHAM edu catio n CO'I'llln 
APPOINTMENT OP SENIOR Sene''' 

dental surgeon 

Appljcxiionx nrc inMied fer the 
School Dental Surscon Sabr. P , , 
rising by annual increments of 
additional cmohimcnis of £iTO rrr ^ 
Maternity and Child Welfare Scni f ^ 
must have had at least Ei'C >c 3 rs ctrr ^ ^ 
the working of a large and « i 

under a Local Authority and must N ^ 
supervising the existing dental sera ^ 

two dental surgeons arc at t — 

person appointed t t’ 

in private practice and will be req 
\Mthm the Count. Boroiich r^i'P " 

The post IS dcvicnatcd under the Lcs ^ ^ ^ 
mem and Other Ofliccrs Superannuau 
and the successful candidate nul ^ 
pass a medical examination Apr 
be over 45 years of age . t , 

List of duties and form of apr 
must be rcturnvd not ,, f - 

August 17th 19^5 may ftra . 
undersigned Canvassing sin t^> £psjivv 

f. f C 


Education Offices 
OIdh m 

July 27lh 193S 


W 


D rest 


OLnCI 


O N D O N C O u N T 3 C 

Applications in.iicd f"'"’ Z' 

II Icist one scar slarJin 1 ^^ ^ 

lOSMions nxp{.ricn c in ^ ip'* 

I g(.ncra! hospital for at 
Vljfricd ouarlcfs not i; - F 

Queen Mars s Uo-ual for 

r^^cl'aucanVo.Sca ' s„ 

two position > " \- 

,oard lodging 
car only m first 

cir under certain co ^ ^ - 

Xp'Nticainn fan o ^ , 

ool vjp envelope rcce ^rv^ 

,f Health Staff nm '' 
cturnabic hy . 

Canvassing disqud li s 






31 


Al-» L.ST 6 THr BRITISH M EDICAL JOURNAL 

ROYAL NAVAL MEDOL SERVICE. 

Vacincics c.\i<t for Medical OITicers in the Ro>aI Navy, and applications are invited for entry 
in September 195i> 

Candidates belovv the age of 28 years arc preferred and they must be registered under the 
Medical Acts No avamination in professional subjects vull be held but candidates vull be 
required to attend for mtcrv leu by a Selection Board 

Selected candidates will be entered for Service for .a period of three years, which if desired is 
usually extended to five years at the discretion of the Admiralty 

At the end of three years service officers may retire with a gratuity of £400, but those who 
serve for five years vmII receive ;C1,000 

At the end of five years Short Service, permanent commissions will be given to selected officers 
who wash to make the Naval Medical Service their permanent career Officers transferred to the 
-oermanent list will receive a gratuity of £1 000 (less Income Tav) 

Full opportunities exist for transfer to the permanent list and periods of unemployed or half 
pay arc very rare The assistance of pnv ate income is not necessary for the purpose of supplementing 
official pay and allowances 

Opportunmes arc available for officers on the permanent list for post graduate study, to specialise 
o take higher examinations and to obtain further quahfications 

Naval hlcdical Officers arc included in the Scheme for Marriage Allowance under the same 
conditions as for other Naval Officers 

Copies of the regulations for entry and conditions of service including rates of pay, allowances 
and retired pay may be obtained from the Medical Director General of the Navy, Admiralty, S W 1 
and from the Deans of all Medical Schools 

Applications for entry from intending candidates must be received not later than 
.1st August, 1938 


HIS MAJESTY’S COLONIAL S 

COLONIA L MEDICAL SERVICE. 

Dunng 1938 the Secretarj of State for the Colonies proposes to select a number of Medical 
Jfficers to fill vacanacs the majority of which vmII occur in Tropical Africa and Malaya 

QUALIFICATIONS- — Candidates must be Bntish subjects of European parentage under 3 d years of age 
possess a medical qualification registrabfc in the United Kingdom Preference wall be given to 
andidafes who have held Hospital or Public Health appointments or who have special '..now ledge of 
maesthetics radiology surgery medicine ophthalmology gvnaecology and midwifery diseases of the 
ar nose and throat, venereal diseases etc 

— Initial salanes vary from £600 to £700 and rise by increments to a maximum of between 
I 000 and £1 200 

PRACTICE — Private practice is not allowed as of right but in the case of some appoint 
nents it is permitted on certain conditions 

QUARTERS - — In Tropical Africa free quarters or ^n allowance in lieu are provided In Ma!a>a 
quarters are pro\ided at an annual rental not exceeding 6% of the officer s salary 

ASSAGES — -Free first class passages are provided on first appointment and when proceeding on and 
etummg from Iea\e Assistance is also gi\en towards famil> passages 
^lERMS OF APPOINTMENT — ^The appointments arc pensionable subject to a probationary period which 
^anes from two to three years 

BOURSES OF INSTRUCTION IN TROPICAL MEDICINE AND HYGIENE — Selected candidates will 
mrmally be required to attend a course of instruction leading to the Diploma in Tropical Medicine and 
vgiene before proceeding overseas 

3UT1ES — Although Medical Officers are appointed m the first instance for general semce there are 
ipportunities for work in special branches of medicine and surgery in public health and in medical 
esearch 

urther particulars and forms of application may be obtained from the Director of Recruitment (Colonial 
oervice), 8, Buckingham Gate, London, S W I 





32 


THE BRITISH MEDICAL JOURNAL 


August 6 19'? 


I T Y 


o r 


PORTSMOUTH 


SAINT MARYS MUNICIPAL HOSPITAL 
(1 050 Bed> ) 


Apphcauoft^ are invited for ihc appointment ol 
a SENIOR ASSISTANT RESIDENT MEDICAL 
orriCER for the Malcmuv Department of the 
above Hospital Applicants must be single gentle 
men dtjlj qualified and registered not exceeding 
30 jears and must have had at least one years 
experience m a Maternity Hospital The Depart 
ment has at present SCO births per annum and 
Ante natal and Post natal Climes are conducted in 
connexion ihcrcv.itb There is a Resident Medical 
Superintendent at the Hospital and a Consultant 
Obstetrician attends regularly and is on call for 
emergencies The appointment is one of value to 
a medical man specializing m obstetrics who tie 
sires to take the M M or M C O G Diplomas 
The appomtmem includes service at anv In 
Mitution belonging to the City Council that ma> 
be required and will be limited to a term not 
exceeding two >ears Salary for the firjl >car 
£3X0 and for the second £375 with residential 
emoluments valued at £125 per annum and the 
appointment will be subject to one month s notice 
on cHhtr side 

Application forms maj be obtained from and 
must be returned to the Medical Officer of Health 
The Guildhall Portsmouth not later than 
Ihursday August 18ih 1938 
Cmvassing either directly or indirectly will be a 
disqualification 

The Guildhall F J SPARKS 

Portsmouth Town Clerk 

iuly 22nd I93S 


‘OUNIV BOROUGH OP DEWSBURY 


ASSISTANT MEDICAL OFFICER OF HEALTH 
AND 

ASSISTANT SCHOOL MEDICAL OFFICEH 


Applications ire invited from qualified and 
registered medical pracinioncrs (men or women) 
for the post of Assistant Medical Officer of Health 
and Assistant School Medical Officer 

Applie mts bhould have had at least three years 
experience smwc qualification and possess the 
DPI! Experience in eye work and refractions is 
desirable I he duties arc in connexion with School 
Midjc)} work Ould Welfare and Tuberculosis 
and there arc ilso opporiunuies for experience in 
general Public Health work 
The salary is £^00 per annum rising by annual 
Increments of to £700 per annum The 
appoimmeni will be subject to the provisions of 
the l»pcal Government and Other Officers Super 
annuatton Act 1922 and the successful candidate 
wiP be required to pass a medical examination 
Particulars of the duties and terms and condi 
tions of the appointment together with application 
form may be obtained from Dr J F Galloway 
Medic vl Officer of Health Municipal Buildings 
Halifax Road Dewsbury to whom applications 
Accompanied by copies of not more than three 
recent tcsiimonnls should be delivered not liter 
than Monday August IXth 
Canvassing in any form will be a disquafificaifon 
Town Hall HOLLAND BOOTH 

Dewsbury Town Clerk 

July 26lh I93S 


^OUNTY BOROUGH OF DERBY 
DERBY CIT\ HOSPITAL 
ASSISTANT RESIDENT MEDICAL OFFICER 


Applications arc invucd for the post of Assistant 
Resident Medical OfTKcr (male) at the above 
Hospital of 300 beds This Hospital provides 
treatment for acute medical and surgical eases 
obstetrics and children & diseases etc 

Candidates must be registered in medicine and 
surgery 

The appointment K for a period of six months 
two months nonce of icrminaiion of duties may 
be riven on either side The successful applicant 
will be required to commence duties on or about 
September ''ih 

Salary at the rate of £-00 per annum with 
board and resrUcncc 

Applications stating age experience and 
accompanied by three recent testimonials should 
be sent to itic undersigned as soon as possible 
Public Health Department GORDON LILICO 
I Derwent Street Medical Officer of Hcaltfi 
D-rb> 


C 


ir^ or BRADFORD 


MLMCIPNL GENFRkL HOSPITAL 
St Luke s 


lUil SI PH') SICIANS and HOUSE SLRGFONS 
rcvnnrcd Sabry in ea h cave £1^0 per annum 
r VI'S b\ ard and Isxlams Thc«^c appomimcnt> arc 
t r It rr nih\ renew jb*c for a further p«.riod of 
V t m nthv 

Ape'll -UK n ft ms nav be obiaineJ from the 
Med ai o cr of Health T wn Halt Bradford 
at'J vh fj be fcturnnJ to the undersiRncd rot later 
I t I 2Nh tot 

L ILLNHNG Town Clerk 
Ha t BraJf td 


th I 


‘OUNTY BOROUGH OF SOUTHPORT 


DEPUTV MEDICAL OFFICER OF HEALTH 
AND SCHOOL MEDICAL OFFICER 


The Council of the County Borough of Southport 
invites appitcaitons for the post of Deputy Medical 
Officer of Health and School Medical Officer from 
gentlemen duly qualified holding a Diploma of 
Public Health or a degree m State Mcdicmc and 
not over 40 years of age 
The salary wiH be at the rate of £700 per annum 
with two annual increments of £25 to a maximum 
of £750 per annum 

The appointment will be subject to three months 
nonce on cither side The person appointed wiU 
not be allowed to engage in private practice 
An allowance of £50 per annum will be made foi 
the maintenance of a moior<ar if used in the 
scr^cc of the Corporation 
The person appointed will be required to pass 
medical examination and to contribute to the 
Corporations Superannuation Scheme 

Experience in the diagnosis and treatment ol 
external eye diseases and errors of refraction will 
be regarded as an additional qualification 

Applications on the prescribed form obtamablr 
from the Medical Officer of Health 2 Church 
Street Southport should be addressed to the under 
signed endorsed Deputy Medicxl Officer ol 
Health and delivered not later than August 12th 
I93S 

Canvassing direct or indirect will disqualify 
Town Hall R EDGAR PERRINS 

Southport Town Clerk 

July 25lh 1938 


lOUNTY BOROUGH OF GATESHEAD 


ASSISTANT MEDICAL OFFICER OF HEALTH 
AND ASSISTANT SCHOOL MEDICAL 
OFFICFR 


Applications arc invited from duly qualified 
medical men in possession of the Diploma of Public 
Health or similar qit tlificatton for the post of 
Assistant Medical Officer in the Public Health 
Departratnt Fhe person appointed shall work 
under the general supervision and vontrol of the 
Medical Officer of Health The sahrv payable is 
at the fate of £500 mtng to £700 by annual mere 
ments of £25 and the appointment is subicet to 
the provisions of the Local Government and Other 
Officers Superannuation Act 1922 The appoint 
ment will be tcrmmihlc by one month s notice from 
either side 

A list of the duties of the office may be obtained 
trom the Medical Officer of Health Grccncsfield 
House Mulgravc Terrace Gateshead to whom 
applications stating age and experience and 
accompanied by not more than three recent testi 
menials should be sent not later than August 26th 
1938 in envelopes endorsed Assistant Medical 
Officer 

J W PORTER 

Town Clerk 

Town Hall Gateshead 8 

July 27th 193S 


OUNTY COUNCIL OF THE WEST RIDING 
OF YORKSHIRE 


SCALEBOR PARK MENTAL HOSPITAL 


T!ic Visiting Committee of the Scalcbor Park 
Mental Hospital invite applications for the 
appointment of JUNIOR ASSISTANT MEDICAL 
OFFICER at the Scalcbor Park Mental Hospital 
for private paiicms at a salary of £3*50 per annum 
riving by annual increments of £25 to £450 per 
annum with board and residence as the Hospital 
with an additional £50 for the D P M or M D 
in P>>chological Medicine General hospital ex 
pcricncc will be an additional qualification 
Further particulars and form of application may 
be hid from the undersigned by whom all appli 
cations together wl h copies of not more than 
three recent testimonials must be received not 
later than August 29th 1938 

J CHARLES McGrath 

Clerk to the Visiting Committee 
county Hal! Wakefield 
August X93S 


C 


ITY OF BIRMINGHAM 
SELLV OAK HOSPITAL (520 Beds) 
JUNIOR MEDICAL OFFICERS (MALE) 


Applications arc invited from fully equipped 
Medical Pracimon*rs for the whole-time appoint 
ment of Junior Medical Officer (male) at the ScHy 
Oak Hospital Birmingham The appointment will 
be for a period of six months in the first instance 
but may he extended at the end of that time for a 
further period of not exceeding six months 
Salary at the rate of £200 p<.r annum and full 
residential emoluments 

Further paniculars may be obtained from the 
Mcdtcal Sui?crmtcndcnt at Sclly Oak Hospital to 
whom applications stating age experience and 
qualificaliofts with copies of recent testimoniaU 
should be forwarded not later than Saturday 
August 20th I935> 

F H C WILTSHIRE 

The Council House ToA’n Clerk 

Bitminsham July 1938 


1 1 


WEST 

OF YORKSHIRE 


SCOTTON BANKS S^NATORini 

APPOINTMENT OF~ SENIOR \SS STVS 
MEDICAL OFFICER and BErny 
MEDICAL SUFERINTENDEST 


The Couniv Council of the Wm Ru i j 
Y orkshire mviie applications from rcps::j < r 
medtcal practitioners for the arr«ri"'cpt v / 
Assistant Medical Officer and Denij vi ^ 
Superintendent (non resident) at the Voc T is 
Sanatorium near Knarcsborough Iwn-rniv 
beds) and children (100 b ds) 

Candidates should have prcvioav’T f ^ j? 
appointment as House Physician ot }b‘<cS-' 
Experience in Pulmonary and NcnF'- 
Tuberculosis is essentia! and a Irex : i 
Anaesthetics will be an advamage 
Salary £600 per annum rising by a = 
crcmcnis of £25 to £^00 per annum 
Further particulars and forms i 
mav be had from the undersigned arJ > 
tions together with not more than ib r r - 
tcstjmonnls must be sent to me r<.t L’ 
Monday August ISih 1938 
County Hall J CHARLES McGRATH 
Wakefield Clerk of the ecu yC- 

July 1938 


QHESHIRE 


COUNTY 


COIN . 


CLATTERBRIDGE (COUNTY) GENERt’ 
HOSPITAL 

(Nr Birkenhead) (300 Beds) 

JUNIOR RESIDENT ASSISTWT MEDCtl 
OFFICER 

Applications (male or female) arc iw 1 3 ^ ** 
above ippointmcnt which falo v 
August 8ih 

The appointment is for a penod ofstr- 
at a salary of £250 per annum to: i‘*'r • 
usual rcMdcniial allowances Th arnc ** 
be renewed for a further period of st r 
There is a Non Resident Medical Sj'“ 
a Resident Deputy Medical Surstmci t * 
Consulting Siafi from Tcichtnc Hc«ff t 
Applications to be mide on Lfirt < - 
from the undcrsiened nnd returned r-'t u " 
August 12ih 1938 
24 Nicholas Sircci IAN 
Chester County Medical Ofi c'f'H- 


^OUNTY 


COUNCIL or ROjS o 
CROMARTY 


Applica'ions arc litMled 
RESIDENT MEDICAL OFFICM (« 
Lewis Sanatorium ami Infeciioui pun ' 
for a period of sit monlhs Jl'!' 
tension Salatrj at the rate of C'O r« > 
with board lodcine and Imindr} p ' ^ 

dent Medical ptHcer ai the . 

Infectious Diseases Hospital and * 

Health duties as required by Mw ai v 
Health or his resident Assi tint , _ , * ; 

Applications giving rarti^lars N JT* , 

and previous expcritncc and staff , - 
take up duty accompanied by v . 

and of testimonials to be , 

signed on or before August ^ 

County Clerk s Office T S H ^ 

Dingwall 
July 27th 1938 


JNT\ COUNCIL Of 

uty medica l offi cer or 

County Council '"'I'' 
post from rcsisiered i 

under 40 scare pt J'' , - In 
Diploma m r»Wii: .. I 

riperlencc Dtittcs Gene _ 
Housme \\Mt Sunr' re ^ t 
s Diseases Food and 
subject to deduction under 5 

?raltons staline ate auah^J ' - 

- tosether svdh corlea « , , 

,|5 should reach the uni nr 


nuulu . 

am on Autust ZdJ 


7 M MiTwra^^ 


' Duildints 

Fife 
I93S 


5UGff Ol OUiLO''®* 

ITY AND C HILD ^rtFArr 

M pef ^ 

none staimt onahf an T ' 

r. 

'’'^fraldh n VIU',. 

;3l Oiricci Guildl 'f J 
h Id'? 





\t<. I sT (> 


THC BRITISH MEDICAL JOURN \L 


tot Mil OJ MlODUblX 

HVKI nru> \ND CLtRL H \Ul NNN MOPI t 

f>CCirvlU>SSL TIUKNP^ 

A'T ca •\ arc tav i'\l t t I'^c •>r’> rir-crj J 
ix^ci rvTiONM. iiaRvr'i insiricioks 

a* t^'C «N'f V.r’U na V Vn «»Jcvicc 1 t^c 
t **6 { a ! t r a r ( l^’C i -J r~cn » n-O 

ub-ct r- c-' ra*' c 

Pn-' "f Icj *'cr» ’nV. 

t t*- rx Its let’* ti 

liir*-! ^ NXJ tV n<\\ t t c ^ tV 

r\ i- I'o.nli’Vc >> t*ic T r"** -« S a? { r 
i’'c "» ra ap- a*^ r »n a~-» « n - <, 

I -N r^tv r -era— at t c cutci- t~-rt »'‘C 

1c •'C^~~-5 •-1 V t 

trr "at - — ^ "I* asc C sa s. t - a"J 

rirxtvf t cct^-' «* h V f r* r~ tp I'^an 

t cc teer*: ir* r* t Pc T-^-n cJ P> t c 

u-x^cr-vr- '<\3 rir< Utrr i an ^ur 1 t t's*'*'' 

l«»a v*-- t » ' r*c~*Nn’ cr t**‘'cT p ^^^ 
C I Ok 1 r- Pc u-v. c^cx. IT t^c arr >-ati i 

Mcvcn s- "a ^ valr% * I Pc fc^L. TC%. n ra * 
r-cv-val o-”* --t 

x.at'i *> f r*“s arc pH 7 \iv.fO rn\c '*v<. 
r-u I Pc rr- ''■c%J tK— ~-.i -- l^cfa''^ I'v 
«tnxt ■ex Can\ax or •'>v. cct »i 1 

Pc a t~ai 

c x\ Rttxrurn ~ “ 

Oai tt I c Mtc OCX C -x C •« 

GoVMr 

WC' 5X\ 1 

Ic»? * fX iw>« 

^TOfvE ON IRINT CtlFTOKMlON 
LONDON ROtD lU>srnAL 
RLSIDLNT NSSISTANT MEDICXL Of* ICtR 

« e lx -x* ! rtx’x cmJ rs*x.-.a 
r act tx '•crt Ih t*>c *»-vv— 'r*t c RlJ&lDTNl 

tSSlSrtNT MLOICVL O! HCf R irM li tP 
L rjJon R-xaJ S V,PHr>-Trr^U at a w-atx 

c l-^o per t'*~ n » h K’xiftJ ro'-cni.c l» *x-n 
Cl an fro rcccr ct5 to be p-f. t”> t'-e 
CarxJi. Ok pt •V, be x.***? 

Art p* 'xt baxc b , at *caM c-c jea 
rex xtfs fc-^-ul cx’«c'>rvt T>- 
rnxo ap~'oi'~ai cN bcx. .•>». tbert » cicc c- 
»*cr< fH T o*x.fc .a xic^l, The '■‘cn (apt h 

«in b* ce cTn-t-** e b) «x p'-v h > ftv».e on 
etbcT *Jc) »iS be fx- 1 pcnxS ft o-^- xcar 8'‘iJ 
, r‘rt<roHe «_J be t cn t caN. Jj et »bo arc 
» Iff b c rr c_a 1 tat 'h 
A rr^jcat *• XX. » .xc c,ai ^cai a*vl ex 
ivncnoe a.*-r»*— u« {\. r c^rx of r'*»c i a*» 
»h ce rccen -tc } ^ >j 4 be tfcfj ernf 1 

the uiwcfxjjr-ctf PH Uict than «‘'xi rv* on Alcl < 
’ * t B ^tXRPLn 

Pub- AiPjnceO^o T-an C«L 

K> cs'«a> S:tWc<o-Trrri 


OF SHREW SBLR1 


gOROtGH 

TEMPOflARI assistant MEDICAL 
OFFICER 

Arr'caicf« are xrxrcd freert re* rtered r~*x!^j 
f aitKocrs Icr tbe aboxe r«t ter a rcn>l cf 

X roorihx 

l^tklctK-e »il he Jiicn lo a-r-^-ar * »bo hjip 
hjiJ ptpioH! a-wasiOc I- 're crrtrullr in school 
Mcvical In.rTO .0 1 I !an Welfare WenV anj 
admir .!Tat.<!n et aoaeubel a EeKtiercc 

' T,vi' -t' *■*' "" 1“ “n 

anj cen-jcaticn ef merjl ) defeciire children 
«i 1 be an ad4 t cn_l recoTnr"eTWarien 

teiTSfc”^’'” ** *' 

'fbm ibe 

° arnieati'm iboulij be 

Itrutre^ n in enielote erd ner) Temperar, 

"" >-'“ O'- 

r PRIDEAUS 

fn? 7 ‘.l,’=“P 5 iS Toer, aerv 


and cc>\ entr^ 

JOINT COMMITTEE FOR TLBERCLLOSIS 
king EDWARD XH MEMORIAL 

sanatorilm 

Henferd H I NAar-kki k 

/ «S-S‘'T ^EDICAL OEFICER (man or 
^ 'r "i' '■'b’-ceial Sanatcriun rear 

W^Kk Of _5 bed! 

wUr> MOi be ar I'c rare cf C >.0 per amjrj 
iV/r and laLndD «n adtJ:t on and 

IT- rthx --^daie »ll be appo rted for x 

Sarutenun’^ ether Afcdical erx at the 

T* ^ ^ ^ copex of icstim n-aU h^uU 
11 Med «J Surcrntcn.ert 

^ h»n by na later than 

7h jiMiai Al£l« ifih 19 R 

u'. *- EDGAR STEPHENS 

bib ™S, 191 * Clrrl,ofihe)enrConinniee 


Q«»iNn noRoi rn oi stNorKtAND 

nilRRA KNOWLE 

<Str <t it\S Cuntv B rvush Mcrtal Hr pitaS) 
K\h pc rear S e.crlxrd 

AUNtlNlMlNl nr DlPtTA MFDICAL 
M H RISUNDINT 

Xpp at n re inx t-Hl I j^c xf DcpcilX 

Xffd al S i»Hiin fpjf't ■>! t hefty Kn le 

Ap*' atttx nu t hx\c bcM H xp^c arr imm nt 
I a Ccnral 11 -^pjtal The xalxry mil be (' 
re nti-x adx p.»,ine u** c»:t tt vsttsfa *t •)£> 
et c be ami at ip rertert of t x to per 

a T) *n plux CP* « •"crlx alued 1 t purpfHtx of 

'x.ian 1 li'n at tl t» ret anru-n 11 in r<*'’<x'ion 
of a d - PM in pN h ct-al tred ire the 
per n p'n*. n cd 1*11 icvc c an ado l pal un of 
l O per am -n 

Ibc ar*v tTcri » he b cvt 1 the pro i r 
c! i*-c A \1 lpx O^ tf A •Hfapnualufl At I Axo 
1 1 f*n t apo at n mai be btatpcd Ircm ere 
rd a*'*' 1 n fc.w cxi<\3 j r^e and ctk. i cd 

n i r D *- t> AlfU t AurcriPtcndcnt Cherrv 
K.n^^^lc i rctXf » th p ex of three rccc t 

ifxi "n •* al 0*1 1 re Cc cr<^ at m» « t Ti »n 

Hal V vCT ar- p la cr than Tucxday 
Aur l XfO Pcxt Ca «a r c tbcT dircirtb o 
J*v rrtr* I f afirr tie t r»t xclcciim of an. 
d to bx the Co*-'*- ttco % n be a d^ual -.-at on 
I »in Hall r S AlflNIIRl 

S -Seft a-d 1 -»n rink a^d Clc k J the 

J« \ X vi^ |vt A Cop*— ttce 


“'OINTI ItOKOl OH 


n{ 


PRlSItiN 


H 


AHARnl <RIIN HovniAL 
I lt<x.\ » 

XS*5IMANI KIMDINI MIOICM 
<»! I ICI R ilo*ul I 

Apr K l •* a c in\ cu (f -n f fl> H la d d 

itfi errv. r t -cf 1 t tbe aN — « tr* -1 

V ft X rate t''"* pci ap n * h f 

bxj L a-J ff- w •>. Ibe r*v n — p 
I— -sr fx - n., * I K I f per xi 

n -*i X 

1 TO’ ■“ X rxpcT p < no .% 1 t oacp lai b 
c ex «t fi r oa n X ett al k 1 1 

r* tap tx brv a c r ex') »* th i*'e x. -x t 
the « r at path s al * k f the H •*- a 

Ap- •t n a ate uLj at - aftw 

rcncp T I ct^-cf p h p o f ih re rcvcpi ' 
r"p al h n 'J rr h t**e Ato- al S ner r n 

n - U ff th n f r t pnt n Sj r». > Auf n n 
I tx 

Qiri tx nKADitiRo 

assist ANl MUtWn MlDJfM ftlMtlw 

Apr ..at “Px c nx cd for the fv**i 

A iPt S*b>t MeJs-aJ cr at a xal > » 

I '* per am -t r x n t i9t |iK b> bcr-ai 
t<xcfcr*<rt f 1 O tx-e brxt inTcf-cPt t take ePovt 
f n April I t mi 

Tbf xalafy t xcbi-ci ix 4 .cdt, x»on <f * pet 
cent per am ~x or- f the tern of the I xal 
C cirr'er arJ Oibef O'*” Tr> Sl-ct p a 
An »rd the x. co ful ca - - tc » 'i be 

rex; sred t pa x a rned -al eurni ji n 

Apr ail n formx r*>a> be ob air-nj U m ih 
Alev val O"" ■cr of Ileal h levin Hall rd 

a-d 00 d be rcturred 10 ihe under isncd n t 
later thart Auru'i th | 9 ^A fnxe T' h uid 
bear th- x»x*rdx A » tarn V.hoo1 Mcdj-al OT er 
m Ibe I n left hand Tn-r 

N L rtCATINC Toxxn Clerk 

To»n Hall Bfad rj 


J^ADNORSHIRE COUNTS COUNCIL 

APPOINTMENT OF COL NTS MEDICAL 
OFFICER or HEALTH 

Apr at n arc tnx ted fo the at c ap- pi 
rrent fr -t rtcdi^l n'cn of poi ncre than hfi 
>xat of ape who are daty quali led (or the appi- 
PXent pur vani tx the stalutPD Proxt on cent, ned 
n the Local Goxerr— -nt A t I9tt and the Reru 
lation rude b> the Miniitcr of Health thereunder 
and b\ xtnuc of the Pub! Health Act 19 6 
The duticx will i-clude all tatmory dut ex a 
C unty Alcd cal OTi tr ard SthCNsJ Med cal O'*" r 
w rk rcQin ed i n.er the Mental Defiacm. .»nd 
AJatem i> and Child Welfare and Af dm ex A -tx 
t ether with dutm »n onrexjon with tbe per 
ion f the work of the County School Denipt 
nd iiealih A » iiorx f^cral upervt icn and 00 - 
tf 1 ( tb Maicfp ty and Chi v Welfare C mre< 

nd n u Cl nt -x ard u h other vui ex a ma 
be picx r bed 

Salary iXt pet apnu"i iPcrea tng after «w 
car \cj c by four annu 1 1 - rcr'cni of t 
I > iSxAl 

The ap-v ninert will be xutiect lo the appr al 
f ih < xcrmcpi D pann rtx cvrccrrcd t the 
rr i T i f i**c Local Goxcrmicnt ard O her 
cTx Superamujt n At 19.. and to a xatrx 
f t r> Pled *31 exapt uti n and will be terr" naWc 
b three PI pfbx p i*e on either s dc 

\ f -rm 1 jpp »vat) n ruy be obtan-nJ f m tbe 
n.c en-d b wb en a-p icatiotx nv t be re 
Cl ed p later than Aueuxt 19th |9t'« 

C n re d renh r rdircct! w <i p n- 
vered V V I al n 
f uip y B V GW MosELEA 

L -xd rd d W I C f he C n 


ORSIORIH I RBAN DISTRICT COLNCIL 


Appi t-tmcPt ol P n itpyc MEDICAL OFFICER 
Of HFaLIH 1 r tbe Horxfonh Urban D er t 
Saettiary OC eex (Oat dc London! 

Rrtuliiiom 19'* 

Apr -aiton are inxiied for ih^ aboxc-ment nned 
rx>xt at 3 xa ary of Cl 0 p^r annupa The appei nt 
menr wtfl be rude m areordar> e t»ith the pfA" 
xt 1 p» of the aboxe menttooed Rerulati >n and 
will te^ nate on Afarch Xfyt 19X9 

Apr i-atjopx endorsed Medrca! OfE er 
hould reach rtc by roon on Au««x( l<ih 19XA 
I orrrx of arpl cation nay be bad on recttri of a 
tamped foo x*3p cnxel pe 
The Green C A\ DOT ES F C I S 

H t f nb ClerL of the Council 


P EAIBROKF COUNTT W \R AIEAIORIAL 
HOSPITAL 

Haxeif fdwexf renbroLcxh re 
tr-1 Bed 10 be ipcicased to ICO Bev » 

RESIDENT HOLSE SURGEON 

\-p act tt arc nxited for the roxt cf Rex d nt 
H v*e Surjrcon male or female from daly quali ed 
res xered Aled cal Pra-tiuopers with rrc'ii- 
rextdent cspeTier e to ccevnciuc as soon . 
pcxyib « Salary *‘200 per afinxm with tc'id.cp.-c 
(priyate tonralow) board and laiirdry 

Apphcaitortx siatns Zfe and acconranicd bv 
c p ex of rot more than three lesimon als to be 
ent to the undcrx>*ned at the aboxe address 

8 GUANA ILLE DAMES Secrciao 


)u 


ivl 


S' 


AMORnkMIRt COI NT\ COLNCIL 


w KDslfy M BLIC assistance 
iNsrm TiON 



I rif LR 

c ed f -X ter ered T d 
h r -wt { A f 
T K w. 4t W c> P b 

n r h jrbnvf 
pe m » th b»'«fu rex - n « 

J ‘ utv rpvv-xh dheu marred 
The — n nt » be t » l rxt n tar 
I re xl f rs -ih b t ihe uctex f I 

p- V I will be t b c for re rn - r- nt (xf a 

I b T pxr -O t X r* Ih nv f tbe encaec 

mm xo eHebdcd I r week! w i be eranied f t 

h w 

Th lb 1 in n pr '*.0 r n nt 

It -p ..I a d t i ex w II be be! 

n ypvr cr* c n r* J e r r* dw er 
J V a I b V cn Ihcf * U a «o b 

X c cPt rr rt t -i f r tud n f r b b 

Qjalifeati n 

Funher deta max be bt- -ed n a p at n 
1 the C u ly 'ted al ofl ci <.f Health 

Ap- -at n uti" a qua! Svac -x ard 
erxfc-c wth rex f t^tm n aU ould be 
ert th u 1 -ed no later than Tburyd x 
A t t Uth 19 X 

H L LNDERWOOD 
C»c. k f 1*1 Count Ccun-d 
C nr B 1- r;< Suf* rd ivlv Cth 19 S 


T Hf RADILM INSnrLTE AND MOLNI 
AERNON HOSPITAL 

ASSISTANT RADIOLOGIST 

Appi ai p r nxticd (r n fully qual fed -rwl 
fcjn tered Med al Praexmo-ers Lr the po*i cf 
wh ic i me Radio ci t tn the Deep Theij»*v 
Depannent at th Mount Verron Honpu I 
Nonhwood 

Candidatcx mtr>i eex csr a diplcm- in tredical 
radiot ey 

Salary in be arranred 2 cord re to the Qujfi- 
bcatiotx of the ucxrex ful cardtd te imin -num £ **> 
per am.—y> 

Ape icaticnx toeciher wuh full detai of train- 
nc artd cxpcricn e and acermpan ed by cpp ex cf 
n t r-ore than three lextimonial should be 
recc led by the underxiercd as soon .a pos tie 
but not later than Ausxst t th 19X9 

D y lx con em nc the djt cs etc may be 
btaipcd n arr cation 

T A GARNER 

I Ridin* House Street Secretary 

London W 1 


AAtENDED ADA ERTISEMEXT 
gOROLGH OF BEXLEV 

ASSI^ANT MEDICAL OFFICER OF HEALTH 

The stipo ation whf+i appeared in prexious 
adtcTtixcrients relating to ih 5 appomlment -txS 
rcQu ring -ny s\Kx,e^ fu! vroT’an appli*an to rcxim 
on mamage has now been delete from tbe con- 
d tjo- of arrcmupcm 

The I ■-•ire date for receipt of application b.as 
been extend'd to August 1 tit |9tS 

Ccuncil Oakes AA AAOODWARD 

Bolejheaih Town Oerk 


34 


THE BRITISH MEDICAL JOURNAL 


Augost 6 


JgURRCV COUNTY COUNCIL 
PUBLIC HEALTH DEPARTMFNT 


SURREY COUNTY SANATORIUM 
Milford (300 Beds ) 


JUNIOR ASSISTANT RESIDENT MEDICAL 
OEFICER 


\Pp!jcauon^ arc invited from rcRi'iicrcd Medical 
Praumoners (cHhtf sex) for ihc ippoimmcnt of 
Junior As’^mam Medical Officer ii Coumy 
Sanatoruim Milford near Godaiming Kesident 
experience in Rcncral hoxpin! csscnlial Appomi 
mem IS for «ux months renewable for further 
period of SIX months 

Salary £-50 per annum toccihcf with full 
rcstJcntul emoluments Appointment ts subject to 
the SiafiinR Regulations of the County Council 
Applications statins aRC qualifications and 
experience ind enclosing copies of not more than 
three recent testimonials should be sent to the 
Medical Superintendent Surrey County Sanatorium 
Milford Surrey to reach him not later than 
Saturday August 20lh 1938 
County Hall DUDLEY AUkLAND 

Kingston upon Thames ClcrK of the Council 
August 2nd 1938 


C 


T Y 


o r 


L I V C K P O O L 


ASSISTANT VENEREAL DISEASES MEDICAL 
ornCER (Male) 


The Hospitals and Pott Health Committee of the 
liscrpcol City Council invite applications for the 
po i {non resident) of whole time Assistant 
\ cncrc il Diseases Medical Officer (male) for the 
Ccntril S cncreal Diseases Clinic and Male Venereal 
Diseases W irds of the Mill Road Infirmary at a 
sat iry of £400 per annum the appointment to be 
tenable for t period of one year 

ApplKanis must be registered Medical Prac 
iitioners with experience in modern methods of 
trcaiing these diseases 

Applications on forms to be obtained from the 
Medical Officer of Health Hospitals Dcpirtmcnt 
Municipil Annexe Liverpool 2 to be endorsed 
V D Medical Officer and adUrcs cd to the 
Town Clerk Municipal Bui}dinj.s Liverpool 2 so 
is to be received not later than August 20th 1938 
Canvassing of members of the City Council vmII 
b" deemed i disqualification 

Municipal nmidmgs S% H BAINES 

1 ivcrpool 2 Town Clerk 

\ugust I93S 


W 


OUCeSUR COtNTY AND CITY MENTAL 
flOSPIfAL 

Povvick near \S ortester 


Appliciuons are Invited for the post of 

ASSISlANf MEDIC \L Omcru Applicants 
must be male single under thirty five years of 
aev and duly qualified m medicine tmd surgery 
C I 'Timcni.mg salary 13^0 rising by mnual in 
vicmcnis of to a maximum salary of £4^0 per 
annum together with furnished aparim nts board 
liundrv ind attend lOuC A further £^0 per annum 
will be paid If the selected candidate holds or 
obi un a Diploma m Psychological Medicine 
I xpcricncc in Anaesthetics will be a rccommcnda 
lion ItK appoimmcni is subject to the provisions 
of the 4 yhims Officers Superannuation Act 1909 
Apphvitiom stitin^ a^c and full pirticolars of 
quaftb ii»i ns ind experience accompanied by 
espies of three fctcni icstimoni ils to be forwardtd 
i ) the Mediv il Superintcndunt not later than 
Vkednesday August lOih 19)8 


jyj\NCHlSrCR royal infirmary 

Ific Board of ManaKcmem of the Manchester 
I xy il Infirmary invite appftwations (or the post of 
Kf SIDES I MIDKAL omCER of the Private 
( tttenis IK me of 100 beds 

\prhcants must be registered and hold a Medical 
mJ Surgiuai quilificuion and must have had 
pfLvi u resident experience in a general hospital 
I he ipfH mtment n for twelve months ren-w ible 
( f a further period Salary £-<0 per innum with 
biurd ft idcTi c and laundry allowance 
( iiU mfssrmation iv ol tamable Item she under 
to wham applicants must send twelve copies 
f th If applicaii in *’nJ testimonials on or btforc 
* im cn Ihurdiv \ugust ISih I9)s 
By Order 

I J CMILE 

General Surcrintcndcni and Secretary 


HI JISSOP HOSPITAL fOR UOMEN 
Sh fficM (1<I Beds ) 


in B trd of Manj cn-a tnvjf** ap^lt aliens for 
rvnx o* RLSIDINT AS XTSTHtTlST (fern dc) 
t a rvri xl ri vjx non hv commen in” 

4 I i H h Sj ry fliiO per an-^un to ether with 

In I J r c jnJ bjndry The canJidjt- 

a'^'v " ^ will bv- cxpcctcJ to ca r> tut other 
H r 4 a ( a 

S*''' all aii"^ ag-“ to/ j»-cr with cop 

dbv a—dfCNNcxI t'* t^** urJcf 

/- j t > 

DWID OSW XLD 

S •> f - rt and Se\.r-t3fy 


>RESTON AND COUNTY OF LANCASTER 
ROYAL INFIRMARY 


RESIDENT SURGICAL omCER 


H 


ILL END HOSPITAL ASD CHS' 
for the Prevention and Treair rt o! 
Mental and Nenous Dixord-r 
5i Alban> Herts 


The Board of Manaficmcnt invite applications 
from unmarried gentlemen for the post of Resident 
Surgical Officer the duties of which also include 
care of the Senior Surgeon s beds 
Candidates should possess a fcllowshtp of one 
of the Royal Colleges of Surgeons or a post 
graduate degree in Surgery 
The Infirmary and us two Homes of Recovery 
contain 420 beds Total Resident Staff S 
Salary at the rate of £300 per annum with board 
residence and washing One years appointmenj 
Applications staling age qualifications and 
previous post held together with copy icstj 
monials to be forwarded on or before the 20ih 
instant to the undersigned who will supply any 
desired mformaiion relative to the post 
Royal Infirman JOHN GIBSON 

Preston Superintendent and Secretary 

August ]st 1938 


JJUDDERSFIELD 


ROYAL 
(321 Beds) 


INFIRMART 


Applications xrc invited from gentlemen possessing 
the Fellowship of one of the Royal Colleges of 
Surgeons for the post of RESIDENT SURGICAL 
OFFICER to commence duty on September Isl 
1938 The salary will be at the rate of £225 £250 
per annum with board residence and laundry and 
the anpomimcnt will be for a period of twelve 
months in the first instance 
Apphcattons together with copies of three recent 
(cvtimonials to be addressed to the undersigned 
immcdi itcly 

H J JOHNSON - 

Gen Supt and Sccrctnry 


-•Hr 


LADY CHICHESTER HOSPITAL 
Hove Brighton 

For runctional Nervous Discxscs 
(60 Beds ) 


HOUSE PHYSICIAN male or fenil j , 
age under 30 years Appo mmem for sv 

at the rate of £165 pa wiih board and r j 

renewable for x further s« months at i'- n < 
£200 p a 

The Hospital has over 1 000 bedj aM « e 
County Mental Hospital for 
Laboratory Psychological and Child G 
Clinic Occupational "nicrapy etc 
Application forms from the Medial Dre** n 
be returned with copies of recem tf\ — ^ 
Duiics to commence in September Dls 


j^OYAL 


VICTORIA HOSPiTvl 

Belfast 


RESIDENT MEDICAL OEFICCR uy ft 
Gynaecological Wards (52 bedj) Aproiri-^ f 
six months from September 1st 
Salary at the rate of £100 per annum -i- 
must have held a resident appointment f r i 
one year This post offers facilities for ca 
who wish to qualify for the membenhp f t 
College of Obstetricians and Gynaccdc' i i 
Applications with three icsiimomah tote hi 
Superintendent not later than Ausuvt lUh 
(By Order) F A HERON Hoi 


S WANSEA GENERAL AND EU HOSPITM 
(336 Beds ) 

HOUSE PHYSICIAN wanted gcmlcra'i i. 
Salary £150 per annum with board rev ‘cn^ei 
laundry Appointment for six mornh D x n 
commence early September 

Applications stating age nationality Cji 
lions and experience together with corit' of “ 
recent testimonials to be forwarded d t 
undersigned O C HOUELIS 

Secretary Sur^n cc 


SENIOR HOUSE PHTSICIAN (woman) re 
quircd Six monih< appointment (£100 per annum 
all found Valuable experience for Diploma m 
P ychological Medicine 

Also JUNIOR (woman) it £73 per innum 
Applications with testimonnl to be sent to the 
Secretary Mr P F Siooncr 33 West Street 
Brighton 
July 25th 1938 


ORTON GENERAL HOSPITAL 
B inbury Oxon (60 Beds ) 


RrSlDENf MEDICAI OmCCR (female) 
wanted for six months from the middle of August 
Salary at the rate of £1<0 per innum with board 
residence and htmdry 

Apphtaitons stating age qualifications and ex 
pcricncc tn the admini tration of amcsihclits with 
copies of two rucent testimonials to be «cnt to the 
undersigned not later than August 9ih I93S 
RICHARD H IRCSCOTT 

Secretary and House Governor 


AST SUrrOLk and IPSWJCH HOSPITAL 
' (350 Beds — 8 Residents ) 


Wanted August 17th CASUALTY OFFICER 
(male British) Salary at the rate of £144 per 
annum with board apartments and laundry 
Applications stating age qualificolions and ex 
penence to be sent to Ihc undersigned together 
with vopics of three recent testimonials 

ARTHUR GRirriTHS 
The Hospital Ipswich Secretary 

August 6th 1938 


jyjANCHESTER R01AL E\£ HOSM' 

OUTPATIENT MEDICLL omCER ( ' 

'll once Applicams raiw le Ml) >. 
Medical PractiooncR and must »lw J f 
Lno>\lcdcc of rcfraciion work Siliri i ' 
•innum for morning oorL onlj Pd"’ 
appointment cm be obtained on retiii''t 

Apptieationr with recent IcstiittoniJU i i 
the undermentioned as carl) as posuM 
H R NORTH ^ 

Gen Supt anl V t f 

J^OYAL UNITED JIOSPITAL f' 

HOUSE SURGEON required (Ger til S ' 
and Ear Nose and Throat) for Jub 

Salary £150 per annum with boam i’' 
and laundry , . 

Applications with cones of ihr« n ^ 
to be addressed to the 

J LAWRENCE MC3RS 

July Sth I93S Secrclar) Siipef 


R 


po ' 


OVAL VICTORIA HOSPITAL 
(66 Beds Two Resident > 

Wanted for Aueiisl p"’ - < 
cd and registered Sabr) fNP prr ’ 
oard residence and laundry u r ^ 

Applications statin^ age r 

crlcncc accompanied by ^ > 

rsiimonials should be sent to ^ 

)on as possible ^ 

;t PAUL s eor 

) AND SkIN DlStkSj^^ 


IRMINGHAM AND MIDLAND HOSPITAL 
' FOR WOMEN 


IIOUSF SURGEON (man or woman) wanted for 
SIX months from October 1st 1938 Salary to 
be at the rate of £100 per annum 
Applications with full parttculafs and copies of 
totimon al to be sent not later than August 20th 
to Hugh C Aston 45 Ncwhall Street Bir 
mm^ham 3 


,UCHESS OF YORK HOSPITAL FOR 
B\BIES MANCHESTER 19 


Applications arc Invited for the post of AURAI 
REf^lS'TRAR D-tatk of the appointment can be 
obtained from the Secretary to whom applications 
ro"ethcf with icstimomals should be sent by August 
%ih 1938 LOUISE BAILEY 

Secretary 


D 


UCMESS OF *iORk HOSPITAL 
n\DICS MVSCHES^TER 19 


FOR 


Apnl -^fion arc invited for the po t of CLIN I 
C\L ASSIST Wr to work in the Out Patient 
D'‘parimcni Details of the appointment can 
o^sfm-d frtra ih- Secretary to whom applications 
hi lid be sent b> August 24ih !9)s 

LOUISE BMir^ 

Sccrcta > 


cations arc invned 
' SURGEON Candidates rJ'J ^ , 
giftcred Salary £100 
estdence The t.Pt».e.mr« « , 

In the first imtenee arti i ' „ 

: chitible for the twl o' ' 

Dunne his “I’oruniiTeri ' , 

ICS insotvc ssork m the 
out patient Gepottmeet ^ . 

enlions «"*> cop cs ol rc« 
ubmiticd pot lat^ th j- 

ul candidate "i" be teqai cd 

eptember I4th^^^ cmsIETT ^ - 


THOMA^J^ 

V'ACJ'sCV 

,pointmcnt of a ''■/» l 

3 rhisietsp^ 10 \i- - 

0 the -1 f 

wnh charre of Octlc p , 

relloes or Mcr-t-” o' 


o' 5 


t,Sns w«h full d 

ainable ^ A 

- .n. no liter 


r 













AiH I'sn (i lyit' 


THr BRITISH MEDICAL JOURNAL 


A ^ R < O U S 1 \ U i> s r M \ t 

(\ uniar> Ccnct»l H r’a*) 

The D Text tc arr^K-iHt n< f l^c r*'' i n 

t UJIICIR (mate tr<3\!rrn 

Valan rc^ ar**i'Ti uiih Nvif\J arvl ro U r c 

r ca^c u c ar. ntTreni x K 

tM 't\ r** nh\ ScTict~V«eT > \ arJ <Vn ber 4 > 

respect 'c r 

^r^ ati - « t*i cv r tc'ti'n « j t I x rexi 
xit*h the encu 1 r Kl 'T'c Viti v. 

Aunrt I't’n t'* ^ 

Hmrui lOlIN ) ro\ nu 

J Vvt tsT> arxJ ttca t'ct 


B rR\ I S » I K M A K \ «r ANO > 

< |4 Kx > 

Arrt'>iNTAtr'»T <»i not m m pci on 

A '‘•"no * aS ^c an^c< oo the Rr^xlf**! 
McOx-aT 5i " ar“' n\ ?v. f «^ 

r>'^t 

Thf Rc'w-: f r^RSO a 

I?it>c j-Tun a*s3 t» ^UvT^^ *» 

The ar^x " f f a r \ r* ^ 

sfxj iVc xaUrv i a\ t*-c T»?c it l! O tvr 

f***j'*i « ih rrvdf^ t a*‘J Jj •x-O 

^Un hct"c t'***r3vcu t Cl * r< ** 

c rflt cl a tw-x - — r"J lo t**? '-■i t 
Her r^T f’< a rcT^J o V \ r* ^ 

THc L Vo ''*t a-'" vi N c *'c teJ t t Ic 
»> <?ufJO ’i 

Af^ fca It ~c arc c a1 K,at -i "■w 

TvitKca’ y ti cr*— T S C't“' c- tex -r 

to o-na »c t be ('Ok-i i.c'J t iH 1 “^CT 
trtvvJ a' o ■* * fv--. Cc c**o *%} Hn-* 
S irrci n Fu 1 rurt uLn c i.tof"ibcFl 
*1 arr »ca t-^ 

H WJLkINSOV A - cf*.c^t 


B irmingham wo midland fai 
HO^ riTAL till Rev ) 

Ar^ -.j icncJ/f'inv c\<\. 

Mc<lK'al pT3n f f tH IS cf RFMOrsf 

itHGlCAL OrnCTR at tH Nr Hf-~t J 

NiUo £*0O rcT fi-i*!.— a d lio Ui.’vn f »ansc 
T>c Ro«^c“t S a** -HI la Po 

O*" cf ••>>- t*- f- flo*-vc 5 pcx*^ a-j 1- 
thc o-^t c c— c I'-e i_ cr bci- 
» Vre rc*'t -n ff Pr,.r“ S t cal £>-■ cf a— 
'ar < *• lI 4 state er tHe\ ui I tx -ft 
Xept 3— <c*p-cn: o Hc-x i. t'— *j * xjjm 
f fPP (n nf at i**? esd cl t- - vat 
fact r> cTMCc to £l rj jxf n- -n 
ArN -atjo-^ %iH ^ 

tetntraio-i r-u t he free* cJ n^t later x\ n 'fc-v 
ti3> A«r \ ih 

Ovrets StTM J \\ RCvPCC 

Cl' ern r 

(^RVELU ASD Es^r rxiPSET llO^PlIiM 
r-of tx-<n (1 ( En. 1 

IIOLSE PH>SICI^S 

Arc'atK'm arc nii ci! (frci-. i rr-c r-<n1 I- 
tie pent of House p^j -urr 
rcTi-KS end -X Maj~»j tj t ipto Sa,cn -t i^c 
rate o £| 0 pj h i:s^, c- L 

arpoptr-e-t r-j> he ip-Ixd for and ,f rra- cd ♦ 
s-lan « at th ra C cf ir< rer a-n n D jo 
I cmn-n-c on Auru i jpti 

Ihe Hospul IS recojriied hj the R<>»3i c r ccc 

Cirfx ^ connexion v ih tPc 

TjiuI Etani-aiKn for the FeloMshn 

na:/onaf!> ex'-ermc 
aiyJ cua A^tio-s torether mith cop*Cs c* ihfce 

TSi 

AJ 0 rra h t*jc umJer ixred at the Hck- isi 
a ro.H.e-1 apnointment in a 
■ £ A Hart Secretary 


QOV U^R«IC^.M..KF 

A» POINTME.NT OF MEDICaL REGJSTKaR 

re*r<terc<I und-t the Mcdi-) Acts 

1 • honor^o , h evt 

* cier> tMctic no-ths 

f.cai'Sf**!"'"' and ouxi 

and r vHK<*or^Vll^ ^ Ren traticn Cer»if»-3tc 
bnda>rsi»n.wi ^ *^‘'’^onal nmi he addfes ed lo the 

S CrCIL HILL 

. - House Cottrnor «ind S<xrci3r> 


C”“HAM >.1EV10RIAL HOiPlTAL 
H«pRs«ood Bn lol 

medical OLLICER Salary £1 0 
•< »t{h board and 1 undry to remain for 

s<M.v4 k 1!* insianvc Applicants (male) 

lertsierrt ft n ujnalio fully Qualified am) 

copici cf reveni ie»tImonial? 
•o he 'em jo the Secret n 


gr MAR\S IIOMITAL LONDON \\ 

I AR NOSE AND THROAT 

OrrARlMENT 

Anpl -at n nrc n itx! f r the rs'st ^^ 
honor \R\ KirfAIKARi the Far Novp rd 
)h \ t r> rs rtment 

CjrtKl tn m t he fctl h f the Re jl 
' c- e f A tree ''s i r a Cravii ic in S ifrcT> 
‘ a R » H I n sff ri \ op < f the ree ta 
I p » vern •'r the r^t nt he h d n appj a 

Ihc npp im Tit ikd) he in the f rxi n lar e 
f ^ a ret xl 1 f tMchr month h l the h d r 
"11 he cl c h c f r fr fijs c n*eri fra nond 
scar 

Arr ati - f f t IS t t ihcr ui h c r r* 
of three re -nt test n hi j J he icri to 

|H 1 edft c eil p t I ICT than Auto, i J jh 

\V parkfa 

ffo c Co etc r 


T^Hl f I rsr HnSflFAL DLDIIS 
A iCcr nl If p tj1 I <» Red ) 

T> Kes y. nt A ** - fa Pc' s- nt < c t 

O- CT J t" fl e S ce - 

App ~«t Of, jtp j ff T fpj I 

Pr It' •'rrx f r the r '»i r* PFSIOfNF 
SI KCIC At OUtClR <>- (e» Pm e i i n- 
m-nse Act t I H jot Vi r> t ih r e 1 

f n. n PvT m »*i a re In e Rser •* c 

iH f - **rJ '*»! — — h fo J-d I -s.r» 

f A"",.-- cs r* t hj e h OP<f ♦'iC in cmcrcce i 
ti ■> a-,. PC tc- c "it he esen t t'^ 

be- X*' „ nt n f I R C S cr M S 

Ar- at - at e c i ’ i - 

c fxr me a '—pun rd hv *s i f l-Rf — 

I h s<--t t I I -uef t~ d 

H ) AT MONO in PSI 
I I t H Eoictr f -- A r r> 


T in rt rsr hospital di ni i a 

(C - 1 H --lit pt PCs. I 

O' fes - A •• t ef a ttc' v<-t s t al 

O'* r d t" M e A J ree- 

IWU FfOL SI SvhCrONS (p a t tcs td 
O' |o e- e I - n h c » *x N. - c ■‘d 
ts t „ J. n \ I IS 

Sa 1 i A f te il > — f arm "iih furp Ae\5 
i'' np*e— h d J t -Jfs Ca V V ICS n i 
he fa 1 c a w 'J fct c cd 

App i -t n C 1 at ' J 

c rc'''n,T a '•tsneJhsc-“s<f tc*t “ 

( h c*t 1 t t r^cf I “ed 

H I ASA OND Htl ST 
J 1 A )g H eF \cin f p,. Sc i t rv 


T m A I O c k P O k I INI JKN1 \KA 

fiwt n-v ) 

A— at -s re in t d I f the p -t f Mol SI 
SI KClON Ap- a n t W r- -w - 
malt cv SaLi tl " ref cn — uith h rd 
r v-n e md I i r-Jr> I) tic ^ j kp--- n c 
Sep rrn»vf f t 

Ihc Resv pt AtaT n t rf a R- n S rj, al 
c (■‘O He e S tf mJ s Hi e 

I*S> cun 

Ap-i '3H n tor'tlTXkthcir f three rcvcnt 
testr-vj tain* arc run n,iln\ and l>i 1 
cat n 1 1 he CTif lo ihc i ndcr ncJ r r let 
ih n A« u I 9th 

If < PRICE 

Se 'retjri Sorcrirtcrdcri 

T MF mClIlSS OF TORN HOSPIlAL I OR 
BMtllS MANCMtSrCR 


Arpl at n ate tniued fit the ts— t t U NIOR 
RIMDINI MLDICAL OFI ICCR f r x m nth 
frt»m Octoher I t I^tv Salary l < per «nium 
" ih Nurd fesiden e and laundry 

Appt-air n tprcihcT %ih copes rf lexii 
mopial to b< ent to tSv SCvretaty b Aum i 
I Ih 19ts 

lOUISE BAlLtA 

A-vTcury 


'J'HC general INFIRMARA AT LEEDS 

ArphsjUon arc Inxtied f f the tH'p-i if SENIOR 
KESfDEVr ANAESTFfETiC OmCFR 

Salary fI49 ref annum "Hh the i ml re i 
dcntial ino"an ex 

The aproinmeat « for ticic month iibicvt 
I renewal Candidates muit he fully giiaM ed 
and resi teted Appl caticn< with copies of tesu 
r- nial i he ent in at cn c to the unders sped 
S CL-ATTON FRTERS 
Hou e Governor ard Sccretar 


T^HE HARTLEPOOLS HOSPITAL. 

1 (9S Bed5) 

Appl cations re invited for the pctjticn of 
HOUSE SURGEON a •alary cf fl*0 pa pus 
tcwiTd Tcsidetice and fcondiy 

Appcpnimcnt for sa months ub eci to renewal 
and dm es to ctnuneocc immedtatcly 

Ar^lKatiom to C« made to the tindcrmcrucncd 
NORXfAN O DEANS 

SecicoD 


K ent colniy mest\l hospital 

MAIDSTONE. 

\SilST\NT MLDICAL OFTJCER lm,,lc) fc 
o 1 red C mmerunfi salary inctuxne of cmoti>- 
rnenii L09 per annum rr<trjr h> annual increments 
ol * to £6^9 pet annum Excellent (acilit ex I r 
» rkine for hi her cxaninjtion and for attend- 
W . Diploma in P hi to'i at 

Med c nc for iihu.>i Dip cma an additional Lf) ptr 
tnmn i paid 

Pmioii cxpetien e na es emial 
, ‘ “ ” nable under the 

^ Act |9t>9 

^ . lahfied rcii’itcred 

IPX e ard net more than t< year, of age 
Arplfations gism- full particularx ■with copies 
idtfr-cnul ard endorsed 
SI ' , «• *'*' <^h\ctore shp ild be ent to the 

aie perntenvent of the Hospital at an early 


CTROLD CENER At hospital 
Stroud Clos 

RESIDrsf MFDICAL OFFICER requ red 
t nd vjtcs n., t he fu !) Qualified and registered 
Six r* ■* hi app ntme djticx to commence a 
xvy ai p,s, ,h f Sa’ary CO per annim mih 
r jfu and L undD 

App jtl ni taiing age fution^l ti el to- 

Feth-T with c piex of ih cc recen testrr nial t 
he err to (he ur.dcriufrcd frix*! whom further 
pan t jr r- V be obtained 

C FORDSlCNCER Sei-rctars 


T“Hr CMIIDRFNS HOSPITAL SHCrriELD 

* rl Reu I 

'rr II 4 c II Tcd f r Ih p >,1 f IIOLSE 

I HA Aff f aN 13 jnt September It |9 C 

Ih p-Pf-rt ff xr*»ih Saayili 

p r ,.n -1 uuh b ard resOcr jhd !j rdry 

Cars, cs (ru jpd rt-tamedt who r-v-t 

pr-vrs rc' tcf d u 1 ( at n hiud f rwarv 

r" t ' I t n jr ojii -~Mi et t '-ether 

w h - -s f thr e ri. cn lestm nai lo th 

Ps-e J 

I H G ( AP II AND 

A Per p cPd nt d Sv ret d 


T he AATNCriELD-AfORRIS ORTHOPAEDIC 
HOSPITAL HE-ADINGTON ONFOPD 

IMt H>PD sLTTFFLD SCHOLARSHIP IN 
OHTllOl AEOIC SLROERY 

MALF resident t ft) rc an" ra for two 
v-At f r-n cd h\ i ce r-entbs tm I fflNH 
Ke J r c n vii^""cn e about Sotr^^r I t** 
9 r Onhrr cd e'retic" c es er laf 

Inf -T-at n can he t n*d frrn -o ar-'ic- 
I n hef rc (\t her th hPv \S tc nade to 
r (cv t G R Gird'cMO" 


T'ME HOSPITAL FOR SICK CHILDREN 
X New-a t!e-u"cn Tjfty. 

Th Biafd of Marasem bt hai declared a 
i.cap V f r the r»i cf HONOR \R\ OPKTHAL 
AllC SLRGFON a"d iim ap- oh f r tbc 
ar'^intmcpt tat pk asc ard Quahfiotion fj be 
lirwardcd to the Scerctao Mr Ncii Bred c lx 
City Road Ncwcast e uro Tyn- I accomnaoeil 
w rh V tries of three rci.em ic>t menials 


V ICTORIA HOSPITAL DEAL 
( 0 Bcdi I 

Appl otion arc nmed for the pe-t ■>< 
RESIDE.NT MbDlCAL OFFICER (male) Bnu h 
naitc n. I ly unnarried The a-poimmcnt to com- 
rren e imr*cdutcK for ix rnomh> Satao il P 
pa with bcarv lodgine and laundry Spci- ' 
Lnwlcdcc of anacxihctici p dc'trab'e 

Appli'anon iiat HE age and quahheauon t >- 
kcther »i h copies of three recent testmona! i 
he xcni to the Sccrctan Afedical Board \n ra 
Ho'pita! Deal Kent 

W/EST CORNWALL MINERS* AND 
\y A\ OMEN S HOSPITAL REDRUTH 

AA anted HOUSE SURGEON Lady Sertember 
I t or October 1st. 90 Beds £1 0 per annum 
with b«rd and laurdry 

Apr) mvons wivh icsunonals. to E. FOi L, 
Hon Secretary 


X^ITEST KENT GENERAL HOSPITAL 
y T (Incorporated) Matdsione. 

(135 Beds) 

AFrli'*3tion’ arc insited for the po«i of HOUSE 
SLRGEON who must be a mJe of Bntish 
naitotahli 

Salary at the rate of El^S per annum «id' 
board apartments ard laundry 
Candidates must possess registered Qualifwations 
Apcbcalicds s aims aoalifications and expen 
en«.e t getber i ith copies of testiraonials. houkJ 
be cm to the understsned tnnediately 
EDAAARD J GREGG 
H(hBC Gotemor and Secretary 









36 


THE BRITISH MEDICAL JOURNAL 


August 6 19K 


C IIESTERriELD AMD NORTH DERBYSHIRE 
ROYAL HOSPITAL 
(220 SurpiLal and Mcdjcal Beds ) 

HOUSE SURGEON to Ophlbalmic and Ear 
Nose and Throat Departments 

Applications arc invited from fully qualified 
men (or the above post The appointment is for 
sit months Salarj at the rate of £150 per annum 
Applications stattne aRc tORcther with copies of 
three recent testimonials should be sent to the 
iindersiRned as soon as possible 

M H BOONE 

Ju4 29th 19^8 Superintendent and Secrctarj 


\R AND THROAT HOSPITAL 
Birmingham 3 


FIRST HOUSE SURGEON required (resident) 
Must be fully qualified and with clinical experience 
Salary at the rate of £1‘'0 per annum with full 
board and residence Appointment for six months 
commcncinR October Isi Facilities for irainmR 
for D L O 

Applications and testimonials to be forwarded 
to the undersigned 

\V H LOMAS Secretary 


AR AND THROAT HOSPITAL 
' Birmingham 3 


THIRD HOUSE SURGEON wanted (non 
resident) Musi be qualified and with clinic il 
experience Salary at the rate of £1^0 per annum 
with lunch on six week days and an allowance of 
£^0 per annum in lieu of board and lodging 
\ppoinimcnt for six months commcnc nc Octo- 
ber Jst Candidates arc chfiiblc for election to 
senior posts Facilities for tr lining for DLO 
Applications and testimonials to be forwarded 
to the undersigned 

U H LOMAS Secretary 


L eicester r o \ a l infirmary 

(500 Beds) 

RESIDENT RADIOLOGIST 


Applieaitons arc invited for the above position 
vaca,nt early in September 
Tlic successful candidate will be expected to act 
as House Physician to the Radiolocists and assist 
in (he diagnostic and therapeutic sides of the \ rav 
Department 

ffic appointment is for stv months in the first 
inst incc and the salary is at the rate of £200 per 
annum together with board residence and laiinUrv 
Cindiditcs holding the Diploma of Radlologv pre 
ferrs,d but not essential 

Applications giving full particulars as to age 
qualitications experience and accompanied by not 
more than three testimonial should be sent not 
liter than August l^ith to the House Governor and 
Secret iry 
Ju V 29th I9TS 


LLEDS 


JEW 1 S H 


H O S P 1 T \ L 


Wanted October 19as RESIDENT MEDIC \L 
Of FfCLR (mate) SaJarv £200 per annum The 
appcinimcni is for six months but may be ex 
iLndtU by mutual arrangement Candidates must 
be fully qualified \pplications stating qualifica 
lions cxpericrtcc together with copies of tcsii 
moniils should be sent to the undersigned bv 
I Tiday \ugust 26ih 

LIL'i CURITZ (Secrctarv) 


L 


I\ ERPOOL 


MATERNITY 
Oxford Street 


hospital 


HOUSE SURGEON required for the six months 
commencing October Isi next silary at the rate of 
£W Per annum with board residence and laundry 
Previous experience as House Surgeon essential 
Membership of a Nfedical Defence Society is a 
conJition of appointment 

Applitations staling age qualifications and 
experience together with copies of tcslimonnls 
to be sent to the Honorary Seirciary of rht 
Mcdieal Board on or before f ridiy \ugusi .6ih 


L.yms 


H O S I n \ L SIORNOW 
Isle of Lewis 


\pp’i aliens arc invited fo the post of HOUSE 
SI R( LON Salary at the rate of £1^0 £200 per 
-mmm (acci rdin tv experm e) veith boird 
re Olp e and laundry The appomiment to be fer 
\ ra •'ihs ind iib cet to renewal Dutic to tom 
n c cirU in O tobef 

\rp all n to be h deed wiih the Suptrin 
I r I r bef re \i/ u i “th from whom 

I iiMcr pirti ulvr m »> be intoned 


L 


INt I ILL!) 

( HI 


L ! I I F I T 1 C COLONS 
aw. j 1 > .*0 chi dren ) 


\SMS1\NI MtDlCM OrilCER req ured 
pfcl -V. S ary I '•a a >ear vsiih b ard 
r V u \ 

X''r M tat n j c a r -aior and ex 

l t ■' 1 ‘y r « t r of tc>t m nu t > 

^ l t*' M-d il Sn'^T-'i ni nt fh- 

li-' V. br-'s 


M 


anchester 


RO^AL INFIRM \RX 


MEDICAL CHIEF ASSISTANT (Nonresident) 


The Board of Managcrrtni invite applications 
for the above appointment 
Applicants must bt registered medical prac 
tilioners Higher qiiahhcalions desirable 
The candidate appointed will be attached to a 
medical unit and will be required to attend on 
seven half Sessions per wccFw of which at least four 
will be morninc sessions Dunes will include work 
in the In patient and Out patient departments and 
participation in teaching There will be facilities 
for research work 

Salary £300 per annum The appointment will 
be for one year m the first instance but may be 
renewed for tv\o further -periods of one year sub 
)cci to the provisions of the Bve Laws as to 
notice etc 

Candidates should forward fifteen copies of their 
applications giving particulars of age cxpcncncc 
etc together vsuh copies of recent testimonials not 
later than 9 am on Ehursdav August 18ih to the 
undersigned from whom further information may 
be obt lined 

Bv Order 

F J CABLE 

General Stipcrmtendcni and Secretary 
July 2sth 193S 




RTH'iR GENERAL HOSPITAL 
(118 Beds) 


RESIDENT HOUSE SURGEON required for a 
period of SIX months 

Salary at the rale of £150 per annum with 
board ind laundry Applications stating age 
nationaluv qualifications and accompanied by three 
(copies only) recent lesiimonials should be 
addressed to the Secrctarv of the Merthyr General 
Hospital 


RESTON and CObNT\ OF LANCASTER 
QUEEN VICTORIA RO\AL 
lNnRMAR\ 


RESIDENT OBSTETRICAL OFFICER 


The Board of Management invite applications 
from unmarried Medical Practitioners for the 
above post with duties in the Maternity 
Hospital (43 bed ) under the direction of the 
Consulting Obstetrical Surgeon Candidates 
should have had experience in dealing with 
cmcrgcncv eases and in conducting ante natal and 
post natal clinics Twelve months engagement 
from October 1st 19(6 Salarv fjOO per annum 
with board residence and washing 
Applieaitons stating age qualifications and 
experience accompanied by copies of recent 
testimonials to be forwarded to the undersigned 
on or before August l^th 19 8 

JOHN GIBSON 
Superintendent and Secretary 


ROY YL 


MCTORIA AND WEST 
HOSPl r \L Bournemouth 


HANTS 


The Board of Management will after the 
expiration of one month proceed to appoint an 
HONORARY ANAESTHETIST 

Appheations staling quahritaiioos age and 
experience should be sent to the undersigned by 
August 30ih 1938 Canvassing personally or 
othcrwi e will disqualify 

By Order of the Board of Manaptmcnl 
GORDON M S\UL 

July 2'ih I93S Secretary 


J^OX \L 


BUCkINGH \MSH1RF HOSPITAL 
Aylc burx (I|S Beds) 


Xpphetiions ire invited for the post of 
JUNIOR RESIDENT MEDICAL OFFICER (male) 
for four months commeneinu September 1st IQXS 
After this Period the candidate appointed will be 
eligible for the Senior Post Salarv £1^0 per annum 
wiih full boird residence m own flat and laundry 
Previous Hospital experience is dcsirab c 
Opportunity will be afforded to undertake all 
b an-'hes of medical practiec including anaesthesia 
and work vviih London consultants 
Sciceted candidates will be required to attend 
for interview by the Mcdieal Commiticc on 
Wednedav Nugust l*ih 

Applications should be sent to the undcrsiLncd 
by All ust lOth l9aS 

r G D \\\ ES Secretary 


R 


O X \ L E E 

Ptvens-y Rtvad 


HOSPITAL 

Eastbourne 


NON resident HOUSE SURGEON required 
to eor^mcn e duty m \iu.u t The appomiment 
will b* for IX months in the first invian c 
Sa’arv £!(H) per annum anJ allowance in heu of 
bvjrd csiderw-c £17^ per anau^a 

Xppli atten stating age quahficaiionY and 
O'vhihaln c cxpcricn c together with rcecnt tcsti 
ra a tt hould tea h the uaJ rsigrral as soon 
a p-Hsib'w 

B 'vre en a nt cand Jitex have to be inter 
vjfvtJ by the Hon Surge n from whom further 
pa ti iilars c uM b obtained in person 

H BXGPWL Hon Scerctary 


J^OX \L 


BERKSHIRE 
Reading (3^S BedO 


HOSTlfV 


RESIDENT ANAESTI ETlST (male) wh s l 
vacant on August 6th 1938 
The appointment is for six monihs la i** f 
instance Candidates must be fully Qua''-< v. 
registered and have had considcrabV evrer** 
in the administration of anaesthetics 
A salary of £250 pa wiih board rcv*d i * 
laundry will be paid to the candidate 
suitable qualifications for the post 
Applications stating age and cxrcricr't t 
cop •'s of not more than ihrcc''re».cni lev tr 
to be sent to the undersigned as soon av {Vv x 
H E RX\N 
Secretary and House Gova 


AL 


BERKSHIRE HOSPITAL 
Reading (33SBcds) 


ASSISTANT RADIOLOGIST required ( ( 
lime duty Salary £40C)-£^00 pa cerrJ i 
qualifications Candidates must be fuliv c i 
Mccfical Practitioners and have had ILip n 
pcricnce in Radiology and Deep lhi.rar' a 
possess the D M R E qualificaiion 
Applications together with not less ihinu^ 
copies of tcsiimcnials to be sent to the i 't 
signed on or before August 30ih 1938 
H E R\A\ 

Secretary and Hoii^c Cover r 


AL 

(114 Beds 


WEST SUSSEX H0SP17V 
Chichester 

including 12 in the Privaic Pas 
Block Two Residents) 


SENIOR HOUSE SURGEON required r- 
atcly Sahrv at the rale of £17 p t anri."i » ' 
board residence and Jaundrv 

Applications should be sent to the unJ n ' 
together vviih not less than three revnt t 
momals stating age nationaluv cxtx.ti r a J 
qualifications 

By Order of the Board of Manaecment 
J COXOS INCF 

Julv 27 th 1938 


R oyal l a n c a s t r r inur'hm 

Lancaster 

(140 Beds) Four Rcsidcnlv 


Applications arc invited for the pafo!5^'^ J 
HOUSE SURGEON Salary £.00 per ' 
board residence and laundrv The arr . 
for SIX months m the first pi cc anJ " 
renewed for a further six months 
Applications stating age ou^nricatin 
cnee and nationality together with ^ 
recent testimonials to be sent to the tind t'* 
FRXNK A M1LNES 

Supcnmcndv nt Seer u» 

D OY AL LANCASTER INflR'''’' 
tv Lancaster 

(140 Bed ) Four Rcsidcnn 

Applications arc invited for *hc pesi 
HOUSE SURGEON Salary 
Mih board residence and laundry '•’r 
aicni IS for six months ^ 

Applications stating age Adalifiaiie ^ 
:ncc and nationality together wiih 
■ccent testimonials to he sent .Jv^rc 
TRANK A 

Siipcrinlcndaitj221iL 

DOYAL LIVERPOOL RABIES IIOSlR'I 
tv W oolton 

Required RESIDENT Ml (rr'-" ' 

'or iht above HoNpiial J? /per J " 

Xlobtr Isi Salary at «hc ^ate of U r 
or the first six months £1 0 
iccond SIX months ,, i 

Applications with copies of testin’ 

,cni to the Honorary ( (*' 

Board 9 Coppi.ras HiM Liverpool 
■\iigust 20(h 


OYAL CORNW \EL IMriRMVRI 

(‘S4 Bed! ) 

:OLSE SURGEON (male) ','1 ^ / ’ 
cn-e of Anac^th ll'' 'j' ^ ar "r ' ' 
;u I l« next Solar) £1'>’ P" 
rd ind xva hms " 

ppl) xMih comes h'rt pit. •' 

;hc Secretory of "him (utino 

obioined oRrvrrii 

ruro » » tf « c ^ ' 

.ily 4lh 1938 



iOUSE PIIYSICIYM !^ro'e) , 

he me of £U0 per onnom • _ , 

biindry p?"' n’r If O " 
cco ntred for the D .-i 

ppUitnm in nmirr oc m ^ 

,nK should he 
retxrv Dyl-' Ko'J 
'Xlh 193b 













THE BRITISH MbDICAL JOURNAL 


37 


APPOINTMENTS — Important Notice 

Muln.ll pnclilioiiLr:* irc rtqiR'tcd nol to tipph for in\ iiipmutmuit rcterred to in the folloMin<> 
tihk without In in., tir-l comniunioted with the Seeru ii\ to the Bnti h Medicil •Xvsocntion, B AI ■C 
Hoti-e, Tnntoek Squire, \\ C 1 (in the ci e ot Stntiivjrnppointnient-, with die Scotti-li s’ecietan, 
7, Druni'heuqh Girdeii' Bdniburi,h) , 

(a) British Islands 

Tc»T3 ct Dn-irn I T «n <t I) r^ct To^^n cr District 


CONTRACT PRVCTICC 


ARERnxs^\G yiiDicM. AID iocitn 

(Mr^ c- O" o-> 


ELAENNNOS MEDICAL SOCII H 
(C^ rf \fr cni O r } 


CILFACH r<X:H CLAMOPCAN 
111 1 'fr /5<>rfnr) 


LLw^-N^riA cl^dach \ ale 

rrS^GRAlG GLAMORGAN 
<11 1 cl {» <■ ) 


COSTRsCr rRACTICE— M 


MIDKUOSDnA AtEDlCAL AID SOCIEr^ 

«4j , \tr r ) 


M Allf AND DISIRICT 
tUe » 4 4 fi 1 


OTMORI \AILE\ CLaAIORCAS 
(II ^ I •••j C r 'fr c 4lt, ) 

(II t 'Ir et A *!/»*•< ) 


' OAKDAir AU»S 

\ (If o- i If/- ^ AJ 4i Vi. 


PUBLIC HEALTH 


COLNT^ OF ROXBURCH 
M itanr If dret OPcer ct Healil ) 


DISPfNS VR\ VPPOINTMENTS 


LJAIERICK cm 

1 11 f rf ( r P > Ifrt/ tf ^ ) 


j (h) OicrscTs 

j Medieil pnclitioners ire reque-ted not to ippli foi iin pji'iinlnu nl releiiid to in llii tullowin., 
tible without hiiin., first co nniuincited \ ith the Hoiiorin ''eirtliri ol the Diii-ion or Brineh 
\ mined in the 'ecoiid colui in or with tile ''eere. in to the I'rili h Medieil \"iieiilion B M X Hou c 
I Tuivtock Squire \\ C 1 


Town or D sirn. 

H n Sec of D si *n ' 
or Br-r-vlr> 

' Ii*«n l> » f 

II n Ac r D n 

« r Pr --.r 

I n r D irKt 

' Ht,n Set ! Di 1 1 n 

1 -r B rvh 

^E\^ SOLTI! 
A\AI.£S 1 

(4f/ Frtri'i 

Scc'ry A-'^enr 

r'CR.i ) 

The Vlewr-al Secrttin (; 
Ne» S.xJt*i Wales II 
PmrKb M* 'I c- j 
Ciurie Street S>d cy i 
NSW Ij 

I 

1 

1 \ I C T 0 It I S 

t/4ll In t tm! f 

Ibe H ^ r» Ac iCJD 

1 A Kic ‘ n Branch 
; B 11 h Atfv I A ^ 

Ul^NTl HN 
AINTK\I lA 

Tbc H n Sev Western 
Au ir lun Blanch 
Brut h Mcucal A > 
cution She 1 House 

: T> )l m Sev Ovr*^ 1! 

I “J Bfaixh Bnl^h i 
i Alevlical A vvution, 

B M A Jkvse ^ I 
W (clhaP’ Terrace | 
B i bane B 1 1 

<u A1 e c 1 - 1 1 

QrEESSL.SND 

iPni*y^e .4isi. f 

Frer±f 5pe*r n 
im ate ) 

» ry } 

1 

Vvets H A bc't 

At 1 - 1 Ate b *be » 
V r 1 f a J 

1 

(Coni kAt kuui 
i t r tin) 

ra c Penh Western 
Australu 


luh 30 19i'' Bi Order of the Conned G C \ND1 RSON StLri'ar\ 


gUTE llOSriTiL. LL 10 S 

HOLSE SLRGEO'* (trjlc) «jr ed lo 
lutic' «i soein a pvv "v ^ S*. -n Cl 0 per anr 

th Lccrd res.'-’ence ard laL'v.r) 

ApTr-auc-T* suing arc r-JiifuI y arJ orert 
TTcc lc*gci>cr w h c<»- 1 1 rv r rrt fc n ihrec 
^cm tf't.n -a!i v.*i'«o J tv rrt i— —cd-itcls to 
Adsi PH Cn'— ttJcc 

I t^c taj 

/ R C. liNGARD 

Scc’-ctan B.«c tal 

pOSSHAM memorial HOSPIEAL 
^ Krrrtword B'' pi 


R O r H r R II A M II O S I I T A L 
<pn ped 1 

CASl ALT> HOLSE M RCFON 

A"p .to- arc rr ted fr q jl Cd r'en f r 
the r»''t rf Cj jain fl j\c 5 rrePT Dot o to 
♦mg'! c a w n « r'' *i'l tf il work 

in (he I at N -sc rd Ih Dcraitrncri Et 
Cci cr! ctrvttCTUc I Iv gjired in ihc ifc irncnt 
f frat! rc« Sj'jty CI*o rcr jnn rr »iih full 
Njrd mccrvc arj Uu ett 

Arp!i*ai» MNt S V *> «l ic ertt tr-.!n3 n al 
h t Id tv s-nt to the SccTctart C W H«ritT< 
>> 'locrgatc Street Rtihcrhan k 


A\*ped anad-i -d HONORARY SLRC 

r general s**raal v«k 

Arp y ist h lull rameuLrs. to the Sc rcu 


geCLES 


AND PATRICROrr 

rear AJar^h-^ cr 


SLRCEOS fcqu.rc 
/'vrier-Vcf 1 t 10 i; A^rio n„-acrt |n first in^tar 
ra e o '‘ork Salary 

J^ELLING SANAtoRILM HOLT NORFOLl 

'■'aitarc— ent of the KcIIi 
tJnirc apnj cations fre 
r ih 'Uiiabic Qua! .catio 

t c ^’EDICAL slperintenden 

t Kell IP Sana -on L-T Hoi Norfolk (169 b« 

vrfcewi r ^ CJten to applies’ 

/ a “s of lAj~) fi^c and t*ho ha 

rcihX, op^oe- - knowledge of nod« 

ru- Sanaion *n trc-tmem and V ra tsci 

abrs^wtVs" ” OcTOtv' 1st 19 

„ f ^ rreu-ds A Sap-ram ration S<rhr’nc 
Qualin-aiion lo oil 

Ke tot -lonals «Ji uld be ert 

>^etary Kel ng Sanaimum Holt Nerfo 
J>«ncmbcr ru 1935 


L FICESTCR RO^AL INFIRMARY 
( CO Beds ) 

S fl -IHS I II P :CO J Res Anaoth 
I Rd. Rwd 

VACANCIES I OR OCTOBER It I9ts 
HOLSE SLRGEON 

Salars £l»* per arnun Apphr^rts mus ha c 
held a Resident Hr p aJ rr*! or had n Lr c\ 
pcricn c' of Hosp tal werk 

Lmjcvess ul candKlaies ssill tv con td red f t 
Senior CaseialiT OFi cr il they so ntmatc 
CASLALIT OFFICERS 
Senior Casualry Ofli'er Fcllo dnp ardard 
Salary £1_5 per annim 

Junior Ca.u3lt> O^-e' Salarv £103 per nrim 
HOUSE PHkSICIANCIES C.) 

Salary £1^ per annnni App!r*ants mutt ha c 
held a Res dent Hospital pcKt or had 5 *nilar t\ 
penm c of Hospital work 

RESIDENT anaesthetist 
S alary at the rate of £1*0 per ancan for Tir^ 
SIT moQths £-00 per annuin for ecmd lx 
month f -* f r third aix months t- 0 fourth 
T months 

Ap''!i'3tioT»T With cepes of three re ert tcsti 
mon a! lo be lirwarutJ to the Hotrv Giverncr 
and SeK.retao not later than A(.gir>r Hth 

Appointments for six rrmih will be rr dc cn 
August r4ih 
July 1 th 19 tg 


R 


OCHDALE INIIRMARV 
DISPENSARV 

(110 Bed Three Ko/c. r s ) 


AND 


Ihc Biard if Atapjecfrcnt n itps applKjt m 
f r the a-'' mimem of HOLSE PHYSICIAN 
(male) The salary attached to (be ap-Xirirrcnl 
I at ibe rate of £1 0 per -rn m mih beard rest 
d-^ e laundry The duttm in lade work in tbc 
On Patient \ural Ophthalm ct dcrarir"inL 
well a m the wirds The Hrsp t-1 eosers 
a larrc industrial area and Tords excellent 
omriunty (or rTpctirn-e 

AppI -ations latine ge nali nails etc rub 
three resent lest/monial* to be sent to the Sccrc 
txry Rpshdalc Inflrmars 

Infrman O"' e U WV'N'NE 

Rochdale Secretary 


L OUGHBOROUGH AND DISTRICT 
GENERAL HOSPfTAL. 

Applicat ons arc inx-ted from duly renstered 
candidates (male and unmarried) for 

a HOLSE SURGEON salary £1 0 per annum 
Lcmt Aunrtt Ist 

a HOUSE PHYSICIAN salary £1-5 per annum 
from July 1st 

The appointments arc for six months and nv-lrdc 
apartments board ard laundry The Heuse 
Surpeon me x an experienced an-csthetrst 
All 3001*03 1028 statra? ape etc xntb copes 
of tcstmunals to be sent to me at once 
FRANK H TOONE 

9 Leu.es er Read Sccrc:^ 

Lcii hborou^ 


jyjANCHESTER ROYAL E^ E HOSPITAL. 

JUNIOR HOUSE SURGEON reemred SaJan 
<■1 0 per annum with rcs'dcn'r board c*c. 

Apr cations (wnh cop es of testimcm_l > 
endorsed House Surgeon to be addres cd to 
the uodcrr'cntioned 

H R NORTH 
Gen- Supt and Secretary 


lArpcn/ e/i/t ct* tt nurd an r 










THE BRITISH MEDICAL JOURNAL 


August 6 


CHARGES for ADVERTISEMENTS 

CIRCULATION OF THIS ISSUE— 41,000 COPIES 


Cl ASSIFIED The Minimum charge is 9s , which covers up to 30 
Tvords Extra words are charged 1/6 for 5 or less 

Example 33 words would be charged as for 35 
Name and address should be included when 
counting words for cost 

If Box Number is used it should be reckoned as 5 
words in the total 

Replies should be addressed separately to each 
Box No care of this office 

Adsertisements, accompanied by remittance, should reach 
this office not later than noon — ^Tuesday, to ensure 
INSERTION IN CURRENT ISSUE. Please write clearlx 

DISPLAYED Whole page £24, and pro rata to one-eighth page 
Special positions, dates and rates on application 


outdoor unvu«, 

▼ » ASSISTANT ncnr CarUitT Salarr — 
to cxpcncncc -minimum wuh f ~x 

rooms and attendance and car ^rovlJ^} n , 
licence essential ouni, cncrpcik j* 

snic niiionaliii ind igc and Iurn^>itc- 
and pholopraph niih apphcaiioa — aj* v 
7809 BM A. House TiMsiock Sq>,a c \\ r , 


W ANTED OUTDOOR kSSISTVST d 

once Pmcl and private rraai'e v 
Manchester English or Scotch State • 
single Salary £500 p a and toons 
— Address No 7SI6 BMA House Tj» 
Squire W C 1 


W ANTED AN ASSISTANT WITHMEW 
partnership and ultimate suc'essi i i i 
opposed country practice in West Sum’ 
man prepared to settle down and has own f ~ 
State essential particulars and give refe’e •n 
Address No B M A Houve TJt^ 

Square \V C I 


W ANTED IN COUNTRY TOWN IN vr 
lands male Outdoor ASSISTANT N 
£400 to £450 according to c'tpcncncc Car 
\idcd Ample time for readme — Address N 
BMA House Tavistock Square WCl 



Everj eflort is made to ensure the accuracy of 
ad\ertisements appearing in the Journal No 
recommendation is implied by acceptance and the 
British Medical Association reserves the right to 
refuse or interrupt the insertion of anj advertisement 


ADVERTISEMENT MANAGER, BRITISH MEDICAL JOURNAL; 
BMA HOUSE, TAVISTOCK SQUARE, W.C 1 



CJCliull Zl 1 1 


NOT CL^SSiriED 


CIGARS (ENDCUT) ALL HAVANA 

lOllvCCO GOOD SMOKES n -i low price 
cuilitj guaranitcd Box of 50 for 25/ post free — 
Sok Manuf iciurcrs J J Erfiman ^ Co Ltd 
90 f lucadill) London N\ 1 (GRO |529) 


“BIZIM” CIGARETTES 

llirsc luxurious deliciously salisfying smokes 50 s 
or 100 s at C/3 pur 100 58/6 per 1 000 post 

frtc — Sole Manufacturtrs J J Effeman N Co 
Ltd 90 Picuadilly London W 1 (GRO 1529 ) 


“SOLACE CIRCLES” TOBACCO 

IMF lincM combination ever discovered of Choice 
Natufil Toblv,co^ Every pipeful an indescribable 
pka Lire I -/0 per ^ lb tin post free — Sok 
M inufauturcrs I I Fpecmas 5. Co Ltd 
pKuadilly London W ! (GRO 1529 ) 


M I e T H C S E DESIGNATORS 

1 O ^ letters after a CHIROPODISTS 
name indicate th it he or she is a MEMBER ol 
the INCORIORNTED SOCIETY OF CHIRO 
I ODISTS I ounJed 1912 Patron His Grace the 
Duke of Purtland KG PC GCVO Panel 
of Examiners in Medical Subjects approved by the 
Hoyil College of Physicians and Royal College of 
Surgeons of I ncland respectively The regulations 
of the Society PROHIBIT Members from 

advcrtisinc but names and addresses of Chiro- 
tHxli IS in the district who arc members o! the 
Society and also information regarding training 
fur NIembership nay be obtained from the 
Scvrciary Incorporaicd Society of (Thiropodlsts 
1 Cavcndi h Square Ltndon AS 1 (Tele 
phone Langhara ^22S ) 


O rPErFD IN DENONSHIHE FOR DELI 
calc 


\CC OMSTOD \ HON in b nc of cxperien cd 
n 1 jt rv'uh "t t A oun f nilv Educational 
li t lies lovuv sirrtunLinc> Terms bv 

arrin< r — At, Jr-ts Nu ”t B SI A Hoj c 
T \i\t 'vL Sv,uarc AA C 1 


T APiASKniSG DLPLICVTING TRNNSLA 
tidss ~U\-<rts n V: TLSTl 

SI'INIMS THLSLS ct" auCL atcly co"i*d n 
lb It a r n — AAiPiis IIlxeal 

D j>t n II t c r ru n St -ct London AA C 1 
( -- U I \ H - c> LL S OQ r’X 


T A PEAA KITING — SPECIALISTS IN TA PING 
Medical and scientific papers lectures 
theses and books Shorthand typists always 
avaihble Proofreading indexing — Margaret 
AVatson Ltd 16 Palace Chambers Bridge 
Street SAVI AAHItchall 3838 


ASSISTANCIES 

W AN I ED JMMCDIATCLA OUTDOOR 

male ASSISTANT for colliery practice in 
Co Durham to rcMdc at branch Salary £350 all 
lound (including board) plus £50 car allowance-^ 
Address No 7743 B M A House Tavistock 
Square AV C I 


A^UANTED IMMEDIATELY INDOOR AND 
T » Outdoor ASSISTANTS for Town and 
Country Praciiccs with and vvjihoiit view to 
Partncrvhip Good salaries olTcrcd Stale full 
particulars — British Medical Bureau 33 Cross 
Street Manchester 2 

ANTED AT END OF YEAR AA ELL 
» V qualified and experienced ASSISTANT 
with view to Partnership in good-class mixed 
practice 8 miles west of Marble Arch — Apply with 
full particulars Address No 7611 BMA House 
Tavistock Square AV C I 

W ANTED FNO OF AUGUST YOUNG 
male indoor ASSIST \NT English or 
Scotch preferred for mixed practice in North 
London Time for reading Car provided 
Salary £a00 — Address No 7825 BMA House 
Tavistock Square W C I 

W ANTED \SSISTANT OUTDOOR MALE 
single English or Scotch for industrial and 
private praCTicc Yorkshire Age under ^0 
S_Iary £300 and all found with tar allowance 
— Address No 7623 BMA House Tavistock 
Square AA C I 

W ANTED MALE ASSISTANT BRITISH 
Isles for South Yorkshire town Indoor car 
dispenser hospifa! cxtcllcni experience Salary 
£t0O-£j*0 pa — ^Addresx No 7X01 BMA House 
Tivislock Square AA C I 

W ANTED OUTDOOR* MALE ASSISTANT 
for panel and private practice by Scottish 
d>rt''f In the Midlands Salary £400 per annum 
Lvial hvnJ — Address No 75X2 BMA House 
Tavi o V. Sq iarc AV' C 1 


A ssistant^ either sen under ^ 

with view wanted In larpc S U 
Practice ENT Gynac or childrens s 
desirable not essential good rrpvpccti S. 
particular^ photo to— Addre s No vfq pv 
House Tavistock Square AA/ C I 


A ssistant required male scorn 

or English unmarried youne c''* 

ence general practice preferred Own i\'|* * 
branch Kent border £^5n per annun i 1 
£50 car allowance and garage -—Addffts > 

B Nl A House Tavistock Square A' Cl 

A SSISTANT OUTDOOR W ^ 

■tx mdusirnl district Essex Marne 
enced G P Young energetic Engli 
required Salary £430 £50 car allowa « 1 
furnished house Early vkw if 
No 7831 BMA House Tavistock Sqiv^ 

TN GREATER LONDON— \OLX0 
1 TANT Proicsiant Dntish (inclmlm l 
nnrriLd or about to be Larpe ptaeral t 
practice If satisfactory junior pM\r t ^ 
Salary £400 with free house 
copies of lesiimonials — Addr«s NO ‘ 

House Tavistock Square AA' C 1 

M T> ch b over three I ew^ ' 

tj , peritnee House Siircee . 

ASSISTANTSHIP preterabls ,,7'' j 
Tyne district or Co Durham ^ 

absiamer Energetic Good 

No 7819 B M A House Tamfcvi. 

AA' C 1 

IVJORTH wales— WANTED 
In indoor or outdoor ^^nnre n ^ 

sea AVclsh speaking csscninl m ^ ^ 
particulars to-CiiEMic^iJ 
Hoolc Chester 


LOCinVTS 

X^ANTED LOCUM W 'TH . 

W for r>c Ear and Throat „ v 

dern Northern »”• ’ 

September Hospital £5 J ^ \ — x. 
private practice by ,o Xef'*'/ 

provided and nil f^und -Kerb ‘J 
Ear and Throat Hospital LerdnoerJ 
Ireland — 


T^ANTED LOCUM OP K-" 

W LOCUM for two to three ' , f i 
or O tober in Lanca hire e^' W > , 

three guineas per ''^ck r^ ^ so ^ 

Own car css-ntnl — Addr^ 

Hou^c favisiovk S quare A\ u ^ 

XX/ ANTED LOCL 't TOP T'p” - - " 
W O I :nd to Ihih in 

tice ntar Mancheaier M „ H 
— Vddreas No B " ' 

Square AA C I 


\x7anted ioclm r'' ' 

W V™ of Neath ' to 0 « 

„ceLlj «.th all foond S a^r r^ , 
canon. U tral bond , 

Ifot. c Ta.iMock >;ou.re W L 















■\l.GU'?! 6 19'''^ 


Trin BRITISH MEDICAL JOURNAL 


39 


H our)^^ uxruMs xnd assistant'; — 
I t*vn‘-t>'CNl f <• *< a*Kl t ax-ailibc 

iT'-'-v.uic rr rest future arc m'licO to c m 
nx n-cate « th—Tur MrrK a An-s^ ■LTr* 

^■*1. *'a~— --n "^rcci ^irarvj NX C 


T OCUM MEDICAL OmCTR WASHD 
AurJ't n■>■•r^s. <incn rr» 

icn n* 't-a^ a'cv'ruif'c »o c\r<Tifrcc t*ih 

to-rU-rcsi-TKe— Ar-Iy Xfiotr'i ii rT»t>TTx^rsT 
OxTTT Krh»« <■ fXu'ijcrafKj Nfrr ■»! tat) 

R)*u>rv i-'wtlati. 


L OCLM KCOIIRED FOR TWO WIFKS 
Afv VI Fa’ Auf or HuJJm eJ 

Car Qi-'*' M Fut jT •ance »f u •'t rv.n cat 
— Ad- css No * PM N If- c Ta^ tosl 
Ss,^rc. \\ C X 


ywpicvL POSTS DisrriNSFns 


MO MR CP WANTED TO JOIN 

* , ^ three oihcR in South Coast pneuct 

S)l\RL cQUj) tnrscsenh of about C ROO nsini; 
to ex, a) tv C xvJ h ue fif ourcha e Hosrital 
fa 1 lies av’iiliMf — \dJrtv So -SI BM A 
Uca* TaxtstocA Asiurc W C t 


pARTSrBSJlir WANTED AfONTTfS* 

*• r rt n nary Ass tan iirrooor if r«>s'tblc> 
N.*' cr**'cf C.t If S Ortho»ucd«c Casual > Sur 
ft Jt >ri Vferfal lfo«Mtal arrointrncnt 
St n ChPtCItJ Cath 1 AO yn Sursicaf 
^corc — Au Jrr»v No 619 DMA. House 
Taxi txV V. ate \\ C I 


COXHRSfT CYHST -- PARTNrRSHfP fS 
CO tfx town Xfan Iccn on ncsfi tre and 
tvi t "^cd I s rat cnt« larcl 1400 

Oxrr fti>M pa lb r^.-sharc at t»o years pur 
tfba c Hose vile Of rc^i — Tirr WfsTirv 
xfipir i Arivry Clare Airecf Rn of I 

(Rrn f - / >» apj K Rfsl erd Street Strand 
XV C . (le*~rc Bar ' » 


A LADN DISPCSTR COON KEEFER SLP 
r’ o- at y on revues <Ii,a ^ 

vJ »iJi ntjeal cipenc« c h rriratc rraciK-e 
a"d d ST^-virr wc.t, al o fa inJ h Ca'iepT o *01 
LaS-^ '•ns c i*- LONDON COLU.CC Of 
PHARXtxCN FOR WOMEN Frcrar-tjcr^ f t 
Eii"* SaLo-s — Wr e we c (Bayi* 

-*■3 -• C^9) SeartafT - XX estSjs.m Fart 
Read. WJL 


A COLRSE or TRAINING IN n!<TENSlNO 
vtd PNama-y U ni-n at CORDON HALL 
>CHO0L or PHARVlAO a-v. Secit-arjDv 

..xe^v-rt can be r..-^ -d fn Dvxctirv Sos 

-•'-arx A— il a-d Ser ~~Sr — Ar-’y rri~--'r\al 

vAocI c r**a*nt-“y D-axton Moose Gcri3;.-j 
trcci XX C 1 Ph'-)' Etrt cfl 39 o 


T hird partnir htoLiRrn rapjdlx 

tnerex n pr tt c rear Miph‘*stcr Share 
r'*e th d 1) >ear\ ptr^ c rv 

clu.* re Nv V vr*'t« C cat ♦ pe IJirre Sou xnc 
cs a r< Itr— >fw-»ic «n r v. a tnry t •cir"! o'^^cfCd 
SI wrel — Au res N ^ R '! A Hruse 
lux's fvli. Nq a W C I 


U rCFNT— ON tlHIRD SHARE IN INDLS- 
trial rra n» e r^^ar Lo**- n e r p r 

c^a c Las year « re e o rr £ I "1 L- Tea e 
H-*v. I fc~t I rt < N.ot Fs'sencrccd 

CP Ac-qu tc rr-s^ d istoI — \Jotcs N 
-OCXfAHveT* vLNj rare W C I 


niSFENSJSC CAREER FOR lOL^C LaDHS 
y FLLL TRAINING fof Apod^-a |U j 
-crt_a e. E" r •"-tri rtery iFree r*p- ‘n — 
Xr-f 7> rruv—sal Cer -al SJjvf c» rca'r-aey 
3 A e^'-i S cel, Lcn. a, S W 1 TcT’^oa, 
IA41 

niS^ENSEP rilALL) AGED 3< SEEKS POST 
^ % h DiVOf Of Hch~ \X j I r-ake h r*>e i 
cfxera} ) uve' f ce eci-d dxic-^j b s fce-t becla 
•n'lislscn rt’eren-t^ ch-.r— er ruarap eed by f— i 
f V. ICS nrs— Ad- »N No -*C< B Xf-A House 

a'ls OCX. S,-*a t XX Cl 

3OCTORS REQLIPrNG QUALIFIED 

A Swrctirr 

ts-v-ae-s Of Ou-''cuse-D -<crs«y are fisitcd 
> ^-•t *ie c p'-c— Te— -e Bar <««» Titf 

“7^21* 3 U-r-ar Hew M 

h-iat**y Axf e Lrtj^cv X\ 

ADI B5w OLALiriED AS DlOATnEMlST 
a»d trc3 Arulnx) 
arcpe*«-d ycyd Werc*a*ri n frr, -d rn re 
cs POST I- /'oss'ul Or pnxatc «crV 
No -snj 

c*’v: Tzrrvk. SQ”,e W CJ 

'^epical CORPS 
\\ 1 Ecrfcrc-i Sqtiarc 

'' ' X rtena 2-—) sepp c* 

D ’>~»n BcxMec«iers Laboratory 
^^=3. Sj^Tzs'r A, 1-03 Mate Slooi 
rxlT- . Tm-'cnt Ord-il cs Dental 

iCTk O -crLis Pc-ers Carc,^kcn. e-e wiihcot 
U.S- to r*c5-ecijTe crployen 


/OUNC ^ 
V NHP* 


- J CENTLEXX OXf AN DESIRES POST AS 
NURSE SECRCTART lliSiS, 

rf '’~C* '."T IT erwed in r-cd al 

^mdo*.E Sduie, W C 1 


rAItTXUtSHITS 

V'-'^ED better-class PARTNERSHIP 
PTcWimcr act 47 n Otfotd 
7 2^ fl-*t«-£2.0P0_Add,c, No 

° Hcnnc Tax-u ock Square XX C 1 

in-mted for a 

old-csabl vbed sutJ b-n 
Pri-cstant shen pro* 
) cue vi-*rTPr^"^ e srpoictncnts held 
f^e c.oxpccu Sh rt worth Cl -50 

4¥sd'2r\tc'i f.t^ 

'-'’’x — partnership in 

T' 1 .r Pra'nicc. Pare! 2 <00 

« {nI Haff-share £a OOO or near 

how — Tut XXcerryv Midical 

LJ Bc-fo d Sired SitaiJd \9 (Tcmp'c 


~ The NTnie<; ird Atldrcstcs of S 
^ Adtcrti 9 crs using ^ 

I BOX NUMBERS | 

S Tre held h\ us in <lricl con S 
S fidence and max not be disclosed s 
S Applications should be S 
S sepanteix enclosed and cicarl) — 
S addres ed S 

sr Address No =: 

“ B-\1 A House S 

” ToMStock Square 11 Cl ~ 

~ All CfT'~iunoati r' are forwarded " 

S to -dsTTt sen under r’aia erxer m 

^iiiiiiiiiininiiiiiiiiiiiniiiiiiiiiiniF 


rn vcriCES 


IMXIEDIATCLT PRACriCE 
Lorvxn Iru-fnc fl <C0 upwards P^nel 
c"cn uf Amp c caruf No area > -“-Adurew 
No - 6 D X| A Heuxe Taxijiock Square 
XX c 1 


Wanted 

>F Lorvxp 


wanted immediately 

» » countrx PRACTICE from i 


UNOPPOSED 

country PRACTICE from £1 000-f 1.500 pa 
with Panel Good csrden and hourc cc'^nial — 
Address No TO B M A House Taxatoefc 
Square X\ C I 


\X/ANTED GENERAL PRACTICE IN 
» » London m omc about £2 ©00 per annum xsith a 
tfubxtantul lunJ Preferably N XX XX or S X\ 
Cash as-aiTable — Add cs No “607 DMA 
House Taxtsiotk Square W C 1 


F or sale at athlone, lire the 

Medisaf PRACTICE of ihe lire Dr Thomas 
P MacDoPncH Tbc Purchaser would haxe the 
ortiort of purchasmr Ihe resid n e which contains 
a theatre rosarc hotenaf odfce waion^ room 
coapoundioc room -cd laboratory dark roo-m and 
XTOlei rax and r ray apnararo ard bousehoW 
furniture -—For foil pam ulars apply to Fai* aw 
M tTtTAGH SoJici prs Athlone 

F or sale old-established high 

clo-s PR \cnCE in fa.h ciuble easide resort 
South Coast Excellent ho«s- and sarden ell 
or let Another conxmicnt bouse can be had 
Practice f l.3<0 Ample scope for increase and for 
surgery hospital and pnxatc. Two years pur 
chase — Address No “S2-< B 'I A House Tati- 
stoek Square. XV C I 


pTOR jSXLE— COUNTRY TOXX'N MIDLANDS 
■*• PRACTICE Gros income £Jjr>0 Ideal fer 
pannerxhip Panel -Imost 3 CCO xiodem ho-osc 
and garden with tenns court Educational faoliUcs 
unusually ample Ccit-re IjosriiaJ XX^idc scC"e 
Premium | years purchase Hou e 
£- <00 Or y app’icanis with sorre capi.al r’eve 
^Audre« No "S 9 B M A House Taxistcck 
Square W C 1 


F or sxle practice of fx-oo suitable 

for nan and wife n Nonh Midlardv Two 
years rori.ha«< Panel -_00 Good scope — 
Aourcs* No Ps B Xf A Hou^ Tanstexfc 
Square XX C | 


M idland cm— womans practice 

This Pract c car ea i y be ar^almmated with 
the ab'jxc and xxorked as a Partnership if rcqui ed 
Receipt axcTairc pa mte^sne Panel V’') 
Gc««xi vi-v Prern urn £1 <00 Home rem — T he 
X\ f Tr»s Mroir i Aervry Cl re Street, 

Bn tol I (Britt I - ^<91 and 1< Bedfo d Street 
Strxnd VX C (Temp c Bar <3 ) 


\/fIDLXNDS cm —MIDDLE AND XXORK 
Ix'l- In -cla s PRACTICE n r’'^<3'tt suburb 
St t M fjr tuo fnerdi tn p rtmhfp or may be 
run by r e man an 3 an a s start Cash rccapts 
la I year ft r>x) Par I I < n Good ptm-ect-t oI 
t eidr mTc- e rr-eJ'^r r*od*m eorrer bCTr*e 
txko re eft n f c bcurc'om er-a’^t prclcs cnal 
rpof'* d Hib c carat- - lud-d ra dm AI o 
brjjxvh i/rr-ry -both r op-rr fc vile Pre-" um 
rra t c £( OiO — Adu psx No 1 B M A 
H '' e Fa itivk S<. re XX C I 


M idland cm -steadily increasing 

PRACTICE A cr^re £ - A p j (Rceemt 
£ - < I t >c3 > Parxl - ICO XVell esjib '**'ed 
Prir^ium £< -JO Houvg jb rt cllesj rcmir— -T he 
XX fstttv Mine t Arfv Y _ Clare Sj cl 
Prr cl I iflnn f (<9> a-d l< Bcdftrd Srreer 
Strard \V C (Ten le B r -<J-1 


N E\\CX5TLE-41NTYNE-\\ANTED PRAC 
TICE •thin 0 riles Newesitte-tn-Tyre 
Iv '~e ur to Il,-C0 Parel Eua-arcvl fa il; 
tr Carder — Xd-rrns N so< B XI A He- 
ia i«'o.k Sqiure x\ C I 


P RACTICE IN COLNTPY DISTRICT 10 
mlm so th t Gla g-w fer s- e Iivome 
ap-rotirjttl) £1.. A Goed bouse a’<o f r <-fe. 
Sjbsfa-ial Par J CocO r rod- tio- gi n — 
Ar-h Ct wroin Hr*»ns vp C rtsov So i itcr« 
‘ WcM Ccerce Street Cla oa C- 


S OUTH coast - PART PRACTICE t TO- 
retber •iih dr ab - CORNER HOLSE 
tardcTi rar--^ Ex e ’eri pos -n Sj t rjr or 
• I man Xficht c n der ra*tnerxh p Hoj«c - 00 

Share by arrancerent —Add C' No “91 B XI A 
H cie Taxiitc'ck Square \X C 1 


W EST RIDING OLD-ESTABLISHED PRAC 
TICE axcrayng £1 -no Pal -fO to- 
creas ng Amp e scc-e Prem uma £2 <C0 

Pic- ant house tcn-is fretho J £1 "CO — Address 
No "6 I B XI A House Tavistock Sq-are 
X\ C J 


IT XHLES CHARING CROSS RAPIDLY 
X ir-icusTR ..m Piref / ’ 0 Prrtafc 
£J PO Dcnri t on prerr^ss House freehold 
to let cr sell — Address No B M A HOwSc 

Taxistotl ^uafe \\ C 2 


HOUSES CONSULTTSG ROOMS 


ESTABLISHED I94< 

ELLIOTT, SON & BOYTON 

(H C Rowt F S I) 

\'ERE ST„ C A.A*EN DISH SQUA^RE, Wa 

fjrc e Agents Auaipnee f end Suneyo s 
arc the BEST LOCAL AGENTS for HOUSES ard 
CONSLLTING ROOMS m th H..rl<ry Wimrole, 
Oueen Anne ard other streets tn tbc Caxcrdrsh 
Squ-re d,.m't \alu 2 tjons for -11 purposes 

Telephore 3^04 MwFsut 


D EXONSHIRE STREET TWO DOORS FROM 
Jfarley S reef -n crcellea CONSLLDNG 
SUITE of three good roo~y m op- ol the Pnest 
p ofcsstonal bouses Rent only £2.0 pa or 
single rooms may be b-d at £100 poi with plate 
on the door and all sernccs, A -can Sept 29* 
tg^S— Address No “fiio B Xf A House 
Taxastock Square XX C 1 


"VEhTAL SURGEON CAN OFFER SURGERY 
J XXAITING-ROOM LIVING ACCOXIXIODA 
ION efe in irrowjng seaside town-— Ad r^ 
,o “fcne B-M.A. House. TavT-tock Square SX C 1 
























-10 


THE BRITISH MEDICAL JOURNAL 


August 6 , I 93 S 


ESTABLISHED IS60 

BEDFORD & CO. 


Suneion Auctioneers ond tstate Agents 
10 WIGMORE STREET 
CAN EN DISH SQUARE NV 1 

Speciniists in Professional Houses, 
FJtIs, nnd Consulting Rooms 

in Jfirlci Sfrctf md IcndmR Medical Postfions 
Teiefhane Lant^ltam 3927 and 392** 


D U'rcriN \I)JC)IMNG SLOANC SQUARE — 
\ dcJij-hfliiJ HOLSE m order jwsl rc 

fJiLor Hid \icommod')non con j is ol fine liMnn 
(foni jnclodmE »dcil con oltinc TOd uiiunc 

r< n <to the cre tmd He t r Upper part perfect for 
pu\ itc re idcn c S\ rifienl price £2 9^0 feir Jonp 
Ic ISC It It " eroiind rent — \ppli Sole Asents 
J Issspr tiiVTc ^s^> PstTsfRS 2 Hans Road 
S\\ Ken \HM{ 


H M<ir\ sriiEn and district— a num 

her of Cttedcni CO\Sl.fLTfNG ROOMS arc 
a\ D aUc (oi (wU and part urnc use at moderate 
rem^ I irneuhrs on application —T lcood and 
C o 10 Henrietta Place Caecndisli Sauarc 
W 1 I anr 2fni 


Q l I EN ANNE STREET —ONLY 140 PA 
St ores cvccptionallv fine CONSULTING 
RtinM tor use uhen rcpi ■* 

all services Rcndcninl 
— Adelrce^ No 6*5^ ( 

Square U C 1 


S t Run —( ROW INC DISTRICT DOCTORS 
HOUM ti' Rtnt n Cd per week inclusive 
4 l di ais ear lec garden Panel 41 intrcjsjnc 
iMd nil iciJv did 1 jO list jtar Will accept 
llM ( I \ \ I ondun W C 1 


HARLEY STREET 

AND MEDICAL DISTRICT 

for all i>pcs of available accommodation 

BERTRAM & CO , Acenis 

fO ConnauBht Street W2 PacJclinston 1D49 D 


il^PO^TANT 

lo ME5IBERS of iJie 

MEDICAL PROrCSSIOiV 

CLOTHES or DISTINCTION for GENTLEMEN 
ol DISCRIMINATING TASTE Specially Cm 
Fitted and Moulded to each individual figiire 
made from Tmest Quality Materials and in the 
Best Possible Sf>lc cost no more than mass 
production readymade clothes 
The invaluable Practical Experience and Advice 
of our 14 Expert West End Cutters and Titters 
IS alwajs ai your disposal 

VII IIVJL/ONt Produrtfonii are 11 MSD 
riMSlIID IN MCIlT FS^TNTIVI OErVII 
SPFCl 1/ OFFUt 

jVCKrr \FSr (m hlaek or prc> ) £4 

I Incrl he t qualily \ri Vrt ‘'ilk oi Vlpaci 

‘^Ol ID F VNCT WORbTED TUOUbER® £3 2 
The ideal ^iill for Profe lonal or Ru lnes« vc ii* 

1 OHNf'F SUIT^ to mcfl lire from £0 f» 

OTLRCOVTS , £5 

DIAMR stirs £n 

DRESS SUETb from £10 JO-* 

PLUS TOUR suns from £6 Ci< 

Till IDLVI ‘'OH for Country and Sivorlmc W Car 
rOID MID VI RIDINt IIRLTCIiri- from C- Jh 
RIDINT II \linS iR fl^ 

niDINT IIOOTn £a 

COsrUMIs £. LONf COVTS 16 6 

UNSOLICITED AIPRECIATION 
I stronch luhtse all nuthcal men nho msh to 
hai e saltdacuon to vatrotu e Harn Hall Ltd as 
all the clothes / ha\e had from them dunne 
itars htne been perfect in Fit Cut oud Finirfi 
(Sicncd) SJA MA MB FRCPS 

Patterns post free 

perfect Fit Guaranteed from Simple Self measure 
meat Form or Pattern Garments 
\t itor to I ondon cm t»r<ler md fit 8amc daa 
Sj>c<rlal 1 iticcns ould then be cut «nd PcrU^i 
I ittlo^ Ctothc** supplied after witlioiit tr>jne on 

HARRY HALL, LTD 

Oovcrnmfi Director Harry Hall 
t Ur Co If Itrcerlic II ibit and Co-<tuine 
*" 5 pcrial|H| 

Ifll OMORDST W 1 119 CHl VPSIDL LC2 

Tciephones 

GERrard 4905 4906 and 4907 NATional R696/7 
Makers of Finest Qiiality Bespoke Cnd Sporting 
and Hunting Clothes for Ladies and Gentlemen 
Jiie.be«t \»*ard>* 12 Told Medal 

Li over 10 ye ir' 


mSCELLANEOTJS SALES, etc 

INCOME TAX 

TOUR burden le OUR biiidness 
Tax Specialists lo the Medical Profession 

HARDY A HARD!" • 

19 CHVNCFRT LViNE LONDON WC2 
Iclcplione Ilolborn 6639 
II'r//e for free copy ol Adxicc on Income Jnx 


COVTRS FOR BINDING 

Vols 1/nnd 11 of the BRITISH 
MEDICAL JOURNAL for 1937 
nnd previous years can be had 
price 2s 6d by parcel post 
2s lOd each 

Orders with aporopnale re 
iTiiltance should be addressed 
to 

THE SECRETARY 

BRiaiSH MEDICAL JOURNAL 
B M A HOUSE TAVISTOCK SQ 
LONDON VVCI 


APPOINTItnDNXS — Conf d 


D UEADNOUGHT HOSPITA! 
Greenwich S E 10 
(Seamen s Hospital Sociti> ) 

Halftime Non Resident Male RECflVlNG 
ROO^^ OrnCER required from September 1st 
for si\ months Morning or afternoon sc^ionv 
With alternate Saturdays 9 a m to 12 noon 
Previous experience m residential pasts essential 
The post IS suitable for those studjing for hiphcr 
examinations Salary at the rate ol £150 per 
annum with mcaU 

Applitation slating ace nationaUt> end expen 
cnee accompanied h> copic* of tc umomals lo Ic 
sent at once to the undersigned 

r A LYON Sccrctart 

July 30th 19^8 


SMALL ADVERTISEMENT FOR INSERTION IN 
BRITISH MEDICAL JOURNAL. 

The M/mmim cinrge is 9s wh.ch covers up to 30 words Extra words vie chirged Is 6d ' 
or or less txArriplc 3i words would be charged rs for >5 NTine Tnd “iddress ‘^hould 
he included when counting words lot cost ^ 

U Box Ni Mill n IS used it should be reckoned ns 5 woids in the totnl 

PLEASE WRITE CLEAR! Y— ONE WORD IN faph ePAOP 


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(30 words) 

91 







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I’ -JSC insert m\ idv ertiscnicn! in 
i . -0 


tSslICS 


Nnmc 

Address 







An LSI (> lO^S 


THF BRITISH MLDICAL JOURNAL 


41 


COLST'i COliSCIL 
nniic HiMTii Drr\mMrvT 
cossiLT\sr o->;inrin\s 


T^ C 1 C il inM o flrr fr "i 

ret trtr\t r''*\ j rf» t it t, 3 ol 

^•v} c«'v^ fri rJ in c*-' nrKal w i for i p ' t ■" 

zp^y- -"f-t > c " i uri H m lf'rvt> ca vh-^c 

n't J ■" rra tiui *'cr> tro^ r h » a t Th 
cc" 1 an ar'N'"' fil » ’ rrq rl f*j' t attcT>J 
ca n i**c I ttv 1 D nt of fu f anj 

^ u 1 •» Ot " to- ar>J Swan (•'r-V i rn c 

01 ^ ml n- cr in Of re f t c c itf t r“ f •nJ 
ftN t anj ( ) to »r'w "t a c*^ tT r*i i be 

arr ciJ t^c Col** > C _n l t a t In b c 
her aN ”-~c 

Cc**' I t^t •< wi h* a ra- M by r'^n-u ! pra li 
ti rf*n b i*-e oc* » I ht fcv.ttf rj t 

t rc*v tn c- cn 1 iSe Cx't.r > XfnfNjJ 
O'*" 'cr a**,* c w lb tj nb-* frCJ rrr* r i 

mav be ’see rJ fr t*~c 1 t •’•c b> b rn 

Tb tc’- "^a >n of »Sf c “ -art bt a< 


Co** u tat) fM at Of * h n on* n c cf 


r*” SA, —TTi 2 2 0 

lpn^r*“t 330 

I rrm ^ to IP r* *n 4 4 0 

I rr-n 10 tn 1< f-t-i 3 5 0 

t>kCT 1 ^ 6 0 


The sr-v "nert « J be »t t*’e r 
Cc««.n T Cxj’v.5 a**!! lb afrap**r’’' “t wtl be re 

tacw n_ t**c enJ < ' t»'c rnr rear 

rr-'T"^ of a**^ cat -m ar>d if revi rerf f Tthf 
detj) i c I** a"'* ’•t’nen can be o*’ta netJ from 

lb Coen? Mo-^f e* Vs *-1 Hxnc MaW 
»»rn^ to mbm eo’’*’^’t*ni ar~ ication f srm tbc** tJ 
b** t«u B-%5 run later ib-an Auiru Pt** 

\% L rt-MTS 
Oert of the Crunty CcurwT 

Sen on lto**i* Matw tone 
Id) 


J^ASC^SHIRC COLVT^ COUNCIL 
^\msTos couvn hospital 

Sear Pres^ct 

AppoisTSfcsT or Resident surgical 
orncER 

Arr * 4 Uon are tn? ted f>f t'te arrs-tntnert of 
Pe< -en v rt-al OT cr (f— omed) at th- 
^^^•s cn Coj**ty Ilofntal r-ar Ptes-ot t b<dt) 

A**^ cant p*u be reic»»'» of the bovaJ Cc te^e 
of c hold D - e« Of Ot o-ui of 

"• ar »i 4 fK.irjr and nest be car-t c o* deal ne 
»>h »tj sjcal e^eTBen-f*^ 

Th- Oary « at the rate of f-PO per an- •’a 
tcfei***” t^e tnjal rciw-ertial lu*" p 

Tbe ar*V‘’*j~c"t w f'*' a jetiod of C"’’ ^car tn 
the frtt ifniaosc but nay b'* fe*'mcd for a further 
year only 

rorrn of amli-ai n tnay be obtained Iron the 
C<n.r*y Med cal OP’^'cr of Health Hinnital ard 
Medea! Don-nmert Coupty Of^cs Prettc-i to 
»hcrti app caimt rn tt be return-d rot bter than 
hurnt 3Ul I9tS 

County 0 --ec« GFORGE ETHCPTOS 
Preston CWl of the Coj"t) Cojnet! 

Jul) 2 ih 19 tS 


L 


ASCASHIRE COUST4 COUNCIL 

nHISTON COUN-n HOSriT\L. 

Near Prcncot 


appointment or resident medical ^ 
OmCER 


Ap” n< arc ini ted for ibe rrontr~cnt of 
Ren dert Medical er (urntair cd) at the W h 1 on 
Cminty lloipul near Present (*0O t ds) 

App cants rn-j<i ha\e b Id rrc' borstal 
ap’x.in r’*cr % In »b eh they base raf'd etpcrier e 
in clini^l mdsTirv apd p'throir) ard the) sbould 
hold one c the higher rn'di .! Qualiricaticns 
The vi'ary ts at ih- rate of £400 per annjn 
ro**rthcT uiih tbc osual rc^ dcr lal cnoUtneris 
Tbc appointui'ni « for w perjod cf c^e year in the 
first insian e but r- > be renewed fo a further 
year only 

Terms of appl 'atjon may be c*-tained frm tb** 
Cfnrrr) Medjml OT cf of ffcafth Hospital anJ 
Med caJ Depanment Count) O’f'sss Preston to 
whom an a’m.icatiens must be returned not Utcr 
than AuBi«t 3Ist 1938 
County Offices GEORGE ETHERTON 
Preston Clerk, of the Cou'*t> Coun'* I 

Ju y 2Sth 1938 


E ast ilam memorial hospitau 

Shrewsbury Road E “ (IM Beds) 

Appl catiotis arc imted for the port ol HOUSE 
PHYSICIAN fmalc) The appo ntxacni h for six 
•moeths comicncinB Septemvir 1st 

Salary at the rate of £i<0 per -nnum wnih 
board residence and l-ondry 
Appheattons siaiina ate nationality experience 
and full r_TtJcutars loteiher with copies of three 
testitnontal< should reach the Lisdersitncd by 
Aonai ISih. 

REGINALD PERRY 

Secretary 


j^\NC\SllIRr COUNTS COLNCIL 

NMIISTTON roUNTT HOSPITAL 
Ne f Pren o 

MSniNC RADIOLOCIST 

Appt jt ’•s a e I 1 rd f r the ap’* intm'-"t cf 
a \i t »'r kau ! •* t iPan ti'^c) at lb- Uh on 
C *• > Hm** j| n ar Prpicot KemjPcTation at 
t*' nte cf 3 m neat per ic* nn 

Ap** an n f rmn a'sJ fern's of aptv pfmert may 
be »b "•'nl frm 1 . e Crunty Meu cal Om cr 
n r il a J Mes al Derirtmert Cruniy 0'‘cc< 
Pre* on t wbm all a-*** vai orts r^tp*! be f r 
watofu r t later than Auru t 3ht 19 < 

C tt O"" r» CLORCf ITHLRTON 

Pfm on C*erl. of lb** Coun y Council 

July r h I 


J^^HLIR 


r r s r p A L hospital 

Cr f**i« h R vd S E in 


Apr all •“» a e I- cJ f m f i* ne pr**! 
HOl Sr III^SICIAS «r-ac ii"-* m-dj Salary 
£lC»t per an- *n 

HOUSL ACPOftyN rr^iie u^marr -d) Silary 
fion per ar -m 

CASUALTY OTflCrH <r* Ic) part t me" af er 
Pixn "s n Ni-iry £1 0 per -.rrum rcr-rcidcrt 
TlIIct panel- m n a^n on 
Tbc a^po tm-T t are for ttr nn**tb< freen 
CKto^r lit I9t« Tbere arc sft Reiser en 
Ap'* eaten fermt can be rb-a ned from t‘*c 
Vvrfta*> and p*tr»t be returp^ ro later tban 
Aur« I 2mh 193* 

Aura X ifd W**? 


T he PRINCE or uales's gentr^al 

HfySPfTAL. London S I< 

The followi t Rea dent Posu will be vacant on 
SertetnVf I h neat 
<a) One JUNIOR IIOLSE PHASICIAN 
tb) Two JUNIOR HOUSr SURGEONS 
Salary al the ra c of £90 per annjm Nxird 
mJerce and laundry Ap-xiintr-crts heU Lr ix 
ncrtbi but hil-m a e el c few a further aenn 
It SeniP 

Cardi*-ates (male and unmarried) mutt be fully 
dual led and reni ered ard applcatiopr fon tbe 
pfcn nbed fnm) lorethef « th eoptci of three 
recent tent-'n-^ma $ should be sent to tbc urder 
u red on c bef-^e Nami 3lt 19 S 
J C BURDHT 

July .ht 193^ Directcf ard Hco e Gcte**nor 

T he prince or \\ \Lts*s general 

HOSPITAL LONDON N 15 


Apnidtiipt are Invi ed for th* arroinL-*c**t of 
HONORARY CLINICAL ASSISTANT with 
rpeoal Psythjitnc experieiNe 
Ar*l caiicns shuuld be sent 10 the urdenlTed 
cn cr before Aurutt 3Irt 19^8 

3 C BURDETT 
D rector and House Got error 
July >bh I93S 


gT BARTHOLOAfEAAS HOSPITAU 

APPOINTME.NT OF DENTAL HOUSE 
SURGEON 


Ap-livatiom arc trtnied for tbc effi e of Heme 
Surscun to the D "jl Depanment (Zarddatm 
rruMt hold a re*w rab e dcrtil qua f cat on and a 
medical qualification in adJit on is ucsjublc but 
Pot mNcrut 

Cardiv- Cf will be required to c-IJ upon i*'e 
three D ul SufBcons Ap’X nicient will be made 
for SIX Cf twcl>c ninth's as fronj Noterrber I : 
1938 The salary atta h-*d to tbc cC cc »$ per 
an-am (non rcsiuen ) 

Twetc co-ics of app! aliens uith testimonials 
must be left w th the undersicned on or before 
Afonuay Semember 19ih 193^ 

<Sd)C C CARUS-AAILSON 

July I th I93s Aettn Clerk to the Coserrers 


T'HC QUEENS HOSPITAL FOR CHILDREN 
A Haclcrcy Road Lerdon E.2- 

<160 Beds) 

HOUSE SURGEON requ red September In 
1938 

TSAO CASUALTY OFFICERS reqj red Septem- 
ber 1st. 1938 

Six months appo ntments Salary -t th* r'tc of 
£100 per year with board lodnnj and laurdry la 
ea h case 

ApNiaUt.-rs must be m_de on fonrs to be ob- 
lair-d front the undersicned and be sent in with 
cop es of not more th_n three test-men als on or 
before Aujust I2ib 1938 

CHARLES H BESSELL, 

July 19th 1933 Seerr-ary 


' UY S 


K O S P I T A U 


SE-1 


Apn iatiOf*s are invited f<m the port of AA OA! AN 
VIEDICAL OFFICER for the Department of 
\ cnercal Dseascs commeoans OctoVr 1st, 1938 
to attend on six sessions per week each of three 
hours Salary £350 per annum 

Appliatior» BISIP* asc <jo-l ficanem and d-taus 
of cipcncocc acd aceomnamed by lesnciCTual? 
must be sent to tbc Suficns enden Guy s Hcnp-ul 
Lof'don Bridte SX 1 not Lter th-n S^,cmbcr 1st 
1938 


Qurn, 


CHAPLOTTE S MATEPNITY 
HOSPITAL 

Man ^c" Pc^d N AA 1 


Ap** — ajors arc mv cd fru-n rc'' cred A -1 
Pra t 1 rers f r tbc LI ow j? ap*^! cr: r 5 
ASSISTANT PESIDENT MEDICAL OFnCER 
(male) SaLiy £'0 per a mi— 

RESIDENT anaesthetist AND DISTPICT 
RESIDENT MEDICAL OFFICER six r- ’•J*s 
Sa ary £'> pe* 3S*'sr3 

I RLSIDEVT ANAESTHEnyr th er ir-nJ-j 
Salary £iro per nr m 
AA I h tua u res denvC a-d laccdry a! 

(■•s weekly) Ap“cirx’'cnu to cctt"**— ' e cn 
October ijt 

Tbc As start Pesder At’t. uil O'^cer t ap- 
prtrtcd for th cc no-ths -rd cr cctrp cue- % I 
be cireaed to r ccecd to tb pest c' S-’- m' 
Pex-'^ -* Medical er ( - 42 a tJ'O p** 2 
0‘'<re’*v ex’X’icncc dm n*' * 

Apr carfO'’s 5 — ar and « {»* cepes cf 
th cc tmt 'nD-.als she** d tc cc to tt Sou 
ty Au-*ust — nd 

H B STOLES 

Secre'-ry Su-er- w-d’m 


Q LEEN charlottes MATERNITY 
HOSPITAL, 

AfaryleNmc Poad N \A 1 

RESIDENT AfEDICAL OFnCER e cr 
fema'c) r'x: ed for th I o -t on 
PucmxraJ Fever) at Pa -rxou'i S^uare H “t- 
menm th AA 6 to co'”m*rvC du v on Oro'^cr 1^ 
1938 

Ar*x3ir m-rt fo s t p*c'’*h rerms b e fm a 
funher ux mo* hs Tbe viLi'y is - tbe rate cf 
CC*} pj with board res der-e a~d laj-dry 

^Mowapce 

Appl a pns with copes of tcs*st:en-aj s^ou d 
be sent to the Secretary ty Aim**s .-_rd 
H B STOLES 

Secrct-ry S^pen- e*der 


TTHE SALVAHOS APAf\ THE A OTHEPS* 
A HOSPITAL 

Lo»c’’ Oap Pex-d CLp ea, E.5 


Ar*l»^tJ 0 *^ -re mvi ed from MnJcal \Acre*a 
for me rent o JUNIOR RESIDENT MEDICAL 
OmCEP mar OctcTr Is 19 jS Salary £S0 
ret arnjn with beard resdercc -nt. lau-xT 
The ppoi jE m « fo stx ertr’J'i 
Ap- auors wih testi— onals most b- sem* ro 
the S<'’’eta’y cn or befo e Afo-diy turrit 29^3 
193~ FRED HAMMOND S«reU.ry 


THE DOaOP IN PRAaiCE OP 
ABOUT TO ENTER THEPEIN SHOUED 
BE ADEQUATELY PPOTECTED BY 
INSURANCE IN RESPECT OF 


HIS LIFE 
HIS HEALTH 
HIS HOME 
HIS PRACTICE 

AND 

HIS CAR 


D 

FOR ALL THESE 
CONSULT 

The 

Medical Insurance Agency 


(Limited by Guarantee) 
BRITISH MEDICAL ASSOCIATIOH HOUSE 
TAVISTOCK SQUARE V/ C 1 


V/E CAN ALSO ARRANGE 
ADDITIONAL CAPITAL FOP THE 
PURCHASE OF A PPji.aiCE OP 
PARTNERSHIP 


Slate age next birthdar 
irlicn icnting 






42 


THE BRITISH MEDICAL JOURNAL 


August 6 I93S 


PERCIVAL TURNER 

LTD 

MEDICAL AGENCY 

-T -'Ttt I fcfitn CO ^F\ns— I— >!■ I 

M\rnr:N eane stband, 'vvcs 

(Corner of BcJford SircLl) 

/rlrcrjfn Fp omJan London 

Mm ro Ifiiiple I ar 90H (3 line ) 

AUc cfli c hoiir’i \V ilton on Thames 17^5 
A t f I'i ml 1 c cums Provided wiihoui tee to 
In ipj s Pricucc^ invcvUKMCcJ Bool» Keeping 
Debt Collci^tin etc 

MWlMtM nCM^»>r COMMI^VION FOI 

<*riM o\ s\n oi nuCJiCF on 

^fixfu I \( n '•tM or pnoprnn 

10 U M II llM** ON UfQl Lsf 


lOR Di^rnsvL 

NOiUHlRN TOWN -ABOLf £2 000 

j I \crv Id (. td r mtl Club »nd Appi^ 
t I r a \ I It ^ to L Prem incl 

t ^ t Cl Hiu'c onl\ 1 0\> —1 

kl M CONST —WOMANS PRAC 

I (( t \ cf ICC * -ll'd pi p incI over -ClO N \ Uing 
{<. t > M) < Prcnimm £6^0 House A bud 

knoni'rst \ — HALF sharp of 

* 1 i 1 p 1 i h c Pc I inel 'OH Nppts over 
M I I rumiiim (lO Sice house to rent — 

SI SSI \ CONS I —il W PA NON- 

J \ I I n n-dj p*' r cc - 6 up Premium £ 000 
< I oJ In jsu (S { ud ) tennis etc Freehold miphi 
) t —4 

lONDON \VS— ABOUT £SS0 PA 

f nti Nffi \ j its ^ ( to Pfcmuim 2 vcirs 

pufeh Hoti c 4 bed etc to rent — s 

I ONDON N W — 0\’F FHTH SHARE 

tl ft 00(1 p I inel 0 OCIO Appts over £U0 

lees f tc 10 ( Item 2 veirs piirch SmtU 

m > tie t let — ■( 

S(.()U\NO(N) -COUNTRY OVER 

I I i iM N i inul pTnel of £ 00 p i \ i it to 

£ < Itemutm 1| jeirs purehnse or offer Good 

h u e rent or sell — 7 

MlODirsrX— SUBURB £1030 PA 

\ uvU (>00 ineiLNsvnc ?MS £\00 1 rcmuim 1 

V ts riOelM '• ComfMtousc (4 bed ) Sell or let 

SURRIV SUBURB— HALF SHARE 

fl i fvivo pi Old CM incmsinp modern hou t 
p tdvn nJ Since to let Premium £ UOO — 9 

NUDDl ESI \ SUBURB — PARTNER 

SIJIJ shire pri du me £4^0 pi (o commen c in 
fi If re IS ie I rtcii e Pfcmjum2)rs rurchnsc — 10 

MM)I P\RK NEAR — PH^SICO 

nui \f^ IRNCtfCt tboui iffon pa NStll 
\ \ d ell s Srvr'u 1C cmmeJoion on rental 

1 N 1 11 11 


I we Slows OlDISl ISCREAS 

ft 1 1 in P 1 S It r P nc) of 1 1>W Nice 
I mpic 1 mm d n n I remuin il "sO 

nd DM rs furniture ~-l. 

Kl \ 1 SL in RB - CiOOD MIDDLE 

£ ^ t (H) p I in rcasine select panel 

t « I « iifcerv < Nict Uidor hou e tor 
I hr ivt I fen lum 11 Kirs pur ha e — U 

SOI I H eo \S1 — OLD I ST NE\RL^ 

ti4 . pa tn TCisine I air pintl mntd middle 
S'!! t ttef cU Deta hed hou e j^irdin md 
vfN f r sale or miwht let Premium £2 ^00 — 14 

COl MN TOWN WTTHIN 100 MILES 

(»l I <»N 0<>\ — P \K IN LK^HIP wiihcarf^ ucces 
Si O' I N I Pr !i e about £l <0 p a and 
”* ms £ *0 p 1 ^ jcus parehasc Pur 

V t J h vt f P C S C h >1 e of hou c 

Dl\ON - I NOI>I>OSrD COUNTRY 

* « M I r T n re V in p mcl worth £ Ml p a 

^ pa Irm £|s<n L\ freehold hou e 

-T u n i-J cirar fnr sak t. 

'•f f « r-'" ' I r r- £1 s 0 — Jo 

BU WWOllWl M \R — NLARL^ 

f -C pi- 1 r iris V , , 

» H L n car u fi ejf'* at £s 0 

‘ t ' p \\ Tte'” V rv * I 'cVi — 

n wrs - oi D rsi wer \Gr 

I - 1 r I ' ’ Sp- jK t tl 0 P a ( c >J 

f ” 1 •“ t e ' n j''d i. ra P "n ^10 

{ 1 \c »> V, — ^ 


NDKKsmRI DM IS— BFNLTIFLI 

V c‘^ilA‘'raI_r - a" 

f i - f' 1 S t rv^ - ■* P i •'t 

N1 M NIC 1 OKI \ SNNl— loCkLT 


f 


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r r-' rt" il -I 


N'lni \sns oiDtsr m nk ini 

* ' - - *■ H 

* t sj p- _ 

v ' tllVSUS 
'■* ' ' f \K \N< [ I) 

' , '• nc Nsciis y 

' i.t 


THE MEDICAL AGENCY, Ltd. 

DUDLE1 HOUSE, 3G-38, SOUTHAMPTON ST, STRAND, VVC2 

Telenhonw— Temple Bat 1034 1054 Established in IS'Ja b> J A Rcaside 


LONDON W 2— Mivcd GP rcsidcmnl loc .ht\ 
Double fronted house. Lar^c garden giraee 
Receipts ncarlv £2 000 Panel 1 300 Premium 
for goodwill and house £.4^00 or near offer 
LONDON S E —W orkmg class G P House to ^nt 
Receipts approv £2 700 Panel 3 200 me recs 
I 'C up 1 App Premium 2 scats purchase 
or near offer 

LONDON \\ — Easi distance West End Middle 
class G P House to rent on lease Receipts 
approx £2 400 Panel 1 ^00 Several ipps 
Fees 3 '6 up Premium £4 000 or near offer 
NE COAST— Mixed GP Receipts nppTOX 

£2 QOQ Panel ncarh 2 200 Clubs neirl> £*'00 

1 \pp Premium £4 000 or ncir offer to 
include Book Debts Surgerj Furniture Drugs 
eie 

■YORKSHIRE ^ — Mixed GP Residential localitx 
near large Town Medium sized house Large 
garden garage Receipts £l *'00 Panel over 

2 000 Fees 3^6 up Premium £2*300 

MANY OTHERS FOB SALE 


LONDON W' —partnership Suburban GP 
cope -louse to rent Receipts ncirh £G 000 
Panel approx 4^00 One fifth share 2J jc^rs 
purchase with view to one third share 
MIDDLESEX (\V ) —G P growing residential 
locaUtv Excellent house with large pleasant 
garden Receipts ipprox £a 500 Panel 1 "00 
Fees a/6 up Prem 2 ^cars purchise Free 
hold house and furniture 000 
W EST COUNTR'i (Seaside) —PARTNERSHIP 
House to rent on lease Receipts £o OWi Panel 
1 200 Fees 3/6 up One third shire \\ 
xcars purchase 

LONDON SW 12 — Old cstiblishcd middle-chss 
G P Residential locibtj 1 irgc house splendid 
garden Receipts ipprox £1 "nOO Select panel 
ncirfv 420 Fees 3/6 up Premium 1* >chn 
purchase or near offer 

LONDON NE — Middle chss GP Receipts 
Ipprox £2 ^00 Pmcl 1 200 Premium 2 >cars 
purchase or near offer 

HETAILS 0> REQUEST 


EsTABUSitfD 1B77 


LEE & MARTIN, LTD. 

The Birmingliim Medical Afiencj, 
71, TEMPLE ROW. BIRMINGHAM 

Telegrams Telephone 

Locum Birmingham ^96 Midland B ham 

TRANSFER OF PRACTICES AND 
PARTNERSHIPS ARRANGED 
MAXIMUM FEE £50 if exclusiveh 
entrusted to us 

^irCOLNF? IWESTIGATED A\D l\CO\tF 
TA\ RmURSS PREPARED 
RELIABLE A\D EFFICIENT LOCUMS SUP 
PLIED AT SHORT NOTICE also ASSISTANTS 


II A^TEO TO PURCHASE 

1 BIilKIINGHAM (or withm ^0 miles ihcrcol) — 
Good ^flxcd PRACTICE with i Panel of I 200 
oxer and rvCcipts of Irom £\ *'00-£ bOh 
URGENTLY UEOUIRCD CAPITAL WAIL 
MILE 

2 REQUIRED — Good Engluh Scottish ind Irivb 
LOCUMS Immediate posts to offer \Ko 
assistants immediate posts to offer wnh 
ind without view to Pinner hip 


FOR m^PO^ it 

1 GLOUCESTERSHIRE — Well - cstiblivhed 
middle ind working class PRACTICE Rt 
ccipts av £i 2<0 p a Panel 1 200 scope to 
lOkfci L and good house with a!l crviccs 

2 S7 \FfS — KipidIv increasing mixed Pruitt and 
Panel PR^C^lCE Receipts last star £10 0 
Panel I 23<? over Excellent house ill services 

3 MIDLANDS — Old csnblj bed industrial ind 
middlc-cliss PRACTICE Receipts average 
£106^ pi Pmcl 96’’ scope to incrcisc md 
good house 

4 SOUTH W'ALES — W ell cstiblishcd rruddlc and 
working class PRACTICE Receipts list >cir 
i"* 200 Panel 2 100 Good house 

^ LONDON — Old established mixed ind Pnvitc 
and Panel PRACTICE Receipt'* iv £l 7 0 p a 
Panel 966 \mple scope to mere »sc and good 
hou c 

( WEST COUNTIES — Old cstablv bed working 
chss practice Receipts J “sp panel 2 '*26 
Good deiichcd corner house which mav be 
rented 

PIN \NC1AL ASSISTANCE afforded to ipprovcd 

applicants for the purchase of Practices or Partner- 
hips on Very fcisoniblc terms Full parliculirs on 
application 

RELIABLE AND EFFICIENT LOCUMS 
SUPPLIED AT SHORTEST NOTICE 


I 

I 

i 

{ 


1 


I 


Telephone AAclbcek 272S 
Iclcgramv Assistivmo London 

NURSES 

MALE OR FEMALE 


TR MNhD NURSES FOR 
MENTM MFDICAL SURGICAL 
VND FE\ ER CASES 


Nu scf reii fe on the premises anti oe 
c na'le to urrert calls Dn an I Nict; 


TUB \trsts AS^JOCIITI 

On c -ji " in u rh ih'* MALE NLP 
ASSOCI AHON ) 

19 1<irK‘?t.,BiktrSt London 

Mri MILUCFN1 HICKS 
'' 1 HICKS 4, , 


Estadushed 1S6S 

PEACOCK & HADLEY, Ltd., 

JIEDICAB TRAN-SFEB AGENCT, 
67 68,ChandosSt BedfordSt Strand,VVC2 

Tclesrins Herbarn LcsQuarc London 
Telephone Tetupfe Bor 5564 
LOCUM TENENS ind ASSISTANTS supplied 
free of clnrsc to pri'*cipils 


FOR DISPOSAL 

1 GLAMORGAN COAST— Halt shire of old 
cstiblishcd PRACTICE Rtccipi^ ivcragc over 
£3 000 p a Large pmcl A’cd fine house v.uh 
good grounds for sale P emium for share two 
Veirs purchisc pivible part bv instalments 

2 A number of small PRACTICES at low pre- 
miums ExctJ/ent opportunthes for pnchhoners 
wishing to get a Pncticc with scope 

NEAR FULHAM S W' — WXtlssiabhvficd 
PRACTICE Receipts last >cat over £900 panel 
ncinv 00 increasing Nice house on rental 
Premium £12 0 

4 OUTLMNG SUBURB N — W ell cstabhvheJ 
PRA(2TICE Receipts list vear over £400 in 
eluding small increasing panel N cr> attnemx 
house can be hid on mortgigc Premuun for 
Pneiice ilout £630 

NE-'.R HOLBORN W C — WclI-cnWistiis! 
PRACTICE R(.c<.ims ■i*enBL £1000 r» 
panel 1 104 Splendid surgcD accommodation 
onK Long introduction Premium £2 000 

6 NEAR MCTORl A SW — AS ell-cstiblwhcd 
mixcd-cliss PRACTICE Receipts last xar 
neirli £1 000 Fair pmcl Nice small flat on 
rental Good scope Premium £*3^0 pnaNc 
£600 down 

7 BRIXTOK S W —Old C5nbli>hcd PRACTICF 
Receipts about £•'00 p n including panel 6 n 
Nice semi detached house on rental Premium 
about 2 jcirs purchase 

5 OXFORDSHIRE— Chamune Town A 
csiahliAhcd PRACTICE Reciipis ncari> if''" 

•» pa including fur panel Nice houvc on rental 
Seopc for increase Premium open to oilers 

9 wanted in LONDON OR PRO'INCES 
PRVCTICES with incomes £s00 lo £-0<M pa 
Minv purehisers waiting ind quick tranvaciion> 
for immediate cash 

No c/ioree ruarfc (o purchasers or for 


THE WESTERN 
MEDICAL AGENCY 


Dr 


vvha 


K H BEssrn and Dr AV 3 PA.?.^vtoxE 
give personal attention to cvcr> client 
22, CIAKE STREET, BRISTOI., 1 
Teles Aledgcn Bristol Tel Bristol 2 

13, BEDFORD ST, STRXN'D, W 

Tel Temple Bar 2532 




FOR BINDING 

MbDlCU- 
jc 3 r> can 
lOd 


COVERS 

\ ol 1 and H of the BRITISH 
JOURNAL for 19 " ind prcvio^us 
be had price -s 6d or post free 2^ . 
Orders with ipproprialc rcmittan e " 

udJrc>vcd to 

THE M AN ACER 

RftTISIt MrOlCAL JOUKNVL 

DMA HoLsr TAVtsTrVv Sot-vrt 
LoNfvON AV C I 


ich 

b 




Al ct ST 6 


Ttir nRITISH MrOICAL JOURNAL 


BRITlgOn MIEIIDnCi^IL ffiUmiSAinj 

(The Scholastic, Clerical and Medical Association Ltd ) 


(FOUNDED 1 880) 


NORT 


Ttl'p.horta : 


33, CROSS ST., J^flA.^XMESTIEM, 2* 

J Manchester • Blackfnars 391S Telgrcr'j 

(Manchester - Rusholme 2549 {\t^ht Calls) “Locum Manchester” 


Branch Offices at Leeds and Belfast 


Recommended with every 
confidence to the pro 
fcsslon by the BRITISH 
MEDICAL ASSOCIATION 
as a thoroughly trust 
worthy medium for the 
transaction of all Medical 
Agency business 


TRANSFER OF PRACTICES AND 
PARTNERSHIPS INTRODUCTION 
OF RELIABLE ASSISTANTS AND 
LOCUM TENENS at Short Notice 
VALUATION and INVESTIGATION 
OF PRACTICES, Etc 


FOR DISPOSAL 

I Fc t n f tt c»i | 


Practices and Partnerships 
wanted Large list of 
bona fide purchasers with 
ample capital available 
Enquiries invited from 
prospective vendors All 
information treated in 
strict confidence 


LVNCS TOU'N —Nerv n x-J Par-* anJ Pnvj PR \CTrCC. 

Ca 'i f— c — s l_x \Mr £1 I"*., la*"-! 19^ Ss. G xxl Kiev - 

1 n 4 ' Pn'rsx o"al ronns (vep^rate e-imc-). I rc'n trr— I ra'ticc 

~1J tjr r- ch-ve — N 1 Il3l 

CIlLMlIRf-. — O h ‘'cJ r'lx-J a^J Pri^'3 e PR \CTICC irt p 

Cm - ry t n, •« ca rc-ci- i €2," 7 Pa'v* I \ttra in 

^ 1 .*%. 3 rcvff- " ^ hcu c.'o'nv pari*? 4 1 rs n » ih t nrn coit 
lo ftrt r — -n— -IJ r "i-iw —N > I N3 

MVNaiLSTTR — \Ne -n a*' ith J n xcd P--H 4nJ Pn i e PR VCTICC n 
r "axan i ^oi c « net aJn*er to ns* Hojur^ Cwitf Csih receipu 
ST oti'nj r V £I IOC Pa^l j* I OX) Ctre «•* m >>- rn hoj-. 2 rc,,«^ 
lion 4 bed x*ni cam earj net card a Fwfsj' o mjyberc" J Pre-n im 
IJ jw'x p ‘x**aw— No Jll^ 

NL\R LEEDS— O J-c^ 4b nVJ arj — -cUn PR VCnCC. 

Caih rec**^s sv*— s'- £1^00 pa. Pane* 9'‘'0 C\ct 'cn dta—h-J 

2 rcce^ti n, 4 hfdroorrv, P ofcsjmal r> r-a («c'*4f3 «r r-tvel para— and 

r* Price £1 OX) Monca'** can be arrarjed Pre-’ um — Praoti*©— 

JJ >ej"$ ro^ebAv. Of rear No II»5 

^ORT»tMBFRLV^D CO VST— O J-evab ithed nid^’ -claw PRACTICC 
in Se-t Je a^d Rcudeniul (own n cre*e'-t ban < IS ^earj Cat*! recc r*s o^rr 
£I4nora SmalpanelofW Evceleriboue 

2 rece^ m" < be>.r<xn— * j Pfrfc\^ in.,1 rxim r - - - 

para-e wid n-e pard-n Premtim — 1| 'ears 

purchase — So HS| \V > 

NORTH WTinr LANCS —OJ ^aMtSeJ ^ 

mixed Par-1 ard Pnxa c PR VCTTCt in larp- a f - t-a 
to»n- Cish nscc - $ la« star f I 10_ Panefover AoololADir* 

I 000 Good bouse p easan ly nuated 2 rcaep 

non. 5 bed ootu para-ns -nd small pard-n Tor Immcd 

Premum — Pmctice — H years purrha«e — 

So no< 

NEAR MASaiESTER-— \er> old-esuW shed ^ 

fiddle and .orljr--dMS WACnCE Hllll/allpc 

Cash receipts o xr £2.500 p.a Panel I •. 0 / / v / t' 

Ltce lent detawbed house 2 reception 6 bed I _ _ _ 

room, parare and garden uiih team court 

Price £ I 000 Premium— I J vrars purchase — So 1(03 

DERBV SHIRE. — OlJ-establish d PRACTICE capabJc of preat irscrease Cash 

receipts l-st 'Tear £740 (increasing) Pa-el SS— Eace^ent house 2 reoe-' lOn 

4 bedroom 3 Professional rooms Isenaraie en -ance), garage ..nd good ga den. 

Premimn — Pmcircc ^nd house £J 600 — So 9*9 

NORTH E\ST CO \ST— Ofd<5 ahluhcd mi ed Panel and Priva e PR \C- 
TICE Cash recei-.s last year £2,160 Panel 2.220 Appoin ments (ir-rsfer 
ab'e) o'Tr £400 pj GockI house 2 re-epnon 3 bedrooms 3 Professtor;!! 
r^ms, ^rage and small garden. Pr»-e £"*00 Prerr um— 1 J yTea-s pa-chasc.— 

MVNCHESTER.— Sound o d^tabl shed PR \CnCE n irdus nal d stnee 
C^h rcceims last srar £2.200 Pan-I 2,230 S^o'se House 4 bedrooms. 
- Pro'essjo'ial rooms Rent £50 pj Premium — bes* offer— No lOvf 
CHESHIRE Tons near Manchester^—DEATH N AC VNCY — O d-estab- 
hshed mixed Parwl and Pri'-ate PRACTICE Cash reccirs Ia<t year 6-6 
Panel 2.I^S Scope Excellent d ta bed house (n Onn grounds} 2 reception 
rooms, stud) 4 bedrooms 3 Profess onal room parade "iih se-sam s quarters 
andgaruen Forsal atsalu non Premium — Pr’Tice — best ePer — So 1136 
MONMOUTHSHIRE.— O d-estabi shed Cbrtra-t PRACTICE. Cash receip,* 
last year £2.1 14 of tthxrh oxer £2,003 is from cortraa work Ex«l ent house, 
contaimrg 3 rece-i ion 4 bedroorrs 2 maid s room*, garag- for 2 cars, and 
pard n Rent £52 p,a on lone lease Good prcsnecis of increase n »nu*m- 
Preroiam— best oTer — No 1144 

TANCS T0\\*N — Sound mixed Panel ..nd Private PRACTICE, cloxe lo 
coun r> In present hards ^3 years Vverage cash receipts £1 400 p.a Panel 
I 400 Nice detached house 2 reception 5 bedrooms, gara-e and larg- gari.en 
Premium — IJ years purchase— No 11^3 

YORKSHIRE (V3 R ) — Old-<stab!rsbed midd a-d better w rki s-dass 
PRACTICE in larg- town. Cash receipts las. yra. £1 "'62. Par^I in » 
encourag-d) Good house 2 reception 4 bedrooms, 3 Profess*onal rooi^ 

para-e For sale or nuv be rented Premium — llyears pumh-se — No 1141 
north LANCS— \0RKSHIRE BORDER —OM-estab'isb-d uropposeJ 
Country PRACTICE in present hands 20 years. CLsh re-e p s £1 0(X>p.a. 
Pare! and appointm-ms approximately £--0 p a %N ell built house waihairpe 
accorrmodsuon central beaung. e cctru. light, garage ard gard a of 2 acres. 
_ R«rt £75 pA. Piermum — £l Nendor retiring. — So 1119 


— WAhTED — 
ASSISTANTS and LOCUMS 

Tor Immediate Engagcmcnls 
Apply with full particulars to abo\e address 


NE. 1 R MINCHE5TFR— PARTSCRSHTP n ofd-es •fcU’-d ni.xed<I..5s 
Practice owi— in death of senior p_nrer Aver*— cash rece pj £2,-*46 pj 
(I'vrcasir ) ljrel2.’X) &.o-cft inc-ea.se Good house to re-., 2 rete- loo, 
4 s bcufooms. 3 Prt ‘Ws r.3l rooi-s gara-s a-d small garden. P-em irr — 
or< balf '••ar*— I* sears purcbaic— Sc IIN 

NORTH MIDLANDS— Od-«-l:’fs*-ad muud P.,.-e' Pnva e PR AC 
TICE in Cou trv d-sre* near la— town A>'*ra— ca^h nxei-ts £I 0o7 p— 
Pa-cl 9 0 a^d f*ans.erab e a'^ntp*— s £200 pj Excel ■— det- bed bouse 

2 f eet- ion 6 bedrooms, P o'ess —al roc—s gam-e lig- ga-dea. Pnee 
£1 2-0 — Pi— lunv— 11 ears pL-’*'ise— N^ 1117 

AlANrilESTFR — Very o d-es a** rs d rut-d-c'as* PRACTICE r- Sw-a-bs. 
V'era— Qsh recei- $ £I 3 0 pj Pa— ISai Good corr-r boast ^ bedrooms, 

3 Prof-ss orjl rooms, car-— c*c. Prc'-ium — I* 'ears parcb^je o-fiea*o'*“-r 
—So tl 0 

NORTH staffs — \ er> c'd-e^— i$b-d be*tT *o and rajdd -- cIaxS 
PRACTICE Cash r— er- s list year £2.**3l Pa— I 1,225 S»o-e a» di ina 
d-selo-ire Excel em boas-* 2 reception ■» bed oo-ns maid s room, s«m,ja 
jur-erv premfics. ga'3'— j-J garj-rt fc sals. Fr—bo'd. Pr-nica— Practo.- 
—If ears r rcba.4 cree-roTer — No Il-O 

NORTH ^\ALLb COAST— Ooow<i_s» PRACTICE m s-’ea r-mde*a al 
reson C-aH receipts Lst yea £50^ No 
Pare! or arrpo mm4n.s. Nice d- —bed biytsse 
uuh spl rdid -cco— nodajon. garage ard ga. 
irri - - den. Premranj — Praa*cs — 2 'ears pa*ch-i«s — 

No II<1 

• . SHROPSHIRE. — O d-«sjibltfh-x3 UPOpposed 

ind LOCUlVlS Courtry PRACTICE. Cash receipt l-5t yea. 

£6SS Panel 4 0 Mod-m bouse 2 reception, 
CncaccmcnlS ^ bedrooms, 3 Pro cssjo-jI rooms gara-e -nd 

^ larg- garden Elecinc light. Pent L.0 pot. 

Prem um — best ofier — No 10 S. 
L.AN(3Tt)U-N — PARTNTRSHTP in c'd-e^b- 

'ars loabo\e address 

receipj o'^m £—900 Parc! 2.000 and ap-oi— 

- — — - - I rn-n,s £1S) pjL Good boose 2 recep^n, 3 

bedrooms, gara— and garden. Price £650 P—m 
lum— one-tbird sh-re — £I 750 (to includ- book d bts) — No 1142. 

NORTH 'NEST COAST— M^xal "omans PRACTICE offenog grmi 
scope. Cash rcc-i-ts £267 Good hotac to ren, a £45 pot. Prer- u-' — 
bext oT r —No Un» 

MIDLAND SPA — PARTNERSHIP (after pr*Iim r_rv Ass^ta-tship) nod 
cstablisbeJ Practrec Cash receipts last ear £3"”'* Parcel 1,300 ICi.om.rj, 
pann-r may choose ow-n resid-nce Possfbilirv of Hos-i -I -ppoistme-t. 
Premium — 7,2-»th share— 2 years Da-cb.je. — Fun^^r shar- m thme years. 
—No 1069 

NTLA R A fANCHESTER — Aerv old-esiab isb-d mdd •* a-d worLrrs-cIas» 
PRACTICE m properous iowtj 'erv suitable for two frerd. sr panrersbjp 
or ma be run by or- man and an Assatari C-sh recemts last year £j.220 
Panel 3 000 Nice rrodem h 'J lsc 2 reception 4 bedrooms separate Profess-cral 
rooms garage ard large garden Forsaleat'-Iuation Premiu-* — bes» offer — 
No 1137 

LLNCOUSSHIRE.— \er> o’d-estab''sbed PRACTICE m p easar coumry 
lowTi Cash receipt las: year £2,471 Panel abou* 1—00 Cot— gs H«— aJ. 
Good house, 5 bedrooms, sma.! gard-s, garaga. etc. P—m-cna — Eractsse 
£3 IR) fcT qui^ safe. — No 1 13— 

NEAR ALANCHESTER — Well-estabfcshed midJ’ -rd bett-r worki^-coss- 
PRACnCE in r?.asart suburb-n district m p esem hards^lS y ears. A ^veme 
cash receipts O'W£a0«X> pox Pa-el I S33 Good sco-^ Cc^ co^ bo^ 

2 recerion 4 bedrooms, ’ Profssnona. rooms, ‘’21^ 

Surce-y prem ses. Both ma be re- -d on lease Pr— ta-a — ! earYper — ase. 
—No II3S 

MIDLANDS —Icneasms midde a-d working-c'-vS PRACTICE m l-gs 
to,,,. Cjh rax.'-is IMI icir £1 O'O PirsI o,— IfOO S=o?:. E-uc'i-u 
irodem bouse 2 reception 4 bedrooms, gar’g- a-d I— rg- garc-n. ro'" sa— 
Freehold. Premium — Practice — £2,OX) — No 1123 

AORKSHIHE (M R.) — O d-es— ’'’is-.ed miTcd Panel and Pn-ate PP^ACTICE 
mbette wotWcg^l-ss -rd rural ds.net. Ca_h rece*p-4 La 'ca. £I IS6 Parxl 
I 35-. Sco'm Good house 2 r-ce—ion, 3 bedrooms, ma d s room, j Pro- 
fessioua! rooms (separate e-tra'aa) gard-n wtth tmi-a co-rt. Rent £-5p.a. 
Garage rented. PrOTiurr — li 'ears purcb— se — No 1122. 

LIVERPOOL— StadD' incmas n- m -ted-class PRACTICE la sub-bs. Chsh 
recrip,s last 'ear £7*S Pa-el 650 ExcrP-ci d-a-ned boijse, 2 mcemion, 6 
bedrooms, gam-e and gard-a. Preni.jp5 — Practice — bes: o2er — No lOjS. 


AU communicat.an. to be addressed to the Branch Manajer BRITISH MEDICAL BUREAU 33 CROSS STREET MANCHESTER. 2. 






46 


Tin: HRinSH Ml ni( M journm 


A( (.( I fi I'lfs 


PUBLISHERS 


INDEX TO ADVERTISEMENTS 

I OOI)S HI \ I H VC.I S 


Allen L Unvsin 

->■> 

C \\ mur W lilt un L S 

n 1 td 

2' 

JIalc s Medical I ul )i ations 

*1 

Ciciut 'Sin 1 td 


It 

British Medical Assoentu n 

Supp II 

M irmiir 1 i ill xtf act ( 

1 td 

) 

Churchi/f J t A 1 td 

aa 

Mitkhrlhill Hi ini' 


a 

LciMb H K C o ltd 

a 

\c (! s Nidi I f In (s 

I td 


Oxford Un»\crsn\ 1 rt 

a 

S In J ixs 1 td 


14 

WricM Jahn ^ Sons ltd 

a 

Sutnn f s 1 \ 1 h Ic 1 

t I I 

K 


ASSURANCE & INSUR VNCE 

Lvadon ^ Counties McJ Jr t 
So- Lid 'Nupp 1 

Mt li \u II V Ltd I 

MeJ d Tn urin c \t.cr \ *1 


BVNKS & IIiNVNCL 

Cnti h Mcdicil Pin IP «. Lid 2^ 


CHLMiSTS 

Vbbou Ltbontorics 1 td 17 

Alkn ^ Hanbiir\s Ltd l! 11 

A1u7MPu Products 11 

Ba^er I roducts Ltd K* 

Boultlls Ltd 14 

British Drut, Housc»i Ltd 1! 

Burroughs NNcHcome 1 Co 19 

CibaLtd II 

Duncan riocklnrt ^ Co ^ 

Ch Lill> ^ Co Ltd 10 

Ev tns Sons Lcschcr ^ Webb 
Ltd 9 

I-eHo\ss Med Mfi. Co Ltd lO 

KaNlcne Ltd [( 

Nltw S Son \ Sons 1 td 6 

Robinson ^ Sons Ltd 46 

Sacchnnn Corpn Ltd 
Sandoz Products Co\cr i\ 

S P Charges Co 2^ 

TbacLn> C F Lid Supp i\ 

\ alentine s Liter Extract 14 

Wander A Ltd 

Washington Chem Co 1^ 


\ VMI IM Mis cU 

Mall I n L C . 
llcid s J C \ 

1 Ci\ lA n K c c ltd 

0<Ik fi I C C Ilf 
\\ hue Hr n e ( > 


rUIMlNC I MM \\\u\ \ 
tic 

T a\ I r s 1 N I Nsfiicrx I 


SUKGiCAt VPrARAKtS 

Grout ^ Co Ltd f 

llawkcxle) C Sons I td 11 

Ihllnid 14 

Milhkm C L i«)CA 24 

Robinsi n C ns I td -tf 

S tinion O Is Ltd 11 

Salt C Son Ltd ^tipj in 

Smith C Nephess T J ltd Cisxrn 


TAILORING & CLOTHING* 
etc 

Burberrv s Ltd 2 

Dcimcl Fabric Co 2^ 


lOHMCO A tl(.\Ulllls MDIORS A \f C I ssOIEH s 

< Hr n I I 1 * 1 1 ! I ' '' 'll- S 

I ii\ir s *>. ivv C » 


\ \( ( IMN n \ lie 

f »f ''If* 

( Itt I t* fjl H 1 J } 

II XS If 


IIOMI S A l\snn UONs 

III < < 


IIOI si \f I MS 

r I 


HOSIMI \l> A ( I l\l< s 

1 • 1 I ( 1 1 

Sill ( I I 


M/ nn \} sf iioois 

i( lous ^ n ( n Rf Rs 

I } '» t. 1 


Nl IvSlNf etc 

1 > 

IR VNSI Mi Vf r MS 

I f M ► \ t 

I X* 1 I 41 

1 Mil I I » 

j f \ - If 

, / A ' M I » 

1 I II 

^ xt I \ Y 

j 

I 

' c(>MR\r 1 rnu nn 


MOSRI! M N \( \N(n 


ANSIDIUt 


1 1 u M X' t\ U « 

\ t 1 41 

( otMM 1 1 Smil r»i V. 

, a 


1 1 mil Pf vn )I »h S ID 

r< f o 1 Pee N tn 


( I \NSll It I) 

.p\s niAnn 

KI SORIS 

1 \D\l Rllst Ml VIS- 

(\\ intcit nnd \ icantl 

, « 1. " 

1 » ' 

A U\l)Kt)S 



Citcsluni Ci’utt Hi tc’ 

1 2» 

(.1 M R\I 

H in 'KJte 

27 

1 - , f 

1 llfiii *1 0»>K n C o If* 

Pj f ins Spa 

!•> 

i N, t«, h V 1 J' I f ■ i-v’-*"-! ,, 

MeJ Ir, I 'k 

H< Lside Il'ilfi' 

2S 

Smcdlc' s llxdfi 

2x 

1 1 impix 1 td 



— 


For me in the treatment of the 
Clnes^ and LB&Mgs 
and surgical uses generally . . . 



ule c\nillj nicording to tli« 
dirtclion of Its m\ tutor the litc 
S iiiipson Gningtc, F H S F Con 
'lilting Surgeon to tlic Quetn-" 
llo-'pitil, Birimngli im Coui]u>'iil 
of high grich cotton wool imlo'ul 
in ih'orhcnt ginre 

Otitainnhlc in iJiri-cqnofilif' from oil ch'onl’ 


P^PRIEIORS S. MANUFACI URERS ROBINSOV &. SONS LTD OE CHTSTERriELD S iSS 01 D ST I ONDON ECi 


E,-^svU■^Tdm^S^rl^c^s?Tom^'on^^^^^ Tui'toll Sqooc London W C I iml prnKcd In I 'rt im. 

m Grt »i Urn im Lnlcrtd -li iccond Cl 1" H Ncvi \ oik, U S A 


I'ovt 


Alci-’iT 6 193 *! 


THE BRITISH MEDICAL JOURNAL 


BovRiL Medical Agency, Ltd. 

^LDI^E IIOLSE, 

ion nrnroim strict, stk\nd London, wc 2 

Tcicjmm*; BOOH I)IC\L lONDON Telephone TE^IPLE BMi 1616 (3 Lines) 

Cliairman and Manajjin^^ Director Dr J ITEID ILALL. 

The mAxlmnm commission p'i\n1>Ie on the sale of an% Dmctfcc or Partnership in Great Britain placed exclosivelv 
In the hands of this ARcncs is C'Q (fifts pounds) nhicli sum covers goodwill drugs surgeo fittings fixtures and 
Dimlture instruments and liool debts hut not house properU Scliedufc of Terms uiU be forwarded on application. 

\cco«nnnc> and legal services furnished b\ the Acenev where desired at moderate inclusj\e charge^ 

No charcc is made to Pnncipnls for the introduction of Locum Tenens or Assistants 


I iAsr\ Nr\R rmsc roRfsT— s rRAcrirc 

CMah 4J \rar\ Re t l ^3 ^ Cl CIS anj f r-4't 4 r*< r hv £4 * 
c r aK u VO units m-rca ir^ a P u « w S ot-" e a'Ct tia 
U’^n a ailaS p Tt~ al ai C"' p « P'eeiurri £!w^5n f f ut>«-C 

Z m KtlAM COLVIN — O u-e^taHnli^ ind..n oat IRACTtCL r j«'~ 

O'^l p 3^ t “I aN^xa £4^0 IS frc"i tjnl 

*■ »rr . KO u- t Praa-.^ his N*«n ^e^J !• tleserucrf aK>- ^0 ear 
P'T'^ i.~i £ rvX) t inc Lce K\ V d t. cuirs Ss. ptr fur itJrr et“ (r-ft 
hv a raT-cr'-rti r osh d 'kr 

V CO\ST lows VMTHIS >a MlLli Ot LOSDOS — W€tf-CN -H i*'cJ 
PR NCTICL pr-*^ <5‘'K aKna Clcacpa it ^ ch hr»ut £1 lOIpa is 

V nsfu (r nt pj.'^l t a'**' c s -sj cl I (tl p« r"* s I Nl^ c G<vhJ 

f't<S .J h a I T1 ft *'1 f'c'd rnred a"J f vnerated cr'^tral 

hca “p \r-“ c \ j it r farden pjf3'*r t r £1 ^CO | tctri im 

Z ra s pw * ^vc Ne**>. r au'ises th fc » v.t *'c f ar i uht can d 
s '^rv 

A C^^ LOCK LP— a^l ‘•cu PR SCTICr prtx^u -k aS't t £l^<n P a 
p r V, or arn ' '*'■4 '‘h £ 0,1 p a ret I tO ( and 2l CtVHl ccal rf 
<'<-T V'a'‘% c r* Prrr-mtm £1 !>'' « furn turt equ "mert « c at 

\a uai fi. Ilcun STr^daja tt I rti.aM nl lOto^ 

\N t ST tSD — O*'** ‘lu*’ tN f r^' 14’' d^sirjifs cf en ermp West frtJ 

PK \CTICL M k C I rr ri'*'u'n qi—t anc n e scr i_! Fu I deta 1$ on 
rs al a’'r -ratsn- 

6 LASTLOSDOS — Wc!I-<ntalr!rv^fd PRACnCC pfoducirRa*-/*i.t f I ^ Opa 
c‘'v.’i h aK £7*0 pjL tsc fi cd frt rj pa'Tl cf aSut I 0 paticr s P IS 
a^J Pc** ^ V I 3’^'t skpffc Larfc pri'vmcn of ca h Prer* un Z >ea'\ 

PUT !■,««< 

7 SOUTH nnON — PNRTNLRSHIP — \ third partr-r (after pre iminar> 
as h r) »s req r*J tn olu-c'iab sh J niscd<',.ss Pr* tix Shara to 
rfDdu”" £ V 3 p i Sutabc Mase bmi ab'-* v>ith a'n-'e acvo'rmi.da i ru 
R«- exjpa. Pfc’^iu-n 2 rarv pi-r hasc SaUr> durnt, rre!i*ninaD 
as' star O'l'^ a rate of £fA3p a 

f COUNT’! TOWN wmtIN t:f» miles WCST of LONDON — 

1 VRTNERSHIP— \ n\LF SHARP n c d-establishol pooj r- leu-cLsv 
Pr.-’idc r*i'doc3’'S «’*'*ro\i'" els £— 00p,a include larpt r4''*cl fees 

2 6 to I' Los Pu batar can choose h s O' n hou e as Pra ti'c 

t^s^OTt.tdfron^ctnt^«l vuT£-r> Pre-ns-'n I* jearv rurc‘'-sc lo^ n^panner 
ah c d be tvrcrrnved a-d u-J-t *0 

0 SURRC\ —WITHIN 15 MILES OP LOStXJV—PARTNPRSHIP — 
ONC H LLP SH VRE tn ser\ r'is.«d<'js Prani c s tuared tn f o in-' 
rwiwffp lal d trie: Cross cash free pts arnfo\ir“JteIs £i000pa« ssith 
5ubst..p r^lpap^L Ners pi-r houses* th-Unoo rnccnsenienccsaodhc-Jtiful 
pafden O recenu n 4 bedreo'’'! e c > Can be rer cd or p urch4 rd Prerriun 
2 seapi pcf hasc 

to LONDON S VV •— 0’d<itablnhed niied-<Uss PR \CT1CC produ ire f'r 
Jast 12 rr..r hs £7*0 in^Judmc rarrel of 2§0 Plat can be ren cd at £ b p a 
PieTsiL-n £I 250 

11 LONDON EAST — AliJdle and sscr£ms<lass PRACTICE prodcartg oser 
£500 pjL ss I h pc*od sci pe Panel cf about 7*0 Fees from 2 Ten rooised 
convr house Pris.e fir lease £5*0 Premium f*00 to irv*Iuu' drugs, surgery 
(Ittinm, etc and some Turn ure 

12 ESSfcA CO\^— PARTNERSHIP — V third partner n required in old 
established Practice Suiiab’c bouse as ailable Premium 2 jrars purcb,ase 
Further d tails on applicaiioa. 

13 DE\OS COAST— POPULAR HOLIDAY RESORT— Old-establubed 
non-dispensiog PRACTICE asrraging for pa« 3 sears £I 640 pj- including 
panel of 400 SuaabI* house smh amp c -cccmmodation. Freeho d £1 ”00 
or might rent Premium £2,500 

14 NORTH WELSH COAST,— Good midd e-c!ass norvpjnel PRACTICE 
aseragmg about £900 pa., with good sco'se lO^ached house osertooLmg 
bcaLtifuI baj ssitham" eaxommodation Smin of all kinds. Good schools 
Frer'mm 2 sears purchase III health reason for safe 

15 Lives— MARKET TOW'N — O d<siablish^ PRACTICE in prosperous 

district producing nearly £2.500 pj including panel of I 3S7 Well built 
house (2 rccep ion 7 bedrooms) rent £”3 pj wmium II >ears purchase 
or jsear olTcr for quick sa’e Ccsod introduction 

1^ ' ate PRACTICE in r>ctare<que 

Parel of 300 \ eo easil> wxjrLed 
* 1} sears purebase 

' ^ ssith succession m 2 or 3 sears 

" 1 s«D F’easant surroundings 

Pare! of aK ui 8*0 On 
largs loun'— hall billiard 
■cofTtrodation nice garden 

_ ui s jjjc A.I 6 u 

18 UEOS— PARTNERSHIP— ONEDIIRD SHARE in ssefl-esiablished 
mned-class Practice producing £I 67* pj Parsel of "60 Suitable house 
easily obtainable Premium £1 000 Definite sco'^e 

— W elLestabI shed good routed PRACTICE produwing 
os’cr £2,000pa inclLdicg panel cf 14*0 Soitab’e house ssrth ample 
accommodauon good garden and garage Rent £50 pa Premium £3 000 
for quick sale , 

20 SURREY —RAPIDLY EXPANDING DISTRICT— PRACTICE at present 
produces about £700 pji., but ecu d be much increased Panel of 3*0 (t- s- 
couraged) No midssifery E^l ent house with all modem conveniences. 
Premium for Pr-ctice and house L> 000 

*'1 midlands.— GOOD RESIDENTIAL COUNTRY DISTRICT— Com 
r~ct PRACTICE prodJang fTTOpa., with good prospects. Choice of 
- rocscs. VIocerate premium III health reason for sale 

22 SW ENGLAND— FAVOURITE COAST TOWN —HALF SHARE afier 
r^^inarv assrstantship in chiefly better-class Practice producing reartv 
t2.CK» pa Small parel Choice of res derre Ma.t be espenenced and 
preferably knowledge of EN T premium 2 v cars purchase pan bs arrang- 
rnent 


17 


'•3 NORTHANTS— O d-«ijH,sbed Cm "ti^ PR ACTICE averag -t: £I 6^ pj 
Pan-l cf I *00 Pr^ctica ly L''op'v>s^d Prc'^i m 1 1 scars pa ha * Lon,, 
parr-r hm m foduvtion 

24 LONDON S E.— Wcll-csiab’ sb-d PRACTICE chi-^v cash Receip^. 
a rrac“ about fiojopa., with panel a^d club pri.dujmr o £-P0p.3 
Can be fun ~s a lock up Sa ta'*^c premises avauab - Pr mum 2 ymirs 
pur *ias.. 

25 LONDON SW — RFSIDENTIAL DISTRICT —Good mJd--c»av. 
PR verier p ox. cir" abnut £1 4C0 p a includmj p..r I of *C0 pa imt a-M 
appi i"t'^crt w nh jN at £.,00 House on r al Gcods^O'^f re"e tk- 
wnrkcf Prc'" um 2 -^rs per h»se or r~mr o Ter 

”f SURREY — We'I-cs j''I s*’“d lOvre-tm'’ PRACTICE situ., ed n i.me’o''in'’ 
rc id-nii 1 district Gre s casn receipts for l_i 12 mo tb afcov. £j<X) 
i*'».loJ n pan 1 ci aK u *00 Sma I comp..'t freeho d hoa«c Pr ce ,-"^*0 
part or or would mt at £S5 p a. Pr ’^lum £1 00 Amp'-e 

t cr f -tK. w rker 

27 GROWING RESIDFSTIAL DISTRICT WITHIN 10 MILES OF 
LONDON — RfcntN estabf led upper and nidd -vlass PRACTICE 
prodtxing ab«out C^OOpj with dehm e ~ope for mTc-.'e Sel«red p^r-"! 
of 72 Fees ' up sarus. Prominent comer hou^ wi h 2 recept on 5 bed 
ftxmt Sep-ra e en ran— to Pnfessjoral rooms. We 1 Lid o-t card p 
House on remak Premium IJ >e~rs purchase 

>8 LONDON S W —WITHIN EASY RE^VCHOFCITY ANDWESTEND — 
VVel-csah ch-e^v mdd e a d bc’ter<Jass PRAC^CE w th sure cal 

Ss.ore prodo aboi. £1 4*0 pa Selected pan 1 cf «»* Fern 5 ...nd 7 6. 

Go<xl-s red first Poor Pat w ith a’l conveniences. Pu chaser shou d fcw a** c to 
d vur-**r\ a''J F R CS w nuld be adv.ntamrnus. 

29 LONDON WC— Wei -esta^'ished PRACTICE poducjn-neurlvEl-OOpji 
Avera'’- £1 Pa-el o 1 6‘<i Sui ab’- awonmodaiitn avai ab and 

sjf*eo prem vs avd -* lock u-^ on rental Premium 2 ears pu chase 
I ONDON— WESTERN DlSTPICT— Old-esiafc ished po-njis'vnsi-g non 
pan-* PRACTICE p oJa*in about t^OOpA. Ca-abe of exp-nson 
especu Iv if panel work urdenaken We'I situated cor— r house on r,.n 
road with ampls -c cmmcy.atKn Prem- n I jc^r s ptreh-v Pmatiewoud 
be sod a^'an from houv if wK'-ed 

31 SOUTH W ALLS — OU-«tab ubed mamly PRACTICE prowu mg 

las* ve-r £. "(D of whr h £2.0*0 is from contrac* wori. a-d p-r— I Sj atb * 
house available Future rrc«*>*ct^ ..re conjiuC-eJ to be es“el -t, r-w works 
have rc-ertl ^en efeiTcJ in 1 *“- dis n-t Premium £3,.00 

32 LADY DtXTORS IR ACTICE — - BIRAJINGHAM — 0>d-es bh»bed 

PR ACTICE F odUvir- last \e«r over £I CC ** 

ra-el Fees*’ upward Midwifeo usu^'lv 1 

Su labe house ava lab Premum 1* jears 
cash for qu*ck saV 

33 KENT COAST— FAVOURITE SE^VSIDE RESORT— O afc» s'-'d 

rmddle-clats PRACTICE producing about £6"0 pa. StraH panel -CO 
patieris. Ve-j house in best end of the towm with amp e ccorr— od- 
tion Freebc'd availab'e Prerotun £1.200 Ernin-n ly suitable for retired 
armv ofTiccf wishm- to aug.-nent pension cr th*re is scope for vourgef man 

3-. SUSSEX— FAVOURITE COAST TOWN -Old-established PRACTICE 
producing about C*00pa., including panel which brings in about £I*0pa. 
Good houv on two flvirs Z reception ■* bedrooms, ciw Freeho d for sale. 
Premiun 2 vears purchase 

35 SOUTH COAST SEAPORT— PARTNERSHIP— ONE THIRD SHARE 
avai'ab'e in old-established’ and rapidly increasing Pranice wh*ch Lsi vear 
produTd approximaiel £3 ’S* mclmiinc a panel cf ov--r 1 600 patients. 
I u chavr can choose his ow-n rcsid pce Pranice is corduaed from central 
surcerv and the expenses arc not high. 

36 LADY DOCTORS PRACTICES —Several availab’e Full details on 
application 

37 NORTHANTS— ASSTSTANTSHIP with view to Partrership m ..n o’d 
established county Pron>~e with good future prospects. Initial salary 
£*00 pj., intfudmg car allowance the assistant to live out Full d t..ils on 
appljcation 

MIDLANDS — FAVOURFTE COUNTY TOW'N — SURGICAL 
opening — A QUARTER SHARE (after preliminary assutactship of 
" t Iished increasing Practice produvcing approx: 

bou 2,£00 Ore ap"om rrent worth about 
o dispensing. Suitabl-* boose with gard-n 
mum 2 years purchase pan by arrangement. 
35 expeneoced andab e to do some surpery 
SOUTH OF ENGLAND— COAST TOW N —PARTNERSHIP —A HALF 
SHARE in good mix«!<lass Practice estabhshed over 100 ears, averaging 

. , — ,-c7°2' 

about £ « ' 

midd a 

House - ’ 

purchav n ^ j-t DO ^ r-rrmc „ /V* 


38 


..-Tiroxitnatel £I 200 pjj-. widi cood scc'v Panel brmgs in wbojt £700 r.a. 
Good house with 4 bedrooms, etc. Rent £50 p.a. Ve^ rcasonafc e p’emiu'n 
for qo'ck sal* 


IJe Agenej has made arrangemenfs for special facilities on reo favourable terms to be afforded to approred pur- 
chasers for tbe advance of part of the premium for any suitable practice or partnership Full details on application. 



Tur HKinsn MinicAi iournm At^ i r, 103 



Espcrimt ut il itifi cliiMc-il Joi«ntn<!Ci»virlM*^^^t) -Itr' ’r iit"r t I*^ 

OCULOCARDIAC RLCLFIX DPRMOGR APIIISM R{SRIR\10K^ Nf^Ri 1 3 f i !\1! A fi! i Of<[ 

AND An I R iiLl LI RG \I I RP \ I Mf \ f 


Bi-forc Bi-llpr; 1 rc-\ln\riit 


1 Oculoc irdnc 1 

Dcriuo j 


* R. Hex i 

pTTpliism j 

\rriis t 

— 6 ( 

r ll 

- 

-Mr j 



j 1 ' > 1 

r \N 1 j 



j ( rli-M 


'--T f ’'•I*'- f ^ 1* I r*- ’lu 

‘ !i- < 

, r [.Kii 


I\' ii % ' 


!•> i 

'' ( 


Lnd r O', uloc. irdmc i fl v 


vi iMfic hU < \!> I" lU loti * \ mt ‘ 

\nI »l I >s \ ^ tl- tier t t ‘ j Nil f- ! 


It !<; seen that llie oculocnrcli.ic reflex was nt i \li\oin «)nK L ( )-^r Lrfurr hi itnirnt witii Rell'-r^ '! f’'it 
in 1 7 cases after treatment ^ lute clcrmo^rajihi nr rsa*" olrst r\.( c! in ! < a i U fine t>\il oal> in one < a e Tfter 
treatment, respiratoij arrlrr thmia present m 18 ease eii ippeirtcl j'lipt in o i*- t i e 

RESPONSE OF THE BLOOD PRESSURE TO AUTONOMIC STIMULANTS BEFORE 

AND AFTER BELLERGAL TREATMENT 


Action of Acinniiinc 


Befort BcIIct^ *v! trf^tinrnt 
Xftrr BcUrr^M ttriinicnl 


Ai tu n < f IMtu n I in'* 




li i I R ( t tr- 


20' n,n 30' 


In subjects with a labile autonomic nervous system Bellerg.al diminishes the exaggernted reactions 
especially of the diastolic pressure to stimulants of the autonomic nervous s>stcm such as adrenaline an 
pilocarpine It also inhibits the action of adrenaline and pilocarpine on the pulse temperature oculocardiac 
reflex dermographism and respiratory arrhythmia 

Clinically, 40 cases exhibiting marked irritability of dre autonomic nervous system were treated 
Bellergal They included a senes of neurogenic disorders of various forms nervous heart troubles witn® 
oiganic basis stomach troubles of the ulcer type without an ulcer being demonstrable ulcer and spastic con 
stipation By treatment commencing with 2 tablets of Bellergal three times daily graduall> 
small doses we obtained in all cases a marked improvement and even complete disappearance o 
symptoms in the majority of cases Secondary effects were never observed The preparation maj ^ ^ 
be described as a very effective remedy for the sedation of numerous conditions of hypcrexcitnbilit> 
the autonomic nervous system 

/ III! parliciilan from ^ 

3 nihr, SA^JDOZ PRODUCTS, 134, WIGMORE STREET, LONDON, 




JOURNAL OF THE 



ASSOCIATION 


SATURDAY AUGUST 13 1938 


PRINCIPAL 

Prevention and Control of 
Puerperal Sepsis p 331 

Treatment of Undulant Fever 
with Prontosil 342 

Antitoxin in Malignant 
Diphtheria A Comparatn e 
Test 344 

Treatment of Pellagra ith 
Nicotinic Acid 346 


CONTENTS 

Leading Articles p 352 

Scientific Sections at Plymouth 361 

Correspondence 372 

Psychotherapy Congress 369 

Surgery in General Practice . 

Colles’s Fracture 357 

National Health in Figures 371 

Reviews 349 

Epidemiology Section 384 


WITH SUPPLEMENT AND EPITOME 


L O N D O N 

BRITISH MEDICAL ASSOCIATION 

TA\ISTOCK SQUARE 


No 4M9 \\EEKL\ PRICE I 3 


Copyright 


REGISTERED AS A NEWsPAPEP 



11 


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Infantum, when it is Essential to Sustain 
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Organs, the Ease of Assimilation and 
Power of Valentine’s Meat-Juice to Restore 
and Strengthen has been demonstrated in 
Hospital and Private Practice. 


quickness and power with which 
^ VALENTINE’S MEAT -JUICE 
acts, the manner in which it adapts 
Itself to and quiets the irritable stomach. 
Its agreeable taste, ease of administra 
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JOURNAL 


BRITISH MEDICAL 

AUGLST 13 193S 


TABLE OF CONTENTS 


\DDRCSS1^ \ND r \PI IIS 
Prci cnlion and Conirol of Putrpcnl 
Scpsi<! R JOIISSTONE M IJ 
FRCStl' ■’ll 

Prcicndon of Pucrpcril Sepsis 
Lth lC\'sie m d d p II 

Pucrpcril Sepsis \dtninis(ntiie 
\spccts A M \SSE1 M D DPI! ' i7 
Puerperal Sepsis Baclcriolopical 
\*^pccts R \I Frs m p c s '-la 


Trcilmcnf of Undulant Peter ttilli 
Prontosil C Z neemass md 142 
CoTipanfiie Test of *NatunI and 
Concentrated \n(ito\in in Malig 
nant Diphtheria B A Peters 
M D D I II ■’44 

Treatment of Pelhgra ttitli Nico- 
tinic \cid M R SCHttlLEttlT? \1 D 
and Helen 1 Cllecr m d 146 


SURGICAL SERIES 

Colics s Practurc and ChauITeurs 


Fracture R A Fitzsimons f k c s ’37 


CLIMCAL SIEHORANDA 

-Basal Narcosis for Tetanus p T 
O Fsrrell frci I 14S 

Stable Sodium Nitropruss de So'u 
lion for Acetone Bodies in brine 
John Ingham ric 14S 


OBITUART 

Saltalore C-ssar ID 377 

H M Cochcroft l R.C p 377 

R 3 Heam m d 37S 


GENER AL ARTICLES AND 
NEWS 

Report of Ministn of Health 371 

Pst cholherapt Congress (con luiei) 369 
Nota ct 'N clera 

Some Echoes of \\ itchcrafi 60 

Prfparattons and Applianoes 3SI 

Medical Notes in Papliament 379 

b lAERSITlES AND COLLLCEN 378 

Medical News 3S6 


ILVDING ARTICLES 

Pretention of Puerp- al Sepsis 


Nicotinic \cid for Pellagra 303 


ANNOTATIONS 

Pneiimonilis 4 

Seicnu 'll as an Inuu trial Hazard is 

Inheritance of Sebaceous Ctsis 3aa 

The Carotid Sinus Rctlev aft 

'dMsort Conmilice on Blinuncss 6 

Tesiimonial to Dr Hutchison 6 


SUPPLEMENT 

Earliest Nfcdicinc in England 
Profe-sor C SiNCEP s Lcclurt 

ProUsfional Jurisdiction forth'' 
Belgian Medical Profession 
Bt Renl Sand m d 

Secretaries’ Conference 


The B M \ at Torquas 

The Annlal Exhibition at 
Plan oh II 

Inserancl Medical Sera ice 
Charities Trlst Fend 

CORKESI ONDENCE 
PoSICRADL ATE NEAA S 
Naaau Militara and Air 
Force Appointments 
Association Notices Vacancies 
and Appoinlirenls Diart 


CORRESPONDENCE 


Abortion and ihe Lau Geoffrea 

E\ ANS M D J A lES A OL NO SI D 

C A H Franrlan md 372 

Diabetes and Pulmonart Tuber 
clIo IS G D Piriie m b 373 

Lndescended Testicle P Ni F 
BinHop bm Denis Broaan-e 
F R c s 374 

Sulphanilamide for Menin_o"occal 
Meningitis H Stanlea ' Banks 
MD 37a 

Chen-olberapt of Conor hoea 
H M HtNsCIlELL ARCS 37a 

\ Rat Screening in Gerc-a! Prac 
lice Hilara 'Rcche m d 373 

Complicaliona of Gold TherapA 
Mai RICE Newman md 3"a 

Tiirercuhn in Diagnosis A E 
Finckh mb ' 376 

Blood Groups and Lcgislal on 
A G Newell mo " 376 

Steinach II Operation for Prc^tatic 
Enlargement T Hlnter md 376 

PsAChoaomatie lllneas \\ 
Hitchfson md s76 

The Fhing Squad in Matermlt 
Sertices John El am mrCS >77 

E F Harrison Alfped Cox xi b >77 


REVIEWS 

SAslem of Medicine and Surgen 349 


When to Operate 349 

John Keats 349 

Ophthalmological Principles 350 

PsAchotherapt >30 

For Notice Ship Surseons 3a0 

Notes on Books 331 


LETTERS AND Al^S^^ERS 

Spasm of Colon , 3S6 

Green Stools al 74 ^'*6 

Teaching of Obs^eincs “86 

RecoNerv after I *'00 Grams of 
Aspirin 

The E\olu»ionar\ Theo’^ ->86 


EPIDEMIOLOGl SECTION 

Epidemiological Notes 38 

TsBLE of KFECTIOU*! Dli»E\StS 

\ IT \L Statistics "^8 


THE SECTIONS 

Summao of Proceedings 

Medicine 

SurgerA 

Obstetncs ^nd GAnaecoIogA 363 

Orthopaedics and FractLrea 364 

Public Health 36^ 

PhvMcal Medicine and EcLCClion 366 
Medical Sociolog\ 367 

OphlhalmoIogA 368 

Exhibitions ot Films and Radio 
graphs 369 


A KEA TO CURRENT MEDICAL LITERATURE till be found at the end of the JOURN'-»L 








1 < !'' 



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\i. ''i <-1 n 1*)’^ 

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Andrews’ 
oi Tbe 

CONTENTS 



G'‘^cral Vnitonu -incl P'itholo^ 

S\np omatolojrv and Gcroml Dnp 
no Js 

Ro*'ntpon Ra\ Thcrapj 
Radium Thcrapv 
Dermato e*' Du' to PhjMcal 
Pruritu'; a id Cutaneous Ncuro-'C« 
Dermatitis \crcnata 
Dermatitis Medicamentosa 
Er\thcaa and Lrtirana 
Eczema and Allied Coadilioas 
P*ona«U and Allied Diseases 
Lichen Planus 
Acae ^ ulgans 

Mi^'CellancoUb P\oi?enIc Infectiois 
Disea es Due to Fungri 
Tuberculosis Cutis 
Other Diseases Due to Bacilli 
SjTihilis 


Dibca^e^' Du to \»'imal Para itc 

Dl'^oasc" Cued !»\ Filtcrat le 
\ iru« ^ 

Ptmphi£tU‘- and D'^rmatiti'. Hcrpeti 

forrnis 

Dcfici* nc\ Di east- 
H\pcrtrophKs and Mrophlt 

Cutancouc Infiltrations of Product 
of Metahoh-m 

Diteasos of Conpc u al Origin 
Btnign Ncople-ms of the Skin 
Malip,nant Ntoplasr s of the Skm 

Disease's o*^ the Hematopoietic 
S\ -tern 

Disease^ of tbe SKln Appendages 
Dl eases of the ^ ucous 'lembranes 

Affections of tbe Cutaneous Blood 
\ es«cls 

\nomahcs of Pigmentation 
Tropical Di-tascs of the Skin 



For this neu edition of his deser\ ediy popular book Dr Andrews has dra5ticall> re\ised e\er> single pa^e. 
Man> new subjects hate been added there are mo’-e tian 230 new illustrations o\er 75 diseases that 
were not in the first edition are taken up and altogether the revision constitutes a new and up to date 
dermatologv for the general practitioner and specialist 

B> George Clinton Andrews hi D As ociale ProfesbOr of Dermatologj College cf PIij ician> and Surgeons 
Columbia UnnersU) Ocla\o of 899 pages with 938 illustration^ Cloth 45s net 


NiW — Mallory's Pathological Technique 

JUST READY — ^This cnlird\j nen book b> Dr Frank B iMaIlor> is a piacliLal manual of pathological 
technique It was wntten in response to a constant demand for such a book and i:» a decidedly thorough 
presentation of modern methods and their application 

It opens with a concise descript’on of the equipment required in this work then takes up in separate 
cnapters such subjects as preparation and examination of unfi'^ed material fixation decalcification 
embedding processes d>es solutions and nuclear staining methods cleaning and mountmg reagents 
micro incineration injections etc There is an entire section on special histological methods inciudmg 
methods for special organs bacterial stains and tests for miscellaneous infectious agents There is a /0~ 
page section on postmortem technique and chanters are included on the preservation and photographj of 
gross «‘pecimens 
/ 

B> FRANtv B MallORV AM MD SD Con^uhmg Palholcgt l to the Bo ton Citv Hospital Octavo of 434 
pages illustrated C’otn 20s net 


W B SAUNDERS COMPANY, LTD , 7, Grape Street, LONDON, W C 2 




4 


inn nRiiisn mi nu ai iournai 


At ' list 13 lO’s 


IIPORTANT ANNOUNCEMENT 


EARLY VEGETABLE 
DIET for OPTIMUM 
NUTRITION of INFANTS 

It IS now \Mdcl> admitted tint \cpttiNL foods 
should supplement the milk diit of infmts is 
early as possible The difiicult^ in prestribinj, 
these foods it an early me Ins however ImlurPi 
I Lcn the fact that the weik diyestions of iiilants 
cmnot suecessfulh de il with tile fibrous cellul ir 
tissue, which therefore eauses intestini! irrituioii 
ind consequent upset, frequetith nnnifested b\ 
di irrhrea 

The Libb^ method of Homopemr.iiion dism 
teprites this touph, indigestible cellul ir fibre, tints 
cnibling It to be e isily eliminited the ' bulk ’ 
however beinc in no vva'^ ifieetcsl T his breaking 
down of the fibrous vv ills also h is the kIv int i< e 
of enabling the full nutriment to be thoroughl> 
issimil iteei 

Libby’s Homogcniced Vcgetible Foods for 
inf lilts arc prep ired in six seieiititic ill^ toniiul iteel 
eombinations of Cereil, Vegetibles ind Fruit 
These can be prescribed as needed to prov ide thu 
necessary balance of X’ltimins, Miner ils me! 
other essentials 

The accompanying table shows the eompiritivc 
results of carefully controlled experiments with 
supplementary vegetable diet 

AVERAGE TOTAL INCREASES IN HEMOGLOBIN 
AND ER3 THROC’i TES AFTER SUPPLEMENTING 
THE MILK DIET W'lTH HOMOGENIZED \’EGI I A 
BLES OR STRAINED VEGETABLES 


Per Cent Inert itp 
Abotc An enn > Let cl 
Red 


Food 

Hemoglobin 

Blood Cells 

Specially Homogenized 
Vegetables 

(carrots, spinach, peas) 

89 

117 

Commercially Strained 
Vegetables 

(carrots, spinach, peas) 

76 

S4 

Home Strained Vegetables 
(carrots, spinach, peas) 

80 

95 


Snmples topother with clinicil dit \ nnd 
hboritoiy reports will be ,;hd!y sup 
plied upon request to Messrs Libby 
M'^Neill Se Libby, Ltd , 15, Lime 
Street London, E C 3 



‘SUMMIT’ Ilyporlermtc Noodle 
noiv ALL-niUTISn 

Itie vole niaiiiif itiiirini nrlii of ilie Sl'MMII hvpodermic 
needle liivini rceenltv been I iLcn over b> S and R J I vcrell 
and Conipiin limited it iv nov cnliicK Briii'-li 


EXCLUSIVE FEATURES OF SUMMIT' 

(1) EASY TO WIRE 

li» > f' ffiJ 4 I'' n 4, »vn Ihr nrr ! c 

( 7 ) Finn SILKY FIT 

1 CM rf I t S 3 < tl Utif ^ n'- »t c IH I a il > rtm i ctl 

rri lint (I jt > 

(3) EASY TO ATTACH 

U » f " I" i r « nt rnib rs I I he I i"^iv 

t? r *<41 t'-twren It »Fi r * ! f trf f r 

<4) LECIDLC NUMBERING 

<Jifctn- I th" »f 4'* 1 n f ifj t 4 f the r* i ft rr'ctJlt 

%frr U t > t I o ji I » 44 ) 1 B f ih f Iff! 

(5) APPEARANCr 

lh<* \f^t m-i 4 j vvi V ht tj II V f« I n r u ^ trt itr« a retfevt 

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•SUMMIT' Needles 

Fiom ill Siitoicil Iniliumcnl Supplicij 

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PURITY AND RELIABILITY 

PHIL-SANO 


l\ran ! 

TAKLETiS 3<r 

it) nnt! purit\ ccmpourcfcd in 


Asviniis 

me of excrptionni icmcdnl -xctiN 
mo^t scientific mnnner to secure ihenpeutic rfTicipnc) *llic inj^oitmt 
frntures of Phil Snrtr> 

BRITISH MADL ASPIRIN 
TABLCTS me the Nshilcne^* 

of the Tnhlcl4 the extreme 
punt) of the A%pinn u'cel in 
ihcu mnnuficturc nnci their 



25 

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50 

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tht\ \mU Im: 4eni r'"*! lice on rcctin 
of rciminnKC 


instant dmntcnrTlmp properties 
there nrc no Aspirin 1 iblcts 
of better or hiphcr qunlit) 

Phil-Sano Limited 

106, GREAT RUSSELL STREET, LONDON, WC1 

Telephone MiJscjnKSTT Coilr^ AUC ^th rJuion anil Marconi !nlfrn>.uorc! 


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S^iiblica Lions 

li M Model Forms (No 1) for 
Docloi’s use iilicn sending a Pnlunl 
to Ilospit d 

PriLO per 100 po-^t free 

DMA Model Foims (No 2) f«r »*‘- 

® of Hospital when P itu nt attinds wH * 
out a Doc loin's LlIKt 

Price G(1 per book of forms 

j^Hcaliejsl Afe>s«eiaCi«** 

B M A House, Taa istotK 5q , London, W C 1 

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either plain or cork- 
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brilliant unhappy sage of Chelsea —Thomas Carlyle 

Notable, m matters of smoking, is that other famous 
number—Player's No 3 It is a number with defi- 
nite associations the mellowness, the distinc- 
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PLAYER’S 

NUMBER 


EXTRA QUALITY VIRGINIA 



20 FOR 1/4 


iO FOR 3/3 


50 TINS (plain only) 3/4 




6 


I in: HR1IIS11 MIDKAL JOURNAI 


Aik.dsi n i9lS 





EN CHARLOTTES 

portable 



GAS AND AIR 

MACHm 

DESIGNED FOR 
SAFETY-LOW COST 
PORTABILITY 
COMPACTNESS 
SIMPLICITY 


BY THE 

CEfSSTRAL 
MrOWIVES 
BOARD 


The Queen Chailoltes apparatus has been 
recognised by the Central Midwives Board as 
one which may be used by midwives in 


accordance with the terms of the Boards 


ruling legarding the administration of Nitrous 
Oxide and Air by midwives Three models 


are available which can be supplied to 


STATEMENT AUTHORISED 
BY CENTRAL MIDWIVES 
BOARD SEPT 22, 1932 

“ The Queen Charlotte’s Gas 
Air Analgesia apparatus has 
been recognised by the Central 
Midwives Board as an appara- 
his which may be used by 
midwives in accordance v;ith 
the terms of the Board’s ruling 
regardmg the admmistration 
of Nitrous Oxide and Air by 
midwives " 


midwives and full particulars are obtainable 
on application to the address below 



' MEDICAL SECTION. 

j 


EAST LANE, WEMBLEY, MIDDLESEX 
TELEPHONE ARNOLD 1234 (10 Lines) 



THC BRITISH MCDICAL JOURNAL 


CORSETS AND .POSTURE 




f ? 
K 

: \ A. 




T > I ciM Ii tn ftf t>o Jure in I Kture < f I >c r «I I " rl l*cfor •» i I min Mlel 

It r } (. n flicatio 1 of ll e ''J ncer ( rr ct»\t '-uf j»ort |nier»al of a f nun.-t 1 Ineen 

I ict ir \o I \ . 


Fron 
Fi p n 


lilt, \nlue 01 S|Kncti ^upp irt' iii concciiii" pos me h i~ loic; Iieeii itio^ni'Cd l>\ tliou' md- or 
doctors \ Iio u c the n re..tdiil\ 

When «c impro\c pj'lmt tliKiii.,li i spcinci Coi'tt or ^uppoit ue cdl this I\[JI\ lUL AL 
1 I SIGNING/ Licit ''(t Heel ^Jpptrl i' de'i!,ni I to meet the indmilud neeil' ot the pitient tiom 
complete niensuremeitts md lieme de cnplion til eii I>\ i ti imed CmseiiLie 

The Spencer either tlie I ell or the Supportmt, Cutset i- designed m two seetions to £,t\e idequ tie 
'ihdomtml support md iipliit md correct hlek supp >i t 


svrroms roh 

11 ilernits llovililc Ividncs Hernia 

Enleroplo is S icro i)i ic Strain Post oiicriiive 


Pendulous* 3re l 
Peiululoii’* Abdomen 


W\nr OF LD-TITITION — s, n III rre Itlrnrr 

»«h rr lo lor Is r p Iff II j rr^rribr I s ^prr« Suppo t a C't»r« 
to noi d r*tsn 1 ihr '»prn r p n Ipir of n li tfu I Ir l(cninK. | 

'•PL>CFn Lab ! 

Trijneef Sj ncvr Cor cticr iri: re !e it tbroiiLlfut tl»e 

Km floiH Aar'c of near t t.U!)\ upHi i on rti|ijc t 

A JCifPt r irei Sf rcer C rs tt r t( ll ctU it '»i 

j jc* \ r Jf jour f a icrt j h e ! t k me fj e ts n t iir 


I r • nJn^ iJ r n ! ’ll I ofe on ll » In r I o lanrr 

I of anoihr n kr I bn ub I i Ir I an I brran r i maker* 

brrn n I f loo L*-f p nu n Sj mrrr •'uppo 1 bejf ll 


CORSETS - GIRDLES - BELTS 
BRASSIERES - SURGICAL SUPPORTS 

Branch la and Salons 
LONDON GLASGOW BKISIOL LU LRPOOL 
BIKMINGHAM LDINBLKGH AIANCHESinL 
(Sec Local Telephone Dirccton ) 

E-MHfrt Fitter (Trained Aur c > at %our immcRatc bcr\tce 


rrt j 


Spettevr Supportfs rtui Cnrst is nrc 
never snltl in shops 

sent! \ou lliis iNe" 
Profe«''iomI Booklet de= 
cnbing Soencer Supports 
nnci itieir Accepted Lses’ 


SPENCER CORSETS LlfllTED 
Spencer House Banbury, Oxon 

ft (Mi Siiid vt \oitr ftlnitrati-d hookl t I am f'arlt t Iarl\ 


III/ r sUd tn vnl'forls for 
\awi Dr 


■iddr ss 



8 


ijir, uRinsH MCDirAi journal 


At f.t m I"'. )‘j’8 



uestion 




]]' luif f/>r Mor/ ij)ectivc ahdni/iiiidl 


Answci DIRCCI Tiitcntir pitstcriiir pri.'-Mirc 


It . 

c 




Answer 


ll D) . ih'ii 

Tt m\cs LM.n, ptititnc prt.'-siirt. uhtrc 
the IkhK niDst itct-cis u 


Oiutnon 1! hnc n thu fot » oj tiipp'nl jttml ti' its 
he r/ '' 

\iis\\ci In ihi. ( iirtis Mulnmintl Snpptiri \n i 


Out moil 
An\\\ (. r 



It hat III it< out <hti <I I !, Iiiitjihj i 

No umlut. cott^inction <tt the lower 
ihdonun 1 \trtmd\ ln;ht M-winitim 
•iupport IS comhint-cl with complete tree 
ilom t)f the hips MedicnlU npprovecl in 
the treitment ol 'll! forms of ihtlommti 
ptosis — Msceroptosis, enteroptosis inti 
i^nstroptosis — inti lor the support ot 
scTr tissue tiurmc: consolulition 


n F cuuns e'l bUN in) 

" MnnOr^illr 1 I x*- ^Irrri I tt I » V' I 

S Ifit/ rri / ( tirlV \| pUattfe \ | «l«*» ilrttl I* ll 

iintl K «r p! I la itf lit U y I n»* «■ < 1 i »»»y 

\j j Unnff* rlf IflcKrant*; < ttrll W^llrV •»»! 
UUl it nr ^ I t I rk i 



KOROMEX METHOD 

71ic 

Koromex Occ'usne DnplinEin is rmde 
in a range of sizes to fit each indiMciinl 
patient, puie laicx rubber pessaries 
Light and comfortable, practically jnfcit 
Two-year durability guaranteed Prac- 
titioners and birth control clinics, for 
more ceitain protection prefer to use tiie 
perfect fitting Koromex Diaphragm with 

KOROMEX VAGINAL JELLY 

Stainless and prolonged cffectiee 
spermicide The carefully gauged ms- 
cosity of Koromex Jelly affords the all- 
important mechanical block No toxicity 
or irritation makes the diaphragms 

easier to insert 

/Idvise the Koiomex Method Your 
patient will be giateful 


The Highest Record of PROVEN 
SUCCESS in Contraceptives 


O Cvjdcnce of the high degree of cfficncy of the Koromex 
Method IS based upon the experience of 234 clinics 
140 hospitals — oxer 50,000 phvsicians 



THE KOROMEX METHOD 

KOROMEX DIAPHRAGM + KOROMEX lELLY 


A sample of Koromex Jelly wall 
be sent on application to medical practi'ioners also a 
booklet the Physician s Guide on the technique of fitting 
the Occlusive Koromex Diaphragm No charge Write to 


• Tlie Koromex Diaphragm appears on the 

Control Association’s approved list with seven 
products, including Condoms, Sheaths, Jellies a 
Suppositories llUislratctl descriptive Price List on renues 


PRENTIF LIMITED, CONTRACEPTIVE SPECIALISTS, LONG’S COURT. ST. MARTIN’S STREET, LONDON, WC.2 

Sole agents in Great Britain tor Ho 11 a n d - R a n t o s Co , Inc , New Vor 


if you. ore not rcccinn#; rig^ularW the PnuUf Qunitetlv Mtdtcal nitUttiii Contract ptiit 
Practice ” / ifidlv inform iis U'e ht pleaded t» sii/jplj niis^iiiff had uumhers 

and nrraiif^o that future issues are specinWy i/ 


\trisi !' I9'?S 


THE BRITiSH MEDICAL JOLRNAL 




^ MEW 

NATURAL FRUIT JUICE 


If \ our pnticnts ■\\ouItI likt t nev fnnt jiiicc in their diet \ou cm 
=TftU n.coiiiiiiciid Dole Piiicnpplc Jiucc tlic pure, unsi\cetcued 
juice of lu=ciou= I^^^^^lIln Piiinppks Bt'ulcs Leiiig n delicious 
rcfre^iing drink it is t good source of Mtniiiiib A, B iiid C and 
natural fruit sugar* The tapicil aiiaKsis biloa\ shons >ou avliat 

Dolt Pineapple Juice is composed of 



XQt V i 




iirce of Mtaniiiib A, B and C and \ "■> \ ^ 

; il aiiaKsis btloat sbons >ou avbat 

acapplt Juice is composed of K *, -/'■ 

JX- . J ' ] 

TYPICAL ANALYSIS VO A /' ^ S 

as 3 , OoJ f b r o 02 , f ». V V ' 8 

O 3“~ Ilrdn me * Jn rt KA^|4 t*A | \ ? I. 

OJ% •.pr 12 t V v\ « i ! »i i 

CA/iioh «lratr olb r tli a Y*\ \ i 

(Ly dlff renee) O 3P l ^ \ ^ \ \ f H 

1/ >o« irouIJ like to taste this /ono drtnf' ice tctll b* V 
p*cxi ^ to send you a sample tin on receipt of >oir nam 
and addres 

2000 doclor< hare «!read» arailr^ ihem^flee* of ibw offer Do'e Piccap-' c Ju ce 

Pare nns>»eetened packed bi the escln ire Dolp Fa_! corrss ^ or: Ha-waii *~d 

cj , , o » « ' *s «■* 

beal iflcuuzn l acking i roce^ Pi'*'^*‘**’es 


Seal ^acu^In Packing Proce> 


DOLE 


HAWAIIAN ill.'IHitilillillMl 

J K HUSBAND « CO. LTD , ID EASTCHEAP. LONDON, EX3 « 


FOR THE TREATMENT OF DIABETES 

PROTAMINE INSULIN (wilh Zinc) Suspension-Boots 








Supplied as follows 

40 units per c,c. 

5 cc. rubber-espped 
vials S 

10 cc. rubber capped 
vials ^ 

80 units per cc 
5 cc rubber-capped 
vials 4 

Paces net. 


Accurately standardized and tested 
before issue May be used alone or 
with Insulin according to the needs 
of individual patients 

Cases of Diabetes of moderate 
severity can usually be controlled by 
one injection of Protamine Insulin 
(with Zinc) Suspension-Boots 
a day given before breakfast. 


INSULIN . . . BOOTS 


ONE QUALITY ONLY 


THE HIGHEST OBTAINABLE— PURHY AND POTENCY GUARANTEED £b^' a O I 


Lterature sent on request 




trmm 




u.~nmwm 



TllC BRITISH MLDICAI JOURNAl 


Aiuusi n 191fi 


ACIDOSIS ^ 

Osier and McCrae advise 

the employment of Sodium, (‘jCv 

Calcium, Potassium and 

Magnesium Salts for the pie- ^SALVITAE promotes Elimimtion 

vention of Acidosis \\ AlHIcsccncc by idcqintcly 

dfOv \ supplying these silts, thus miln 

nining the rciction of the blood 
/r../r,„onni mmpUx nmi It pncticilly 1 fixed ipd constiut 

ttQurst point 

COATES & COOPER LTD, 94, CLERKENWELL ROAD, LONDON, EC1 







THiRIA PROPHYLACTICS 

Made and standardized at 

EVANS BIOLOGICAL INSTITUTE 
RUNCORN, CHESHIRE 


APT Evans 


1 ht 111 "t luictlmn >'lu>u!<l 1>( 0 1 loCiZii mul ilu liinl min-tmn 0 i ii 

_ ,, illsi two wciks I oi ihililjin of ii,,Iil \i Us mid uiiikr 

(Alum Prccipitntcd Toxoid) 

TAP Evans r \ r vlioiild lit u-'kI wIkii tliL siiliHii Is niou th in lujlit m iis ot 

(Toxoid Antitoxin Flocculc**) 

T AAA Evans I’liuluits imiminus molt slouK thin \ 1’ 1 nul J \ 1 

(Toxoid Antitoxin Mixture) 

PI" Evans iHlwitn I ami b mus ol iqi 

(Formol Toxoid) 

(Special piicc'< and detailed literaliiie mil he Jnruarded to 
Public Health liitlioritie'> ) 

Evans Sons Leschei* &. Webb Ltd. 

LIVERPOOL and LONDON 


VALUABLE, DOUBLE-ACTION ANTISEPTIC* 

LoctI trcTtment willi Splingnol PctI Ointment give*^ rapid Ins proved beneficial over nnd over igun vslicrc pcr^i^tcnt 

relief in the most obslimte cases of psornsis Incmoi rhoids resist incc Ins been encountered 

eczema and skin eruptions Tlic reason is tint Sphngnol has In ca’^c >ou have bad no personal c\pcncnct of Sphngnol 

n twofold action First of all it soothes and nllnjs irritation shall he pleased to send vou a clinical size simple for t«ling 

and burning sensations secondly tbe natural antiseptic proper if }ou will write to Pent Pioducis (S(ibagnol) Ltd Uept 

lies of tbe pent distillates rssisl in general treatment Splingnol BM | I! 21 Bush Lane I,«oiulon LCd 


CONTAINS 
DISTILLATES 
OF PEAT 




MEDICAL SOAPS 
OINTMENT 
SUPPOSITORIES, ETC 



Ai i-;7 13 li3<i 


THC BRITISH MEDICAL JOURNAL 


LAGTAGOL (Edc^-linc ( jlriiiin Pho jilioni**) 

licljis lo ooniix'iisnio for tin coiisi ml 
(Iritii In tliL fo( Ills upon tin r(»tr\»5 of 
llic cxpcci ml motlnr 

II c- a \nlu ililr rolioraiil cliiriii" rnn\ iIc-- 
ct net follinnii^ p irltinlion imi « \< rlx 
T (Irfimlc f:alnrn 2 o_mc aitum on tlit 
nnmnnr> pi nuN of iIil imr-m" mollirr 
Spocinunx for rlirnr il Inal frto on ippli 
mum L tel ipol Ltil 3Iiirli mi, I^nr^c^ 



HEWLETT'S 

ANTISEPTIC CREA 

AN EMOLLtENT HEALING CREAM 

FOR 

BLEPHARITIS. ACNE. ECZEMA. 

and all abrasions and irritations of the skin 

MEDICAL OPINIONS 


I consider that Messrs (Ie\\letts Antiseptic Cream 
IS the best ointment that can be kept for general pur 
poses lu soothing and healing properties are most 
marked and 1 have never seen its equal 

E N L-RCPEd MRCSEng 

I think this a most elegant preparation and certainl> 
IS excessively useful in s>in abrasions 

T C E. M R CS L.R C P 


! have found great improvement from the use of 
>our Antiseptic Cream in a case of Eczema of the 
Scalp which had been chronic for 18 months 

D k LFPSGIasg- and L.M 

Antiseptic Cream is a compound of zinc oleate with 
bone acid lanoltne etc which should serve man> 
useful purposes 

— Bnslol Medico ChruPtcol Journal, 


In cnirnelled collapsible lube^ cr I oz pots labelled cnl> The Ointment To be used a» directed 
In bulk, 5oz , lOoz, 22oz , 40oz , 4fib and 7Mb pots 

Introduced and prepared onlv by 

C. J. HEWLETT & SON. LTD.. 

35/42, Charlotte Road, and 83/85, Curtain Road, LONDON, EC 2 




THr HRITISII MHOICAI JOURNAI 


Ai'oi SI 13 I01S 


A PRODUCT OF DISTINCTION 


LUBLE TAR PASTE 


INDICA It D I\ 


^TP. (MARTiNDALf’i 

^ Soluble Tnr t j 

’Ptif no,j alninmi ‘ 

A (I / n ' .,f I * j 

'W MARTINDAI-'* 

^ Afanufoettf tnr 

LOMJO'J " ^ 


ECZEMAS, PRURITUS, 
PSORIASIS, etc 


PRI sCRIIil AS 


" E. S. T. P” (Ma rt i n da I e) 


I'^iRcl 111 2 1 Ttid 8 or pot 


LlIrMtuir »n(l rlirur «! a>mp*r» in iniu^'il 


W MARTIN^’ ALE 

75, NEW CAVENDISH STREEf .ONDON, W 1 

Ol ^ , 



GODDLSS \ 
NEITH \ 
Posotlifti I ' 
lion of L in \ 
Ihyss Xiliiih 

ciuii ( <! 
inalion 





IN SICKNESS AND CONVALESCENCE 

T HC impairment of clif;csli\c powers ^\hlch is commonlj met 
with in the fc\ensh patient combined with the lack of 
desire for food often nggrn\ntes the difficiilt\ of adeqiiatel}’ 
replacing the increased loss of energj and destruction of tissue 
wfhich occur 

Ovaltine provides a satisfactory solution to the problem of 
alimentation in many cases of sickness and m the stage or 
convalescence after sev'ere prolonged and debilitating illnesses 
wheie an easily assimilable palatable and concentrated nutrient 
IS required It is ahvaj's acceptable 
Ovaltine replaces with advantage the ordinary milk prepari^ 
tions which so often prove distasteRil to the invalid Prepared 
from full-cream milk eggs and malt extract m carefully bal- 
anced proportions it provides complete nourishment in the 
most readily assimilable form 

/■) lihiKil 'iiippl} foi clinical Inal \iiit fni on riipicit 
^ WANDLR LTD 184 Queens Gnle S\V7 Works kinp s Lsngle) Herts 


Wf/mmfrmnn 





\Lri‘^T I' 


THI BRITISH MEDICAL JOURNAL 


B.D.H. TETANUS ANTITOXIN 


B D H Tetanus Antitovm is prepared 
from the serum of horses which hate 
been highl\ immunised against tlie 
toxins of Cl tetani It is standardised 
in mtemational units m accordance 
with the Therapeutic Substances 
Regulations, 1931 It is issued m rwo 
strengths, 1000 or more intemauonal 
units per c c for prophj laxis and 3000 
rnfemacrorta/ antes or more per c c for 
curame use 


As a prophj lactic, tetanus antitoxin has 
been found of extreme \alue , a dose 
of at least 1000 or, preferablj, 3000 
International units mtramuscnlarl}, 
proximal to the lesion, is advised m the 
case of all w ounds mfected with manure, 
Soil or dirt, espeaallj in tnose distncts 
in w hich tetanus is known to occur 
In treatment of estabhshed tetanus 
toOyOoo to 200,000 units mtravenousfj 
are recommended 


Sample on request 

THE BRITISH DRUG HOUSES LTD LONDON 

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BRITISH MEDICAL JOURNAL 

lONDON SVILRDV'^ \LGLST J3 1938 


THE PRE^'E^TIOl^ AND CONTROL OF PUERPERAL SEPSIS, 
INCLUDING ITS MEDICO-LEGAL ASPECTS* 

R 33 lOllNSTONr. CBE 31D.rRCSrd,rCOG 

VrofcsiOr of \tld\\lfor\ Of d DlStioei of Uonitit irotrstlx of Cdu h trj 


There IS no qin^lion lhat conditions in rccard to piierp.r il 
infection ha\e considcrablj iinprosed during the prciCiit 
gen. ration but «c ire far from liasing reached an\ irre 
ducible minimum in ns incidence What we base 
achiesed is a fiirh complete understanding of its causes 
We know something about the conditions upon which the 
patients resistance depends and that toxaemia haemor- 
rhage exhaustion and malnutrition depress it We know 
that trauma and haemorrhage diminish the local resistance 
of the tissues 3\e know the common sources of the most 
dangerous organisms and we haxe learned a good deal 
regarding the methods of presenting their access 

Tspes of Infecting Organism 

To make ms subsequent arguments clear let me sa> at 
the outset that broadls speaking there are two tjpes of 
infecting organism to be guarded against Tnerc are first 
the organisms commonlj found in the skin of and around 
the sulsa on the hands and clothes and on unsteriliZed 
dressings and instruments — for the most part anaerobic 
and non haemolstic streptococci staphs lococci and coli 
form organisms These organisms most commonl> gise 
rise to infection after labours in sshich there has been 
considerable injurs of the tissues Thes cause a true 
ssound infection and against them our presentise n\ethcds 
are essentialls the same as those adopted in surgers 
Secondlj there is the haemolstic streptococcus associated 
ssith scarlet feser and erssipelas but most commonis 
ssith tonsillitis nasal infections and morbid conditions ol 
the upper air passages generalls The siew that this 
organism is the cause of mans puerperal infections and of 
the sast majorits of the fatal cases seems to haxe been 
prosed b> the work of Smith (1927 1931 1933) Paine 
(1931 1933) Leonard Colebrook (1933 1938) Dora Cole 
brook (1935) King (1930) and others N'ot onis is this 
t>pe of infection more deadh to the indixidual patient 
but as often as not it attacks the woman xxho has had a 
no-mal spontaneous delixerj and among rccentlx delixered 
\ omen it appears to haxe a degre. of contagiousness 
comparable onlx to that of small pox A great adxance 
in recent sears has been the clear demonstration that this 
organism is practicallx nexer present in the birth canal 
betore labour but is conxexed from without and usuallx 
bs droplet or sprax infection from the nose or throat ot 
on^ or nio^'e of those in attendance at the delixer} or 

* R"-d in opening a d seuxsion at a joinl m-cting of the S'amoas 
of Oj ' incs and Gxnaccoiogx ■*nd Public Hcallli and H>geat "xt 
d i.jI Xl-cting of Iht Ur li li Xtedical A xociation I Ivmoulh 


during the pucrperium not excluding the patient herxelt 
The djiig.r is greatest xxhen an> of those concerned is 
.ctuallx sulTering or has recentlx suffered from some 
infection of the nose o' throat Afte- recoxerx a small 
proportion estimated at about 7 per cent in general bui 
probablj nearer '0 per cent during seasons xxhen colds 
and sore throats are rife continue to be carriers ot 
haemolxtic streptococci but there seems to be exidence 
that in St ch circumstances the organisms are not so 
xirulent and the risk of their infecting a patient although 
bx no means absent appears to be definitelx less venous 
(3Iurrax 1930) In medicine as in warfare each nexxlx 
discoxered method of attack is quicklx countered bx a 
new method of defence and in this case the defenc. is 
twofold first the usc of masks to coxer the mouth and 
nose of all in attendance and secondlx the tracing ot the 
cause ot -the inlection bx bacteriological examination ot 
the throat and nos- of each per-on xxho has been in close 
contact XX ith the patient and if possible the exclusion from 
obstetric work until alter recoxerx of anx person found to 
be a probable source of the puerperal infection 

One final prchminarj statement is that in the last txxo 
xears there haxe been txxo cases in England in xxhich a 
patient xxho xxent into a small maternitx hospital or home 
for her ddixerx and there contracted puerperal inlection 
has successfullx claimed damages from the hospital 
authorities or doctor concerned because of alleged lack of 
reasonable care against infection 

It IS these recent adxances in our knoxvledge of the 
nature of the attack and of the means ot defence together 
XX Ith the disturbing situation created bx the legal actions 
mentioned xxhich make this subject so suitable for dis 
cussion at a time xxhen the State is placing on local 
authorities an increasing responsibilitx in regard to mid 
xxiferx 

3'aluc of Ante natal Supemsion 

In trying to lax before xou a brief consideration of the 
points xxhich obstetricians in general regard as important 
in the prexention and control of this disease I xxould 
stress in the first olace the xalue of ante natal superxision 
It must be interpreted in its xxidest sense and its aim n 
this connexion must be to build up the patient s resistance 
The general health of the patient should be assessed as 
earix as possible during pregnane and treatment directed 
to anx faults I haxe had *he opportunitx of studxing 
some hundreds ot maternal death schedules through 
the courtesx of Dr Charlotte Douglas of the Deparlmen' 

40^9 ^ 



332 August 13, 1938 PRHVLNT ION Of PUlIRPHRAl SI PSIS 


Iitr n*trt H 


of l-lcTlth for Stoll ind snci this h is impressed upon me 
the hmentablc number of CTses of dc ith from puerpcr.il 
infection in which preen incj should nesci hi\e been 
.illowcd to occur beciuse coexistent conditions of diseise 
md debility midc these women unlit to lesisi the infeetion 
which ultim.ilcly destroyed tlicm Here we impinie upon 
vast and complex economic ind soci il problems t|uestions 
of self-control and birth control possiblv even the vexed 
question of the law m rcgird to iborlion, which I hive no 
time to discuss 

Apart Irom iltcntion to gener il health ind inv special 
indications of diseisc the ante nal il prevention ol puer 
peral infection involves the ircitmcnl of septie foci in the 
body — for ex implc, teeth tonsils sores ind the cervix 
uteri The verj red dinger of maril il intercourse m the 
later months of pregn incy should be expl lined to the 
piticnt md, if need be, to her husbind 


Diet 


After this comes the import int question of diet In 
general it is quality rither than qiuniiiv tint is it fault, 
and the ultimate cure is cducition in the elements of 
dietetics Vit imins irc greitly in vogue at the present 
time and there is probablj no profession more suseepiible 
to the diet lies of I ishion thin our own Tint vitamins 
particul irly A B C D ind H arc essenti il m iv be 
accepted as an ixiom but in pilienis who are on i 
rcasonabl> good mixed diet it is probibi> unnceessirv to 
administer supplement iry vitimin prepar itions If cverv 
pregnant woman would include fresh fiuit in her tlaily 
diet and add to the fruit fresh green vegetibles dairy 
produce and fresh herrings, the needs of the siluiiion 
would be fully met md incident illy some of our economic 
difhcuities imcliontcd In iddition to vitimms the 
mineral elements of the diet arc of gre it import inec as 
the growth of the foetus makes red dcm.inds in respect 
of these substances which must be supplied from the 
mothers diet if her own tissues arc not to be depleted 
to an extent which m ly undermine her powers of resist 
ance But here again a reasonable mixed diet should 
suffice, and it is only in cases where a deficiency of for 
example iron is clinically detected that direct medication 
is desirable * 

The more strictly obstetrical side of inte nat il care is 
preventive in an important degree By foreseeing causes 
of danger and difficulty, steps can be taken to ensure i 
method of delivery calculated to minimize trauma and 
haemorrhage, to control toxaemia, and to eliminate the 
risks inevitably associated with delivery in unsuitable 
surroundings 

The Place of Delivery 


This brings me to the question of the /oci/r of the 
delivery where circumstances offer a choice 1 see no 
objection to delivery in the patient s own home provided 
It IS suitable, and provided that the patient is in good 
general health and that no Obstetrical operation of any 
gravity is likely to be lequired , but only medic U con- 
siderations, and not sentiment, should determine the 
choice Unless the patient s own home is clean and airy, 
and she can have a bed and preferably a room to herself. 
It IS not a suitable place for a confinement Far too many 
vvomea are still delivered in wholly unsuitable houses 
and if there is no hospital accommodation for them then 
We must press for its provision Other essentials are that 


.With diet m rehtion to the prevention . 
tionJ'r.r ."iS 'idcrim reports of the unfinished mvestii, 

Puhlii Honlii,°'^ Midwifery me most siitgesU'C Si 

Public HeaUh April md November 1937 md March 1938 


vlctilc oiiifils of dicssini’s etc must he provided either 
by till, pititnt or by the loc il itilliority 1 iirlhcrmorc 
the thiqcr of coni icl with members of the household 
newly returned from infeelioiis disc ises hovpit lis or with 
rnnnini c irs or infected thro Us or sores must he Icpt 
ele irly m mind md the presence of iny such risk should 
determine reiuov il to liospit il Any eompirison of the 
lelilive s ifely of tielivery it home md in hospinl or a 
in iicrnily home invi)lvi.s the issiimption lint in the litter 
the conditions md the tetlmiqiic irc jord This point 
w.is mule by the judge in one of the iej d cases men 
tinned in the pisi most hospil il reports Inve shown 
i lower general morl ihty rate in the outdoor cises than 
in the inilour rises md the obvious cvplimlion is that 
difiietilt .md compile tied e ises n itiir illy griviiite to the 
hospil ils ind so wet} hi their firiircs uKcrseh The com 
pirison IS therefore f ill leioiis as the two i roups of c iscs 
ire not striellv comp ir thic \\ h U more concerns us to day 
IS 111 It evidence is leciinuil Him that so fir as infection 
IS eoneerned the st itisties of hospil ils in which c ireful 
b iclerioloi ic il control is exercised ire beginning to show 
i lower meidenee of infection m hospit il than in district 
practice (1 C olehrool l‘)1S Rose 1937) I am there- 
fore in fivour of instiiniion il midwifery except where the 
domiethirv conditions rci irded from the obstetrical stand 
point ire re ills yood ind in my vievs forlunatciv, the 
soei il trend in fivmir of institution il inidwifcrv vvil! 
probibK coniiniie ilespit. inv opinions to the contrary 

It therefore behoves us to see to it ihvt ill maternity 
hospit ils md homes conform to the high stand trd in 
lecommod ition pvrsonnel md technique which iheir 
existence is now leg ilK t iken to imph Overerowdinc is 
too common even in some of our famous hoT^iib 
Aeeommod iiion should be iv iil ible for the complsic 
sepiriiion from the verv outset of clem md ot suspect 
ciscs — tint IS cises which hive been ex imirftd or handled 
outside — md for the immcdi ite segregition of all pucr* 
pcric vvho piescni svmptoms suggestive of infection 
Recognized ciscs of infection should be transferred at 
once to in entirely separate unit or a spcciil hospit d 
In the design of new hospitals these points should be 
insisted upon is prim try essentials 

Malcrnitv Insliltifiors 

M ilcrnily homes should be inspected more trcqucntly 
ind more scarchingly than has often been the case hitherto 
by a responsible oflicnl of the locil authority vvho has a 
real piactical knowledge ot midvviferv Much of the so 
cillcd inspection at present is merely a formal compliance 
with the letter of the law 

In every m ilcrnily hospital ind home one individual 
should be ch irgcd with the ultimate responsibility for 
distribution of patients to the various wards and the noti 
ficalion to doctors in charge of patients as well is to the 
local authority of ill cases of puerperal pv'rcxia or infec 
lion In the larger hospitals this should be the resident 
obstetrical ofiiccr , in the smaller hospitals and nursing 
homes the matron 

Another question aiises in regard lo the admission of 
cases of piierpeial infection to maternity institutions 
Unless a whole sepiiatc block is reserv'ed for such cases 
this seems to me quite vviong Again, if such cases are 
housed in a separate block, or in a hospital for infectious 
diseases, it seems desirable that they should be under the 
supei vision of in obstetrician This recommendation is 
not intended as a reflection on the competence of the stu 
of such hospitals but as a plea for increasing the expert 
ence of the obstetrician in a particularly important type 



AiriJST n 19’S 


PREVCNTION or PUERPERAL SEPSIS 


Medical Ioltnu. 


o! 1 (o uhith he ts often cilled is i tonsiillnnl Whil 
ol abortions whieh nre nimosi al\s i\s suspect > Should 
lhc\ be sent to i nntcrnils hospil il to n e,\ mecoloycal 
ward or to a sp^ci il u ird eonneeled with i matcrnils 
hospinl ’ The hst seems to me tlie b-st pim tor team 
ind c\en more cmphilicills thes, c iscs should nivsass 
bw under the enre ot nn obstetrician 

Intra mtnl Tcchniiiuc 

Intra natal technique is the most important point of all 
for It IS durint I ibour th it the danger is at its m iximuni 
The simple mam requirements are a clean \uls i clean 
hinds clean dressings clean instruments and the preecn 
lion of the conlamin ilion of an\ of these clean things 
during th^ I ibour The itlammcnt ot these decider ita 
meins sitetv an\ thing short ot it spells danger \ com 
pteteli as.pue technique is even more uniltainable in 
midwilerv thin in surgers ind there are those who reCog 
nizing this rch w holts upon the lasish use ot intisepties 
and produce fm^ results in support of their pohes But 
1 thinlv the b.llcr and more ration il plan is to combine 
both methods — to render aseptic b\ boiling csersihing 
that can be boiled and to ippK idequ ite antiseptic 
meihods to those that cannot Thus gloscs gossns sheets 
dressings and instruments can and should be sterilized 
the skin ol the hands and of the Mils a can be rendered 
reasonable s.ifc b\ thorough antiseptic treatment 

1 cannot here enter upon the relatise merits of the mins 
antiseptics in use For intormalion upon that point and 
indeed upon this sshole subject I ssould refer sou to the 
insaluabic ssork of Dr Leonard Colcbrook (191S) I 
ssould onlv emphasize that the strict routine obsersance 
of a careful technique is much more import int than the 
particular antiseptic used Tlie one cs ential is that the 
an'is.ptic should be used in a strength sufficient to bw 
re ills and rapidls germicidal Let me rather gise sou 
an outline of the technique sshich sse folloss m the Ros il 
Maternits Hospital Edinburgh and sshich 1 put forssard 
not dogmaticalK but just as an example 

t At ihc out ei of labour the patients ssholc boilj should 
be Ihorouehls ssa hed if lime and her general condition permit 
In ho pilal this i> done bs a spras bath ssilh the woman 
silling on a stool or l>mg on a stab to present the possible 
entrs of soiled water into the gaping sulsa of a multipara In 
the absence of such facilities a bed bath or in an emercenc> 
a thorough ssashinc of the lower abdomen sulsa and thighs, 
must suffice 

2 The sulsa and pubes are shased again sscll ssashed ssith 
soap and ss-ater and dried Thereafter a soap and ssater enema 
is gisen iinles the patient is bleeding or is adsanced in labour 
and after the rectum has been esacuated the ssholc are i is 
treated ssith s per cent dettof as a lotion or in the form of 
'0 per cent dettol cream 

Before ans examination and in ans cise alssass at the 
end of the second stage dettol lotion or cream is again 
applied We more often use dettol blue — that is dettol ssiih 
an inert pigment— tor the skin as it clearls shosss the limits 
ot the area treated 

4 Before examining or delis erini, the obstetrician ss-ishes 
his hands thoroughls ssith ssarm running ssater and soap 
rinses them in methslaled spirit dons a sterile cap mask and 
long sleesed gown and sterile gloses Dettol cream is used 
as a lubricant for the fingers and for such instruments as the 
forceps If running ssater is not asailable care must be taken 
that the basins used base been sterilized and the ssater itself 
should be boiled sshereser there is ans dubiets about it 

5 The sagma is not treated antisepticalls except m the 
presence of a leucorrhoeal discharge in sshich case it is 
douched out ssith a per cent dettol solution immediatel) 
before dehsen 


6 After deliscrs the sulsa buttocks and thighs are swabbed 
clem with 5 per cent dettol and a sterile gamgee pad applied 

Obsiousl> such d technique is not applicable m detail 
in mans of the houses of the poor but gisen he pro 
vision of a slenie outfit bi ihe local authont} something 
closels approximating to it is usualls possible I ssould 
drass atlention to L Colebrook s (191S) esidence that 
drj hands or drs iinsterihzed gloses can be rendered 
sterile and csen actisels antiseptic bs rubbing pure dettol 
or f() per cent dettol cream into them until thes are 
drs In an emergenej this is an insaluable hint 

1 anticipate that the question of masks ssill arise in 
this discussion but if ihe importance of spras or droplet 
infection from ihe mouth or nose of an infected attendant 
or esen a healths carrier upon hands dressings and 
instruments or upon the sulsa itself, is admitted then it 
seems to me that the wearing of a mask is the obsious 
and tnescap^bk common sense presentise measure The 
onis allernatise to a mask is to conduct the labour in 
absoliilc siknce but an unexpected and irresistible cough 
or sneeze mav betras csen the most desout Trappist 
Morcoser the mask to be adequate must consist ot n; /east 
four lolds of fine meshed gauze and must itselt hasc b.en 
sterilized Mans of the masks in use are more figuratisel> 
than lileralls of Ihe nature of hpsersicc to the doctrine 
enunci lied 

With this technique Ihe further endeavour to present 
infection during labour lies in the obsersance of the prin- 
ciples of good midwiferx m the conduct of the case 
in particular in the avoidance of trauma haemorrhage 
and exhaustion Unnecessarv interference is cerlainlv to 
be deprecated bul unnecessarv delav is also undesirible 
and the obstetrician vvho has conscientiouslv observed the 
precautions mentioned need not fear to undertake an> 
minor intervention such as a low forceps operation 
Major forms of inlervention especiallv those involving 
the introduclion of Ihe hand inlo Ihe uterus must alsvavs 
remain more dangerous and will alwavs carrv some toll 
of subsequent mleclion Whenever possible thev should 
be carried out m a hospital where the surroundings the 
facilities and the number of assistants are more suitable 

Tlie Fuerpenum 

In the earlv davs of the puerperium similar precautions 
must be maintained for there is abundant evidence that 
some women become inlected a dav or two alter 
dclivcrv The mam principle is again the prevention ot 
infection from the hands nose and throat of Ihe nurse 
or others attending the patient and to this must now be 
added Ihe prevention of contagion air borne or other- 
wise from one patient to another Before giving anv 
attention to Ihe genital area Ihe nurse must scrub her 
hands and forearms and should don a mask and sterile 
gloves In hospitals and nursing homes each patient 
should as tar as possible have her own individual outfit 
and equipment and where this is impcssible all articles 
should be sterilized before use In particular does this 
applv to bed pans The importance of fresh air and 
surfshine and the promotion of drainage of the uterus 
bv propping the patient into a sitting position at frequent 
intervals after the first twentv four hours need onlv be 
mentioned 

The sphere of drugs m the prophvlaxis of intection m 
the puerperium has received attention from time to time 
Quinine for example has long had a vague but rather 
unsubstantiated reputation in this respect and m com- 
bination with ergot is vvidelv used The recent introduc- 
tion of sulphanilamide preparations and their striking 



334 August 13 1938 IMlCVCNT ION Or I’UrJUM RAI SI'PSIS 


success in the thcrupeulic ticilmcnt of strcptococcil 
infeclions nUurilly nisctl tiic question wlicllici thtir 
idministration would be corrcspondinglv successful in 
prophylaxis To test this mv colic igucs ind I in the Ro^ d 
M itcrnitj Hospinl Cdmbtirgh (Johnstone 1938) mide 
T rough- ind rcidv cliniCTl experiment on i 1 irgc scale bv 
gixing a prophvltctic course of these driqs to cseix 
putent delivered in the hospil il during the veil 1937 
A compirison of the lesiilts ol the \cirs working xsitli 
those of the prcMous xcii showed t reduction in the 
number of pucipeiii which were morbid iceoiding to 
the BM \ stmdird from 3 06 per cent in 1936 to 19 
per cent in 1937 In order to lest the icvl siunilie nice 
ol this ippireiii iinproxcmenl we ire tins ceir using 
Ul sulph mil imicic diugs onK is thcuipetitie igents in 
eiscs of p>rcMa in which infection is suspected md the 
hirihci comparison ot our 1938 figures with the two 
picMous jcirs m ij prove interesting In the me m- 
lime ] hesilitc to nuke wlnt mn prove to be exicici ited 
chims for the prophylactic use of these dings dtlunigh 
in our experience their idministr itton w is ippiientU 
beneficial md w is seldom if ever, issoci ited with in\ 
dclrmicnt 

Control of Jofeclion 

I piss now to the question of the control of infection 
In the lirst pi icc i chart of the morning ind evening 
temperature and pulse should be kept during eveiv 
pucrpcruim and the nurse should m tke i d iilj note of 
the state of the lochia md of mv thnornnl svmpioms 
^ny rise of icmpcratiire to 100" T ifter the first twenty- 
four hours should be reguded with suspicion and if u 
recurs within the next twentv-four hours without some 
obvious exlragcnitnl reason the p ilicnt if m i hospit il 
or nursing home sliould be remosed foithwnh to the 
segregation room or depirtmcni This is no eoiinsel 
ot perfection but a most reisonable prcciution A high 
vaginal swab may be taken with advantige md sent to i 
competent bacteriologist preferablv one who li is the 
means of grouping stieptococci Here 1 would interpolate 
that in our experience the mtcpiitiim taking of viginil 
swabs has not proved helpful ind the gcncril conclusion 
IS that such streptococci as m ly be found occ isionallv 
in the vagina before liboiii larely cause serious infection 
after It I do not dcpiccalc the pioccdiirc, but 1 do 
not regal d it as part of the essential technique, which I 
am trying to keep down to its simple elements 

After segregation of the patient the next step — ind 
one of particular import ince in hospitals and maternity 
homes where infection is lor obvious rcisons most apt 
to become epidemic — is the b ictenological investigation 
of the nose and thioat in all conticts with the piticnt 
who has developed infection The logical sequel to this 
IS when at all possible the tcmpoiary exclusion from 
obsteliical work of any persons found to be ‘ caiiying ’ 
haemolytic streptococci and the segicgalion of any othci 
patients m the same waid who aie harboming these 
organisms Here again ! would make an intcrpoiuion 
Where there are no symptoms referable to these 
organisms, the preliminary swabbing of the thioat and 
nose of those about to engage in mateinity woik, as well 
as the routine swabbing of those already engaged in it 
seems to me unnecessary provided a technique such as I 
have described is conscientiously observed Admittedly 
the omission of this step tails short of the full and rigid 
application of our present bacteriological knowledge, but 
1 submit th It the full application of that knowledge might 
well lead us into positions so impracticable as almost to 
paralyse the vvork of our hospitals as well as of the single- 


Mrr>!fAt}ni> ai 

h itukd toiinlrj prittilioncr Lyons (1936) of Boston has 
esiim.ifed that in winter when infections of the air- 
p issues ue eommon the cxeliision of dt curicrs of 
hicinolytie streptoeoeei -th it is of hcdlliy carriers as 
Well IS those with reeoimi/ ible infect ions —would reduce 
the St I IT of a hospil il bv 30 per ten! I believe ihit 
even the b leteriologists teeogm/e tiie impractie ibilitv of 
tins situition Mot' over if routine lest svv ibbing is to 
be done how often is it to he don^ ’ If forinirhiK vvhv 
not vveef Iv ' If sveeHv, win not d iilv ’ 

It should however he i rule m everv niilernity hos 
pilal or home that am nurse or w ird serv ml siilTcrine 
from 1 sore thro ii or even trom i cold should report that 
f let to the m itron ssho should irr ini c for the prompt 
tillin’ of sss lbs for b letermUv 1 C il examin ition and tor 
relieving siieh i person fiom duty in the i ibotir room or 
piierperil w irds iiiiiil sh- his reemered ind has hail 
two sw lbs Pel itise to iiiemoisiie streptoeocci The 
sime pnneiples sliould be observed bv ail doetors 
engaged 11 ) muK ifers Where these pree unions cinnoi 
be cirried out wiiboul grive disloe ition ot titc vvork to 
be done — is for ex miple in hospit ds viiih limited stiffs 
or in single h inded pr ictice in eoiintry disincis— pre 
L unions ij amst droplei infeetion should Iv intensified 
md rigidts observed 

\ir-l)i)nie Infection 

One list ns) deserves consider ition — nanielv ur 

borne infection A few vears igo most of us would 
hive belittled the serious suggestion of such a possibililv 
but recenllv the work of Cruicksbink (19351 W f md 
M W Wells (1936) md Dirv) H irl (1937) has shown 
us tint the ur in rooms occupied bv infected pilieiits 
coni tins mullitiides of sinilent orginisms TTus 

possibly i)ic cvpl in ition of some epidemic outbreaks of 
sepsis in sm til hospit iK md miternits homes winch have 
no aelequite meins of segreg iting infeeted ewes as well 
IS of some sporidic cises in clomiciliirv pricticc 
Incidentally it miv iKo possiblv hive been the explana 
lion of the infection m the two recent cases in which the 
patients sued for md weic iw trded d images In both 
of these mstanees i clem cise w is pul into n "'"'d 

in vshieh there w is another pilient who hid i high 
temper iiiire and other symptoms which were stronslv 
suggestive of piierpenl infection md who ought there 
fore to have been segregated Personalis 1 do not think 
we e in cscipe the eoneltision tint such i procedure does 
constitute i lick ol rcisoniblc piccuitions m an 
import int respect 

These two ciscs aie profoundly import int beciusc thes 
intiodiicc in clement ot the fear of the law into otdmary 
midwifeiy pricticc but we must not allow ovn selves (o 
exiggcrate the position No sane judge would allow' 
damvges agiinst i doctor or in inslitiiiion simplv because 
the plaintill had conli acted pucipcral infection He 
would fcqiiirc to be s itislied th it in some cssenli il pomf 
or points there had been a breach in the observance ot 
icasonabie piecautions At the simc lime one successful 
claim IS apt to encourage others ind we must protect 
ouiselves against vexatious actions The doctor who 
signs 1 ceitific.ate of insanity or who treats a fricturc 
without having lecouise to radiographs does so nowadays 
al some risk to his peace of mind and bis pocket TVt 
must not allow any smiilir paralysing ipprehcnsion to 
enter the field of obstetric practice for lack ot a clear 
statement as to what m the piescnt state of our know 
ledge, are the simple and reisonible essentials of the 
proper conduct of a midvvifeiy case And if such a stite 



\HOST n IQIS 


PRCVCNTION or puerperal sepsis 


Tirr CAmn 

M D CAL la 7SAI 


nicni cinnol be derntd from t discussion such ns this 
then ul nn\ possibI\ ln\L to look to the Ministn of 
Hcilth or to some cqinlh nuihorilniiNc source to frame 
one 

Rmi I Nets 

CoVhrook D'*n Nted Rcs CncI Sp- c Rep Str No 

20^ I onJon 

Co’ebtook Lcomrd (I^ ■') linti^h ^ Jo irn ^ 2 7-t 

— — (193V) Praeinn <f I iicrpcr Sc*js \ iiit * An isrput tn 
Shcrralt and Miich''s Mnnul u ter 
Crui k Innk R (I 9 ^S) J r^ih P 41 67 

IHrt D (1937) trcfi Siir 31 ^7- 
3ohn^to^c R W (i9'?S> JirttiOi Mt f kiI Joiirr ai 1 ^62 
kmc \\ \\ (19 0) Ibid 1 
L^cn^ C (19 6) \eM Pn-} J Vn* 215 1027 
Murnv C P-rqulnr (19^0) British \fr'*nal Journal 1 S14 
Pune C G (19 n Ibd 2 lOS^ 

— (19 ) Ibid 1 :;4 

Rose J k (19 7) J Ohstet Gj/mr- Jlrtt Ptup 44 27^ 

Smith J (1927) J /l\t: Cimh 26 420 

(19^1) Causation aid Sourif of Infection tn Puerpetd 

faer HM Stationers OfTi e 

(19t^) J Gsnier lint Lmp 40 991 

\\elk \\ r nnd M \\ (19 6) J Amcr tied Ass 107 

169s 


PRnCNTION or PUERPERAL SEPSIS* 

ETHEL C\SSir M D D P H 

Senior yfssislanl Meihcnt Officer of tleallh (\faleriiit\ anil 
Chilli H elfrrc) Birntii ;/iam 

No excuse IS needed for the dciailed consideration of a 
subject like puerperal sepsis where slight carelessness or 
e\en loo great enlhusi ism on the part of the nursing or 
medical personnel for remaining on dm\ mas result in 
Irageds 

The Modem \ len of Puerperal Infection 

It IS of great interest to notice the complete change of 
attitude since the ssar regarding the causes of thi condi 
non This shosss more clearls than an> other fact the 
progress that has been made and gises us increasing 
hope for the future When the Public Health Act 1936 
oflicialls eliminated the term puerperal feser the end 
of an epoch ssas indicated The sers points I base been 
asked to discuss to das emphasize the general acceptance 
of the modern siesv of puerperal infection We are no 
longer content to consider the possibilils of infection in 
relation to the delisers ^lone It is recognized that 
during the ante natal period certain definite precautions 
should be taken 

A good deal of stress is laid bs some authorities on 
the importance of dental care It is obsious that a clean 
mouth IS a first step in personal hjgiene and the provision 
of dental treatment in connexion ssnh ante natal clinics 
IS noss recognized to be not onls adsisable but necessarj 
During 1937 8 974 svomen reccised treatment at the child 
welfare dental clinics in Birmingham The majorits or 
about 60 per cent, ssere sent from the antenatal clinics 
and represent roughI> 50 per cent of those attending the 
clinics This does not gi\e a complete picture of ihe 
need for there is still a good deal of prejudice against 
dental care The proMsion of cheap dentures does much 
to encourage the remosal of deeaxed leeih howexer and 
actuallx 96S xxomen \xt.re supplied xxith dentures in 1937 
At Ihe Cit> Maternitx Homes the xxomen are so anxious to 
obtain admission that thex submit to haxing denial care 
xvhenexer the medical officer considers it necessarx this 
being a condition of admission 

• Read in opening a discussion ai a joint ni“eiing of the Sections 
of Pub'ic Heallh and Hxgicne and Obslelncs and Gvnaccolog> at 
the Annual Meeting of Ih- British Nlcdical Assoaalion Plx-mouth 

lO'iC ® 


The careful examination o' exerx xxeman suffering 
from a xaginal disehargi. with an inspection of ihecerxix 
IS an essential step in Ihe prexeni xe side of an e natal 
care and the treatment required must be insisted on The 
possibililx of throat and sinus intections must be 
remembered also 

On the educational side xxhile the preparation of he 
dclixcx room is asked for bx exerx district midvxife 
insirLClion should also be gixen to report the occii'rence 
of anx inlectixe condition in ihe faaiil net fergett ng 
the child xxiih impetigo o' otorrhoea Such cond uons 
should of coiir e receixe immediate attention HwEI h 
talks at ante natal clinics should include inferma icn on 
su'-h points 

knte-natal Care 

There is also the xerx important question ot building 
up resistance It is obxious that an anaemic and badlx 
nourished xxoman xvill haxe a poor chance of recox erx 
if she should be infected and «he is more liable to infec- 
tion A complete sxstem of antenatal care shou'd 
include Ihe proxision ol a salisfaclorx diet Milk alone 
IS obxiousix not enough although it is so xaluable a 
food The supplx of meals in necessitous cases meets 
Ihe need to some extent but in the iiorj' cases onlx In 
the diet of a large proportion of xxorking class xxomen 
iron calcium and xitamins are pnmarilx deficient and 
these can be supplied as uselul supplements 

Antenatal care plaxs its full part in the prexention ot 
sepsis onlx when exen eflorl is made to obxiale mal- 
prcsenlations and disproportions causing difficulties at 
labour The importance of carix induction of labour or 
of Caesarean section in suitable cases should not be oxer- 
lookcd m this connexion The associa'ion ot toxaemia 
and ante parlum haemorrhage with sepsis is imixersallx 
recognized It is not possible to deal successtullx with 
toxaemia outside an mstitu ion and ante partum haemor- 
rhage howexer slight, also requires full inxestigation 
Sepsis often follows where repealed small haemorrhages 
hdxc been alloxxed to occur 

An obxious step is the proxision of sterile dressings 
for district midwifer> The maternitx packet is noix xen 
generallx axailabic but it is not xet xerx generallx used 
I should like to see such sterile dressings supplied in 
cxerj case and the cost included m the midxxifes fee 
Meanxxhile the careful instruction of the expectant mother 
m the proper preparations for the delixerx is essential 
The suppi) of drums of sterile dressings to exer> midxxife 
rather than the use of sterile packets mxoixes a prohibitixe 
cost for transport as xxell as a high original expenditure 
but some such proxision for emergencies is adxisable 

The dexelopment of ante natal care has proceeded xerx 
rapidlx dunng the last ten jears and the general standard 
IS conslantl) rising but exen jet there is too little appre 
cialion of Ihe amount of actual ill healih requiring 
inxestigation and treatment in un institulion properlj 
equipped for such xxork such inxesligalions moreoxer 
require to be guided b> the ph>stcian rather than bv the 
surgeon for pregnancx furnishes more medical than 
surgical problems 

The ante natal clinics must be used to assist the district 
midxxixes but there need be no failure m co-ojieration xxith 
general practitioners or hospitals if there is sufficient under- 
standing and good xxill on both sides 

The Spread of Infection 

The spread of infection bx the midxxife or docior in 
puerperal sepsis is noxx more often due to direct infection 



336 August 13, 1938 PREVENTION OF PUERPERAL SEPSIS 


Till 

MrniCAL Jot * lAt 


^s in eiily thioit, nose, and cir condilions thin to dirty 
instruments or neglect of person il hygiene It is the 
attendant in the early stages of a sore thro it, where there 
IS little moic than malaise to suggest dinger or igiin one 
who has not sufficiently recovered from such i condition 
who most frequently appe irs to be responsible for normal 
labours becoming septic Where inquiries ire m ide, such 
infections arc often found to hnc been present or for 
that matter a husb ind or child m iv be the origin of the 
infection though in such cases there is less opportunits 
for direct contigion NnlurilK with mere iscd minipiili 
tion the possibility of infection is greitcr 

It IS essential tint the midwife ind doctor should 
regard their own state of health is in important I ictor 
and those with any septic condition howcvei mild should 
feel themselves bound to i\oid midwilcri Eieii where 
some condition like otitis medn or a chronic intrum 
appeals completely quiescent there is d ingcr, for with 
fatigue and sti un the infecting organisms re ippc ir This 
mav be obsersed for inst inec in the eisc of i midwilt 
so ifTecttd two or three notilicUions of puerperil 
pyresia in her practice will be issoci itcd with i rush of 
work and a discharging cir or a piinlul sinus Susp^n 
sion for weeks follows with ipparent rceoieri iiul liter 
some months the some incidents recur The d inger of 
a hcalthv indisiduil becoming i c irrier for i short time 
cannot be o'criooked 

The need for a high st ind ird ol person il lugieiie is 
now so clearly understood that it need h irdh be referred 
to, but those responsible lor housing midwases should 
remember that i bathroom is as neccssiry as i kitchen 
and that f icilitics for sterilization of bowls, instruments, 
etc , are essential A brief summ try of the instructions 
issued to Birminghim City midwivcs may be of interest, 
and IS available 

The Midwifcrs Sen ice in Birmiiighaiii 

One of the essentials of a midwifery service is the 
piovision of sufficient relief midwives It is necessary 
to arrange that the relief midwife does not come into 
contact with her sick colleague a precaution th it is easily 
forgotten The wearing of masks by mtdwiscs, whether 
aeting as maternity nurses or midwives, is now prictically 
universal in Birmingham — only a few independent mid- 
Wives are not using them The eity midwives wear gowns 
with masks attached The patients raise no objections, 
and the measuie of protection afforded is considered well 
worth while 

' 'ith regard to institutional care I should like to 
mention the very good record established at two of our 
maternity homes The larger of the two homes with 
847 deliveries in 1937, had only thirteen cases of notifiable 
pyrexia and no case of pueiperal sepsis , the second home 
with 518 deliveries, had not a single case of notifiable 
pyrexia These aie genuine records, and most careful 
supervision is exercised to see that no rise of temperatuic 
IS overlooked The aseptic technique employed in these 
homes has justified itself As regards the methods used 
1 should like to draw attention to a few points 

All attend ints are gowned and masked throughout all 
contact whdlevei with the patient Dettol and flavine aie 
the chief antiseptics used Boiled bed-pans are employed 
on every occasion, and a second bed-pan is provided foi 
swabbing A gown for the use of the nurse when giving 
bed-pans and swabbings hangs at each bed Masks are 
of fourfold gauze with paper between folds, and on 
removal they are placed in antiseptic lotion Fresh sterile 
misks are avulable at the entrincc to all wards All 


bedding is disinfected after rich case, as well is beds 
lockers etc All wards arc washed down after each 
bitch of piticnts W ird floors arc never swept, but arc 
polished and kept clem with damp mops to ivoid raising 
dust Nurses do not sort dirty linen which is imme 
di itcly removed from the vicinity of the wards 

1 imc docs not permit of other det ills but I might add 
tint t.ieh pitietit IS provided with a piper big to hold 
dirty handkerchiefs etc and th it only husbands arc 
illowcd to visit No nurse or doctor vvith the slightest 
cold or sore thro it is permitted to enter the vv irds If 
invthing the smilltr home his observed i more stringent 
aiiliseplic technique ind this his been jiistilied by the 
result 

I broil mil Nose Swabs 

rile nurses ire not iccepted it these institutions with 
out I prelimin irv medic il cximmilion and ihev are all 
geiieril tr iineel nurses \t one time i throat sw ih vis 
t iken iiul if 1 hiemolviie streptoeoeeiis vv is found the 
ipphcint w IS rejected but the percent 'ge o! rejections vv is 
so high th It this h id to Iv ib mdoned II must be under 
stooil ill It no typini’ vv is c irried out Sw ibbing vtiuid 
onlv be done it the institution in the presence ol sever il 
e ises of pvreMi md so his not been tound neeessirv in 
the miternily homes 

With regiid to thro it ind nose swabs in district 
priClICe It IS uKislble to tike these where se'eril ciscs 
of puerperil pvrexii hive been notified in a midiutcs 
pr iciice The sw lbs ire ilmost mevitibly positive to the 
hicmohtie streptococcus md it is then neccssirv to 
suspend the midwife till two ncgiiive sw ibs arc oh! lined 
which miv mein weeks oil dutv Tvping may help here 
but when not iv iil ible iltcntion paid to the throil and 
nose ind the usiiil holid t> in the coiintrv undoubtedly 
benefit the midwites heillh B icteriologists ippear to 
viry in their findings md it is sometimes helpful to try 
a second expert when the period of off duty is loo pro 
longed Without tv ping swabs give onlv a vague indica 
tion of the source ol infection but m in outbreak with 
one common aiicndani swabs ire worth while and offer 
some mcisure of protection 


Notificitioii of Pyrexia 

On the occurrence of puerperal pv rexia it is the mid 
wife s duty to send foi medical help at once She must 
then notify the supervising authority through the naidwives 
supervisor that she Ins been ' m contact with a person 
vvhethci or not a patient suffering fiona puerperal fever 
or mv other condition which may raise suspicion ot 
infection m the words of Rule 9 


The medical prictitioncr otten misunderstands the 
situation He considers the pyrexia is not yet notifnble 
and he mistikcnly instiuets the midwife thu there is no 
need to inform the superxisoi There is, as i mUter of 
fict no connexion the one is i question of keeping the 
lilies of the Cenlial Midvvives Board, md the other is a 
notification No midwife can notify puerpcial pyrexia, 
bill having been in contact with it she is bound to obey the 
rule Oui own practice is to instiuct the midwife to 
infoim the doctoi that she will not be allowed in the 
ordinal y couise to continue on the case, and to request 
him to call in the district muse whose tel: will be met b\ 
the local authonty Only under very exceptional circuni 
stances would the midwife be peimitted to continue m 
attendance She would then attend no other case 

A further safeguaid in relation to midvvives and spread 
of infection is the enforcement of a rule that the pmc 
tising district midwife must not attend miscarriages owing 



\irisr 1' 19 , prevention OF PUERPERAL SEPSIS 


10 iliL frtqiii,iic\ of ^Lpsis in lhi.sc cisl. As i nnHi.r 
ol f itl lh^\ ssldom would fo' as i rule thes hisc not b.tn 
hoCM-J so cirls in pr^gmncs htil ihi-rc is some ding..r 
lint the midwils might be cillcd in bs i doctor Thi. 
district nurse is olniousU the right person nnd thtr.. 
nppears to Iv no reason whs she should not be used 

TIic D sinct Nurse Midwife 

Rural areas arc frequenth sersed bj a district nurse 
midwile This is m m\ opinion a bad practice and is 
no longer needed with the sufficient use of motor cars 
and telephones Where distances are too great for this 
It IS surch the dul\ of the loea! authorit> to proside 
institutional care and a home help sersice Rural local 
authorities arc loo often content to throw up their hands 
and talk onh of th- difiicultics of long distances mean 
while making no effort to meet them There is also a 
great tendenev to sa\ countrswomcn will not accept this 
and that when thc\ arc gisen no chance to sa\ ihes vs ill 
\s a matter of fact the patience and long suffering of the 
rural popubtion arc wonderful but are wearing rather thin 

Provision for rtncrgcncs Cases 

Tlte situation in a maternils institution admitting emer 
gencies is often \er\ difficult and there is undoubtedls 
a higher sepsis rate in such institutions than there would 
be It the accommodation was of a higher standard 

Separate deliscn rooms and separate wards with ample 
single room isolation are esscatial for satisfactors ssork 
with mergencies but are seldom or never available 
Frequenth the institution tries to do more than if has 
accommodation for and so lowers the general standard 
No maternitv institution moreover can afford to be 
without isolation rooms for the potcntialh septic cases 
and these should be provided even where arrangemenTs 
are made for the immediate removal of everv case of 
notifiable pvre\ia 

Conclusion 

I would like to emphasize that the prevention of 
puerperal sepsis depends on intensive and intelligent ante 
natal care with precautions directed towards safeguarding 
the patient from infection carried bv the attendants both 
during and after deliver) The greatest danger lies in the 
patient being infected through the attendants own failure 
in health and the best safeguard is the building up of 
the patients resistance bv proper nutrition and the carlv 
and efficient treatment of all tosic or debilitating condi 
tions as well as b\ intelligent anticipation and treatment 
of obstetric abnormalities At the same time the most 
stnngenl precautions should be taken in relation to 
asepsis dust infection etc since all the ordinarv risks of 
wound infection are constantlv present 

The results of a careful technique show that institutional 
care can be rendered free from risks other than those 
inseparable from midvvifer The situation is verv 
different where proper care is not c\ercised 

I should like to add a plea for closer co operation with 
the public health authorities on the part of general 
practitioners Notification of puerperal pvreMa is not 
a meaningless formalitv it helps to ensure efficient super- 
vision of midwives and gives information of the utmost 
interest in assessing the value of various precaiitionarv 
and preventive measures 

The present statistics of puerperal pvrevia are valueless 
for district practice thev arc fallacious since a verv 
large number of cases are never notified 


TirEBRmni 33"^ 

M -ZilCKl. JOLTNI. 


THE PRE^E^TION A^D COISTROL OF 
PUERPERAL SEPSIS 
ADMIMSTRATI\E ASPECTS* 

By 

A M4SSET, M D ,D P H 

Mciiicnl Officer of Beallli Cm oj Cot entry 

Evtent and Nature of the Problem 

The Report on an Investigation into Maternal Mortalitv 
published bv the Ministrv of Health last >ear contains 
interesting figures relating to the role of sepsis in the 
causation of puerperal mortalitv In this connevion for 
example it is shown that m a series of 770 maternal 
deaths investigated in selected areas puerperal sepsis was 
deemed to have been the cause in no less than 79 per cent 
of cases In the countrv gcnerall) it appi^rs that 30 per 
Cent to -to per cent of all maternal deaths are attributable 
to sepsis For the vear 1937 in England and Wales the 
maternal mortalitv rate was 3 11 per 1 000 total births the 
rate for puerperal sepsis being 0 94 Although figures 
relating to maternal morbiditv are not availab'e it is safe 
to assume that sepsis is similarl) a dominant factor in 
causation 


Material \!ortrlit\ for the ) car 19 u in Certain Towns 


T MH-n 

Ma crral 
Mcri-lit 1 
T«r 1 <XV3 ! 
Tcta* B rths 

1 

Fron 

S«pst> 

From 

OiHr 

Cajs«s 

pMTOT. n r\jtn*AV ' 

^9D i 

09a 

35- 

Bcl 

6 10 

0S7 

5 23 

BooJ 


1 Sj 

1 S3 

Coum '^otth 

2.5^ 

071 

2.14 

pMtd! 

3 53 

I 12 

Ztl 

Co'tn:r\ 

306 

0 0 

Z76 

Djrtms on 

1 6S 

0S4 

0S4 

P ib> j 

4 6S i 

I J? 

3J:7 

I>und*e j 

5 12 i 

1 92 

3.20 

Eastbourn- 

4 63 

1 -^6 

3 13 

Cdnburgb 

AJ5S 

1 17 

3 33 

I-»«rpool 

2.31 

0.53 

1 73 

Middl'^broos'i 

4 59 

I 77 

2S2 

Sloke-on Trent 

4.59 

0S4 

3 '.a 

SurderUrd 

3 45 

I 06 

2o9 

WaUa'l 

.04 

! 2-02 

2.02 


These considerations underline at the out'et the first 
importance of measures directed to the prevention and 
control of puerperal sepsis It must be confessed how- 
ever that hitherto these measures have been attended 
with but limited success It is notorious that in contrast 
with a spectacular reduction in infantile mortalitv little 
or no impression has been made upon the maternal 
mortalitv rale Maternal deaths due to sepsis have m 
fact increased to some extent in recent vears The 
measures of social economic and environmental ameliora 
tion th-*! have lov ered the infantile death rate in so marked 
a fashion have hitherto proved of much less avail against 
maternal mortalitv Some investigators indeed, have 
adduced findings to indicate that the incidence ol puerperal 
sepsis actuallv tends to increase on ascent of the social 

-* Peed in opening a discu sioa at a joinl m'-eung of P e Sections 
of Pub*ic Health and Hvgen" and On t‘'trics and Gvn-eco'ogv at 
Ihe Annual Meeiin„ of th Bntoh Medical Association PJvrnotilh 
19 3 



3^8 August 13 1918 PRCVfZNTION OF PUFRPFRAl SEPSIS 


scTle But there nre nnny complex f ictors licrc it work, 
such as, to t ike a single example, the larger proportion of 
first confinements among the more well to tlo cl isses 
Improved stand irds of gene al midwifery prietiee ire 
admitted to constitute the bisis of incisures lor the pre 
vention and control of pucrpeia! sepsis To att im these 
stand irds is not entirely a m itter of obstetrics but pirtl> 
ilso a mattci ol administi ition The idmimstr ilor e in 
do much to ruse the standard of skill and method in 
midwives practice ind to improsc the eonditions under 
which obstetricians ind midwises work' ind ilso the 
human material with which the\ have to de il To the 
administrator also tails the task of csohing pohc\ not ibl\, 
for example, in connexion with the lelitise cl iiins of 
institutional and domicilian midwifers with the eondiiel 
of inte natal centres with the enfoi cement of notificition 
of puerperal pvrcxia and like m ittcrs Then igiin — and 
this IS all-importanl — he is concerned with the cducition 
of public opinion on behalf of matern il welfare 1 will 
deal briefly wath some of these points 

Stindard of Midwnes’ Practice 
Although the proportion of confinements itteiided b> 
doctors and midwises rcspcctiscly vanes somewhu widcK 
area by area, it is probible that in the countrj as i whole 
some 70 per cent arc attended b\ midwises done In 
accordance with the modern tiend of thought moreoxer. 
It IS likely that a still larger propoilion of normal con 
finements will be undcrtiken b\ midwises in future Thus 
It IS that in the prcsention of puerperil sepsis no me isurc 
IS more important than tint of raising the stmdiul ot 
midwives practice This u once indie ites the supiemc 
rationale of the Midsviscs Act, 1936 wiiicli Ins for its 
primary objects the improscd education and stilus of 
midwives, the elimination ol unsuitable persons from mid 
svifery practice, and the competent control and supers ision 
of mid wives icmainmg in public or pris itc practice 
The schemes of full-time silaricd midwises for 
domiciharv piacticc nosv being operated under the 1936 
Act by local authorities or by ipprovcd volunt iry asso- 
ciations under the surscidance of loeil authonlies, base 
attracted to their seisicc the best ot iv iilabic personnel 
in the various localities Incicising numbeis of residual 
private practising midsvivcs lie cipitulatmg to the lure of 
compensat'on as oflered them by the Act ind under the 
stress ol decreasing practice due to the competition of 
official SCI vices This in time svill tend to pioducc a better 
type ot midwife, under improved control, and should 
devoK'e advantageously in the combat svith puerperal 
sepsis Administratively the full time salaried midsvifc has 
many advantages relevant to the present theme Impor- 
tant among these is the fact that, unlike her colleague m 
private practice she has no financial inducement to avoid 
suspension fiom 'duty following conttict with infection 
An intei diction by local authorities and voluntary asso- 
ciations concerned, in respect of the continuation in then 
service of midsvives after mairiage, may welt be a neces- 
sary measure against puerperal sepsis, for when she has 
young children of her own, sVith their liability to scarlet 
fever, otitis, sore throat, and the like, the married midwife 
is moie than ordinarily liable to convey infection This 
does not, of course, apply to midwives of middle age, or 
bevond who were already long mairied when initially 
idmitted to the service 

The Part of tlie General Practitioner 
The increasing tendency for normal confinements to be 
conducted by midsvives restricts the experience in this 
branch available to medical practitioners, who are never- 


Ti?r T'tfTnii 
VfcnirAt 

thclcss expected to be ccpial to ill emergencies to which 
tliev are summoned bv midwives In this connexion it 
In of course rceogni/ed ih it iinsl died or unlimcij inter 
ferenee is i eommon c itise of puerper il sepsis These and 
siiiiil ir conskler iiions h ise led to the adiocic} in some 
i)uirleis of pincls limited to doctors with special cxp.ri 
cnee in midwifer) for de ilm;^ with midvives emergenes 
e ises inste id of the present sjstem wherebj all rncdicil 
pr letilioners ire eliijible for the or! 

Notificition In medic d pr iciilioncrs of c ises of infee 
tious disc ise IS recoj ni/ed is i necessiry condition of 
control This applies to puerper d pjrexn no less than to 
other infeetious dise ises and jet in m mj areas the 
notdie itions of puerper d psresii ire notoriously incom- 
plete As I result of the Publie He dlh Aet 1936 ihc 
procedure in reg ird to the notdieation of puerperal 
Icbrdc conditions Ins been simplified I ormcrij, for pur- 
poses of notdic ition it w is n-cess irs to e itegori/e ihes- 
conditions into cither puerper d feser or puerperal psrexia 
The etfeet ol the new legisl ition is that the presioib 
idmmisir itise ddferenti ition between ptierp.ral lever and 
puerperil psrexn is removed ind ill puerperal tebnie 
stiles ire notdiible IS puerperil pvrexia \ more com 
plete ssstem of notificition of this condition bs medical 
pr letitioncrs is i neccssarv ind re ids line ot reform m 
connexion with the control of sepsis 

Iiislitiitional V Domicdi irs Muhiifirs 

In recent scars there his been a progressive increasi. in 
the hospit ill/ Ition of m itermlv c ises The Midvvives Act, 
1916 mis now serve in some degree to check this 
tcndencs for one of its objects ippeirs to be thit of 
lestonng domicdi irv contiiiements to grcitcr t iioiir TTjw 
has a bciring upon the prevention and control of '-psis 
although It IS ddlicult to deline or issess fn mewt itsas 
the mtreising pnblie demand for institutional confine 
nients Ins overt ised iv ul ible beds md cither in over 
crowding of cises or i diminution of the routine length of 
st i\ in hospii il Ins resulted In this w i\ the risks of 
puerperil sepsis Inve been incrctsed Thus it appears 
that I necessary me isure is cither subst inti dli to increase 
m itcrnity bed lecommodation or to limit idnussions 
The latter mav well be the right is well is the readier line 
to like, notablv in view of the improved domiciinrj niid 
wiferv SCI vices drcidy nailable is a result of the 1916 
Act 

C ises lor institution d nniermty beds might usefullv be 
icstnctcd to («) those showing ibnornnhty as revealed 
It antenatal investig ition, (/>) pnmiparae and (c) cases 
fiom unsatisf iclorv homes Thus the maternity hospital 
would deal liigcly with such tvpes of case is constitute 
the worst ‘risk" in conncsion with the possible super 
scntion of puerperil sepsis Then again, the admission 
ot cmcigcncv cases of potential sepsis has to be considered 
’ These things indicate that the careful planning of accom 
modation in mateinity hospitals and in maternity units 
attached to general hospitals is a nieasiiie of fundamental 
impoitance in the prevention and control of puerperal 
sepsis For this piiiposc separitc isolation blocks arc 
desirable for the accommodation of (u) eases of sepsis 
occurring m the routine piacticc of the hospital or unit, 
and (6) emergency admissions of actual or possible stpsis 
In too many maternity hospitals oi units the lay out ot 
accommodation is such th it difficulty arises in circum 
scribing infection Nowulays it mav well be niort 
important to have ample isolation accommodation for 
cases of puerperal sepsis than to have small pox hospitals 

With regard to the hazard of puerperal sepsis there is 
some division of views as to whether a materndv hospital 


Auisi l'< 19'S 


PRC\ ENTfON OF Pl/ERPERAL SEPSIS 


The B msH 

>tEr) CAi JOt?N4L 


339 


15 b^l((.r IS T scpinlc cntii\ or ns n unit ntnchtd to n 
tsnsnl hospiinl The latter gises grcnitr cconom\ of 
ndniinistration and it is Iikch that an\ epidemiological 
risk that mas ittach to the arrancenient as such can be 
olmated h\ proper planning of the unit and bj careful 
interna! administration of the hospitil 

Laboralon racililies 

In controlling puerperal sepsis a combination ot 
epidemiological and bacteriological investigation is usuallv 
necessarj as for example in the determination of earners 
and other agencies of infection It should be just as much 
a matte- of routine practice svstcmaticallj to investigate an 
occurrence of puerperal sepsis as it alrcadv is in the 
case of the other major infections Appropriate adminis 
irative action — in connexion with matemilv hospitals in 
the suspension of midvvives from dutv and like matters — 
depends verv often upon bacteriological findings From 
the administrative point of view therefore adequate 
laboratorj facilities arc of obvious importance and should 
be made available wherever possible in each area In 
regard to laboratorv services in general there is useful 
scope in manj districts in the matter of joint laboratorv 
schemes conducted bv the local authontj and the local 
voluntarv hospital m partnership 

Nutrition of Expectant Mothers 

In the attempt to promote m expectant mothers a 
resistance to infection attention to the nutritional state is 
clearlv of importance For this purpose general powers 
for the care of mothers are contained in Section 204 
of the 1936 Public Health Act This section replaces that 
part of the 1918 Matcrnit> and Child Welfare Act which 
dealt with the promotion of maternal health It appears 
that the word care now introduced is capable of the 
widest interpretation Most or all matemitv and child 
welfare authorities include in their schemes arrangements for 
the supplj to expectant mothers of liquid milk or dried milk 
at cost part-cost or free according to the ascertained 
means in each case In a few areas the schemes also embrace 
milk meals or dinners for necessitous cases The 
milk meal consists of milk and bread and butter, and 
IS usuallv served about 11am The dinner is a com- 
plete meal produced usuallv m a municipal I lichen and 
served at middav To ensure that the exp-ctant mothers 
themselves actuallv receive the meals the latter need to 
be served at prescribed centres under supervision Such 
measures as these have relevance — indirect but important 
— in the genera! combat with pue-pcral sepsis 

Formation of PubUc Opinion 

Public or private agencies working on behalf of maternal 
welfare cannot achieve the best results without the active 
CO operation of the individuals whom thev seek to help 
The expectant mother herself mav often be the final 
arbiter on the question of whether or not her confinement 
IS to escape contingencies In order to induce her to seek 
adequate ante natal care and to follow faithfullj the 
advice she receives popular education in these matters 
IS necessarv This comes largely within the province of 
the health administrator althou^ the familv practitioner 
can lake a vital part as an educator within the limits of 
his practice 

Medico legal -Vsjiects 

In connexion with pue-peral sepsis it is important to 
sav a word concerning the liabilities and responsibilities 
of those in administrative charge of matemitv hospitals or 


domicihan midwifery s.rvices and of those in clinical 
charge of matemitv cases I shall be briel however 
because a later speaker is to deal with this matter specific 
allv The Lmdsev Countv Council v Marshal! case 
which was carried to an appeal in the House of Lords in 
1936 threw much light on the subject notablv m so far 
as concerns responsibilitv for the conduct of matemitv 
hospitals and concerning the respective liabilities of local 
authorities and their medical officers 

TTie present position appears to be that any medical 
practitioner — whether in public or private practice — per- 
forming clinical work in the conduct of matemitv cases 
IS p.rsonallv liable for all that flows from his for her) acts 
or omissions On the other hand where a medical officer 
15 performing an administrative act or a ministerial act 
as required bv some statute or order of a governing or 
employing authority the latter would be the defendant 
or would b- joined as a defendant In short it appears 
that the clinical practitioner stands alone m this matter 
whereas the administrative medical officer has his employ- 
ing body behind him Despite the foregoing however 
there are bo-derlme cases in this connexion which fully 
lax the legal judgment 

In the Lmdsev Countv Council i Marshall case the 
appeal of the local authority in question was dismissed, 
and the main grounds for the decision appear to have been 
that the focal point in the case was an administrative 
one — namelv that at the time the plaintiff was admitted 
to It the matemitv home administered bv the county 
council was not reasonablv safe bv reason of the prior 
presence of a case of puerperal sepsis about which the 
plaintiff was not informed 

The responsibility of a local authority or other govern- 
ing bodv in connexion with a matemitv home appears to 
be to satisfv I'self so far as possible as to (a) the suitability 
and safutv of the accommodation provided (6) the supply 
of prop.r food (c) the adequacy of the equipment and 
(</) the reasonable elficiencv of the staff it employs The 
last two points also applv in the case of a domiciliary 
service of midwives 

Conclusion 

The part prescribed for me in this discussion has 
relation to the administrative aspect only and I trust that 
I have kept the bounds of my allotted sphere The 
subject under consideration is complex and wide and in 
respect of omissions I must plead the set limits of time and 
space 


The Minwter of Health on lulv 26 opened a new general 
hospital at Louth Lincolnshire The hospital was formerly 
a Public Assistance inslitulion which has been converted by 
the erection of a large ward and alieralions to Ihe existing 
building at a cost of about £71 soo It has accommodation 
for 200' beds The public health hospitals should co operate 
with and not rival the voluntarv hospitals said Dr lEllioL 
Indeed this principle of consultation is a statulorv require- 
ment of the Local Government Act of 1929“ He desenbed 
Ihe sreat change that had come in the status of the old Poor 
Law' hospitals with the passing of the Local Go\emment Act 
of 1929 which empowered local councils to appropriate 
individual institutions to the public health services This 
process expunged the so-called stigma of the Poor Law and set 
up a new hospital service of great national importance He 
noted vviih approval that in the Lmdsev area of Lincolnshire 
a consultative committee had been 'et up representative of 
Ihe voluntarv ho pitals and the coun'v council which did 
excellent wor) in co ordinating the hospital services as a 
whole 



340 August 13, 193S 


l-ULVfNIlON 01 rui HIM K \l SI l’S|S 


Ti«i r r 

'tt At J A 


PREVENTIOIS AND CONI llOE OE 
PUERPERAL SEPSIS 
BACTERIOLOGICAL ASPLCIS* 
in 

R. M. I RV, M R C S. 

Assistant Dinitor of tin Ihnihan' lUnon Isisianli I < I ort 
toms Qtniii CIniilotli s Matinuts Hosintal I tnulin 

Under the name of piiei peril sepsis \\e hi'e to inehtile 
bicternl dise ises due to i number ol dillerent inteetini 
oiganisms ind dissimil ir both elmieills ind in the nnnner 
m which the infeetion is spreui Tile orj’ inisins eon 
cerned in the more sesere lorms ol piierper il sepsis ue 
foitiimleiy few in niimbei Thej are 

(0 Hicniolstic stieptocoeeiis (1 ineelieUrs Cnoup \1 
HaenioKlic streplocoeei helon^iii} to Citoiips It C ind (i 
Tie miieh less common tiuI the inteetions cuned tn tliein 
arc seldom sc\crc 

( II ) Anacrobie streptocoeci 

( III ) Bacilhts loll 
(i\) Staphs lococciis 

{\) IJacillns lu/i/iii and other spoic 1 e trim in icrohie 
bacilli 

(si) Pnciimococeiis 

For purposes of prevention ind eonirol ot sepsis i Inow- 
Icdgc of the common sources of tlie mleeinn^ on inisms 
IS of more importance lit in knowletige of the elinieil 
fcaUircs of the eliscasc 


Two Groups of Orgtnisms 


The organisms cmimcrited above fill into two cleirls 
defined groups The first grotip with which 1 sh ill de il 
first in order to dismiss it coni iins the an icrobie strepto 
cocci, B coll ind R wtlilni These orginisms ire ill 
normally present m or ne ir the genit il traet — the 
anaerobic streptococci in the sigini, ind B (oh and 
B sscicliii in the 1 leccs and ihcrclore probibls con- 
taminating the skin of the perineum The c\pl in ition 
why such infections arc not more common appe irs to he 
in the fact that these three org inisms do not miiltipK 
readily in normal lochia or scrum but their growth is 
favoured by the presence of necrotic tissue sueh is miy 
be found when there has been seseic truimi or when 
fragments of placenta or membranes have been retained 
The passage of the oigamsms into the uterus is of course 
facilitated by the introduction of hands or instruments into 
the uterus The influence of injury or interference on such 
infections is shown by figures from Queen Charlottes 
Hospital Isolation Block Duiing the foui years 1933 
to 1936, out of thirty-eight consecutive cases of anaeiobic 
streptococcus septicaemia only four had noimal l.iboiirs 
without severe trauma or interference such as mamnl 
removal of the placenta or self-induced abortion This 
is in striking contrast to the haemolytic streptococcus 
septicaemias during the same foui years, when, out of 
eighty consecutive cases, no fewer than forty-four followed 
normal delivery with no interference or trauma 
These figures, with similar ones which can be obtained, 
on a smaller number of cases, for the B colt and B 
welc/iii infections, clearly support the view that infections 
by these organisms are mainly those of complicated 
obstetrics, and I would suggest that the control of such 


* Head m opening a discussion it a joint meeting of the Sections 
of Obstetrics and Gyniecology and Public Health and Hygiene at 
Meeting of the British Mcdicil Association, Plymouth, 


infeclmiiv liLs mi'll- in lla h iiul ot the ob'ti.ifii.i n ihm 
(>i ilii. h n-kriohn I t 1 tin not p'opi'-,': to jo into If 

I t'L tpii'iion ol m I I ptiv- tcdinnitic from ihu b'Cioio- 
lojn.ll j'Oiiil o! VK V 1 foiii tic nicdicoLyil '■vpi.i. it 
IV tloiiltilnl It iiikvtioiis bv till- - tlircc ruf ant nw ari. c' 
imivli impotiiiiwi IK, do not ipp- ir to h. ci'nimenl 

II iiiviiiitiiil trom pill nt to pi'i^nt md in irv vi' 
p ool ol si vh ir iiisini ^lon would K bird to cbtim la 
Miw ol lilt tniiiiviivv With vtiivh tlicV arc nornalli 
loiiml 111 o- 11 II tfu t vinl i! tr kI 

in iiift^tionv dll- to tin. o h.r i roup of orpnnns-if 
lin.milvtK s ici'ti -oveii'- th- ‘t ip'i\IiKOci.iis aaJ if 
piit-iinu >.o-,,iiv ve in. i vtil vviili I verv da v vn' 
1 'iol’li.m 1 jiropo V to dt il with the li i-mohiii. s' if o 
covciis done lust II w iv vhovn bv 1 uaviti-Ul and Hi i 
in 193' tint m i v- i- m '■‘'*1 v u inal sw ibs tik-n im 
norm il wom-n it the 1 iiipin' ot 1 iboiir no haimo'vi- 
stri.piOi.ovi .1 b-Io'ii nil to 1 irivcticld v (iroop A wiii s 
Ilit-ft. IS IS Vet no record ot ih.'c o'l inivnis b-ing 
in till no''m d v u m 1 sw ib I -tori d-Iivirv It h 'a 
inlircstiin tut tint ot th- patients it Qu— n Cliarlct.i' 
iso' ition I'lo-k mli-iid widi th- humolvtic siripiCiOiO-' 
iboilt '9 p-r Lint li ivi nn iltVc \ igin d swats b fc 
disihiric itoiii hovpi' d md dmost ill uc nc-ain- "i‘K 
i month tier divchirj- Ihis su usts tint ih- noirij 
{iintil ir lit IS not 1 tivoiirillc sitintion for ih-5i''i''t' 
of the li iiiiio*) tic strip’ococciis Ciroiip \ 

In till il'Miicc ol evidence to the contrarv "c t" 
jiistiliiil m issiimim ih it lliisc mtccoons irt intrwrc^ 
Irom sonic cstrucnitil source That this 'v , 

CISC Ins b-.n shown b\ the rt'cirihcs ot J Sn’iih tti 
ol Dbr i C olebrook both ot whom toiind vtriro-uV 
scroloi’it dij identic tl with those infecliiii, ll c f'’ 
some e\ir leeiiit d source in the patient or a Ci'ii'- 
ibout "‘i per Cent ol e ises eMinined 

We hive then is one of the fund inientil 
the invesiii ition of hiimolviie streptococci^ ’ 

to 1 lee the f.iet ih it pr letic dlv ill ire inircdvccu r^^^^ 
sonic extiitenitd source during 1 iboiir or 
divs of the puerpcrium There ire two 
f icts which 1 shill give m the form of figures H'"-') 
the records of Queen Ch irlotte s Isol ition Block of 
seven yeirs 1931 to 1937 Tliesc ire d' 
puei per d pyrexia .idmittcd onlv 33 per cent "J 
with the hiemolvtie streptococeiis (2) ol .(o 

of puerperal sepsis 70 per cent were hnemohtic s tvp 
coccus infections 

Sources of Ilicmoivtic Slrcptococciis Inrcclio"* 

Il we consider the chief possible sources 
streptococcus infections we find the following tiu'vi 

sonic 

1 Infection? from the rcspir dory tract or rare ) 
othci septic focus, of an attendant or other con n 

2 Infections from the respiratory trict, or some 

septic focus, of the patient herself jij 

3 Infections transmitted from another septic ens 
attend inls, dressings, instruments, or dust 

How may such infections be prevented? ^ tin 
that it IS only through close co operation be ' 
obstetrician and the bacteriologist that ®’^'''*'^f*j,m;terie 
achieved If 1 appear to stiess the impoitance o 
logical investigation too much it is for tvvo 
first that as a bictciiologist 1 am natiiially '^s^^ 
secondly, that the tvvo recent well-known case 
legd iction has been taken and heavy damages 
awarded have shown so clearly the dangers o 



Xtci'sr n I9^S PRLVENTION OF PUERPERAL SEPSIS 


lo nnki. Mich insc-ilig'ilions Tlie point for considcntion 
then IS 10 dLCidu what mi. istircs to nke m order to a\oid 
doing too little on the one hind or on the other hand 
triing to do too inuch so th tt the whole nutter of 
bacteriologicnl iniestigation becomes impr ictieable ind 
ibsiird 

Infection from Conticts 

In the first of the three groups mentioned ibo\e we hi\e 
infections from attendints or other contacts It is eleirle 
too much to attempt frequent routine ex imimtions of ill 
nurses ind doctors engaged in midwiferj practice and it 
IS extremeU doubtful if an\ xaluable results would be 
achieeed b> such measures On the other hand it is 
essential to take swabs from the nose and throat when 
there are an\ svmptoms suggesting respirators tract infec 
tion or an\ liistorx of a recent infection of this kind 
This should in ni\ opinion apph not onh to medical 
attendants but to an\ member of the patients famils who 
IS hkeU to he in the house at or near the time of dcliscre 
Not onh IS respirators tract infection lo be witched for 
but also an\ septic focus on the skin and in children 
cspecialh an\ aural discharge I would suggest too as 
a reasonable precaution that a throat swab sho ild b. 
taken from ans nurse h-forc she starts malernits work 
esp-ciill> if she has been recenth engaged in general 
medical or surgical nursing At Queen Charlotte s Hos 
pital all new nurses and resident medical oflicers hase 
throat and nose swabs taken before thev start their duties 

Infection from an Extragcnilal Source in the Patient 

In the second group — that of the infections from the 
respiraton tract or other focus of the patient herself — 
we are on more dilTicult ground It is probabl) neither 
necessary nor wise to swab the throats of all patients 
as a routine but when there is anj historj suggcstise of 
recent respiratorj tract infection this should certainly be 
done This affords protection for the patient for if the 
swab be positise special precautions can be taken such 
as the yyearing of a mask b\ the patient and the steriliza- 
tion of her hands bj dettol cream It is m such cases 
too that the prophylactic use of sulphamlamidc at the 
beginning of labour might be expected to be of use 
The doctor may also rcceixe some protection for if the 
patient should dexelop puerperal fever no claim for 
damages would be likely to succeed if there were definite 
evidence that she had haemolytic streptococci in the throat 
before delivery 

Infection Transmitted from Patient to Patient 

In the third group we are faced with the problem of 
what must be done when a patient develops puerperal 
sepsis to safeguard the other pitients First a vaginal 
swab must be taken and examined as soon as possible 
1 xvould emphasize this apparently obvious point particu 
larlv because there is a tendency at the present time to 
swab the throats of alt attendants and take no steps to 
find out the nature of the patients infection Since it 
IS only in haemolytic streptococcus infections of the 
patient that the question of infection from the throats of 
attendants ari'es and since onh about one third of the 
cases of puerperal sepsis are due to that organism this 
practice is to say the least irrational While waiting for 
the report on the vaginal swab the patient must, of course 
be regarded as a suspect case and be strictly isolated and 
those in attendance should not attend clean cases If the 
swab IS found to be positive for the haemolytic strepto 


Tiir British 34 1 

'•ftDICU. JOLOvU. 


coeciis then and then only is it necessary to investigate 
contnets Apart from this investigation of contacts 
efficient sterilization of the room and everything it con- 
tains must be carried out before admission of another 
ense — another obvious point vvhicn is sometimes over- 
looked It IS not always recognized that the haemolytic 
streptococcus enn survive in a dried form in dust for a 
long lime This wns- conclusively demonstrated in 1936 
bv \\hite who showed that the dust of single bedded 
rooms in which pntients infected with the haemolytic 
streptococcus were nursed was always infected with that 
organism She also showed that a human infection could 
be caused by infected dust and that the streptococci could 
live in the dust for as long as ten weeks 

Tliroat Carriers 

The question naturally arises as to what is to be done 
with nurses who arc found to be throat carriers of haemo 
Ivlic streptococci In mv opinion there is only one possible 
answer — that thev must be kept away from maternity 
work until negative In view of the natural variations 
that occur in the amount of growth from a swab two 
consvciilive negative results should be obtained before 
return to dutv is permitted There are I know those 
who hold different opinions from this who believe that 
haemolytic streptococci in the throat are of no importance 
if the throat is clinically normal This view has the 
advantage ot putting the onus on the clinician presumably 
a laryngologist instead of on the bactenologist but the 
dangers from the medico legal point of view must be 
great It is difficult to imagine the line of defence m an 
action for damages where it was known that a nurse 
present at a delivery was a carrier even if a healthy 
one of haemolytic streptococci 

Co-operation between Qinician and Bactenologist 

Finally, I must deal with the question of co operation 
between clinician and bacteriologist Speed is essential 
in all these investigations and in order to help the bacterio- 
logist a definite request for an examination for the 
presence of haemolvlic streptococci should be made 
instead of the usual vague request for bactenological 
examination or even more briefly '> orgs It must be 
remembered that a complete bacteriological examination 
of a swab from the throat or vagina may take many 
davs a provisional report on the presence or absence of 
haemolytic streptococci can however nearly always be 
given m the morning after the dav on which the swab is 
received and the bacteriologist must be prepared to help 
by giving such provisional reports by telephone If 

grouping of any streptococci found is to be done a 
further twenty four hours will be required but the number 
of cases infected bv groups other than Group A is so small 
that a provisional report of haemolytic streptococci 
present in large numbers is sufficient evidence on which 
to take all necessary steps of isolation specific treatment 
and examinations for the source of infection «- 1 may 
mention here that the haemoly tic streptococcus in the 
vaginal swab in puerperal sepsis is nearly always present 
in overwhelming numbers or is absent so that there is 
seldom much doubt as to the nature of the infection 

Commentary 

It may appear that I have laid great stress on the 
haemolytic streptococcus infections There are three 
reasons for this First as already mentioned they are 
responsible for the majontv of fatal cases , secondly they 



342 August 13, 1938 


PREVCNTION or PUCRP1;RA1, SLPSIS 


Tiir Hurrmi 
MrnicAL JotiiSAL 


nre the infections in which wc know th U the orginism is 
introduced from in c\tr igcnit.il source ind in which, 
therefore the possibility of spread from attendants or 
from patient to pttient his to be considered , ind thirdly 
they arc the infections lor winch wc li ivc now i specilic 
method of treatment in sulphanil imidc ind its dcri\ itiscs 
so that early diagnosis is import int for the pitient herself 
as well as for others who may run the risk of infection 
transmitted from the s imc source 

From the bacleriologic il point of mow then, the issue 
IS clear Wc hi\c first to insestigitc esery cise of 
puerperal pyrc\ia bs taking a sw ib from the \ igina ( i 
cervical oi intra-uterme sw ib is not neecssirv) ind c\im 
ining primarily for haemolytic streptococci M iv 1 inter- 
polate at this point my belief tint there is no substitute 
for this CMinination and that csidencc g lined from the 
clinical state of the piticnt cm nesci gi\e in iccuritc 
answer to the ill-importanl question Is this i hiemo 
lytic streptococcus infection'’ 11 ising icccised i positise 
report on the swab steps must be t ikcn to find the source 
of infection, both in the piticnt herself and in ittend ints 
and other contacts The finding of i source in the pitient 
IS of little use in preventing the spre id to others is she 
will in any c ise be isolated but from a medico leg il point 
of view It may be of use as a line of defence If the 
vaginal swab is ncgatisc for the hicmolytic streptococcus 
no investigation of contacts is ncccssiry since other infec- 
tions, with the possible exception of the sery rirc staphylo- 
coccal and pncumococcil ones ire not gcncrillj trans- 
mitted from an outside source 
This much is clear, but the problem still remains of how 
to get the necessary examinations cirricd out quickly and 
accurately Iheic can be few places in this country tint 
are not within easy reach, by post at ic ist, of a laboratory, 
but because of the necessity for speed it is essenti il th it 
the laboratory should contain at least one full-time experi- 
enced bacteriologist If haemolytic streptococci arc to be 
“grouped ’ — and this is important, especially in examination 
of throat swabs, to avoid suspending nurses unnecessarily — 
the difficulty is greater still, as the number of laboratories 
in which this can be done is still small At the Research 
Laboratories at Queen Charlotte s Hospital we attempted 
to fill this gap by instituting a service for the examination 
of any swabs from maternity cases or their contacts for 
haemolytic streptococci only, and foi the grouping of 
any such organisms found If a few more laboratoiics 
would undertake similar work in some of the large towns 
throughout the country so that practitioners resident any- 
where in England could be suie of obtaining accurate 
cheap, and, above all, quick reports, there would no longci 
be any excuse for attempting to solve the problems of a 
bacterial disease by clinical data alone 


Standard specifications for protective clothing respirators, 
gloves and other articles of personal safety equipment maS 
result from a meeting called recentlv at the request of the 
National Safetv First Association and the Associated Slate 
Quarries The meeting was attended by both makers and 
users of safety equipment as well as by representatives 
from employeis organi/ations engineering institutions trade 
unions voluntary associations and Government departments 
A resolution was carried asking the General Council of the 
British Standards Institution to set up a representative industry 
committee to deal with all personal safety equipment There 
aie alreadj BSI committees dealing with individual aiticles 
of safetv equipment such as bools and goggles The pro 
posed mdustrj committee would take over control of these 
committees and would also deal with any future requests 
for the standardization of personal safety equipment 


TRHATMrNT OF UNDULAIST FEVER 
WITH PRONTOSIL 

nv 

CHAULTS /AURA ^i^UMA^^, M.D. 

The rcmediLS which it his been proposed to use for the 
trcitmcnt of uiulul inl fever arc so numerous and varied 
th it the n itur il conclusion is that few or none are reallj 
consistent m their action V'leeines so fir have proved 
of limited use except in a few e ises where they were 
injected intravenously and where the curative effect may 
be iseribcd to shock tlicripv In my experience the 
results of V iceines with few exceptions have been 
dis ippomtmg The severe and uncontroll ibic reactions 
leeompinying intriveiious vaccine theripy militate against 
the geiieril lecept nice ol this form of treatment 
When trvpiflavine vv is inlrodiieed great hopes were 
eiitcrt lined ind good results were chimed Ccrtainlv 
some piticnts recovered fairly ripidly alter the dye but 
in others no result vv is forthcoming The same may be 
s lid of mercuroehrome Both these drugs arc relatively 
toxic ind their direct introduction into the blood stream 
incrcises inv polcnliil thnger I have used foiiadm a 
triv ilcnt antimony prepirilion in a few cases but the 
number is as yet too small to arrive at anv conclusion 
Good results have been reported by Manson Bihr and 
by Young 

A greit desidcrilum would he an clTcclive remedy that 
could be administered orally and that did not exert any 
undue toxic iction If the claims put forward in the 
ciscs described be'lovv arc confirmed then prontosil and 
its congeners would be ideal remedies in undiilant fever 


Cases Treated bv Injection 

In Cises 17 to 21) prontosil was administered intra- 
muscularly, the dosage being one injection of 5 cem on 
iltern lie days The urine was stained red within a feiv 
minutes, which showed that the excretion was very 
ripid With the dosage adopted, concentration of the 
diug in the blood was not likely to be high enough to 
influence the discise, ind in three cases the results were 
disappointing The first of these (Case 17) was that 
of a youth aged IS , as soon as his Widal reaction 
proved positive in a litre of I in 150 he was given a 
iiuhttn'ns vaccine every thud day in gradually increasing 
amounts After three weeks he still ran a high fever 
and I decided to inject prontosil He was given 5 
every other day for another three weeks At the end 
of one and a half months of persistent treatment the 
patient w is still feverish and sufiering from rheumatic 
pains The other two (Cases IS and 19) voung children 
3 and 4 years old, failed to respond after more than 


three weeks treatment by prontosil injections 


The 


foul th case (No 20) was that of a boy of 6 ' During the 
first week of his illness his tcmpeiature was as high ns 
104° F, the blood-serum reaction was strongly positive 
to Bi imlitcnsis and he was then treated with 
mu^uUr prontosil injections on alternate days , nt Inc 
third injection the temperature was 100° F in the evening, 
and he was completely afebrile on the tenth day ot 
treatment No second wave of pyrexia occurred, 
although the patient was kept under observation for six 
months 

It will be realized that in three of ihese cases the 
results were meagre, while m the fourth the norma 



AurusT 13 19^8 PRONTOSIL IN UNDULANT FEVER 


duniion of IIil di>ci<;c •ict.niLd lo ha\e btcn matcrialK 
ciirlailcd In the light of further experience with 
pronlosil b\ mouth it is probible that the dosage ad 
ministered intramusctilarl> ssas too small 

Oral Troafnicnt 

In all sixteen patients xxerc treated xsith prontosil red 
oralh the) were mostl) children and the results m 
the majorits were gratifsing It must be premised that 
none of the patients \sas sescrel) intoxicated and that 
th^ average duration of s)TOptoras at the beginning of 
treatment was a week lo ten daxs In all a strongly 
pOMtivc 'Widal reaction lo Br mcluensts was obtained 
The initial dosage for children was four tablets of 
prontosil dailv "Souths and adults received six tablets 
After three or four days according to the gravity of the 
case and its response to treatment the number of 
tablets was reduced to three in the case of children 
and to four or five tablets in adults Usually at the 
end of a week children vvere given two tablets and adults 
three tablets dailv and this was continued for a few days 
It IS adsisaWe fa give the drag far seieral days after 
the patient has become afebrile 

Children sometimes dislike the red colour of the 
tablets and it is a good plan lo powder these and to 
mix them with some jam or marmalade which is then 
spread on a cream cracker Alternalivelv one can use 
prontosil album The effect of the drug on the tern 
perature is usualh prompt and a daily fall of I F may 
be expected In some cases prontosil acts in an almost 
sp-cific manner while m othen a minoritv the effect is 
disappointing If no result is evident within a week the 
drug will be ineffective even after prolonged admtnislra 
lion Whs there should be this variation in individual 
cases cannot be explained 

If given early in the course of the disease a great 
deal of the debility caused bv the long duration of the 
fever is avoided and the patient can often return to 
school or to work within two or three weeks after treat- 
ment has been started It must be remembered thfit the 

disability period of undulanl fever averages two to 
SIX months 

No severe toxic effects vvere observed after the ad 
ministration of prontosil In a few cases a curious 
lassitude perhaps more correctiv an abnormally quiet 
attitude was noticed This began about two days after 
the first dose and lasted for two or three davs Anorexia 
Is usuallv asserted to be one of the toxic sequelae of 
the drug but as this svmplom is verv common in un- 
dulanl fever and does not become worse after taking 
prontosil little importance need be attached to it In 
three cases slight vomiting occurred during the treatment 
and in one case strangurv both these svmploms dis- 
appeared in a dav or two when the dose was diminished 
In two cases a slight degree of evanosis of the cheeks 
was seen In no case was there anv ground for alarm 
and although the dose was with advantage reduced the 
drug was never cntirelv suspended 

It IS important to continue the treatment for a few 
davs after the fever has disappeared In two cases 
where this was neglected the pvrexia reappeared but it 
as promptly vanished when prontosil was again given 

Analysis of Cases 

Most of the patients were treated in the acute stage 
of the disease and more experience in the chronic cases 
of undulant fever would be desirable 


The BiuTKa 3^,3 
Med CAi JfyrHAx 


Case / — \ child aged 4 had been fe\ensh for over a 
rnonth when first seen His csening temperature oscillated 
between lOI and 102 F His general condition was good 
'tnd he was usualh active enough to plav with his brothers 
He was given four prontosil tablets daih for four davs the 
humber beme then reduced to two in the twentv four hour» 
On the third dav after the onset of treatment the evening 
temperature was 99 F on the fifth dav it was normal and 
has remained so ever since There were no rheumatic pains 
So common a complication of undulant fever 

Case 2 — \ voung man aged 28 was seen after four or five 
davs of high fever His blood «erum reaction vvas strongU 
positive lo Br mehrensts His general condition vvas fair 
but occasionallv at night he was restless and his mind 
Wandered He vvas given six tablets of prontosil dailv On 
the second dav the temperature had dropped from 104 to 
102 ^ F Bv the fourth dav the patient said that he fell 
much belter and the temperature was barelv 100 F On 
the sixth dav the patient was normal and the prontosil was 
stopped Two davs later the temperature suddenh rose to 
102 F whereupon the drug was again administered with the 
result that within two davs the fever disappeared completelv 
and the patient has been free from it since No rheumatic 
pains or other complications marred an otherwise uneventful 
Convalescence 

Cases 3 4 6 7 and 8 — These patients varied in age 
between 3 and 6 vears In all the blood serum reaction wa> 
positive to Br mehtensis and the spleen palpable Four 
tablets were given dailv in jam this was rrfuced to three 
and subsequenilv two tablets as the condition of the patients 
Improved None of the cases was senouslv intoxicated and 
rccoverv was prompt In Case 4 slight evanosis of the 
checks was obsened on the third dav this disappeared on 
reducing the number of tablets to one dailv 

Case S — \ voung man aged 25 had been ill for three 
months and the fever had latelv been o allating between 
loo and 102 F^ with apvrexial periods lasting tor a week or 
ten davs He complained of rheumatic pains about the ankles 
Jind the knees and had lost weight considerabU for which 
bis severe anorexia was miiinU responsible The spleen vva^ 
palpable and the blood reacted strongU lo Br meUtensis 
The usual dosage of prontosil red was presenbed — that is 
Six tablets daiU After five davs the patient was free from 
fever His rheumatic pains persisted for a week and no 
further then graduall) disappeared Although he was kepi 
Under constant obserration for three months no further wave 
Of pvrexia were recorded 

Cases 9 10 II 12 and 13 — These consisted of children 
the vouncest of which was bareU 3 vears old and the eldest 
10 The latter as well as Case 10 — a girl of 7 vears old — wa 
given six tablets for three davs and four tablets subsequentiv 
The average evening temperature among this group vaned 
between 102 and 104 F In a few davs the fever chart 
showed a definite response to the drug and in ten davs all 
the cases were apvrexial In all the first was aUo the last 
Wave of fever No relapses were observed during the three 
months of observation 

Case 14 — -k child aged 5 vears was afebnle after a week 
of treatment and to prevent possible toxic effects pronto il 
Was suspended ^^hen three davs had elapsed the patient 
developed a slight evening temperature which ro've to 102 F 
the next dav Four tablets of the drug were given for a 
further five davs although the temperature had dropped to 
Oormal after the second dav of treatment 

/j — \ woman of 70 had been suffenng from malai!>e 
and generallv increasing pvrexia for over a weel when a 
\\idal reaction confirmed the suspicion that she had undulant 
fever \\’hen prontosil was presenbed she was in poor con 
dition her temperature was 104 F there was a certain 
amount of bronchial catarrh and traces of albumin were 
found in her unne with a few hv aline casts In five dav 
the evening temperature fell to 100 F„ and on the seventh 
dav she was free from fever for the first time Her genera 
Condition improved considerabU in the next few dav^s unti 
!i severe sciatica developed which lasted for two week* 



344 August 13, 1938 


Tur nuiTi >r 
MrntrAi Jrttvjii 


PRONIOSIL IN UNDULANT IXVLR 


during which period there wts no fc\cr She wns comp^r•^ 
tiNe!> well for t month when p>chtis set in with cvcntinl 
hcTit fiilurc ^nd iincmn 

C()\t 16 — A bo\ igcd 12 w is dngnoscd as sufTi.rinp from 
undid int feser and this was conhiincd In the positisc Wood 
scrum reaction His temperature at the hccinning of treat- 
ment was 104° F and he had a consider ibic amount of 
bronchial citarrh this improved with in expectorant and with 
poultices but the fescr remained high ind was still 102'' F 
on the evening of the tenth dav although lie had been given 
six tablets of prontosil red dailv This vv is now suspended 
as albuminuria and casts appeared in the urine and it was 
feared that prontosil, if not the actinl cause might still 
further accentuate the renil condition After a month the 
box gradiiallv improved and his appetite returned Albumin 
disappeared but tachvcardia set in during conv ilcsccncc This 
condition is fairlv common during convalescence it rirclj 
leads to anv serious results, hut iisiiallv persists for two or 
three weeks Occasionally there would be a rise to 100° or 
101° F for three or four davs and then an apvrcxial period 
of a week or ten davs The total duration of the fever in 
this case was a little over two months 

Table ill me Refills oj Tnalimiil 


Case 

No 

Age 

fNcirs) 

Si\ 

Do^'jgc 

DnratJon 

of 

PcNcr 

No 

of 

NSa\es 

Hemarks 




hitronunctil 

ar t/ijrcnou 

t n/ Proa 

tnul 

11 

IS 

xt 

14 m3 of 

2 months 

5 

Vlad prcMous \accinc 




5 c cm 



treatment (intra 

IS 



each 



niusciitarh) 

3 

M 

6 inj 

1 month 

2 

Had pfCMous sflcsinc 







treatment (inira 

19 






mmcularh) 

4 

M 

S inj 

3 weeks 

2 


20 

6 

M 

5 inj 

10 davs 

1 





1 rvtuoul Red gi\cn Orally 


1 

4 \ 

M 

A nbleis 

6 <Jajs 

1 1 





i dails 



2 

28 

M 

6 lahlcts 

10 

2 1 

Prontosil siKpciulcd nt 




1 (Imlv 



end of fifth da> Had 




1 



a second \sasc lasiint, 
two dass 

3 

6 

M 

1 4 tiblcis 

1 8 

1 

Vomiting from second 




Utj1> 


to fourth dav 

4 

5 

F 

12 , 

I 

C>anosis of checks on 







third dav 

5 

25 

M 

6 nblcts 

5 .. 


A chronic case— no 


1 


diil> 


1 

other waves after the 
first \sctk 

6 

5t 

F 

4 tablets 

5 .. 

1 





d wlv j 




7 1 

3 

F 1 


2 , 

1 

Vomiting from second 







to fifih dav 

8 I 

6 

M 


6 „ 

1 


9 

4 

M 


s 

1 


JO 

7 

F 

6 tTbIcts 

10 , 

I 

Vonimnf from third (o 




at first 

4 tablets 



fifth day 




after 

wards 




U 

10 

M 


7 , 

1 


12 

3 

M 

4 tablets 

to , 

1 

Strangury on fourth 




daiW 



day 

13 

10 

F 

6 tablets 
at first 
then 4 
tablets 

10 

1 





daily 




14 

5 

F 

4 tablets 
daily 

6 tablets 

12 , 

2 


15 

70 

F 

7 , 

1 

pjcd 14 months from 




daily 



end of treatment 

16 

12 

M 

2 months 

5 

Prontosil suspended 







after ten da>$ 


Summary and Conclusion 

1 Twenty cases of undiilant fever treated with prontosil 
are reviewed 

2 In four the drug was administered by intramuscular 
injections on alternate days In only one of these cases 
was the period of the disease perceptibly shortened 

3 In the remaining sixteen cases oral administration 
was carried out In fifteen of them the average duration 


of the fever w is seven days ringing from two to twelve 
days In one case the drug was apparently ineffective 
As a rule ciscs which arc untrcitcd become fever free m 
two to SIX months, though consider ihlc variations arc met 
with 

4 None of the cists w is seriously inloxicilcd, though 
sonic hid high temper ilurcs 

5 Ilecuise of the limited number of ciscs definite 
conclusions c innot .is yet be drawn, but these results make 
further rcscireh dcsiriblc 

(i Prontosil red and other or.il sulph inthmtdc prepara- 
tions so far represent the most eonvcnicnt treatment for 
iindulant fever ind if the results described here be con- 
firmed these drugs m ly eventually find a valuable place 
in the light ag unst this crippling ind long drawn out 
disc tse 

Milla Mn> 5, 193S 


A COMPARATIVE TEST OE NATURAL A>D 
CONCENTRAIED ANTITOXIN IN 
TREATMENT OE MALIGNANT 
DIPHTHERIA 

BV 

B A ri-rrus. M D .B p.H 

Ml (Inal bupcnntindiiu Ham Gniii Hospital anil Stmalaniiia 
itiiir Rnslol I ci Hirer in Feiirs Lbiiwrvifv oj Ihislol 

Owing to the convenience of its administration the use 
of concentrated diphtheri.i antitoxin cont.unmg only the 
globulin fr.iction of the serum ol the immunized horse. 
IS probibly univers.il Tltc serum m iniifacttircrs clunt 
that by depriving it of ill its inert protein and other 
useless constituents it is Jess toxic to human beings, .md 
thev continue to offer more and more concentrated anti- 
toxins at higher prices Since the appearance of malig 
nant diphtheria in Bristol in 1921 there have been a 
few cases in which the idmimstration of antitoxin in 
large doses intravenously filled to sive life, even when 
the patient was treated within fortv eight to fiftv s'X 
hours of onset of the disease It therefore occurred 
to me to investigate the relative values of natural (whole 
scrum) antitoxin and concentrated (globulin only) serum 
to sec if in the process of concentration the anti- 
toxin had lost any of its therapeutic efficiency Con- 
centrated serum might still neutralize the same quantity 
of toxin III Mtro but it might not have the same avidity 
for combining vv ith toxin in i n o especially as the peptiza 
tion of the globulin is not so perfect when redissolved 
after precipitation as it is in the un.iltcred natural serum 
This can be demonstrated by extmining each micro 
scopically with a dark-ground condenser 

The cases chosen tor this trial are those which on 
admission were considered by the admitting medical 
officer to be so giavely ill as to need a large intravenous 
injection of antitoxin (usually 30,000 units) and 60 to 
100 c cm of 20 per cent glucose, together with 16 000 
units intramuscularly I have mcluded only those ctses 
in which it has been possible to give the full dose of 
antitoxin and glucose considered necessary sometimes, 
with a restless patient, the needle has slipped out of the 
vein before the completion of the injection The cases 
received natural or concentrated antitoxin alternately 
As the number of cases suitable for the test has vane 
between only 1 1 and 23 per cent of our total admissions, 



Avcu<;t 13 19^8 


COMPARISON or SERA IN MALIGNANT DIPHTHERIA 


It his nkcn SIX and a half stars lo amass tht data noss 
inalssed Since the milerial ssas obtained from two 
soirees oscr a long period the strum of stseral horsts 
ssas used thus climinal ng i possible error as the scriini 
of difftrent horses sarics in its liibihts lo product reaction 
TIu solumc of the natural scrum ssas tsso lo three times 
that of the concentrated scrum The morlalit> rates 
ind complications obsersed arc gisen m Tiblcs I and II 


TKEBumsir 54^ 
BiUdJCAI. JOLTlhvAL 


Ii>perp}re\ia and ssmptoms of collapse Temperatures 
up lo 107 F base been recorded in this senes These 
reactions are dangerous unless the temperature per 
rectum is recorded eser> ten minutes and the usual 
measures are taken lo deal ssiih h)perp>rexia 

Misled bs the adsertisements of serum makers sse were 
ser) much surprised lo find that these sexere reactions 
occurred in 21 per cent of those treated with concen 


Tener I 



Teni r II — Cornpticoiiont of Cases Rtcoitred 


1 

1 

1 


pjral)j..4 


T la! 

1 

* 

i 

OifTer 

eev^ 

1 

I 

Scrum Rajh« 

1 

Ri iirx all C3.es fjn Ip 

1 Confrol 1 5 

S') of 1 
Caj« 1 

1 

Ps ate 1 

PjIj c j 

1 

Pi< Phar 
Oca 

phmsm 

Difler j 1 

' j 

D.tT r 
ence | 

SE o') 
Ditfer 1 
cn'« 

Total j 

3 Differ ' 

1 cocc 

SE of 
D ffer 

cn * 

Cemrot (“^n-en 1 


I 

3 { 



37 S 

: *119 

ss j, 3 

<2 7 

‘199 

56 

42 

i) 0 ( -.19 1 


scoim) 













1 1 


(natural j 

135 

30 j 

J 1 

2 

\ 35 

2^9 


1 •‘3 

54S 



? 

1 1 


serum) 1 





1 



! 



1 


1 



Tsdle 111 



[ Da> of D aih from Onset of Disease 



3rJ 1 

4ch 

i 

j 5(h 

6th 

! -ih 

Sth 

9ib 1 

lO-h 

liih 

I2ih ] 

!3th 

Mih j 

Ortr I-» 1 

Tojf 

Con ro** (-oocen rated serum) 

3 1 

^ 1 

5 

3 

3 

) 

2 ] 

1 

5 

> 1 

- 

1 


>4 

Teits (natural v.rum) 

I ] 

’ 1 

4 

2 


3 1 

1 

I 

1 

5 

■> 

J i 

2 

= 1 

’ i 

43 


Mortalits Rates 

The percentage difference in the two senes appears lo 
fas our the concentrated serum slightls (18 6 per cent 
compared with 22 8 per cent) but as the difference is 
onis equal lo the standard error it cannot be regarded 
as statistical!) significant Therefore the two sera appear 
equal in life sasing properties 

Paralises 

In this series I base included onl) the more serious 
forms (palate phar)nx and diaphragm) as ciliary 
paral)sis is difficult to proie unless the patient is old 
enough to read The difference here appears in fax our 
of the natural serum but as it is onl) twice the standard 
error it is not strictl) admissible This is also borne out 
b) the fact that fatal paral)sis occurred in four of the 
control series and fixe of the lest series 

Late Scrum Rashes 

These occurred in a2 7 per cent of the control cases 
and 34 8 per cent of the test series As the difference 
here is oxer three times the standard error it is probabi) 
significant 

Rigors and Hx-perpxrevia 

The great disadxantage of gixing foreign serum intra 
xenoiisl) IS the occurrence of sexere rigors associated xxith 


trated serum and in onl) I 1 per cent of those gixen 
xxhole natural serum although the latter cases receixed 
fir more foreign protein than the former It xxas 
obserxed that rigors occurred with equal frequenc) in 
the patients who recoxered and m those who died It 
was also found that in 50 per cent of the fatal cases 
treated xxith concentrated serum death ensued xxithin 
sexen da)s of the onset of illness but onl) 30 per cent 
of those treated xviih natural serum died so earl) 
(Table III) suggesting some immediate toxic effect ot 
the concentrated serum Hoxvexer whole horse sen m 
IS probabi) nearer human plasma m its buffering electro 
l)te content and the phxsico-chemical slate of its protein 
than a single protein fraction that has been dehxdrated 
and precipitated The colloid chemist tells us that no 
l)ophilic colloid rexerls exacti) to its former state after 
rough handling — the phenomenon they term hxsteresis 
These findings are not applicable to all therapeutic horse 
sera as xxe found in attempting to carrx out a similar 
series of obserxations xxith streptococcal antitoxin 
natural and concentrated administered intramuscuhrlx 
to scarlet fexer patients using alternate cases as before 
but xvithout gixing h)pertonic glucose simultaneousix as 
xxe did xxith the diphtheria antitoxin With both l)pes 
of streptococcal antitoxin serious and alarming reactions 
occurred m so high a proportion of cases that we did 
not feel justified in continuing the trial in such a com- 
paratixelx benign condition as scarlet fexer 












































346 August 13, 1938 COMPARISON OF SCRA IN MAI JGNANT DIPHTIICRIA 


Commcn(nr> 

I do not think th.it the intravenous glucose is the 
factor concerned, as m scscral cists where the piticnl 
received onlv naturil diphthcrii intitOMii without glucose 
(not included in this senes) no reaction oecurred It 
would therefore appear either th.it streptococcal mti- 
to\in IS moie toxic than diphthcrii antitoxin on intr.i- 
venous injection or th.it the sensitnity of pitients to 
foreign protein differs in the two dise.iscs The time 
taken for the membrane to separate and the durition 
of the albuminuria — which latter is an index of per- 
sisting toxaemia — were also tibulited, but the\ showed 
no significant difference with the two tjpes of sera 

As a result of this investigation we have decided in 
future to use natural diphtheria antitoxin for intruenous 
injection The smaller bulk of the conccntrited scrum is 
still to be preferred for intramuscular injection m the 
milder cases 

Conclusions 

When given intrasenously with 20 per cent glucose, 
(1) the therapeutic effects of natural and concentrated 
diphtheria antitoxin on the death rate and paraUtic com- 
plications are cqu.il , (2) conccntrited antitoxin is twenty 
times as likely to gi\c scserc immcdi.itc reactions ind 
one and a half times is likely to gi\c late scrum rashes 
as whole natural antitoxin (3) On this account natiiril 
diphtheria antitoxin is to be prcfcircd for intraxcnous 
injection (4) These findings arc not applicable to strepto- 
coccal antitoxin 


TREATMENT OF PELLAGRA WITH 
NICOTINIC ACID 

BY 

M. RACHMILEWITZ, M.D. 

AND 

HELEN 1. GLLECK, M.D. 

{rrom ihe Oiit-patieiU and Medical Depai tnicnt o) the 
Itothschild Hadassah Hospital Jcriisalciii) 

^ The work of Elvehjem and his associates (1937) on the 
treatment of canine black-tongue with nicotinic acid, 
and the resultant cures, have stimulated clinicians to use 
this substance in the treatment of human pellagra 
Fouts and his co-workers (1937) reported four cases 
treated with nicotinic acid These patients, after having 
been placed on a control diet poor in the pellagra- 
preventing factor, were observed for three days During 
this time their condition remained stationary or became 
worse Treatment was then begun with nicotinic acid 
in doses varying from 0 5 gramme to 1 gramme daily 
Within forty-eight hours after the initiation of the treat- 
ment all the patients showed distinct improvement m their 
general condition and the stomatitis was completely 
healed In two patients suffering from diarrhoea normal 
stools were obtained on the third and the fifth day 
respectnely The dermatitis disappeared within six to 
tweniy-five days All the patients noticed warmth and 
tingling of the skin ten minutes after ingestion of the 
nicotinic acid 

Almost simultaneously Spies, Cooper, and Blankenhorn 
(1938) reported eleven cases of pellagra placed on basic 


Tiir Tl»rrmi 
MtOtCAL JOI 


control diets poor in the pell igra-prc\cnti\c factor The 
most sinking cffccls were observed on the glossitis and 
stomitilis which tisu illj disippcircd forty eight hours 
iftcr the bifginning of treatment The pcliigroiis 
glossitis, stomatitis, pty ilism urethritis, and proctitis did 
not rcippcir while the p.iticnts received nicotinic acid 
In one CISC the jlossitis .md stom.ititis which had disap- 
pc.ircd with the use of nicotinic icid recurred when it 
w IS discontinued Mild cases of dcrm.ilitis in which the 
epithelium remained int ict hi inched within twenty four 
to forty eight hours after the administration of the drug 
However severe ciscs of dermatitis in which the lesions 
Were moist, ulcerated ind thickened did not seem to 
benefit by nicotinic .icid In scvcr.il cases there was 
flushing of the dermil lesions with tingling of the skin 
shortly ifler the idministration of the drug These 
iiilhors conclude tint O'* jramme daily in five doses of 
100 mg c ich IS 1 sifc ind cffeelivc amount in the usual 
erse’ of pclhf'rt 

In .1 further report Spies (1938) describes fifteen cases 
-similirly studied ind irc.itcd In these the urine was 
tested for porphvrin In one cisc the porphyrin dis 
appeired from the urine forty eight hours after the 
beginning of treatment, only to reappear when the 
nicotinic .leid was discontinued In a later communica 
tion Grint Zschiesche ind Spies (1938) igam confirmed 
these observations and pointed out that the healing of 
the dermaiitis was completed by the end of the second 
week 

Smith Rullin, ind Smith (1937) report a chronic case 
of pellagra with typical dermititis hy pcrkcratosis of ih® 
f ice diarrhoea, and mild dementi i which responded to 
nicotinic acid Yudkm Hawkslcy, and Drummond (1938) 
report a cisc which was successfully treated with a ' Iwct 
filtrate ’ factor In a later communication Hawksley 
(1938) records a case ending in recovery after treatment 
with nicotinic acid He concludes that the liver filtrate 
fictor used in the previously treated cisc must contain 
nicotinic acid 

Wc shall briefiy describe two cases of pellagra which 
were successfully treated with nicotinic acid 

Case 1 

A woman igcd 62 was idmiltcd to hospital on April 12, 
1938, having prcvioiislv been observed for eight days in the 
out palicnl department Four months before admission “^hc 
began to complain of severe diarrhoea consisting of four to 
SIX foul liquid stools dailv The di irrhoea persisted in spite 
of medication The pitient then put herself on a diet o 
white bread, crackers zwieback nee milled cereal, "h't 
cheese, and black coffee Sugar, meat, vegetables, n'-h, 
butter, eggs, and milk were rigidly excluded from the diet 
The patient felt weak and listless and lost considcnblc 
weight The diarrhoea persisted One month before admis 
Sion she noticed that the skin on the dorsum of the Innas 
was tough and scaly The lesion progressed rapidly unm 
the dorsum of the hands became fiery red and scalv A 
the same time she noticed red circles under the eyes, some 
what similar to the skin of the hands One week before 
admission she began to compl iin of burning of the UP o 
the tongue 

Physical Examination — The patient was well orientated 
and CO operative She appeared chronically ill and under 
nourished The skin of the face was dry atrophied, an 
wrinkled Linder the eyes it was reddened rough, and scaly' 
Around the neck there was a wide band of brown pigmenta 
tion The dorsum of the hands was wrinkled fiery rei, 
and covered with a scaly dermatitis extending from the nai ^ 
beds to the wrist There were areas of deep brown pigmenta- 



Aurosr 13 193S 


NICOTINIC ACID IN PELLAGRA 


TKw BurriSH 

\fiwcjLL Jovicva 


347 


lion at tfic ind ihc carpo mciacnrpil irticul^lions 

Tlicrc NMs a modcraic piumcniation on ihc dorsum of ihe 
feel The longue MioNvcd vomc atrophN of ihc 
ihe margin a\iih rcddcninc of the tip The patellar and 
Achillea reflexes were somewhat hvpcracii\c but no abnormal 
reflexes were present Vibrators sense was diminished to the 
knees as was ptr«plion of touch the patient being unable 
to distinguish between the head and pointy of a pin There 
was no pain on pressure on the leg muscles The Romberg 
sign was absent Motor power appeared normal The rest 
ot the examination produced nothing abnormal 

Laboratory Data — ^The stool contained no parasites or ova 
The urine was normal The red cells numbered 3 900000 
per emm and the haemoglobin amounted to 75 per cent 
Sahli The white cells totalled 7 200 per emm and the 
difTcrenlial count was normal Radiographs of the stomach 
and duodenum resealed nothing of note The gastnc juice 
showed complete achlorhedni 

Clinical Course — The pUicni was pul on a basic diet 
similar to that of Spies sufTicienl in protein fat and carbo- 
hvdrales but deficient in the pellagra prcvenlnc factor The 
dermatitis and diarrhoea became more marked weight loss 
was rapid and the appetite continued poor On the fourth 
da> after admission while continuing the basic diet she was 
given two 50 mg doses of nicotinic acid b> mouth The 
amount was then increased to 150 mg dailv given orafl> in 
three 50 mg. doses until discharge from the hospital On 
the second dav of the trcaimeni there was a slight improve- 
ment in the dermatitis with desquamation starting in Ihe 
central portion of the dermal lesions of the hands The 
tongue was no longer reddened and the marginal papillae 
appeared normal The appetite improved considcrabh On 
the fourth da> of treatment the diarrhoea suddenly ceased 
and throughout her sla) in hospital the patient had one 
normal stool dailv Five davs after the beginning of treat 
ment she complained of tingling of the finger lips flushing 
of the face and diziiness The drug wtis discontinued for 
two doses but on the sixth da> was continued without 
untoward effect 

B> the sixth dav of treatment the dermatitis of the hands 
had disappeared except for a small area of pigmentation at 
the wnsts Bv the tenth dav the skin was entirely normal 
Since the results of the nicotinic acid had been so striking 
eggs milk puree of vegetables and chicken were added to 
the basic diet Her onU complaint was weakness of the 
legs and some difficultv in walking The results of ncuro 
logical examination made at this lime were the same as 
on admission except that vibrators sense was now normal 
Because of these svmptoms from the fourteenth dav the 
patient was given one ampoule of cr>stalline vitamin B, 
(betaxin) iniramuscularlv dailj until discharged nine dajs 
later At discharge the reflexes were still hvpcraclivc but 
sensation was complctelv normal She no longer complained 
of difficultv in walking or weakness in the legs Her weight 
in spue of the pronounced general improvement remained 
constant (44 kg) However this woman was seen in the out 
patient department ten davs later and had gained 3 kg in 
weicht with no treatment other than a normal mtxcd diet 

Case n 

The patient a porter aged 46 was first seen m the out 
patient department ten davs before admission to hospital 
^^'hen admitted on April 28 J938 it was impossible to obtain 
a detailed fusion, from him because of Ms obvious mental 
confusion depression and anxietv However a historv was 
elicited at a later period of his illness when his menial 
condition had greallv improved He had been uncmploved 
for five months and during this interval his diet had con 
sisted enlirel) of unleavened bread nee potatoes lentils and 
occasional cabbage or boiled egg plant His appetite had 
become verv poor For three months he had felt exircmelv 
weak could no longer lift heavj objects and finalh could 
hardiv walk He complained of dizziness and dull aching 
pains over the entire bod> One month before admi>ston he 
first noticed that ht> hand^ were becoming fierv red and 


painful This he attributed to constant exposure to the 
sun He did not complain of diarrhoea or a sore mouth 

Physical Examination — The patient vvas uncooperative 
disorientated and appeared badlv nourished and severelv ill 
His face looked apathetic and listle<^ The dorsum of the 
hands was covered with thick scalv hvperkeraioiic fierv red 
dermatitis decplv fissured and ulcerated In some areas there 
were blotches and brown pigmentation The feet showed 
a similar but less severe dermatitis The orifices of the 
sebaceous glands about the nose were plugged with hornv 
concretions The tongue was coated no glossitis or 
papillarv atrophv being present The heart sound were 
distant and of a tick tack qualitv Neurological examination 
revealed absent patellar and Achilles reflexes The abdominal 
reflexes were present Sensors examination was impossible 
bccau e of the confused mental condition of the patient 
The gait vvas ataxic and swajing with small steps The 
Romberg sicn vvas absent The re>t of the examination vvas 
rot notable 

Laboratory Data — The urine was normal but porphvnn 
was present on admission There were 3 000 000 red celU 
per emm when admitted and 4 100 000 on discharge the 
haemoglobin was 60 per cent Sahli and the differential 
count was norma! The Wassermann reaction was negative 
The stools contained no parasites or ova The gastnc juice 
showed complete achlorhvdna A radiograph of the stomach 
revealed sevure gastniis with thickening of the rugae A 
radiograph of the heart did not show any enlargemenL 

Chmcal Course — The patient was pul on a basic diet 
similar to that of Case 1 His appetite was poor and he 
refused most of his food He was uncooperative and dia 
orientated and urinated on the floor of the ward On the 
dav of admission treatment was begun with 50 mg. of 
nicotinic acid The next dav he was given two do>es ot 
^0 mg each Aftur the second dose the patierit complained 
of severe Itching over the areas of dermatitis flushing of 
the face and faintness An uriicanal rash appeared over the 
knees back and arms this persisted for two hours The 
drug was discominucd for the third and fourth davs Mean 
while his dermatitis and mental state became distmcilv worse 
On the fifth dav he was given two doses of 10 mg. each on 
the sixth dav 10 mg eight limes on the seventh dav •'O mg 
three limes and subsequenilv ^0 mg four times dailv until 
discharge No further reactions to the drug were observed 
On the seventh dav after a tola! dose of tOO mg. of the drug, 
the dermatitis showed marked improvement The appetite 
vvas verv good but the mental condition had not improved 
Bv the twelfth dav of treatment the dermatitis of the hands 
had complctelv disappeared except for a small area of pigmen 
tation at the wrjsis The skin of the nOiC was now entireh 
normal The patients mental condition had shown marked 
improvement and he was now rational and co operative and 
walked about the ward In spite of his basic diet he had 

gained 1 S kg m weight By the thirteenth dav of treatment 

he was complctelv normal mentalh and his appetite could 
no longer be satisfied bv the pellagra producing diet He 
was therefore given a regular diet on the fourteenth dav 
Neurological examination still revealed absent knee and 
Achilles reflcxCN but the sensorv examination appeared 
normal The patient vvas now exposed to the direct sun 
light for periods of one and a half hours on several occasions 
The dermatitis did not recur On the eighteenth das the 
unne in sshlch porphsrin ssas found on admission and on the 
eighth das in hospital no longer contained this substance 
On discharge on the issents third das he ssas in excellent 
health and had gained 3 kg. m sscight 

Summars 

Tsso cases of pellagra are reported in sshich the patients 
sshile subsisting on a basic pellagra producing diet, ssere 
treated ssith nicotinic acid Both patients recovered from 
the disease the first bj the ninth and the second b> the 
thirteenth das of treatment The average dose varied 
from IvO to 200 mg oraII> a daj Both patients had 



34S August 13 I93S 


CLINICAL MEMORANDA 


Tiir Il*mm 
%li Die Ai Jm « 


reactions to the drug early in the ircitincnt In C'sc 11 
the mental symptoms disnppeircd sviih treitmcnt 

Bim looRM in 

Bcckit, W Lllingcr P, nnci Spies, T I> (1917) Qi/ar/ J Mril 
6, 305 

nivchiem C A Madden, R J , Stranp F M , and Whoolc), 
D W (1917) J Anicr cliciu Soc 59 1767 
routs, P J Htlmer, O M , Lepkossks b and Jules 1 It 
(1937) Proc Soc exp lliol NV 37 40S 
Gnnt, J M , Zsclneschc, E, and Spies T D (1913) lancet 1 
919 

Haukslcy, J C (t918) Ibid 1 944 

Smith, D T, Ruflin, J M ind Smith S O (1917) J tiiirr 

tncii /Isj 109 2014 Arch inlirn Mul 59 611 
Spies, T D (1938) Lniierl 1 212 

• Cooper, C and Blinkcnhorn M A (1918) J Unrr 

nice! Ass 110 622 

and Aring C D (1918) Ibid 110 1081 

Yudkin, S Hatvkslcj J C , and Drummond, J C (1918) ! anerl, 

1, 253 


Clinical Memoranda 


Basal Narcosis m the Treatment of Tetanus 

Recovery from gcnerah?ed tetanus of short incubition 
period IS rare enough to justify presentation of this cisc 
The remarkably beneficial cfiTccts of continuous and intcr- 
millcnt basal narcosis (in this particular patient with 
nembutal) would seem to suggest that this form of Ircit- 
ment is a most valuable means of combating a drevd 
disease 

Case Report 

A man aged 28, of robust build, u is idniittcd to St 
Vincent’s Hospital, Dublin, on March 24 1918 presenting 
the classical signs and symptoms of established gencrah/cd 
tetanus, temperature 101° F, pulse 102, respirations 10 The 
patient, who was fullv conscious stated that he had been m 
perfect health until March 19, when he dcseloped cramps 
in his legs and pain and stiffness in his jaw and neck which 
subsequently spread to all parts of his bods He remembered 
basing cut his forearm with a shovel on March 12 vshilc 
handling animal offal in a factors' He did not pas any 
attention to the cut except to apply iodine As the nature 
of his illness had not been recognized locally no anti tetanic 
serum had been given before his admission to hospital 

Treatment — The wound in the forearm, which was septic, 
was freely incised and treated with hjdrogcn peroxide For 
the first three days in hospital continuous narcosis was main- 
tained with 74 grains of nembutal, given intravenously at 
chosen intervals and during this time continuous intravenous 
drip glucose saline was administered (10 pints) From the fourth 
day onwards the nembutal was given bv mouth m 44 grain doses 
so as to produce intermittent narcosis, which allowed the 
patient to have adequate nourishment, aperients, and plenty of 
fluids during the day-time As the patient was rather restless 
on the fifth day two intravenous injections of the drug were 
necessary Extending over a ten day period a total dosage 
of 75 grams of nembutal was given bv the intravenous 
route and of 63 grains by the oral route During the same 
ten day period 240 000 units of anti-tetanic serum were 
administered 6,000 units intravenously (under chloroform 
anaesthesia) 20,000 intravenously, and the remainder bv the 
intramuscular route 

Pi ogress — All tetanic spasms had ceased by March 28, 
temperature and pulse were normal on March 30, but residual 
Stiffness did not show signs of passing off until the tenth day 
of treatment After this the patient made an uninterrupted 
recov ery ^ 

Notwithstanding the large quantity of anti-tetanic scrum 
administered m this case the clinical behaviour of the 
patient was such as to suggest that the outstanding bene- 
ficial agent was the prolonged narcosis produced by the 
nembutal m conjunction vvith the intravenous drip therapy 


The use of basil n ircotics in the tre itmcnt of tel inns 
IS of course by no nicins new Avertm was employed 
for this purpose by L'lWcn as far bick as 19Z7 since when 
there hive been frequent references in the literature 
to the use of v.irious narcotic drugs — chiefly barbiturates 
This present cisc is placed on record with a view to 
emph isi/ing thc_vahic of i method of treitmcnt which is 
easily ipplicd and sshich oilers i consider iblc prospect 
of i successful outcome 

P T OfARitru TRCPI, 

Dublin DrH,DTM 

Stable Sodium Nitropnissidc Solution for 
Acetone Bodies in Urine 

Most of the tests for iccionc bodies in the urine are 
performed by dissolving just before use, a lew crsstals 
of sodium nitropriisside in 5 ccin of w iter and adding 
a few drops of this solution to the urine containing 
ammonium sulphate and fioitmg on ammonia This 
iqucous solution of sodium mtroprusside is scry un 
stibie, turning blue when kept for a few hours, so that 
lor priciicil purposes it his to be freshK prepared every 
diy Unless a lirgc number of urines have to be tested 
dull much of the sodium nitropriisside is w istcd Wh-n 
onlv one or two urines h i\c to bw c\ immed some workers 
simpK pi ICC i few crvstals — ipproxim itely 0 2 gramme— 
of sodium mtroprusside and a sni ill qiianiitv— about 3 
gr immes — of immonium sulphate in a test tube, then 
idd about 5 cem of the urine direct to the mixed salts 
ind flo It the ammoni i on the top This procedure is 
also xerv w isteful of sodium nitropriisside 

Sodium nitropriisside is m expensive chcmii-il“9'er 
26s per 500 grammes — ind i stable solution would there- 
fore not onlv be much more convenient for urine icsiing 
but would also help to reduce the running costs of the 
liboniory An iqucous soliilion of sodium nitro- 
prusside can be rendered quite stiblc however, merely 
bv the addition of i little coneeniraled nitric acid, which 
in no way interferes with the reaction for acetone bodies 
in the urine This solution will keep indefinitely me 
so IS always ready for use With regard to the 
ammonium sulphate used in the test it is also more con 
xcnient to keep it as a mixed sohilion xvilh ammonium 
hydroxide 

The reagents for the improved test therefore would be 
Solution No 1 — Ammonium sulphate solution 

200 c cm sntiinled solution of ammonium siilplntej 
200 cem ammonium hvclroxide sp gr 0 88 

Solution No II — Sodium mtroprusside solution 

10 grammes sodium nitropniseidc cristiJs dissolved in 
90 c cm distilled vv ater and 
1 c cm conccnlralcd nitric acid then added 

Tin Test — To 5 c cm of urine in a test tube add 5 ccni 
of solution No I and mix Then add 1 c cm of solution 
No II shake and allow to stand for a minute before judgini 
the coloui reaction A deep purple colour will then In'® 
appeared if 0 1 per cent or more of acetone bodies is present 
If only a xery faint trace is present the colour will be merely 
deep red 

The saturated solution of ammonium sulphate used m 
solution No I should be prepared as follows Place 780 
grammes of ammonium sulphate in a 2-litre flask and lud 
1 litre of boiling distilled water Shake inimediatcly until 
dissolved, then allow to cool at room temperature De- 
cant the supernatant solution (or filter if necessary) 

John Ingham, TIC, 

Biociieniist to the Mcdicnl Unit Welsh National 
School of Medicine, Cardiff 



\ucusr n I9jS REVtEWS , XireB.mm 349 

^[IDICA1. JotTL'.AL 


Re\1e>>'S 


V S\STIM or MCD1CI^C A^D SURGERY 

The Praciilionrrs Lihran of Mcihnnc and Siirxfr\ 
Volume \III Siipplenieni Index Superxisini, Editor 
Profexxor George Bliimer MD (Pp 1161 IS4 figurex 
including 4 coloured ilUixtrationx £30 for xel of thirteen 
xolumex.) London and New 3 orL D \ppIeton Centiirx 
Companx I94S 

The thirld-tith and supplcmen(ar> xoIimiL which contains 
an indt-X to the whole publication occup)ing more than a 
quarter of the xolunic is an cxtrcmclx imposing instal 
nicnt It contains sexentx one chapters corresponding to 
articles in the prcxious txxelxe xoUimcs so as to keep 
the Libran up to date and this alternatixe to a loosc- 
leaf arrangement as it saxes the reader the trouble of 
rearranging the pages is more likelx to be popular 
Among the fift> sexen contributors thus concerned xxiih 
more recent adxanccs there are man> of the leaders in 
American medicine to di> Professor Henrx Christian of 
the Peter Bent Brigham Hospital Boston gixes an account 
of relapsing febrile non suppuratixe panniculitis (Weber- 
Christian disease) and thus joins the distinguished band 
of those such as Paget xon Recklinghausen and Osier 
who haxc more than one disease as tributes to their 
clinical actixitj Professor Warfield T Longcope of the 
Johns Hopkins Unixersitx describes with a number of 
photographs the generalized form of Boeck s sarcoid 
(maladie de Besnier Boeck or Hutchinson Boeck disease) 
but has forgotten to gixe a reference to his own account 
in 1936 of this interesting disease in which the bones and 
lungs are affected as xxell as the skin Dr L G Roxvntrcc 
late of the Ma>o Clinic and now of the Philadelphia 
Institute for Medical Research gixes under the heading of 
Tlie Th>Tnus and the Pineal in Health and Disease an 
account of the remarkable results which he and his col- 
ic igues haxe obtained bx experiments on successixe gener- 
ations of animals thus suggesting that these glands haxe 
an internal secretion Professor Musser of Tulane Unixer 
SUV xvrites on pvoexaneus infection and Professor Btiimer 
of Yale contributes sexeral articles including one on 
proctalgia fugax a sxndromc of unknoxxn aetiologx and 
palhologv 

This xolume is full of interesting material, and attention 
max be directed to the rex tews of recent adxances m 
diseases of the blood forming organs bj Dr R Isaacs on 
the reticulo-endothelial sjstem bv Dr C A Doan to 
Dr Gxvathmev s full rexiexx of anaesthesia and to that on 
the sex hormones bv Dr Theodore G Klumpp of Yale 

MHEN TO OPERATE 

Die Anzeige ziiin Operatoen Eingnff Bx Dr Med 

Richard Goldhahn (Pp 474 RM 16 50 bound 

RM 18) Leipzig Georg Thieme 1938 

The idea behind this book bv Dr R Goldhahn xxho holds 
the post of chief medical officer to a municipal hospital 
in the busx industrial town of Liegnitz, is a good one 
especiallv at a time when it is felt m some quarters that 
surgical technique has come loo much into the forefront 
of surgical practice and is apparentlv regarded bx some 
as the be all and end all of the xxork of a surgeon It js 
easier to operate xxell than to know when to operate and 
— xxhat IS perhaps more important — when to withhold 
ones hand and what reactions and complications to 
expect from a particular operation in short un bon 
operateur serait quelquefois un mauvais chirurgicn. 


Dr Goldhahn s textbook is clearl) set out in a senes 
of sections arranged on a regional basis and the darl tvpe 
on dull paper which makes it allractixe is clear and 
casilv read There are no illustrations A bibliographx 
immcdiatelx precedes the index at the back of the book 
but although this includes some hundreds of authors 
references to English and American authorities are \er> 
scarce It is annojing to the foreign reader of this work to 
be confronted with an attempted nationalization of tech 
meal terms thus the mediastinum has become Mittelfell 
the xtrmiform appendix Wurmfortsatz, and the duodenum 
Zxxolfiingerdarm This makes reading unnecessarilx 
difficult for English and American readers We beliexe 
that the more international scientific terms become the 
better for science and for mankind Osier reminded us 
that in the halcxon daxs of the Renaissance there was 
no nationalism in medicine but a fine catholic spirit made 
great leaders like Vesalius Eustachius Stensen and 
others at home in exerx counirx m Europe The 
nomenclature in Dr Goldhahn s work is a retrograde 
step and xxe hope that a second edition max be corrected 
in this respect and may also become more representatixe 
of what IS best in British and American medicine since 
both the idea and the general form of the book are good 

JOHN KEATS 

Keats os Doctor and Patient Bx XV Hale XX'hitc (Pp 

96 5 illustrations including frontispiece 5s net ) 

London New York Toronto Oxford Unixersitx Press 

1938 

Str William Hale White has long been knoxxn as a loxer of 
Keats He is consulting phvsician to Gu) s Hospital 
where Keats receixed his medical education and thus has 
access to the school registers and he has an expert s 
knoxviedge of consumption His little book therefore 
on Keats as Doctor and Pattent contains all that is Iikelx 
to be knoxxn about the poet m these relationships During 
his student career Keats appears as a strong and healthv 
minded bov taking notes of Sir Astlex Cooper s lectures on 
anatom) and surgery xvalking long distances for the sheer 
enjoyment of the exercise and making friends with all 
and sundry Having obtained the L he never prac- 
tised or put his medical knowledge to any use but turned 
at once to poetry by which he intended to make a living 
He was in good health until August ISIS twenty five 
months after he had left the hospital when he began to 
complain of toothache and repeated sore throats Sir 
William Hale-White is careful to explain that these were 
noL in his opinion due to any tuberculous infection 
They were evidence of lowered resistance for Keats was 
working hard at writing and his hvgienic surroundings 
were unsatisfactory His serious illness began on 
February 3 1820 when he had haemoptvsis after a bitterlx 
cold ride from London to Hampstead on the outside of a 
coach The disease progressed in the usual vvay and he 
died in Februarx 1S21 little more than 25 years old He 
caught consumption almost certainly from his dearly -loved 
brother Tom with whom he lived for months before the 
disease killed Tom in ISIS Sir XVilliam Hale XXTaite 
points out that throughout his illness Keats had the best 
medical advice obtainable Dr Robert Brec F R and 
Dr William Lambe who both held high office in the 
Royal College of Physicians and James Clark afterwards 
Sir 'James Clark who became phvsician to the Prince 
Consort and wrote the article on tuberculous phthisis in 
the Csclopaedia of Practical Medicine But the fates were 
against the recovery of Keats nothing was known about 
the cause of phthisis bleeding was in fashion and fresh 
air was considered to be dangerous in the sick room. 



350 August 13, 1938 


RCVIKWS 


The book ends with two letters from Keats — one to his 
publishers the other to Woodhoiisc — which show that he 
was not much aficcted by the nnligmnt resicws in the 
Qiiaiteih and the Edinburgh ind that thev hid cert unly 
no elTecl in hastening or causing his dcith as has been 
generally staled Any worry tint he felt was associitcd 
with his brother Toms illness, ind not with mv attick 
upon himself Lovers of Keats will welcome the book 
It corrects many errors about him, and eaplains his illness 
in the light of modern medicine 

OPHTHALMOLOGICAL PRINCIPLES 

Introduction to O phthahnoloj,\ B\ Peter C KronfeUI 
MD (Pp 331 32 fipures 15 tables 3 50 dollirs) 

Springfield Illinois ind Baltimore, Marjl ind Charles C 
Thomas 1938 

Dr Peter Kronfeld professor of ophth tlmology in the 
Peiping (Peking) Union Medical College, has written a 
book out of the usual rut of eje books Inste id of a 
volume that is full of illustrations and blocks of instru- 
ments, and not a few coloured prints, there arc %cr\ few 
illustrations Instead of a ctlaiogvie of disc iscs with their 
interpretation and indications for treatment there is an 
absence of what may be called svstcmatic c Ualoguing , 
details of diagnosis are omitted, ind there is nothing or 
next to nothing, about methods of cxamin ition and 
treatment 

The book is w'h it might be called i philosophical 
disquisition on the principles underlying that portion of 
ophthalmology which is a necessary part of basic medic il 
education It is intended to be retd by the student in 
contunclion with the short and practical courses to which 
the teaching of ophthalmology has had to be reduced in 
the curriculum of many medical schools In effect, in this 
book the professor discusses with his students what he 
has shown them m the eye clinic He has undoubtedly 
achieved his aim It is a book calculated to make his 
students think If it may be taken as a fair average 
specimen of the teaching that Chinese students receive 
in the Peking Medical School, then there can be no doubt 
that the work of that school is on a high level, and wall 
be a credit to medicine and a blessing to the suffering 
Chinese Paper, print, and binding are perfect 

PSYCHOTHERAPY 

Concepts and Problems of Psscliotbei apy By Leland E 
Hinsie MD (Pp 199, 5 tables 15s net) London 
W Heinemann (Medical' Books), Ltd , New 5 ork 
Columbia University Press 1938 

The continual outpouring of works on medical psychology 
must fill the reviewing staffs of journals with dismay, but 
now and then a book stands out which is a real pleasure 
to read because it is likely to be of outstanding value to 
the profession and to all interested m the subject Pro- 
fessor Hinsies belongs to this class It is short, simple, 
and to the point, and gives information which is essen- 
tially valuable He reviews the psycho-analytic approach 
of FreucL and the psycho-biological approach of Adolph 
Meyer, with a brief note on the contributions of Jung 
and Adler He shows how Freud, dealing principally 
with psychoneurotics, seeks by researches m the uncon- 
scious division of the mind to reorientate the basis of the 
personality so as to allow the psychoncurotic, with his 
drive towards adaptation fundamentally unimpaired, to 
adapt himself to life to better advantage Mever, on 
the other hand, dealing principally with psychotics who 
do not have that drive to adaptation, is concerned almost 


Tiif n^rrnn 
MiMCaL JOERSAt 


t\clusi\cl> with the conscious mind and, while remairung 
entirely citfiolic with rcgird to theories of pathogenesis. 
Seeks to trim the p ilicnt to become a proper member 
of the famih ind of the community by means of his 
team of psvehi itrist, psychiatric nurse, and social worker 
ind 1 full org 11117 ition of mtcllectuil interests, occupa- 
tion, and rceic ition 

Next comes a statistic tl survey of thcripeiitic results 
which imperfect is it necessarily must be, is of the 
grcitest interest It shows tint there is no striking differ 
ence between the v irious iher ipcutic methods, a recovery 
rite of ibout 40 per cent being common to them all 
Psycho inihsts, in spite of their cl urns to siipcrioniy, 
mikc no better showing thin the rest so far as "cures ’ 
ire concerned ind hivc the disadv image of the small 
number of ciscs wiih which thev .arc able to deal and 
the length of time expended on irc itment but no one 
wall deny to them the verv greit service which they have 
rendered in the elucid ition of the p iihology of mental 
disc ise 

A find chapter shows the dilTicuIties and outlines the 
requirements in attempting i siirvev of therapeutic results 
in anv dep iriment of medicine and cspeci illy in mental 
illness 

EOR NOVICI SHIP SURGEONS 

Tilt Ship Surcions IltindbooL Bv Brvec J Macaulav 

\t D (I’p fifi 5s f,il net ) Bristol John Wnt-hl ’’'’d 

Sons 1 Id , 1 ondon Simpkin Marsh.ill I id 1938 

This booklet of si\tv-iwo piges will be found useful m 
some degree by doctors who wish to join the Mercantile 
Marine Its small compiss a good part of which is likvu 
up with emergency operitions has left the lulhor hitk 
room for dcihng with manv points which arise m ntcdieil 
life at sc i There is a good introdiiciorv chapter in very 
gcncril terms of a surgeons duties the details ot which 
differ in the various shipping companies Net enough 
cmphisis IS placed on the need lor closclv supervising 
the heilth of the erew, who on arrival m manv ports arc^ 
subjected to personal inspection bv the port health oflicer 
Nor is the subject of “ R idio pratique ’ instituted in 
1937 bv the New York Quarantine Board, referred to 
The rcsponsibililv' for this pratique lies on the ship 
surgeon, and, is was seen last vear m the case of a 
German liner, non observance of its demands led to 
much loss and trouble 

The popularity of ocean travel and the large minibi.r 
of steamships with big passenger and crew lists now' 
crossing the Atlantic require more attention than the 
author has seen fit to give for the guidance of novice 
surgeons Casts arise which h ive to be handled 
ditlercntly from those on land The management of 
mental derangements to forestall jumping overboard, the 
best method of disinfecting ctbins at sea, the isol ition of 
infectious disease contacts, and the mcdico-lcgil aspects 
of accident claims which can involve the shipping com 
panics in great loss if the surgeon has not been careful to 
observe and note full parliculais, are some of the points 
with which the author has omitted to deal Co operation 
and consultation with doctors who happen to be on boird 
in serious emergency cases arc a special form of medic d 
ethics about which an experienced ship surgeon like the 
author could helpfully advise those who find themselves 
m difficult circumstances of the kind that occur at sei 
Every ship surgeon takes, or should lake, with Inni 
reference books, and if the space devoted in this small 
volume to surgical and medical details were given to the 
points mentioned in this review the book would gam added 
importance 



\Lrusi 1' 191S 


PRCPARATIONS AND APPLIANCES 


Tn£ B JTWH 
MtDiCAL JOCXNAt 


3^1 


Notes on Books 

\\uhin till, compass of a sm^li- 'olumi. of 1 234 p igcs 
\ an Nostrands Lt lmIopihiIui (London Chap 

man and Hall ^Os 1 cosers the basic sennets of chtniistrs 
pin SICS mintralogs botans astronoms and mathematics 
tliL applied sciences of nasigation aeronautics and niedi 
cine and also engineering The responsibilits for each 
science rests largeh upon a single author the result being 
a units otherssise diflicult to atfain The inquiring reader 
ssill find in the solume much to interest and instruct 
sshile the trained technician ssill b\ the use ot the 
numerous cross references be able to correlate the m 
fcmiatioa he seeks Naturalls ssiih such a ssidc range 
01 subjects the length of the articles is restricted but tor 
the most part treatment m is be considered adequate 
The ssork IS clearls printed and ssell illustrated 

The Doctor Reiutnihirs is a posthumous book bj Sir 
Js-sirs Criciitos Bross-\e IG Duckssorlh and Co 7s 6d ) 
Those ssho remember the attractise reminiscences and 
anecdotes of Sir James s long and successful life ssill turn 
to this further selection ssith a sure anticipation of finding 
a storehouse of interesting esents It ssas completed 
sliortls before his death in Tebruars last but it empha- 
sizes hosv much he obsersed ssnh an escr actise memorj 
and sense of humour He had a sside acquaintance cspeci 
alls as the inde\ proses among medical men 

The second edition of Dr Erssis Rissk s evcellent 
little book on Clinical Obsersation (Der Khmsche Blicf 
Vienna Julius Springer R'l S 40 bound RM 6 30 
paper) of sshich the first edition ssais published last >car 
has been considerablj enlarged bs the insertion ot ness 
sections on the skull mouth neck thorax abdomen 
sexual organs and anus as ssell as bs other additions 


Preparations and Appliances 


FORMAUh STERILIZER FOR C\STOSCOPE CVDLES 

Mr H P ^^HITE F R (London W) untes 

The presence of water jn some pan of the insulating 
material separating the two path^va^s which complete the 
electnc circuit from the source of suppU to the CNstoscopic 
lamp IS one of the commonest causes of a failure of illumina 
non because of short circuiting- For this reason the most 
practical was of stcnlizing those cables which are fabric 
cosered is h\ means of formalin sapour but this i\pc of cable 
must be considered unsalisfacton bccau'*c the fabnc maj 
become wet dunng the csstoscopio ejammaiion Of recent 
>ears rubber-cosered cables have been in general u'^e but for 
various reasons certain of them still have the shortcomings 
of the old fashioned pattern To be efficient the rubber 
covenng must be reinforced in the weaker places and there 
must be complete watertight junctions between the cable and 
(he switch and the cable and the balierv terminals \forv 
over the studs connecting the two pbics of the switch should 
be made entirelv of non-conducting material 
There is one pattern on the market which fulfils these 
requirements and has withstood the te t of two vears use in 
ni> hands including j-egular sterilization bv boiling 1 do 
not doubt that the periods of usefulness of these parts of the 
c\sio>copic armamentarium will be longer if sterihzaiion is 
effected b\ formalin vapour In order to do ihi convenientlv 
1 have devised a formalin sterilizer for endc^opic cables 
The rack has four separate cvlindncal compartments (B) 
ot such a size as to take one cable folded m the simplest 
manner the common floor to the compartments i> perforated 
so as to communicate with a shallow chamber which contains 
formalin tablets and the floor of which unscrews The rack 
hits in and out of a c>lindrical drum (A) the Iid of which 


IS kept firmlv in position bv two thumb screws so as to render 
the interior airtight It is easv to remove one cable with the 
finCtr without disturbing or even touching anv of the others 
If it desired to effect sterilization bv boiling after unscrewing 
the floor of the formalin chamber the rack with its cables cun 
be placed m the stcnlizcr Personalh I use the appliance a» 



a storage place for spare cables and I feel that it wouM be 
verv useful for such a purpose m hospitals as well as to tho e 
who use several ivpe^ of endoscopic instruments and alwavs 
want to have a spare cable at hand The cables and the 
sterilizer can be obtained from Messrs Willen Bro:> 44 Nev 
Cavendish Street London W I 

P\XLOTOAn FLASHING NOZZLE 

Mr A WiLPFiD Adws MS F R C.S (Clifton Bn^tol) 
writer 

MTien the surgeon wiihdravvs after pvelolithotomv it is wi h 
mingled feelingN The catch in the operation is the dread 
oi recurrence Gnii> particles detached from the sione(N) 



dunn^ Its extraction mav remain behind as a contnbutoo 
cause of further fo mations To reduce this iT'k an efficient 
irricator i> wanted It needs to oe long to reach the kidnev 
that resists dehverv and the end of the nozzle entenng the 
pvcioiomv must recurve so that its jet projects upward* and 
flushe* the vault of the renal pelvis The «mall calibre of th*' 
instrument should offer no hindrance to the recurrent stream 
which gushes out of the pvelotomv wound carrving the 
debris wa h it These features are incorporated in the pvelo 
tomv flushing nozzle made for me bv Messrs Down Bro* P 
li made to fit a Record svnnse or small tube and funnel 



352 August 13 19\S PREVENTION OE PUERPERAL SEPSIS 


BRITISH MEDICAL JOURNAL 

LONDON 

SATURDAY AUGUST 13 193R 


PREVENTION OF PUERPERAL SEPSIS 

No more appropriate subject could have been 
chosen for discussion at this year s Annual Meeting 
than the prevention and control of puerperal sepsis 
The recent achievements in treatment ha\e tended 
to divert attention from the less spectacular but 
no less important advances uhich have been made 
in knowledge of the causes and mode of spread 
of the disease The importance of these matters 
in the admimstiation of maternity homes has been 
painfully emphasized by recent litigations uhich 
have resulted in the award of heavy damages for 
failure to observe due precautions in treating cases 
of puerperal pyrexia and in preventing spread of 
sepsis This subject is of grave concern to e\ery 
doctor who practises midwifery and the opening 
papers published elsewhere in this issue wall doubt- 
less be read with more than usual interest 

Professor R W Johnstone w'rites from the point 
of view of the clinician and administrator and 
his comprehensive and thoughtful paper contains 
useful suggestions and much sound advice Dr 
R M Fry contributes a paper on the bacteriology 
of puerperal sepsis and in a short space gives a 
clear account of the more important of the recent 
findings in this field His opinions are based on 
experience gained as a full-time worker in a hos- 
pital dealing exclusively with puerperal sepsis 
Dr Ethel Cassie and Dr A Massey discuss the 
problems as they appear to the medical officer of 
health, and touch on medico-legal matters To 
readers who wish to pursue this subject further we 
would specially commend the interesting and 
scholarly paper on the history of the prevention 
of puerperal fever by Professor Miles H Phillips ’ 
and also the article on puerperal infection in 
relation to midwifery attendants by Messrs J L 
Miller Wood and F E Camps,- together with the 
subsequent correspondence by Miss Dora Cole- 
brook and others 

It IS plain that during the last few years much 
of the confusion regarding the aetiology and mode 
of spread of puerperal sepsis has been cleared and 
new facts have come to light which have impor- 
tant bearings on the conduct of midw'ifery Dr 
Fry describes two distinct grou ps of infections one 

‘ Briiish Mechcnl Journal Janu^ry 1, 1938 

* Ibid , October 23 1937 


Tlir pRftRH 
Mr JlCAt JOLTMtt 

prcdisiloscd to by local ir.iuma and presence of 
dcvitali/cd tissues and which is associated with 
the B coll B nddiit, or the anaerobic strepto 
coccus This type of sepsis may sometimes cause 
serious illness but it is not readily com eyed from 
patient to patient The second type of infection 
IS much more dangerous and is also highly con 
tagious characteristically affecting women who 
have had ‘ normal ’ deln cries as readily as those 
who have been subjected to obstetrical interference 
It IS caused in the great majority of instances by 
infection with the “Group A \ariety of haemo- 
lytic streptococci but now and then other forms of 
haemolytic streptococci, staphylococci or pneumo- 
cocci arc responsible Ample esidcncc has 
accumulated to prove that in some 75 per cent 
of cases the source of this second type of infection 
IS the upper respiratory tract of the attendant mid 
w'lfc doctor, or other “ contact ’ The commonest 
means by which the organisms are conveyed to 
the patient would appear to be the fine spray which 
IS unavoidably projected from the mouth on 
speaking but other less direct means of infection 
arc also important such as the transfer of organ 
isms bv fingers which base become contaminated 
— for example, by use of the handkerchief A 
nurse or doctor who has rccenth had tonsillitis 
or a sinus infection is an obsious danger and must 
avoid obstetrical work until the throat and nasal 
secretions arc proved to be free from virulent 
streptococci The issue is clear on this point , but 
the value of routine swabbing for prophylactic 
purposes and the attitude to be adopted to the 
chronic carrier arc more complicated questions 
which are discussed at length in the papers 
already mentioned and also in an annotation m 
this Journal on July 16 1938 Since no throat can 
be guaranteed to remain indefinitely in a healthy 
condition, the use of masks must now' be regarded 
as an essential part of midwifery technique 
Their use is imperative both during delivery and 
during the nursing necessary in the puerperiuni 
Here it is fitting to quote from Professor Miles 
Phillips 

“ Apart from its use in Caesarein section there has 
been an astonishing delay in the employment of 
face mask m hospitals and, e\en more so, in domiciliary 
midwifery practice It is sid to reflect that its adoption 
or more rigid use in this or that institution, on this o 
that maternity district has so often been and still >s UJ 
direct consequence of an epidemic more dr less rapioiV 
controlled in the hospital itself It would appear tna 
some even await the stimulus of legal proceedings 

It IS perhaps pertinent to point out that not all 
masks are adequate in preventing the transmission 
of organisms The thin linen veil is of little value 
in this respect , four or more thicknesses of fine 
gauze preferably interleat'ed w'lth paper or cello 
phane, are necessary When once the mask is 



PRCVCNTION or PUERPERAt SEPSIS 


TftE Btmsti 
'ItOlCAI. JoCTOfAL 


35J 


\UCUST 19'?S 


idjustcd to the face it should not for obsious 
reasons be fingered the mere prosision of a face- 
piece maj acluall) increise the danger unless it 
IS used in an intelligent and conscientious fashion 
A puerperal patient \sho dcselops pjrexia should 
at once ha\c a sample of \aginil secretion sub 
mitted to bacteriological examination Dr Fry 
cmphasi7es that there is no substitute for such 
inscstigation and that dclas in ascertaining the 
presence of hacmohtic streptococci maj base 
dangerous consequences Esidence positise or 
negatisc is of the utmost \alue for on it depend 
both the manner of treatment of the patient and 
the precautions to be obsersed in presenting the 
spread of the infection The further classification 
of the streptococci according to Griflith s types 
or Lancefield s groups (the latter is the more 
generalls useful ssstem in obstetric ssork but the 
two methods are complement iry to each other) 
gises more precise information and is essential in 
judging the significance of organisms found in 
the throat sssabs of ‘contacts Bactenological 
ssork of this nature is time-consuming and Dr 
Fn makes a strong plea for the establishment of 
suitable regtonal laboratories The diagnosis of 
streptococcal sepsis and the prompt suspension 
from midssifery ssork of a nurse or doctor found 
to be a carrier of sirulent infection raise problems 
sshich are essentially similar to those associated 
ssith the treatment and control of diphthena and 
in such matters the practitioner ssill doubtless look 
for equal help from the bactenological laboratory 
The question of air-bome infection has lately 
rcceised attention In some French surgical clinics 
there is esidence of a return to Listers early ideal 
of a germ free atmosphere and an attempt is made 
to rid the operating theatre air of dust by electrical 
precipitation or to render it innocuous by chemical 
means The importance of dust as a factor m the 
spread of sepsis has been shossn by the fact that 
the ssseepings of rooms in sshich patients suffenng 
from knossn types of haemolytic streptococcal 
infection ssere nursed base been found to contain 
the identical organism in sirulent form for periods 
up to ten sseeks Such dust has in fact produced 
human infection With this in mind Dr Cassie 
adsises that the lying in room or ssard should be 
Slashed polished or cleaned with a damp mop but 
neser dusted Other points in the management of 
maternity homes — such as sterilization of bed pans 
— are also discussed in her paper 

One ssoman in esery three ssho dies as the result 
of childbirth dies from sepsis The most recently 
asailable figures shosv an encouraging trend but 
It IS certain that sse are still far from reaching 
the irreducible minimum in this the most important 
of any single cause of maternal mortality 


NICOTIMC ACID FOR PELLAGRA 

In 1911 Funk had prepared in a nearly pure 
state the substance which cured and presented 
beriberi in man and polyneuritis in fowls He 
called It the beriberi vitamme and thought it 
was a combination of nicotinic acid with a pyrimi 
dine base As further purification of the actixe 
substance was attained both by Funk and by other 
workers it became exident that nicotinic acid was 
certainly not the anti neuntic factor and its possible 
activitx in other ways was not investigated In 
1914 Goldberger with the aid of xarious assistants 
began an investigation of the relation of diet to 
pellagra It had been obvious for some time that 
pellagra was rife in the districts where much maize 
was eaten and by accident it was discovered that 
the condition known as black tongue in dogs 
could be produced by the same diets that seemed 
to lead to pellagra in man Thus the dog became 
available as an experimental animal for work on 
this disease By 1926 Goldberger and his co 
workers had become convinced that pellagra was 
a deficiency disease and was not due to the 
presence of any toxic substance in the diet More 
recently EKehjem and his co workers’ have made 
further studies of ‘ black tongue in dogs They 
found that a liver extract cured this condition a id 
that certain highly active concentrates had 
chemical properties and solubility relationships 
which together with the obsenation that mcotin’c 
acid to some extent stimulated growth in rats 
suggested that it would be worth while to trv this 
compound on their dogs Tlie result was little 
short of astonishing The appetite improved 
immediately the dog showed a growth response 
similar to that brought about by the liver extract 
and the diarrhoea disappeared This was re 
peated on three other dogs the amide apparentlv 
being as efficient as the acid Meanwhile Chick 
and co workers"' had been investigating the 
Goldberger maize diet and the active pnnciple of 
autoclaved yeast extract which rendered the diet 
satisfactory for pigs When the outcome of 
Elvehjem s work with nicotinic acid was announced 
two pigs were under their observation which had 
been fed on the maize diet for several weeks and 
had been used for testing v'anous yeast fractions 
which failed to produce any effect These pigs 
were both the same weight as they had been 
eleven and seven weeks previously they had severe 
diarrhoea and refused food Both were in 
extremely poor physical condition and would 
probably have died within a few days Injections 
of 100 mg of nicotinic acid were given at intervals 

4mer cheiT’ Soc 1917 59 1767 
'Bwchtm J 1937 31 2065 
•Ibid^ I93S 32 10 



354 August 13 193S 


of three days one pig receiving two tlic other 
three, injections Aftei wards each had 60 mg a 
day with food Both pigs recovered promptly 
The appetite lelurncd within twenty-four hours, 
the diarrhoea abated and they began to increase 
m weight The skin became clean and of a 
healthy colour and fresh hair grew They con- 
tinued to grow rapidly on the maize diet fortified 
with nicotinic acid Harris' has produced in 
monkeys a disease (monkey pellagra) .malogous 
to human pellagra which he has cured with 
nicotinic acid 

It remained then to test nicotinic acid for its 
effect on human pellagra Dr A Hassan has 
used It on five pellagrins in Egypt two of whom 
were inmates of an asylum and three of a prison 
The composition of the daily diet the amount of 
work done each day and the extent of exposure 
to sunlight w'ere kept unaltered for all subjects 
One third of a gramme daily of nicotinic acid 
benefited all five patients but the asylum patients 
more than the prison inmates w'hich suggested that 
pellagra as sometimes encountered mav be due 
to more than one dietary dchciencv Other 
woikers also have tried the effect of nicotinic acid 
on pellagrins Pouts Helmer Lepkovsky and 
Jukes'" in the USA gave 05 or 10 gramme 
nicotinic acid daily to four pellagrins in hospital 
on a diet on which it w'as know'n that pellagrins 
did not improve The response w'as immediate 
and they were all cured the recovery being in 
some details similar to that of the pigs In this 
week’s issue two further cases cured bv nicotinic 
acid are reported by Dr M Rachmilew'itz and 
Dr Helen I Glueck (p 346) That pellagra is 
sometimes complicated by other deficiencies is 
proved by Spies and Anng s'" observation that 
pellagrins suffering from peripheral neuritis (and 
not all pellagrins suffer from this) could be re- 
lieved quickly by injections of vitamin Bj 
Aykroyd and Krishnan' have found that stomatitis 
can easily be cured by giving eggs and yeast auto- 
claved in an alkaline medium They think (hat 
the effective factor m curing this condition is 
probably the factor which cures pellagra in man 
and black-tongue m dogs , but stomatitis as usually 
observed is not a serious condition, w'hereas 
pellagra is a formidable disease with a high 
mortality Sebrell, Onstott, and Hunt* have 
demonstrated that whole whey powder, delactosed 
whey powder, and American cheese are poor 
'•k sources of the factor that prevents black-tongue 
Thus it IS that the course of investigation pro- 
_feds Some improve ment m laboratory technique 

Nature mi, 14:0 lOTO 
’ Proc Soc exp Biol N Y 1937 37 40S 

J Amer med Ass 1938 110 1081 

Indian J wed Res 1938 25, 643 
• Piibl HItli Rep U'os/i 1938, 53, 72 


Tnr H«msn 
VlitiirAL Join ut 

leads to the recognition of the existence of an 
essential factor, chemical w'ork leads to its idcnti 
lication further work leads to a 1 nowlcdgc of its 
distribution and the clinician applies the findings 
to the relief of human suffering Perhaps the 
most notew'orthy example of this seen in recent 
xcars is the discover)' of nicotinic acid as the 
pellagra-preventive factor for man 


PNLUMONITIS 

The term ‘ pneumonitis though criticized bv some 
writers lias undoiibledh come to stav In March of 
this \ear Morton Gill' published in article in which he 
used the word “ pncumomiis ’ as signifying an infiam- 
matorv pulmonary rc.icUon As the actiologs of such a 
reaction \ancs Gill dnidcs the condition into three 
groups — namch (ol acute simple pneumonitis (h) 

secondare t\pcs and U) chronic pneumonitis Acute 
simple pneumonitis mav occur at any age though most 
of the cases described were m children and young adults 
All the patients had pulmonary symptoms but the tern 
perature and pulse and respirition rates were onlv 
slighth raised The physic i! signs included localtrcd 
are IS of impiircd resonance and “sticks rales on 
ausculiuion The ridiolog’cal appearances arc not 
gi\cn in detail being described as a localized opacity or 
hcaw shadowing with some enlargement of the hihr 
glands In ill cases the radiological abnormalili dis 
ippcarcd within .i few weeks In children cpitubercu 
losis may simulate pneumonitis but it takes a much 
longer time to resohe In discussing tuberculosis in 
young adults Gill refers to Wingfields- “secondary 
lesion, which is a loc.ihzcd reaction in a lung allergic 
to the tubercle bacillus Although radiographically 
such an allergic reaction may simulate pneumonitis 
Gill concludes that simple pneumonitis is not a mani- 
festation of tuberculous infection of the lung because 
a-ray evidence showed that pneumonitis clears up com 
pletely, and scicral of his cases gate a negatne Mantoux 
reaction to 1 1 000 old tuberculin Tlie secondary types 
of pneumonitis include that which may be caused by 
influenza and Gill quotes Stuart-Hams,'' who regards 
the condition as a “ bronchiolitis with patchy atelectasis 
Among other examples in this group is the pneumonitis 
which mav be found in association with bronchiectasis 
and abscess of the lung To include the last is open to 
discussion , undoubtedly some cases of abscess begin 
as an acute simple pneumonitis which, instead of re 
solving, becomes a suppurative pneumonitis, a term 
which may be regarded as synonymous with abscess 
of the lung The evidence for the existence of chronic 
pneumonitis is scanty In a paper on influenzal pneu- 
monitis Woodruff quotes Bowen s'" statement that in any 
case of influenza with even apparently insignificant pul- 
monary symptoms a radiograph will ordinarily show 
the presence of -an exudative process i n the lung 

’ British Medical Journal 1938 1 S04 
P«lmonnr\ Tuberculosis in Practice A Modern Conception oy 
R C Wingfield London Edwird Arnold and Co, 1937 

^ British Medical Journal 1937 2 S16 

• J Ml Sinai Hasp N Y 1938 5 49 

' Aiiicr J Rocnisen 1935, 34, 168 


NICOTINIC ACID TOR PCLI AGRA 



VtrusT n 19 A 


PNEUMONITIS 


TfiE Bjtmirt 

'fiDtCAi. 


355 


^\ollJrufT c;i\cs dttiils of i cal of infliiLnyi in t nnn 
pi.Moii‘:I\ engined in dust\ oeciip ilions which included 
working with cement An t n\ photognph of the 
cliLst rLieilcd a condition of confliiLiit peribronchial 
infihntion cMcnding from the roots of both lungs into 
th^ piilmomn fields The ndiograph siniul ited that 
of pneumonoconiosis A week later mother him showed 
•>h lost compIetL disappe irincc of the infiltration and 
1 fortnight after admission the radiographicil ippeir 
inccs Were considered normal Our knowledge of 
pneumonitis especi ills is regards its pithologs is still 
ii’complLte The condition has conic to be recognized 
heeiuse of the ssider use mide of r ns e\iniimIion is 
pirt of the routine insestigation of di'cases of the lung 
It A important to realize that esen in a rclitiscls mild 
feb'ilc illness ssitli pulmonarj ssmptoms ibnormil v rav 
sh idows may appear and mas also quickly disappear 


SELENIUM AS AN INDUSTRIAL WIZARD 

The increasing utilization of selenium and its compounds 
in industnal processes and the recognition of toxic efTecU 
produced in animals bv the injection and ingestion of 
these compounds make it relcsant to consider the 
possible hazards that may be associated with this 
element in industrial conditions The extent to sshich 
selenium exists in the earth s crust is stated by Strock 
to be 0005 per cent The principal source of the 
cLmcnt at present is from by products in the electro 
htic refining of copper and men engaged on this process 
base been reported as showing symptoms of selenium 
poisoning with, demonstrable quantities of t.he sub- 
stance in the unne Tbe primary industries where 
danger of selenium intoxication ma\ occur are 
summanzed by H C Dudley' as folloyys copper lead 
and zinc refining roasting of pyrites and in certain 
disiricts lime and cement yvorks TTie secondary 
industries in yyhich selenium compounds are used are 
gl iss and ceramics rubber (yulcanizing and curing 
processes) steel and brass (alloy furnace fumes) com 
pounding and mixing of pigment for paints and inks, 
mixing and pressing of plastics melting and casting 
operations for photo electric cells and in seyeral 
chemical syntheses Tlie selenium (Se SeO. SeH,) 
m ly attack the yvorker as dust or fumes and its use 
in organic combination may make it possible to pene- 
trate through the skin as yyell as by inhalation and 
ingestion The soluble compounds of selenium mav 
produce acute or chronic toxic effects and these appear 
to be proportional to the amount absorbed The acute 
effects consist pnmanly of earlv cellular destruction of 
the Iner parenchyma yyith later generalized pathological 
changes throughout the organism Small quantities 
taken oyer a long period lead to general debility 
associated with pathological changes in the lixer and 
kidneys Hydrogen selenide inhaled by guinea pigs 
causes seyere fatty changes in the hyer and after a 
time to hypertrophy of the spleen The symptoms 
re-corded among men in copper refineries included 
pallor gastro intestinal symptoms a garlicky odour in 
the breath and perspiration nasal and phanngeal 


irritation coated tongue metallic taste in the mouth 
and neryousness and the unne contained selenium 
These manifestations are in the main the ordinary 
symptoms of metallic poisoning but the garlicky odour 
IS charactcnstic and persistent As in all studies of 
industrial hazards it is essential to establish the physical 
state in yyhich the selenium may become ayailable to 
the organism Dusts in a giyen process may be of 
such a nature that no soluble selenium compounds are 
produced Soluble dusts — for example SeO SeO, 
H SeO, H SeO, — and halogen denyatixes yyill be 
readily absorbed both from the lungs and from the 
alimentary tract and hence must be regarded as dehmte 
industrial risks Although skin absorption has not been 
established expenraentally a case is recorded in which 
bums from hot acid containing Se_Br yyere followed 
by the appearance of selenium in the unne wo days 
liter Knoyyledge is required of the possibility of skin 
absorption of organic combinations of selenium as they 
may occur m the processes inyoKed in plasticizers The 
need for cleanliness and good habits in the works sense 
among the yyorkers yyhereyer there is a selenium hazard 
must be appreciated by the industnal physician On 
the academic side compounds of selenium (sodium 
selenite) haye been shoyyn to inhibit the oxygen uptake 
of yeast cells and the rate of eyoluuon of carbon dioxide 
during fermentation of yeast Rats injected with 
selenium salts show a sinking decrease in the ascorbic 
acid content of the liter and the adrenals The practi- 
cal importance of these observations requires further 
elucidation 


INHERITANCE OF SEBACEOLS C\STS 

Although sebaceous cysts are common even common- 
place the research yyorker has on the yvhole paid them 
scant attention For many years it has been suspected 
that heredity plats an important part in their causa- 
tion Cockayne in his ttell known work Iiiliented 
Abiionuabties of the Shn mentions cases of families 
in yvhich sebaceous tumours of the scalp ttere common 
among the female members (although the males ttere 
unaffected) and also remarks upon the cases of 
multiple sebaceous ctsts of tthich notice ttas first 
taken bv Pnngle tv ho gate them the homble name 
“ sebocy stomatosis In this disease numerous small 
cysts filled ttith sebum are scattered over the trunk and 
extremities both males and females mat be affected 
Recently seteral families each ttith numerous members 
affected hate been studied three mt jMonro and one 
by Ingram and Oldfield Monro ‘ ttho is more inter- 
ested in the genetic side of the question than the clinical 
belietes that the ctsts result from a single dominant 
Mendelian factor and that mditidua's suffenng from 
the condition hate the gene m heterozygous form It 
IS knotvn that there is a great difference in the effect of 
an abnormality upon its possessor depending upon 
tvhether the gene is in heterozygous or homozygous 
form In the latter eyent it often happens that the 
abnormality is so senous that it is incompatible yvath 
life Noyy among Monro s cases was one in which both 
husband and wife suffered from sebocy stomatosis This 


' PiM Hhh Rep Hash 1918 53 2St 


'J Cenencs 19j7 35 61 


356 August 13 I93S 


INHCRlTANCn or SCliACCOUS C Ysrs 


Hir nkmur 
MtnirAL JoL* a 


pair had three children (among others) who died m 
infaney, and wlio were know'n to be abnormal hence 
It IS possible that tlic gene which in hctcro7\gous form 
produces a minor abnormality here may ha\c been 
present in homoz 3 goiis lorm and ha\c caused a gross 
disorder fatal in childhoQd It iKo appears that there 
may be a genelieal relationship between sebaceous 
evsts and malignant disease In the families affected by 
the former there were several cases of cancer NS'heihcr 
this IS a mere coincidence or not can onlv be estab- 
lished by the investigation of further families In the 
family studied by Jncrim and Oldfield a father and 
daughter and two sons were affected , the mother and 
four other children were free Se\eral cysts were re- 
moved from the daughter and were subniiltcd to patho- 
logical examination, the results of which suggested that 
these cysts arise as new [ormauons and arc not due to 
letention and secretion in a hypertrophied sebaceous 
gland Indeed, in these cases sebaceous glands far 
from being hypertrophied arc often actually atrophied , 
moreoter, in sc\erc acne, a condition in which 
sebaceous glands are undoubtedly much hypertrophied, 
cyst formation is extremely rare Thus we find that 
modern view's on the origin of sebaceous cysts support 
those of Sir James Paget who as long ago as 1870 
formed the opinion that most evsts of the scalp were 
cysts of new' formation, and are tinfaxoiirablc to those 
of Pringle, w'ho may be regarded as the advocate of 
the retention theory Ingram and Oldfield come to the 
same conclusion as Monro, that the factor which deter- 
mines multiple sebaceous cysts is a dominant rather than 
a recessive character 


THE CAROTID SINUS REFLEX 

The effects of stimulation of the caiotid sinus arc most 
familiar m connexion with paroxysmal tachj'cardia. 
pressure on the sinus having been practised though not 
always successfully, for the arrest of this abnormal 
rhythm More recently the carotid sinus has been 
related to a form of syncope and the possibility of its 
implication in essential hypertension investigated The 
effect on the electrocardiogram in normal subjects, and 
m those with cardiovascular lesions of carotid sinus 
pressure has been studied by J Lenegre * who finds that 
in young normal subjects there is no appreciable change, 
or at most there is some change iii rate, usually a slowing 
Positive responses most commonly evoked in elderly 
people, and especially in the presence of degenerative 
xardiovascular lesiOns, are of three main types a brady- 
cardia w'lth or without auriculo-ventricular dissociation 
alteration m the form of the ventricular complex , and 
alteration in rhythm Complete arrest of the heart was 
noted in several instances, and when this lasted for more 
than five seconds the subject experienced faintness and 
vertigo, and more rarely there were convulsive move- 
ments or loss of consciousness Some of these symp- 
toms may occur apart from bradycardia, and are then 
attnbuted to the reflex fall in blood pressure The 
reflex was found to be readily exhausted and with 
continued pressure on the sinus the heart w'ould recover 

'Arch Mot Ccci/r 1938 31 421 


Its normal rhvthin uidiin ten to twenty seconds, and 
repealed .itlenipls to eheil the reflex would meet with 
1 r.ipidlt diminislimg response A pathological carotid 
sinus reflex — that is one that leads to anything more 
than a slight allcralion in heart rate— is held by Lcnegrc 
to depend on the presence of coronary sclerosis with 
perhaps lesions m tlie sinus iiself plaxing a lesser part 
and the clianges in cardiac cxeitabilits and conductiwty 
result from the elTeets of bradycardii and lowered 
arterial tension on a heart already suffering from 
ischaemia The routine praelicc of compression of the 
carotid sinus with the object of revelling latent cardiac 
sclerosis is recommended but the distressing symptoms 
that may result, even though transient will surely dis- 
courage most phvsieiaiis from indulging in this diag 
nostic aid Mans will also disagree with the assertion 
that pressure on the carotid sinus will not arrest 
paroxxsmil tachvcardn in young people The author 
docs not sav whether or not his experimental subjects 
were under digitalis though some of the curves pub 
lishcd suggest the action of digitalis , the previous ad 
ministration of this drug may be of importance in 
determining the cITccl of carotid sinus pressure 


ADVJSORli COMMITTEE ON BLINDNESS 

The Minister of Health has appointed an Advisorv 
Committee on Blindness, including its prevention and 
treatment The committee will carrv on the work 
hitherto performed by the standing committee on the 
Prevention of Blindness of the Union of Counties Asso- 
ciations for the Blind, which has ceased to exist Tlit 
following have been appointed members of the new 
committee Mr P M Evans, LLD (chairman) , Mr 
H R Bickcrton M B Mr J D Magor Cardcll. 
FRCS, Miss Grace Cracknall Dr James Ferguson, 
Mr Percy Flemming FRCS, Mr N Bishop Harm in, 
r R C S , Dr E K Macdonald Miss Ida Mann, 
FRCS, Mr R Foster Moore, FRCS Mr G F 
Mowatt, Sir John Parsons F R S , FRCS, and Mr 
A H H Sinclair, F R C S Ed The committee has been 
appointed for a period of three years Mr H G 
Benjamin vxill be secretary and Dr A E Hallman 
medical secretary 


TESTIMONIAL TO DR HUTCHISON 

In case any reader may have missed the letter published 
on July 23 (p J95) vve would draw attention to the 
proposal now afoot for presenting Dr Robert 
Hutchison W'lth his portrait The election of Dr 
Hutchison to the Presidenev of the Royal College of 
Physicians of London has given great pleasure to a 
very wide circle of admirers, to whom he stands “for 
all that IS sound m the practice of medicine and all that 
IS good in tradition ” The project will vve know, com- 
mend Itself to old students, friends and societies m 
London Edinburgh, and the Provinces Personal 
donations should not exceed three guineas Cheques 
should be sent to the Manager, National Provincial 
Bank, 10, Marylebone High Street London, W 1 for 
the credit of the Robert Hutchison Testimonial Fund 




VtrusT n 191^ 


COLLESS fracture 


Tke B?mJH 
'UdiCaL JrK'OuL 


5 '7 


SURGICAL PROCEDURES IN GENERAL PRACTICE 

Ths IS one of a senes of articles contributed bv imitation 


COLLES’S FRACTURE 
AND CHAUFFEUR’S FRACTURE 

R A riTZSIMONS, F R C S 

I COLLESS FR.\CTURE 

Ol all fracture-) this probabl> is ihc commonest Its 
reduction requires ncilhcr cxp.rt skill nor elaborate 
apparatus and the after-care is simple Accurate rediic 
lion Lads to excellent results in most cases Failure of 
reduction alwajs entails some degree of permanent dis 
abilits These considerations make the treatment of 
Colics s fracture a matter of great importance and 
g^n.rat mteri-st While most frequent in itomen of 
middle age and omsards it often occurs in soiinger 
p-ople of both sexes Before the age of about 20 when 
the loner radial epiphjsis fuses \sith the shaft the 
corresponding injurj is a fracture separation of the 
epiphssis This resembles the adult fracture in all 
essential features and its treatment is the same 

The fracture occurs nithin about an inch of the losser 
end of the radius The situation of the fracture and the 
Oisplacement of the loner fragment are determined bv 
the local anatomv and the direction of the caiisilive 




effect of such a force can best be understood b> resolv ng 
It into tno separate components acting m directions at 
right angles to each other In the present instance one 
component displaces the loner fragment upnards along 
the axis of the radius and the other displaces it directlv 
backwards and also rotates it backwards Impaction 
IS common and is due to penetration of the soft cant-ehous 
bone bv the sharp ends of he broken cortex Further 
the position of radial deviation into which the hand is 
forced at the moment ot impact often causes the loner 
fragment to he displaced and rotated outwards so that 
traction on the internal lateral ligament mav result in a 
fracture of the stvioid process of the ulna or a rup'ure 
of the ligament The hand and carpus remain attached 
to the lower fragment IFigs I and 2) 

To summarize this one can sav that in a tvp-al 
Colics s fracture the loner fragment is displaced up ^rd 
backwards and outwards tilted backwards and ojt 
Wards and the ulnar siv/oid is broken Bi a, the most 
constant clement ol the delormitv is the backward tilt 
and this also is the mos' impa tant one to eor ec In 
addition there is al v ns some degree ot in)urv to me sott 
tissues 

Viriations of the ivpical picture are common Com 
minution mav be present with fissures running into ihe 
joint and olicn separation of the fragmenis The bone 
mav be cracked with little or no displacement The 

f 


Fio 


Fig -r 


Fig I r,G 2 

^ Aniero posterior view showing oulw-aril rolalion and displacement of lower fragm-nl fracture 

Ol ulnar si>loid radial desiaiion of hand and abnormal relation of sijloid proccs es 

“ Lateral view showing backward rotation and displacement and dinner fork deformits of wn>t and band 
Fig 3 — Anicro-poslerior view afier rcduciion 

Fig 4 Lateral stew after redu-tion The normal anterior concavils of the radius has been restored and the tower am ular 
surface face slightls forwards as well as downwards 




violence The lower inch of the radius although ex- 
panded to twice the size of the shaft is covered bj onlj 
a thin shell of cortical bone so that it readilj >ields to 
a breaking strain This weakness of the bone is further 
accentuated bv the strength of the anterior ligaments of 
the wrist joint reinforced bv the tendons passing to the 
hand which explains the comparative ran v of pure 
dislocation 

In most cases the fracture is due to a fall on the 
outstretched hand or some equivalent injtirj The force 
of impact IS transmitted through the hand and wrist and 
bears obliquelj on the lower end of the radius The 


radial styloid or the posterior lip of the radial articular 
surface may be fractured the rest of the bone remaining 
intact Fracture-dislocalion is uncommon displacement 
IS marked and fixation sometimes difficult An apprecia- 
tion of these points and some knowledge of the normal 
radiological anatomv ot the wrist are necessarv tor 
successful treatment 

Diagnosis is generallv easv Pam and swelling of the 
Wrist following a fall generallv signifv a Colies s fracture 
A\hen there is at the same time anv obvious degree ot 
backward or radial displacement of the lower end ot the 
radius and hand and an area of maximum tenderness 



358 August 13, 1938 


COLLCSS FRACTURE 


Tilt Burttui 
'lEDiCAt Journal 


over the bone just \bovc the joint line, the diagnosis is 
certain The classical dinner-fork deformity is found only 
with severe degrees of backward displacement Lesser 
degrees of deformity are often masked by the general 
swelling, and it is important to realize tint, if not cor- 
rected, these become much more conspicuous when the 
swelling subsides The tip of the r idial stvloid 
normally occupies a level about onc-third of in inch 
below that ot the ulnar styloid, and an alter ition in this 
relation, caused by the upward displacement of the 
lower radial fragment, may be felt (Fig 1) A more 
constant sign is a loss of the fonvird concaMtj otcr 
the lower end of the radius, and with atcrage posterior 
displacement this is usually obvious, even in the presence 
of swelling (Figs 2 and 4) 

The final diagnosis rests with the radiographs Cases 
will occur where no a-ray facilities arc ivailtblc ind 
the question will then arise whether or not the fracture 
should be reduced before it is radiographed This 
should be done if any displacement cm be detected 
Clinically, because the physical and mcntil relief afforded 
the patient by reducing and immobilizing the fracture 
more than counterbalances the risk of an error m 
diagnosis The risk is alwass slight, since most 
injuries which bear anv resemblance to Colics s frteture 
are Colies s fractures In doubtful cases some tem- 
porary immobilization — for example a Carr or improvised 
splint — will give relief iiniil the radiographs can be seen 

Needless to say all possible fractures must be r tdio- 
graphed after reduction to check the diagnosis if this 
has not previously been made to sec the position of the 
fragments , and to satisfy legal requirements It is only 
possible to form an approximate estimate of the 
— jic^racy of a reduction by clinical means, particularly 
intbe presence of much swelling 

Anaesthesia 

The essential surgical requirement is a quiet relaxed 
patient , any form of anaesthesia which ensures this iS 
a good anaesthetic for the immediate purpose of re- 
ducing the fracture, but various other things have to be 
considered especially the patient s age and general 
health It is impossible, except through sheer good 
luck, to secure an accurate reduction in a struggling 
patient 

Local anaesthesia has not yet achieved any great 
popularity) principally because expert general anaesthesia 
IS available in most treatment centres, but its advantages 
under certain conditions are so obvious that they deserve 
to be more widely known With proper aseptic pre- 
cautions the method is devoid of risk and can be used 
where general anaesthesia is for any reason undesirable 
or unavailable The patient is not totally incapacitated 
even for a short period No special preparation or 
after-care is required Repeated manipulations can be 
earned out with one injection — for example, where x- 
ray examination shows the position to be 'unsatisfactory , 
this procedure usually requires at least two general 
anaesthesias Local anaesthesia is unsuitable for nervous 
patients and children It is dangerous where absolute 
relied upon, since the solution tnfil- 
^Pre tha cavity It is unsuitable for fractures 

sealing m celhihr activity is 

>t cannot between the fragments Finally, 

anaesthesia relied upon to produce complete 

tissues, which associated injury to soft 

ns solution may not reach 


Technique of 1 ocal Anaesthesia 

The requirements arc a sterile 2 per cent solution of 
notociin, .1 20 cem Record syringe, needles (No 1 
Record! tincture of iodine, and sterile dressings The 
not oc tin solution must be of ginranlccd stcnlilv The 
safest solutions arc those in rubber capped bottles or 
scaled glass ampoules, which keep indcfimtclj Solulions 
contained m ordmirj corked bottles arc always suspect 

The ssringc incl needles ire sterilized, preferably by 
boiling The biels of the forearm wrist and hand are 
clcincd ind swabbed with lodmc The surgeons hands 
irc sterilized as for my aseptic operation The 
position of the friciurc lint ts judged by palpation and 
presious reference to the t ray films The needle 
attached to the stringc coni lining the anicslhctic is 
midc to pierce the skin over the back of the radius a 
little ibo\c the eslimiied line of the fracture and between 
the long extensor tendon of the thumb and the common 
extensor tendons and is then pushed in an oblique 
direction downwards md forwards until it enters the 
haemalomi caxiU With average backward displace 
ment there is no diflicullv m doing this, with minor 
displacements a few tn ils may be ncecssarv but a single 
skin puncture is suflicicnt The tip of the needle is 
known to be correctly placed when (J) the solution flows 
rcidiK from the syringe with moderate pressure on the 
piston (2) blood can be aspirated into the svrince (3) 
the injection docs not raise a local swelling as it would 
do if placed m the superficial tissues About 15 cem 
of novocain irc injected into the radial fracture and 
then a few cubic centimetres around the ulnar stv/cud 
The anaesthetic should be given about five minules to 
act, after which the fracture can be reduced 

Reduction and Fixation 

For the actual reduction it js desirable though not 
essential to htvc the help of tvvo assistants, vvho need 
not be skilled Their function is to steady the hmb and 
maintain the reduction vvhilc the splint is being applied 

A dorsal unpadded plasIcr-ot-Paris slab is rccom 
mended as being both safe and efficient for all cases with 
average displacement, but for gross displacements an 
encircling plaster cast is advisable The distance from 
about two inches below the elbow to the knuckles is 
measured and a drv slab equal to this length is made 
from a six-inch-wide plaslcr-of-Pans bandage so that d 
contains eight folds or thicknesses of muslin One of 
the assistants holds and steadies the elbow while the 
surgeon lakes a firm grip of the fingers and exerts 
vigorous traction m the axis of the forearm, followed 
by a forced extension movement This disengages ihe 
fragments, whether impacted or not, and the lower 
fragment can noxv be felt to move with the hand While 
full traction is still maintained the wrist is flexed and 
the hand forced to the ulnar side and it the same time 
the lower fragment is taken between the thumb and fore- 
finger of the surgeon s free hand and pressed forwards 
and towards the ulnar side as strongly as possible The 
restoration of the normal anterior concavity of the 
radius, which is the clinical proof of a satisfactorv te- 
ducUon of the backward displacement, can be felt by the 
index finger The patient s hand is now transferred 
to the second assistant without disturbing the position 
or the traction Separation of the fragments of a com 
minuted fracture, if present, must be corrected at this 
stage by pressure between the surgeon s hands m the 


Aucitsi I' I9's 


COLLESS FRACTURE 


Tjie Enmaii 

'!cJJ CAL JOLTS-*L 


3^9 


ippropriilc pi me and wIiLfi. there, is radial desniion 
Ih tin il LOrrection of it is now nndi. bj lateral pressure 
While the hnib is still being held b\ the assistants the 
p'aster IS thoroughU wetted in cold water the excess 
of water squeezed out and the slab applied to the back 
ot the forearm wrist and hand as far as the knuekles 
The plaster is carcfulh smoothed out everywhere to 
adapt It as accuratelv as possible to the contours of the 
limb and to present creases on its deep aspect which 
might cause pressure sores The upper end of the 
p’aster extends only about hdfway iround the limb 
but in the region ol the much narrower wrist it extends 
Well on to the flexor surfaee and care should be taken 
that It encircles the radial side of the wrist more than 
the ulnar in order to maintain ulnar adduction The 
Wet plaster is now quickly covered by a few turns of a 
three inch cotton bandage so that it can be handled more 
casilv The surgeon once more takes the hand still 
keeping up the traction and again places his thumb this 
lime outside the plaster over the lower fragment 
pressing it forwards and inwards The plaster still 
b.ing soft the hand is now placed in us final position 
usuallv one of ulnar adduction and about 20 degrees 
of flexion and held until the plaster has hardened 
(Fig <;) 




Fig s —T he usual posiiion of the hand after reduction The 
plaster slab is shovvai m outline The dotted tines indicate its 
anlenor limits (Colton bandage not showat m diagram ) 


A second cotton bandage is now applied firmlv but 
not tightlv beginning at the upper end of the plaster and 
finishing with a dozen or more turns about the wrist 
and hand where it passes between the thumb and index 
metacarpal down to but not going bevond the proximal 
transverse crease of the palm Plaster or bandages 
which extend beyond this line limit flexion at the 
metacarpo phalangeal joints TTie thumb is left free to 
move Fixation is completed bv a piece of strapping 
around the wrist and another around the palm 
The above technique which takes more time to 
describe than to perform is applicable to the majority of 
fractures but has to be modified to suit certain cases 
When no radial displacement is present in the fracture 
the position of full ulnar adduction is unnecessary but 
a slight degree of ulnar adduction is always desirable 
as this IS the physiological position of the hand WTjere 
little or no displacement exists it is onli necessarv to 
apply a dorsal slab as described with the hand m the 
neutral position Fractures with gross displacement and 
also those m which fixation bv the dorsal slab has 
proved unsuccessful generally require an encircling 


plaster cast The only difference from the routine 
technique is that in the place of the second cotton 
bandage a plaster bandage is applied and m exactiv the 
same wav This form of fixation gives greater security 
in all cases but it introduces an added element of danger 
to the circulition which necessitates closer observation 
in the post reduction period 

In cases vvith severe backward displacement such as 
fracture dislocations fixation with full flexion of the 
wrist IS sometimes advisable This should not be main- 
tained bevond about ten davs or so because it is a 
position of strain and it also makes full flexion of the 
fingers impossible At the end of this time the plaster 
should be carelullv removed the hand brough' up to 
the OwUtral or slightly flexed position and a new piaster 
applied It cannot be too strongly emphasized that the 
reduction of this fracture requires vigorous manipula- 
tions and that the great majoritv of unsuccessful 
attempts an. due to the application of insnflicient force 
rather than to insufficient skill There is no danger of 
over reduction of backward or outward displacements 
Good results can be obtained by the use of rigid 
splints but plaster of Pans has advantages over all o a-r 
forms of fixation It adheres o and exerts pwrleetly 
uniform pressure on the skin iherebi giving a maximem 
seciiritv to the iraclure with a minimum dange ot 
damage to the skin and also ensuring that it hall not 
loosen or b-come displaced With adequate s ren_ h 
It represents the minimum of bulk and weight, so that 
the arm can b. passed through the sleeve and eisdy 
used The addition ot padding removes these advan’ages 
and reduces the elTieienev of the splint 

Following reduction all fractures must be radiographed 
in two planes The radiographical evidence of good 
reduction is (1) in the lateral view the backward dis 
placement and till are corrected the anterior concavity 
of the radius is restored and the lower articular surface 
of the radius faces slightly forwards as well as down 
wards (2| in the antero posterior view the outward dis- 
placement and tilt are corrected and the styloid processes 
occupv their correct relative positions (Figs 3 and 4) 
Minor degrees ot displacement are consistent with 
good functional results In judging what is a satis- 
factorv position the special circumstances of each case 
particularly the patients age and occupation have to 
be considered and much greater latitude should be 
observed with elderly than with younger patients m 
whom an anatomical reposition should be obtained if 
possible At least one further radiograph should be 
taken a week or ten davs following reduction to see that 
the correct position has been maintained Later dis 
placements are uncommon 

After-care 

With average displacements the plaster is retained for 
a month vvith severe displacements for six weeks 
During these times the plaster must not be removed 
except for the indications I have mentioned After 
reduction the important instructions to the patient are 
that the fingers elbow and shoulder shall be used from 
the first for light work of every kind and that pain or 
swelling of the hand shall be reported immediatelv If 
the patient s co operation cannot be depended upon the 
movements must be performed dailv under the direction 
of a masseuse A sling if used at all should not be 
worn for more than a couple of days 
The important complication is swelling of the fingers 
caused by a too tight bandage Slight swellmg due to 



360 August 13 1938 


COLIXS’S FRACTURr AND ClIAUmiURN FRACTURC 


the trauma is neaily ilwtys picscnl, and disappuirs with 
time, elevation of the limb, \nd finger movements 
The danger signals arc pun, severe swelling ind blue- 
ness of the fingers If these appear the position of the 
fracture becomes of secondary importance md pressure 
must be relieved at once by cutting the pi isler Tlie 
danger of severe circulatory obstruction is inscp irable 
from the use of an encircling unpadded cast on i suollen 
limb, and for this reason, as alreidy indicated, it should 
not be applied as a routine Dam igc may be caused in 
a few hours that may not be recovered from in as many 
weeks, and finger movements may be permanently 
impaired In doubtful cases the only safe thing to do 
IS to divide the plaster 

There should be a complete range of finger nioxc- 
ment and a fair grip a few days after reduction When 
the plaster is removed there is nearly tin ays some slifT- 
ness of the wrist, which generally recovers ripidlv with 
the patient s own movements Extension and supination 
are slower to recover than flexion and pronation, but 
there is nothing constant about this The paUent s age, 
the kind of reduction obtained, the presence or ibscncc 
of swelling, and the patient s ability to co operate ire 
all important factors, but fractures comparable in all 
other respects often show considerable difTcrcnccs in the 
times taken to regun full function 

There is no doubt that physiolhcr.ipy helps those 
patients who are slow to recover mo\cmcnis and dso 
those who complain of slight pain after rcniosal of the 
plaster It is doubtful, however, whether it c\er 
influences the ultimate result, and it is quite certain that 
it can never give a patient a good wrist and hand where 
the initial treatment has been bad For the m.tjoniy 
of patients it is unnecessary, though harmless, except in 
so far as it tends to obscure what is a clcar-cut surgical 
issue and produce a feeling of divided responsibility 
between surgeon and physiotherapist 

The sequels of neglect or unsuccessful treatment arc 
various degrees of finger stiffness, weak and painful grip, 
stiff and painful wrist, and an obvious deformity The 
shoulder-joint and elbow-joint may also become stiff 
from immobilization, as in wearing a sling for too long 
The deformity of an unreduced Colics s fracture is an 
unsightly one, and constantly obtrudes itself on the notice 
of the patient 

Tate Cases 

Manual reduction may be attempted with some prospect 
of success up to about three or four weeks following the 
injury , after this the use of a wrench or an osteotomy is 
necessary 

Reiersed Colles’s or Smith's Fracture 

This usually follows a fall on the back of the hand so 
that the lower radial fragment is displaced forwards The 
wrist should be immobilized m dorsiflexion 

II CHAUFFEUR’S FRACTURE 

This generally differs from the common types of Colless 
fracture only m Us aetiology It may be caused by a 
sudden forced hyperextension of the wrist or from an 
^ actual blow of the starting-handle Comminution is 
fairly common, also isolated fractures of the radial 
styloid process, as from a direct blow Some of the cases 
arc of the reversed type Both bones may be broken, 
either at the lower ends or, occasionally, higher up in the 
shafts Treatment, except in the cases of shaft fractures, 
follows the lines already described 


Nova et Vetera 


SOMF ECHOLS OF WITCHCRAFT 

The isionishing story of the town of Hampton in New 
H impshirc, USA, ifter 282 Vc us restoring Us citizenship 
to Euniec Goody Cole, tried as <i witch in 1656, md 
tccording her a mirtjrs fiincril opportunely coincides 
with the 350th inniscrsary of the death of one who first 
rcgirdcd witches is mentally sick women 

lolianncs Weser, Friend of Witches 
Johannes Wcjcr or Wjer (hiinizcd Wicrus) was horn m 
Grise on the Maas Northern Hrabint, in 1515 or 1516 
Sludjing under the sccptic-il alchemist Cornelius Agnppa at 
Bonn ind ificrwards il Puis, he took his mcdicil degree at 
the age of 22 Cilj plnsician at Arnhcim, and personal 
plusiciin to Duke Wilhelm of Jtllich Clcsc Ikrg in a 
turbulent igc he lived a serene life practising his profession 
ind pursuing knowledge Two of Iws sons were phvsicians, of 
whom one was pioiislj n imcd Galetuis In 1563 appeared 
his work on the prestidigitators nature of the devil ( De 
pricsiigits daemonum ) which was prompth placed on the 
lihronitn prohihilontin In language csvcntiallv com 
posed and even kindlv though nevertheless outspoken, he 
bids Ihc monks leivc the management of witches and of the 
bewitched to tbc pbvsicians The pain inflicted on witches 
is unncccssirj ertieltv, since their mental anguish is punish 
ment m itself Among his medveal colic igucs Wcver on the 
whole found less crucitv but scucciv an> more sjmpathj 
or understanding An inquisitive and talented observer he 
described trichinosis, the English sweating sickness, ervsipehs 
and scurv} His reputation in medical historj sccurel) rests 
on his humane attitude towards witches his emphasis on their 
mental sickness and liis founding of clinical psvchopitholog) 
Wcver s storv was told bv Gregorv Zilboorg in the Noguchi 
Lectures The Medical Man and the Witch during the 
Renaissance’ (1935) and has more rcccnll) been revived bv 
Miutin Vogel m the March 17 issue of Htppokrates i 

Richard Gale, Enemy of Witches , 

In the December, 1937, number of the Tr<i>isticito»s o/ the 
Bi/i/ioirnphiKi/ Smitlx Ethel Sevton gives an account ot 
Richard Gabs and the witches of Windsor which, apnrt uom 
Its valuable detective work in bibiiograph), is interesting 
because it contains the testimonv of the bewitched believer on 
the one hand and that of his rationalistic f.alhcr on the other 
Gale (Gabs) an excitable and credulous fanatic, son ot 
Richard Gale, innkeeper and three times mavor of Windsor, 
having sutTered from tbc malice of witches, became their 
implacable encmv His violent behaviour as self appointed 
witch hunter alienated lits fithcr and annoved the magistrates 
Imprisoned in a ‘ deep dungion, m answer to his pruers the 
chains miraciilouslj fell off his feet Three months after the 
hanging of one of Ihc witches in 1579 he brought ou' x 
pamphlet written m ferventiv pious stvle the nnin part ot 
which IS occupied by an autobiographical account of h's 
personal dealings with the witches Reginald (Reynold) Scoll, 
the teicentcnary of whose birth occurs this ycir, in liis book 
The Disco-iciic of Witdwiaft (1584) alludes to Gale as x 
madmxn, and refers to his ' follie lewdness, impudence, 
and dishoncstie” The most impoitant sourcebook on the 
history of witchcraft it was written with the object of pre 
venting the persecution of aged and simple persons popularly 
believed to be witches Early editions are rare, because 
James I ordered this work to be destroyed It is said that 
from Its pages Shakespeare drew inspiration for Jus portraits 
of the witches in Macbeth p p 


Thom vs Annandalc, who became regms professor of 
clinical surgery at Edinburgh m 1871, when Lister - 
London was born one hundred years ago He died m J4U', 
and at his university his memory is kept green by 
Annandalc Gold Medal for Clinical Surgery 



Augunt I' 191^ 


THE SECTIONS SUMMAR'^ OF PROCEEDINGS 


The B JTtiH 
lEDlCAl. Jo 


161 


ONC HUNDRED AND SIXTH ANNUAL 
MEETING 

of (he 

British Medical Association 

HELD m MOUTH, 193S 


THE SECTIONS 


SUMMARY OF PROCEEDINGS 


Dnn/ii. rht next few months there will ht ptthhshcd tn the 
British \fEDic\L JoijRN^l the opening papers conwitnu 
canJ to the Scientifn Seitions of tfu Annual Mtittm; at 
Pisniniith The reports of dncusxtons toitcituUil from 
iint week (p ■»/^) art intended to x*i\e members who were 
tot pnsint a f^enerol itlta of the proceedings 


SECTION or MEDICINE 
Frtda\ Jul\ 22 
Advances in Organolhcrap\ 

Miih Dr_ F A Roicr in (he chair Sir \\ altlr L\sctx>N 
Broun opened (he di^cu^ision on recent adsincc^ in organo 
Ihcrapv Recalling Starling s conception in 190^ of a 
chemical control of the bodv b\ hormone*; he meniioned those 
subsequent disco\eries uhich had supported this hvpoihcMs 
FiiNt the recognition of Mtamms or exogenous hormones 
secondU the principle that a chemical substance uas liberated 
at even nerve ending on stimulation the ecrciion of adrenn 
line and pituitrin being onK special instances of a general 
law and Ihirdh the discoven bv the Needhams and 
Waddington that Spemann s organizer in the embrvo was not 
cellular but chemical in its activjijcs and ihil it was closeh 
related to ocstnn Moreover there was considerable overlap 
between the chemical constitution of certain hormones 
vitamins and caranogens It had been believed in the past 
that hormones would not act as antigens but the existence 
of aniihormones had been established A further advance 
in organolherapv was the realization of the interaction between 
hormones and mineral metabolism the relation of calcitim 
and phosphorus to parathormone being a notable instance 
Zondek s conception of hormones being activated on reaching 
their destination was connected with this field of metabolic 
relationships in which further research was required The 
po tulates for rational organolherapv were that the gland in 
question should form an internal secretion that the active 
principle could be extracted and that a method of admims 
tration should be available which would admit of its uliliza 
tion in the bodv Organotherapy might then be emploved in 
the following wavs as substitution iherapv as a pharmaco 
logical agent as antagonist to other hormones to influence 
general metabolism or in an attempt to utilize antihormonal 
activa\ These substances might also be emploved empiric 
alU Sir Walter Langdon Brown emphasized the possible 
deleterious effects of injudicious organolherapv mentioning 
examples in relation to ihvroid insulin parathormone and 
oesinn While oral administration of thvroid was successful 
this route was not generallv available though certain sex 
hormones in large doses might be useful when given oralh 
The subcutaneous route was the onlv effective one for the 
majonlv of hormones though thc\ might be goen intra 
venously m emergencies as m diabetic coma Refemng to 
the problems of recepuvitv of the tissues the speaker recalled 
the observation of Zondek that the absorption of a hormone 
such as ihvroxine is decreased irr’ihe presence of narcotics 


such as the barbiturates which adhere to the cell surface and 
thus displace hormone from it Perhaps future recearuhei 
would result in the discovery of simple basal group-, v^hich 
might be effective while escaping disintegration b> the digestive 
juices possibU newer means of production might result in 
T reduction of the cost of these preparations 

Dr A S PvRkFS spoke on the relation between method of 
administration and effectiveness of hormones He pointed 
out that the natural action of a gland was not necessanlv 
reproduced bv injection of ih a^toe principle and there was 
a distinction to be drawn between the amount given and the 
amount utilized bv the bodv Referring to subcutaneous 
injection of oe\trone testosterone and progesterone he con- 
sidered that three factors should be considered the rale ot 
absorption the rate of de truciion ard the rate of ewe ion 
Little was known regarding the last two ot the e but mo e 
work had been done concerning ab orption A substance 
injected at daiU intervals might not be available to the bodv 
during a large part of the dav Delaved absorption could be 
achieved bv esterification of the active principle or belter 
still bv implantation of i in the form ot tablets under the 
skin The speaker sho ved a chan illustrating the inffuenvC 
of the method of administration upon the effectiveness of 
testosterone when j^iven to rats Judging the result bv the 
weikht of the testes and «emina! voiclts he lound that ih** 
propionate and acetate were both more active ib^n i 
stcrone The combined forms could also be given effective 
at lonctr intervals than the tree testosterone 

Sc\ Hormones 

Professor E C Dodds gave his views on the pr-^.tiwaJ us« 

of oestrogenic subsi-nc*. vvnh sp^ ui reference to svn beriw 

compounds There w t a lack of chemical reLtionsbip 

between the vanous hormones some were of protein 

structure and would if taken bv the mouth be converted 
bv the digestive enzvmes into amino acids and so rendered 
inactive Anterior pitutiarv and parathvroid hormones were 
destroved in this wav Until recentlv the onlv hormone wh cn 
could be given bv the mouth was thvroid extract It was no 
known that bv the introduction of eihinvJ groups oestrogenic 
substances would resist the action of trvpsin pepsin and 
crepsin Ocstnol oesirone oestradiol eihinvl oestradiol and 
other derivatives had been administered to rats b> the sub 
cutaneous and oral routes Except m the case of oesiriol 
which produced equal effects bv the two routes these sub- 
stances were much more potent when given orallv 

Dr S Lew Simpson described his experience of the thera 
pcutic use of testosterone propionate He had found that m 
the castrate rat or monkev this substance would produce a 
return of the pnman and secondarv sex characters There 
was also a range of Tciiviiv in female animals the develop- 
ment of the Graafian follicles being inhibited in the monkev 
a suppression of oesinn ecrelion had been observed The 
speaker had used this substance in the treatment of the human 
male castrate these patients (whose deficiencv was usuallv 
due to tuberculosis or war wounds) were restored in their 
sexual libido and no longer cxpenenced the hot flushes 
and migrainous headaches which had previouslv troubled 
them The anabolic effect was also verv remarkable these 
patients who were usuallv lean might gam one stone in 
three weeks when given lebtosterone propionate 50 mg. (hnce 
wceklv The weight would fall again when the injections were 
stopped This substance had abo been u>ed for enlargeiTent 
of the prostate but so far no one had produced conclusive 
and controlled re^uUs to show that it was of value In 
women menorrhagia dvsmenorrhoea and painful breasts with 
or without mastitis might be benefited bv this preparation 
Its use in hvperthvroidism vvas ba^ed upon the expectation 
that u might reduce the function of the pituitary and so 
decrease the secretion of pituilarv thyrotropic hormone Con 
traindicaiions in general were enlargement of the clilon> 
hin»uysm and acne 

Dr G L Foss (Bnstol) had used testosterone propionate 
for the past vear His experience related chieflv to 
eunuchoidism and menorrhagia For the former he had found 



362 August 13, 1938 THE SECTIONS SUMMARY OF PROCEEDINGS 


40 to 60 nig per week Tn Ttlcqintc dose, tihI he Ind 
supplemented this \Mth inunction Doses of 300 to I 000 mg 
hid been given for menorrhign. metrorrhagn, and metro 
stTMs , such doses would gi\e beiiefit but three weeks might 
elapse before bleeding ceased With doses of 1 *>00 to 
3,000 mg unwanted side cflccts in women might occur these 
were a slight deepening of the voice, acne, chloral cnl irgc 
ment and grow'lh of hair on the face , this last effect could 
be reversed by rubbing in an ointnicnt cent lining ocstradiol 

Dr S J FOLLta (Reading), using testosterone propionate 
bad been nb)e \o prodnee TnaTTOnars dest\c>pnaen\ in i i\s and 
a growth of teats and breast ducts m guinea pigs In monkeis 
a duct development of abnormal t>pe was seen, the epithelium 
being cunouslv folded Mr V \V Di\ (London) had treated 
enlargement of the prostate with testosterone propionate He 
had found a remission in frequencs and other ssmptoms but 
agreed with Levs Simpson that it was doubtful whether there 
was any effect upon the particular' sarieti of prostatic change 
that occurs in man 

Dr Roper (Exeter) referred to Sir Walter Langdon Browns 
remarks on substitution therapy , he considered that in some 
cases of diabetes there was esidcncc of rccoscri in function 
of the islets as a result of rest 

Anterior Pitui(ar> Hormones 

Dr A W Spence discussed the therapeutics of anterior 
pituitary and related hormones Thjrotropic hormorc was of 
limited use, it produced the sarpe effect as tlnroid extnet 
but in a different wav Cretinism and mvxocdema were not 
relieved bj it The most important of the anterior pituitarv 
hormones in therapeutics were the gonadotropic hormones 
whether extracted from the human urine of pregnanev or 
from the serum of pregnant mares The former preparations 
were valuable in the treatment of undescended testis hut onlv 
provided there was no anatomical abnormalitv Doses of not 
less than 500 rat units intramuscularlv twice a week should 
be given In the treatment of eunuchoidism the gonado- 
tropic hormones provided a stimi'lTting therapv which could 
be combined with the replacement effect of testosterone pro- 
pionate He advised 80 Evans rxt units of pregn int mare 
serum intramuscularly on alternate davs, or 500 to 1,000 rat 
units of pregnanev urine extract intramuscularlv twice a week 
SVcrvbfy TivigbS be. dwe \o bypoWysswdvswv wwd sebexed by 
suitable substitution therapy , in an uncomplicated case due to 
failure of the tubules to produce mature spermatozoa gonado- 
tropic hormone might give benefit The same treatment could 
be employed in women when sterility was thought to be due 
to failure of ovulation 


SECTION OF SURGERY 
Fiulny, July 22 
The Septic Hand 

1 11 H C Rutherford Darling (Sydne>), a Vice-President of 
the Section presided over a meeting at which Sir Daxid 
Wilkie (Edinburgh) opened a discussion on the septic hand 
There had been Sir David said, an unfortunate tendency 
to regard infections of tbe hand ns minor surgical maladies 
But thev were of primar> importance not only from the aspect 
of danger to life but because of their potentiality m producing 
lasting disabihtj in manual workers Much was owed to Bier 
for his studies of the infective process and to Kanavel for the 
pathological anatomical pictures Bier s great contribution to 
treatment was his advocacy of control of the return of blood 
and Ivmph from an infected pact so that by slight lymph 
stasis central spread of infection was delayed until immunity 
was fullv under way and the totuns produced were diluted 
In this countrv Bier s treatment had been misunderstood, and 
was taken to imply a well marked venous congestion by elastic 
pressure Sir Dav id Wilkie thought that Bier s mild passive 
hvpcraemia was a most valuable line of treatment provided 
It was emploved properly Besides this principle of seeking 


to locili/c infection while immunity was rising there was 
now ilso the powerful iid of sulphonamidc He thought that 
antitoxic sen ilthoiigh ovcrshidowcd it present by chemo 
therapeutic measures, should also alwiys be emploved in 
severe cases of Inown charictcr 

After describing the p ithological anatomy of the various 
hand infections Sir Divid Willie passed to the consideration 
of those cases of acute streptococcal infection with 
Ivmphangitis vvhich might follow upon a pur'cturcd wound or 
scratch The patient should be put to bed and given copious 
ftvvwls A xsassw swwvst dses,s,wvg, sbwvvW be -vyibhed to the t.'.w.ti 
ind .1 fevv turns of a thin clastic bandage wound /ig/ir/y round 
the upper arm This bandage was applied direct to the skin 
so that a gentle pressure obstructed the superficial veins and 
Ivmphatics without producing anv blueness pr duskiness The 
secret of successful application was the ibohtion of pain If 
pain was increased the bandage was too tight The bandage 
might be left on coniiniioiislj for fortv eight hours with advan- 
tage Treatment with sulphonamidc was instituted and 30 cem 
of streptococcal antitoxic scrum given after dcscnsitizaiion 
No incision vvas nude until there was localized pus, except m 
the cave of pulp infections, where earlier incision might be 
required to prevent necrosis of the phalanx If no improve 
mcnl vvas t iking place in i pulp infection in fort' C'Eht hours 
then an incision should be m ide 

Immediate Treatment 

Mr R Kisnon (Liverpool) said that the general view that 
Ivmphatic absorption except in the case of the pleura and 
peritoneum, vvas a slow process appeared to have been dis 
proved by the experiments of McMastcr and Hudack ^hesc 
observers, bv intradcrmic dve injections, had shown rich 
capillary plexuses one in the papillarv stratum of the corium 
and the other in the lower lasers of the coriuPi Within thirtv 
seconds the dve could he seen m the Ivmpbatics 14 to mm 
awav , in forty five seconds 2 5 cm away from the 'ite ot 
injection These experiments showed the necessity for tmme- 
diitc treatment in the case of a prick to delay ab'orpuon 
A handkerchief round the base of the finger or a 
umbrella ring or locallv applied Biers bandage was suitable 
McMastcr bad stated that, while bv sucking a "ound mue 
material might be removed, much vvas also dislubutcd loca tv 
Bui mere local congestion vv as not enough ^ d 

escape for I)ic exudation so evoked should be •piw'.v^ 
Therefore all pricked fingers should be denuded of epithelium 
down to the coniim around the puncture point 
performed with a razor blade A minute mcision should e 
added if it was thought that the infection had gone deep 
to the skin, vvhich must be a rare occurrence, since e 
epithelium cleaned the puncturing agent He thought it wa 
difficult for septicaemia to arise m a wound free from tension^ 
Bv these means an oozing focus was produced Becaus 
there was little or no Ivmph flow in a resting hmb immobmza^ 
tion vvas of great importance He believed that it ' 
Ivmphangitis there vvas pain at the site of the puncture 
incision should be made Pus would usually be found 
vvas the surgeon s duty to relieve tension, nol 'o 
pus, and he advocated incision in all hand infections 
after lbirtv-si\ hours there was rot evidence of tbe subsidenc 
of all signs and symptoms 

Prognosis of Scpfic Hamds 

Professor J Paterson Ross dealt first with the prognosis 
with regard to the hand In infections of the pulp e"® 
sleepless night warranted incision because of the danger o 
necrosis of the phalanx This was an exception to his 
rule of waiting for pus The usual result of t tendon shea 
infection was a stiff finger which required amputation, bn 
a good result with a mobile finger would be obtained if * 
sheath was opened up within twenty-four hov'rs, followed y 
early movements in a hot saline bath He thought tna^ 
sulphonamidc vvas of value as an adjunct to local treatmen 
because it enabled the patient to mov e hiS fingers free y 
without suffering the severe reactions which used to occur o 
movement Cellulitis and lymphangitis, though diffuse pr^^ 
cesses, respected anatomical barriers in the great 'majority 



The B jtoh 

MvDfCAt 


363 


\LCtsr n I9U THC SCCTfONS SUMAfAR\ OF PROCEEOrNGS 


castH Where rjreh Ok ’•prcid y\j\ nilhoiil respect to the 
hrijtaiion'* of fascii! pl^no or sheiihs the outlook was grn\e 
not onl\ for the limb but tor the patient s life since there was 
an olnious consiitutiom! inabilii) to deal with the infection 
Regarding procnOMs as to the patients Iitc Professor Ross 
thought that in serious eases it was too often assumed that 
a strulcnl organism was to blame ^ ci in mans cases the 
oppo itc was tnic and he thought that a feeble resist mcc was 
mo c often the cau«c To influence this resistance benchcialh 
fatigue mental and ph\su.al had to be avoided The anxious 
overtired patient had a rclatnelv poor prognosis Similarh 
a patienl wjih nausea was a poor risk compari-d to the one 
who could take his meals It vsas of importance to maintain 
re istance bv processes of elimination 

Mr ZvCHsRa CoiE stressed the economic importance of the 
septic hand and cmphasired the need for rest to the whole 
uppwf limb where the hand or a finger was inflamed In 
diignosis ditliculu might be experienced in distinguishing a 
thecal infection from a pnmarx osicomvelitis of the under 
King phalanx Radiognphs should be taken in the aivpical 
cav. or in the case which did not clear up qutcklv 

Mr \ DicIcs.on Wrkmt advised as a prophv lactic measure 
in infected pricks the imme-^ion of the finger in a pore 
alcohol bath bv use of a rubbc" finger <iall The evacuation 
of a. subungual hacmatonaa bx trephining the na\l was 
also a valuable prophvlactic procedure Moulded plaster 
gutter splints gave complete rest \ sicnosinc Ivmphangitis 
in the axilla might occur after hand infections and fom taut 
fibrous bands which held the arm to the side Dissections 
and tenotome incisions were di<ippomtinc in this patience 
and rest were sufficient to cure the condition 

Mr Chxrles Dosvld said he thought the three chief 
faults in local treatment were the prolonged use of fomcnia 
lions not thoroughlv wrung out incisions before pus was 
present and the making of small niggling incisions when pus 
was present No notice should be taken of finger creases 
where incision was required It was too gencrallv assumed 
that hmphangitis and cellulitis were of a streptococcal nature 
in quite a fair proportion the staphvlocoecus was the infecting 
organism Mr J\mes Rlssell (Glasgow) also advocated the 
use of the Bier treatment in the earlv stages and the great 
need for local and general rest Mr JvxfES Hxrdmxn 
(B irmingham) said that in fifiv out of fiftv two pulp infections 
he had found that one night s loss of sleep meant the presence 
of pus and that such a criterion for incision was therefore 
not an exception to the rule of waiting for pus 

Mr Hxrold Dodo advocated drv heat applications the 
value of general rest and the use of a tourniquet at operation 
In the rehabilitation of the stiff blue cold hand he had 
found the wearing of a thicl woollen glove dav and night 
of value The Omjrxhs emphasized the importance of a 
general anaesthetic of free and adequate drainage and of a 
bloodless field at operation 

Sir Dwid Wilue rephing said his disagreement with Mr 
Kennons procedures was probablv more apparent than real 
The surgeon did not see the cases at the period of which Nfr 
Kennon had mamlv spoken He agreed with the remarks 
about sodden hands and thought that plaster-of Pans vvas 
probabi) not 5ufficienil) used far rest 

Sur^en of the Heart 

Subsequently Mr L F OSHXLOHSEbSV gave a short review 
of the modem surgery of the heart After dealing with the 
recorded instances of operations for pulmonar} embolism 
and stab wounds of the heart he passed to the curable 
extrinsic cau'^es of cardiac dysfunction Theve included dexiro 
and lae'o-cardia acquired by fibrosis from chronic Jung and 
plural disease mediastinal tumours causing either direct 
pressure on the heart or embarrassing the heart bv pressure 
on the sympathetic and vagus nerves Although these extrinsic 
cau es Were Tare their occurrence emphasized the need for 
radiological examination in all tvpes of heart di«:e3sc Dis 
cussing the surgerv of the pericardium he was doubtful if its 
pbv siologtcal function was as creat as had been believed The 
purely mechanical factor of compression v as of considerable 


importance and timeh relief of pericardial exudates gave 
remarkable alleviation In the late cases of pencardifu it was 
the consisiencv of pericardial adhesions rather than tneic 
extent which determined the degree of cardiac di'^turbacse 
There were two groups of cases of chronic adbeaiie pen 
carditis In the fir t group were patients wuh a large heart 
visible retraction of the intercostal spaces and often signs 
of compression of the lower lobe of the left lung For these 
the operation required was removal of part of the rigid chest 
wall The second group presented a small heart oedema of 
ihc legs ascites and an enlarged liver Actual excision 
pan of the fibrous pericardium which was encasing the heart 
and impcdinc the venou return was required 

Turning to the surgerv of coronarv di ease Mr OShaugh 
ncssv said that when an omental craft was u ed Vt^NCular 
adhe ions formed whether the graft was appli'*d to no^^il 
mvo'ardium or to the sjte of a recent or even on old fibrous 
infarct At the Lambeth Clinic ihev had performed cardio- 
omcniopexv on twentv occasions Fifteen of these patients 
suffered from angina and of these five died one on the taole 
one ot uraemia three months after operation and three oi 
heart failure two months after operation All The others we e 
grcatlv improved The othur five patients had svmptom 
cardne ischaemia other than angina The most sucuesstul 
case in this croup was a woman suffering from hvperter>wc 
heart failure NIr O Shauchnevsv concluded bv diswUssin^ the 
indications for cardio omentopexv 


SECTION or OBSTETRICS \ND GYNiAECOLOGT 
Fnda\ Jill) 22 
Chorion Epithelioma 

During the first part of the concluding session Miss Msbel 
R sMssa (PK mouth) tool the chair as Vice President and a 
paper was read b\ Mr Js'ics Riddeli iPhmouth) on 
chorion-epithtlioma 

Mr Riddell said that this condition uas alviass connected 
v'lth pregnanes ]n about one third of cases it followed a 
hvdalidifonn mole About 6 to JO per cent, of moles become 
malignant Months or even vears might elapse before ths 
onset of a chonon-epnhclioma The tumour usually occurred 
in the fundus of the uterus but metastases m the vulva or 
\agma might be the first obvious growths Secondanes m 
the brain lungs and heart showed a tendenev to regress 
Formerli it was customarv to cam out a livstereclomv for 
certain cases of mole but tne advent of the quantitative 
Zondek-Aschheim test had rendered this unnecessarv Atler a 
mole has been evacuated the Z.'A test should be repeated at 
frequent intervals ft might remain positive up to two months 
after evacuation of the mole but more commonlv it became 
negative within a few davs It should be remembered that 
curettage in a patient who vvas bleeding after the evacuation 
of a mole carried wnh it the nsk of wide dissemination if a 
chorion.epithelioma had occurred It vvas much better in 
such cases to be guided bv the Z A test. If this remained 
positive after removal of a mole then an exploralorv bvsrero 
tomv vvas a much safer procedure Abdommal hvsterotomv 
was best done also m cases of moles where the cervLX vvas 
closed and m all cases in which doubt arose Several inier 
esting cases were described and discussed 

Mr L CVRNVC Ris-ett (London) pointed out that the re 
appearance of a positive Z-V test after a negative one w..s 
the important point m the diagnosis of a chonon-ep the! omi 
following a mole He also uttered a word of warning against 
too much reliance being placed on a high quantitative result 
In a case of twins this was found to be posjtive m I 100 
dilution He stronglv agreed that il was better to perform an 
abdominal hvsterotomv than to curette m cases of doubt. 
Professor I Prestos Movvvell (Pel mg) remarked that mans 
abortions showed more or less hvdalidiform degeneration He 
agreed that a hvsterotomv was better in cases of mole where 
the cervix vvas closed The Z A test might remam positive 



364 August 13, 1938 THC SECTIONS SUMMARY OT PROCEEDINGS 


for three months Tfter i mole wis expelled It XNns the re 
'tppcnrtnce of t positive result which wis the sitnificmt 
finding 

InvcstigTtion of Stcrilitv 

Mr AUBLin Sharman (Ghsgow) rend -v pvpcr on persoml 
experiences in the ln^esllg^tlon of stcrihtv He sod it could 
be roughlv estinnted tint there were ibout Inlf i million 
sterile couples in Greit Bntnin Stcrilitx wxs reckoned b\ 
Germm luthoritics to c^use i deficit of 100 000 births cich 
xenr Onlv two sspccis of the problem of stcrihtv were 
deilt with — mmelv ^novuhtlon ind tubxl blockncc In IRR 
esses of sterilitv where cndomctrisl hiopsv wss c irricd out 
within five dsvs of menstrinlion 174 pitients hid normsl 
premenstrusl endonietrn Thus onlv 7 4 per cent of this 
group showed snovulstion A Isrge scries of normsl ind 
sbnormsl cndomctfis were shown ilso photomicrogr iphs 
of dailv biopsies on one pitient throughout s complete cvcle 
In s series of 309 esses of slcnhtv where the lube w is in 
sufflsted It wss found ihst there wss complete non pstenev in 
40 per cent a much higher incidence thsn ususllx reported 
The kvmographic method of Rubin wss ulilued for this work 
The sdvantsges wcie thst the psticnt did not need to go into 
hospitsl snd slso s permsnent record of the esse w is 
obtained Lipiodol wss a most useful adjunct in diagnosis 
Several interesting charts illustrating various forms of tubil 
contraction were shown 

Professor J Prcston Mawvlll (Peking) said that he had 
used the kvmographic method for two vears and although 
verv satisfied with it he thought that hpiodol w is quite is 
important in that it showed the exact location of the blockage 
which was important when operative measures were being 
considered Professor F J Brownb also preferred the U'c of 
hpiodol which was inserted bv the ridiologist He thought 
true anovular menstruation was cxcccdinglv uncommon and 
had never discovered a true case in a woman bleeding at 
regular monthlv intervals 

Hormone TIteripj in Gvinccologv 

Dr M Boxcott (London) in a paper on this sulvjcct said 
that the hopes that were enter! lined of successful hormone 
therapv had not been realized ind all treatment emplovcd 
was onlv a form of substitution therapv with all its disad- 
vantages In pnmarv amenorrhoea the production of 
cvchcal bleeding was justifiable onlv as a means of correcting 
the patients mental and phjsical under-development In 
secondarv amenorrhoea with pituitarj failure there was no 
certain method of pituitarv stimulation but giving the patient 
small doses of oestrone was harmless and often successful 
Patients showing earlj mv xoedematous failure were those who 
responded best to treatment He did not consider it justifiable 
to attempt to re establish regular bleeding in patients with 
ovarian failure and it was unnecessarv to treat amenorrhoea 
with a psvchological cause bv hormones as it was usuallv 
spontaneouslv corrected To avoid further depression of the 
pituitarv intermittent oestrone therapv must be used and the 
dose of oestrone which was all given in the first half of the 
cvcle onlv could be regularlv diminished Treatment with 
progesterone would shorten the duration of menorrhagia of 
puberty but he had found both progesterone and luteinizing 
hormone ineffective in menopausal menorrhagias and in 
metropathia haemorrhagica The treatment of habitual 
abortion with progesterone, though it had no rational basis, 
was often successful when begun as soon as the Friedman 
test was positive An attempt was being made to correlate 
a low gonadotropic hormone production with this condition 
Hormone assav was a lengthv business but Dr Bovcott felt 
It was desirable as a method for the direction and control of 
treatment It limited the number of cases dealt with and a 
long time must pass before sufficient material would accu 
mulate to allow anv dogmatic statement on treatment or 
progress 

Dr James Riddell (Plv mouth) refeired to the difliculties 
of hormone therapy in panel practice The cost of hormones 
was so high that it vvas impossible to treat all cases The 
problem of hirsutes in the female vvas a difhcult and tragic 


Tiir tlinnn 
xiiniCAi Jorn 

one ind the results of ocsirin thcr ipv in these cases were apt 
to be disappointing Dr S M Davidsqv fPljmomh) 
described i verv interesting cisc of extreme hvpophsn treated 
bv ocstrin rrcatmenl hid resulted in the growth of the 
iileriis vulvi and breisis with "> m irked improvement in the 
rnenl il state of the p iticnt Dr B mi tv (Plv mouth) mentioned 
that the use of ocstrin vvas often verv beneficial in mental 
involutional si ites 


SECTION or ORTHOPAEDICS AND IRACTURES 

r nihts July 22 

Eracturcs involving {he Kncc-joint 

With the President of the Section Mr C M Klssedv 
iPlvniouth) in the thair Mr H Os'iovd Clarke (Man 
Chester) opened the discussion on fricturcs involving the 
knee joint excluding the p-’tclla 

Mr Clarke thought it hkclv that these tracturcs, hitherto 
uncommon might soon be seen more frcqucntlv as the 
commonest cause vvas a blovv from the bumper (American 
fender) of a motor car \t Manchester it was found that 
this group constituted 0 67 per cent of all fractures ninctv 
four ciscs hid been observed during a penod of eight vears 
— twtniv in the femur and scvcniv-foiir in the tibia The 
femoral condvlar fractures gave little trouble fifteen of them 
being mere cracks and none of them comminuted Fractures 
of the tibial spine of which there were fifteen occurred in 
patients between the ages of 10 and 19 The fragment was 
torn awav h\ the anterior cruciate ligament strain on the 
he invent occurred not as was usuallv supposed in hvpcr 
extension of the joint but bv the femur being driven back 
XV irds on the tibia with the knee in a position of flexion 
Closed reduction was alwaxs possible and the joint was held 
bv plaster m full extension for from six to eight week' The 
full none of knee joint fractures and tinfortuniteh, the 
commonest of them all was the fricturc of the tibml 
tubcrositv In five cases both tuberosities were broken m 
four the mcdi \1 and in fortv eight the lateral These frauurvs 
occurred in people lound about the age of ‘>0, an age when 
agihtv in jav walking tended to decrease It "as no! 
surprising to find a predominance of lateral tubcrositv 
fractures for this was the exposed side of the leg and a 
blovv falling antcro latcrallv caused abduction of the tibia on 
the femur and splitting or fragmentation and depression ot 
the lateral tubcrositv The spreading (vertical split) tvpe o 
fracture presented no particular difficultv replacement bv 
compression with a rcdicsseur followed bv plaster fixation 
being suflicient There was nothing to suggest that the 
external meniscus vvas ever an obstacle to reduction A large 
depressed fragment called for operative replacement with as 
little disturbance as possible of the neighbouring ligamentous 
and tendinous attachments The difficultv came in dealing 
with the rclativelv frequent cases in which the lateral tubcrositr 
was pulped as well as depressed — prcsumablv due to the 
fibula being driven mcdiallv Open operation vvas disappoint 
ing for one found a mass of fragments of articular cartings 
and bone Adduction of the tibia and compression of tn^ 
fragments in the hope that some sort of plateau woul 
re form, was probablx the best treatment Since there was no 
hope of producing a smooth surface for articulation with the 
lateral femoral condvle the lateral meniscus ought ccrtainl) to 
be preserved 

Mr Charles E Kindlrslev (Bath) described a method of 
dealing with the difficult fractures of the tibial tuberO'ities 
He pointed out that comminution of the lateral tuberovitv 
was followed bv a scattering of fragments not onij latcrallv 
but antenorlx and posteriorlv For this reason he advocate 
circular compression at the site of fracture Aftei appl'int 
traction to the limb through a pm transfixing the os calcis ne 
elevated anv obviouslv depressed fragments with an inslrii 
ment inserted through a puncture wound Circular com 
pression was then achieved with a rubber bandage apphe 
from below upwards this squeezed the fragments up m ® 
place A few blows with a heavv hammer disengaged m 
halfimpicled fragments and allowed the bandage to sqiiccz 



Nurusi n 191S the SECTIONS SUMMAR'^ OF PROCEEDINGS thzBjt-jk 3 ^ 

IfirCAJL 


them inlo phcc Ktmark-\blc rcvon^iruclion of the libial 
plilcaii had been obiamcd b\ this method md the end 
results in the fjn»t three were excellent 

It Nsas '\Iso the experience of Mr \ M A MooRr that 
fneture^ into the knee joint were rclitixclv uncommon In 
1 senus of 6 106 fresh fncturcs he had found onI\ ihirix one 
of which one third were femoral and the remainder iibial 
He dealt with the fcmonl condxlar fractures bv pm track 
ihrouch the upper end of the tibia aspiration of the enormous 
effusion that so often wns present and replacement of the 
fracmeni either manuaJJi or with a redresseur or in a 
diTiculi ease b\ inserting the point of a Stcinmann s pin and 
Icvcrinc the fragment into portion \ftcr suhsidcncc of the 
swelling a piaster xras applied for a period of about cicht 
Weeks The immediate results of this treatment were pratifx 
inu but It remained to be seen whether osico arthritis would 
dc'clop later 

V Nesv Technique 

Profcvsor JosL! n S Barr /Boston Mass ) described an opera 
tion which was of \aluc_for fractures of the lateral tuberosux 
of the tibia where there wtis a cortral fracment of some size 
The knee was rested for ten daxs after the patient was 
admitted and then explored throuch an antero lateral inct'iton 
The lateral mcnisais whi^h was usualh d imaged xsas 
remoxed the ongin of the anterior tibial muscles xxas rcHecied 
from before backxvards until the anterior fracture line xxus 
reached The lateral fracment was displaced outwards and 
such smaller fracments as micht be present were built up to 
form a reasonabU smooth joint pbteau The lateral frag 
Trent xxas replaced and held in position bx means of a 
Sherman boll passed through to the medial surface xxhcrc 
through a separate small incision a nut xxas screxxed on 
Before the xxound was closed the knee was flexed and the 
lateral joint surface of the tibia inspected After immobiliza 
lion for one v.eek acli'c mo\emcni'» xxerc permitted m a 
hin-.ed Thomas splmt Six eases had been treated bx this 
method and the results were gratifsing 

Mr k H PRiDtt (Bristol) had been able to treat malunion 
of a femoral condxlar fracture bx open replacement of the 
fragmt-ni and fixation xvith a Sherman screxx For fractures 
in the region of the knee generalU he preferred traction and 
earix noxemeni to fixation m plaster A troublesome and 
apparcnilx inexplicable sequel of these injuries xvas painful 
Inperaesthesia oxer the upper end of the tibiae Mr S T 
ipxxiN (Belfast) had also had difficulties with depressed frac 
lures of the lateral tuberositx of the tibia and he was 
cratefol to Dr Barr for describing a satisfactorx method for 
open reduction Mr CuxRkE in replx said he thought that 
Kinderslex s method was probablx the best where commmu 
lion was the chief feature of a fracture of the lateral libial 
tuberositx and Barrs operation where there xx-as a fairh 
large fragment He too had seen patients xxilh troublesome 
h> peraesthesia oxer the upper end of the tibia and he sus 
peeled that it might be due to minor damage to the external 
popliteal nerxe 

Acute Poliomxelitis 

A paper on the diagnosis and treatment of acute polio 
mxehtis xx-as read bx Nfiss Msto E Forrester Brow'n (Bath) 
The lime xxas oxerdue she said for us to app eciate that this 
disease should be borne in mind xxhenexcr a child xxas seen 
earix stages of a febrile illness Such local «icns as 
abdominal pain and diarrhoea might herald the on«el of the 
d^ease and it had recentlx been obserxed that transient 
effusion in a joint might be an earix sign A most xaluable 
arcount was gixen of other earix signs pariicularlx tho e that 
led to establishing the diagnosis Splints rather than plaster 
xxere reconmended for a position of phxsiological rest for 
muscles Serum and clecincal irealmenl xxere of no knoxx-n 
xalue The paper was discussed b} Mr D O Broxx-s 
(Melbourne) and Dr L O Betts (Adelaide) Mr H O 
Clxrke (Manchester) asked jf there ivas anx harm in moiwg 
the joints of a paralxsed hmb once a dax lO order to a»oid 
stiffness the speaker ansxxered that it xxas her regular 

practice and she thought that its effects xxere enlirelx 
bvneficial. 


Mr GeoftrexJ Lillie (Exeter) reported the result of eighty 
two spinal manipulations In the majoritx the complaint xxas 
one of pam in the Jumbo sacral region In firtx-sexen ca^es 
Ihtrc xxas an abnormalitx of posture and radiographic 
cxidcncc of anhniis in cexenteen The recalls xxere 'on the 
xxholc not dramatic Pam was rehexed immediatelx m elexen 
cases and after an interxal in twenlx four there xx-as improxe 
ment in twcntx-eichi and no change m nineteen ODServation-> 
made bx Burrows and Coliart on a ':enes of ca^es treated at 
St Bartholomew s Ho pital led to similar findings The con 
elusion xxas that manipulation for pain in the back not due 
to senouv orcamc trouble xx-as a xaluable p’-ocedure though 
bx no mcan'i a panacea 

Mr H } Seddon read a paper on the diagnosi of earix 
tubcrculoux arthritis of the knee bx examination of an inguinal 
Ixmph gland Poxttixe findings xxere obtained in fourteen out 
of sexentcen undoubted ca«es of tuberculous disease In ten 
cascN subsequcntlx shoxxn to be non tuberculous uniformlx 
nccatixc examinations xxere reported TTie value of the 
method w-xx chiefix m its simplicili though a negative finding 
did not unfortunate!) exclude tuberculous disease 


scirrioN OF public helvuth 

Friday Jiih 22 

DctcJopmenl of the Hospital Sxstem 

With Dr T PfciRsos iPKmouth) a \ ice Pres dent in the 
chair a dix-'usxion on the future development of the ho n lal 
x<tcm was opened bx Mr R H P Oroe ihororarx ctretarx 
British Hospitals As Owiation) who dealt with the ubject 
from the xicwpomt of the xoluntan hospitals and D 
A S M M xcoREC OR iClasgow) who 5po^e trom the point Oi 
view of the muniuipa! hoxpit»-ls Their p«per ' dl appear in 
the Suppleiucnt to ihi Journal in due course 

Dr W S Mxcdosxld ‘Leeds) who xpoKC from the xie 
point of the general practitioner said that the eeneral pracli 
tioncr xxas the Cinderella of the hoxpiiai sxstem so lar as 
ho<pUal boards and consultants of the large general ard 
teaching hospitals were concerned the cottage ho pifa/s 
recognized that the general pracliiioner w-as essential to their 
existence He supported the xiexx that the central hospital oi 
the future should be u<ed almost entirelx for consultation and 
diagnosis and that treatment should be relegated to places 
where accommodation was not so precious In the field ot 
mtdicine and midwjferx the expenence of the general practi 
iioner shoulcfbc con erxed bx using him as a clinical assistant 
under the guidance of consultants the patients interests 
would be better served m this wax and the hospital service 
would become a more personal one The »ierxices of the gereral 
practitioner should be used to deal with the problem of the 
chronic and subacute cases in hospital practice He hoped 
that in the future the fields of research would not be limited 
to academic centres 

In his unavoidable absence Dr T N V Potts s paper 
giving the point of view of a counts medical officer xx-as read 
bx Dr E Hlghes Dr Potts discussed the extent to which 
new general hospital beds appeared to be required as thi> 
was a mailer of great importance not onlx to the local authon 
lies but to the xoluntan hospitals He said that extension 
should not be undertaken in a haphazard manner but should 
be based on a considered policx the local authontx and the 
xoluntarv institution having constant regard to each others 
programmes Moit hospital boards and local authonlies in 
planning new hospitals xxere influenced to a great extent bx 
finance bx the hospital wailing lists — an unreliable entenon — 
and bx the xanable information obtained as to pressure on 
beds in existing hospitals He then gave figures showing the 
number of beds per 1 CKX) of the population and the comem 
plated extensions of sixteen countx boroughs (population 
200 000 to -^DOODO) and concluded from these figures that this 
countrx was xen much behind others m the provision of 
hospital beds In his opinion on an average no less than 
SIX general hospital beds per 1 000 of population xxere needed 
fo cope with the present-dax toU of ill health He emphasized 



366 August 13, 1938 THE SECTIONS SUMMARY OF PROCEEDINGS 


Tiir IlHTUit 
Minicit. JoLKs^t 


ihe nctessitj for considering the extent to which such new 
genenl hospittl beds should be prosidcd b\ the locnl luthonts 
on the one hand and b\ the local solunlary hospilnls on the 
other and described the action taken in this respect h\ the 
West Riding County Council 

General Practitioner Visiting Staffs 

Dr S W SwiNDt-i-LS (Gninsb\> commented on the mere is 
ing number of patients passing from the gener il practitioner 
to the whole-time hospital official A polici must be adopted 
that would result in a hospital sistem under which the gcncril 
practitioner, as one of a team would take not send his ciscs 
into hospital using what specialized assistance was ncccssirv 
or aiailable Apart from those cases admitted for speciilizcd 
iniestigation or treatment there were mans which were sent 
into hospital because the doctor could not obseric, inicstigitc 
or treat them in the patients homes though such care might 
be well within his province A practitioner visiting stiff 
would be financially economical compared with i whole time 
salaried resident staff Dr C LsNorn (Gillingham Dorset) 
drew a parallel between the voluntarv hospital to dav ind the 
voluntary schools in 1820 Voluntarv education w is super- 
seded bv State education and he thought thit the voluntirv 
hospital svstem would not long survive He commented on 
the term voluntary, when in most cases a charge w is midc 
for tfeitment He did not hkc the idea of an essential 
service being dependent on charitv and was in fivour of a 
Stite service Mr J AuMsaROsa (Bailsmen i) declared th it ill 
the speakers had confirmed his belief th it nation il he ilth 
should be a primarv charge on the national resources Isolitcd 
efforts to provide for nation il health (voluntarv hospitals, 
municipal hospitals, etc 1 hindered full recognition of this 
The logical thing was a svstem of Stitc hospitils which would 
absorb all tvpes of institutions and lead to elimination of over 
lapping and to standardization of methods, etc With good 
will the doctor in charge of a district hospital could m ikc 
that hospital a centre of contact for the members of the 
profession 

Dr D Sver Sutherland (Manchester) referred to the place 
of the infectious diseases hospital, and advocated a scheme of 
regional co ordination of fever hospitals He felt that in this 
wav opportunity would be afforded for retaining the medic il 
staff and the more highlv skilled members of the musing staff 
for a longer period in the fever hospital service Dr W 
Asten (Bournemouth) said he was mainly concerned with the 
administrative aspects of the question The Voluntarv Hospital 
Commission had indicated that the voluntarv and the muni- 
cipal hospital must work side bv side He was m fivour of 
full co operation in hospital administration He commented 
on the dispantv m vaiious areas between hospital accommoda- 
tion in relation to population 

Dr C E S Flemming (Bradford on Avon) thought that the 
voluntary hospitals would not last long — in spite of the public 
desire for their continuance — if they did not do all thev could 
to co operate with the municipal hospital service The general 
practitioner was the backbone of medical practice, but in the 
hospital service he was a backbone without ligaments or 
muscles he was, however, essential Dr Flemming com- 
mented on the lack of facilities outside hospital for the ncwlv 
quihfied man to carry into practice the high standard of 
technical clinical knowledge he had acquired in the training 
schools and his professional hopes and ambitions were 
destroved He declared that the general practitioner should be 
provided with institutional beds somehow or other otherwise 
his clinical knowledge and technical training would in part 
be wasted, and the public denied the full benefit of medical 
skill to which they were entitled 

Dr W Allen Daley President of the Section emph isized 
the importance of full co operation between the voluntarv and 
municipal hospitals Before providing new accommodation 
there should be mutual consultation He deprecated the ten 
dcncy of voluntarv hospitals to find the capital for new beds 
Without making adequate provision for cost of main 
tenance In connexion with the regional provision of hospitals 
he suggested that the same area should be covered bv both 
public health services and general hospital services, and 


advised that the hospitals should be used so far as possible 
to provide the vinous clinic services of the public health 
dcptrlmcnts Except for fever hospitals and sinitoria the 
spcciil departments — mitcrnitv ophthilmic etc — were better 
IS sections of a large gener il hospital than as separate 'clf 
Loni lined entities Finillv he referred to modern develop 
ments in the tre itmcnt of acute infectious disease and the 
prevention of cross infections ind expressed the view that it 
was impossible to do justice to the piticnt in a small fcicr 
hovpiiil In tint field of worl region ilism was essential 

SECTION or PHYSICAL MEDICINE 
AND EDUCATION 
rrult>\ Jiih 22 (at ror(jua\) 

The Basis of National Fitness 

With the President Dr A 1 CsKxtR (lorquav) in the 
chair Professor F P Csthlskt (Giisgow) read a paper on 
the plivsiologicat pproich to n iiion il fitness, his paper 
ippearcd in the Journal of August 6 tp 271) 

Mr A E PoRKiit spe ikinu on fitness ind the average man 
defined fitness is i state of being well adapted The averace 
nt in bad so fir filled to re let to the Nitionil I itness Cam 
p ngn vv Inch had been I vunebeil vt i dilhcuU time but the idea 
was King fillow for a period as did most nevs ideas m 
this eonscrv itivc eonnirv I be next move must ncccssanh 
rest miinlv with ibe gener il pr iciiiioners and consist of 
gridu.il cduLition of interest in personal fitness bousme 
childrens rcete itions phvsicil trainine under medical super 
vision ind p irtieiilarlv soci il rccrc ition out of doors He 
sugccsied til It cverv hr inch of the DMA should have one 
meeting with a qiiibhed speikcr to diseitss the best method 
of stimulating inicrcsi and ih it cverv practitioner should 
inquire into the reereittons of lits patients Fitness depended 
on whit 1 citizen did to ind for himself 

Dr 1 P Lot ktiviiT (Nottineh im) discussing fitness and the 
indiistrul worker sud that the essentials were good manatc 
meni good leadcrsliip ind good w igcs Work could be 
looked upon as i form of oeeupiiionil thcrapv and pride of 
crifl was cssenti il to contentment He then outlined vatious • 
subjects deserving studv m rcKition to induslriil workers— 
for voting persons medic il supervision protection from cv 
posiirc and acquisition of specific skill for women proper 
footwear proper middav meals ind abolition of the j'O 
brc.ikfast hibii, and for the industrial worker gcncrilh 
protection from noise and dust suitiblc working elotlie'. 
f imilv illowanccs, Sund iv ginics, and the provision ® 
creches 

Phvsiquc of Recruits 

Major Gener il H H zA Emerson Dirccloi of 
AA'ar Office spoke on fitness and the Services Am m''” ^ 
suitable age vv is iceepted is i recruit unless suffering 
serious incur iblc defect and onK 2 per cent were liter 
ch vrged on medical grounds During their first three j 
tr lining thev usuallv gained about 9 lb in weight, one 
of an inch tn height Ifi per cent increase in power of g^^P^ 
,ind were smartened up in everv direction Fnch man 
watched as in individual ind special corrective 
cmploved as required Both satisfactorv 
education were ncccss.irv to produce fitness, and both ' 
present at the tr lining depot 

Titncss and the Marine Health Resort 

Sir Henrv Gvuvain (Alton) discussing fitness .and 
maiinc health icsoits said the health of residents at J”' 
health resorts tended to become stabilized it i normal 
but to the visitor the sea was a strong stimulus 
basal metabolic rile veil greatlv A normil 
tike his holidav in August and the benefit, would earn 
well into the winter In the carlv spring the body j 

the stimulus of increased light and this stimulus com 
until iboiit June After tint there was a tendenev to 
tion, ind bv August a further stimulus was dcsiriblc A 



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II 


SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 


August 13 , 1938 



eiptimoHp by members of the 


, Medical Profession 

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free from flic irrifafinR effect on the stomach iihicli is inscparibic 
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if amplj bear out nii own \iei\s ” 


"I'tiiiiniiiiiB 


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of icsilmonlils received 


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(This offer npplies only to the British Isles We repret that wc cinnol send * Ty phdo lea abroad) 





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postP*^^ Oys’n®” «ps 

s:®''”" 






"mi 














SUPPLEMENT TO T HE. 

BRITISH MEDICAL JOURNAL 

LONDON SATORDV\ AUGUST 13 1938 


CONTENTS 


The Earliest Medicine in England Professor C. Singer - p 
A Professional Jurisdiction for the Belgian Medical 
Profession Rene Sand, M D 


129 


Annual Meeting of the B M A Honorary Secretaries 
Conference - 

Annual Rxhibition at PI) mouth - - - - . 

The B M A at Torqua) 

Postgnduate Nen'S and Diar> ------ 

The Insurance Medical Serricc Meek b) ^^cek. - - - 


. no 

ni 
m 

134 

135 

ns 


Correspondence 

^^andsno^th and a State Medical Sen ice Sir Henry 


Brackenbur) M D - - - - p 136 

Night Duts under a General Medical Sen ice Slanlej 

C Alcock MB 136 

Naial Mtlitan,and \ir Force Appointments - • 136 

Association Intelligence Dian ard Notices - - - 137 

^acanctcs and \ppoinlmcnts - - - 139 


THE EARLIEST MEDICINE IN ENGLAND 

PROFESSOR C SINGER’S LECTURE 

The Popular Lecture in connexion \sith the PI> mouth 
Mctting of the British Medical Association was 
delivered to a large audience in the Guildhall on Jul> 22 
bj Dr Charles Singer Professor of the Historj of 
Medicine in the University of London Dr H G Dxiv 
presided and introduced the lecturer 

Professor Singer vv'hose subject was The Earliest 
Medicine m England began by quoting Kipling 

XAonderful lilile when all is said — 

Wonderful little our fathers knew 
Most of their medicines killed you dead 
All their knowledge was quite untrue 

The earliest medicine m England should of course be 
Celtic medicine but unfortunately the records of that 
had disappeared The British with whom Caesar had 
so much trouble — Boadicca Caractacus and the rest — 
were too recent immigrants and hardly had a culture of 
their own nor did they absorb the culture of the previous 
inhabitants Celtic medicine properly speaking hardly 
existed not even Celtic superstition Such medical 
works as had survived in Celtic languages were sub 
stanlially translations from the Anglo Saxon It was 
therefore Anglo Saxon medicine he proposed to tall 
about that evening 

What were the sources of knowledge of this subject? 
A hopeful source would seem to be folklore and folk 
habits Over quite a long time stories from peasants 
m out of-the way parts of the country were collected 
but the results were disappointing There were many 
medical superstitions and habits among our countrv folk 
but prolonged examination proved that they were not 
really of very earlv origin Now and again a glimpse of 
Anglo Saxon folk medicine was obtained from monu 
ments — as for example from the tenth century fertility 
figure in the church at Oaksey Wiltshire Far and 
away the best source was the actual written documents 
Some twenty or twenty five medical documents dated from 
Anglo Saxon limes some of them written in Anglo 
Saxon some in Latin For the most part these MSS 
wc'e written m a sprawling hand with well formed 
letters but when magicians wrote their magic on paper 


they were reluciant to write it completeK and m'en 
tionally left out certain words or letters That v as the 
chief difficultv m reading the MSS 

The Anglo-Saxon Doctor 

What kind of p.oplc practised medicine in Anglo 
Saxon times'’ The idea had got about that thev alwavs 
came from monasteries because it was believed (not quite 
accurately) that the onlv people who could read or write 
were ihe monks But pictures of Anglo Saxon mediea! 
men which Professor Singer showed his audience revealed 
that they were not tonsured a feature about them 
indeed was their abundant locks Moreover in many 
medical MSS cerlain remedies were set out for the use 
of which the calling in of a priest vvas necessarv which 
could not have been the case had the man giving the 
remedy been a priest It vvas more than probable that 
the Anglo Saxon leech like the Celtic belonged to a 
special family of leeches Such families were known 
in the Highlands and also in Wales where one of them 
only became extinct in the eighteenth century In 
Anglo Saxon England there were almost no towns the 
biggest vvas Winchesler with a population perhaps of 
5 000 There were no roads and in the absence of 
towns and roads it would be impossible for the medical 
man as known today to make a living It seemed 
probable that the medical men were farmers who had 
gained a reputation for their skill in remedies and were 
consulted by their friends and neighbours from time to 
time and that these farmers passed on their knowledge 
to their sons 

The best picture of the way in which these people 
worked came from a German source which was less 
remote from Anglo Saxon England than might be 
thought In one document prepared in Germans in 
which the illustrations were clearlv under Anglo-Saxon 
influence doctors were seen actually at work Nearly 
all their remedies when not magical were of vegetable 
origin Weights were not given except in the form that 
one substance should be twice the weight of the other 
Some of their anatomv and physiology was derived 
faintly from the Greek no doubt through ecclesiastical 
transmission It vvas the working hypothesis of the 
Greek men of science that the body had four humours 
corresponding to the four elements of matter, and by 

1759 




130 August 13 1938 


EARLIEST MEDICINE IN ENGLAND 


sum rMFST TO Titr 
Humsn MtoiCALJou sjkt 


the mingling of these humours the complexion or 
constitution was determined This idea was idoptcd in 
a distorted form m the Anglo-Saxon The four humours 
Were also associated with the four seasons of the jcir 
and the Anglo-Saxons played with the idea and weaved 
it into all kinds ot absurd and imaginary schemes It 
was strange how little bits of classical ideas crept almost 
by accident into Anglo-Saxon writings The Anglo- 
Saxon doctor did not put much stock in theory Most 
of his books were made up of remedies He was a 
practical man — and the practical man, said Professor 
Singer, was the most dangeious of all practitioners 

Influences on Anglo-Saxon Medicine 
On studying these remedies Professor Singer was able 
to divide them, according to their sources, into eight 
groups Some owed their origin to Greek medicine, others 
to ecclesiastical influence, others again were derived from 
Salerno, a very few were native Teutonic, fewer still had 
a Celtic tinge, some of the herbal lore suggested an 
origin in Southern Italy, some had a Byzantine origin, and 
a certain residuum came from pagan Rome 
As an illustration of the first of these sources he men- 
tioned the centaur, which was copied into Anglo Saxon 
herbals As foi ecclesiastical sources, illuminating side- 
lights were often found in marginal inscriptions in missals 
A good one was from an eleventh centurv MS pre- 
scribing as a means of stopping bleeding the marking 
of a cross in blood on the forehead, and to the prescrip- 
tion were added two words which were the central words 
of the Greek mass A good manv of the Anglo Saxon 
drawings in herbals were taken from Salcrnian sources , 
these included the story of the uprooting of the 
mandrake, which m its Anglo-Saxon form passed direct 
into Anglo-Norman medicine Native Teutonic magic 
had certain characteristics which rendered it unmistak- 
able when It came into the Anglo Saxon Here the 
belief was expressed that there were certain venoms or 
poisons blowing about in the air and causing disease , 
also that these venoms were arranged, like other evil 
things, in groups of nine They were associated with 
the serpent, or sometimes in the Anglo-Saxon with the 
worm, and it was also considered that manv diseases 
were due to what was called in the Anglo-Saxon elf- 
shot The idea of poisons blowing about in the air 
coi responded to the German word Blase’ from which 
came our word ‘ blast, both a blowing of wind and an 
oath The pernicious influence of the figure nine had 
passed into all kinds of modern folklore , it was well 
illustrated in King Lear and in the incantations of the 
witches in Macbeth 

Wearv seven nights nine times nine 

Shall he dwindle, peak, and pine 

As to the “elf-shot,’ the word “elf” had quite a 
different meaning in Anglo-Saxon times, and often meant 
Satan or the devil, a terrifying being, whose darts were 
felt as a stitch or sharp pain By Shakespeare the elves 
had become merely mischievous imps, and the Mid- 
siimmei Nights Dieam would have been incomprehen- 
sible to an Anglo-Saxon audience 

Finally, by some queer chance or misunderstanding, 
Anglo-Saxon texts were found to include certain pagan 
Roman charms which must have been brought over by 
Latin ecclesiastics under the mistaken idea that they 
were Christian The lecturer read one such invocation, 
pointing out that it was clearly pagan, and that the 
ecclesiastic who had brought it had mistaken a pagan 
goddess for the Virgin Mary Among saints frequently 
nvoked m Anglo-Saxon charms was St Cohimcille, 
ibbot of Iona, and St Germanus, who gave his name 
to St Germans in Cornwall 


One-third of the medical profession in Yugoslavia are in 
practice in the three principal towns of Belgrade Zagreb and 
Ljubljana The Goiernmcnt has therefore decided that for the 
first two \ears after qualification all doctors must practise 
for two sears m places with less than 4 000 inhabitants 


A PROFESSIONAL JURISDICTION FOR 
THE BELGIAN MEDICAL 
PROFESSION 

ny 

RCiNT SAND, M D 

Mtimtr\ of Piihlit Ilialth Bnisscls 

In Belgium, as elsewhere, medical practitioners arc sub 
tnittcd to the civil jurisdiction for legal contests with 
their patients and to the criminal jurisdiction for trespasses 
against the law The practice of the irt of healing by 
unqualified persons is repressed by the Courts 
There was, however no jiinsdiciion to combat the 
ofTcnces committed b> some doctors agunsl professional 
ethics such as advertising themselves, advertising quick 
cures for venereal diseases rheum ilism, or cancer, 
exploiting their patients in v inons wajs, and, generally 
speaking falling in that honesty which it is so esscntnl 
to keep between doctors is well as between doctor and 
patient 

Ordre dcs Mcdccins 

To prevent and punish these ibuscs a law has been 
pissed rLccntlv m Belgium establishing an official profes 
sional jurisdiction under the name of Ordre dcs 
Mcdccins The text was prepared by the Federation 
Mcdicalc Beige which includes about 4,000 of the 6 000 
practising phvsicians The Minister of Health, M Arthur 
Wauters supported the proposal so cffcctivcl) that it "is 
passed by the Senate and the House with hardlj a 
dissenting voice Thus a long cherished claim of the 
medical profession has been satisfied 
Tor the purpose of obtaining an aulhonzahon to pwe 
Use, every doctor is required to register w'lth the Ordre, 
and this can only be refused if the applicant has proved 
himself morally unworthy There is i right of appeal 
against the decision to exclude 

Dufies of Provincial Councils 
In each one of the nine Provinces a Council, elected 
by the medical practitioners from among themselves, 
investigates and passes judgment on every case submitted 
to It A professional judge ndv'ises the Council, but has 
no v'ote 

The Council is entrusted with a mandate to maintain the 
rules of medical ethics, the honour the discretion, and digniW 
of the members of the Ordre in the exercise or at the occasion 
of the exercise of their profession 

The Council deals with questions of fees in three cases 
onh (1) when the amount claimed^ constitutes a serious 
breach of medical ethics , (2) when both parties agree to 
submit the case to the Ordre , (3) wlien the Courts apph to 
the Ordre for advice 

No sanction can be based on religious philosophical 
political linguistic, or sjndicalist motives, nor on the fact that 
a doctor has contracted with an agency organizing medical 
care for a group of persons ’ 

This means that the Ordre cannot intervene between 
the doctors and the sick funds, the public assistance 
authorities, etc 

Court of Appeal and Superior Council 
Above the Provincial Councils sits a Court of Appsah 
composed of three Presidents of Provincial Councils 
drawn by lot, and three professional judges On the 
other side, the Superior Council of the Ordre des 
Medecins gives advice on general questions, and classifies 
the judgments passed by the Provincial Councils and the 



\LrL‘frI' PKOrESSION'AL JURISDICTION rOR BELGIAN DOCTORS sifflc^iest ~o -na 

BRITUM MtDCULJo RX<L ' 


Court of Appi-il ^o ns to build up graduaIR a co 
ordiii itcd junsprudcnci. 

The Superior Council is elected In the Prosincnl 
Councils with the addition of a professor from each one 
ot the four medic il schools cMsiing in Belgium in fact 
the prolessor of forensic medicine will be chosen The 
Council IS presided o\er b\ i professional judge 
• The sanctions applicable are admonition censure 
reprimand suspension ot the right to practise for a 
ma\innim of two jears and permanent suspension of this 
right This last penalts requires a majorits of two thirds 
in the Council and csentuallj in the Court of Appeal 

The professional jurisdiction seems thus to gise esers 
reasonable guarantee to the doctors of Belgium as well is 
to the public It will no doubt check certain abuses for 
which \er> few phssicians were responsible but which 
were a reflection on the whole profession 


Annual Meeting of the B M A 

HO>OUkR’y SCCKETVRIES’ CONTI RENCE 

The Conference of Honorarj Secretaries took place during 
the Plj mouth Meeting on Jiilj 20 in the Citj Council 
Chamber Dr B E A B\rr (West SulTolk) presided 

Dr G C Anderson (Secretarj of the Association) ga\e 
a brief address confined to one point He said that the 
othce had had eapericncc during the past jear or two of 
incidents occurring m the Divisions of which it would 
have liked to have had some prior information An 
evample was^a dispute arising m a locahtv on some 
hospital matter and the action taken locall) had pro 
ceeded to a somewhat advanced stage before the oUice 
was informed about it It would save a great deal of 
diflicultj if Divisions and Branches would ask earlv for 
advice He begged honorarv secretaries to report as 
carlv as possible on ani developments in their tocaliu 
in the hospital or public health sphere 

The nim as Propaganda 

Dr H. A Nvthan (Kensington) drew attention to the 
important part placed bv the film m propaganda No 
professional bodj or organization of interests could afford 
to overlook its possibilities as a medium for pubhcitv and 
enlightenment He instanced the success of the pictures 
made and exhibited on behalf of the National Ophthalmic 
Treatment Board their function being to explain simplj 
and convincingh, that a medical eve specialist was the 
onlj jierson fullv qualified to examine and prescribe for 
the ejes as living organs of the bodv In general these 
films were shown to cinema goers as pan of the normal 
programme and as the cinema going public m this 
counirj approximated to nearlj twentv millions a week 
the propaganda value of the N 0TB films could not be 
over-estimated 

Films might be emplojed to advantage in other wavs 
on behalf of the medical profession First of all to 
counteract the harm done bv newspaper reports that 
were misinformed or otherwise undesirable No one 
would denj that the general practitioner stood in need 
of publicity of the right sort Short impressive films 
exhibited throughout the countrj could do much to 
educate the public bj giving a sincere picture ot the 
general practitioner as he realij was Another direction 
m which the film might be usefullj emplojed was in 
teaching the public to realize that counter pre'cribing 
bj chemists and mail order cures were far from satis 
faclorj and might be dangerous to patients It was lime 
that the public was made to understand that it was unwise 
to secK advice on health matters from the chemist — 
shopkeeper whose primarv aim was to secure profits from 
the sale of patent medicines toilet accessories and 


cameras and who in an> case was not qualified to 
diagnose disease or to prescribe 
There could b- useful propaganda bv films for recruit- 
ing new members ol the Association especiallv among 
medical students A film illustrating the advantages ot 
the public medical service might demonstrate how people 
ot limited means instead of fijmg to the quack could get 
cxp.rt medical attention from their lamilj doctor 
Thousands of inielligLnt men and women could be reached 
through the medium of films shown at meetings of 
litcrarv societies rotarj clubs etc Opportunitj was here 
atlordt-d of going deeplj into the subject ot the doctor s 
training and work and it could be done m such a waj 
as to convince anv audience that on health the doctors 
advice was the onlv advice worthj ot consideration Dr 
Naihan instanced a number of propaganda films serving 
the purposes of medicine and science which had alreadj 
been produced— the Pasteur film was one example — and 
the various subjects including safe milk and national 
fitness to which the film could be adapted for the nse 
of the protession All such films should be censored or 
inspected b> a bureau of the Association and when 
passed might bear an inscription to that effect The 
bureau could also be available for film companies when 
Seeking advice concerning the production ot medical and 
educational films Finallv a film illustrating the worK 
of headquarters mi_hl do much to ansaer the repeated 
quer) What does the B \I A do lor me’ He moved 
that the Council be asked to consider the advisabilitj 
of establishing a film hbrarv for the use of Divisions and 
Branches 

In <ome discussion on Dr Nathan s paper Dr 
Alvstxir French (Metropolitan Counties) said that it 
was a question ol monev and ii did not seem to him a 
job for the local professional organization to educate the 
public It was lor this purpose that ihe Public Relations 
Dcpiriment of ihe Association was created Dr O T J 
Clvvre (Southern) thought there was a case for the 
Council s consideration Dr E V Clvvdon (Eastbouine) 
took up a remark made bv Dr Nathan that novels m 
which the doctor was faithfullv depicted might usetullv 
be put on the screen There was often so much difference 
between the written book and the film version that he 
was a little afraid of the idea 
The Secretxrv said that he represented Ihe Council 
on the Medical Panel of the British Film Institute which 
had made a catalogue of medical films Perhaps there 
was an mclmalion to talk too ghblj about film produc- 
tion The film produced bj the NOTE Eves Right 
onlv ran for three or four minutes but it cost £7^0 
There were two different aspects of the question one 
the establishment at headquarters of a librarv of scientific 
films of interest to the Divisions and the other the 
making of a propaganda film The latter he thought, 
would involve an expenditure which the Council would 
hardiv be prepared to sanction Mr McAdvxi Eccles 
commented on the usefulness of a bureau at head- 
quarters at which anj member could applj for informa- 
tion in regard to medical films An incidental matter 
but not unimportant was the provision of projectors at 
headquarters which could be hired bj Divisions Dr 
MoRRtN fLambelh and Southwark) pointed out the need 
for deciding as between the different sizes of film — 35 mm 
and 16 mm Dr N'xthvn thought that the expense of a 
propaganda film could be met from the same fund which 
bore The burden of the publicitj campaign He also 
appealed to amateur cinematographers in the Association 
to let headquarters have a copj of their films 

The motion asking the Council to consider the subject 
was carried unammousl) 

Pubhcitv Propaganda and the Local Units 
Mr A W Rxslett (Public Relations Officer) opened 
a brief discussion on Ihe bearings of the new pubhcitj 
propaganda ot the Association on the local units He 
described the events leading up to the creation of the 



132 August 13, 1938 ARM CONFERENCE OF HONORARY SECRETARIES 


wr/’irw/.'.r to the 

rptiiwt M mc*L JoLUNlE 


Public Relations Dcpaitmcnt The prolcssion had 
suffered to some extent from its own aloofness, mcl the 
individual practitioner could not as a rule gi\c Press inter- 
views In local areas publicity on bchilf of the pro- 
fession might be called for on occision, but it was 
incumbent upon the Division to get in close touch with 
headquarters 

In the course of a brief discussion a number of ques- 
tions were asked and answered Dr iNGLtb Cami ron 
(Glasgow) asked whether the attention of those respon- 
sible for publicity had been driwn to films ind wireless 
Mr Hasleit replied that the BBC was notified of any 
material which was sent out from the Association to the 
Press, and talks had been attached to the news bulletin 
Films had not yet come within his departments scope 

Liaison between Dnisions 

Dr R H Robinson (Torquay) asked the conference 
to express the view that greater tacilitics should be 
afforded for the interchange of information between 
honorary secretaries concerning divisional actiMties He 
urged that all Divisions should be encouraged to print 
their annual reports in a uniform size and st\lc as far 
as possible, and he exhibited a specimen of his own 
Division report, which was a four page document of 
Supplement size and conveyed its information succinctly 
and with plentiful headings In this wiy Duisional 
reports would be available for secretaries of other Dim- 
sions, and much useful interchange of information would 
result 

Dr J C Matthews (Chairman, Organization Com- 
mittee) said that the Committee on Peripheral Orginiza- 
tion had discussed methods whereby one Division would 
be enabled to know what another Division was doing 
The suggestions which Dr Robinson had brought for- 
ward would receive consideration at the hands of the 
Organization Committee next session Dr L Kilroe 
(Rochdale) said that the Branch Council meetings might 
be usefully turned into meetings of divisional secretaries 
Dr Clayre (Southern) said that in his Branch all the 
Divisions invited the Branch secretary to attend their 
meetings 

Dr Robinson moved that greater facilities should be 
afforded for the interchange of information between 
honorary secretaries concerning divisional activities and 
that one means of doing this would be by the interchange 
of annual reports This was agreed to 

Medico-Political Work of Divisions 

Dr A Keith Gibson (Regional Secretary, Metro- 
politan Area) presented a memorandum on the medico- 
political work of Divisions One of his suggestions was 
that there should be published in a convenient form at 
the latest useful date all the motions for the Annual 
Representative Meeting received up to that time, together 
with the relevant paragraphs of the Annual Report of 
Council This should be issued to the secretaries in 
sufficient number for distribution to members likely to 
be interested, and a Division meeting could be summoned 
to which a number of members would come already 
knowing what was going forward and perhaps what was 
being done m other Divisions, so that more adequate 
instruction could be given to representativ'es and interest 
in medico-pohtical work promoted Dr Nathan (Ken- 
sington) referred to the work in his Division of a General 
Practice Subcommittee Every time a man made a grouse 
he was elected to that subcommittee' 

The Chairman of Council said that the Annual Report 
purported to contain one years work of Council The 
first meeting of the Council was held immediately alter 
the Annual Representative Meeting Committees would 


begin their work in September and October, and an 
immense amount would be done in the winter months 
If members only knew the pressure of work on the 
office they would congratulate it on being able to produce 
most of It in the Annual Report by April It was im- 
possible, IS one member had suggested, to get the Annual 
Report through at m earlier stage A Member sug 
gested th it the Annual Report should be issued at the 
end of the year, the new Council functioning as from 
January This would give the Divisions six months to 
consider the report Mr Bishop Harman suggested that 
some interest might be given to divisional meetings called 
to discuss the report if one member were specifically 
assigned the t isk of attacking it and another of defending 
It Dr W Paterson suggested that the Council be 
asked to consider the possibility of publishing in th; 
Suppkmtnr ns late as possible all the motions and amend 
mcnis received instead of publishing them week by vveek 
as at present Dr Matuitvvs promised that this would 
have consideration 

Other Business 

Dr R H Robinson asked tint the Orginization Com 
mittce be requested to consider the adequacy of the 
present arrangements for bringing to the notice of the 
Branch Councils information concerning candidates for 
election to the Associ ition Dr Matthew's promised 
tint this also would be considered bv the Organization 
Committee 

Dr L Kilroi (Rochdale) was elected Chairman of the 
Conference for 1939, and Dr Alastair Erexch (Metro 
politan Counties Branch md West Middlesex Division) 
Deputy Ch iirman 

SECRETARIES’ DINNER 

After the contcrcnce the honorary secretaries assembled 
for dinner at the Continental Hotel, Dr Batt again pic 
siding The chairmans hcilth was proposed by Dr 
Barbara Abcrcrovibic who spoke as one of the most 
junior of honorary secretaries, her tenure ol office 
back for only six months Dr Batt, on the other hand, 
spoke as a veteran whose service as divisional secretarv 
extended back to 1912, with an interval while on 
service during the war Dr Batt proposed the health ot 
the permanent staff of the Associ Uion Dr Anderson 
m replying, said that he wished the honorary secretaries 
to bear in mind not himself md his medical colleagues, 
but the staff behind the scenes who worked most willingly 
and efficiently in the Association s serv ice It vvas a 
loyal staff of good friends who pulled wonderfully "'v-u 
together and made his own job as director of the slatt 
a very happy one 

There were the usual calls — and embarrassed responses 
— for other members of the staff present, including me 
Deputy Secretary, Dr Hill, the Assistant Secretaries, vr 
Macrae and Dr Potter, the Public Relations Officer, Mr 
Haslelt, the Scottish Secretary, Dr Craig the Metro 
politan Regional Secretary, Dr Gibson, and also *1® 

‘ genius ol the Plymouth Meeting,’ Mr Mavne Om 
the fact that most of those present were due at the cut 
reception at the Guildhall at an earlv hour stemmed m 
flow ot oratory 


SUPPLEMENTARY REPORT OF COUNCIL HONG 
KONG BRANCH 

The paragraph under the heading of Hong Kong m 
Supplementary Report of Council (Supple iiwiil June I < 
p 378) should have stated that the B M A activities have 
been quiet during the vear owing to the heavy work under 
taken by medical practiUoncrs in connexion with choler.a 
Uphold [not typhus] etc 




\LCLisr 13, I9’b 


ANNUAL EXHIBITION AT PLYMOUTH 


St fi’Lruf \T TO rsz tJJ 
B'trTTiH 'an '•AL Jo '•VIL ^ 


ANNUAL EXHIBITION AT PL'i MOUTH 

SccoND NoTicr 

[The pretiminan article on the Exhibition appeared m 
the St-VruMCNT o/ 3iil\ 9 {p <0)] 

Tht Drill Hall al Millba> which hoiistd the Exhibition 
and the Reception Room nn\ bo barn like in iix (.xiorior 
bm commercial art made it surprisingh attractixe wnhin 
In the old daxs xxhen the technique of showmanship was 
less wlU understood the Exhibition ma\ well hast boon 
an austere and exon grim foaturo ot tho Annual Mooting 
but noxx almost cxerx one of its cighlj or a hundred stands 
offers some bcgtiilemont to the oje A number ol stands 
also appealed to tho taste sueh xxero Cadburx s xxith 
their cocoa Gaxmers xxith their oxder the HAG 
catfoin free coffee and the xarious displays of tonic xxaters 
— Ingram and Roxle Schxxeppcs Alexander Riddle and Co 
and Raxaier and Co Czechosloxakia the storm Centre of 
Europe had a special stand draxxing attention to the xxa> 
in xxhich Nature has endowed it xith six hundred mineral 
springs and the British Health Resorts Association a 
noxxcomer to the Exhibition produced photographic cxi 
dence of the charms of the coast and inland resorts of 
this country 

Newcomers 

A number of the exhibitors xxere newcomers to the 
Exhibition In the preliminarx article wo mentioned that 
there xxere being shoxxn for the first time the standardized 
preparations of the British Cod hxer Oil Producers (Hull) 
Ltd the footwear of Dowie and Marshall (an old firm 
on whose stand xxas an enlarged rep'oduction of a letter 
proxing that in his dax thex proxided foot comfort for 
the sage of Chelsea) and the homogenized foods for 
babies prepared bx Libbx McNeill and Libbx Among 
others exhibiting tor the first time xxas the Chartered 
SociLtx of Massage and Medical Gxmnastics with demon- 
strations and film showings The Vernon Spencer hearing 
aids principalis in a three-xaixe model supplied in two 
forms for the users conxcniencc and surprisinglx small 
and light in weighl were fresh to the Exhibition as also 
was the exhibit of Tampax Ltd — a long fibred surgical 
cotton sterilized and higfilx compressed for hxgienic pur- 
poses during menstruation The stand of S Maxx Son 
and Sons xxas described in the earlier notice but a later 
inclusion here xxhich xxas of special interest to xisilors 
was the Bragg Paul pulsator Cflher new exhibitors xxere 
the Automobile Association and Pickford s Traxel Serxice 
and the electricit> and gas undertakings of Pl> mouth 

Surgical Appliances 

The Holborn Surgical Instrument Company shoxxed 
three constructions xxhich haxe recentlj been described 
and illustrated in the Journal The first xxas a simple 
trac_tion table for hip-nailing operations (October 16 

1937 p 751) the second an improxed ear sxringe and 
trough (December 18 1937 p 1226) and the third an 
instrument dexised for the special purpose of induction 
of labour bj the Drexx Smxthe catheter method (April 16 

1938 p 848) The Genito Urinarx Manufacturing Com- 
panx gaxe prominence to instruments tor chest surgerx 
xxhich also haxe at xarious times been noticed in the 
Journal Their Brompton Hospital models of operating 
and instrument tables xxere again shoxxn and thej had a 
full range of cjstoscopes and exsto urethroscopes bearing 
the names of a dozen xxellknoxn surgeons The John 
AVeiss and Son exhibit xxas dixided into txxo sections one 
of them occupied xxith surgical instruments m general 
especiallx the smaller patterns and the oxher xxith oph 
thalmic instruments among xxhich a nexx model of the 
Schiotz tonometer and of Cruises reposilor xxere to be 
noted 

The makers of apparatus for the ophthalmologist were 
ingenious as ever Theodore Hamblin in addition to sets 


of contact lenses had a comprehensixe section dexoed 
to apparatus lor orthoptic training and mu'cle testing 
Attention xxas specially draxxn to the strabismuscope 
Melson Wingate also had a fine displax of ophthalmo- 
logical instruments xxith ophthalmoscopes gixing a fundus 
xiexx conxpleielx free Irom shadoxx also a range of goggles 
and exexxear for exerx purpose 

Short and Mason Ltd in addition to their xxell known 
sphxgmomanometer and their thermographs (or recording 
thcrmometi.rs) shoxxed their passixe xascular exerciser 
xxhich xxas described m ihe account of the Belfast Exhibi- 
I on last xear A portable jr rax msiallation — the xxhole 
equipment fitting into txxo canxas cases xxeighmg 
altosc.ihi.r lortx nine pounds — xas shoxxn b> Konl s 
Scientific Instrumxnts Hanoxia Ltd had their special 
sun lamps m operation and m a graphic exnibit xxith 
models and photographs shoxxed the p-ogress ot the 
mamilacture of their lamp from the o-igmal block of 
quariZ 

Supports Dressi"gs, Ligatures, Beds 

The Camp surgical supports are a xxellknoxn leature 
of successixe Exhibitions Thex xxere shoxxn as con- 
structed to post ope-atixe maternitx and post natal use 
and also tor us- m general prax'ice The suppo U, are 
both rigid and adaptable easx in m-nipulaiion and based 
on anatomical principles H E Curtis and Son also 
exhibited ihxir wide range ot abdominal appliances n- 
cludmg belts eorsets and trusses tor hernia The pa terns 
all appeared exeellen 

Elastoplast adhesixe bandages and p'as'ers xere ex- 
hibited bx T J Smith and Nephew Ltd The doctor s 
elastoplast Se is a metal ease containing about one 
hundred dressings or dressing s r ps ot xarious hapes and 
Sizes Cuxson Ge rard and Co shoxxed xar ous plas er 
bandages and surgical plas ers mcludmg a new txpe of 
plaster ot Paris bandage the feature ot xxhich is its rapid 
absorption ol moisture and non detachment ot the plaster 
from the bandage material xxhen dipped in xxater so that 
a firm and perfeci cast is lormed This firm also showed 
sterilized ligatures as did the ligature department oi the 
London Hospital xxhose product is xxell knoxxn 

The Irequenc> ot road accidents has led Thermega 
Ltd to dexise a speciallx strengthened electric blanket for 
ambulance use This can if necessarx be transterred 
from the ambulance to the hospital bed and plugged up 
again to maintain he xxarmth and axoid so far as possib e 
the cold tolloxxmg the shock until the patient has receix^d 
attention The Denxer Chemical Manufacturing Com 
panx again showed iheir antiphlogistine dressings a 
familiar leature at successixe Exhibitions Hoskms and 
Sewell once more demonstrated the science of bed 
making and an inspection of their xanous dexices lor 
comfort ktt one xxondering xxhx seeing that one third 
of the normal life is passed in bed so little attention 
has been gixen until recent xears to making the bed fit 
the sleeper 

Pharmaceutical and Biological Products 

Among the nexx products at the stand ot Boots Pure 
Drug Companx xxere gastomag (magnesium trisilicale) 
for the treatment of hxperaciditx and rusxen (Ru sells 
xiper xenom) a poxxerful blood coagulant tor local appli 
cation in the control of external bleeding The sulphanil- 
amide ot this firms manufacture xxas shoxxn also 

supersan a non-poisonous and non irritant general 
antiseptic Attenlion xxas draxxm to the range of sex 
hormone preparations 

Ot the Burroughs Wellcome displax xxe gaxe some 
account m an earlier notice but mention should be made 
of the diphtheria antitoxin globulins xxhich combine the 
adxantage ot increased concentration (4 000 Ehrlich units 
or more per cem) xxith reduced p-otein content A 
notexxorihx introduction xxas a calcium mandelate com- 
pound for Use in ur narj tract infections It lacks the 



134 August 13, 1938 


ANNUAL EXHUHTION AT PLYMOUTH 


svrnr\irsT ^o ure 

IlPITnll MtnitAL JotT>.<L 


disagreeable taste chaiactcrislic of sodium or ammonium 
mandelate, and has a ready miscibility 

The well-known Bayer pioducls were agiin shown, and 
the firm, who have made many pioneer introductions 
in the field of chemotherapy, staged an cficctise exhibit 
illustrating fifty years of Bayer progress Among the new 
pieparations was “ bioferol,” based on haemoglobin ind 
liver extraet and “ clityran ’ a new thyroid product An 

interesting display was made by the G1 i\o L iboratorics, 
in which their ‘ examen liver extract shown for the 
first time last year, was again prominent A series of 
dissolved vaccines piepared according to a new technique 
developed in the laboratories was shown also a number 
of vitamin preparations, as well as the firms oslocilcium 
tablets, which have lately been improxed both in flavour 
and friability and increased in calcium content 
The stand of Eh Lilly and Companv was interesting 
for Its wide range of high quality products including on 
the pharmaceutical side a crisiallinc material isolated 
from ergot , also a liver extract consisting of the fr iction 
of liver sometimes spoken of as fraction G offered in 
powdered form for onal administrtlion and m solution 
for intramuscular injection One new feature at the stand 
of Roche Products, Ltd, was ‘ncstrovite a prcpira- 
tion of vitamins issued as emulsion and as tablets the 
result of prolonged researches iindcrt iken to provide the 
four indispensable vitamins (A B„ C, and D) in a form 
both pleasant to take and medicin illy reliable Pharma- 
ceutical Specialties (May & Baker) showed two sulphanil- 
amide products, “ soluseptasine ’ for injection and ‘ pro 
septasine for oral administration Another preparation 
shown here was “ vinesthcne, an inhalation anaesthetic 
for minor operations requiring a short but profound 
narcosis 

A wide range of preparations was shown bv Continental 
Laboratories, Ltd , including a ' sercnol, which cont iins 
no barbiturate A firm boasting a history of over 100 
years, C J Hewlett and Son had a ver> modern exhibit 
of what might be called the old-fashioned pharmacy with 
creams, ointments, lotions, and so forth A feature was 
made of P A B S (Hewlett s), under which title the firm 
has introduced its own brand of para-aminobenzcne- 
sulphonamide W R Warner and Co again showed their 
“ veracolate,” a compound containing bile salts, with 
cascara, phenolphthalein, and a minute amount of 
capsicum Attention was also drawn to their haemor- 
rhoidal suppositories for local emollient and protective 
action m inflammatory conditions of the ano rectal region 
Anadin, Ltd , and Bisodol, Ltd , shared a stand devoted to 
their respective preparations, the one an anodyne tablet 
and the other a digestant consisting of a number of 
ingredients in finely divided form Kaylene Ltd , ex- 
hibited their colloidal kaolin and its derivatives, one of 
these being “ carbokaylene,” offered as combining the 
detoxicating action of kaylene with the properties of highly 
activated vegetable eharcoal 


Books and Pamphlets 

The bookstands as always afforded a pleasant relief 
The Oxford University Press had an excellent selection 
of their own publications and those of the Clarendon 
Press and the Presses of American universities One work 
was the second edition of Barrington Wards Abdominal 
Singery of Children and another the tenth edition of (he 
Manual of Bacttiiology by Muir and Ritchie Bailhere, 
Tindall and Cox showed a large number of recent medical 
books published in this country and in America by various 
firms Other publishers stands were mentioned m the 
preliminary notice 

The British Medical Association showed, in addition to 
the British Medical Journal and the special journals, the 
various publications it has issued, including the Doctors 
Cookiiy Book the reports of the Association special 
committees, and the various “ grev books outlining 
Association pohev The British Medical Bureau and the 


Medic il Insurinci. Agency c ich had a st ind at which their 
stalls were av iil iblc for consultation, ind the Agency had 
ilso enlisted tlic services of in expert automobile engineer, 
prcpircd to give idvicc on car problems, and i b inking 
ofiicial for information and counsel on investment and 
simil ir nutters Tlic Exhibition was fully up to the 
si ind ird of previous years, and it was a pity if the many 
diversions of Annti il Meeting vvcck in Plymouth pre 
vented some visitors from giving it the attention it 
deserved 


THE BMA AT TORQUAY 

CIVIC DINNER 


On the last Eriday of the Annual Meeting the Mayor 
and Corporation of Torquay entertained a large number 
of the principal officers and dclegitcs of the British 
Medical Association at dinner at the Imperial Hotel Dr 
Cohn Lindsay President of the Association, Lord 
Burghlcy President of the Amateur Athletic Association, 
Sir Rave Le 1 Icming Chairman of Council, and Dr 
G C ^ndcrson, Secretary were among those present 
Proposing the toast of the British Medical Association, 
the Mavor (Aldermin the Rev I 'Pugh) said he had 
followed With interest the deliberations at Plvmoiith 
which he was sure had been as profitable as on previous 
occisions He referred to the growth of the Association 
since 1832 There were he siid many aspects of health 
which had shown vast changes during the past cenliirv, 
and the future was bright with the prospect of further 
progress particularly in the prevention of disease His 
work in life had brought him on manv occasions into 
coni icl with medical men, and he esteemed the family 
doctor as the invaluable friend and adviser of all Bui 
the country owed a great debt to doctors for work outside 
their professional duties in philanthropical organizations, 
in literature, in local government, and in Parliament 
Dr CouN Lindsax , responding, said the meeting had 
been an unqualified success and he acknowledged the 
hospitality the Association had received from all the 
South-West of England The benefit to members of tno 
profession of these meetings in perfect harmony', upon 
which they could look back with pleasure, was incalculable 


AIMS OF THE NATIONAL FITNESS COUNCIL 


The toast of the Physical Fitness Campaign was pro 
posed by the Deputv Max OR (Colonel R Ward, 
who referred to the changes in England which had tot 
lowed the industrial revolution These chinges, he said, 
together with the increasing leisure of the people, ha 
focused attention on the problem of physical culture, 
which each part of the world was trving to solve in ns 
own particular wav, the British way being that of voiun 
tary effort 'He coupled with his toast the name o 
Lord Biirghley, who had upheld the honour of 
on many Olympic fields and was not only an athlete 
but a leader 


Lord BurgIiley in reply, said the National Titness 
Council was concerned especiallv with young persons alie 
they had left school and gone into industry The "ors 
of the council was entrusted to people with experience m 
sport and in professional and social organizations kin 
part was concerned with applications for grants to assis 
m providing swimming baths, community centres, pnving 
fields, clubs, gymnasia, camping sites y'oiith hostels, etc 
Applications at present amounted to 31 million pound , 
of which grants of £400,000 had been made The counc 
also aimed at maintaining the tradition of voIunliO 
service and helping existing voluntary organizations nn 
co-oidinating work A college had already been 
for teaching and for research Another part of 
councils work was propaganda, and in this *Bey 
really selling ideals rather than goods , it 
willing CO operation of individual young men and 
and It was breaking new ground He believed it we 


SlPPLE^IE^r TO Tvr M5 
Bwrmf M Dicu. JocRNAt 


Nv-Olm 19'^b. 


THL B \l A AT TORQUAY 


l-i. suc^.ts^fuI bccaii^L people now reilizcd lint to be 
liLalthe was to b^ happv md Ivv uise the State was 
onK the indmdital written larger and the tlTicicncs of 
e tell person in his aeliiil work w is a duo to the 
comniunits 


Phtscal Illness Dispbs 

V disptas of phvsical fitness w is cOen in the afternoon at 
Torqini in eonncMon with the niecting ol the Seetion of 
Ph\ steal Medicine and Phisieal Ediieation and was attended 
b\ some 500 spectators The first p^rt was a demcinstfsiion 
b\ Phniouth pupils of the Marcaret Morris In litutc led bs 
Miss Rhoda LuMon the aims of the insliliitc were Iricfis 
dcseribcd b\ a member oi the hondon staff Miss Betts 
Simpson who also controlled the di'phs and explained the 
sanoiis esoliilions includinc the attention gocn to posture 
wallsmp rhithm and craceful nalunl mosements The 
sceond part was a demonslranon bs thins recruits from 
the Phssical Dcsclopmcnl Depot hs permission of ihe \rms 
Council and arranged hs Major General H H A Cmcrson 
DSO MB The recruits wore coloured shorts red or blue 
which bore a Icltcr of the alphabet the men were paired 
and the corrcspondinc letter on red and blue showed the 
oilTercnce bctsiccn an entrant to the Depot and one ssho 
had spent some time there Each spsclator rcceiscd a list 
of the recruits gising the ape wcichl hcicht and chest 
measurements of each man on arrisal at Ihe Depot and the 
present weight and chest measurements of the senior recruits 
this was accompanied bs some ccncral information including 
prints ot interest from their medical histon Colonel Proctor 
speaking at a microphone explained that Ihc'c were not 
picked men but just a routine sample had the dtsplax taken 
place a month prcuousis he said there ssould base teen 
an even greater contrast Some of the recruits who had had 
their tonsils remoxed at school seemed to remain mal 
nourished but showed proercss afler reaching the Depot 
Each xsas studied mdisiduallx and there was a full medical 
oxcrhaul with specialist facilities whenever this was indicated 
Ml the exercises were undertaken so far as possible in the 
open air and as gimnauum apparatus could not be taken 
out into the f eld these were improsiscd and sera succcssfulU 
With thick bamboo canes 

It was a most interesting and instruciise demonsiration of 
what IS being done for these men All ssho were privileged 
to watch It must have been impressed ssnh the contrast in 
health and phssiquc between the entrants and the senior 
recruits 


POSTGRADUATE NEWS 

The Fellowship of Medicine announces that a course in 
phssiologs in preparation for the Primars FRCS examina 
lion Will take place on Mondass Mednesdass and Fndass 
at x '0 pm from August 15 to November 4 Insiruclion ssill 
consist of lecture demonslralions and a paper of questions is 
«el each week The follow me courses have been arranged 
rheumatism and hidrolherapi at Rosal Bath Hospiial Harro 
gate on September 16 17 and 18 fmoming) ophthalmologx 
at Roial Mestminster Ophthalmic Hospital Scpiember 24 and 
2X plastic surgers September 14 and 15 childrens diseases 
(for DCH candidates) at Infants Hospital September 19 
to 24 proctologs at Gordon Hospital Sepicmber 26 to 30 
diseases of the heart and chest {for M R C P candidates) at 
Rosal Chest Hospital Mondais Wednesdass and Fndass at 
S pm from September 12 to 50 Courses arc open onli to 
members and associates of the Fellowship of Medicine 1 
Wimpole Streel W 1 

WEEKLY POSTGRADUATE DIARY 

Edinburgh Postcr-adlate LEcri/furs — -At Edinburgh RDA-al In 
firmar' Thurs 4 ‘'0 p rn Prof A J CHrk F R S ThcnpcuUC 
Actions of BDTbiturDtcs 


THE II^SHRAKCE MEDICAL SERVICE 
D'EEK BY IVEEK 

Aaccination 

\ question has been raised bi a practitioner as to his 
liabilils to perform saceination as part of rnedical benefit 
in 1 case in which he had recommended the patients 
admission to an orthopaedic hospital and it ts a requ re 
ment of the hospital that all patients must be xaccinated 
before admission The Panel ComnuUee for the area 
has been consulted and has expressed the Mew that in 
the circumstances vaccination comes within the scope ot 
medical benefit The Panel Committee in ihis case has 
prcsumibK drawn a distinction between a routine requ re 
mcnl bs the hospital and a similar requirement on the 
part o! a prospective emploxer In the latter case where 
a person is xaccinated solelv in order to satisfx the 
prospcctise emploxer s requirements the insursnce praclt 
tioner would be lustified m charging a fee 

The general posilion with regard to xaccination was laid 
down bs the Department mans sears ago and is quoted 
on page 64 of 'Jedirnl fiisiironce Prictice as follows 

It IS for Ihe pracUfjoner to deeide in ihe firs* mst nee 
whether ans panieubr form ot treatment p eseniise or 
oiherssiic is m 'he interests ot the pAtienls health bet in 
general he would be cxpecied to cise the same treatment that 
he AAOuld adM c one ol hi pri\aie psiienis \o uncerco 
similar ctrsum lances In the 'lew ot the Minister the fact 
that the trcaimeni could be obiained from a public Succmaior 
would not m itseh juslits an insurance practitioner relusing 
to xaccinaie one ol his insured patients who desi ed him to 
perform the operation 

Praclilioncrs’ Expenses m Attending a Hearing 

If ssould appear from a recent report that the expanses 
of a practitioner attending before a medical sersjce sub 
committee in those rare instances where such expenses 
arc claimed are not paid on a xerx generous basi' A 
subcommittee reported that it had receised a communica- 
tion from the doctor concerned claiming lOs 6d lor 
himself and 10s 6d for his depute The cost of irasel- 
Iinc b\ rail from the residence ot each of the pracu- 
tioners and making the return journes was appareml) 
lOd and the committee resoixed that the sum of lUd 
should be paid to each of the practiUoners concerned 

Fractitiorers’ Lists 

Statistics are not ordmarils to be found m this column 
but the following extracts from the annual reports of the 
London and Glasgow Insurance Committees ma) be of 
general interest 

THE LOVDOX XIEDICU, LIST 

The number of pracutioners admitted to the list dunne the 
sear was 196 and the names of 215 practitioners ss ere wnh 
drawn during the same penod The figures appended mdicaie 
the number of practitioners in the insurance medical sersice 
at December 31 oser a senes of rears 

1913 1 462 1918 1 427 1923 1 650 1928 2 092 19 3 

2 178 1934 2174 1935 2 la6 1936 2 162 193/ - 155 

The Allocation Scheme presides that a prartitioner 
earn in" on practice otherwise than in partnership shall not be 
permuted m hare more than 2 500 insured persons on his list 
Li the case of two or more insurance pracutioners camin^ on 
^cuc^ m partnership Ihe number on the list of ans one of 
K maetitmners shall not exceed 3 000 and the average of 
the numbers on Ihe lists of both or all the partners shall not. 
exceed 2 500 

An insurance practitioner or partnership of insurance practi- 
tioners cmplo\m 2 one or more assistants maN be permitted a 
hi«»hcr limit proMded that the additional number Nhall rot 
exceed I 500 in respect of each assistant 

In the following table particulars are pnen of the Mzes 
of the lists of insurance practitioners It should be borne in 
mind that assistants do not ha\e lists of their own and that 
in the larger lists the pnncipal would ha\e an assistant In 
other cases a oractivioncr tn paUnersVno fxMVh ot without an 



136 August 13, 1938 


INSURANCE MEDICAL SERVICE WEEK BY WEEK 


SUPPLl MENT 10 THE 

Brithii Medic*i. Jourval 


assistint) maj have a larger number than the aacragc bj 
reason of another partner haaing less than the average 


Insured Pet sons on List 1937 


0 

58 

2 101-2 750 


M 

1- 250 

598 

2 751-1,000 


19 

2M- 50Q 

206 

3,001-3 250 


14 

SOI- 750 

185 

1,251-3 500 


16 

7SI-I 000 

186 

3 501-3 750 


6 

I 001-1 250 

154 

3 7v 1-4 000 


7 

1 2S1-! 100 

121 

4 001-4,210 


8 

1 101-1 710 

117 

4 211-4 100 


3 

I 711-2 000 

97 

4,501-4,710 


1 

2 001-2 210 

90 1 




2 211-2 500 

67 ' 


Total 

2 008 


‘Arerage number of insured persons per list (excluding 
assistants and limited lists) 1937 993 ascrage per practi- 
tioner 1937, 866 


GLASGOW MEDICAL LIST 

‘ The number of practitioners on the medical list of the 
committee on January 1 1938 v.as 483 (421 men ind 62 

women), being a decrease during the year of 14 During 
the year 31 practitioners retired from the medical list and 
9 died The number of additions to the list was 26 Of 
the 483 practitioners on the list 367 arc resident within and 
116 outvvith the city These 483 practitioners ha\c 667 
consulting rooms— 562 in and 105 outwith this area Ten 
practitioners have notified the committee that they practise 
homoeopathy The number of medical partnerships in the 
area is 67 affecting 137 practitioners Sixty -file arc partner- 
ships of two practitioners one of three practitioners and one 
partnership of four practitioners 

There are 18 practitioners required to cmplos assis- 
tants owing to the number of insured persons on their lists 
exceeding 2 000 the number allowed under the provisions of 
the Allocation Scheme to be on the list of a single handed 
practitioner There arc also 32 other practitioners who 
although not required by the Allocation Scheme cmplov 
assistants 

The following statement shows the number of insured 
persons on the lists of practitioners 


5 practitioners hive no insured persons on thi 

66 

» 

have lists of from 1- 50 

21 


, 51- too 

32 


, tot- 200 

36 


„ „ 201- 400 

42 


, , 401- 600 

26 


, , 601- 800 

32 


, 801-1,000 

40 


1 OOl-l 200 

39 


, „ 1 20t-l 400 

37 


, , I 401-1 600 

33 


I 601-1 800 

39 


„ 1,801-2 000 

26 

» 

, „ 2 001-2 500 

9 

tt 

, „ 2 501-3 000 

483 




‘ The Allocation Scheme of the committee piovides that the 
number of insured persons on the list of a single handed 
practitioner shall not exceed 2 000 and in the case of a 
practitioner with a whole-time assistant 3 000 


Naval, Military, and Air Force 
Appointments 

ROYAL NAVAL MEDICAL SERVICE 

Surgeon Captain D G D Fergusson to the Caledonia in charge 
of Sick Quarters 

Surgeon Commander W B Macleod to the Pembroke for 
Royal Nava! Barracks 

Surgeon Lieutenant Commander F M Duthie to the Drake for 
Royal Naval Barracks 

Surgeon Lieutenants F H Lamb to the Pembroke for Royal 
Naval Barracks S C S Cooke to the Pembioke for Royal Naval 
Barracks (August 22) and to the Nubian (undated) R M 
Brcmner to the Fcnion R E Lauder to the Roynl Oak 
v\ Wilson to the Barham 

Rovae Naval VoLUNtrEa Reserve 
Surgeon Sublieutenant G R Dodds to be Surgeon Lieutenant 

ROV AL ARMY MEDICAL CORPS 
m ^t heir'^^anks" ^ McC Etlles have been confirmed 


Captain LRU Keitinrc to be M iior (provisional) 
Lieutenant R A Smart to he Cvptain with seniority October 23 
1037 

Liciitenvnt (on probition) D W Btll Ins been seconded under 
the provisions of Article 213, Royal Warrant for Pvy and Promo 
lion 1911 

ROYAL AIR tORCl MFDICAL SERVICE 
Squ vdroii Lc idcr G S Str vchan to RAF Station Manby for 
duty IS Medical Olliccr 

flight Litiilcnant C Crowley to be Squadron Leader 
riyini ODiccrs C D Clements F V Maclaine J R McWhirtcr 
(seniorities May 1 1917) vnd P A Wilkinson (seniority July 1 
1917) to be riight Lieutenants 

Rovvl Am loRd VoLuxTirR RrsiRvc 
J r Bromley to be riiglit Licuitnanl 

W MaeP Cross, J A M tins and T C Wilson to be riying 
OUtcers 

TLRRnORIAl ARMY 
Roval Arviv Mioitvi Corps 
L icutenmts M B Collins ind J E Wells to be Captains 

Ti RRiioKiAL Armv Rfsirvi OP Oi I ici rs Roval Armv 
Mi nicvL CoRi s 

Major A McDovvall from Aetoe List to be Major 
Second \ levdtmnV J D R Murray to be M vjor (SubsVviutcd 
for notification m the Lottdtm Gazette of July 12 1938 ) 

W A Robb lo be M ijor 

INDIAN MEDICAL SERVICE 
Licuten vnt Colonel N S Sodhi M C to be Colonel 
Lieutenant Colonel S S Va/ifdar his retired from Ihc Scrvi.e 
Tlie services of Major U W Mulligan have been placed at ibe 
disposal of Ihc Governnuni of Madras for appointment as Diieclor, 
Pisicur Institute Coonoor 

Lieutenant (on probalionl A F Goode Ins relinquished Im 
probition iry ippointment 


Correspondence 

WANDSWORTH AND A STATE MEDICAL SERVICE 
Sir — 1 have been assay from home since the Plymouth 
meeting and have not \ci seen any Journal since then I om 
now told that vou have reported quite correctly, that m my 
remarks on motions bv Glasgovs and Kensington on the 
subject of a Stale medical service 1 associated the Wands 
worth Division with these m their attitude towards such n 
service 1 am very glad lo know that vou have recened a 
correction from Wandsworth The error vvas entirely nunc and 
was inexcusable No doubt I owe an apology both to Wands 
worth and to Kensington for having mistaken the con 
sliluency of one of the latter s representatives But to 
Wandsworth and its representatives my apology cannot be too 
complete To have attributed to them such an opinion "i!> 
an almost unforgivable error 1 can onlv hope that this 
acknowledgment may be held to mitigate the offence At any 
rate 1 rejoice to know that only two Divisions and not three 
have been led astray — 1 hope only temporanlv — by the un 
certain connotation which still attaches to the phrase ‘ a State 
medical service — I am etc, 

Truro, Cornvvill, August 1 Henrv B Brack-ENDURV 

NIGHT DUTY UNDER A GENERAL MEDICAL 
SERVICE 

Sir — There is one point 1 would like to ruse with regard 
to the proposed national health service It seems curious to 
me that in discussing a national health service the position 
of the general practitioner in terms of other workers has not 
been considered On one point only 1 as a general practi 
tioner, view this extended service with horror, and that is 
night work It must be realized that the millions of people 
to be included in this scheme will no longer have the bop 
of an extra fee for night work and also that these people 
not being the workers who aie the healthiest members of t»c 
community will be drawn from the aged the married women 
and the children, who require a great deal more attention than 
the workers I must make it clear that while I vvish to be 
paid adequately for my services 1 do not wish to gam by these 
penalizing night fees 1 do however wish to give up niglR 
work and live as every other worker with certain hours on 
duly and certain hours off 1 wish to work so many bows 
a week — the same as anyone else Should the general practi 
tionei s Utopia ever be created without night, work, I hope 



UcusT n 19->s 


CORRESPONDENCE 


u wiU be mxde tllci-d m ihc n c of vhc \cl) for i 

e.Oelor on di' dut' to work iftcr hoiirv CtturvMic kind 
friend-, wouid n-.k ui to to it nicUt a- n ".ritet d tnxour md 
■-con thinu' would be if sr fii <7111' I supro'C there nre nbout 
2 000 people to c'cr\ general prnctitioncr in thii coimtrr ind 
if eich '■hoiild call the doctor at nicht onh once a \car the 
latter would in\c nearla fort\ nicht valk a week This is 
not the C3‘C at pre^nt but the -■lu.htC't la\il\ in cunom can 
ea'ilx lead to a doctor a life beconiinf, impo-viblc 

How could this be dealt with'’ In distriels where the popii 
lation i< ‘■unicienlli iarce \ounc doctors could be cmploxcd 
on pcrmanenl night dun Thci would be recarded in much 
the same light av house phvsicianc and hou'e surgeons md 
would take up the appointment to gam capcrience or while 
tbei were readme for an examination Thet would onlx 
spend ihcir carli tears in this work There must be some 
work for these men and with the increase in the number 
ard size of partnerships the number of lociimtencnis required 
will become less and less Thes would not hasc a great deal 
of work to do because the public knowing its own do lor 
to be iinas ulablc at night would send for him in good lime 
on mans more occasions ihan it docs at present These night 
doctors could deal with the work of mans practices Thes 
ssould see the patient at nicht and hand him os cr at 9 am 
the next dax to the appropriate doctor The pasment of 
the e men could be made ssith little or no loss to the doctors 
concerned a small deduction from the capitation fee and a 
paxment for each private case This expense could he offset 
bs the doctors since u ssould no lonccr be ncccssars for him 
to Iise in the town sshere rents and rates arc high and it 
ssould no lonccr be necessars to keep extra -maids »o that 
the house should not be left das or night He could lisc in 
the counirs and surds no man needs peace fresh air and 
ss-nshine more He ssould base a small office in ihe town 
Emails 1 would suggest that the doctors hours 'hould be the 
same as those observed m shops — I am etc 

Reading August 2 Stsvlex C AkCOCk 


British Medical Association 

OFFICES BRITISH MEDIC \L ASSOCIATION HOUSE 
TAVISTOCK SQUXRE LONDON WCI 

Addresses, etc 

SrcRETsRX fTclegrsms Mcdisecra Wessccni London) 

Echos Bshisu Medicsx. Jdvr-nsl ITelcgrams Aiuologi Wcstcent 
London) 

StEscwptioss Ad\iiriisesie>ts esc fTelcgrans Mcdisecra 

Vi essceiit London) 

Tetrphonr numbers 0/ Bnnsh Medicrl Associoiion end Drinsli 
Medical Journal Huston 2HJ (inicrml cschensc fitc tines) 
Scottish Secretary 7 Drum'bcugh Gardens Edinburgh (Tele 
grams Associate Edinburgh Tel a-rSbl Edinburgh) 

Irish Free Stale Medical Union (I M A and B MA ) IS Kildare 
Sircet Dublin (Tclcgrasns Bacillus Dublin Tel 62550 
Dublin ) 

Diarx of Central Meetings 

September 

22 Thurs Insurance Acts Commiltcc H 30 a m 


Group of Orthopaedic Surgeons of the Association 

Notice IS herebj gixen of the formation bs the Council 
of a Group of Orthopaedic Surgeons which shall be 
composed of all those members of the Association who 
are predominanllj engaged in the practice of orthopaedic 
surgers Members of the Association ssho claim to con- 
form to this definition are requested to appU to the 
Seerelan B M_A House Taxistock Square WCI not 
later than September 17 193S for a form of application 
for membership of the Group The first general meeting 
of the Group will be held at a dale to be subscqueml> 
announced m the Supplement 

G C Anderson 

Augu<t 12 Secretary 


SITPLEMK\T TO TFE 
'fcoiCAi Jo JWna-L 


B M 4 CHARITIES TRUST FUiVD 

The following subscriptions and donations ^ ere recened b4 
the B M \ Charities Trust Fund during the pened Januar4 I 
10 ^pnl 0 1938 for allocation to medical chanties at the 
discretion of the Trustees of he Fund (the Council of the 
Assocntion) 

£J00 — Dcrbvshiri- Pane] Conrnittcc Portsmouth DiM<ion (pres 
cctdsof dan'*c) Aork Local Medi-a\ and P nel Conmittee 

/“j /d — Southport DiMsion (proceed'^ of annud darcc 1**^ 
b> ladt(r> of the Dojsion 

— CirditT Division (proceeds of dinner and darce) 

/6j id — South Uesi Es<c\ Division iproceeds of d„nce) 

£/5 /<3 — H M Dav n 

//J ij /(/if — Lirdsev Lowo! Mcdica! and P.,<ne{ Conmitiee 
£/£> JOs — H M HaHiJav 
ilO — Panel Committee J B Lowe 
fS — North Midd'^set Di'i< on 

/r/rj E C Wvnne M J Uvnne 

ft V — Anon A T Bfca e A H Burgess D R Car>e 
A r Dj«.k son J Hu<b-nd Glutton G S Lund P Mvcdcnaid 
k G McGowan R. L Newell VSe«l Middlesex DsMMon (proceeds 
of dans.c) C f \\iUiam«on 

/r — E DuT Gnv I Humphre> Owen J A \aughan 
£t ts — The Hon W S ^faci3' 

A tOd~K C S Waters J A Hislop W J Fnth 

f*r — Irene F Callender 

CS fOs — North E-s Cl ter Division 

£3 Si (d — U S Ormiston 

£3 6s — Warnngton Dim ion 

T Brain 0 I BuKkIev P C Colls J G Cumd 
R O Ewde^ C C Easierb ook C*.ptam G K Graham E Gre 
F C Ingall G L Kevnes J H Paul S G Platts Major t. 
GndcrhiU 

£3 h ^d — \ B''rnard -nd U A D Lawson 
Fi — -SLss Ruth H Western 

Mr Id^) W \ Wihon and J I Willums 
£3 JSs 6d — C R Gunsen 
£2 lOi — Surgeon Licuicns.nt J G More Njsb it 
£2 4s — S S W at on 

f’ L Groom 

£2 2s’^} C Adam W S Adam^ G C Anderson C rtrdre^ 
r L Anmor A Baidi Margaret BJl A J Eallanivne J B 

Bennett M W BbGwood N A Boswell J W Bra h H 5 

Brown H Caiger D CafwcII J C-rr H C.rson J A Cnane 
Major Gcnenl T S CoatCb Li'‘uten.nt Colonel C J Coppinc-n 
R U Craig H Gu\ Dam D Davidson Lieutennn Colonel A d 
Dick T W N Dunn D Evans Lieutenant Co'or-1 C H Fi Idrg 
L S Frv 3 B Fulton Gateshead Loval Medit.~i and P.—i 

Comm ttec Janet hf CJibson J Gordon A C HaUowes ' rv 
Ha\ H W Hills W A Hislop S Hovie F C Hunt J W \ 

Hanccf H G %f Hcnn R F A Hodge W F J-cV cn 

A L Jaccer W L Johnson D I Jonfc. Surgeon Lieuter rt 

Commander C N H Jovnl Dorolhv L M kwts Squ-d cn 
Leader J kemp L kilroe R Langdon Down E 
Surgeon Captain L Lindop Colonel J R Lunham F J McGrue 
Hckn Nf M Mackav D D Mackmiovh L F ^5nrks and 

Parker W Marks J Milne A M A Nfoore A Moss R fc 
Moves J R Munro P k Musprait J Nekon W Parker K U 
Parsons A M Pollock H W Pooler D Ramacc Lieuiernm 

Colonel W D Ritchie NIL Rollason I RidceJones JAN 
Scott G C Shaffner H Simmons P G Simeon ^ I ^ 

SJatfdcn J Sneddon H S Soutur E J Siaddon FAR 

Stammers G Stap’eton W Stifling G S Strachan L^utpan 

Colonel A Street A E, Siruthers D M SuiherLnd E G 
Thom J M Thomson G S Trower W A Tweddle C 
Dorothea E Walpole A E R Weaver G M Wes wo^ C H 

Wicbf R J Willan J R Williams D C WiKon S P Wil on 

W Wil on T N Wood WHO Woods A H Zar 
f7__Coloncl C C Muribon Major A V O Bnen A de w 

Snossden 

it 17s — C H Laser R S_ndeman ^ r- 

£J 11s 6d—A K Bousfield Sir Henrv Bruckenburv G t- 

Dodds K gists Jones M C R Grahatnc Lieutenant Colonel 
R H Lee / f Lesh E'lzab'tfi M V H B Maclennan C S 
Pantin F J Psper Surgeon Lieutenant T J Kobarls In a 

Turnbull P H Ward C \I JMtson 
£l M Sd— N Chilton R P Ntilchell 
£1 Ts Sd—\\ G T Macfie 
£1 7s 7d—A LsTSdon 
£/ (Ss—Mrs J L T Birkett C Thoma5 
£/ h PI — J B Bamford 
£1 2s 7d—C V. Hosse V. M waran 
a 2s 6d—D M Bladon 
£l 2s 2d— V. H Carhsl- 
£1 2s —H I C Balfour D J Rose 
£1 Is lid — S Gosensor 
ft Is 9d— J Dwner 
£1 Is 6d — R L J Le Qezio 

£/ Is — P H Abercrombie HTrrict E Acheson J H Ad_m 
N, F Adenes J B Alderson E A ASibone A Anderson 
H M Anderson Lieuienant-Colonel H S Ander cn M Arder«on 
p V Anderson S E H Andersor \\ Anderson 55 B G Angus 
C S Applesard R G Apihorpe B McC Armour J L Armoar 
55 G Arthur 55 F Alhwater R- D Avlcward 55 C Avlisard 



]}8 August 13 , 1938 


BMA CHARITIES TRUST FUND 


mFrintCNT m me 

BrITHII MCDICRt JOtRNM. 


ewe B-xm, e B BimCord, H B>nks, K C Birlow, 
J Bittcrhnm, H S Bcndics, T Benton, S P Beclson, A S Beer, 
E C Begg, H } Bell, F P Bennett, Mnjor R A Bennell, A R 
Berne, T Bcrril, E Biddle, MAM Bigby, F W H Biglty, 
e N Binney, e A Birts, e D Bishop, H 1 Bhckic, R Uteasdnlc, 
G W Blomfield, W R Blore, D hi Booh in, E S Bompns 
B F M Bond, G H H Booth, H B B Boueher, J G Bourdillon, 
M Bowman, A Boyd, G J Boyd, J D Boyd, R Boyd, 
S A Boyd, W M Boyd, J C Boyde, S Bridbury, J Bradley, 
J V Bindley R Bradley, F Braid, A G Brand, \V 11 Brisil, 
F R Bray, E J Brewis, G E Brierley, E E Brierlcy, 1 S 
Bnggb M Briseoe, P M Brodic, R K Brooks, N BrostolT, 
C mown, C V Brown E V Brown, F A Brown, J Brown, 
J A Blown Major 3 P Brown, S N Browne and Btrbrra 3 
Browne R Bruce, Hon O B Buckley P J Burke, Oh\c K 
Burnett R H Burnett, R McG Burnic H F Burlt, L BtirMlI 
Holmes 1 H Butler, Bertha M Butters, R 3 Buxton, 3 A Byrne, 
3 e Byrne 

A J eaird, G Y Galdwcll, J Cildwcll, A N Cameron, 
Dorothy Campbell, G Cimpbcll 3 Cimpbcll, J G Cimpbell 
K S Campbell, L M R Campbell, R H Campbell, C P 

Campion W H Carse, E Casson E Catford, P T Cilto, 
C 3 Cellan Jones, V Chadwick, G P Chandler, E Chappie, 
R 3 K. Chatty, D S Cherry, W McM Chesney, J C K 

Chilcott A J Chillingworth, J W Chnehton H Christal S V E 
Chiistison, D G Churcher E A Clark, E B Clark J C Claik, 
B R Clarke, 3 Clay T J Clayton, W F Clcucr, H J 

Cluttcrbuck Alex L Cobban T S Cochrane, W R Cockshut, 
W D Coghill J Cohen P C Colly ns A B Connell M Connon, 
R G Cooke C R Cooke Taylor F H Cookson, M Coplans, 

J G Cormic V Cotton Cornwall, Nancy M Coulls A Cox, 
E L Cox, J Craig J Crawford F T H Croft Lieutenant- 

Colonel R G G Croly, B A Crook, S Crown 11 C Crouch, 
A P Cummings, W T Cunning, G M Currie 
S H Daukes J P Davie, E M Davies, J C Davies, L Davies, 
P O Davies T R Davies, R Y Dawbarn A C Dawes, T D 
Dcighton J A Dclmege J T D Ewart, M Dia J H Dick L M 
Dickson M G H Dickson W L Dickson, J T Dier, A V Dill 
H C Dixon, M V M Dodds H D Dodwcll C S D Don 

H G Donald, J H Donnell E F Dott, N McO Dott A S 

Diummond H H du Loulay H Duck, G E Evelyn Duddcridge, 
G Dudley, A Duguid, Lieutenant Colonel A W Duncan, 
J Dunlop M R Dunlop G H Duthic W G P Dyson 

P H C Eardlcy, R Eddie D C Edington, N L Edward, 
A C Edwards, E S Edwards, F H Edwards \V P Elford, 
G E Elkmgton A H Elliott, C Elliott H H Elliott A O 

English H English, A Evans D C Evans, E C Evans F A 

Evans, M W H Evans R J Evans T Evans 
D C. Fairbairn H Fairbairn C F Fairlie A T, Falwasscr, 
Ruth Fennell, W J B Fergus A S Ferguson, J Fettes, 
A Finigan, Isobcl M Fmlayson J L Firth F P Fisher R Fisher, 
AUliur M M Fitzgerald, G A Fleming C G Fletcher C H 

Flory, W Foote A Forbes T J L Forbes, R K Ford C W 

Foit J M Fosbrooke Major M F Foulds, S F Fouracrc, 
P H C Fowell, M Fraser, T Fraser, H R Frederick, J O 
Ficnch C Frier D Frost Lieutenant Colonel G H Frost A C 
Fry V Fry D Fyfe 

H W Gabe R P Gamraie J H Gann, F W Garrad R J S 
Gariovv, H N Garrus P C Garson, H S Gaussen W E Gemmcll, 
E A Gerrard W W Gerrard, T Gibson M L Gilchrist, J L Gilks, 
J M C Gill R U Giilan and Geraldine Gillan, J J Gilmore, 
H Giiling T J E Gittins A Glen, L Goldman, F J Gomez, 
G M Goodwille, G A C Gordon, M H M Gordon R G 

Gordon, S G Graham J V L Gi int W Grant, W D 

Grantham R Green, W Gregor A Giegory R J Gregory, 

C B Grieve D Grieve C A Griffiths, J L A Grout, C A 
Gunson 

C J Hackett L L Hadley, C E Hagcnbach, J E Hailstone, 
F Hill J Hamilton J W Hamilton W J Himilton J E 

Hancock G B Harland, J R Harper D J Harries, J N J 
H-rtley J K Hasler, T Hawley W E Hayes J G F Heal 

H E Heapy P M Heath D J Hemingway J Henderson 

Mary K Henderson A S Herbert R H Herman F Hern iman- 
Johnson G M A Herzfield, E F Hill H C Hill, J F Hill, 
RAP Hill, F G Hinks, B Hirson H F Hiscocks T H 

Hobbes S Hobson G A Hoffman Elizabeth Holland 
A Hollinsworth, H W H Holmes, N Holmes A C Holms 
M Hook C A Horder, J G F Hosken H Sv Honicson 

H Hudson W Hudson H E Hughes Davies Lieutenant Colonel 

E V Hugo J G Hume A-E Hunter, D M Hunter S Hunter, 

D A Hutcheson M M L Hutchinson R C Hutchinson W J 
Hutchinson B Hutchinson, A E Hyatt 
I G innes 

D B Jack A K James G C W James, E Jamieson, F E 

J irdinc L M Jeftries J P J Jenkins G A Johnston, Professor 

T B Johnston B R Johnston Emma M Johnstone A T Jones 

D J Jones D N R Jones H H Jones 

J S Kamester D M Kipp, J J Kempton C R Kenchington 
Eric Kcnderdine Ernest Kenderdinc C S Kerr D L Kerr 
A B Kettle H B Kilroe J M King P S Kinhck K F 

Kitchen F J Kitt N Kramer J L Kydd A H Kynaston 

Laidlaw Sir P P Laidlavv A H Laird Mary D Lambie, 
Lang L B Langmead A M Laurie A G K. 

Ledger Sir Kave Le Fleming S B Legge G Leighton B M 
rTr F H W Lewis Phillips W A 

Mumm/rv ^ 1 ^ Lockliart J P Lockhnrt 

Mummery J L Lochlicad, A Lomas T C Lome B F Lovibond, 


L Lowe, W C I owry, Limlcii ml Colonel W E C Lunn 
Roeklillc Join L Lush A Lyal W J Lytle 

DAP M It ilisttr, MijorGtneril Sir Robert McCarrison, 
J F MtCoiiehie, J S McConn ichit, P J McConnon and J 3 
Geiny, A C H McCuIl igli A A S McDonild, J R McDonild, 
K M M icdoii lid, J McDout ill 1 L McFwin, P F McFarlanc 

R M Macfarl me G Nl itfeal, J McA McGill, A R Maegregor 

S W MacGregor, A Maeinnes, N Mclnncs, A f McIntyre 
C W M M ick ly , P W McKcag, J J Mckenn i, E Mckerrow, 

I Mickinliy H D Mckinni Lieutenant Colonel J Mackmnon 
Helen i M Mcknight, J McLaughlin, Sir Lwen Maclean G D 
McLean, J M iclc in, R MeLc in, I A M Macicod, R Mackod 
J J IvIcMillin, M H Macnicol, A MatNivcn W \V McPliail 

II C McQu iide J G Macqueen L MacQueen ECO 

Maddock Q M idgc, 1 G Maitl ind J H Malloy Captain 
M M M insficld II 1 Marrincr, P II Martin, A T Mason 

J C Mitthews, D B M tunsell C Mayhew, A W C Mcllor 
L Mence, H G V Mcnce, G Millar, T MeW Millar Lieutenant 
Colonel A Miller, J B Miller, J C Miller, W H Milligin 
C G S Milne, 3 I Milnes S N1 Milner, F 3 Milward Anne 
Mitchell J M Mitchell, L M V Mitchell R S Mitchell F G 
Mogg \V J Moir 3 C hloor, E M Moore T E Moran, 
J Mel Morgan, 1 W Morgin, W G Morgan, Lieutenant 
Colonel J Morison, W Morrison, L W Morris, J M Morris 
Ciptiin 1 H C Morton R Morton, H H Moyle, A Rv Munro 
W A Miirriy, W G Nliirray 

M L New house, D A Nicoll, J S Ntcolson, G S P Noble 
A Ofenheim, L Olipliant, G M F Olive, L W Ormcrod 
L L Orton P M Olerlon R D Owen 
A F Pigc, A O Parker F B Parson A S Paterson J J 
Paterson \V Piterson T Paton J Patrick, T W Pattinson 
C H Pauli, H D Pavicre, W J Payne, F Y Pearson, 3 W 
Peden A A F Peel 3 H S Petcrkin J M Petne C C 
Phillip P W Philhp Professor R M F Pickcn, RAD Pop" 
11 R Potter, W II Prentice R F Price T L Price 3 A 
Pridhim, TAP Proctor, Non Proctor Sims, C G Pugh 
H E Quick 

F RadclilTc, M W Ranisden, G Rankinc M 0 R^'™> 
11 R iwsthomc,-Helcn E Redway, E 3 Rees R D Rcid, F A 
Richards, J E Richards W G Richards G Richmond, L r 
Richmond S M Riddick k M Riddle H J Riley J R ^ 

Ritchie R W Ritchie, S Ritson, F H Robbins A C Robctis L D 
Roberts L O Roberts R I Roberts J k A Robertson, B J D 
Robertson Joan Robinson Joseph Robinson M Robinson J U 
Robertson G D Roches H C Rolhn H D Rollinson A w M 
Rookc E M Rookc W S Rooke A D Rope, Colonel L i 
Rose Ilulchinson A Mvk Ross J A Ross, Jean A RosS J 
Ross R P Rosser, ATT Rowley, R S Riidlind, M " 
Rushforth - 

A Said C 11 Sansomc E M Sexton, 11 Scholifield C U 

Schurr, GET Scott, G W Scott Captiin W H Scrivsti, 
T A Seekings, S F Seelig, A Selkirk, Captain M. Sendik, 

C Shepherd, E G Sherwood, J F D Shrewsbury, J A Simon 
J B Simpson, J V A Simpson, J Sinclair, Surgeon Commatida 
J C Sinclair, W A Sinclair, KGS Skene Lieutenant Colonel 
r R B Skrimshire, J A Small, E G' Smallbonc H D Smart 
E B Smith, H Smith, F E Smith H G T Smith J F Snii li, 
S Smith r G Smyth, H K Smyth W R Snodgnss E So y, 

B Solomons, E Somciiillc ind A G Hallow cs 1 F Somerville 

W G Southern, B Southwell R Spears D B Spence D l 

Spence, P B Spiirgm, F E Stabler, C S St iddon, A E St innu'’. 

J F H Smallman, R A Stark \V 11 Steele W Stephenson. 

J B Stevens L Stevenson R A Stuart, E P Stibbe, J A btiriinij 
Major E G Stocker, k H Stokes Sir J Stntlicmn G J 
Summcis, \V F Sumner Anne Sutherland, R Siithcrlanu, 
G Svvapp, W S Syme, A Symon _ r 

F W Ta’Bois, W H Talfouid Jones, C E T.mgye, F L 
Taylci A Vera Taylor C Taylor, H Tnylor, M R Baylor, 
Surgeon Lieutenant W B Taylor, J W T Thomas R Tlioniis 
T B Thom IS W E Thomas, \V Thomas W H Thomas, C M 
Thompson, T Thompson Hancock, G R Thomson, J m 
Thomson R H Thomson, W Thomson, F J Thorne, B G 
Thwaitcs, S V Tinsley J A Tomb A H Topping G C Trotter, 
N E Trouton, Victoria S Tryon, A D Turnbull, J N Tiitnoun 
C F Turner, R H Tinner, W E Turner, N S Twist J M 
Tyrrell 

A Urquliart, D A Urquhait 
G C Vaughan, F L Vaux V C Veitch 
A W Wakchcld L S Wakefield, H Walden C W B'alkcr, 
E H Walker E R C Walkei G T Wilker, H F Walker, R L 
Walker, A T Wall ice, W Waibuiton C A G Ward E H 

Watkins E M Watkins H A Watney, D Watson, H D" Watson 

H K Watson H F Wattsford, E R Webb A M Webber, 
Lieutenant Colonel W J Webster, E A Welsh West Middlesex 
Division, Lucie B Wcvill, S Whalley A E White, C F W""? 

E S White R G White F E Whitehead Major N E Whitehead 
Dorothy F Whiteford J Whitclaw, Lieutenant Colonel i' 

■ Whitcmoro C H Whittle E M G Whittle, H E Wiggm, 

D M Wilkins, D Williams G C Williams, H N Wil nms 
J McG Williams V G Williams A B Williamson, A S Bbison, 
D McG Wilson, J Wilson J T Wilson L F Wilson R ^ 
Wilson, Squadron Leader T W Wilson W B Wilson W M 
Wilson W R Wilson T N Wiltlievv E Wingate J WisInP 

W H Wishart E Wordley, E A Worley, C B'roth, H G 

£/ Atkinson D Baird and Matilda D Baird D Bdhon 
E W C Bradfield, E Braithvvaitc E C Braithvvaite, C R Crystu 


I 


B M A CHARITIES TRUST FUND 


<■1 FPLEMr^7 TO THE / 7p 

BJITEH MTD CAt Jet- '•At 


UcAST IV I93S 


O'lNcIalV P L Giu<crpi M Go den J Hirknc'^ R S Har\cx 
1 vi tenant Colonel M i Moljmtc II C Alt Ibnliim P aha J A L 
Innc' D P Lambert R M D lj>cft> I Lu'a< J M clnnc^ 

J I Murn3\ A D Nicholl 1 Piton R II Pcirvc S \ P 
Id! G S Robertson O N Roussel R Samp'on M M Sicxcn on 
O I S'dcnhim H \\ Toms JOS Turner L E Wicrim 
\\ H Wositho’me 
/Cj Jd^r G A Beckett 
/9s d — A Pain 
/‘j (d — Ionise H Wilson 
/“« -d — D E doling 

/"'—A Connal P N Cook G J G Di\idson Dons A Dean 
Hid« M Denholm ^ounp J R Garmon S K Guthrie A S 
Hatch J Kciman J \I Loftus C J \Iaclarcn J 1{ Otta 
W F Roper J Smith F H S exenson W S Urquhart 
/<j 6d^i: R Daaics 
/■* — K S Maurre Smith 

/•»<— J A W Robertson 
/ * fi — H B Martin 
/ s 'fd — G II Lucas 
/’j 6d — R W Armour 
]^t 2d — C T Noms 
/"< — R L Osmaston 
/ff 7d — J R F Poppicssetl 

s (d — J B Adanson R M Ainstsorih J S Aldndfc 
J S Alman M N Andrews N Ance! Nlajor General R W 
Anthoax G \<hton N L. Auchtcrionic 

L A Bacon H C J and K D Ball J Bal'entinc R T 

Banni ic- P L Barloxx A S Barr J Barr AMP Bittx 
E A B-xendme P W G Baxter O R Bmxon R Btair P L 

Bo-'d A M \ Bonhotc Captain J W Bowden W Boxd P G 
Brain Major J E Brooks W D T Drunxate A F Bf>son 

} L Burn H Burrow-s 

K Cameron M E M Carter A G Chamberbm M C 

ChappcI H M Cohn W M Cole R T Cooke R G Crawford 
C M Cusden M Cutner R J and If G R Cxnax 
J DalzicI H J Daxidson J D Dear F M Deiphton G W S 
dc Jer'ex A Dohbx A R Do'Ie G T Drummond 
L T Eden I F W Edxxards W Edwards A C J Elwm 
J A S Fmshc W J A Er^kine A L Exans H A Extras 

M F M Exans 

H D Fairman J C Fiddes J M Fleming T P Fxans 

H M Garliwk W Gibson J D Gilhcs H W Gothard A S 

Couch Licmenant-Coloncl R Q Graham B S Grant J W Crax 
H J Green E N Gregg: G R Gnbl>*n M W Grxinstcin 

\ Gurewa h 

A W Hall K R C Hallowcs R H Harding J G Heathcotc 
A G Hemsiex J Henderson A B Henrx A C Hill J L Hill 
H S Hogc E Holmes J R R Holmes W G R More M J 
Houghton D M How sc J Hunter M Hunter G Hurrcll 
J B Jack D S Jackson A N Jones J D Jones R F 
Jordon 

A ^l Keith Kathleen C M Kenned' W L Kennedx J Kerr 
J D O Kerr B M Knight 

Su-geon Lieutenant R W G Lancashire I Lapman J Lcckic 
W J Lloxd Dr and Mrs DBM Lothian M G L Luca* 
J S Lxle 

C B McArthur I B McCrac J M Maefarquhar N A A 
McIntosh W MacLax T S McKean W McKendnek A V 
Mackenzie Exclxn T D MacLagen A I MacMahon E J R 
MacMahon A M C Maepherson G McPherson K Madders 
W Mailer T Mahms E G L Mark Phxllis Marsh P S Martin 
V* M Martin Dora Mason E W G Masterman L M Maxburx 
GEM Mexcr G W Millcdgc T M MiUcr G Mitchell S D 
M ichell Florence S R Moore C G Morgans D R M Mo risen 
J R Mountain T > Muir J A Milligan A J Murrax W A 
Murrax 

R A Newsom W W Nicol B R Nisbct 
A Ogg Ethel £ M Ogilxne 

Captain G R C Palm'*r W Park W G Parker M W 
P^tcr^on D S Patten S G Peill R A Piachaod E Pigeon 

J H Power D S Praej J Prentice A C Pnee 
C F H Quick 

L Rees E C Roberts L W Roberts P L C Rothschild 
Lieutenant-Colonel J V Sax age K J L S^ott W R Scott 

S K Sm A Shapiro W Simpson H C Smderson Pasha D A 
Smith Olga F Smxth E H Snell M R ^ni Surceon Com 
mander L P Spero A B Stenhousc C Slexvart G M Stirling 
H Thistlethwaile A K TTiomas J and A H T Thomson 

A T Till H S Townsend C A Tnxers L H Tnxers D M H 
Tnpp 

W R x-an Lancenberg 

A Waller A S Wallis V H Wardle J Watt J W' Waxte 
G V Webster H G Webster A S Wicfield R Wiggins A J 
Win G Williamson A J Wilson D Wilon D Wood W C 

Wood R F Wxatt 

705 — Surgeon Lieutenant Commander G D J Ball R A 
Berlov. A M Barron D L Baxter M N Blake J W Bradburx 
R A Brown J C Brownlee D S Brvan Browm Margaret b 
Brxson M M Burton Kathleen F Butterfield A A Caniihers 
L H Chandler D CoUinshaw S W R Col'cr K J Daxis 
D L C Dax Louise E Fraser N M Goodman D G J Gordon 

E D ^ Grasbx D D Graxson W E Haich Major M R W 

Hart A Hawkxard Esme M J Hill Enca M Hutton D Me! 

Johnson J W Jones E A Keith J R Keith J J Kcllx J D 

McCallum J A McClinlocl Lieutenant C E McClogbr^ 
G \ T McMichacl W E Mathic G P Midd’cton Laun M D 


Mill Professor J C Mo r F Muncl 'Icrns Marx F Mimro 
W P H Murden W L Peacock D M Pul'en W C Ramsburx 
C Rrhard on R M Saleh A Salmon Captain W J SVehan 
M Smellic O M Somerxille D B Soutar N H Stem E M 
Strong G C Taxlor A K Trail! H M Twnng J L ^ 
Web le EVE Whidbom"^ H White J M WngheTd Mcl'x B 
Wilon M E Wihon A H M loung 

Miscellaneous cortributtons of ]e<s than lOx each total d 
£*6 I-s 2d 


VACA^CIES 


■iU rdMrtise Jienis sfodd be addressed to the 
Ad\ertiscr^ent \fan ;cr erd NOT to the Edt or 


UtSlDEVT POSTS 


BxRssLtx CoLsrx Bo^olgii — A s.:i<{^nt MOH SaLrv £^C0£-_5 
£700 pn 

Dstii Roxal Lmted Hospitxl — HS Salarv £I'0 p.a 
Birx isGiux! VXD Midlvsd Eve Hospitvl — S urgical Ofii'*er Salarv 
£.00 p.a 

Bikxiimhvm CiTX — <M JA V O (male) for the Mental 

Dcparim''nt Rufc-*rx Hill ard Hollxmoor Division SJ-rx £ 0- 
£-0 pjs |2> Who’-’iim- JMOs imales) .t SclK O.v 

Hosp lal Salanes £>C0 p.a ca'-h 
Bxvoro D Cm — HP« and HSs to th- Murn-ipal Gerer.I 
Ho pn*.l SaLni-s £l<0 p-a each 
Bristol Ext HospjrvL — JHS S.brx £!OJ pj 2 
CA‘tLi''LC Clm ivLvxd Ixfirxurx — Surg cul Ofn er In.'t. ur 
marned) Sv.Iar\ ..*0 pa 

CfVTRvL LcxdOx OpHrHvlxjK HosPrtvL Judd Street WC— tl) 
Senior HS iiJHS Salaries .1.0 .rd . rw) p a rep- vex 
CHEXItRFIELO ASO SOXTH DERBXMIIRE ROX VL Ho^PI v S lo 

the Ophthalmiv ^nd Ear No e a-d Throa Cepartnen s b l-r* 

£H0 pa 

DfKBX CoLsn Be OLGH— AMDs (maK) fer D rb Citx 
Ho piial Salaries £-W r *• 

Doxir Roxvl NtcTo^iv Hospital— MO Sabrx £1-0 pa 
East Ham Memo^ul Hospital Shrew bu x Road £— HP (male) 


Salarv £H0 pj 

HviirAN CoLvn Booloh— JMO (male) for Halifax Gcr* .1 
Hospial Salarv £2*0 pa 
Harilepools Hospital— HS Salan .1^0 pa 

Hertford Colxtx Hospital — HP (male) Salarv £1^'^ p-a 
Ho-t Kellisg Savatorilvi— M edical Superintendent SaLrv 
£«00 p.a 

Hlddersfie.d Rox vl Infirx akx — Surg cal Offiwer (maP) Salarv 
£22* £:*0 p.a 

Hlll RoxaL Isfikmakx — H P (male) to the Sutton Brarth 
Hospital Salan £160 p.a 

iLFO^o West Ham Hospital for Mental and Nerxols Dis 
ORDERS Goodm-'cs — ^J AMO (malt unmarned) SaLrv . 

£2* £***0 p.a 

Infants Hospital Vinctni Square S W — H P Salarv £l(y> pj 
ISIE OF \UV Nobles Isle-of M.n Hospital and Difpcnswi 
D oug’as — H S (male urtnair cd) Salarv £17^ pj 
JERSEA Genek^ae Hospital and Poor Law Infirm^a (1) H S u) 
CO and HP Ma'es Salanes £17^ P-a each 
Lavaashipe CoLvn Council— (D Surgical O'rccr and (2) N! O 
for Whi-TOT CouniA HoApilal rear Pre<LOt Unrr-rr -d 
Salan p.a each 

Lancaster Roxal Lancaster Infirmvrx — (1) Sen or H S (2) 
Second H S Salanes iZOO pa and £I7S pa ^e^pettlxelx 
Leamington Spa W arneford Genen.al Hospital H-P Sa an 
£1*0 p.a 

Leicester Roxal Infirmarx — R adiologiM Salarv £200 pa 
Lixerpool Cm —A M O for Fazakcrlex Sanatonum SaLn .2,0 
P-® ^ 

Lolghborolgh and District 

Hi* Mal-s urma ned Salaries £1*0 p.a and -1- P-a 
rc'-pectix clx 

Lltdn Blte Hospital — HS (male) SaLn -I 0 pj 
Manchester Christie Hosp^al and Ho-T Radilai Inshtute — 
M O to the Radiothcrap' Deparlir-rt S-L-n £ 1^0 p.a 
Manchester Northern Hospital —S urgi-al OTcer SalaiN £i'0 
P-a 

Manchesteia Rotal Et-e Hospital— J-H S Sal-rs £120 p.a 
Manchester Roeal Infiraiare M O S^I-r> £2d0 p-a 
Meriher Gen-eral Hospi'al— H S Salan £1'0 p-a 
Miller Geneilal Hospital GreerEEicn Read SE — (I) HP (2) 
HS Males unmam'd Salar e< £100 p.a each 
Neee CASTLE L PON Tent Roeal \icioria Intir-aiake— S e-icr 
Accident Room H S Salan. £1^0 p.a 



140 August 13, 1938 


VACANCIES AND APPOINTMENTS 


svri’l FUF'.T TO TIIC 
IlRiTmi MroicAL Jotf n»i 


North Shields Ttnemouth Victors Junitir Inurmvrs — US 
(tmlc) Sahiy £150 po 

Nornmch Jenny Lind Hosiital ior Childrin — MO Solirj 
£120 , 

Oxford Rtdcliffe Infii mart — (1) Hon P lo (he DcpulmciU 
of Physicnl Medicine (2) RSO Sihry £150 p n (J) Three 
H P s (4) Obstetric HP (5) H S to the Cnr Nose rnil ThronV 
Department (6) Three HSs Mtles Sthrics £120 pa cich 
Plymouth Prince or Wales s Hosrn il Grccnbinl. Roid — (1) 
Amcsthctist and HS to the Special Depirtments (2) Tyyo 
HSs Salaries £120 p a each 

Preston County Borough — AMO (femilt) foi Shiroe Green 
Hospital Salary £300 p a 

Preston and County or Lancaster Royal Infirmary — Siirgical 
Oflicer (male, unmarried) Sal iry £300 p a 
Prince or Wales s General Hospital N — (I) JHP (2) Taao 
JHSs Males unmarried^ Stlarics £90 pa each 
Rochdale Infirmary and Dispensary — (I) Senior HS Silirj 
£250 p a (2) H P (male) Saliry£150pa 
Ross and Cromarty County Council — MO (male) for Lcaws 
S inatonum and Infectious Diseases Hospital Salary £250 p a 
Rotherham Hospital — Casualty HS (male) Salary £150 pa 
Royal Eye Hosiital St Georges Circus, SE — (1) Senior HS 
(2) Tavo assistant HSs Salaries £150 pa ind £100 pa cicli 
respectively 

Royal Free Hospital Grays Inn Road, WC — CO (female) 
Salary £150 p a 

Sr Albans Hill End Hospital and Clinic for tiil Preainfion 
and Treatment of Mental and Neryous Disorders — HP 
Salaiy £165 p a 

Saly'ation Army Moitiers Hosiital LoAser Clipton Roid, C 
— M O Salary £80 p i 

Sheffifld Childrens Hospital — HP (male unmarried) 

Salary £100 p a 

Shefiield Jessop Hospital ior Women — Anaesthetist (Rmalc) 
Salary £100 pa 

Shreavsbury Royal Salop Infirmary — Suigicil Ollicei Saliry 
£250 pa 

Southend on Sea General Hospital — (1) Amcsthctist (2) HS 
Males Salaries £125 pa and £100 pa respectiAcly 
Southport General Infirmary — J H S (unmarried) Salary £150 
pa 

Stole on Trent North STArroRDsiiinc Royal Infirmary — (1) 
Second HP (2) H S for the Auril and Ophthalmic Dcpait 
ment Salaries £150 p a each 
Stroud General Hospital — M O Salary £200 p a 
Surrey County Council — (1) First AMO for Epsom County 
Hospital (2) Two J A M O s (males, unmarried) for the County 
Council Mental Hospitals Service S ilaries £350 £25 £450 p a 
each (3) J A M O for Surrey County Sanatorium, Milford 
Salaiy £250 pa 

Taunton and Somerset Hosiital — ^Tyvo HSs Silatics £125 
p 1 each 

Waravick Warwickshire and Covintry Joint Committee for 
Tuberculosis — A M O for the King EdAvard VH Memorial 
Samtoiium, Hertford Hill Salary £250 pa 
West Hartlepool County Borough — AMO (female) for 

HoAvbcck Infirmary Salary £350 £25 £450 p a 
West Riding of Yorkshire County Council — ^JAMO for 
Scalcboi Park Mental Hospital Salary £350 £25 £450 p a 
Worthing Hospital — (1) HP (2) H S Males Salaries £130 
p a each 

York Dispensary — M O (female, unmarried) Salary £200 p a 


NON-RESIDENT POSTS 

Bradford City — A ssistant School MO Salary £750 £50 £937 10s 
pa 

Buckinghamshire County Council — (1) Deputy County MOH 
and School M O (2) Assistant County M O H and Assist int 
School M O Salaries £725 £25 £800 p a and £500 £25 £700 p a 
respectively 

Cardiff King Edward VU Welsh National Memorial Asso 
ciation — ^Three Half time Assistant Tuberculosis Officers for the 
Cardiff, Newport and Pontypridd areas respectively Salaries 
£250 p a each 

Darlington County Borough — Assistant MOH Salaiy £550 
£25 £700 p a 

Di ptford Metroi olitan Borough — Dent d S at the Central Child 
Welfari. Clime and Tuberculosis Dispensary Salary £60 pa 

Dewsbury County Borough — Assistant MOH and Assistant 
School M O Salary £500 £25 £700 p a 

DimvDNOUGHT Hospital Greenwich SE — Halftime Receiving 
Room Officer (male) Salary £150 pa 

Royal Eye Hospital Pcvcnscy Road — H S Salary 

L 100 pa 


Ldmomon Borough — A ssist ml MOH ind School MO Salary 
£550 £25 £700 p i 

kiNT LmicvrioN Cosisiirin —Whole time Assistant School MO 
(Ophtlulmicl Silary £700 p i 

LANCASHiur County Counch — Put time Visiting Radiologist for 
Winston County llospitil near Prescot Saliry £3 3s per 
session 

Liyiriooi CouNiY Boroucu — A ssistint School MO (fcmakl 
Sihry £500 £25 £700 pa 

Manlhisiir Royal Imirsiary — ^T\ vo Medical Chief Assistants 
Salaries £300 pa c ich 

Miiiir Gisirm IIosriTAt Greenwich Road SE — CO (male) 
Silary £150 pa 

Monmouiiishiri Cousiy Council — AMO Salary £500 £2a 

£750 p a 

Nl AACASTLI Ul on 1 Y M ROY Al Vlt KIRI A Isl IRMARY — ^TwO McJiCal 
Registrars Silirics £250 p a each 

PiiiNLi oi Waiiss Ginlial lIosiirAt N — Hon Clinical 

yXssistant 

Radnorsihri County Counch — County M O H (male) Salary 
£800 £25 £900 p i 


UNCL/VSSinCD 

UiLFAsr Qupln s Uniairnhy — Jolin Diiiuillc Rcscirch Fellow 
ship m Experimental Pathology Sshry £500 pa 
UiiADioui) Royal Iniuimary — Hon S 

Brighios Nias Sussi \ Hosiital roa Moailn ind Childrev — 
Hon Ophthalmic S 

CiitcHrsnit Roa AL Wist Sussi v. Hospital — Hon Anaesthetist 
I-DiNiiuiiGH Royal Colli cf oi Surfioss oi Edimiurgh — Con 
servatoi of the Museum uid Direelor of Postgndiialc Sliidies 
Sihry £1 000 p i 

Hosiifal for Sick Childkis Grcit Ormond Street WC— EunieC 
Oakes Researeh Fellowship Sahry £700 pa 
India GoscRNAtcsr — Professoi (female) of M itcrnily and CliiU 
Welfire at the All Indii Institute of Hygiene and Public Heallli 
Cileulla Sahry R< 1 050 Rs 50 Rs 1 350 per cilendar month 
Lhhook Kino (jroncLS Sanatorium for Sailors — AMO (an 
married) Salary £200 p a 

London County Council — Assist int Pathologist lo ihc 
Histological Labor ilory, Archwiy llospitil, N Salary £650 £-5 
£800 pa 

London UNiAbRsnY — UniAersily Chur of Radiology tenable at the 
Royal Cancer Hospital S ilary £2 000 p a 
Mynchcster Duchess or York Hospital for Baoies — (1) Aural 
Registrar (2) Clinical Assist mt to the Out patient Department 
Reading Royal Berkshire Hospital — Assistant Radiologist 
S il Try £400 £500 p a , according to quahhcations 
South Africa Union of — (I) Senior Professional Ofiicer physio 
logy) (2) Senioi Professional Oflicer (Biochemistry) Silanes 
£700 £25 £800 p a each 

Sunderland County Borough — Deputy Medical Superintendent 
for Cliciry Knowle Salary £550 £25 t650 pa 

Examining Factory Surgeons — The following Yacant appoint 
mciits me announced Mclls (Somersetshire) ChITe (WaoucL 
shire) Applications to the Chief Inspector of Fictones, Home 
Oflicc, Whitehall S\V1, by August 23 

Medical RErriiEB under the Workmens Compensation Act 192' 
for the New Milton, Scarboiough and Whitby County Couri 
Districts (Circuit No 16) Applications to the Private Secrctiry, 
Home Oflicc Whitehall, by September 3 

To ensure itolice in tins column ad\ erttsemenis mnsl be reccuei 
not later than the first post on Ttiesda) morntngs 

Notifications of offices sneani in uniicrsilus medical 

of lacanl icsidcnl and other appointments al hospitals iwfi ac 
found a! paKes 31 32 33 34 35 36 37 3S 39 42 and 
43 of our adiertiscmcul columns and ad\ crtisemeitls as lo partner 
ships assislniilships and locumiciiencies al pages 40 and 41 


APPOINTMENTS 

Back Frederick MB, BS, DPM, Medic il Superintendent 
Sunderland Mental Hospital, Ryhopc Co Durham 
Gray John E MB, B S Junior Surgical Registrar, Royjl 
Victoria Infirmary, Newcastle upon Tyne 
O Reilly T J MD Medical Rcgistrai, St John Clinic and 
Institute of Physic il Medicine London 

Examining Factory Surolons — W C Sharp MB 

the Clcland District (Lanarkshire) Jean W Symington M k 
for the Johnstone District (Renfrewshire) E S 
MRCS LRCP for the Bath District (Somersetshire) if 
G reenwood, MRCS, for the Horncastic District (Lincolnsliire; 



u, lst 13 19 ^^ 


SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 


i 




/ Gwarantec 

^g'-annteetoeltcr I 

j <xcisngccr£ca!^SxT j 

j ^^wncfesyejr £ — 

! <rflftajJcotfcRfau 
‘^Haice] Profa 
I fa::)dSuU3itc 

,:^i; 


SALT'S 

VISCEROPTOSi 
BELT r 


POSITIVE 
SUPPORT 
FOR THE 
ENTIRE VISCERA 


9 Sail s Vi'ceroptosis Belt not 
onI> affords uplift to the losser ab- 
don^n it acluillj presides comfort- 
able and comple e support for the 
sshole of the viscera 

For the foregoing rea'on this par- 
ticular Belt IS also extensivelj used for 
post-operalne cases sshere support 
aboie the umbilicus is required 

Its consistent efficiencj obnates the 
necessits for corsets m many cases 

Upon request sie shall be plea'ed 
to send the latest edition of Salt s 
Corset and Belt Book to anj medical 
man This book gi'es full details 
and Measure/Order Forms for all 
SALTAIR indis iduall> -made 
Appliances 


T1 .1 ' 










k SALTAIR \ 


IV 


SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 


August 13, 1938 



\l'rL'ST I' 19'S 


.67 


THr SECTIONS SUMMARY OF PROCEEDINGS 


ncnml inilnidinls houc\cr rcfii cd to rcict 'ind thc> 
divlikcd the ^c^ ind ^verc loiter cl‘-c\%hcre Sc^ hiihing 
it'^lf tf follo'vcd bv a glo"inc feeling mo^i bcncficnl 
but jt «-honld not be overdone in the cttIv snecs and b\ 
ibo«.e uho'-e rciction was poor \ bntbc win followed with 
advaniapc bv warmth friction and simlipht Sir Hcnr\ 
preferred to have the \er\ sick and children under ^ scars 
for an initial period at Mton before moving them to Havling 
Island because if ihcv were over stimulated their appetite 
micht increase but their digestion could not cope with the 
food Thev lost weight became irritable and often ran a 
slight fever 

Dr J IsGLis Casilros (Glasgow) stressed the psvchological 
aspect and demonstrated the value of elliptical movements to 
produce suppleness rather than strength Surgeon Lieutenant 
Commander L J Corbctt R N (Portsmouth) slated that in 
the Navv the medical ofTiccr was paid to keep men fit Not 
enough 'Ire'S was laid on the correct starting position for 
cxerci cs In his cxpencncc javelin throwing was the most 
clficacious method of producing the perfect female figure and 
poi'c He WTS astonished at the rapid improvement in the 
phvsiquc of recruits under training and the increase in 
cxcrcj c tolerance and Mial capactiv Ten minutes in the 
open air w^s the routine ^pell of phvsical trainmc but medical 
supervision and graduation of exercise were most essential 
Profesor W P Kensldv (Baghdad) pleaded for education of 
the pubi c on the working of the bodv and in sjmpic 
phv'siiologv 

Dr B V Dlv’s (Torqua>) had noticed more obstetrical 
difficultKs in the extremeU athletic mother than in the average 
woman Dr Doreen Ninon (Bnstol) said she found lectures 
on personal hvgiene were more popular than those on general 
hvcicne Cold bathing was of no harm during menstruation 
if followed b\ a glowing reaction Dr K R C Hsllowcs 
(T orquav) stressed the importance of making patients feel 
thev were improving, and hence the value of occupational 
ihcrapv m conjunction with phv'ioiherapv He advi<cd 
woTTcn not to bathe in the 'ca the dav before and the first 
dav after mensiruaiion Sea air was of value without <un 
and therefore shelters were to be recommended 

Dr A R Neugxn (Droitwich) mentioned the importance of 
posture training and the fostering of pndc in position and 
use of the bodv He advocated the u e of a badge m schools 
to mark those who had attained good poi'c Dr A E 
CsRVER (Torquav) emphasized the ncccssitv for the individual 
having a will to be fit this needed gradual education He 
believed that a custom of regular medical overhaul would 
dcsirov the lav fear of this ordeal He advocated two meals 
a dav fcT manv older people 


SECTION OF MEDICAL SOCIOLOGY 

rnda\ July 22 

Co-operation in Public Health 

With Professor Crsrles Singer President m the chair Sir 
WiLUss! WiLLCON opened a discussion on Cooperation m 
Public Health 'Administration His paper w-as in part a 
recapitulation of his arguments in opening a similar discussion 
recenth in the Kensington Division {Supplement Julv 2 
p 6) The medical officer he said must be supreme but he 
needed the close co operation not onlv of specialist experts 
but of the general practitioners of his district Co-operation 
would be facilitated b\ the appointment of a consultative 
medical advisorv committee consisting of representatives of 
the local praciuioners the medical officer of health to be 
chairman At post natal child welfare and immunization 
centres to lake these as examples there were man> oppor- 
lunities for the general practitioner to be of enormous help 
and It was important that practitioners consultants as well 
as general practitioners should equip themselves for iheir 
responsibilities AVith regard to the consultation on hospital 
services as laid down bv Section 13 of the Local Government 
Act 1929 he drew attention to the lead given bv London 
Manchester and Liverpool Evervthing possible should be 


The BirrifH 
Mjs caj. Jo 


done to do e the gulf which had existed between munuipwl 
ind voluniarv hospitals 

Position of the M O H 

Professor R M F Picken fLniversiiv of Wales) said that 
if the issue were simplv co operation between medic-l oPce s 
and private practitioners it would b^ easilv adjusted Thev 
were all trained in the same school «pote th** same language 
and tended to fraternize But the officer wus part of a 
machine which he must strive to make efficient If hi 
authoniv determined that things were to be done m a certain 
wav he must lovallv see that ih,.i was done even though the 
method was not generallv acceptable to his profession U 
wis unthinkible that he should conspire with hi^, med cal 
collcacuc' to undermine the decisions of his council Parha 
ment had placed on local auihonties an increasing burden 
of clinical re ponsibilitv often the result of p op^garda b\ 
the profes ion it clf all o^ which was malmg it increasmglv 
difficult to draw a clear cut line between the province of the 
medical officer and that of the general practitioner If medical 
benefit had covered dependants from the beginning some of 
the departmental wCtivities might never have been nece ,,rv 
The atmo phere of suspicion created bv the e modern de elop- 
ments could be made less fierv bv an\ mean> whicn \ ou’d 
foster co operation b-tvveen medical ortice s ^.rd the rcvt ot 
the protcssion Tlu most valuable ot the e\i tma a ..r^e 
ments ior such co operation was he inter repres^runen 
central and lo al between the executive bodie> of the A c- 
cnfion and the Sovieiv of Medical Officer> ot Hea h 

Tlic General Practitioner and Mid«ife’’v 

Dr J A Bm>\vn iBirmiPeham) sa d that u w^s ">01 realized 
bv medical othwers ot health ^nd the -uihori ev whch 
emplovcd them that c\erv doctor workin- on a on^r<ici b-'i 
was an assistant medical officer The ditferen e was th^i irc 
medical officer av commonlv understood aimed -t irdividu^i 
health through communal health and the ceneri’ p actitionc'* 
at communM health through mdivjduil het.lih The obMOus 
machincrv for local co-operation was the Brit an Meaical 
Association through the Divisions the boundaries of which 
were usuallv coterminous vvith thoac of the lo-al wUtho ties 
It would not be a difficult thing for the local auiho^ues to 
hand over to the general practitioner all the pureh medical 
Work done for expectant mothers at the ante nat^l centre 
this work could be done at the surgen or at the patient 
home the vvelfare centre being av ..liable as a consultation 
clinic in difficult cases In return the general praciii»oner 
must be prepared to fill in caps which might exist m his 
knowledge of ante natal and post natal care and to perfect and 
carrv out an ante natal scheme m conjunction with and ic 
the satisfaction of the medical officer of health The proper 
adviser for the expectant mother and the best attendant at 
confinement was the patients own doctor 

Co-operation in Practice 

Dr G N Gebbie (MOH Hull) gave instances of co 
operation in hi> localitv Afost of the members of his staff 
were members of the British Medical Association and he 
himself was on the council of the East Riding Branch In 
areas where co operation with the Bnti h Medical Assoaation 
existed there was no need for the appointment of a special 
medical committee to deal with a sudden public health 
emergenev The health administrator was now asking hitrself 
whether the passing of the Phvsical Training and Recreation 
Act did not inaugurate a new epoch In the past the endea 
xour had been to make heajthv the unheallhv m the future 
It must be to make the healihv fullv efficient This new pha e 
meant a changed outlook for the public health administrator 
and for the general practitioner also Co-operation of the 
whole profe^^sion vvas essential if it was to lead as it should 
the moverrenf towards positive health The public health 
administrator must realize that be was first and foremo t a 
medical man and a member of a great profession The 
general practitioner although a member of one of the mo t 
individualistic of professions must envisage the communitv 
and not the individual patient as the umL 



368 August 13, 1938 THE SECTIONS SUMMARY Of PROCEEDINGS 


Difficulties in Co-operation 

Sir Kaye Lr Fleming (Churmm oC Council) drew 
attention to some outstanding difficulties in bringing ibout 
CO operation In his belief a large number of publie health 
authorities did not know they had anj power to cooper itc 
at all Many authorities failed to realize how decplj under- 
lying many of their problems was a medical issue Some 
local health authorities were extremelv unwilling to hue 
doctors sitting on their committees 1 heir members often 
knew really nothing about health thev relitd on their medical 
officer and did not mind exposing their ignorincc to him 
but they did not want other medical men sitting with them 
Perhaps also they disbelieved that the general practitioner 
xvas in a position to supply them with information and help 
There were faults upon the general practitioners side also 
He would not apportion the blame for the lack of the spirit 
of CO operation which prexailed The root cause was that the 
medical student in his education was nexer taught anything 
of his responsibilities towards members of his own profession 
He looked forward to the day when those responsible for the 
training of medical students would sav to them, ‘ When xou 
go out into practice xou haxe no right to sit alone m your 
oxvn little circle seeing hoxx much money xou can make by 
attending patients who are ill You xxill remember that you 
have duties to the profession as a xxhole to the public as a 
whole and to the State 

Dr Peter Macdonald fYoik) did not share the pessimism 
of the last speaker Manx of those xvho had been concerned 
for some time xvith the relations between the profession and 
representatixes of the local authorities behexed tint the 
atmosphere of suspicion had practically disappeared so far as 
general practitioners and medical oflicers of health xxcrc con 
cerned had largely disappeared as bctxxeen the profession and 
the Ministrx and was disappearing rapidlx as regards the 
relations betxvecn the profession and the local authorities 

Dr J W Bone (Luton) said that he had spent a good deal 
of time trying to get established scheme ot pathological 
sei vices in his locality xvith a laboratory in the hospital but 
after long discussions xxith the authorities they had insisted 
on a laboratory in the basement of the town hall In regard 
to maternity services the aim seemed to be to get nearly all 
the cases into maternity hospitals xvith whole time officers, 
with specialists perhaps coming from thiitv or fortx miles 
axvay while men who had spent their xxhole career doing 
midxvifery had no plate in the scheme Would it be deemed 
the acme of co operation for the prixate practitioner to commit 
suicidet 

A Lay View 

Councillor H M Medland (Plymouth) a Vice President 
of the Section said that he felt as if he had come mto a 
syndicalist society of people who behexed in the profession 
running everything themselves In Plx mouth on setting up 
a municipal hospital, they had been extremely anxious to gel 
the co operation of exerxbody concerned Representatixes ot 
the medical committee of the voluntary hospitals said that 
they xvould be delighted to help xvhich they did by asking the 
municipal hospital first to take all the chronic bronchitis cases 
then the very bad iheumatic cases then the cases of adxanced 
cancer That was the sort of co operation thex offered His 
experience of pathological departments xxas that ft had nexer 
been possible to make them go until the public health 
committee had been induced to foot the bill by more than 
half In maternity and child xvelfare services the doctors had 

missed the boat He did not see xvhy doctors should expect 
to be co opted on public health committees xvithout going 
through the hurlx -burly of popular election The voluntary 
hospitals xvould fail unless they had municipal assistance and 
it thex took such contributions they must expect to concede 
representation on their management 

Dr T Ruddocl-West (M O H Norfolk) said that m his 
area co operation was xery much in evidence He himself 
knew practicaity every general practitionei Almost all the 
welfare work xxas done by general pracuiioners There xvas 


Tiif Orithu 
Medical Jourv^l 


no dilhcultv iboul co option on commtUecs He believed m 
continuUx the sime practitioner so far as possible should do 
the intc natal work and the mitcrnity ind child xxclfarc work 
Dr Lithia rAiiiniLD snd she had been an official throiighom 
her career but never a biireaucrit The patients welfare was 
the crucial test Dr J Binm it (Warrington) said that he had 
been eighteen years in the public health service but his bias xxas 
in fax our of the gcncril practitioner At the same time in 
working maternity and other schemes, practitioners were not 
always above reproach He instanced a maternity home 
intended for difficult cases but to which practitioners sent 
many normals 

Sir Wiiiixxi WiiLCOX in reply said thit he was in faxoiir 
of co option of medical men on subcommittees but not on 
the councils thcmsclxcs for such scats they should run the 
gauntlet of popular election He hoped the outcome of the 
discussion would be tint the Branches and Divisions xxould 
gel into communication with medic il officers of health in 
their different districts and talk the matter oxer as to hoxx 
CO opcrtlion could best be brought about Professor Pickcx 
ilso in replx said that 'xhilc co operation xxas an adniinbk 
xxord so mucli time coiitd be spent in trxing to xxork out 
methods that the spirit of the thing faded awax The solution 
ot the xxhole problem would be found in that admirahk 
document — ‘ Proposals for a General Medical Scr'icc for the 
Nation 

Mr R R Blixxlti of St Dax Cornwall addressed the 
Section on Some Medic il and Social Changes in a Dcrxiict 
Mining Area \ report ot his remarks and some comments 
thereon appeared in the Journal of ■Viigiist 6 (p 29^) 


SECTION OF OPHTHALMOLOG\ 

Fridnx Jtih 22 
Cornctl Transplantation 

With Dr C B F Tixx (Plx mouth) a Vice President m d'x 
chair Mr 3 W Tudor Thomas (Cardiff) read a r'tP®'' 
corneal tiansphntalion giving results of fift' operations 
on forty -eight exes a senes extending oxer neirly eic 
xears and showing 6^2 pci cent of successes If onlx cases 
that could be regarded as favourable from the operative pom 
of view were considered 92 1 per cent of successes were 
obtained Since 1916 he had used a modified technique an 
the results on a comparable basis were better all favoura’i- 
cascs were successes 

Sir Stexvxrt Dull-Elder ind Mr H Cxiger 
expressed their gratification at the results and Mr A . 
Gunn related his personal expeiicnces with one case of cornm 
grafting 

Pathologx of Glaucoma 

The President Sir Stewart Dull Elder took the clnir 
to introduce Professor K WessELX of Munich xxlio reat 
paper on some special problems in the pathology of ghuconn 
He drew attention to the difliculties in diagnosing glaiicom^ 
in high myopia The appearances of the disk in 
tended to mask cupping the attenuated sclera interfered "i 
tonometer readings and choroidal atrophy with the iiiappm*- 
out of field defects These difficulties could be oxcrconie i 
stereoscopic ophthalmoscopv repeated tonometry and spxcia 
care with perimetry He described in some detail thirtv one 
cases of glaucoma in mvopes, mostly of 10 to 20 D 
impoitant than the recognition of the fact that glaucoma 
occurs in myopes xxas the fact that myopic eyes "cn- 
especially piedisposed to it In anisometropia glaucoma 
tended to occui in the mxopic eye 'only and there seemed o 
be a special piedisposition in mxopic eyes with aphakia n 
drew attention to a transient acute glaucoma frequently seen 
two to SIX weeks after operation tor cataract m mvopes am 
urged the sparing use of mxdriatics in the post opcrali'C trea 
ment of such cases Theoretically thcie xvas some basis to 
the view that high myopia xvas a kind of bupfidmlmos 
Another group of glaucomatous conditions that he disciis'C 



\LGl.'ST n, IPj*: 


Tut Bwnai 
MiX- Jovx. 


69 


THE SECTIONS SUMMARY OF PROCEEDINGS 


ihc ric of len^jon <ccn in h icniorrlnpic ’iiudic^ of the 
eve The old mcw thit the pi mcoma Nsns econdin wis 
probabU noi valid It was more likclv tint the two procc^'^cs 
had a common factor 

The PKiMDisr eniphasi/cd the points brotiplu out bv Pro 
lev or Wesseh who he said had brought a wide philos^ophicil 
outlooV. to the p oblems of gbucoma Too much infiucnccd 
b\ the teachincs of Pncstlcv Smith ophlhalmolocists tended 
to o'erJoot^ glaucoma m mvopes It was well to rccocnize 
that glaucoma wns not one disease but a svntplom of a vanctv 
ot conditions and that blockacc of filtration was not the 
oah cause ProfcNsor A i fULL.sxn'vr (Glasgow) sugccstcd 
that l^e claucoma of hich mvopn michi be secondarv to 
chronic uveitis itself a part of the nivopic process Dr 
MsRK Gsrdver t^Mclboumc) gave the details of a case which 
supported the views of Professor Wcssciv as to the association 
of the glaucomatous processes with vascular disturbances 
\fr W S Blrp (PIv mouth) had found that a glaucoma 
iridcctomv prior to lens extraction m high mvopia avoided the 
complications of glaucoma In regard to glaucoma associated 
With arterjosclero'is he held that such patients were un^atis 
facton subjects from the general point of view 

Contact Lenses 

Mr A Rigg Gunn read a paper on the Contact Lcn> 
Centre Its purpose and policv He explained the workings 
of the centre which w-as now responsible for-some of the 
finest work in this field It was not run on anv profit making 
basis such surplus as was likelv to be accumulated would be 
utilized to further the training of people for this work for 
« Samanian fund and to encourage further research These 
actiMticti were under the supervision of an advisorv committee 
consisting of some of the leading figures in ophihalmologv 
Miss Ids VIunn stressed the value of the centre as a research 
ba«e Others who took part in the discussion were Mr W S 
Bt.RR tPivmouth) Mr J M Bickirton Dr Maw- Gardsfr 
(Melbourne) and Dr C B F Tiv\ (Ph mouth) 

Miss Ids Mann showed a number of patients wcanng 
contact lenses both of the Zeiss pattern and individuallv fitted 
The patients illustrated the conditions for which such lenses 
could be used high mvopia monocular aphakia keratoconus 
comeal scarring and high hvpcrmclropia There was good 
tolerance in all eases some patients wearing the lenses up to 
fourteen hours a dav and showing improvement m visual 
acuiiv ovc' ordinarv spectacles 

^l(aI Sfaming of (he Fundus 

Mr Arnold Sorsbv in a paper on vital staining of the 
fundus gave an account of the experimental work that he and 
his colleagues had conducted to establish the clinical possi- 
bilities of vital staining in ophihalmoscopv The difficulties 
that had to be overcome were the blood brain barrier and the 
toxiatv of Vital dves ^\hen staining of the brain was 
obtained cxpcnmentallv no retinal staining could be seen 
owing to the reduction of the dve to the leuco-base In rabbits 
with retinal degeneration produced expcnmcntallv reimal 
•^taming was alwavs present The preliminarv clinical use of 
this procedure had established its leasibilitv and had shown 
this to be povMble in a vanctv of conditions of which the 
localization of holes and retinal detachment was an example 
Mr J \V Tlewr Thomas (Cardiff) and Sir Stewart Dlke- 
Elder asked about the po«sibilitv of avoiding general staining 
bv vising the dve locallv In replv Air SorijBv stressed the 
difnculncs and uncertainties >et to be overcome 

Mr A L Candler (Exeter) read a paper b\ himself and 
Air N L Capen-er (Fxeter) on the avian nictitating membrane 
After bnefiv descnbing the analomv and histologv of this 
Mructure thev showed that the membrane was proiective and 
also that certain birds such as ducks and penguins completelv 
clo'ied the membranes when under water and saw clearlv 
through them Photographs taken through the membrane of 
ducks were shown This profusely iIIuMraied paper was 
disruA^d bv the President Atr A Rlgg Glnn Mr R 
Pawe (Plvinouih) and Mr J M BicKEirros 


EXHIBITIONS or FILMS AND RADIOGRNPHS 

A most interesting addition to the Scientific S-^ctior-s at the 
Annual Meeiinc at Plvrroulh was a show of cinema filn< 
miinlv in colour which was given on the afternconi of N\ed 
nesdav Thur dav and Fndav JuJv 20 21 and 112 The fell 

list of films which were projected bv kodak Ltd with the 
name of the demon iraior was as follows In ihe Seciion 
of Gvnaecologv and Obstetrics Resuscitation of the Ne\ 
born Dame Louise Mcllrov Section of MedKire 

p4-renlcral Liver Therapv in Sub^-cute Combined Decenera 
(ton of the Cord Polv neuritis \ ith Special Re^ereni.e to 
A itamm B Dr C C Lnclev Section of Pathologv 

PMttacosi', \ iru '' A Studv of Tissue Culture (W :h 
the late R G Canti) Dr 3 O Yv Bland Section ot 
Phvrmacolog Sanctions to Anaesthetics in a AIou e 
Colonv Pro^c ^or A J Clark Section of PhvMolop 
Difficuliics ot Po'^turc and Equilibnum in Blind Children 
Dr Phvlhs kcrndcc Section of Surgerv Surgerv ot the 
Hcari Mr L O Shauchnes<JV Svmpathectomv for Hv per 
pic<t<‘ Mr A Dickson Wricht Partial Thvroidectomv for 
Thvrotoxico is Mr G Armiage Abdomino penneal Re 
<cction of the Reaum Mr A Lawrence Abel There \\e e 
aho films on the Action of the NIuscles of the Foot Air C 
L'’mbrinudi O tupational Therap in RhcLm^iod 
\rthriti Dr Flizabelh Carson and Plaster Lc)et lor 
ScialicT Mr N Caperer 

Mr E O Oosv honorarv r*.diographer to the Meeting, h'^d 
'‘l<o arranged an exhibition of radiographs and clmical pho o 
graphs. Manv of the photographs were m colour ard v ere 
cntirclv Iws own work 


PSYiHOTHERAPY CONGRESS AT 
OXFORD 

The following report of the tenth International Mediw_al 
Congress for Ps}chotherapv held at Oxford from Julv 
to A^ugust 2 IS a continuation of that published last v eek 
at page 29S 

Disorders of Adolescence 

Dr Evianlcl Miller opened the morning <^«5ion on 
August 1 with a paper on the disorders of adole'ccrce 
This penod was marked he '^aid bv an overflow of instinctual 
pressure where ego detences were weak or the development of 
x moral tvrannv from within which was met bv neurosis 
formation Character trails might be hardened The mental 
reactions might be petrified and the mind stav in a stale of 
suspended animation Socieiv became a projection screen 
for the tragi-comedv of adole^^ccnl interpretation The 
neurotic mechani'^ms were nearer to the surface than at other 
periods clearer and more admixed with psvchotic qualu es 
The problems aro'^ out of the struggle of the maturation ot 
functions that of the super-ego with the growing *^exual and 
aggressive demands Societv must meet the aspirations which 
this phase of temporarv disintegration tended to produce Dr 
E. H Larnln suggested that psvcholherapists tended wronglv 
to treat adolescence as being necessanU pathological The 
attempt to get awav from a pnmilive bigoted super-ego 
tvrannv into the freer and more fruitful democraev of a 
religious svstem was not a pathological process Dr 
Low.'ENFelo suggested that when »he endocrine functions of 
pubertv came into operation the whole pnrrarv sv<iem 
of the mind became recharged and the adolescent strove to 
express everv part of it which had not vet been expressed and 
so to gain masters of it A varied societv and a rich 
therapv could give him the maienal for this expre^’^ion ard 
enable him to adapt the pnman matenal to the needs of his 
own per onalitv and of the soaal life 

An Open Clinic for the Maladjusted 

Dr 1R.A S Wile (New Aor>) explained the vvorKing of the 
Open Chnic for problems of ju enile behaviour The child 



370 August 13, 1938 PSYCHOTHERAPY CONGRESS AT OXFORD 


Tdt Dfnim 
Nttmcxi, 


•ind Its parents took part in an open conference with the 
clinic officers and a hrge audience drawn from all classes 
and callings of societj — the parents of the children attending 
the clinic, and interested persons The behaMour problem was 
thus regarded as a maladjustment between the child and his 
naiheu The family was seen as part of the social orgtntzt- 
tion and the discussion transferred the responsibility to the 
large group representatue of society itself A ncyy system 
ot ethical y allies greyv up from yyhich cyeryonc concerned 
yvoiild profit The Open Clinic sersed as a mouthpii.ee of 
society Emotional tensions yvere drained assay from the child 
and Its parents and an opportunity ssas gisen foi cffcctise 
suggestive therapeutics in the presence of the mass Di 
VAN DER Hoop asked svhether the psychic examination was 
like the clinical examination ‘to the ssaist only Dr Wile 
replied that it ssas total and that all sexual questions sscrc 
brought fully into the light 

Lose, Maturation, and Monogamy 

Dr VON HATaiNGDERG speaking on lose as a process of 
maturation said that lose ssas an indispensable tunction in 
the deselopment of the personality Its importance had in 
creased svith the increase of consciousness This method of 
deselopment was one of the basic ideas of analytical psxcho 
logy and the silence of the literature about it ss is remark 
able It took place only step by step and needed intimate 
human contact ssith the sexual partner as a vital stimulation 
Love had the task of making good the harm done hv hxper- 
consciousncss It made bearable the unavoidable growing 
pains caused bv consciousness and the inner conflict between 
the nameless groups of forces aroused bv the love passion 
Love expressed the hidden repressed childish side of the 
personality and provided a kind of reserve for the ex- 
pression of primitive tendencies The relationship of 
conscious individuals in marriage developed into an analytical 
situation The repeated upheavals provoked bv the reciprocil 
innei disturbance of the partneis could lead to the realization 
by each of his personality This possibility gave a psycho- 
logical background to the ethical demand for an indissoluble 
monogamous marriage 

Dr O H Woodcock, mentioned the contribution of Adler 
to the subject he had regarded maniage as a constructive 
task demanding equality between the sexes ind monogamy as 
indispensable for full maturation 

Stage Fright 

Dr F VoLGYESi (Hungary) in a paper on stage fright 
and neuroses in professional life said that this class of 
neuroses clearly demonstrated a long series of neurological 
and glandular reactions and interrelations It could involve 
organic causes or short circuiting within the insulation of the 
sympathetic system, congenital abnormalities and accidental 
factors It offered a particularly favourable field for hypnosis 
and suggestion In a study of over 2‘i 000 cases he had 
gained an insight into the mechanism As Pavlov had shown 
every nervous irritation first excited isolated nerve tracts and 
centres but if energy were accumulated or the excitement were 
v'erv intense it would irradiate adjacent centres and become 
general The whole body might ache with the generalized 
tension Professional neuroses primarily represented asso 
ciative disturbances caused bv psychological tactors in the 
temporal and frontal lobes Therapy must aim at interrupt- 
ing the subjective phobia le iding to the feeling of panic and 
breaking the vicious circle at producing an intimate and 
confidential relationship with the patient and at training the 
patient to discipline himself bv turning his attention from the 
fixed idea and opening other channels for the stored energy 
He must see his troubles in their true proportion and 
harmonize his neurotic feelings with the outer world 

A paper bv Professor Erwin Stransex (Thenna) on the 
relationship of subordination and authority in psychotherapy 
was read in his absence Dr H Ncugartln (Germany) ex 
plained the phenomena of psychotherapeutic reorientation 
md religious rebirth 


Psychollienpy m Orgtnic Disc.asc 

Dr H Slot MS, (Hollindl dcilt with psychotherapy for 
patients with circiihlory disease The circulatory system 
like tvers other sornitic system he said had a psychological 
as veil as i pin sic il function Most sufferers from circu 
latorv disorder needed psychotherapy especially if the 
physical condition were o\crIaii1 with neurosis or depended 
on spasm He described the use of the electromagneti; 

tensognph for mcisurmg essential hypertonia continuously 
and showed the psychic laclors in its causation Active 
rclixalion ind Schultzs autosuggesttve methods were valuable 
but the important requirement w is a good rapport between 
phvstcian and patent 

Dr \ T M Wit SOS in in address on the psychogenic 
factor in haematcmcsis gave the results of a study of fifty 
cases of icutc peptic ulcer or chronic peptic ulcer with com 
plicition Of fifty -eight hicmaicmcscs fortvjivc had been 
preceded bv some gross iltcration in the patient s Iite of a 
kind likelv to produce emotional stress In ten of ths 
renutnder there was evidence of precedent gross emotional 
stress The resulting psychological tensions were such as to 
threaten security — independence or dependence PrccocioU' 
and ipp ircntlv successful assumption of adult responsibility 
had often been concerned in the development of their char 
actci traits and strong primitive moral values Haemorrhase 
often relieved the tension for several days The selection 
of the gastric function is the site of the symptoms might 
result from similar tensions in verv carlv phases of develop 
ment Cnjovment and use of anxiety and a martyred attitude 
were common This might be resist int to psychotherapy 
hut the ulcer producing conversion might be broken down 
without much difliculiv The piticnt must first be iulpcd 
to convince himscll of the sequence of external and internal 
events 

Dr D \NNVt. (\ugoshvii) contributed a studv of pj'vho 
therapeutic po'-sibilitics in organic disease illustrated by tyyo 
cases The first pitient a voung woman suffering from a 
severe disseminated encephalomyelitis was treated bv hypnosw 
for neurotic symptoms and extensive movements of the leg 
were obtained with and later without, hypnosis When the 
treatment was interrupted the symptoms became worse The 
second case was one ol hemiplegia with motor aphasia m a 
rich man who at first made little progress but was later much 
improved bv emulating the superior progress of a workman 
who suffered from a similar condition Psvchic components 
were too seldom looked for and dealt with The effects ot 
organic injury could often be overcome 

Dr W Brown said that such a trauma would certainly 
increase suggestibilitv Certain cases of disseminated sclerosN 
and paralysis responded to hypnosis with relaxation treatment. 
An organic neurological disturbance was always accompanied 
bv a psychological overlap Self-understanding throuen 
analysis gave help but every case of organic trouble wouta 
benefit by autosuggestion and progressive relaxation 

Dr Clifford Allen tracing the relation of the ps'i-he 
to the endocrine glands pointed out the reciprosa 
action ot the psyche and the glandular system 
opinion all h> persecretoi y endocrine disease in which there 
was no neoplastic disease was psychogenic Similarh u'C 
glandular functions could be inhibited bv psychic factors 

Professor Jung closed the conference' bv answering m detail 
a number of questions whichTiad been submitted to him m 
writing During the conterence the University of Ovlor 
conferred upon Professor Jung an honoiary doctorate o 
science and on his return in his robes to the congn-ss In 
delegates stood and applauded Di H Crichton Miller sal 
that their applause expressed their appreciation and that t> 
Oxford and the world of his great services to psychotherapy 

On July 30 the Vice Chancellor of the University Mr X D 
L,indsay held an evening reception in the Ashmoltan Museum 
On the morning of Sunday July 31 delegates and their 
relatives went on an excursion to Henley and Wargravc an 
made a river tup in motor boats On Monday cveninc t s 
Mayor and Mayoress of Oxford gave a dance in the Town 
Hall 



13 19'S 


■N \TIOKAL HEALTH IN FIGURES 


THE NATIONAL llEVLTH EIGURCS 

ANNUAL RLPORT 01 Till MINISTRY 

In T foreword to the Annual Report ol tht Mmi!>;r\ of 
Hi-Jllh’ Dr U alter Elliot compares conditions is Ihes 
Were 1 hundred sears igo when Edwin ChidwicL began 
fits reforming work with whit lhe\ ire to di\ The 
general death rate has been haUed the intaniile death 
rate reduced to one third the tubereulosis de ilh rale to 
one si\th In 1S3S o\cr 1^00 persons per million died of 
ts-phoid over I 000 per million of smallpov over 20 per 
miHion of cholera Tlvc tvphoid death rate is now down 
to 5 per million and from smallpox and cholera no deaths 
were recorded tn 1937 Dr Elliot adds We arc onl> 
beginning to realize how much can be done even in the 
case of those who arc at present considered normal and 
fit 

TTIal Statistics 

But, after all this is the nineteenth annual report of the 
Ministn and the record of the post war era though 
less dramatic than thaUof a centurv is perhaps rnorc 
encouraging Take 1921 as a convenient date The 
general death rate vvas then II 3 it is now 9 3 The 
intant mortaUtv has fallen during those vears from !>3 per 
thousand live births to 57 the tuberculosis mortalilv from 
I 117 per thousand of the population to 0 657 The 
figures for Males the subject of a separate section are 
shghtlv in advance of those for England — a general death 
rate of 10 3 an infant mortalitj rate of 63 and a tuber- 
culosis death rate of 0 S62 

The report embodies the usual 'ables relating to tuber- 
culosis venereal diseases enteric fever, and cancer The 
notifications of new cases of tuberculosis are slightiv up 
both m England and tn M'alcs A decrease in the 
incidence of sjphilis but not of gonorrhoea is noted 
Despite the Croidon outbreak the notified cases of 
entcnc fever fell from 2 490 in 1936 to 1.149 m 1937 but 
the first figure vvas swollen bv the Bournemouth outbreak 
of that vear The number of deaths from enteric was 
206 a rate of 0 005 per thousand which is about the 
average of the last eight years The total number of 
deaths from cancer m England in 1937 was 66 965 the 
highest figure vet recorded — an increase of some three 
hundred on the previous year It is slated that plans 
are being worked out in SI areas for co operation between 
local authorities and the radium centres at voluntary hos 
pitals with a view to making the treatment at the centres 
more widely available The notifications of diphtheria, 
pneumonia dysentery, and puerperal pvrcvia or sepsis arc 
up on the year those of erysipelas and scarlet fever arc 
down 

Matcmitv Services 

The Ministry expresses itself well satisfied wnh thc 
result of us two pushes — the Fitter Britain exhibit 
at Glasgow and the National Health Campaign The 
full effect of the latter cannot yet be as'essed but it is 
said to be reflected m the figures of attendanevs at 
infant welfare centres and ante natal clinics These 
figures for 1937 show a considerable increase though the 
c^paign did not begin until the autumn of that vear 
The children under 1 vear of age attending the centres 
reached a number equalling 63 per cent of the tola] of 
notified births (as compared with 60 5 the prev lous \ ear) 
while the percentage of expectant mothers attending the 
ante natal clinics reached 54 1, again a record figure 
(against 48 S the vear before) The maternal mortalitv 
in England fell to 3 11 per thousand births comparing 
with 3 6 in 1936 and 3 9 in 1935 The proportion 
ascribed to puerperal sepsis is 0.94 compared with I 34 
^56 In M'ales the maternal mortalitv vvas 4 54 con 
siderablv higher than the English figure although a note- 
worlhy reduction on the M'clsh figures for the previous 

^ H Vf Stalionco Office Cmd ssoj nel ) 




siv vears which have alwavs been over 5 0 ,.nd n .. 
reached 6 6 

It IS too soon again to estirr-'ie the effect ot me 
Midwivts \ci but in the countrx gene-ally the wort o' 
establishing a va'a'ied service of fjlJv qualified mid v .5 
available for attendance on motners m th-ir ov n ho"es 
at a cost commensurate wiih their mean^ has ceen 
snntiallv achieved Durm,. the ve„r 649 addi. oual 
mucrnitv beds lincluding ante natal beds) wee provided 
bv the local aiithoruies and the number of munic pal 
maiernilv homes was increased bv inree Consuhing 
sc'vices enabling midwive- to call in a doctor at need 
have b.tn established bv 340 authoruies out ot a to _I of 
,65 and mobile em,rgencv umi available ‘'or worren 
who cannot safelv be removed to hospital ha'e b,en 
completed bv 36 authorities while 18-t have put into 
openlion the service of home helps’’ 

Public Health and Hospital PoUev 

Ten vears ago the Roval Commission on Local 
Governmen laid it down that medical officers of heahn 
should wherever possible be whole lime officers m the 
public Service and should not engage m pr va e p -et -e 
further that m areas whc“c the Jutes sji ,, ne r p, 
cient to occupv a whole urn, othae he a- ^ eo a- 
should b. required to male p oposa's i jr ''e ce~'‘' r 
tion of areas tor in's purpose fhe pre c- epj 
that the ^Inls e liis ta! en everv eppo^ _ i Je" 
local aiilhoriliee, e follow h s coarse kr e' cn i-.. c 
been formuiit d n ,.11 cXeep nine o r " i 

counties in tn.L id nd in ee ,. n rsij'-we 'e ' i n 
has not hes la'ej >o u.e hi po er o e, vg "e 

formulation o scheme w h n s \ m''f “ i 

default formalalin^ it himself J st unJe n,.i e, 
counts districts o England are ne ,r eo b oiTi,.-_ 
who are resirieied as' to priva e praci c^ ,.nJ ot "'s 
officers including lemporarv officers approved d ng the 
year under review s 3 mil not pract st psivaieiv \ 

the end of March last out of tne to a! ot ja t e 

1 000 medical officers of htalih m England 4e" did 
so engage 

The report mentions that a survey ot the whole ol ih. 
hospital and institutional facilities of the countrv h.s 
been m progress Sir George Chnsial the Secretary of 
the Minislrv^ told the Press representatives at a reception 
at which he expounded the Annual Repon that this 
survey had now been completed and was likely to vie'd 
most useful results not onlv m the event of war wh ch 
was Its primarv purpose, bu in the normal planning of 
institutional facilities 

The report states that the appropriation as general 
hospitals under public health powers of the institutions 
taken over from the old boards of guardians is making 
progress although in the counties where there are special 
difficulties the progress is 'low Out of the 109 hos 
pitals with a total ot 57 3JS beds so far appropriated onlv 
22 belong to the counties (excluding for this purpose ihe 
countv of London) and half this number are in the 
metropolitan counties of Nfiddlesex and Surrev It is 
hoped however that the time is not far distant when ihe 
majoritv of beds m local authontv hospitals will be pro- 
vided under public health powers In patient admissions 
to these hospitals are increasing bv about 50 000 a vear 
and out patient attendances (verv largelv in the nature of 
attendances for continuation treaiment of patients pre- 
viouslv admitted to the wards) increased bv not far short 
of a quarter ot a million Afajor surgical operations done 
at these hospitals and institutions numbered 131 000 an 
increase ot 10 000 on the vear One does not expect to 
find current controversv mirrored m a report of this 
description but co-operation between volnntan and local 
authority hospitals is declared to be growing — ^as a result 
sometimes of the setting up or committees for formal 
consultation in connexion with particular schemes a; 
others of the establishment of joint consultative com- 


372 August 13, 1938 


NATIONAL HCALTH IN riGURCS 


Tiir Britiw 
McDICHL JOURN»t 


mittees aiming at a liaison of a more continuous' char- 
acter or, again of joint hospit il boards such as hive 
come into being in Manchester and in Oxford and district 

National Health Insurance 

The insurance practitioner comes in for his usual 
‘ pat on the back ’ after he has been reminded of his 
kick downstairs (that is not the Ministry’s expression) 
in the reliisal of the Court of Inquiry to raise the cipita- 
tion fee A review of the disciplinary proceedings says 
the report gives every reason for thinking that there hvs 
been no deterioration in the high standard of scrxicc 
reached by insurance doctors and chemists though with 
regard to the chemists to be sure, there is an increased 
number of cases (161 as compared with 119 the previous 
year) in which money has had to be withheld on account 
ot breaches of the terms of service, mostly substTnual in »c- 
curacies in the dispensing of test prescriptions In only 
one case during the year was a representation made by 
an Insurance Committee that the continuance of a doctor 
on the medical list was likely to be prejudicial to the 
efficiency of the service, and even in this one instance the 
representation was later withdrawn In only 92 cases in 
England and 16 m Wales was remuneration withheld from 
practitioners on account of infringement of terms of 
service, and only in a very small number of these did 
the patient suffer from the doctors negligence m URnd- 
ance the majority of derelictions were failure to keep 
proper medical records or to turnish information required 
by regional medical officers or some non-observance of 
the medical certification rules The largest sum withheld 
(m two instances in England) was £50 A form of 
irregularity which the Welsh Board of Health views with 
grave concern is the issue ot certificates of incapacity 
by a practitioner when he has not seen the patient In 
one case this was judged so seriously that a heavy fine, 
again £50, was imposed 

The cases of excessive prescribing come into a different 
category The regional medical officers paid 861 visits 
to doctors whose prescribing appeared to call for explana- 
tion but in only six cases did the Minister feel it neces- 
sary to refer formally lo Panel Committees the question 
whether the doctors’ prescribing had imposed charges on 
the available funds in excess of what was reasonably 
necessary, and in all of them it was found that such 
excess had been imposed But altogether it is a wondci- 
ful record of absence of serious complaint, and it must 
be remembered that the insuied population of England 
and Wales now numbeis 17-} million persons as com- 
pared with 11“ million when National Health Insurance 
came in a quarter of a century ago Two developments 
during 1937 from which much is hoped are the extension 
of benefit to juvenile contributors — the 14-16 class— and 
the scheme for postgraduate study for insuiance practi- 
tioners 

Miscellaneous Items 

There is much else in the Annual Report of the 
Ministry to make it one of the indispensable documents 
of the year for the social student There are sections 
dealing with the Ministry s action in respect to foods and 
diugs, with sanitary services, with public assistance, with 
housing and town planning On the subject of nutrition 
It IS mentioned that quantitative siuveys on family diets 
are being carried out on the recommendation of the 
Advisory Committee on Nutrition of which Loid Luke 
IS chairman in half a dozen rural districts, and n is 
believed some valuable data will be collected to supple- 
ment the Ministry of Labour survey on family budgets 
A leflection of the National Health and Fitness Campaign 
may perhaps be found in the fact that the public open 
space purchased during the year measured 12,113 acres 
as compared with 9,059 the previous year, and that the 
loans sanctionea for public baths and swimming pools 
Tmoiinted to over a mitiion pounds as compared with a 
little more than three-quarters of a-mdlion in 1936 


Correspondence 


Abortton and the Lass 

Sir — Mr Aleck Bourne s letter in the Journal of Jul> 30 
(p 254) clcirs a confusion that svas m my mind at least 
Before the case was tried it seemed to me that Mr Bourne 
had ictcd for the sikc of a cause thereby risking ho 
professional reputition and his freedom When the case 
was tried the fight for a principle seemed to be dropped 
Instead the case turned on the jury s optnion as to whether 
or not Mr Bourne was justified in terminating a pregnancy 
in a certain child And now one understands from his 
letter that the rc il issue after all is a principle He is 
standing lor a further definition of the present law to the 
end that ibortion miy be legally recognized not only when 
there IS 1 danger lo life but also when there is a serious 
danger to health I believe th it there is a large body of 
moderate opinion in the profession that is opposed to 
the views set forth by Mr Bourne, and I would like to 
St itc an alternative case in the following terms 

The law as it stands is satisfactory Abortion is legally 
recognized when lilc is in danger and this interpretation 
of the law has alvv ivs been recognized and acted on It 
IS m keeping with general medical practice for we doctors 
are primarily concerned with life and death In simple 
terms it is our duty and our object to preserve life Life 
IS more important th in health Many a life that has been 
sivcd from the jaws of deith has afterwards been a good 
life, even though health has not been recovered In (not 
we do not take the prospect of health into account when 
vve arc trying to save a life 

The very uncertainty of thcMnw as it now stands is 
an advantage It places a great responsibility on tn* 
members of the medical profession and it leaves the 
decision as to the life or death of a foetus to their dis 
cretion There is no doubt that some of us on accoun 
of a lack of courage Or for some other reason fail to 
maintain the high standard expected of us" K t man 
falls below the standard of integrity that he has set him 
self he may find himself m a difficulty and he may be 
greatly worried But that the members of our profession 
have m the past generally acted well in the opinion hot 
of their colleagues and of the people is proved to my nnn 
by the tact that I remember no single occasion on whic 
a doctor of good repute has had to stand his trial by jurj 
for unlawfully terminating a pregnancy ^ . 

If the law IS to be alteied by a further definition it "'i 
be no easier for us doctors to interpret than it is no" 
There may be as little difference between one case an^ 
another as there is between the numbers 1, 2 and 3 
further definition will leave us with the same diflicully o 
judging between 2 3, and 4 And because the definition is 
more exact we shall be more likely to bicak the law in sue i 
action as we take 

If, nevertheless the powers that be determine to frame 
a law that is more explicit, and so restrict both the freedom 
and responsibility of doctors, then I enter an earnest p^ 
that they will keep to such primary considerations as^ > ^ 
and death, whether it be in terms of a life that may 
lost or a life that may be wrecked and refrain from 
ducing any phrase that suggests as a primary consideratio 
a danger to health To qualify the danger by the 
“ serious ’ will make for difficulties The human hea 
often quails on the brink of great adventures The r ^ 
month or two of a pregnancy may be the beginning o 



SucubT 13 


COR R ESPON DENCE 


The E jno? 

'lO CA-. TOL-'V L 


the grcilLSt ^d^Lnturc in i persons life nnil the nddnion 
of the word seriou-s, as sut:i,estcd b\ Mr Bourne to 
tiuilifs nniicipalcd danger will lead lo trouble — 1 am etc, 

bondoa 1 August I Grot I Rr \ Ee SNS 

Sir — ^To those who arc in geiicrtl •'grecmcnl with \oiir 
leading article on the Bourne trial it must seem that Dr 
F M R Walshe {Journaf Aligiisi 6 p 11 “il has mis 
interpreted the significance of the \erdict This is siircli 
not affected m anv war b\ the consider ilion to which 
he has directed his powerful polemics~namcli whether 
and how far danger to hcilih connotes danger to 
life The important fact ts that the verdict has clarihcd 
the position m law of the doctor who induces abortion 
on adequate grounds based upon danger lo health In 
the past the doctor who has carried out abortion for 
reasons other than danger to life as this is ordinarilv 
understood — that is imminent or serious danger of death 
— has had no securitv in law The verdict has now 
regularized a long standing medical practice This is a 
different issue from that inherent in Dr M'alshes state- 
ment that lo the aphorism life depends upon health 
the inference that danger to health neccssarilj connotes 
danger to life is a non segniinr 

WTaile as I suggest this raises another and quite 
different issue it is perhaps relevant to point out that 
It would be difficult to cite influences which damage the 
health of the pregnant woman which do not at the same 
lime connote not certain death but a real morlahiv risk 
The essential medical problem remains as it was before 
the verdict— namelv what measure of danger to health 
and life is an adequate indication’ This like all such 
problems must remain a matter of discussion and in 
general will be determined bj the average good sense 
of the profession fseither is it easy to follow Dr Walshe 
in his view that the verdict should make this responsi- 
bihl> of the profession more difficult than it alreadj is 
unless vve admit that it ma> be exploited for illicit and 
extremist purposes But this is not so much a medical 
as a sociological implication 

Finallj, I wonder if we have been quite honest with 
ourselves in regard to the question of rape It can hardly 
be m doubt that as the natural and indeed on!>' court 
of appeal m circumstances of a heartrending nature the 
obstetrician is sometimes influenced bv humanitarian con- 
siderations in performing abortion- on such ravished 
children The medical indications, though obvious ma> 
in themselves be less urgent than are found m many 
married women for whom such relief is refused Are 
we not correct in assuming that the public conscience is 
prepared for a law to deal specifically wiih the tragic case 
of the raped child’ — ^I am etc 

London \V 12 August 8 JAMES YounC 

Sir — The recent case in which Mr A AV Bourne was 
involved received wide publicity m the Jav' press and was 
also the subject of two leading articles in vour issues of 
July 23 and 30 May 1 as a general praciiiioner be 
allowed to say that personally I cannot see that the posi- 
tion IS anv clearer to us now than it was before this case 
was heard I have alwavs been clear in my own mind as 
to what constituted genuine and perfectly legal grounds 
for terminating a pregnanev in a woman and such a course 
would never be entered upon without the concurrence 
at least of fwo other independent medical men of whom 
one at least should possess higher qualifications and greater 
experience in surgery or gynaecology 1 imagine that all 


mv colleagues and others in general prachce are ecua> v 
clvir in Ihis matter and m order tO observe .be ]ai and 
strict medical etiquette would act as I have mdieaied 

It mav be that m a reallv advanced stage of ..ivViza'icn 
the hv will be different and that then no woman will b- 
forced to become a mother unlc-s she ts willing and anxious 
so lo be \fanv advanced and serious thinlers m various 
fields hold this view to-dav and I am very much mc'med 
to It mvsUf However it is not for us medical men 
to male or to niodifv the laws of the land (apart from 
pressing for nccessnrv refo-ms a> citizens) but b-ing in 
a special degree of relalionstup and trust with the State 
to observe the laws as vve find them to dav 

\\c practitioners understand our duty and our posu cn 
quite clearlv we are not to eonnive at or to procure mis 
carnage simplv beeau c the patient desires to be rid of 
an inconvenient pregnanev Mr Bournes case was ar 
exceptional one and I cannot see how it has clarified or 
defined our position any better at all U is difficult to see 
that absolute consislenev prevailed throughout tlie entire 
length of this case or that the same grounds were taken 
for clearing out this girl of 14^ all he wav n ouZ" 
To be logical It should be remembejcd ’hu m *’e '-r 
instance Mr Bourne accepted the case .rora Dr Je.- 
Mallcson and agreed to terminate pregnanev b-tcre be 
had even ‘e-n the ehild It is impossible o resis’ t*'“ 
conclusion that Mr Bourne acted ah it t o an pu e 
sentimental moral and s' mpathet.c grounds Bi be dio 
not stand his iriai on those grounds at all He durnu-d 
himself on the grounds ot it being mednaiK es rab'e .ad 
necessary to lermin ite the girl s pregnanev — a er d fferent 
matter Even member of the jure would natural's v h 
his (or her) daughter in a similar plight lo be aeeo'ded 
the same relief No wilncsees were called bv the A tornev 
General to uphold the view that the child might quite 
well and safely have been allowed to go to 'erm 1 
am etc , 

Charles ‘A H Fr-vni-lys 

luncoljv August 2 H MJLC S 

Diabetes ^and Pulmonary Tuberculosis 

Sir— I f 1 mav be allowed to add a note to Dr S 
Roodhouse Gloynes article in the Journal of Julv 30 
(p 218) I should be grateful because m this countrv there 
has been very little apparent interest m this problem 

At the end of 1934 of the 1000 diabetics who had 
attended the clinic at Kings College Hospital fortv two 
had pulmonary tuberculosis, two of these had developed 
diabetes while under treatment for the tuberculosis making 
an incidence of 4 per cent in those with diabetes The 
mean incidence of figures published at this lime among 
diabetics was m the U S-A 2 6 per cent m the Argentine 
5 2 per cent in Austria 7 6 per cent 

The present rise in the number of deaths from diabetes 
and the decline from tuberculosis, mentioned bv Dr 
Glovnc can be contrasted with war time expenence when 
ihere was a decrease in the mortalitv from diabetes and 
an increase in the mortalitv from tuberculosis (Registrar- 
General s StQUsncal ilevievv for 1934 p 101) Is il fan 
tastic to compare the malnulriUon enforced bv a blockade 
With that produced bv an insufficient supply of insulin’ 
Though what alteration from the norma) is responsible 
tor the encouragement of the seed is still a matter for 
discussion It IS to be hoped that the higher carbohydrate 
diets and other methods of treatment of both diseases vviil 
reduce the morlalm 

The tendency of the diabetic to develop tuberculosis 
should not be forgotten and, as the onset appears to pro- 



374 August 13, 1933 


CORRESPONDENCE 


Tfir Bfirw 
Meoicai Joi'*su 


duce fewer symptoms than usual it might be worth while 
making a periodic radiological examination in all diabetics 
to find It as soon as possible in the 4 per cent or so who 
are likely to develop it — 1 am, etc 
Soiitlnmpton August I G D PlRRtE 

Undescended Testicle 

Sir — I was not only impressed with the clarity and 
logical reasoning of Mr Denis Brownes article on this 
subject in the Jotinwl of July 23 (p 168) but I was also 
grateful to him for introducing me to the “ superficial 
inguinal pouch Having read this article I determined to 
review all the cases 1 had treated with ‘ pregnyl in the 
light of his classification 

I have felt for some time that there would be less 
misunderstanding between the surgeon and the endo- 
crinologist if the anatomical position of the testicle in the 
cases treated could be more accurately defined My 
experience of Ute surgical treatment of this condition is 
limited to the period when I serxed as assistant hoiise- 
suigeon and later as house surgeon at this hospital eight 
years ago My impression is that, U that date, such 
treatment yielded satisfactory results in by no means 100 
per cent of cases My knowledge of the effect of leaving 
these cases untreated is confined to conversations with the 
medical officers attached to certain public schools This 
has led me to accept the view that endocrine treatment, in 
a certain number of cases is redundant I feel that many 
would agree with me that a symposium on the manage- 
ment of undescended testicle written b> an anatomist or 
surgical anatomist a school medical officer a surgeon md 
an endocrinologist would be a valuable contribution to (he 
subject 

During the past five years I have been interested in the 
condition exclusively from the point of view of its treat- 
ment with luteinizing gonadotropic extracts and my 
experience has led me t^ believe that about 70 per cent of 
suitably selected cases' result in the testicle appearing and 
remaining in the scrotum, and that in 50 per cent of the 
successful cases this occurs within three months of the 
commencement of such treatment On two occasions, 
in both of which endocrine theiapy has failed to induce 
descent of the testicle 1 have noted effects to which some 
would have taken exception — namelv, enlargement of the 
penis in one case and priapism in another Perhaps I 
was immodest in failing to be alarmed by the first com- 
plication Fortunately the second was so transient as to 
trouble mv conscience for only a month 

So seriously did I receive Mr Brownes article that I 
was disappointed to learn from his reply to your annotator 
that he had entrenched himself in a “ carefully prepared 
position and that his paper was therefore piesumably 
designed to be provocative I was prepared to accept his 
deprecation of treatment with gonadotropic extracts as 
a sign of the earnestness of his convictions but now I 
am glad that he has admitted that it was ‘ sweeping and 
“ in opposition to the findings of other workers, ’ and I 
feel justified, therefore in reminding him of those cases 
ot general impairment of pituitary function usually classi- 
fied under the title of Frohlich s syndrome in which treat- 
ment with gonadotropic preparations is particularly 
effective in inducing descent of the testicle 

Finally I was sorry to see him raise the unanswerable 
argument of the possible adverse effects of endocrine treat- 
ment in the remote future It was surprising to find a 
man ith his capacity for clear thought resort to such a 

vvhL^' W? T'‘39S^ e'se- 


red herring All the consider ibic knowledge which we 
possess of the effect of endocrine prcparitions leads us to 
suppose th It It IS purely transient, otherwise why wouid 
wc idministcr them in twice- or thncc-wcckly doses'’ We 
have no rcison to suppose that gonadotropic extracts are 
my exception to this impression If Mr Browne mcws 
with suspicion the effect of such endocrine extracts until 
they have been in use for sixty ycirs he must wait another 
forty -four years before his conscience should allow him 
to employ insulin ind thirteen ycirs before he is con 
vinced of ihc importance of Murray s treatment of a case 
ot myxoedema with thyroid extract in 1891 — I am etc 

P M F Bishop 

Diilocrmc Clinic Guys Hospital SCI 
August 6 

*/ In his letter published last week at page 318 Mr 
Denis Browne ascribes two arguments to the author of 
the innolation xvhich appeared with his article in the 
Journal of July 23 He writes “The first is that a testicle 
m the inguinal canal can be felt because the tendon of the 
external oblique is not always tense Reference to the 
annotilion will it is hoped convince Mr Browne that 
what was disigrced with was his statement that “a lestis 
that is in the inguinal canal cannot be felt through the 
skin Mr John Hosford s letter (also published last week 
at p 318) gave further evidence of the validity of our criti 
cism of Mr Denis Brownes statement The second 
argument which Mr Browne ascribes to the author of 
Ihc annotation is ‘ that it is impossible to tell on exanuna 
tion whether a suprapubic testis is in the canal or m the 
subcutaneous tissues The actual words printed were 
“ It seems more reasonable to classify non scrotal testicks 
as (1) those that can be felt — which may be, but are 
probably not in the inguinal canal — and (2) those^that 
cannot be felt which may be anywhere — ^Ed BMJ 


Sir — M r John Hosford s query {Journal August 6 P 
318) about the testicle which can be felt before operation 
above the pubis and which at operation is found m the 
inguinal canal is answered both in my original paper and 
in mv subsequent letter It belongs, of course to one or 
other of the * emergent ' types 

It 15 interesting to me, however as showing the wii 
in which misconceptions have arisen in the past and "" 
continue in the future 1 may be wrong in the conclu 
sions I have come to but the first step to proving me 
wrong IS to understand what those conclusions are 
do not think anyone can do this who has not fu'^j 
identified by examination all the types I describe an 
subsequently made careful bloodless dissections of ihem 
at operation The opportunity for doing this in t le 
normal categories occurs in herniotomies in children, 
when the supeificial inguinal pouch can be studied 
makes a very pretty demonstration, suitable for pos 
graduate classes to expose the fascia of Scarpa push uP 
the testicle under it, open the pouch and define i > 
boundaries But, as in many other demonstrations 
I am accustomed to make, it should be accompanied b\ a 
warning to be veryf careful how knowledge of this m 
IS used in examinations Mr Hosford is surprised I m 
his classes do not recognize the superficial inguinal position 
as an ectopia How many of their examiners do'’ ^ 

I apologize for referring to the testis as the testicle no 
to mention calling the testicle the testis It is "hat 1 
H W Fowler in his Modern Engltsh Usage ciHs n 
Elegant 'Variation — a common fault of unskilful wti ers 
— I am etc , 

Loailon,W I, Augusts DENIS BrOWNE 




CORRESPONDENCE 


U't-usT n I9^S 


Tux 37^ 

CAT JOVX.\A^ 


Siilphanihmide for iMcningococc »I Meningitis 

Sir — ^Tlic Iclter of M ijor I J O Mein m ihc Joiinwl of 
August 0 (p ■^17) indiLilcs sonic doubt ns to the cflicacs 
of 'sulplnnihmidc in iht fulminaling sporadic l\pc of 
meningococcnl nitningilis In one of the uso casts which 
he quotes treatment with scrum and soluseptasmt (Mas 
and Baker) was gisen Now Whitbv [Lmtiit 19^7 1 
I‘5I7) showed thil the benzslsulphonamide prepiralions 
proscplasinc and sohiseptasinc were iitortixt in csperi 
mental /neriiiniKOccnl mtcetions In a recent article 
(Lancer I9'S 2, S) I pointed out this f ici and also gase 
some indications for dosage of sulphanilamidc in this 
disease The scries described coni lined a consider ible 
number of sporadic fulminaling ciscs ssilh hacmorrhagie 
rashes — lam etc 

H STSstxa BssKb 

Medical Superintendent 
Park Ho pit'll 

Hither Green SEP August ( 


Chemotherapj of Gonorriioca 


Sir — A our annotation of \ugust 6 (p 294) rather 
emphasizes the toxic effects of iileron in cases of 
gonorrhoea 

During the last seven months 1 have given uleron to 
200 cases of gonorrhoea in the malt — all ambulator} cases 
under observation bv me at three to four-da\ intervals 
The dosage has been 3 grammes in twentv four hours 
(I gramme everv eight hours approximatelv) for five con 
secutivedavs omission of uleron for two to four davs and 
repeating the five da\ Stoss with same dosage Patients 
were told not to eat eggs or take Epsom salts no other 
instructions The great majoritv have received three such 
Stoss One patient onlv has shown anv suspicion of 
toxic effect and that was a case of photosensitive 
dermatitis like solar ervthema though not exposed to 
sunlight A further twelve cases have received 4 grammes 
in the first twentv four hours of the fivedaj Stoss 
None has shown anv toxic effect 

In mv hands uleron has proved more effective and safer 
in gonorrhoea m the male than had sulphanilamide 
(prontosil album) — ninetv nine cases Uleron is effective 
in earl> gonococcal infections five to fourteen da>s old, 
but even more effecfive in infections of twentj one da)s 
and over 

In staph) lococcal infections — boils and three cases of 
carbuncle — uleron in the above dosage for five consecutive 
davs has been effective and without toxic effects — I am 
etc 


London 


H M Hansoiell 

Honorar) Xtcdicat Supenntendenl and Medical Officer 
i/c Venereal Disenves Departmenl Rojal Albert 
Dock Hospital , 

E 16 August 6 


X-Raj Screening in General Practice 

Sir — With regard to the interesting and helpful com- 
mentarv b) Dr 3 V Sparks in >our correspondence 
columns of Julv 30 (p 256) dealing with the use of 
fluoroscop) in examinations of the chest 1 believe that 
earlv lesions m the lungs would be more frequentlv 
detected bv screening if greater attention were paid to 
certain important factors 

A screen of first-class qualilv is obviouslv required A 
small focus tube is helpful m the elucidation of detail 
\ ra) penetration maj have to be increased in the obese 


the verv muscular and in deep chested subjects The 
patient mi) have to be examined in different positions 
special care being taken to eliminate the shadow of the 
scapulae After a general view of the chest with wide- 
open d^phragms then comparing the same zones on 
cither side with a shghtlv smaller opening it is generaliv 
advisnble to examine anv suspected region with a small 
aperture 

Most important of all factors however is the necessitv 
for taking adequate care to adapt fullv the eves to the 
darkness of ihc screening room It is 1 believe fadurc 
in this regard which probablv accounts for the majoru 
of the cases in which Dr Sparks slates that earl) legions 
of the lungs are not often visualized bv screen examira 
tions ^\llh full adaptation of the eves and oplimal 
technical conditions 1 have seen clearlv on the screen oui c 
small nodular infiltrations limited in extent and small 
Assmann s foci which were not at all dense 

/vs 1 am cmploving radioscopv constantlv I take care 
when engaged m this work to secure sufficient adap ation 
of the eves bv wearing red goggles lor at least ivvemv 
minutes before beginning screening and at an urn- wh^n 
1 am obliged to leave ihe r rav room between easts U n 
mv eves proptrlv adapted tor screening I have rareU heJ 
anv surprises Irom subseqient radiographs —I am e'c 


Montana S'viiztrl nd Aiige t 4 


Hilvrv ROcHE 


Complications of Gold Tlterapv 

Sm — Having used ehrvsotherapv tor the treatment ot 
rheumatoid arthritis since I9a' I entirelv disagree vviih 
Dr H Warren Crowes statement in hia lette- in the 
Journal of Julv 30 (p 261) that vaccines )ield as good 
results as gold therapv I have long since given up the 
treatment of rheumatoid arthritis with vaecines because oi 
the extremelv disappointing results whereas v ith chrvso 
therapv praclicallv all cases have shown beneficial results 
some almost miraculous Patients crippled and bedridden 
who could onlv get about in bath chairs or on crutches 
have been able to walk unaided and in manv cases even 
resume their household dunes and other occupations 
Some of these patients were at first treated bv vaccine 
therapv according to Dr Crowes method with negative 
results and then thev were subjected to ehrvsotherapv 
with remarkable improvement 

With regard to reactions in mv experience those cases 
that produced reactions did belter than those that did not 
so that one should adjust the dosage to produce some 
reaction Severe reactions can usuallv be avoided bv 
simultaneous injection of calcium gluconate In over 100 
cases of rheumatoid arthritis treated bv ehrvsotherapv 
1 have never had anv gold abscess and therefore no go'd 
abscesses which fail to heal for months as Dr Crowe 
states With regard to his statement that one often has 
the greatest difficullv in persuading an entirelv suitable 
patient to agree to chrvsoiherap) most of mv time is 
spent in dissuading patients who come to me requesting 
gold treatment for their arthritis but whom I consider are 
not cases of true rheumatoid arthritis and therefore not 
suitable for ehrvsotherapv 

Finallv at the recent discussion on rheumatoid arthritis 
at PlvTOOUth I noticed that all the principal speakers were 
unammouslv of opinion that chrvsotherapy was the onl) 
effective treatment for this condition and most of them 
had given up vaccine therapv because of its disappointing 
results — I am etc 

London ^\ 1 Jiil\ _0 


Maurice Nevvxlan 



376 August 13 I93S 


CORRESPONDENCE 


Tuberculin in Diagnosis 

Sir — Dr J R Forbes (May li p 1311) states “ I have 
been unable to find any convincing grounds for believing 
that a positive test is of my value in indicatme the 
piesence or absence of active tuberculous disease May 
1 quote Professor Sahli " As much as I consider the early 
diagnosis of tuberculosis of importance , as much as I im 
a film believer in the therapeutic value of tuberculin, yet 
I am anxious to state emphaticallv that 1 condemn tibso- 
kitely the diagnostic injections of tuberculin The experi- 
ence of many workers, as reviewed by WollT-Eisner, proves 
that the result of the so called diagnostic injections, be il 
positive or negative, proves nothing 

Professor Sahli, in a footnote, also states “That great 
value is given to diagnostic tuberculin injections in veter- 
inaiy work is due to the fact that in veterinary work it is 
sufficient to prove that an inteciion had taken place, 
vv/ieieas m human medicine it is a question of the natuic 
and of the activity of the disease — 1 am, etc , 

S>dnc>, July 12 A E FlNCkH 

Blood Groups and Legislation 

Sir — Public opinion on the question of the usefulness 
o! blood grouping in paternity cases has been irouscd 
It IS repoited that Lord Merthyr intends to introduce 
legislation to make such tests compulsory in piternity 
cases to include twelve groups instead of the inlei national 
standard groups of O, A, B, and AB and to recognize 
only pathologists working in certain laboratories In my 
opinion the British Medical Association should make some 
definite statement on this question in the interests of 
science, the profession and ad those concerned There 
aie many points on which only those who have been 
working at the subject tor some years — serotogists, bio- 
chemists, and physiologists — can give definite information, 
but there are some questions which require decision of 
mole general interest alike to the public and our 
profession 

1 Legislation — Has the time come for legislation and if 
so what form should this takci 

2 Gioiiping — What system of grouping is to be recognized"’ 
Can we safely go beyond the four groups and if so what 
other groups are to be included"’ The four groups themselves 
give SIX subgroups Malta would have seven mam groups 
Seveiai parents of A, group were found who had given birth 
to O children fheterozvgotes) so to what evtent could any 
medical man say AB tests are ' infallible ’ "i Landsteiner 
and others have found agglutinin A acting on O cells 
Bauer s theory of inheritance was introduced to explain the 
existence of O children in some cases of AB parents As to 
the M and N agglutinogens they are independent of A and B 
but since they can be present or absent in each group how 
fai can they be recognized as of sufficient value for medico- 
legal purposes’ Can they not be normal constituents^ of the 
red cells and be present or absent according to the state of 
health or disease in an individual at the particular lime of the 
investigation"’ 

3 Statistics — ^These ire not generally agreed upon and 
while the mother miy have a S to 2 chance m her favour with 
certain statistics of ihe four groups to what extent will this 
bt altered alone or in combination with the M and N group- 
ing if these are allowed"’ 

■t Sera — 1 think it would be generally agreed that only 
cerlain laboratories or research institutes or workers should be 
recognized to supply these 

s ll'ho should Giie Cudence’ — It has been suggested that 
a pincl of pathologists only shoutd be recognized Surely it 
1 - i new departure in legislation to penalize science and the 
profc-sion generalh bi such discrimination"’ If reliable sera 


TiicHiuTmi 
MtniCAi. Jotf Ml 


arc available there can be no reason why others shoiild not 
perform the icsts in the inlcrcsls of everybody The court;, 
can he left to judge of the quilits of the evidence produced 
Pathologists ire bv no means the best ivailablc persons for 
the job 

6 Riports — With the range of groups and subgroups it will 
be idvisablc to dctcrniinc what should go into Ihcsc Art 
the temperatures at which the test was carried out to be 
included or not ' 

From this it will be seen tint there is need for the 
British Medical Association to set up some committee of 
mvcsligitton to settle these questions in the interests of 
the profession and the public — 1 im etc 

Ilford, July 23 AG NrwcLC M D 

Sfeinach H Operation for Prostafic Enlargement 

Sir — In view of Mr kcnncilt Walkers unfavourable 
opinion of Steinach 11 operation for prosntic enlargement 
(Joiiiiuil July 9 p 53) two successful cases deserve record 

1 The ptticnt is 72 vears old For some vears he wav 
getting up five to six or ciglil times eich night Several limes 
tic hid complete ohslruclion md had to be relieved by catheter 
The condition culminated m complete obstriiclton which pvr 
sisted An indwelling catheter was fixed for sonic days without 
improvement Stcinach 11 was done in May 1937 For one 
day ifter opertlion the catheter had lo be pissed Sines 
then he has pissed urine naturally ind he can now sleep 
from 9 pm to 8 a m The improvement has been wsH mam 
tamed Miclnrition is normal Residual unne now is li oz 
General hcilth is better than il has been for rears 

2 The patient is 79 years old For some vears he h’d 
nocturnal frequency and once or twice had had icmporarj 
complete obstruction Lattcrlv the freqticncv had been vo 
grc,it that he was being worn out h\ lack of sleep Complex 
obsiruciion with overflow incontinence came on in October 
1937 Slcintch il vvts done under local inacsthesia October 
1937 Al first there was no improvement An mduellmg 
cathcler was used for some davs Thice weeks after opera 
tton he was dischtrged from hospital having been taiigbt to 
use a catheter He began to pass urine natiirallv six vvccKs 
after operation Four months after operation all uriwry 
trouble had passed off and he could micturalc (rccK This 
improvement has been fullv maintained up to d tie He sleeps 
from 10 p m to a or a 30 a m Hts general health has niiici 
impioved 

—1 am, etc T Hunter C f E , M D , 

Ludlow July 28 Lieutenant Colonel I M S (icid) 

“Psychosomatic Illness” 

Sm — ^W'hether the using incidence of psychosomitie 
disease is real or only apparent seenas to be a debatab e 
question, but there is one factor on which stress might bv 
laid as a piedisposing cause of anxiety and an intensuy'int 
factor in many illnesses 1 refei to the manner in wh'c ^ 
the patient s disease is presented to his consciousness b) 
the physician m attendance Too oUen the latter is 
content simply to labef the patient with a medical icib’ 
which means nothing to him — so fir as any useful m 
formation as to the nature of hts conaplamt is coiicernc 
— but which may be the cause of a gieat deal of unneces 
sary worry and concern . 

Patients as a genera) rule even Ihe most stable minded, 
are morbidly apprehensive about their diseases and fear 
the worst ‘ Any vague ache oi jaain is magnified an 
dwelt on, and often the patient s mental conception o 
his disease might well be desciifacd as a “chamber « 
horrors In the case of an anxious and worrying tiP‘- 
of patient i supersducftirc of psychonearotic sjmplonis 
may be imposed on the basis ot some quite simple bu^ 
misunderstood condition How many women suffi-ring 



Sl< tsr n I93f> 


CORRESPONDENCE 


Ti"‘13?rnsH 
MEDf-At Jo TU 


:77 


from '^impk nnsiilis h^^^. worntd tIn.nist.Kc<; into i con 
diticn of ill htillh Kcmist. thu fcir lln.\ mu ha\<. 
cancer inci don l discloee ihu ficl to their doctor’ How 
imn\ patients with some simple hcirt detect fear thee ma\ 
drop dead at ane moment'’ And how mane of these 
people haee gone and read up their diseases in medical 
booVs alwaes taking care to apple the worst interpretation 
to their oeen cue'’ 

\ mild psechological meestig ilion into the state of in> 
patients mind eeitli the object of cliieidating hoee he 
rcgirds his particular illness eeould not be amiss m mane 
ciscs at ane rate if ncccssare the semptoms should be 
assessed at their proper e-alue and a simple e\pl in ition ot 
the trouble giecn to the patient m so far as possible 
non medical terms The ultimate factor in fighting disease 
IS the patient himself and he can siirelj do this to better 
aoeantage if he knows ccactle how he stands and is not 
Icit to grapple eeith his disease in the darkness of his 
oeen ignorance and fear — I am etc 
Reading Julv 27 W HutcHFSOS NJ D 

The “Fhing Squad” in Alafcmita Sereiccs 

Sir — Professor E Eirquhar Murrae is to be con 
gratulalcd on the csccllent results obtained bj his emer- 
genej unit as reported in the Journal of August 6 fp 313) 
but It must be admitted that the acre cMstcncc of a 
fleing squad is in itself an admission of failure 
Cases most urgcnlle in need of the sere ices ofa fleing 
squad Professor Farquhar Murraj tells us, arc those in 
which there eeas shock and postpartum or antepartum 
haemorrhage also cases of threatened or actual eclampsia 
difhcull labour or failed forceps That difTicuIt 
labour should be allowed to take place in the patients 
oeen home or that failed lorceps cases should need the help 
of an emergence unit is a serious indictment of our maler- 
nile sere ices 

Sir Eeeen Maclean is reported on page 304 of the same 
issue as haeing said that local authorities could haee in 
large measure that reduction m maternal morlaitte which 
thee were willing to pav for and it is ceident that if local 
authorities eeerc eeilhng to proeidc hospital accommodation 
for all matcrnile cases eehcre the slightest abnormahtj 
existed or might arise the fleing squad eeould seldom if 
eeer be called to assist the practitioner attending a patient 
in her oeen home Mith all abnormal cases in hospital there 
eeould onle remain the possible emergence of haemorrhage 
to eehich the fleing squad might be called, and 
haemorrhage associated evith the absolutely normal con- 
finement must be rare indeed — I am etc 
Neve Bamet August 6 JOHN ElaM 

E F Harrison 

Sir — eeas eer) glad to see in the Journal of August 6 
(p 295) the tribute to E F Harrison in eieee ot his long 
and honourable connexion with the Journal Perhaps the 
folloeeing reminiscences may be of interest to some of 
eour readers 

I first met Harrison eehen I eeas in practice and he eeas 
a iraecller for a drug firm — in eehich position he eeas 
obeiousle a misfit I next beard of him on the laboralore 
staff of Burroughs and Wellcome and exas delighted eehen 
3 came on the B M_A staff to find that he eeas doing the 
analyses for the Journals Secret Remedies series 
Before the Select Committee of the House of Commons 
on that subject, he was our chief eeilness and made a 
profound impression be his high standard of accurace and 
his obeious desire to claim no more for his analeses than 


eeas juvlified Shortle alter the eear b'ol e out he earie 
into me office in a eere ill fitting khaki uniform He had 
joined one of those ill defined corps eehich eeere intended 
for men past their first eouth and he told me nis a i ics 
eecrt mainie of a domestic nature such as cleanin- out 
barracks JJe was the last man to i.ompIain but evhen 
1 next save Sir Mired Keogh at the Wa' Office I told hira 
It eeas a pile the Arme couldn t ma'e belter use of realle 
fine expert eeorkt.rs I hope my mention of Harrison had 
something to do eeith his next moee tor eehen I next saee 
him he eeas buse eeith anti gas eeork and eeas happe It 
eeas a real grief to his friends eehen he tell a eic im in 
the influenza epidemic of 19IS lor there is little doubt 
that still greater honours aeeaited the man wno so rapidle 
rose from a humble private to be Iieulenant-eolone' with 
a CMC 

ft IS pleasmg to recall that Harrison said more than 
once lh'’t the eonfidence reposed in him be Sir Dawson 
Williams had been ot the greatest assistance to him m 
establishing him as undoubtedle the greatest au horn 
on certain forms of ehemical analesis The Pnarm„ 
cculical Sociele honoured his memore be esiabi sh n» „n 
annual Harrison Lecture Nobode who mei H 
even casualle could fail to be impressed h/s s 
persoaahte his lenacite ot purpose and aboe. ,.ii b h 
transparent hones'e and smcerite — I am e e 

Loacioa W C 1 ■\u-u I 6 ALrRFD C X 


Obituary 


SA.LVATORE CASSAR MD 
The Malta Branch of the British Medical Msoeiation h 
suffered a serious loss be the death on Jule 30 ot PiO 
lessor Salvatore Cassar MD, emeritus professor ov 
surgere in the Roeal Unieersite of Malta and consulting 
surgeon to the Central Civil Hospital, and one of the 
oldest members of the Branch 

He was born on October 5 1S61 he qualified m JSb6 
and after serving as resident in the Central Hospital was 
appointed junior surgeon In 1900 he succeeded to the 
chair of surgery and was made senior surgeon to the 
hospital appointments which he held up to October 1926 
when he retired on reaching the age limit Protestor 
Cassar s career as a surgeon coincided with the revolution 
in surcere brought about by the introduction of Listerian 
methods and it is due to him that antisepsis and asepsis 
were firmle established in Malta even betore they were 
accepted in other and perhaps more important centres 
He look a leading part in the conduct ot affairs of the 
unieersite and eeas alwaes an ardent advocate of all that 
meant progress and development Upon the grant of 
self government he took a leading part in organizing the 
profession and also entered the political field He joined 
the Constitutional Parte and eeas elected a member of 
the Senate ot which he became the eice president 

Professor Cassar joined the British Medical Association 
in ISS9 and throughout his career maintained a eere 
acme interest m the Malta Branch and kept up his 
interest to the eere last He screed almost contmuousle 
as a member of the Branch Council and occupied the 
presidential chair on many occasions 

Dr Herbert Midglex Cocrcroft who died on Jule 
9 aged 63 evas a well knoeen and popular figure in the 
district of Yorkshire knoee-n as Mashamshire. A student 


378 August 13, 1938 


OBITUARY 


Tiic nitmiM 
^frt)^CAL JOURS 


of Owens College, Manchester he obtained the Scottish 
triple qualification in 1899 He then returned to his nrtivc 
town of Masham to continue his father s practice there 
and in 1901 was appointed medical otTicer to the district 
council and medical officer of health During the greater 
pai t ot the wai he served with a temporary commission is 
captain R A M C , and was awarded the Military Cross 
On returning to civil life he became commandant of the 
Masham Branch of the British Legion and was for many 
years chairman of the local sports committee Dr CocL- 
cioft was elected a member ot the Harrogate Division of 
the British Medic il Association in 1901 

Dr Rcgimald John Hcarn who died on July 13, had 
been a member of the Marylebone Division of the British 
Medical Association for the past eighteen years At Cam- 
bridge he took his BA in the N ilural Sciences Tripos 
of 1911 and then entered Guys Hospital Qualifying as 
LMSSA in 1914, he graduated MA MB, B Ch 
Camb in 1918 and proceeded M D in 1921, having by 
that time been called to the Bar by the Middle Temple 
He had served throughout the war as captain R A M C 
and afterwards with a commission in the RAF Medical 
Seivice At Guys he held a number of junior posts 
lesident and non-resident and for some time worked in 
deimatology and venereal diseases He waS also interested 
in diseases of the nervous system, and acted as neurology 
specialist under the Ministry of Pensions Dr Hearn was 
foi some years physician in charge of out-patients at the 
Westminster Skin Hospital and assistant deputy to Mr 
Ingleby Oddie, coroner for Central London In 1922 he 
published in these columns a paper giving the results of 
treatment in syphilis of the neivous system 


Universities and Colleges 


UNIVERSITY OF OXFORD 

In Convocation on July 30, presided over bv the Vice- 
Chancellor, the honorary degree of D Sc was conferred on 
Dr Charles Gustave Jung Professor of Psychology m the 
University of Zurich on the occasion of his presidency of the 
tenth International Medical Congress for Psychothcrapv 
The following ^medical degrees were conferred in congrega- 
tion on the same day 
M D — H F Moseley 

BM — W D Biraton S H Lleacllyn Smith, J B Longmoic 
R R Wethered, AML Isabella (Socicly ot Oxford Home 
Suitients) 


UNIVERSITY OF CAMBRIDGE 


The Appointments Committee of the Faculty of Medicine 
has appointed F R Berndge, M B , B Chir of Timilv College, 
Assistant in Reseaich in Radiology (diagnostic) to the Regius 
Professor of Physic, and A Paterson MB Ch B D Psych, 
of ihe University of Edinburgh Assistant in Research in 
Psvchiatry to the Regius Piofessor of Physic both for three 
years from October 1, 1938 


At the last Congregation of the academical y ear held on July 
30 the. Vice Chancellor Professor H R Dean, conferred the 
following medical degrees 

M D — M Hynes M L Rosenheim proxy T F McN 
Scott 


MB B Chir — A J Daly A C F Green, W W V/iggms 
Davies B J O Wmfield M D Young 3 \V Wood, R W W 
Brown D M Carding J E Hardwick Smith P L Molhson, 
R D Caton, M J Clow, W Goulslone PAR Jones G B 
l-cMon A G McPherson JAR Miles W A M Miller, D E 
VaiTow S G Hamilton L R Holt J Laughlm J S Pratt 
n ^ ^ Alexander R M Johnstone, J Smith J Yudhm 

R R Wdson A P Norman W E Owens N Verc-Hodec 
H r Whalky G M Wnght D Foskclt E L N Rhodes 
ii’ Hunt, P J Wormald, R O Murray B H Price, 

w .uln ® Round J S Pritchard, A J 

W illon C H Bartlett R B Leech J G B Phils 


UNivLRsnv or London 

The Senile on July 20 awaidcd the degree of PhD in 
Palhology (non clinic il) to H Burrows and the degrees of 
Ph D in Hvgicnc (non clinical) to Wci Yung Lee and C G 
Warner 

The following candidates In'c been approved at the 
cximination indicated 

MD — Uronrh I (Afodiemt) Helen Baker R H P Clark 
J R Forbes R V Harris N M J icoby H Nicholson \V A 
Oliver J B Robinson SV J Stokes S J L T lylor P C 
Wickrcmesinghe Branch II (I’ntholot.}) I A Calhn. C V 
H vrrison S F M irsh ill E M Ward Branch III (Psyclmlostcal 
SUdicine) K Soddy Maevc Whekn lirnnch IV (Miunileri niul 
Discatn of IVonieii) if G E Artluirc (University Medal) A 
Barber, E D Y Grisby Branch V (HyRiene) E W Gilbert 

UNIVERSITY OF MANCHESTER 
Mr F H Bcntlcv MB FRCS.^lm been appointed 
Assistant Director of the Surgical Research Laboratory 

UNIVERSITY or ABERDEEN 
The Ring has approved the appomimcni of Dr Robert 
Doughs Lockhart Professor of Anatomy in the University 
of Birmmgliam, to be Regius Professor of Anatomy in the 
Universitv of Aberdeen m place of Professor A Low, 
resigned 


ROYAL COLLEGE OE PHYSICIANS OF LONDON 
At a meeting of the Royal College of Physicians of London 
held on July 28 vvith the President Dr ' Robert Huiehi'on 
in the chair, the following were elected ofliccrs for we 
ensiling year Cenwrv C E Lakm G E Beaumont B E 
Hume A TeilmR Treaxnnr Sir Charles McM 
liciiiMrar H Lclhcby Tidy Uartcum Lihranan Arnold 
Chaplin , Assistant Rci.ixtrar R Hilton 

The President and Fellows decided thit a mcmornl to ine 
laic Registrar Sir Raymond Crawfurd should be placed in 
the College , 

Unanimous votes of thanks were passed to D'’,* 
Phillips for his services to the College as Treasurer and to Uf 
Charles Newman for his services as Assistant Registrar 
The following appointments were announced W csrn 
Radcitffe K.C as Senior Standing Counsel to the Concg^ 
Dr R A Young as Harvcian Orator and Dr J C openre 
as Bradshaw Lecturer for 1939 Dr A W Stott 
of the Joint Consultative Committee Dr A E Clark 
as a represent itivc on the CommiUec of Management ot in 
Conjoint Board 

The Bissct Hawkins Medal was awarded to Professor ftnp 
Greenwood FRS for his rcseirchcs in statistics . 

The Murchison Scholarship was awarded to David Rena 
MB, , 

It was announced that a replica of the President s cadiice 
would be presented to the Royal Australasian CollcEt 
Physicians and Dr Morlev Fletcher was appointed to repo- 
sent the College at the in lugural meeting ot the Koy 
Australasian College 

The follovvinc candidates having satisfied the Cenm 
Board, were admitted Members of the College 

A Ah, MB Bomb, 1 S Buclunan, M B Load , R H / Cbd 
M B Lond N F Coghill M B Camb , H A Dew ir, M B U«»' 
Murid J L Frazer, M D Bcif , G G Gilhm M B Loml E " 
Hart, MB Camb S A Henrv, M D Camb F D M LninC'On 
M B Camb . the Hon W S Machy M D Camb W P n 

BMOxf, P E C MansonBihr M B Camb , V R Nawlu a n 

Mvsorc, H Nicholson, M D Lond , W A Olncr, M “,,V” M 
W W Payne M D Lond , J W Pierce M B Lond , " L 
Poitcous MB New Zeal J M Ranking MBt^nib, d . 
Rodgci, M D McGill, J C Sinclair M D Toronto, T C Siitwr ' 
MBNcvvZtal W S Sutton, M B Liverp O H J Ja 
B M Oxf , J W Todd M B Lond , P H Willcox. M B Cami> 

Licences and Diplomas 

■'Licences to practise vverc granted to 185 ike 

ing thirty-four women), whose names arc Ptw'**!, c.irrcons 

report of the meeting of the Royal College ot ourg 

of England m this issue, as are the names ^ 

recipients of the Diplomas in Tropical Medicine 
(twenty). Ophthalmic Medicine and Surgery (iw'cnty mw, 
Medical Raffiology (three) Diplomas in Anaesthetic 
granted to the successful candidates whose natne 
published m the reports of the meetings of the Royal u 
of Surgeons of England in the Journal of June t”, 
(twenty-four) and in the Journal ot July 30 (p -"I i.rmc 
Diplomas in Public Health (twelve) Psychological Mcm ^ 
(seventeen), and Laryngology and Otology (seven) were g 



UMVERSmnS and colleges 


Thi B*m_<r 
M*t> cal 


379 


\ucusi n I9^S 


to the vuctc^sful cnnUidatCN uho^ mme^ were published in 
the report of the meeting of the Rovil College of Surgeons of 
Fnci'ind in the Journal of Jul\ ^0 (p 265) 


RO'i \h COLLEGE Of SLRGEONS Of h^GL^^D 

Vn ordman. meeting of the Council of the Roval College of 
Surgeons ot Enchnd was held on Juh 28 with the President, 
Mr Hugh Lett, m the chair 

The cordial congratulations of the Council were ci'cn to 
Sir Holburt ^^a^ng and Sir James ^^'llton on receiving the 
Order of Oflicer of the Lccion of Honour 
The Council accepted with grateful thanks the vcr> vahnhle 
gift b\ Sir William WilUox of a chair which was formcriv 
the propertv of John Hunter 

Mp W Sampson Handlcv was reappointed to the Executive 
Committee of the Impcnal Cancer Research Fund 

Diplomas 

Diplomas of Membership were granted to the following 
candidates who have passed the final examination in patho 
logv medicine surgerv and midwifcr) ol the Conjoint 
Examining Board m England 

Mignon B S M Alexander J N!acC Almond A G Ap*cv 

L D Arden A G AmoM J B AtLms Bcrsl Badham R B T 

Baldwin H H Bars! Romana G Banclot O D Beresford 

C \ Berrs R T ^>^10 Natalie S Blun-nfcld E J Bowmer 
B R Bras DAG Brown D J A BroMTi Amdia E Burch 
N C Bamlc> Jones A E Burton J Burton K. A Butler 

H D LI Campion G D Carter Kalhcnnc H Child N G 

Chums H D Cockbum Gwendoline h Co-^krem L H Cooper 

M P M Coorav R 1 G Coupbnd R J N Crozier T W B 
Cull K H S Dalhwall A. J Dal\ G E David H D Davies 

R G Davies A F W Davis V H D'^nton Dorolhv F M 
Di-kinson W M Digglc \\ L Donohue M-r> P W Dowding 
J A C Edwards E O Evans J B Evans JAP Evans 

B R Fink H Foster W F Fra?cr P S Fuber H Gardner 

soW M Garland G H K Genilc A Giordani Mabel L 
Glennv L Goodman M R Grace C L Greenbun Margaret 
M H Halbdav Fatheva Ham^ G J Harnsson W J Has 

G M Heap E A Hedberg J P Henr> A G Hcppleston 

E J F Hinde Kobel T Hnde C H Hoskvn R N Moulding 
A Howxird G O Hughes G LI Humphrc>s Barbara J Hussev 
B A Irvme 1 G Isaac S R Jadhav Winifred N K Jagger 

J I P James S R James D H Johnston Ida LI T Jones 

M T J Jone> V H Kendall A H Khan J B Kinmontb J C 

Kuchin Guan Bee Kruairachue D R Levinson A W Little 

W \ Livingston Eluned M Llovd Davies S Locket R J J 

Lo-khart Niolcl L Lulwjche Margaret P Lvon Eileen M R 
McKee G T B Mackinnell-Childs Margaret h M McLaughlin 
A G McPherson D E Macrae P F Mahm H Matthews 

A H Mavnc B E Miles J Mills W F Mindham Elizabeth M 
Mitchell T J Montgomcne T R Morle> S Moitcrshead M L 
Mundv J D N Isabarro L Nancckievill R E Newman 
L, \ Nichols Irene Nve G Oppenheimer E N Owen LI P 
Owen J L Paleslrani P W J Parkes Elfnede K J Paterson 
B M Phflhps T J A PhiUip^ W Phillips J G B Platts 

C Ponnambalam J S Pochard J H Rake R Ramsa> Barbara J 
Raven W J Rees G I Rces-Jones W Reverson H M Rice 
J F Rickards D L Ridout Nanc) E Robbins Margaret J 
Rowlcv L Saunders A Shannon P H Shorthouse P S Silver 
J R Simpson C S Smith R C Southern R H Spit'cr 

Margaret J Stafford G R Stale) R W Stevenson N G 
Straschun A R D Stuart V K Summers R B Terrv D S 
Theron D M Thomson Cecilc P Thrupp J Todd P Onwm 
K W \andv A M Wadsworth Joan Wagstaff Annie M B 

Walker Marv E Ward J Watson J M Watson G L Wav 
A L J Webb Doroth) J Webber R Wclplv H WTutmore 
J H Whittles L L WT^tchcad C F H Wicssner W W 

Wiggins Davies A J WiKon P Wilson RGB Woollatt 
B M W right G^M Wnght 

Diplomas were granted joinilv with the Roval College of 
Phvsictans of London as follows 

Diplomv IN Tropical Medicine AND Higienc — G A Armstrong 
A K Choudhun Hilla Damn M A J Fandi G Fraser 
Ivanocl Gibbins G R Hand) Ruth M Harris A G Hcmslcj 
R A Hughes H M McGIadderv B B G Nehaul Alexandnna 
M M Parker R Sandler A R Shah G E S Stewart 
M Tnvedi R J \akil R C YcvUina A B Weir 

OpHTHaMic Medicis-e xn-d Surgerv — M Alurkar J D 
Cotelingam G C Danse) Browning, T Das R E Dave J G R 
DilJane M H Gomaah J R Henderson Doreen A Hungerford 
M U Khan S W T Lee I S McGregor A R McKchic T C 
Meurer M A Nair A H Osmond H Pearlman F J A 
Pocklev P C Sen B S Sharma Jane A M Shepherd T P N 
Sinha M B R Sunderrao W O G Tajlor M O 'ioussef 

MEDIC.VL Radiologv — G E Church N A 1-awler H C 
Simchowiiz. 

The following hospitals were recognized under paragraphs 
2l and 23 of the Fellowship regulations Llandough Hospiial 
Cardiff (first and second house surgeons) Northampton 


General Hospital (first and econd house surceons) \ictori 2 
Hospital Blackpool (house surgeon to Lnit No 1) Rov'*! 
Lancaster Infirmarv (conditional recognition) (first and second 
house surgeons) The following hospitals given lerrpo'arv 
recognition up to the present were given further recognition 
for the penods specified Gnmsbv and Distnet Hospital ( enior 
and junior house surgeons till JuU 1939) Wam'^lord 
1 eamington and South Warwickshire Gene a) Ho pita) 
(resident house surgeon till Julv 1939) Pnnee of Walevs. 
Ho pilai PIv mouth and Devonport (senior hou e surgeon till 
December 1938) Cornelia and East Dorset Hospital Poole 
(first house surgeon till December 19:>S) 


RO^AL COLLEGE OF PH’iSiCIANS OF EDINBURGH 

A quartcrlv mectinc the Roval College of Phvsicians of 
Edinburgh was held on JuU 19 with the President D' 
\le\andcr Goodall m the chair 
Dr Fredc ick George Gibbs (Edinburgh) Dr S«imuel Ro 
Burston (Adelaide Australia) and Dr Henrv Anstev Coo^spn 
(Sunderland) were elec ed Fellows 


CONJOINT BOARD IN SCOTLAND 

The follovvmg candidates having pas ed the requisite ^am 
inations have been admitted L R C P Ed LRCSEd_ 
L R FP and S Glas 

Geraldine C W An cs G And r G Andr.e L M ^ "v J 
S Aranof B S Basw.ni Henha E Bi .hot wt 

G Blum G N Brumb-rg-r D Buna F R F U 

CampMl S Chjld> A B Co van M D Ed'ad Fe t 

C Find-r A T FreeUrd Mana FuUe> H A F X 

Gold tcin R Herzb^re E A Hir " Emrrv Ho-j^ De S J 

Kohle H G Koutz Susanr* Koretz J N Lennox J Li u o 
T McConnell J T M Kenna M VN Magd J U- 

C MandcLum E L Mo-cl A N-dJ d L N- la m R ^ 

Neumann 1 Parker H S P« r^on H B H R P b 

Ramesar J Rosenbaum H Rothm_n R J 
N J Shaaban Ce.dc S>P ro T Skeo.h S Sorm r F y -J 
J D Swan Teodor- TvsJakova W A L Tl ker I S W i k<.f 
J L W Walls J C Waugh C M N Willnrr 

SOCIETA OF APOTHECARIES OF LONDON 
The following candidates have pas ed in the subjects indi 
cated 

Slrgerv— A M Attcnboouch H J Xot 

E V Irwin R Lipkin A E RampUng F S^hwaru J A U lor 

M Tombuk C Webb , « « t dm 

Medicine— F B AKcroMl \\ J Bold H R Butkr P H 
R E D Ellis U A Groom J M Hards R L.pmt 
T I Thom 3 > T U ^\c5ton C N'llliams 

Foicsic Medici-e-F B Aierosd \\ J Bold H R Builer 
P H Dasies RED E!Ii» A Groom J 'I H.r 
R LipUn T I Thomas J W Westoa ^ f- F 

Midsmfer-. — P BaUr N J Hetreed I J Malh.as C E 
W intcrstcin 

The diploma of ihc Sonets has ^ 

Akerosd V \I Attenborough W I R , E- ^ Ell.s 

W A Groom R Lipkm F Schssartz, J A Taslor C Viebb 


Medical Notes m Parliament 


On Ju!s ■’9 a Rosal Commission signified the Rosal 
Assent to all Bills awaiting tt including the Finance Act 
Aoung Persons Emplosment Act Nursing Homes Regis- 
tration (Scotland) Act Food and Drugs 
Ditorce (Scotland) Act Statutes nhich base 
earlier in the session include among Gosernment 
tion the Air Raid Precautions Act ^ A 

Hohdajs ssiih Pa> Act three Housing Acts MentU 
Deftciencs Act tMilk (Extension and Amendment) Act 
National Health Insurance (Amendment) Act National 
Health Insurance (Juvenile Contributors and Aoung 
Persons) Act Population (Statistics) Act and the Super- 
annuation (Various Services) Act The Limitation Bui 
and the Marriage (Scotland) Bill await funher examina- 
tion and will presumabls be dropped for this session 
Private Members Bills which have reached the Statute 
Book include the Baking Industrv tHours of Work) Act 



380 August 13, 1938 


MEDICAL NOTES IN PARLIAMENT 


TircBRnuH 
MiOICAL Joi/fSAl 


Children and Young Persons Act, Dogs (Amendment) Act, 
Infanticide Act, Nursing Homes Registration (Scotland) 
Act, Prevention and Treatment of Blindness (Scotland) 
Act, Registration of Stillbirths (Scotland) Act, Street 
Playgrounds Act, and Workmens Compensation (Amend- 
ment) Act Private Members’ Bills which have not passed 
are the Contraceptives Regulation Bill, the Local Authori- 
ties (Hours of Employment m connexion with Hospitals 
and Institutions) Bill, and the Prohibition of Vivisection 
on Dogs (Scotland) Bill The first two have been dropped 
Before the Nursing Homes Registration (Scotland) Act 
received the Royal Assent the House of Commons 
accepted, as an agreed compromise, the House of Lords 
amendment authorizing the Department of Health for 
Scotland to exempt Christian Science homes from the Act 
Both Houses have adjourned till November 1, unless 
summoned earlier for urgent business The Kings 
Speech will be read on November S 


grants from the Education (Scotland) Fund Mr Cxilsille 
replied that after careful consideration of the terms of ihe 
report he had decided that in accordance s\ith certain of its 
recommendations grants of £4 000 and £12,000 should be paid 
from the Education (Scotland) Fund to the Unitcrsiiies of 
Edinburgh and Glasgow rcspccti\cl> before JuK 31 the end 
of their present financial scar With regard to 1938-9 and 
future \cirs he hoped that the state of the Fund would aUo 
make it possible for him to gi\e effect to the rccommenda 
tions of the report The patments m the current tear to 
the Umsersitics of Edinburgh and Glasgow must not be 
regarded as in an> sense impljing acceptance of the pnnciple 
that the Scottish unuersities might reh on the Education 
(Scotland) Fund to meet am future deficiencies which th'! 
might incur The claims of each universitt on the And 
must be considered each vear in the light of the finanaal 
and other circumstances that might arise and of the annual 
reports which it would under statute be the dutj of each 
uniicrsitr rcccning assistance to submit to him 


Milk (Extension and Amendment) Bill 

In the House of Lords on Julj 19 the Earl or Fcncrsham 
moved the second reading of the Milk (Extension and Amend- 
ment) Bill 

Lord Marlcy asked whether pasteurized milk was provided 
for children m the schools and if not what steps were taken 
to ensure that the milk provided was clean and not likelj to 
cause an\ illness He said it was a tragedj that there should 
be any delav in the provision of milk for expectant and nursing 
mothers 

The Earl or Fe% crsiiam said that according to the returns 
made to the Board of Education at the end of last March 
2 672 000 children in clemcntar> schools in England and Wales 
were taking milk under the milk-in-schools scheme That was 
161 000 moie than on the corresponding dale last \car Both 
the source and quahtj of the milk supplied had to be approved 
by the medical officer of he ilth in the area Where possible 
in the larger urban areas and the great cities the medical officer 
of health insisted on pasteurized milk where it was available 
In those areas served b> rural districts pasteurization was not 
alwajs possible and the milk of attested herds was used 
Linder the Bill an increased sum for milk was being devoted 
to schemes organized b> local authorities not onij for children 
attending elementary schools but for nursing and expectant 
mothers It was a feature of the Bill that in order to accelerate 
this service an extra £250 000 was being provided until the 
Government s long term proposals could be placed before 
Parliament 

The Bill was read a second time 

Mental Patients in Divorce Proceedings 

On July 19 Mr Sorcnscn asked the Minister of Health 
whether his attention had been drawn to the recent state- 
ment of the chairman of the Board of Control at the annual 
meeting of the Mental Hospitals Association respecting mental 
patients affected bv divorce proceedings and obligations on 
the part of a medical superintendent definitely to express his 
opinion in reply to questions by petitioners or petitioners 
solicitors whether a patient was or was not curable and 
whether he proposed to circularize mental hospital committees 
to this effect 

Mr Bernays said he understood that the Mental Hospitals 
Association circulated to their members a communication on 
this subject from the Board of Control last January On the 
information bbfore him the Minister of Health was doubtful 
whether it was necessary to issue a circular to mental hospital 
committees 

Grants to Edinburgh and Glasgow Universities 

On July 19 Mr G Morrison asked the Secretary of State 
for Scotland whether he could make a statement on the report 
of the Special Committee under the chairmanship of Lord 
Alness on the application bv the Scottish universities for 


Health of Mine Workers 

In committee of the House of Commons on July 2a the 
vole for the Mines Department was considered Cap>ain 
CiwioKSiiANk referred to the work of the Safety in Mines 
Research Board He said that the programme of pit head 
baths was going rapidlv forward Apart from official work 
a great deal was being done hv all sorts of technical bodies 
which were constantlv making investigations and discuss n. 
them at their meetings Noise seemed to him to-day to be 
one ol the urgent problems that had to he considered A 
gre It nunv miners felt th it with the coming of the machm 
thev did not hear the natural noises which in the past acted 
as V arnmes to them Much research could therefore be done 
into this problem He was not able to slate when the re[Wt 
on the mvcstigaiioHs into silicosis was Iikelv to be produrd 
The inquiry was being pressed on however 


Mcdicnl Refugees and (he Colonial Medical Semee 


On Julv 25 Sir Ernest Grvhvm Little asked the Secretary 
of State for the Colonics whether m view of the large number 
of able and qualified doctors at present refugees from Greater 
Germanv he would consider the possibility of appointing some 
of them to subsidiarv positions in the Colonial Medical Service 
Mr M VLCOLM MacDonald said it was not quite clear "hat 
posts Sir Ernest Graham Little had in mind when he referre 
to subsidiary positions in the Colonial Medical Service 
Admission to the Unified Colonial Medical Service was nccc' 
sarily confined, broadlv speaking to persons of Bntu 
nationality though a person born or ordmanlv resident i 
a Colony, Protectorate or Mandated Territory was no^ 
excluded If the reference was to minor posts in the Inca 
health services it had been the settled policv for some tim 
to tram the inhabitants of the various Dependencies to un cf 
take this tvpe of work and eventuallv to take 
higher branches of medical and public health work as c 
became qualified to do so He did not think it was 
to envisage any general scheme by which foreign 
practitioners could be incoiporated in the State medical ser'i = 


of the Colonial Dependencies 

Sir Ernest Graham Little further asked the Secrelan 


of 

the 


State for the Colonies whether he was aware that 
number of persons to each qualified doctor in Great Bn 
was approximately 1 000 in some parts of the British ^ 
the pioportion was as high as 100 000 to one, and 
in these circumstances he had under consideration any P 
for increasing the personnel of the Colonial Medical Service 
Mr Malcolm MacDonald replied that the ultimate 
tive at which the Colonial Office was aiming in 
medical services of the Colonial Dependencies was to 
the best modern medical resources within the reach o 
whole of the peoples of the Dependencies It "OU 
impossible in most cases to give accurate figures 
the proportion of qualified medical practitfoners to 
tion in each Dependency without reference to the Lo 


\LiousT n I9'S MEDICAL NOTES IN PARLIAMENT Ti.rB»msH 351 

AfEDICAl. JOLTLN*L 


Go'crnmcni*; Nor indeed would such tuurcs gi\c t rclnblc 
ficiurc of the position since t *‘incle Dcpcndcnt\ micht con 
nin nrets nt >cr\ difTcrcnt stigei* of dc\clopmcnt There 
wns no doubt that in some areas we were scr\ far from 
basing attained the objcctisc sshich he had defined On the 
other hand there sscrc mans places svhcrc ample medical 
facilities both public and pmate ssere asailable The public 
health scrsices of the Dependencies were heme coniimialls 
dcsclopcd as funds and circumstances permitted but basing 
regard to the larce areas and populations to be cosered it 
was clear that the cscntual attainment of the objCctisc must 
depend not on an indefinite increase in the number of 
imported medical officers but on the procressisc training of 
medical staffs drassn from the local inhabitants The polics 
of training such stalls ssns heme actisels pursued sshcrcscr 
possible 

In the meantime the rcsponsibilits for the education of the 
local populations in the mans aspects of prcscntisc medicine 
for the organization of the public health <crsices and for 
the treatment of disease res ed principalis on the members 
of the Colonial Medical Senicc and there could be no doubt 
that for mans scars to come that Scrsicc ssould continue to 
call for a steads floss of recruits of the best personal and 
professional tape from this counlrs The present state of 
recruitment for the Scrsicc was satisfactors and it could 
not be said that the demand substanlialls exceeded the suppis 
of fulls suitable candidates. There had been some recent 
difficults m recruiting for scrsicc* in the \\cst Afnean Dc 
pendencies but he had no reason to suppose that this difficulij 
ssas other than icmporarj 

Working Hour^ of Nurses 

On Juls 26 Mr Bill asked the Minister of Health whether 
his Department had considered the working of the nineis six 
hour fortnight for nursing staffs m general with special refer 
cncc to the London Counts Council scheme if he was aware 
that aspects of this scheme «o far as night dots was concerned 
Were relented b\ the staff and if he svould consider the 
possibihts of cvohing some agreed sjstem of hours affecting 
ail nurses which local authorities could introduce without 
essential modification 

Dr Elliot said that his attention had been drawn to the 
decision of the London Counts Council to introduce a nincts 
i\ hour working fortnight for nurses in their emplosmenl 
but he was unable to make ans general statement on this 
subject pending the issue of a report bs the Interdepartmental 
Committee which was considering the conditions of sersice 
of nurses 

Grants for Cancer Research 

Mr \Y GR£E.\ on JuU 26 asked the Chancellor of the 
Duchs of Lancaster as representing the Lord President of 
the Council the amount of public grant made during the last 
tsscise months towards the cost of cancer research insoKing 
expenments on Using animals and the amount granted m 
respect of such re^ea^ch not insohing such expenments Earl 
WivTERTON said that the amount expended b\ the Medical 
Research Council from public funds during the last financial 
sear on insestigations into the nature and cause of malignant 
disease and methods for its treatment was approximaiel> 
£6 000 in addition to which saluable quantities of radium 
were lent to hospitals for this purpose It was not practicable 
to gise sepantels the cost of such parts of this %\ork as 
insolsed experiments on animals 

Health and H\giene in Bntish Ships 

On 3ul\ 26 Mr \Vl^DSOR asked the President of the Board 
of Trade if dunng 1937 of d664 \es«e1s subjected to sarutarj 
inspection h\ the Hull and Goole port health auihorii> 

1 670 were found to ha\c defects whether he would con- 
sider the advisabiUtx of strengthening existing powers for 
ersuring proper standards of maritime hxgiene initiate 
measures to secure a more ngid compliance on the part of 


shipowners with the rulings of responsible medical authori 
lies and take steps to secure the obseiaation of essential 
standards of cleanliness in all British ships 

Mr Oliver Stxnlli said that the port health auihoniies 
had full powers under the Public Health Acts to require the 
abatement or themselves abate on ships wiihm their districts 
insanitarv conditions or other nuisances injunous to health 
The dutv of seeing that crews quarters were kept in a fit 
condition fell pnmanh on the master as representative of 
the owners The Shipping Federation and the National 
Lnion of Seamen had rccentlv set up a joint committee to 
consider methods of improving the standard of comfort and 
cleanliness in crews accommodation As regards structural 
defects close co operation was maintained between officers 
of port health authorities and Board of Trade survevors and 
in appropnatc cases suitable measures were taken under the 
Merchant Shipping Acts 

Tuberculosis m the Grinding Industr} 

Dunnq the discussion on Home Office administration in the 
House of Commons on Julv 27 when a motion was made for 
the second reading of the Appropriation Bill Mr Marshsll 
said the whole scheme of the Metal Industries Silicosis Order 
w^s too narrow All allied diseases such as pulmonarv tuber 
culosis were excluded If the present eliminatorv process 
caused bv introduction of new tools in the grinding industn 
went on verx few workers would come under the scheme in 
a few \ears The silicosis scheme centred on the meul 
grinders of Sheffield where the medical officer of health Dr 
Rennie reported that cases among 4 600 grinders numbered 
149 Among these grinders the death rate from respiraforv 
tuberculosis was four times the rate for all persons over 15 
in Sheffield although the new abrasive wheel which was to 
bring about a revolution in the industrv had been in operation 
in manv cutlen factories in Sheffield for iwentv five vears 
There were more cases of tuberculosis among Sheffield 
grinders than among the miners and stonemasons tn the cilx 
Phthisis fibrosis and tuberculosis were all rampant among 
grinders and the decrease had been much less than the 
decrease among the general population Yet the silico is 
scheme excluded men who had worked for three xears on the 
abrasive wheel File grinders were excluded because <afe 
guards were provided in their case The Home Secretarv 
should investigate the matter with a view to bnnging in the 
men who suffered from these diseases and could prove that 
the disease arose out of their emplovmenl 

Mr ToMLiNbON spoke of workers in Lancashire who were 
affected bv dust m the card rooms He said the medical 
explanation of what took place in the sufferer as the result 
of the inhalation of this dust had vaned verv little over a 
period of vears The difficullj of dealing with the question 
was said bv representatives of the Home Office to be due 
to the fact that it was not possible to draw a line between 
the individual who contracted the disease in the card room 
and the individual who might contract a similar disease 
outside Other persons contended that this line could be 
drawn and he hoped that as a result of his raising the 
question that afternoon some relief could be brought to the 
sufferers 

Mr John spoke of the difficultv of a miner 'securing cerlifi 
cation for nvstagmus He said the medical referee at pre ent 
was judee jurv and court of appeal in one A man might 
be certified bv his own doctor and bv the certifving surgeon 
to be suiTenng from nvstagmus but if the medical referee 
certified that the man was not so suffering, that decision was 
final Even the Bntish Medical Association ^id that was too 
much responsibihtv for one man and that there ought to be 
at least three men forming a Board 

Earl WtvTERTON replvinc to the debate said the officials of 
he Home Office and the Home Secretan were alive to the 
importance ol silicosis The disablement ca'^es certified bv 
the Medical Board in the refractories industries were le s than 
five in each of the last five vears except one ve*> v%hen there 
were ’^even The figures for poUenes had fallen in the ^amc 
five \ears from 70 to 41 and for stonemasons outride the 



382 August 13, 1938 


MEDICAL NOTES IN PARLIAMENT 


The BrmsH 
Medical JoursKt 


sandstone industry from 72 to 56 The figures for metnl 
gnnding were 8 in 1937 Prevention in coal mining and sind- 
stone quarrying was a matter for the Mines Department The 
extension of the Factories Act to coter builders yards and 
building operations would permit further regulations There 
svere legislatne difficulties in the way of bringing the Sheffield 
cl iss of little masters under the Act It seemed hard that 
workmen still emploted in grinding after June, 1927 might 
get compensation if thej became affected, while workmen not 
employed after that date were outside the scheme, hut it 
would be difficult to make the scheme retrospective 

The question of men in the grinding industry who suffered 
from a mixture of silicosis and tuberculosis was intertwined 
with one matter which was under consideration and another 
which was sub ludice A committee had been appointed bi 
the Medical Research Council which w'as inquiring into the 
incidence of pulmonart diseases other than those which could 
be definiteh diagnosed as silicosis The report of that com 
mittee would not be atailable until the middle of next year 
and the question was aiso mixed up with workmens com 
pensation The Home Office recently placed before repre 
sentatives of emploiers and trade unions reused proposals for 
amending the silicosis scheme These included extension of 
examinations to workers in additional processes in the pottery 
industry particularly in the manufacture of earthenware The 
Home Office had no endence to show that the silicosis com 
pensation scheme should be extended to slate workers in North 
Wales but the Mines Department was inquiring into the 
working conditions and in the light of the results it would 
be considered whether a further medical inquiry should be 
undertaken It would be difficult before the middle of next 
year to get the results of the inquiry being made under the 
auspices of (he Medical Research Council into diseases of 
a pneumonic character in mines There had been 5 000 cases 
investigated and it would be necessary to examine the workers 
at another colliery 

The Stewart Committee had presented a report m Jamiaiy 
containing recommendations on miners nystagmus He could 
not say whether the whole or part of that report would be 
implemented The question of card room operators was 
extremely difficult from a medical point of xiew m ascerlam- 
mg whether the workmen suffered from bionchitis or asthma 
due to dust or due to natural causes The committee appointed 
last year to go into the matter had heard evidence had 
carried out statistical investigations, and was now considering 
Its report ’’ 

The debate was concluded and the Appropriation Bill was 
read a second time 


Scottish Department of Health 

Mr Colville answering Sir Samuel Chapman on July 28 
said the Departmental Committee on Scottish Administration, 
of which Sir John Gilmour was chairman, recommended 
four main Scottish Departments each in charge of a Secretary 
directly responsible to the Secretary of State Health would 
be one Department The Board of Control would be recon- 
stituted with a full time instead of a part-time chairman, 
and Its work as well as that of the Registrar General, 
brought more closeh into relation with the Department of 
Health The day to dav administration of these Departments 
would be conducted from Edinburgh The Government was 
in general agreement with these regulations and would intro- 
duce legislation early next session 

Major Stuart Blackmore 

Dr Hxden Guest asked on July 28 whether Sir Samuel 
Hoarc was aware of the circumstances leading to the death 
of Major Stuart Blackmore chief medical adviser Air Raid 
Precautions Department Home Office as a result of over- 
work and other adverse conditions and that Major Blackmore 
left a widow and two children and whether he would inquire 
into all the circumstances and into the propriety of recom- 
merulmg special provision for the dependants 


Sir SxMUti Hovut said in reply that Major Blackmore was 
a valued servant of the Air Raid Precautions Department 
of which he had been chief medical officer since early in 19a6 
and his recent death was a great loss to the DepaUmem It 
was not possible to make any grant to the widow from public 
funds No pension was payable to the widow of anv civil 
servant whether established or iincstablishcd and a gratuity 
w.is only payable in the case of an unestablishcd officer where 
at the time of his dcUh he had not less than fifteen years 
scrv ICC 

Dr Hsdln Gut ST asserted that certificates showed that in 
the opinion of the doctors who attended Dr Blackmore the 
unusual circumstances of hts work contributed mafenally to 
his death Dr Guest asked Str Samuel to investigate whv 
seven days before Major Blackmore s death a letter was sent 
to him informing him that his pav had been slopped— a 
knock-out blovv to a man on his death bed 

Sir SvMtrL Hovre said that in respect of the dependants he 
was bound bv statute lavs He would look into the point 
abovil pax Major Blackmore was ill upon several occasions 
during his cmplovmcnt b\ the Air Raid Precautions Depart 
ment and those who knew the circumstances of the case at 
the lime vvoiild sav that the Home Office treated ihe-case with 
the greale^t sympathy 

Mental Hospital Accommodation in Lancashire 

Answering Mr Porntt on Julv 29, Dr Elliot said the 
number of patients in the Lancashire mental hospitals on 
Januarv 1 last was 14 339 Proposals had been approved to 
increase the accommodation at four of the mental hospitals 
bv 965 beds and other proposals were under consideration 
for adding a further 300 beds Plans vvere also being pre 
pared for a new mental hospital of 1 000 beds The patients 
in the mental hospitals in Lancashire in each of the last five 
years on December 31 were 



Males 

Females 

Total 

f9J3 

6 174 

7 332 

D7W 

1934 

6 310 

7618 

13 928 

193S 

6 294 

7 389 

13 883 

1936 

6 368 

7 707 

14 073 

1937 

6 444 

7 895 

14 339 

V. 

The patients who 

recovered 

sufficiently during 

those years 

be discharged were 

Males 

Females 

Total 

1933 

39S 

519 

914 

1934 

3S4 

53S 

942 

1934 

379 

526 

903 

1936 

3S3 

507 

860 

1937 -- 

311 

462 

773 

Total 

1 822 

2 572 

4 394 


Dr Elliot further informed Mr Porntt that the weekly 
hours of duty expected from the nurses in the mental hos 
pilals in Lancashire were fiftv-tvvo exclusive of time off duty 
for meals The proportion of nurses to patients was approxi 
mately one nurse to eleven patients by day and one nurse 
to fiftv-six patients bv night 

Mr PoRRtTT asserted that there was a great shortage of 
nurses in these institutions and that the proportion W 
patients should be one in six Dr Elliott agreed that there 
was a shortage in manv institutions 

Jamaican Medical Service Appointment 

Mr Creech Ioxes asked on July 28 whether the attention 
of the Secretary of State for the Colonies had been drawn 
to an advertisement for a doctor bom in the United Kingdom 
and of European parentage to serve in Government medicvl 
service in Jamaica whether it was the policy of His Majesty s 
Government that discrimination should be established m this 
and other appointments in-the West Indian colonial services, 
and on what grounds this discrimination was advertised 




Aiol->t 13 19^8 


MEDICAL NOTES IN PARLIAMENT 


The 

^.XDICAL JCCXNAL 


J»S5 


Mr \!\icolm M^cDo^^L^> m hi^ rcpiv assumed Mr 
Jones referred lo the ndxerti^tmcnl for i htalih ofTitcr in the 
Oovcrnmcni Nfedical Scrsicc in Jamaun s^hith appeared m 
the British \tciht,ol Jotnal and the Litcit of Ma\ 2S 193S 
That advertisement slated that candidates must be British 
subjects of Luropcan parentage becaii c the Governor in 
reporting the vacanev stated that there was no suitable 
qualified ofliccr available in -the Colonv It was assumed 
therefore that no uveful purpose would be sersed bv inviting 
applications from Jamaicans Far from there being anv dis 
cnmination against the appointment of ^^csl Indians m the 
local government services in the ^^c<t Indies it was the 
settled policv to utilize the sen ices of local persona for 
appointments for which thev were suitable and qualified 

iritdctict. of Tuberculosis ir the Gold CorU — On Julv 20 
Mr MstcoLM MvcDonvld said that in the report of the Gold 
Coast Medical Department for 19^6 the senior medical ofliccr 
in the ^\cstem P^ovancc^ described the incidence of pulmonarv 
tuberculosis in the mining area as abnormally hich A new 
hospital equipped with high power r rav apparatus had been 
built at TarKwa Two officers of the Medical Department 
working in do c collaboration with the mines medical officers 
bad been posted to Tarkvv'a to conduct an investigation into 
the inadencc of tuberculosis and silicosis 

Dipht) eria Iicidcrce and ’Mortality afttr }i ocidation — On 
Julv 2^ Mr \\EDDtRBLR.s informed Mr McGovern that in 
Edinburgh out of approNimaielv 27 000 children inoculated 
against diphtheria smec 192-* UO had suffered from diph 
theria and three had died In Aberdeen out of approxi 
matelv t^OO children so inoculated since September 1936 
twentv three had suffered from diphtheria and none had died 
Information relating lo Dundee and Glasgow vv^s not available 

-Ivm/nb/hrv of Atebnn end Plasmoqutne — Mr D Advms 
on Julv 26 nsk^ the Secretarv of State for War what pro- 
portion of the new drugs now being emploved m combating 
mabna in the Bntish tropical Empire cspeaallv atebfin and 
plasmoqutne came from countries outside the British Empire 
and vvhether stores of these drugs were maintained vvnh a 
view to ensuring that in the event of war tropical tcmioncs 
and the Bntish Armv would be safeguarded from disease 
epidemics Mr Hore Belishv said that there was no tech 
meal difficuliv in making these dnigs which came from outside 
the Bntish Empire Stocks were held and quantities were 
reviewed from time to time The question whether slocks were 
maintained for u*c bv the cml populations of tropical tern 
tones was one for the governments of tho e tcmioncs 

Health Sersiccs in Trinidad — On Julv 26 Mr Mvlcolm 
MscDosvld replving to Mr Creech Jone< said that progress 
had been made tov'^ards implementing the recommendations 
of the Tnnidad Commission He circulated an account of 
the progress made in which it was stated that under the 
heading Medical and Health Services a draft Ordinance 
had been prepared to transfer the executive functions of the 
Central Board of Health to the Director of Medical Services 
As regarded housing the Governor contemplated the estab- 
lishment of a town planning and housing aulhonlv which 
would carrv out a far reaching plan of slum clearance 
Legislation was being drafted for this purpose 

Mentalh Defccti\e Children in Let cashire — ^The number 
of children ascertained to be mentallv defective within the 
meaning of the Education Act, 1921 on December 31 1929 
was 4 8^8 or 0 67 per cent of the average number on the 
registers of the public elemeniarv schools in Lancashire and 
on December 31 1937 (the latest date for which figures are 
available) 3 702 or 0 56 per cent of the average number on 
the registers These figures do not include children of chool 
ace notified to the mental deficiencv authontv as ineducable 
or on other grounds 

Bandi cer in Prison Surgery — Mr Colv ille told Mr 
David on on Julv 29 that cotton bandages used at Barlinme 
prison for retaining dressings and found to be unsoPed after 
use** were sent to the laundrv where thev were steeped m 


Ivsoi and then thoroughlv washed tetore being relumed to 
ihc surgerv for further u'e His information was th^i the 
conditions were hvgienic but he v\ould look into the point 
Soiled bandages were burned and no bandage which had 
been In contact with a vsound was u^ed again Gt-uze 
bandages were not used twice Replvmg to Mr Gallacher 
Mr Colville said that v\hen a prisoner at Barlinme was given 
medicine in his cell his own spoon was u ed It medicine 
was given in the surgerv or wo kshed the spoon w*.s washed 
and dried with a towel on each occasion, Pnsoners with 
infectious diseases were i ol^ted and their own spoons u ed 
and then slenlized In the sub equent debate Mr Colville 
announced that it was expected that the new Cnmmal Lunatic 
Asvium for Scotland and the Stale Institution for Deledive" 
would be rcadv for occupation next vear 

Rcf,ional Medical Reicret ccs — The number of incapacitv 
and consultation reicrcnces made bv approved bocieiies dunng 
1937 to the regional medical stall m England and Wales wa^ 
Dr Elliot states 4^9 606 Dunng the vear 128 621 insured 
persons received dcclanng ofT certificates before the dale 
fixed for examination while 91 30s did not attend for exam- 
ination 2'7 82S insured persons were examined and m 
the opinion of the examining officers 17s2212 were incapable 
of vvork and 62 616 were not incapable of work 

U orking Hours oj LCC Nurses — Dr EtJUtOT state-b that 
the London Countv Council deaded on Mav 18 last that as 
from Julv I a nmelv slx hour fortnight should be substituted 
for the existing hours of work of nurses The seberre has 
been put into operation at a number of hospitals but it has 
not vet been possible to recruit the numbers of staff necessarv 
to put It into full operation 

Silicosis in Tti \fincrs — Between June 1 J931 and \fav 
**1 1938 the Silicosis Medical Board cenified fiftv un miners 
to be disabled b\ the disease and certified in thirtv seven 
cases that death was due to the disease In twentv five of 
the fatal cases the workmen had previouslv been certified lo 
be disabled For the vear ending Mav 31 1938 there were 
five fatal cases tfour of which had previouslv been certified 
as disabled! und ten cases of disablement 

A ores in Brief 

On March 31 1938 as compared with October 1 1937 in 
spite of a fall of 28 000 in the number of children in the 
chools of England and \\ale« there was an increase of 
74000 in the number receiving free milk and of 99 000 in the 
number paving for milk 

In 1937 the fatal acadent rate to persons under 18 m coal 
mines was 0 89 per 1 000 emploved and the reportable injurv 
rate 5 86 per 1 000 The comparable rate^ in respect of 
persons of 18 vears and over were for fatal accidents I 09 per 
1 000 and for reportable injunes 4 02 per 1 000 

In 19 j 7 compensation was paid under the Workmens Com 
pensalion Acts for these new cases of industnal disease 
nv'lagmus I 165 or 1 5 per 1000 persons emploved beat 
hand 1212 or 1 5 per 1 000 beat knee 4 848 or 6 1 per 
J 000 beat elbow 700 or 0 9 per 1000 svnovitis, 373 or 
0^ per I 000 and other disease*; ]29 or 02r per 1 000 None 
of the cases was fatal 

Sir Samuel Hoare stated on Julv 28 that he had rccewcd 
the report of the committee appointed to consider the 
evacuation of the civil population from certain areas in time 
of war He would lake the matter up at once 

Ot 58,547 applicants for entrv imo the Roval Aaw and 
Roval Mannes for the vear ended March 39 jS 22 029 were 
rejected on medical and denial grounds 

In England and Wales dunns the six months ended March "I 
last 181^-*^ houses were built which is a record for anv 
half vear 

The number of disabiblv pensioners at ^^<lrch 21 IP'S was 
approximaielv m3-* 700 

In England and Wale^ the majoitv of local education 
authorities who are conducting cour es of instruction for 


384 August 13 1938 


EPIDEMIOLOGY SECTION 


TiccBumsM 

'ItDICAt. /otAvii 


unemployed bojs and girls have made arrangements for 
medical inspection either monthly or at more frequent 
fntc'vals fn Scotland until the passage of the Unemptoy- 
rr!''nt Insurance Act 1938 the powers of education authorities 
with regard to medical services at courses of instruction were 
limited to a general power to provide medical supervision 
It has not vet been possible for any authorities in Scotland 
to make arrangements under the new Act 


EPIDEMIOLOGICAL NOTES 

Poltomj elifis 

The seasonal rise in England and Wales in the prevalence 
ot acute poliomyelitis noted in the last two issues of the 
Journa} continues, although the situation calls for no 
undue alarm During the week under review 41 cases 
were notified, compared with 19 in the previous week 
while m the corresponding week last year 17 cases were 
recorded Of the 41 cases one-halt occurred in twenty 
difterent areas, ranging from Northumberland to Cornwall, 
while m no town were more than lour cases notified during 
the week In the past three weeks 83 cases were notified 
with 9 deaths Cases were notified during the last three 
weeks in Braintree 17 (I deathl Halstead 19 Swansea 5 
(I death), Pontyates 4 (i death), Farnham 4 (3 deaths), 
Grimsby and Cleethorpes 7 Reading 3 (1 death), Felstcad 
6, Worthing 9 (2 deaths) Ipswich 4 Ealing 1 Shildon 4 
Although, generally speaking, the disease has been described 
as ot average seventy and in some areas distinctly mild 
the occurrence of 9 deaths among 83 cases notified points 
to the presence of infection ot considerable and varying 
seventy 

Most deaths are due to respiratory failure from bulbar 
involvement, but the use of mechanical methods of artificial 
respiration has undoubtedly lowered the number ot 
deaths Difficulties m connexion with the transport ot 
respirators and the availability of electrical supply of suit- 
able voltage can usually be overcome, but it is sometimes 
preferable to remove a patient to the machine rather than 
transport the apparatus to the patient, provided artificial 
respiration can be operated during the journey To most 
foims of apparatus a device is attached whereby the 
bellows may be operated by hand for considerable periods 
in case of an emergency The Bragg-Paul respirator is 
more readily transported and, generally speaking is easier 
to operate from the point of view of the control and 
nursing of the patient, while technical difficulties m 
working the apparatus have been overcome in recent 
models (See correspondence on the Bragg-Paul pulsator m 
the Journal of July 30, p 254 ) As regards prophylaxis, the 
avoidance of undue fatigue and exposure to infection, 
combined with the use of gargles, are the important 
matters Injection of immune serum (human or animal) 
need only be considered in very special circumstances 
where the disease is rife and exposure intimate The 
horse serum prepared at the Lister Institute (marketed 
by Messrs Allen and Hanburys, Ltd ) has been shown to 
be more potent than convalescent serum and being 
readily available, should be used for prophylaxis While 
in treatment immune serum has not been proved definitely 
to be of value, it may be given to early cases m the pre- 
paralytic stage of the disease confirmed by the findings 
in the cerebrospinal fluid Convalescent serum when used 
should be administered by the intravenous route or com- 
bined intravenous and intrathecal routes 

^ Tjphoid Fever 

During the week under review 32 cases of enteric fever 
were notified, compared with 19 in the previous week and 
33 in the corresponding week last year The 32 cases 
were widely scattered in England and Wales the chief 
counties effected being Essex, 7 cases, West Riding, 


5 cases In the week ended August 6 an outbrea), 
occurred at Farnworih Lancashire in which 23 confirmed 
cases have been reported to date the number under 
observation is 14 So far there have been 2 deaths All 
the cases occurred in Ihe New Bury area and are eon 
fined to 3 small group of houses in which several members 
of a single family have been involved in one or two 
instances Pending the results of bacteriological invesliga 
lions the healih authorities advise that both milk and wa^er 
should be boiled The disease appears to have been of a 
serious type there having been 2 deaths among 23 cases 

Diphtheria and Scarlet Fever* 

Notifications of diphthern in England and Wales during the 
week under review fell from 1031 to 1 007 and in London 
from 155 to 1^4 There was also a drop in the notifications 
for Scotland — 106 as against 123 — but in Eire a slight rise was 
noted — 46 compared with 4S in the previous week m 
Northern Ireland there was a considerable decrease 14 case^ 
being notified compared with 37 in the previous weel. 
Deaths from diphtheria in the 126 Great Towns of England 
and Wales fell from 27 to 19 while in London they remained 
at 3 of the 19 deaths recorded in the 126 Great Towais 3 (0) 
occurred in Manchester and 2 each in South Shields (2> and 
Swansea (0) There were 4 deaths from diphtheria m the 16 
principal towns of Scotland during the week — 3 (3) in Glasgow 
and 1 (0) in kilmarnock There was a drop m the notifies 
tions of scarlet fever in England and Wales and in London 
during the week under review — I 5S3, compared with 1791 
and 128 compared with 191 rcspectivclv both these figures 
were below the median values for the last nine years There 
were 5 deaths from scarlet fever in the 126 Great Towns 
during the week — I each m London (I) Brighton (0) Eavt 
bourne (0). Nottingham (0) Sunderland (0) 

Primary and Influenzal Pneumonia 

There was a decided increase in the notifications ot primary 
and influenzal pneumonia in England and Wales during the 
week under review — S89 as against 493 — and m London — 13 
as against 33 , both these figures are considerably in excess of 
the median values for the last nine years 

Measles and WTiooping-cough 

Measles was responsible for 5 deaths vn the 126 Great 
Towns ot England and Wales during the week under review 
compared with 6 in Ihe previous week of these 1 (2) occurred 
m London 2 (0) in West Ham and I each in Hendon (0) and 
Leeds (0) The average daily admissions to the LCC fever 
hospitals were 8 as against 11 in the previous week Notifies 
tions dropped in five of the metropolitan boroughs in 
measles is notifiable remained the same in three, and rose m 
three Fulham II (.7), St Pancras 10 (9) Stepney 2 (I) 
Scotland the figures for measles dropped apprecnblv— 6- 
compared with 117 in the previous week of these 31 (d6) 
occurred in Kirkcaldy 20 06) in Dunfermline 4 (5) in 
Dundee There were 14 cases of measles in Northern Ireland 
during the week all in Belfast In the 126 Great Towns of 
England and Wales there were 7 deaths from whooping eougn 
during the week — the same as in the previous week only 1 
these occurred in London In Scotland 25 cases of vs hooping 
cough were recorded — 18 (14) of which were m Glasgow— md 
1 death (in Glasgow) 

Cholera 

During the week ended July 30, 121 cases of cholera and 
244 deaths from this disease were reported in Shanghai, and 
in Hong Kong 25 cases with 26 deaths Increases in the mm 
dence of cholera were noted in the Central Provinces — 4 961 
cases with ^398 deaths — in Madras (Presidency) — 374 casev 
with 1 70 deaths — and in the United Provinces — 924 cases vviin 
407 deaths 

* In these paragraphs except where otherwise mentioned fisure* 
in parentheses refer to the week preceding (he one under review 



AliL'sT ir 191S 


EPIDEMIOLOGY SECTION 


Tin; BiunsiT 
'fnrcAi. JouKVAL 




INFECTIOUS DISEASES AND VITAL STATISTICS 

^^c print bclovN a siimrmrv of Infectious Disca<».s and Vitil Statistics in the British Islei. during the week ended Julv ^0 19^^ 

Ticurcs of Principal Notitnbic Distj'es for the week md those for the corresponding week last sear for (a) England and \\ales 
(London mtUidcd) (b) London {admmisiratiNC count) ) (c) Scotland (d) Eire (c) Northern Ireland Median ^Tllues for the last 

9 vxars for (a) and (b) 

Fi^urts cf at d Dcatl ^ at I of Dcatf ^ rtcorded utdtr taeft in/cctioiis distase are for (a) The 126 great towns (124 in 1937) 

in Enchnd and Wales (including London) (b) London (administratiNC counts) (c) The 16 pnncipal towns in Scotland (d) The l_ 
principal towais in Drc (c) The 10 principal towns (9 in 19^7) in Nonhem Ireland 


\ dash — denotes no eases a blank space denotes drea e not notifiable or no return a\ailable 














Disca^ 



I93S 



1937 (Corresponding W eek) 

Corresponding W eel s j 


("t) 

(b) 

fc) 

Id) 

(e) 

(a) 

(b) 

(c) 

(d) 

(e) 

(a) 

(b) 

Cerebrospinal fc«:r 

26 

1 

10 

2 

I 

11 

2 

10 


— 



Deaths 


1 

3 




“ 

n 





Diphtheria 

I 007 

154 

106 

46 

14 

890 

92 

I'O 

6 

25 

9)8 

156 

Deaths 

19 

3 

4 

2 

— 

22 

I 

2 

3 

— 



D\««ntcrv 

36 

5 

31 




25 

II 

12 

3 

— 



Deaths 




— 

— 




— 

— 



Encephalitis lethargica acute 

2 








1 



— 


— 



Deaths 


— 





— 






Enlcnc (l\-phoid and paratsphoid) fe\cr 

X2 

4 

4 

3 

— 

33 

— 

4 

6 

5 

53 

7 

Deaths 

— 

— 

1 

— 

— 

2 

— 

1 

1 

— 



Ensipslas 



42 

2 

4 



4^ 

1 

5 



Deaths 


— 





1 






Infcclise cntentis or diarrhoea under 2 sears 













Deaths 

42 

22 

9 

4 

3 

40 

13 

8 

9 

5 



Measles - 



62 


14 



48 






Deaths 

5 

I 

1 

2 

1 

7 

“ 

— 

1 

— 



Ophthalmia neonatorum 

Deaths 

98 

5 

51 


— 

101 

4 

54 


— 



Prcumonia influenzalt 

5S9 

43 

15 


2 

381 

34 

2 



464 

38 

Deaths (from Influenza) 

16 

I 

1 

3 

— 

8 

1 

— 

— 

— 



Pncutronia primarj 



no 

6 




89 

1 




Deaths 


17 


S 

7 


15 


6 

3 



Polio-enccphalitis acute 

— 

— 




3 

I 






Deaths 


— 





— 






PoIiomNeliiis acute 

41 

3 

4 




17 

1 

2 






Deaths 













Puerperal re\er 

5* 

5 

18 

] 

1 

31 

4 

17 






Deaths 


>t 





1+ 






Puerperal pNTexia 

182 

17 

25 




102 

15 

23 






Deaths 













Relapsing feser 




















Deaths 













Scarlet fc\er 

1 553 

128 

271 


49 

1 593 

142 

2S2 

63 

49 

1 627 

- ra 

Deaths 

5 

I 

1 

— 

— 

2 

— 

1 

— 

— 



Small pox 
















Deaths 

— 

— 


— 

— 

— 

— 


— 

— 



Tvphus fexer 






















Deaths 




— 

— 




— 

— 



W hooping-cough 



25 


15 



aO 


3 



Deaths 

7 

— 

1 

I 

— 

9 

2 

H 

i 

— 



Deaths (0-1 Near) 

272 

49 

52 

34 

n 

296 

59 

55 

24 

20 



Infant mortalitN rate (per 1 000 h\e births) 

45 

40 




50 

49 






Deaths (excludmc stillbmhs) 

3 814 

718 

all 

160 

109 

3 727 

6Sa 

557 

155 

104 



Annual death rate (per 1 (>00 persons h\ing) 

94 

9 I 

10 4 

10 8 

97 

92 

S 6 

11 4 

lU 6 

10 0 



Live births 

6 819 

1 24S 

SSS 

373 

294 

7 085 

1 220 

S-,9 

317 

2^a 



Annua! rate per 1 000 persons liNing 

16S 

15 9 

18 I 

2:»3 

26 I 

17a 

15- 

174 

21 6 

225 



Stillbirths 

249 

33 




288 

53 






Rate per 1 (XX) total births (including stillborn) 

45 

26 




39 

42 








After October I 193' pucrreral foer made notifiable cniv in the Includes pnroa-y form in figu-ss fc England ard W Jes London (-d 
adrometra i e count> of Lender nunjatran^e count%) Nertb-m Irelairf. 

t Death from FuerperaJ sepsis- 



386 August 13, 1938 


MEDICAL NEWS 


Tiil BurruH 

McOICAL JoUf V4L 


Medical News 


In our advertisement columns this week applications are 
invited for the following posts University of London Ch iir ot 
Radiology tenable at the Royal Cancer Hospital -at a salary 
of £2 000 per annum and Consersator of the Museum and 
Director of Postgraduate Studies at the Roy il College of 
Surgeons of Edinburgh at a salar> of £1,000 

The address of the Imperial Cancer Research Fund is now 
Burtonhole Lane, The Ridgeway Mill Hill NW7 telephone. 
Mill Hill 3544 

An Imperial Veterinary Conference will be held at the 
Royal Veterinary College Camden Town London, NWI, 
fiom August 15 to 19 The subjects to be discussed will 
include the work of the Imperial Bureau of Animal Health 
foot-and mouth disease and certain other virus diseases 
lohne s disease bovine mastitis caseous lymphadenitis ot 
sheep, sheep blowflies, fowl paralysis and chronic bovine 
haematuria 

The official Reiclisyazetic of August 3 contains a decree 
depriving all Jewish doctors m Germany of their permit to 
practise medicine in that country and Austria vvith effect from 
September 30 next The Ministry of the Interior is given 
power to make exceptions in the case of doctors who served 
in the German Army during the war who are reduced to 
indigence by the new order After October 1 revocable per- 
mission will be given to certain Jewish doctors to treat Jewish 
patients only Landlords arc required to give notice bv 
August IS to Jewish medical tenants who will have to leave 
their quarters by September 30 unless there is difficulty in 
replacing them with new tenants The effect of the decree 
will be felt most acutely in Vienna, where before the 
Anschliis’! over 50 per cent of all the practising doctors were 
Jewish Henceforth no Jewish practitioner deprived of his 
means of livelihood will be allowed to re enter the profession 


Letters, Notes, and Answers 


All communications in regard to editorial business should be 
addressed to The EDITOR British Meoicvl Journal B M A 
House Tavistock Square W C 1 
ORIGINAL ARTICLES and LETTERS foiwarded for publication 
are understood to be offered to the British Medical Joiiinal alone, 
unless the contiary be stited Correspondents who wish notice 
to be taken of their communications should authenticate them 
with then names not nccessirily for public ition 
Authors desiring REPRINTS of their articles published in llie 
Brilisli Medical Journal must conimunicite with the Secrctaiy, 
B M A House Tavistock Sqiiaie W C 1 on receipt of proofs 
Authors overseas should indicate on MSS if reprints arc 
lequired, as proofs aie not sent abioad 
All communications With reference to ADVERTISEMENTS should 
be addressed to the Adveitisement Managei Oidcrs Coi copies 
of the Journal and communications with reference to subscrip 
tions should be addressed to the Secietaiy BMA House, 
Tavistock Square W C I 

The Telpehone Number of the British Medical Association and 
the British Medical Joiiinal is EUSTON 2111 
The Teleorvphic Addresses a'le 
EDITOR OF THE BRITISH MEDICAL JOURNAL, Aitiologf 
ly estcent London 

SECRETARY Medisecra Weslcenl London 
The address of the BMA Scottish Office is 7 Drumsheugh 
Gardens Edinburgh (tclegiams Associate Ednibtirgli tele- 
phone 2436f Ediwburgbf and of the Office ot the Irish Fiee 
St lie Medical Union (IMA and BMA) 18 Kildare Street 
Dublin (tclegrims Bacillus Dublin telephone 62550 Dublin) 

QUERIES AND ANSWERS 

Spasm of Colon 

“ M B 0\ON wntes Are there any records of this condition 
being due to B coU'> In this particular case no relief js 
given to the condition which troubles the patient chiefly 
“P early hours of the morning by 

belladonna nerve sedatives or dieting This patient has 
for some years been subject to attacks of B coU bacillaemia 
average once in twelve months Hence 


Green Sfools at 74 

Dr J BAitcitorr Andi uson writes in reply to the inquiry 
published last week H is ‘ Mewt ’ excluded mild aluminium 
poisoning ns the cause of the green stools symptoms of 
occisionnl gastritis, notably some pain, especially at 
night 2 

LETTERS, NOTES, ETC 

Teaching of Obsfefncs 

Dr Lion Raman (Stepney) writes May I comment on Dr 
Ldith Summcrskill s statement m the House of Commons 
as It appeared in the lay press concerning the teaching of 
obstetrics in this country ' I was taught obstetrics in a 
leading London hospital twenty five years ago and 1 and 
mv colleagues had plenty of practical work all ot us con 
ducting thirty cises independently About twenty years 
later my son was (,ai/ghf midwifery at the same hospital 
and the method of teaching was the same Compared with 
other European universities {where I spent some time) the 
teaching of midwifcrv m this country is excellent particularly 
on the practical side II is a great pitv that Dr Summcrskill 
was not so fortunate and apparently according to her own 
statement did not show loo much interest in her work 
Childbirth and child-bearing are natural functions and I 
suggest that any general practitioner is capable of attending 
confinements satisfactorih provided sufficient care is taken 
to prevent complications and if the latter do arise that thev 
arc dealt with carefully and promptly 


Recovery after 1,500 Gmns of Aspirin 
Dr G S W Evans (High Wycombe) writes The instances of 
aspirin poisoning recently described prompt me to relate 
the following experience One day about noon an agitated 
man rushed into a shop where 1 was making a purchase 
and urged me to accompany him to an adjacent house 
where his son ii,id swallowed 300 aspirin tablets There 
on a couch lay a youth of about 20 'in a semi comatose 
condition and the production of empty bottles confirmed 
the fact that he had taken 1 500 grams of aspirin » 
seemed that the performance of this feat had 
hours or more I was able to induce the patient to drin 
an ounce of mustard in water and thus brought on P'®'' 
vomiting which continued during his convevance to no 
pttal where 1 believe the stomach was washed ^ . 
some davs aftciwards the boy suffered from tinnitus 
of light before the eves irregularity of the heart ano 
fill of blood pressure but he rccoveicd J sm 'dd®” , 
to Dr English of Crewe for the details of the progres 
the patient in hospital 


The Evolutionary Theory 

Surgeon Rear Admiral C M Bfadnell writes Th*:aendSd 
(ions of forgery and faking repeatedly made against M ^ 
are so unjustifiable that 1 hope you will p^mil i 
second reply to Colonel G F Roweroft, DSO [Jo 
June 25 p 1406) Haeckel admittedly scheniatizecl a ‘v 
of his representations of embryos not for P^rpos 
deception however but in order to help students and ; 
by emphasizing essential features and impressing , 5 

similarity in the different classes of 
Alongside his own drawings and diagrams he ireq 
placed those of other embryologists bv way of corr 
(ion To be logical to and consistent with ines 
evolutionist contentions we should have to j, 

illustrated book on astronomy, physiology, or ofner 
of science as epitomes of fraud Even the exceiieni p 
graphs and skiagrams so often depicted in pag“ ^ 
British Medical Joiiinal would fall obiects 

for they have forced into two dimensions of *P’’^ .Lon 
that in reality occupi^ three • When Kcibcl 

whose own scientific work Professors Hertwig ons 

passed severe strictures — first published his ace 
against Haeckel the latter, declining at first to J®' . „ q{ 
seriously ironically replied that ' six or eight per c 
his illustrations had been thus ‘ falsified, but, as a 
later in the Berliner Volkszeuung of December ■o', 
these so called ‘ falsifications weie what prac . 
scientific men did when illustrating their ,, .gj Dr 
elusion may I recall that when, immediately „ g.-niists 
Brass s accusation forty-six of Germany s the 

signed a protest repudiating the charge one ot n 
eminent embryologist Professor RabI pointed o 
Frankfurterzeitnng of March 15, 1909 I’’®*. , pe-had 

himself had been guilty of the very practice 
so unjustly endeavoured to foist upon Professor w 



Aucust 1 


19'S 


Tkt BiunsH 
\Lj5 Cal Jcvknu. 


49 


KEY TO CURRENT MEDICAL LITERATURE 

GENERAL JOURNALS 


Deutsche Mcdizinischc Ilochcnschrirt 

I cf n ^rl Ji nc » I9*> 

T»»crt> f'c cf Treatfrent cf TfJtcir ral Ncuralfu *. th Gart n 

Irrccti>f*^ — r llincl 

Surf atKe cf 'Icetmn n Prcuion j — O 1! ^fn^u^ and S«.huT/ 

Dcaih after B-^nuth Trcat'^cr wuh Fcr'srVs on » xal cd Seri sica! Jr^i * 
u T fcT Trcarncri cf S\p*iiH --'H Aret? 
r yxl PanctN \I ^rd N Hcrcditj Bevarches m 109 Tani n irto ihe Fa tor 
— P Dahr ard W BJ^v"unn 

lu J Cure cf Tnjx'nral Sruralcia H In ta rn of A1 cfiol — D KulenVamrfI 
Can Esi'snccus F-tetA ArrrrcuMr Infljcrcc Dcvtl rmcn cf Mulnr c 
'h. erc''^'* — H SturA*^s 
Re"et Pan doe to M><>te1c*i^ — \ Ra hart 

\\ hat Mu t ihe General Practmoner Know cf Llcvtrcx-fdi'frar-h''' — G 
B KJef—aim 

Pr nr « cf E^alaat n cf BoKmUj P tc~t SutNiar c* — H \ Svhc 1 *'* 

Mitconsn: in Pnfitmonia — \n account is given of what is 
done in a public ho«;pital in Konigsberg Prussia to break the 
Mcious circle which arises when mcteori^m develops in the 
course of a pneumonia It is stated that in the overwhelming 
majontv of fatal cases of croupous pneumonia meteonsm 
begins and is refractory to treatment 

Edinburgh Medical Journal 

Ediaburjh ^cl 45 ^rtil 19’S 
SLKTdc — D K Hend r^on 

Moccru ^oacsihcsa and the General Pr’amoner cf T^norro^ — J GiU t* 

Nl ved TtmoLrs cf Saln'ar) GLodi — \S r Hane> E K Da«»cn -rd 
J R \J Irnes 

Vf)cc3rd^l IcfarcLca Patholo ical Studj — R M Murray Lycn 
Mc<coi* S\Lf- c' k7 It«ti*tiie— D Ba*A3 

Proehtirc Sfed -lae and Conirc! and Treatment of Tubercufesu ai ecn »a 
S^Tjct Rtjs a — T 'funro 
Surreal Treaiseft of Cardac Patn — J Patcnon-Rcss 
Cave cf Lnfurtured Tubal Prervancy conu-uinjt to Full Term — If Mil er 

\f\ocardial Infarction — Nfurrav L\on reports that evidence 
of mvocardial infarction was found in 110 cases out of 3 200 
consecutive necropsies an inadencc of 3 44 per cent An 
unusualtv high proportion of female cases was found — '^64 
per cent Thrombosis was the cause of the infarction in all 
cases except three of mitral stenosis in which embolism 
had occurred The right ventncle was involved in onlv five 
out of 122 infarcts Approximateh three fourths of the male 
cases had been diagnosed before death but onlv half the 
female cases About half the patients died within one month 
of thetr acute attack 

Edinburth vol 45 May I9’8 

Mcdjcal PractiT cf the Future — J Punes-Ste«-an 
p5>choIcjncal Problcn of \crercal Drseasc — R C L Batchclcc 
Funt and Peura Cenan Xnatcvnscsl Facts in Relation to Divca c — A Fergus 
Henat 

Na^l Sujusnis and Vfental Disorder— A B Smith and C McD Ros 
Bjiif^ Intraihcracic Tumours — E Bloch 
Ml \ Suppij — A S St. Maccresor 
HiyVaod ar^l Islands Medical Service— X Shearer 
TrcatrecPi o' Chronic Cervicitis — G D Matihew 

Anw/ Sinusitis and Mental Disorder — As the result of com 
pleie examination of the nose throat and cars in 818 ca^er* of 
mental disorder Smith and Ross found that 12 per cent of 
these patients suffered from nasal sinusitis Thev found no 
evidence that nasal sinus infection plavs anv fundamental 
part in the causation of the majontv of cases of mental 
disorder 

Journal of the American Medical Association 

Chicago vol no June 4 J9 S 

Eicreiicn of SuJphiBilaTj de — J D Stmn G Rc tc and J G Men 
I, e cf Sulpban laaude after Trar urethral Prostatectomy — H Gaoviin H ^ 
"Zide atvl G Thoror*^" 

C c cf Beruednoe Sulphate in Pcst-enccrhal tic ParV n^onuro — P L Davis 
and W B SicHait 


Fra lure cf Ai’as in Auiofr Jc Accidcrts — H F PJut 
f- I tv Rates in CercbrcKpinal Mcningi'is — G W Ih 

\ I amm C in Bond Sr ral Fluid and Lnne — H V\ cfits J Lictt~ann .. d 
r vvcni 

Cj t Hyg ona cf Sccli — B L Flcnirs 

Stuo cv n Evaluai r cf VI nmoerarhy — R X Reis rd S D Me< r n 
Lipv" tirns ..nd Dangem of Mar'fnvraphv b> Centra i Med a — S X R rr- o 
arj E M M tefriu-e 

Mj !♦* e Penpheral Set-ror-thy » Vlulipe Neuntr* — I S We !• 

\ tamn X Requ rements and Practical Reccmmcrdaijccs f r \ it-rrn X 
IrtaVc. — L E Focb r 

Klinische \\ ochcnschnft 

BcTln VI.I 17 Jure 4 19^S 

Flit tin ard SmJ.jptc of MiPcraJ e« — H GUtrcI 

Jteynapi.> Changes un Newborn In'apt — E Philipp 
Ef*<ct cf t Rays cn Structure ami Fumion cf Xnteri r Lobe «.f Pitu u-ry — 
P r^nirob c^ht F Kc'Icr ard x Loeser 
Redj nt Capa iiv of I>*!ivd o-ascorbic Xcid if Hca thy Irdivnuu-H nd Pa ter $ 
Mjrcnne from Chron c Haemorrhagic Intestinal AFectsors — H Lu**d ..nd 
X 

Pra teal Inponan^c cf Bic-clectrical Croups — R Ke let 

] tand<cn Xdenoma successfully Removed by Operation — G W Par^t.'' and 
K Kind er 

Effect of Xllylformate cn Fatigue Curve of IsoLted C-rdu^ Musi.fc of Frc^ — 
B Zanad^ki 

Ccfnr**'atnc Thcrapcuuc InvesiijraUCRS on Effect of Neriirn (Oleander) co 
Cardiova cular Affections — H Becker Frey^cng 
Homcral Tran$m_ ion of Cellular Charges.— B EsJer 

Brio— Aal EFect of Corp’cx Molecular Compounds cf Mbumi-uus Sub«iar es 
— B Ettler 

E0cct of \ Ra\s on Anterior Pitiiitar\ — ^The anatomical 
structure of the hvpophvsis is not affected even bv verv 
intensive irradiation There is also no appreciable change m 
the ihvrotropic and gonadotropic hormones of the pituitan. 
after a sjpgle irradiation 

J-ancet 

Lendoo \oI 234 June 4 19*S 
Causaiicr and Treatment of Dermatitis— R HalLam 

Su pfian. anrdc xn Treatirent of Memncococeal Mcr rpitrs — E C O 
Jetvcibjry 

Su fical Treatment of Pituitary Easophi isti — A R D Patt^on ^rd W G X 
Swan 

Acti e Imurumion apaiiot Ep'deriic Inlucnza by EIe^cr.ary boi-> Sus- 
ren icos heated at 5” C — R W Fairbrethcr 
Ret nil-cytc Respen e in Albno Rats her In ecxicn cf Gastrx. Jukc — G 
Plaut 

Sidphamlanude — Six particularlv evere ca es of meninco* 
coccal meningitis are described successfullv treated by 
sulphanilamide in combination with antiserum or antitoxin 
Recent reports from Amenca and England are summarized. 
The question of the best route for administration of the drug, 
like that of the advisabilitv of giving it jn addition to antiserum 
or antitoxin still remains undecided 

Pttuiiar\ Basophilism — The wnters sumrranze the symptoms 
of pituilarv basophilism mention the extrapitmlarv conditions 
which mav simulate it and recall the cviop)a«mic changes 
desenbed in those presenting the svndrome in the non- 
neoplasiic npe basophil cells The importance of searching, 
m the first place for an adrenal cortical tumour is empha- 
sized Two cases of Cushings svndrome in voung women are 
descnbcd m which improvement followed the in erlion of 
radon seeds into the sella turcica 

Medical Journal of Australia 

, Sydney vd 1 May J 19 S 

Medical Men av Exp o ers — L Darcaa 

C,.rcircria cf Cervix from it c Ger-fal Pmc' crer — F B Cra - 

Ph\ .cal Thcapy la O o-t-rycsolcn-y — E Girterd - 
Xdbc'Oi in ard .jound Jc-aj — N Enuc. 

M yr^irc frero the XDcrp' Vicwpcin — C S'ppe 

Sete «>n EfTcct of Th T 0 X_mir- Xdmn-vtr'i.CQ cc ..s Jmp ed Ttr-ccr cf 
the Mouse — \\ Meppeu. 


3S6 A 


50 August 13, 1938 


KEY TO CURRENT MEDICAL LITERATURE 


Tnc BMTmi 

McfilCAL 3 o\j»nkv 


Medizmische Kiinik 

Berlin \oI 3*5 June 3 1938 
Problem ol Viruses — Hcnbcrj: 

Task of General Pr^cimoner m Cases of HTcmopivsn — O Schccfticr W 
SlarlioRcr Cober G SchroUcr and A B icmcislcr 
Aetiology of Chrome Bronchiccnsis — -W Ncummn 
Sponf\neous Pneumothorax — H Alexander 

'RTdiogrTphic Demonstnuon of PiilmonTry Tuberculosis lu Pleun y wnh 
Efliusion — I Kuhlmann 

Gold diasporal Thcr ipy in Tuberculosis — A Saltier 
Agranulocvtic Reaction — K Kummcrling 

PIctirisv ti nil EffiiMoii — ^This paper stresses the importance 
of small, mostly mfraclavicuhr and posteriorly situated tuber- 
culous foci in eases of apparentls primary pleurisy An out- 
line of the most suitable radiographic technique for the demon- 
stialion of these foci is described Pleural puncture has 
become superfluous thanks to systematic radiographic exam- 
ination 

Meduinische Welt 

Berlin vol 12 June 4 195*^ 

Problems of Nutrition m Infection with Cximplcs from UhLumauc PoU 
arthritic — H Louc 

Serological Blood Picture clunng IcrminTlion of Syphilitic InfLCtion— P \V 
Schmidt 

*Tht Gulf DiscabC — B zti Jeddeloh 

Otogenous Sinus Thrombosis and us Cerebral Complications — 11 Riclucr 
Lowered Cirdiac Vmhty and Complete Cardiic Failure — k Itifih 
EifcUango Treatment in Orthopaedies -—K UUmuin 
Ireatment of Chronic Cczcma of EttcrnTl tir — G UUrisb 

The Gulf Disease — B zu Jeddeloh describes a disease 
involiing damage of the skeletal musculature nhich occurs 
chiefly round the eastern bays ind gulfs of Germany Ot 
some 500 notified cases only twenty-five lived more than a mite 
from the sea The aetiology is unknovyn, and its elucidation 
is 'particularly difficult as no cases haye occurred since 1933 
Gulf disease begins suddenly with pain in all the muscles , 

' movement is impossible The general condition is excellent , 
there is no fever or catarrhal infection of the respiratory 
passages The muscles remain soft and are tender No histo 
logical changes in the muscles were found in many cases at 
necropsy but a nephrosis is present The urine is coffee 
blown ovving to myochrome , albumin is present creatine is 
increased and cylinders are found The prognosis m most 
cases IS good 

Munchencr Medizmische Wochenschnft 

^Munich ^ol |85 June 3 1938 

Co oni.ration between Tuberculosis Dispcnsiry Hospinl Ward and Sanaionum 
— OntsbTCh 

Uc utts of Planned Anti tuberculosis Campaigns — L Schuler 
Trcatmeni of Haemoptysis in Tuberculosis — T RoU 
cucrcncc of Chlorosis m the Male — W Becken 
Ctusc ot L.\bour Pains and ihcir Import ince m Mmauemi.m of Lxbout — 
\V Wolf 

Trcatmcm of Pam after TonsilIeciom> — G Hcddacus 

Nlsv Pcmciple m Treaimcni of Idiopathic Trigeminal Neuralgia — O Mcycc 
Ob-xCrvabons on a Scarlet Fcttr Epidemic in Pinncbcrg (1937) — O Boyksen 
r muliTl Occurrence of Echinococcus Disctsc — G MarTnEOs 
Treatment of Empicma — R Klahn 

CooRlomcr uion \nd Sedimentation Rate of Erythrocytes — G Nicdtgktn 

Chlorosis III the Male — Beckert observed tvs o male adolescents 
with typical chlorosis The symptoms results of clinical exam- 
ination blood picture and cure after iron therapy were all 
exactly as seen m chlorosis No cause for the anaemia was 
ascertained 

Nature 

London noI 141 June 4 1938 

• 

S«r Frederiek GowUnd Hopkins — H \\ leland 
Thi. rionsbj,d Skull —A fvcuh 

Phoioehemtcal Interaction between Ketones ind Secondary Alcohol — Ch 
Ucumann V Htri.hbcrg and E Bcrk.mann 
Oiotrophtc and roHiculoofisie Hormone — / Freud 
Hi iTminc and Action of Thyroid Ghnd — F Ellingcr 

D 'elopmcni of Giant S'llino GHnd Nuclei of DrosapMa L Frolova 

3S6 B 


Nc« England Journal of Medicine 

Boston vol 218 June 2 1935 

Passms of SiirBicd ^eomc^ — A G Rice 
UcHiion of Newer Drugs to Public Health —G P GribUdd 
Mcdico^lcgil Cxaniimtion of Hilrs — B M Vance 
•Progress in Dnbcics Mcliiius — H T Root ind A Marble 

Progress in Dwhclcs Millilits — ^This is a summar) of (he 
literature which has appeared during the past year It cons 
tains an account of the uses of the newer insulins, such as 
protamine zinc insulin ind calcium insulin A full list ot 
references is appended 

Nordisk Mcdicinsk Tidsknft 

- Stockholm yol tS June 4 1938 

ricctro cnccphilocraph) — O Lhrcn**\ trd xnd T S Frey 
•Ntw \ icwpoiniH m cstfmiimR VhIuc of Tfcaimcnt of Schizophrenia wnh 
Jmubn Comp ifoli'c Study of 200 Cases giscn Ofdimry Clinical Trial 
ment — G L'ini’/cJdi 

Ffcaiment of Varicose Veins with Injections ot Varjcocid (Sodium 
Morrhintc) — A Tillroth 

Arltfici» in Mytvendometrnl Zone of Humjn Uieriiv — H Okktls 

Prognosis of Schizophreiiin — Followup stud) showed' 
lint when schizophrenia was well defined a permanent cure 
could be claimed in only 3 per cent whereas among the ill 
defined uncertain cases the complete recovery rate was 32 per 
cent and the partial recover) rale 35 per cent Hence the 
importance of distinguishing between well defined and ill 
defined schizophrenia from the outset before attcmplme a 
prognosis or forming an opinion of the therapeutic value of 
insulin shock ' 

Poltcimico 

Rome sol 45 MJl VO 191S (Sez Fral ) 

•Oxalic Acid Mctibotivm m Gout —1 Dt Mxrco 

Ttn Practice in Pneumothont -^E MnnJolfo -and R Molan 

First Caves of Intcviinal Schi^tovomiavis from Sctmiosoma tnanspfu in Ub)-* — 

C Cicchltto 

Eirfj GttiinR Up xnd Early Ahmenniion Tftcf Opcr'itions — \ futhnari 

Gout — Of forty-four cases of typical gout Di Marco 
noted an increased oxalacmia m 88 per cent usuall) com 
bined with an increase in the urinary oxalates He suggest' 
that the oxalic acid is here largely derived from excess ol 
uric acid hepatic melabolization of this being defective and 
leading to the appearance in increased amounts ot the inter 
mediate product 

Presse Med tea le 

Pim vol 45 Jnnt J 1938 

•Instibiliiy of V iro vyrnomhuic 'S>stt,m ami Operations on 

Course of PulmomT) Tuberculosis — L Michon I Chaue 
MolHtd 

•Acrophagy — G Leven 

Rcncxoihcnpy of Neurotonic Uciciions — AlqvuLr 

yago-svnipatlietiL Imlahilily in Phthisis — ^The authors as 
the result of five years research have come to the conclu'iou 
that vago sympathetic instability accounts for man) ot ' 
subsidiary factors in pulmonary tuberculosis such as saso 
motor, inflammatory and other perifocal phenomena ' 
importance of which in prognosis is being increasingly' 

They also point out that laboratory experiments have ‘'O®'' 
that the toxin of tuberculosis is a definite vago ' 

poison Hence their object 'has been to endeavour to 
the sympathetic system or at least to render it less unsta 
Foi this purpose they use the method of injecting a 
solution of novocain into the stellite and/or the secon 
third fourth and fifth thoracic ganglia They describe Ibci 
technique and give examples of cases so treated 

Aeiophagy — ^The author is disturbed by recent pubiica 
tions in France and ‘otber countries tending to deny ■■ 
existence or significance of acrophagv He gives examp 
drawn from the rcilms of surgery obstetrics, medicine a 



\tci.sT I' I9^S 


KU TO CURRENT MEDIC \L LITERATURE 


The BKrren 

MroiCAt JouTLvti. 


*^1 


rndiolop to pro\c the import-^ncc of thi*^ sxmplom ind 
tlj^cu^'CN its nctiolof.\ *ind trcilmenl 

rirtv X 1 45 lu c 4 1<5U 

Tat t eruf». \ R») Lxa*- -ut nx in t fh I) tcLt f\ of ri ’n* ran 
lubcrcM n C •~"'unnc^— I lu' m 

Vu'ncfval Da a Cn LL.*n**tr Sx'^'xai^cti Chun ( 0>n ’a — \ Dc r* x 
an R Pi fu 

S\sftmi.tiL, \ /\m I \otrut ( uoi s — Jiilhcn “is the rc'-uU of 
eleven vcirs ^\Ntcm'‘tjc a rav cxamin \lion‘; in the Frenth 
Armv put«; forward a plea for the adoption of the anic 
methods in <y:hool children and vounc people The cxamina 
tion ^ihould be fir^i b\ ^.crccning and then bv filni'^ where 
necev^rv The author gives his reasons for preferring this to 
all other methods for the carlv detection of tuberculosis He 
describes an ingenious portable t nv apparatus 

Schwci 2 crischc Mcdizinischc \Nochcnschnft 

tu. \ul 6S June 4 19^11 

vifn.*'C tM cf Lnj'ual Cauv.ticn (Pa«tn.rclla Meninntix) — VV Hadom 
Nc* Case cf CcTCbTor nal Mertnr 1 » from B b p t itc cu* — R 
Reeino 

Ocr*c I'cran cf Acute Artener Pcliomj-tl ii — C Cxnfat 
Berr^J r -I and Ch*icT Trtw of IlcpatH. runcien— ^f Saxill 

Pa^uarella Mrninniiis — In this and the succeeding paper the 
clinical features and bactenological findings are described 
of a case of meningitis due to an organism of the Pasteureila 
group {B hipotans septtcus) The bacteriological relation 
ships arc diSsussed The illness followed some months after 
a fracture of the frontal bone and in spue of a frankis 
purulent cerebrospinal fluid took a benign course 

Chemollierap\ of PohonncUns — Contat had no mortalits 
as well as a fas curable course and satisfactors end results 
qua paresis in fifts four eases during the recent Sssass epidemic 
He used potassium chlorate both oralis in doses larger than 
are customars and in nasal instillations The prophs lactic 
and therapeutic properties as ssell as the lojticologs and do'age 
of the drug are discussed fulls 

South Afnean Medical Journal 

Carctcvs-ti xol 1** ^!ay 

In «Mcn Tfcatmcct cf \aruc»c \ei«— R Siircm 
£"rdr~*>fc. Foexo of Platue — L Feune 
C.IXC cf Cere*'ri] Turtsotir — 1 Sacks 

Tfircc In erc'un* Cases cf Bilhariial Infevtion m a Familj — P Klcnern%.iL. 


Ugeskrift for Laegcr 

Cepenbae n x 1 100 Jure 19’^ 

i>jrix.fx m Trcair*cri of D ca cs of J ints with S-^ ! Referer c i C 
ri «:ati r cf Treatnent — K S< b-^ 

P \ rthrttis Lrcihntfa S mrSc* >n Four P ucn — S Cicr—'c'cn ard K 
Ka biV 

Ostt »^rihru < treated tviib iTireia! Inject un — H Ja cn 

hmmtal — In 19x2 \\ konig published in the Ztmriiltlait 
fur ChtrnrQtc a communication on the subject of a substance 
immefai he had produced which resembled in consi lencv 
the fluid nornnlh found in a joint and which could reman 
in that fluid for a long time without doing anv harm 
Jacobsen gives an acuount of twelve of his own cases treated 
With injcchons of this substance In all but one the 

immediate or ultimate results were good 


NNiener Klimschc W ochenschrifl 

Vienna 'oI 51 June 3 19^ 

Ft «t cf Stn lure of BJe Ducts on Oall bladder— K B^dinfcr 
Treatment of Vfitrainc — R Usut 
Treatment of l-.mWios« — P Gmnea 
rcremc. Vfedi me in Relation to &.hizophfcnui — J B*fzc 
V nv.her Bo»-man PresnarT Test — B % BodiS 
C..n er 'tonalin and Social Status — G VV o ff 

Clim-al Simiificarce of Eraninaiion of Vforp'jolory and Number cf B vd 
r*atefei< — L Bucher 

Result! in D fcfcntiation of BrucelLa T>Tes aecerdins to Izar ard Famulan — 
K kolJir 

Tfcatnxcm of Anema Pectoris ard Cardiac Asthma — H Sicdck 
Thenreutic ImEHsrunce cf Vitamirs m Obstetnes ard Gjnaecolo'^ — J Ctf 

Treatment of Lamhiiosis — Gruneis reports on three ca«e> 
of lambliosis successfulls treated ssith three tablets dails of 
alebnn for fise da>s At the end of treatment the faeces and 
duodenal secretion ssere free from parasites Treatment is 
simple without danger and can be repeated if necessan 


\l tenor Mcdizinischc Mochcn>chnft 

Vienna \cl tS June 4 193^ 

n mm-t n of Phrcniu Sent In ColIap<u Thcran) of PiiLnonarx TutercuJew — 
A Satticr 

Tberapy of Di^ea-cs cau^ b> W orra — O Ch^w 

Imrortaoce cf B ood Cucu alien in AWcrainal Sur£cr> ard it Cemcquer « — 
R Fnrdnch 

rr~cfjcal Therapy of Leu orrhcca — W Hacker 


SPECIAL JOURNALS 


Amencan Journal of Diseases of Children 

Ch cato xol 5S klay 193f 
Rhcujnaiit. Eoibema Nodosum — A VValsren 

Mctabcltsm ^rd VIodc of Action of Vitamin D Imputtancc of Lixtr ( t. ils 
Aatirachiijc E'*i'^c 5 — W Heiinann 

Rcxulis of Collapse Therap> m Ch Idren »iih Pulmonary 7obcrcul>>t> — 
M Siesel and B S n cr 

Patheecnes s ard Treatmcrt of Mjotuna Conscruia Funher OpxciyaiKn — 
H G Ps^ach-' and H \\ VV ^d 

Insemib e Lc^s of VVei 2 *'i in Infai^cv Findnrs for Fonj-sji Infans urxJcr 
Baxal Condition — J L Latk and VV G Frcuerjck. 

Diatnosi of SiThtiu in NevstN^rn Infants L c of Quanutaitxe W a ermann 
Tests — A L Chnst e 

Menialil) of Infants Rebexed of Hj-dros-erhaJus b> Coaxulat on of Choroid 
P exuses — 1 Puuiata 

Patbc ofx of Chren u Anhriirs of Children (Sull s Dtscasc) — R B Porirs 

Rheumatic Enlhema \^ 0 (Iosum — \ tTse of ihis condition 
IS dc^nbed in detail and proves the correctness of the view 
that acute rheumatic fever mav give nse to ervihema nodosum 
On the other hand the rantv of ‘^uch cases disproves the 
view that ervihema nodosum is often rheumatic 

Collapse Therapy — An account of the pneumothorax treat 
ment of pulmonarv tuberculosis in children is given and the 
remits are analv^ed Manv children improved and life was 


prolonged The best results were obtained among the children 
with unilateral tuberculosis in whom a marked decree of 
colhpse could be obtained 

American Journal of Psvchiatrv 

San Francisco xo! 34 Vf rch 19 S 

Habeas Cotjus Releases of Fcefcic-fsmded Pc^ons and th~T Consequen cs - — 
Leo kanner 

Exrcruijcnial Neurois and Pfob*em of vfcntal D <orcfer — H S Lid«,cll 
loiro-cxiraxenion The Concept and their Clmi-al Lsc — R V Cc iicr and 
Mnna Em h 

Appiaisal of Intel eclcal and Phx' cal Facers after Cerebral Damasc n 
Children — Broruon Croifccrs a-d Eliratcih Lord 
Other S’de of Hal umnaiicms - — lociathan Lan** 

Rexicxs ct RcsulLs from ErapIorhCPt of MaLria Therao m Treatment cf 
Neurosyphilts in Florida State Hosp tal —Varfc F Bojd VV K Stratmarv 
Thomas S F K tufceo -nd W H Kurper 
Hereditao Form of Primary Parer hvmatot^ Atrophy of Cerebellar C nci 
..ssociaied »Tih Xt ntal Deten ration — Ar-rr» J AkcLtti. 

Consmi-tiTc CnUTsri of Cetta a Hospital Procedures — Ka 1 VI B-^-man 
Stausjcal Contri^'t t on from Vfer^I H zi ne Stud) c Eas ern Hca th 
Dsxnct of Ball r"orc. — B Vf Cchett aod R E F-rbarfc 
Diaznosuc VaLdit) of Rc'^chach Tes — J D Benj-jnm ..nd F G Ebouth 
Soire Qirucal and ?h)-sio ozteal -Vsnccix of Brain Pc entuls — J Huf bex E. A 
Sj'eckcr and K E. Ar*^ 

Po't-orer-uxe Psxchoses — VlDton XI Abelcs 


386 c 


52 August 13, 1938 KEY TO CURIIENT MEDICAL LITERATURE 


•Results of Fifteen \ ors Experience with Kcloccmc Diet in TreTimcm of 
Epilcps> in Children — H I Hcimholz md M Goldstein 
Some Dat i of Psychic Morbiditj of Jews ind Arabs in Palestine — I H ilpcrn 
Psychiatric History and Development in Cnlifornin — M H Smyth 

liilio-e\(ia\Lisioii — The luthois record t c ireful '.lud\ con- 
ducted upon 250 psychologists and ps\chntnsts in order to 
find out the consensus of professional opinion legarding the 
traits of introversion and extras crsion As the\ state \cr\ 
mildU The lack of clear-cut associations s\ith either intro 
sersion or extraversion \sas evident and thc\ back up their 
conclusions with overwhelming statistical csidcncc 

Mental HtgictiL Stud) — The authors give a general account 
of a most valuable statistical inquiry into the mental heilth 
of a selected district of Baltimore 


Tiir DRrruit 
MtDlCAi. JoiRSVL 


Intm artinal Ih’nmtth — Kimberl> ■points out that the intra 
irlcrial injection of bismuth is a rare but serious accident 
He describes i cisc of embolism due to bismuth being injected 
into an arters A male aged 51 suffering from ssphilis was 
given his seventeenth intramuscular injection of a 10 per cent 
suspension of bismuth subsilicvhtc in oil He experienced a 
sharp pain in the buttock radiating down the thigh and lee 
Radiographs showed bismuth in the arterioles of the penis 
and part of the glans and scrotum sloughed Five weeks 
liter there was still evidence of injury to the sciatic nerve 
toe and ankle drop absent Achilles reflex flabbiness of the left 
c ilf and hy po aesthcsia on the outer aspect of the leg and 
foot After an interval of eight weeks the neurological con 
dition though still present was improved 


Kttotteme Diet in Epilepn — The authors report favourahlv 
upon the value of the ketogemc diet in the treatment of idio 
pathic epilepsy and found that onlv 5 to 10 per cent of 
those who became free from attacks following its use had anv 
lecurrence of seizures in a period of seven \ears Thev 
believe that a‘'ier such an interval the chances of recurrence 
are slight 

American Journal of Svphilis, Gonorrhea, and 
Venereal Diseases 

St Louis sol 22 Mtv 


Anmlcs dc Medccine 

Pans sol 43 Miy 

Ictfrui 

Introduction — N ricssineer 

Common JAtmdtcc and its InRctiaus Niturc — J ^fOlslcf 
lmo!cf*\n''c and CatTfrlnl Jaundice — J Caroli 
Acute IkniRn Hep iloncphntis — J \a»uc 

Sodium MciTholism in Common Jaundice — M Brule !l S3i>»cr 
J Collet 

• Frcaimcnl of Bcnien Icterus b> Duodenal Drainacc — P ilarvicf 
Treatment of Catarrhal Icicruv by CholacoRuc^ — E Chabrol 
RccurrcnLC of Afebrile Icterus and its Grasiiy Hepatic Catjphjlsai- 
bf ricxxinccr 

Orisin and equilibrium of Two forms of Bilirubm — N fiessinier 


Oualifications of a Venereal Disease Conlrol OfTiccr — T B Turner 
fhtrmal Death Time of Gonocokcus at Fever Temperatures — C M Carpenter 
R A Boak and S L Warren 

Bismuth Studies Vf Bismuth Absorption from Site of Injection in Dobs — 
T SoHmann and K Henderson 
Nforphological Variations of Syphilitic Germ —A Bessemans 
Functional Variations of Treponema pallutum — A Bcs’icmas 
•Complement Fixation Tcbt for Gonorrhoea with Increased Antibody Content 
— Z Weiss and Hovd Arnold 

Case of Congenital Ncurosyphilis aged 60 with Multiple O teo arihrbpathics — 
W C Meniny,cr and C C Carlson 
Tryparsamide Dermatitis — Frincis A ElUs 

Dcteclton of Syphilis m a Urolofiicil Clinic — L Friedman and M L Mater 
Teser due to Iodides — Lawrence Katzenstcin 

■•Sulphanilamidc may Rcyolutiomre Laboratory Idcntirieation of Gonococci — 
N\ R Jones 

Mupharsen m Wassermann fast Syphilis — L Chargin and W Lcifcr 
Is Mercury a Specific for Svplulis*’— D M Stdlick and A Strauss 
•Aceidental Intraarterial Injection of Bismuth in Oil with Demonsuuion of 
Bismuth bv A Ray in Arterioles of Penis — L AV Kimberly 
Effects of Placental Extract on Course of Experiment il Rabbit Ssphihs — 
J E Kemp Clarence Shaw and E M Filtpcrald 
Dcpigmcnialion of Ins in Experimental Rabbit Syphilis — W E Couiis and 
J M Herrera 

Complement Fixation — Weiss and Arnold have developed 
a new technique for the complement-fixation test for gonor- 
rhoea basing their argument on the fact that since serum from 
gonorrhoeal patients contains relatively small amounts of anti 
bod\ It IS necessaiy to use large amounts of serum The 
antigen consisted of a simple suspension of many strains of 
gonococci For the test proper they vise' 2 c cqi of the 
serum to be tested, 0 15 cem of undiluted complement and 
the amount of antigen determined by previous titration with 
saline to make up to 2 35 c cm After incubation foi one hour 
at 37^ C five units of amboceptor in 0 1 cem saline and 005 
c cm of a 50 per cent suspension of sheep s cells are added 
The authors claim that the only non specific results occur 
with sera from cases of epidemic meningitis 

Sulpitamlamide and Laborator) Diagnosis — W Rav Jones 
states that sulphamlamide mav revolutionize the laboratory 
identification of gonococci Films taken from patients treated 
with sulphamlamide show that pus and epithelial cells are 
more degenerate and more extraneous organisms are present, 
while the gonococcus shows changed physical and staining 
characteristics and a varied relationship to the cells The 
drug mav also mask the presence of the disease since it may 
reduce svmptoms without killing off all the gonococci Great 
care therefore should be exercised in examining films from 
sulphanilamidc treated cases Drug-counter prescribing of 
t ve drug produces carriers and may not cure and in Washing- 
ton It has not reduced the incidence of gonorrhoea 
386 D 


Duodenal Dramas in Bcnii;n Uterus — This treatnienl i> 
onlv of use in cases when, the lesions arc localized al Ihv 
end of the common bile duct Diffuse lesions and prolong'd 
illness require treatment bv cholecvstotomv and surcical 
drainage The need for surgical intervention is indinled 
vvhen the icterus becomes worse when the patient is lO'iib 
weight and when there arc anv signs of insiifliciencv of thv 
liver 


Archiv fur KIrnische Chirurgie 

Bvrlm vol 191 April S 19VJ 

TrcTtmeni of \triebnl Fractures— G Macniis 
rseuUTrihroxcs in Rey.ion of \nklc — P Uoxtock 

Efforts to obtun t Reluble Skm Suture — \V Hitxc mil W HcUpm ^ 
Secretion nnd Ab'iorpiion of Cerebrcxpiml Fluid m Cerebral \enin ^ 

G Jorns 

MassiRe TreTtmenl of Chronic Prostntitis — K Boslnmer j 

Thoncic injuries due to Pointed Insirumcnt with Cirdnc PiiKuion con a 
lo Fcjccmn Bouy — E Meircl 
Surgery of PcrforTlcd GTsiro'duodeml Ulcer — L Nicolas 
Result of SurgicTl Treatment of Non excisiblc Gtstne and OcsophiSkii 

— E HTrms j y\ t 

Aitcnovenous AnTsiomoMS of Mestmenc Circulation — K 

A La t 

Review of Patients with Stones m Bhddcr m Jena Surgicrl Clinic danns 
Ten T ears — H A Dcgc 

SiRnilicTncc of Aiypietl RidiocrTphs m Dnsnosis — B Sinton 
Disiurbmecs Nn Ossification in Skeleton of Foot — F Nle*dntr 
Congcnlul Fissures in Articulir Processes of Lumbar Portion of ’ 

F Nbller niif}-* 

Collateral Innammitory Reactions in Limbs (scv-ealle*d Acute Bone / 

P Sudeck , 

Basedows Di case Thyrotoxieoxes — B Breitner rimJ 

Sicnificancc of Thymus Gland in Basedow s Disease H Hiymus 
so-callcd \nli thyroidal Protective Substance — L Ralhcke 
Microscopical Findiups m Cocevx — H Angercr 


Archives dcs Miladies dc I’Appireil Digestif ct dcs 
Miladies de li Nutrition 

Pans vol 28 May 19 .j‘n 

•Volvulus of Stom ich — P Ch^ne and M R imadont GarolTci"i> 

Studies of Diasiaiic Aelion of Pancreatic Juice in Some Fevers — 

Vuamin in Food and Oucsiion of Bread — Nf H ^^llc^ef 
Three Case's of Chronic fancrciuus wiih Atypical Cour c\ J 

Vohtilus of Stomach — ^The condition is t torsion 
the stomach in either the longitudinal or the jc tp 

Uon thus one part of the anterior stomach 'vall i'* b 
face part of its posterior wall In acute cases x ra\ in' ^ 
Uon IS useless and surgical intexxention is indicated , * 



Alcust 13 193S 


KEY TO CURRENT \tEDICAL LITERATURE 


TREB^msH 53 
^^_r5{CAl. JoCTN^L 


of trmmcni ^0 per cent of the patients die In the chronic 
e'l'^ev or \vuh the intermittent occurrence ot xolMilu'i mcdicil 
Ireilmcnt is jiistifiiUc The frecl\ mov'iblc \o!\iilus is ciused 
b\ intcsiini! pneiinntosis ca cs of fixed \o1miIus b\ adhesions 
and pcnt.T'‘tritis 

Arclutcs d Opht ilmologic 

pjrrt \t.\ 2 'Ij> 

Ir n t St\A.v cf I ht -rJ Cert of Con X!o\m‘crt — C Ja) c 

Cx<<: cf Irtrsensn I C Tirrr*. n < f Op i Nenc— P 
Ilam tthaec. t am Xrc ~ tr^ arJ tt O'car C ~’r -t — •! 

Pnir 1. < 

r<7m//ifl/ HaimorrhaL.tc ^rK!on cto^ts — Tirsi described bx 
Rendu in 1S96 and more dctinitclx b\ Osier in 1901 this 
condition his three outstandmu features telanciectasi hiemor 
rhatx ind familnl cataract Telangiectases appearing at 
20 to 0 sears of acc arc found on the skin or the mucous 
membrane^ the former more frcqucntlx on the face the litter 
in the nose hicmorrhaecs oecurnng spontaneousK or after 
some trifling iceidcnt mix be copious the catirict is a 
constant feature Eximiniiion of the blood shoxxs nothine 
unusual Death from anaemia max follou frequent hacroor 
rhigcs The xcnscIs ol the iclancieclasis haxe an irregular 
lumen xxith a simple endothelial lining and a deficiencx or 
absence of clistu, tissue \cnous ectasias and xincositics in 
the rciini obserxed in the reported case max haxe no con 
ncMon xxith the condition There is no specific treatment 
and local dnthermx with the formation of a sufficient scar 
IS folloxxcd bx the appeirancc of a further telingiectisis at the 
same spot in a few daxs 

Archixcs of Pedutnes 

Sew lorK SS tore 19*s 

Hawporrhare of B'ain ard Reuru tn Scun-> — E and S. Horwitr 

n ce cf Ultra >tol« R-d^ii n in Paedtairi-^ — r '-an d<f B^.ecn 
n> lolocj'al SwoIkxis — i G Kuhit' 

Ininuno' "*31 Ourancmtics of Di’crcnt Tjpcs of Tutcrculm Re-* t — 
St ParcMkj 

PmentKn of Cc-nmtn Coniac cs D es^cs — A S Sard cf 
\ It n PS A Brief Oiiilme — H Goodman 
TIjc Fai 1 ounjr cf — f Bran 

Ultra \toht Thcrap\ — \ large group of conditions m 
infancx and childhood can be benefited bx this treatment pro- 
Mded It IS gixen xxuh proper skill The effect is a general 
one except in some superficial skin lesions An adequate 
supplx of cilcium and xitamm D is essential to get the best 
results The indi<^criminaic and inexact dosage of ultra xiolei 
raxs is condemned a trained operator is essential 

Beitrage zur Pathologischcn Anatomic und zur 
Allgemeinen Pathologic 

Jerj »oI 100 March 30 193S 

P3ih>fcrc5is cf Esrerincnt-I Rheumatic Aihercs^Icrcsis Conir | Eipcnrsert 
on Schmitts XXerS.— H Th crsch 
Th>Tod Gland’of Cretin at B nh — J Eucstcr 

SsTuh-anct cf B atcral At uphy of Supr^rcrals «i Pfcduct on cf Surrarciul 
Sccreturi — \\ Ma hefl 

Bren hicfav^ and r-«al Irfcction — A r Xlbcnni ard C X erdan 

Glandular Herm r*'roditisin — G Pich 

r-tal Di'fj'c Cloneru opcphrit s — R HuAel 

Rcsorrticn and Sio'~‘ge in Foetal O'fani m In%c^iigaiiv.n3 bj Xital Stains — 
— E. Bcneckc 

Pars Intermedia of Human HjTorhi-MS — G Habcrt-ann 

Pnmar) xialignant Tumour of P irous Pemon of Tcmperal Bene of T>rc 
of XJiTcd Tumours cf Sal \ar^ Gbrd — F Rxsng 
O h cnc»Mr« Cases — R Gonnermann 


Brili«h Jonmal of Ophllialniolog> 

Londi,n \cl 2^ 'f > 19 

Sm«x h Muscle of th Pe'torbita ^nd the M'^.han sm of ExiT'htb- mc« — C E 
Brtlioa 

A Correo- Icral Sjiur"- in Car raci Extr ct n Its T-xboj; e and Ad an- 
t-jres— H B Siafrard 

Intracupsular Expre^ on of Cataract — C X Kr&hn <w»ni 
Tramplantatio Cor^hae Auncul e New Method cl Cerreet rp Sn^sti 
EntrocJPn of Upper Lid fcTowtrg T tal Tar^cctom — N I Sbcskia 


\ntepo» tia Ccnjjr*tn-'c Fc nicus Operation jn Severe C~ cs cf S’~n'> 
Catarrh — S I Sh — Xm 
C- e o! An I r>a Retinae. — 1 Fci 

Ml rr'triici rc of Er thelial Cel s an- lU Importar e for Aetjol n cf Tr ch'^rta 
— XX CrutcT 

ContostUral Siiturt — This suture presents post openitixe 
hxphacmia and prolap e of the ins It is of great xalue 
XX hen prolapse ot the xitreous is to be expected There are 
no after effects from the suture The needle speculum and 
technique are fullx desenbed The procedure max be u^ed 
in both intra- and exlracapsular extraction 

Intracapsular Exprisstoti of Catarcit — This is a modifica 
tion of Smith s method A small indeclorax is m^de after 
the section and the beh^xaour of the cornea ^nd ihe irido 
lenticular diaphragm observed \\here the cornea eollap es 
or the irido lentieiilar diaphragm remains in its normal 
position easx deliverx of the lens max be expected This 
operation reduces intra ocular mstrumeniaiion to a minimum 
and no second operation is required 

Lcndm \cl *’2 Ju" 19’s 

\i L3l Cell cf Ihc P'J vpjs (Orn Uicfh>p he 1 — K O Dj) 

O moiK: Prr^^e c of AQjcou Hc~*'n-r in E-u^" D Gl_uccr'a — 

E OG kirwan 4~d S N MuXctjcc 
S tu- ^ of Paiho er> of Trachcnei — L A Ju { e 
Mc!..roso'nc~<J« rersin SuStan c n BIcoc and Lnr of Pat c w ih 
Retnfis Pi—ientosa (Prcl m nar> Cor*~’j~ at cnl — E Currin h-m D^t 
C a o of Pf man Bil-t ral Arophih- '"la Cl a^d Hi c eg cal Rcpctr — 
E, Rccordon and C Xf Gnfllths 

M'x.fdJ Bnirm s Retnetor for Daer>ocs-storh notomj — H B Scanafd 

Epuhnuc Drops\ Glaucoma — Epidemic dropsx being the 
onix general disease at present known of xxhich glaucoma is 
a feature it proxides xaluable matenal for research into the 
causation of glaucoma The antenor chamber bein^, deep 
the xitreous does not swell m these cases Changes occur in 
the aqueous the albuminous content being raised Inxestiga 
tion of the osmotic pressure of the aqueous in epidemic dropsx 
shows that the change in the permeabilitx ot the capillanes 
does not affect the usual process of dialxsatioo of aqueou 
from the blood but onlx alters the state of equilibnum 
setting It at a different lex el 

Rcimttis Piuuetuosa — Manx xxorkers beliexe that retiniti 
pigmentosa has an endocrine ongin Freshlx passed unne 
of cicht adult menlallx defectixe patients xxith this di ease 
xx-as made just alkaline to litmus with N '10 sodium hxdroxide 
placed in a boiling xxater bath for half an hour and allox ed 
to cool in the dark ^^hen 0 3 to 1 c cm of this urine xx-a 
injected into the dorsal Ixmph sac of frogs, an increase of 
pigmentation was brought about xarxmg from one frog tc 
another Protein freed blood produced similar re ults but 
injections of cerebrospinal fluid had no effect A more 
constant result xvas obtained bx imfnersing fresh frog skin ir 
the unne Onlx certain cases of pregnancx and perhaps case< 
of abnormal skin pigmentation hxperthxroidism and pituitarx 
disease gixe similar results Three of the eight patients had 
signs of pituitarx dxsfunclion 

Bntish Journal of Urologj 

LoTdoT TO? 10 June 19 S 

To'xrnilcus Er — C A XX c I * 

Tc* s of Renal Fumion — C P Stewarx 

D resmon of Lric Acid Co'sx^l m Penrena) Ci’^-ule and k*dTc> Tissues. 
— G dc Il'jc 

CoTPcoccal Inecton cf LTprer Lmran Tract — XX S XI k -rx. C B 
B han-n „ 

I—r c Pcduc'-ulaied FT' <.ma of K dem — T B xiouau 

C3<c of Hctrincr'tremcmr f h emamr.a — H xicide ^ 

p Anenor XX aft of LnmizT *• -n Lr.rt-Jl * :er 

Reject! Ti cf B’ad-cr I R- Trcatm^ Pros-icct m> — Xf Gmf 

Titbtrculous Epulid\mitis — Evidence is gixen in fax our of 
the palhwax of tuberculous infection wiihm the genito 
unnarx tract being from blood stream to kidnex tberce to 
the bladder bx the unnarx stream and trom the po tenor 
urethra to the epididxmi'^ bx the lumen of the xas The 
higher incidence in recent statistics of renal le ions as^o^iated 
with genital lesion*' is beliexed to be due to improxed f*-cihties 

:s6 E 


54 August 13, 1938 KEY TO CURRENT MEDICAL LITERATURE 


TiiEBurtisii 
'ItOrCAL lot RSVL 


for in\estigTUon ind to belter [ollo^\ up methods In the 
suthor s series of oscs there were sssoented ren il Tnd gcniHl 
lesions in nt lenst thirt\ prosed enses out of fifl>-fi\c The 
esses of epidids mills without demonstr ible rcml lesions me 
esphined bj the presumption tint the rcml lesion his henled 
ot which possibihtN proMded tint the lesion is mercK micro 
scopic there is recent csidence ChnicnlU dcmonstrnblc 
lesions ne\er henl and call for ncphrectoms On this thcors 
It bseime iieeessarN in evcr\ case of tuberculous cpididsmilis 
10 suspei.t the presence of a renal lesion and therefore rc- 
peatedh to e\nune the urine to carr\ out gitinca-pig inocula 
tion lesN ind 10 insestigate fitlK the upper urinars tract It 
IS siic^esitd lint prophs lactic vasotomy on the hcaltln side 
should be ' ei oinied (u) in old age Jj) when one testicle has 
been eewupleiel lost or ncedlcss\\ sacrificed, and (U in the 
presenee oi h mk piostititis and sesicuhtis 


Tes' / / i(ii( lion AtIic following tests arc con 

sideiei I be 1 lie ot seereli and concentration of urine the 
water ei i e n i> on test tJe urea concentration test the urci 
range u ' le iiei ele|Tance test and tests basdd on the 
excretion U u i_n sulstanccs As a test of total renal 


efficienci tb 
sin^e test 

IS probabK 


'e iiince test is recommended while the 
maximum amount of information 
nt test 


Current s t 1 1 in Anesthesia and Analgesu 

Etrr irtV \cil 17 Mw June lats 

ihcsn\'t Ccriiin Cinr icicn tics ot Spiml I lui I 
1 \ In"sihine on Osteen Consunintton ot Uits-- 


Unllucncc upon Spii 
— K M He iij 
Ettccis ot Ethil Ell-cr 
S A Peoples 
*A Rctlcs complical 


sihef elunna AbJonnn il Sureco — C L 
Bursicin and E \ 1< nsiincy 

First Surgical Sections in SI in of Lew i ens Litcrilie (Pam— Temp nture I uh) 
at Brain Stem 1 u Ireutmcnt] ot DiftiisciJ Rebellious Pun — A XI 
Dogliotti ( 

Present Scientiric Stains of Spinal An leWhesn — Co lui 
Scope and Uiiliu of DilTercmial Pressure in rhoracie Surccre — H Killian 
Clinical and Laboralorj Ohset'ations on Inlraeenous Anacsilicsn — O J 
Thomas 

_In> ewiea tion _in Uriatiop of He, at Regulations lo ^aiejilicr Coneulsions and 


Sj ndromes — T \V G Smith 

*rutthcr Eepcrienccs eeiih Vincsihcnc Anaesthesia — 1 S Raedin E L 
Eliason G M Coates T B Haltossai K L Terguson A B Cill 
and T J CooK 


Spinal Anacsiltesia — Spinal anaesthesia is the method of 
choice for all operations below the diaphragm and should 
be more xvidel> used Pantocaine and percame give pro 
longed analgesia and aie the best agents the former for low 
and the latter in 1 1 500 strength (Howard Jones) for high 
analgesia A test is described for estimating the bchaMour 
and effectiveness of the drug the latter depending on the 
alKahnit> of the cerebrospinal fluid A few drops of the 
solution to be used are added to a little cerebrospinal fluid 
m a test tube The formation of a precipitate indicates an 
alkaline fluid, in which the drug will be effective , the 
behaviour of the piecipitate — floating,' sinking or diffusing — 
enables the distribution ot the injection to be predicted It 
N/IO sodium hvdroxide must be added before precipitation 
occurs the action of the drug will be weak or delaved 

Abdominal Smgen — Reflex disturbances of the s>mpathetic 
nervous svstem occurring diirin-. surgical manipulations in the 
neighbourhood of the coeliac plexus are discussed and have 
been studied experimentallv As occurring during upper abdo 
minal surgerv these result in abdominal ngiditv and a severe 
fall in pulse pressure Phvsostigmine is suggested for pre 
inacslhetic administration also for treatment of the condition 
during operation 

I Dusthenc — Divinjl ether (vinesthene) continues to be used 
to an increasing extent for short anaesthesias in all branches 
of surgerv with vcr> satisfactorv results It has completelv 
replaced nitrous oxide-oxvgen for the short operations of the 
surgical out patient clinic 
3S6 r 


Deutsche Zcitsclirift fur Cliirurgic 

Birlin \ol 250 April 12 191S 
ricCirocoTCtihuon of Bonc*^ Ynd Jotnis — If X.>ichau 

KcnHccmcal of I rolonccd I ^icn^ion Trcainrcni bv ^cfc^Wc t\»cn ton Ph'.tci 
Bindnrc in Bone Triciurcs — H KiUnn 
Hire forms of Abdomiml InOucnra — H Ucbcrmulh 
\crcnmc lnncr\a!ion of SnoomB Mtmbnnc of Ifuonn kn c otnl — P Surrd r 
PIis7minn ntiJ k Puibcnsrcck 
'Ih>rot<l CiHnd nnJ \ uamm B^ • — I Schneider 

Supparatnu Saernt Dermoid Aciiofosicaf Diacnos^ of Sdctcv-cocoskil 
Ab<iccsscs and risiijl’t*^ in PnciKt — 1 Becker 
1 \ptrn.ncc wnli Application of I irafTin Plu™ in Pnlmomrj Tuberculous —E 
Iftlfcr and S S htiMcr 

Di iRHostic SicnifiCTH c of Disphccmcni rf Pineal Bodj with Chmg is 
Jnincrannl Presvuru — Tm t 
Chrrnii. Mmui from Lacst I omi of View — U Wanke 


Enriocnnologt 

\\ iston'vtn \ol 22 June l‘> 

I of Ova atcck alcd n ihcir Uiic of Pavvasc through the Fal'tpan Tubes 
of Mitc b> Missive In cctions of Progjnon B —11 O Biirdikk id 

I W hitno 

Actckraiion of Kale of PasiRi. of rcriih/kd Ovv ibrcuiRh I al otian Ttibes 
of Uabbit*! In Mawnc Injection of Iroc>nonB — K \Nhitnc> md 

II O Burdick 

Clincd Indi ation Tor \nttrior pituitary like Skx Hormone — U L S hav r 
r A Sh irp and J \ I amm> 

Ovaric Sttrci 'file Honnoru IV nfr'''‘l oi Ovaiian Ai droctnv on Nccino > 
Si/c in Mouse — U T Hill an I M 1 Strong 
ktlcct of Cqjtnv on Conadotropic Content of liiuiMr> Cl nds of E 

prcRnani Ui\bi\s — A W Malcpcicg G L SNcinstcm and V U 
Fnetlnan 

\niiho mone Siudiv’v m trcitcd with ^nt‘*rlO pituitar>hlc Hortronc f^ 

Ocnital Undtr-dcvclcpmcni — G B DoriT 
Cvio’ogicil CviUtncL of Gonadotropic Activity of Habbii s \niufnr 
— H B rrivJgooJ ind \ U Dawson 
lisuUn Slock m UeUtion to Comronenis of AdtenaU and 
H G Swann and J U I iirccrald 

Best opit CfTct.l’v of Aniertor Lobe FMracis — C \\«.rkrlicii and « " 
\S jcsncr 

riiiiimr> extract m Surmaonds $ Dnease — G F Disf an I N C Bn 
Pilun ir> Dwarfi nt Frt ument with Growth Ho mom - N M TJ'lor 


Fukuoka Acta Medici 1 

nikupLv \ol 31 Mw 1915 

•Rolv of Hiwvmmc m Toimviion of Tovim m Burns (Gvrl — H Ki im-i 
•Chancels in Adrenal Gland'i m Burns and Histamine Poisoning fOcr — 
H Kisima 

Studies of Biochemical Properties of hUicins (Gcr> — H Sakamoto 
Some Ph>Mco-chcmical Pror«.riics of Mucins (Cnc) — N ^csikawa 
Hisiopaiholocical Sections m Planes of CarlilaCt Epiph>‘ical Line and * 
ph^sis m Long Doucs of Normal Rabbits tnd those with Expcritnt 
Rickets (Fr) — S Nakahara 

Epidemic Enccphnhiis and Tuberculous Meningitis (Gcr ) — K Koiotm 
S tudies on Pancreatic Lipase (Eng) — Ntknmura j 

Expcnmcntal Examination of Local Di orders m Luhr Cireiilitnn (Gcr; 
Iked a 

Nifta/ninc and Bum Toxiin — An increise of liivtnntine '' 
found in the orgins of dogs ifter experiment'll burns In'S 
been inflicted - This is highest (seven to ten times the norrua 
figure) in the spleen the kidncv , ind the pmcrcis, mu i' 
woticeible in the blood fiom six to twelve hours ifter tie 
infliction of the burn increasing up to the second or Huf 
d IV and then gridinllv decieising If the dmiiged skin 
IS cut out immedntelv after the burn is inflicted no increase 
in the histamine occurs and no signs of a tovic effect were 
noticed This seems to show that histamine is formed loo " 
and distributed bv the circulation The same observation "w 
made in four clinical cases 

Changes in Adrenals — There is a decrease m the clirontaffm 
and m the amount of adrenaline m the adrenal medulla in 
both burns and histamine poisoning The clinical signs an 
histological changes are similar in both conditions Histani'r'9 
is probably an important factor m the toxin production lO 
burns and alterations m the adren il glands are the probah s 
cause ot death m the fatal cases 

t ’ Hng means that the article referred to is printed in Enclidii 
‘ Fr in French, and Gcr in German 



mclm n iy<s 


KE\ TO CURRENT MEDICAL LITERATURE 


The BpmsH 
'Iedica^ i 


‘^5 


Journal of Lar4nf,oIos\ mil Ololojn 

LnJ n I 53 Jure 19 I 

** “re O X '•'cci cf \ viJ C rJ Ira ti t — lii c> 

XtJn ini iraH n cf a Hcatirc VJ tlr — ? 1 1 Kerr Uf 
Tcrar d Ti’nii. cl •'har^rx — \N H nh 

Ion}/ Cert^ hwlwtx — The lulhor dc enbes n troup of 
CT'^cs of left xoctI cord pinl'M in rn'ins of whith n vpon 
I’lncoii'i rcxONcrx look phcc coninrv lo orihcdo\ nudiol 
tcichinc The left recurrent nerxe is said to be more Milner 
ible than the ncht on account of iix loncer anatomical cour c 
peripheral neuritis will therefore be more conimon on the Icli 
side than on the right 

Journal of Nenous and Mental Disease 

SvrV. Ml S7 Mi) IS’X 

I there a Reutne Irtease h Merial D» ca c**-— Benwrnn Xtalibcrc 
BIvsJ ITr^urc arxl Rjte m Pn t P ich's —Red rh Sch»ar/ 

Ir ii’ n in TrcaimcPl ol -X utc V anj — L C Gr'“^h 

LPcct of IrJu cd Xlonzi.1 Ci n u '•n tn Sohi/ “hren Pauent — H n If 
Keese A H \ar^Jcf^ecr aru A H Wed 
PsirK real EPect t! IknJcdri" Si l"'haie — Paul S^hi det 
C rrejt) nx ct Alh Catai li and H>rf' jcaer^'j — Kalnun Cjaifa 

f}ei.tr<xn-r^*u! ^r^rhr «n D fr >^r srd Lo«.aI^ajir*j rf Im/atraoul Con- 
ti u n — 7 he'd re i C..tc 

Rcl(ttt\t Intruist in Met t( 2 l Di'intsi — As the result of an 
ctammalion of the atailihle "Uaiistics in the Stale of Ne« 
■^ork the author conclude", that there is a relatisc increase m 
mental di ea e but that this msreasc is on the whole 
moderate and must be viessed as part of a fcneral trend 
extending over mans generations It is not such as to give 
rise 10 considerable eugenic concern 

Insulin Trealintni — ^The author gives a brief review of the 
controversial question of glucose tolerance tests in the manic 
depressive psvcho cs He records good effects following treat 
ment with insulin m two cases of acute elation which showed 
unusual reactions to clucose tolerance tests and suggests that 
smular treatment might be advised in other acute elations 
showing a similar abnormalilv of glucose tolerance 

Imliiccil Metratol Coin tilsions —The authors report the 
results obtained in tvvcntv patients treated with metrazol 
(cardiazol) and express the opinion that catatonic schtzo 
phrenics in the earlv negativisuc stuporous phases seem to be 
the most suitable subjects for this form of treatment 


Journal of Nutrition 

PhiUUdrtiia sot 15 Ms) 10 liivs 

Effct of \arjcd \ iiamn B ln«c<iicni upon Xppoinc of Children — F W 
S<.Wuti E M Krou ci of 

SiixJki on Niiamjn Rcguiremenrs cf Crownp Rai — A and C A 

El'chjero 

Rdaiicn of Gnus Ju»cc Factor to Guinea n g Nutnuon.— C O Kohl r 
C A Elxehjcfn and E B Hart 

TevhmqLe of Mcasunns Radution and Conxection — J D Hard) E I- 
Du Bos ft a! 

Basal Mctabol sm Raduuon Conseetton and \apc»n 2 -ti n at Teroperaiures 
of Ii- to 3^ C — J D Hard> E F Du Boi fl c! 

Chect of Vrea un Human Resp ratory E.\chanxc and \1 eofar Corhon Diox>d 

— M CsJTXntcr 

Basal Metabolism in Presnam — J A Jtbmon H A Hunschcr F C 
Humircl Vf F Bates P Bonnef and I O Xfacs 

J'lltimin B and Appetite — The factors affecting appetite and 
food con'^umplion especiallx the effect of Miamm B intake 
were studied in fiftv four children aged 4 to 11 xcapj When 
the diHi Mtamin B intake was increased b\ about 50 per cent 
h\ a dail\ supplement of approximateh 1:>0 units there were 
increases of 17 to 25 per cent in the daih food consumption 
with correlated slight increases in the gain in weight of the 
children Since the higher Mtamin B intakes produced no ill 
effects and did stabilize appetite the\ might be regarded as 
optimum 

Urea and Aheolar Carbon Dioxjde — In a human subject 
ingestion of “^0 to 40 grammes of urea caused a marked n c 


m the alieolar carbon dioxide for two lo two ard a half 
hours and a sjcnificant nse in the respiratorx quotient tn the 
period ironi one to three hours after ingestion both chances 
bcinc rehttd to the alkalosis caused b\ the ingestion of urea 
There was no effect on the total metaboli m Water produced 
a slicht fall in the aheolar Carbon dioxide but no change in 
the rcspiratcrx quotient 


Journal of Pharmacologx and ELvpenmental Therapeutics 

BiJiir'cre Ml 63 M^v 19 s 

Rc'prat r> Para >nraihct Acti n cf S'^^c S'^cner i B rt j fc A^- 
D I ’’tjxcs — C L Bur icin pc t A lo n't n 
Cj ih Life Sr-n ard food Ir akc f White P Fed D r tr •'hen ( ih ugh 
out Life — Xf L Tatn cr 

C l Lrar un I T x*.nt> — A H Xf ! ard A F Bun n 
C m'-ar u c Stcd> of EPca cf V-r a An cs h ti \c nt n Err r^’ Ti"" 
f S* m h — C K Slecih ard E J Van Li rc 
In tier c I Au nim D n E ebt n. — S Lxt^ 

L c f D f S ard rc zat n f Di iul — R X M Gui an rd H A 
McG r-n 

D r-ti n of Xnacsihc'*- rrtx.i. cd m D b> Rercated Xen i iraTicn of D al 
nd Ncmbat-I — G H Eit 

Effect of DfinLm,. So*'i m rol on S tal Oanc-s in Gr ntr Wl* Rats — 
A J Lch'*’an ard W OxV » 

L e of Ocstfo cmc H -more in Eir'ri— crtal Pcn'*hcraKGan''rc c — L Lcc^c 
ard S E LettVe 


Journal of Phvsiologj ' 

London to! 93 Jure I- 19 S 
Roc of Lev cotes in Fat Ab<orrJon— E H Leseh 

Meehan 51*1 cf Ptodun n ard Ph> loJc-'icaJ Si^'nihcan c of ArncuMa — 
G Stella 

Thermal Dcvonro<m n of M tal Purp’e. — R J Lithtce -rd L. S » Euler 
In**ucnce of Xpicmr Piiuiun Ettnci in ected either with cr niihtut Insulin 
on dicrecn ccni_i"“d in Liter of Fa up* A tun** Rabbits— H P 
XlarLs and F G Aounp 


Joumul de Radiologte 

Parr> toJ 22 June 19^1 

tltra-decp t R3> Thcrp> n trued S-tes — J Bclct atxJ R CoIi« 

PtCx^do-d tcnnilar I^acc^ ibfou h FildinR of G-II-^ -dder (Galt-bl-dder ur 
mounted t> a Phrygian Bx. nr t )— R Ledoux tetard «tkJ A Dj an 
S-nc of F»r« Mctaiars-l — X Moo bet 

Ccmfor-mc R-d o •*f:i“al -nd Atuiomo-pathclcf^ cal A c«t of Lur-^ after 
E.\rer»ment-1 Inh-laticn of Du t Particle* — 't X Podk-mir:sK.j 
Annual In emational K uroliyical xjceting of 193* Puin — L Dclherm ard 
P Xlatbicu 

LUra deep \ Ra\ Therap\ —'Xhi'i is a descnption of the 
different ivpes of high tension generators and tubes for 500 000 
to 1 200000 volts Tbe static high tension generators of 
Van de Graaf and of the Massachusetts Institute of Techno 
logv are devenbed and illustrated A bnef descnplion is also 
given of Sloans high frequenev high tension generator of 
Lauritzens continualh evacuated 1 100 000 volt tube of 
Coohdges sealed 600 000 volt lube and of Lawrences cvcio- 
Iron The effects of ultra-deep r ravs and neutrons are brieflv 
desenbed 


Klinische Monafsblatter fur AugenheHkunde 

Siuurrt \cl too Mar i9^h 


Mode of Spread of Tubercul •'is — Lcmmcl 
Tay Sachs s D 'ease — ^T W erncke 

Ecte-enous Tub-rculot> of Coniuncus-a illustrated t> a Ca e — xf 
Co our cf the E c — H Stockmann 
Rov_cca Jn*x5 — E Ofc 2 h 
Oi'er_tion of lndodial>''is — I Czukrasz 
Sarcoma of Lacntaal Fo'sa ••“J Czukrasz 

R-dolocy of Rcpion cf Lacnmal Sac niib Obsercat n on 
Endonasal Sac Orcraiioru — H Bnin-er 
Clau-'oma Arttnu of Cm to — G ra5-»!oro 


Scbm erer 


TtvbnKjue 


cf 


Ta\ Sachs s Disease — ^This is a rexiew of the pathological 
ffndincs reported in the literature on Tav Sachs s disea e The 
histoloncal findings in four additional ca<es showing tvpical 
appearances are described 


Rosacea Intis — Attention i« drawn to the fact that infis 
max occur in acne rosacea without comeal involvement An 
endogenous route is assumed 


386 G 



56 August 13, 193S 


KEY TO CURRENT MEDICAL LITER'ATURE 


Tiir Dnirisii 
McDICAI. JOURWl 


Glaucoma Anuiiiis of Coiilino —Thts condition is described 
as a form of ghucoma which t>picall> is subacute and stimu 
lates haemorrhagic glaucoma It is generally aimlatcral and 
always ends in blindness The characteristic features arc 
new \essel formations on the ins of arterial or aenous origin 
a marked tendency to bleeding at operations and a deepening 
of the anteiior chamber Pathologically it is probably a 
lesion of the yessels in the anterior segment of the eye 

Monatsschrift fur Gehurtshulfe und Gjndkologie 

Leipzig ^o! 108 

Connexion bciwcen Abortion anO In nry — P Hus<;> 

Fxtended Head — I rcssel 

Intrapartum Mctasntic Peritonitis — K PodlcschKa 

Significance of Blood Picture in Gjniccology — K Hollosi and S Mirizv 


Le Nourisson 

Parib \6\ 2B \9 8 

Clin cu and Acliolokical Study of Mongolism and its Trc itnicnt — P tcrcbouPct 
Anaemia Ora\is uuh Enlaracmcni of Spleen — M J Cnthth and P Morel 
•‘SuddLii De^lh m an Infant with Eczenn -M U A Marqticz> and MUc 
Ladci 

2?* 

Sudden Death — Necropsy on this case rescaled much luper- 
aemia of the yiscera \yith marked hvpertropln of the hmphoid 
tissue of the abdomen The central nersous system shoyved 
diffuse vasodilatation and oedema in the regioit of the third 
yentricle The authors consider that these changes arc ex- 
plained by damage to the autonomic nervous system and that 
injury to the temperature regulating centre in the neighbour- 
hood of the third yentticle explains the yascular changes and 
oedema of the viscera The sudden death seemed to be due 
to secondary changes, such as hyperpyrexia and vascular 
collapse 

Quarferly Journal of Experimental P/iysioIogt 

London \o\ 28 June 19^8 

Lftcci of Asphyxn on Adenosine Inphosplntc Conicni of UTbbit ^ Ilcirt — 
I ChTng 

Uelition between Villikminc nnd Absorption of Glucose from Intestine — 
E \ KoKts nnd G > Lud m> 

LiTcct of Alarm Reaction on Water Excretion — St KTndy J S L Brounc 
And H Schc 

Action of Prostigmm and Accixicholmc on Uc'-pintion — \ Scbwciizcr miJ 
S Wright 

Uolc of Gomdoiropic Hormone m 'MmmcnaucL of LvuctI runciton — J M 
Robson 

ExpLrimcniTl ModifiCTiion of Accessors Scxinl Appirnius m Hen — A W 
Greenwood md J S S BWth 

AntTgonism of Viginnl Action of Tnphcnjl Eihslcnc b> Progesterone tnd 
Testosterone — J M Robson 

Kinetics of Cholmcstcnsc — A J Chrk J Ri\entos E StcJmin nud 
Ellen Stcdmi'i 

Hisnmmo as Norm^l Stimuhnt of Gastric Secretion —1 C MTcinio‘>h 


increased cffcctiyencss of cunarcon is probibly due to its 
halogen substitution During the prolonged administrationi 
of these experiments side clTccts, such as spasms tremors 
incrciscd reflexes etc appeared Histological examination 
of the hrain in such animals stioyycd damage to ganglion cells 
Similar cell damage has been reported in the human brain 

Iransacfions of (he Royal Society of Tropical Mcdicmc 
and Hygiene 

I oltdon xol 32 June 25 

*1 (iccnta in Mnhrii with Sptcnl Reference to Rcticulo-cndmhctial Immumir 
— P C C Girnh im 

•SpcctrogrTphic Aml>xis of Pigments in Scrum Tnd Urine of Bbckwatcf rc\er 
— H I o> nnd A Knndi 

Catly Disco' erics regarding Parasite of Oncnnl Sore -C A Hoxrc 
•Immunization of Monkc>s and Humans with formolized Tissue Cultures M 
Typhus Rickettsia — I J Kligicr and Sonn Lcvinc 
rpidcmiotogi of rnicric Tc'cr in Hong Kong — K H Uiilci 
Otnraniinc and the ^!ct.c'l Pilprimagc Growth of an Idea — G 1 Watson 
Uclati'c Aiincil'cncss to /Irdcf of Certain Coloured Cloths— G A 

Brut 

Chjloiis niirnl Ljmphatic \arix Clinical and Pithologicaf Report— T 
O Connor and J Knott 

Placenta in Malaiia — ^Thc charactcrislic placental response 
to malaria yyas only seen yvith P falcipanint infections It 
did not occur immediately at the beginning of a neu attack 
but immediately at the beginning of a relapse Schizonfs and 
reticuloendothelial phagocytosis y\cre not seen before Itie 
fourth month of pregnancy All stages between large Ijmpho 
cylcs ind mature reticuloendothelial cells yycrc seen in llic 
inicryillous spaces Relapses folloyying parturition are 
probably due to expulsion yvith the placenta of a highh acliyc 
reticuloendothelial system of defence No evidence of 
congenital maliria was discovered 

Piqmcnts in BlaikHater fcitr — Pseudo metlnemoglobin 

With an absorption band between those of sulph and met 
haemoglobin has been confirmed as the new picmcnt in (ne 
serum of cases of blackwatei fever in Greece, mcthacnio 
globin was not found in the scrum The matnitude and 
suddenness of the haemolysis is not the onh factor determining 
the concentration of pseudo mcthaemoglobin, nor does it 
diiectly determine the degree of anuni Mcthaemoglobin 
occurs in the urine at a /?H of from 5 to 9 is formed before 
Ihe urine reaches the bladder, and is not dirccth related to Ine 
pseudo mcthaemoglobin in the blood urines not conlainine 
mcthaemoglobin do not develop it at laboratory temperature 

Ty/)/i((v Iniiniinizatinn — Monkeys and humans licated "Ub 
formolized tissue cultures of typhus rickcltsia develop ^ 
positive Weil-Fclix reaction Monkeys given 2 cem 
vaccine in three incieasing injections at three day intern ’ 
were immune to a large infective dose of vims I'm 
latei 


Revue Frangaise de Gvntco’ogie et d’Obstetrique 

pins vol 33 Ma> 19 s 

Trtiimcni of f onorrhocT m Women — M Tabrc F A Pippilon anU A 
Pecker 

'liv.'Wmeni of Prepmi i Woman 'viih Gonorrlioci — A Morisson Licombc 
Tre 'tnient of Gonococcal ViiUo 'aginiiib in Young Girb — J E M ireci 

Schmerz Narkosc-Auacslhesio 

Leipzig xol 2 June 1938 

E pcricnccs wiih \ incsihcnc in ! 000 Short Anac'Jlhcsias — E DofITc) 

Short Evipan AnaesthcMa for Deh\cr> in Normal Parturition — H Rocmer 
•linciti ations into Mode of Action of Short acung Narcotics 1 Comparison 
Animal Expcnmcni of ElTcctt'cncss of E'lpan and Eunarcon 
H Localization of Lesions responsible for Side cRccis — Violet Heinz 
W erner 

Short aitini; Marcotics- — In a scries of animal experiments 
the author has compared the actions of evipan and eunarcon, 
and of the original b irbiturates from which these anaesthetics 
yyere developed The average fatal dose for mice of evipan 
Is highei than that of eunarcon while the rate of elimination 
of the former in rabbits is also considerably greater The 
3S6 H 


Zcilsclinft fur Ordiopidie und litre Gretizgcbitlf 

Sluttg'irl xol 68 June 193S Heft 1 

Biologicii Icciihiriiy of Locomotor App’inius — E Hcidsicck 
Humcrui Varus with Snccnl Reference to Shoulder Contr'iclure C 
Genuine or Peratologic il CongcniiTl Dislocation of Hip — If Konm 
•New Investigations regarding Paihologj of Acetabuiar Fes^a— ff 
S Ictifcl 

A Present day I oot Artist — W Tltomscn 

Acitahidiini — Investigations were undertaken to 
the influence of the position of the acetabular fossa o 
configuration These investigations were earned out on j 
4:ast models of the hip allowing the femoral head to 
pressure in different directions The authors have also 
a new technique of taking v ray films of the acclabulir 
and have inv'cstigated cases of separated epiphysis o 
femur and also cases of congenital dislocation of * ,,1 
They reach the conclusion that in separation of me ^ . 

epiphysis the chief actiological factor is to be foim 
more anteriorly placed acetabular fossa In congen' ^ 
location of the hip the acetabular fossa remains in i s 
position 



sr 13 


1 .? -.'i- ' v-* 







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THE BRITISH MEDICAL JOURNAL 


August 13, 1938 





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24 


THE BRITISH MEDICAL JOURNAL 


August 13 1938 


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under certificates and without certification as 
cither VOLUNTARY or TEMPORARY PATIENTS 
at a vxcckly fee of T3\0 GUINEAS and upwards 


NORMANSFIELD 

For MenlM Defecti\esot eithersev 

Under pruMc m^mgement 

Apph to Dr Langdon Down, 

Norman field Teddini 


WYE HOUSE. BUXTON, AND CLINIC, 

for ihc PREVENTtOS and fREATMENT o' 
NERVOUS and MENTAL DISOROpS in N'J 
*cxcs Large country house beautifully situated 
us own grounds Croquet lawn* hard icnnis wtn 
billiards wireless installation throughout t'W 
facilii> for srccialiscd modem ircatmcni 
pejchothcrap) otcupiPonal therapy 
light diathermy Private rooms with 

If required Volimliry Temporary and CLm w 

patients received— For terms apply 
Superintendent Hclun S E Mlxrxy '1 B 
Nat Tel 1 0 


HOME FOR EPILEPHCS 

MAGHULL (ncir unTHrOOL) 
FARMING nnd OPEN MR 
OCCUPATION for rATIt>Tb 

\ few .aennele. In 111 and 2nd 
TEES Jst Class (men onli) Ron u P" 
wards ».nd Class (men and women) a • 

For further parttcidars apph 
C EDGAR GRISEVVOOD, A CA, 
Sccrolarr ,.0 Exchange Slrce! East LberP” 

HALLIFORD HOUSE, UPPER HAlU 
FORD, SHEPPERTON EstM-iind ttt i 

This handsome secluded residence a 

lark of 36 acres situated 16 mil^ fro^ numbcf 
icen cd for the reception of a imiicu 
•aiicnis ol the upper and middle 025 * 
rom nervous and mental afTections 
Voluntary or certified cas« 
lodcratc Patients arc «ndcr the consia ^ ^ p, 
L of the Resident ,^'ShrscAr 

R A Sleisari from whom full jO 

Tel Sunbun-on 


; obtained 


‘ECCLESFIELD,” Slip cliurst, K" 

(Remosed from Ashford Middlesex) 

PRIVATE HOME for Ihc CARE “"J 
SLCOHOLIC patients (Ladi«) LPre‘- 
ion beautifully situated in JOO seres 
and Extensive views Home farm i jj. 

Jnder the management of the bisiz 
jood Shepherd Apply Bev Mother 
:taplchurst 61 _ 

'cl and "'cicgrams Haynes 

IlTTLrrON lULL, BREN'n'OOn 

.arge grounds 400 ft f JJ?„_„rv*^D 02 rdcrj 
idles Mentally alllicicd ) ®l^l?r?bcnfield * 
:ccivcd Stations Brentwood and ii^yvts. 
iile Liverpool St 26 nun Apply 

tISHOPSTONE HOUSE BEDF0K» 

A select Private Mental Uo"’,' 
ad Voluntars with scp-raic n 

olunnry Boarders Under personal | „it,u — 
Re .dent Mental Snecnilst and P 

Icdical Supt Dr J L.voi.ssi Macauuv 
cdford 270S 











Alci’ST 13 I93S 


THE BRITtSH MEDICAL JOURNAL 


25 





26 


THE BRITISH MEDICAL JOURNAL August 13 


ST* ANDRE W^S HOSPITAL 

FOR MENTAF DlSOnDERS 

NORTHAMPTON 

rou THE UPPER AND MIDDLE Cl ASSES OM Y 


FENSTANTON, 

CHKTSTCHURCH ROAD, 
Streatham IliU, S ■\^ ^ 

A Privnic Home for the Circ 'ind Trcaimcni 
of n llniltcd number of Lidies v.ith MemM and 
lNcr>ou'5 Disorders Certified Voluntary anJ 
Icmponry I'aucnis received LarRc Mamion 
with 12 acres of Rrounds \rr(fical 

Dirretot} p 2H2) Apply RoiJcnt riosicun 
, Telephone Tuhe Hill JIM 


rresiileni Till MOST Hoh THE M AUQUCSS OV C\n CU CMC ADC 


Methcol Sn/fpnnicndrnl litoMAS Tcnnint MD MR CP DPH DIM 


This UtfiiMcrcU HospiiTl is silmicd in 120 ictcs of nvrV md ptcisurc crounds VoUmury patients 
who arc sulTenni. from in ipicni mental disorders or wish to prevent recurrent iifickH of mental 
trouble temporary patients and certified p urnts of noth si.xcs ire received for trcitmcni Careful 
cluneal biocheinieal bacicnolosical ind piiholoRieil examin itions Private rooms with spcual nurses 
male or female in the llospual or m one of the numerous villas m the Rroimds of the various branches 
c in be presided 

WANTAGE HOUSE 


BAILBROOK HOUSE, 
BATH 

lor sulTercrs from Nervous and Mental Bn 
orders with or wnhoui ccrtiljcaiei 

The house IS plorioirsly situated in woedeJ 
crounds of 2n acres with ra-Rnificcnt vici^s cl 
the C»t> and the Avon V’allcy |Scc Mriicii! 
Direcloty pace 2^22 ) 

lor tifrms applv \ Geirouvm MA DM 
B Ch DP M Resident Physician 

fclcphonc Bathcaston SIB9 


I his is a Rcecpuon Hospital in detached Rrounds svith a separde emrinee to vvliieh patiems tin 
be idniitieJ It is cauipped With aR the app trains for Uic most modern treatment of Mcntil and 
Nervous Disorders It contains special departments for hvdrothcrvpy bv tanous methods includlnc 
Turkish and Russian btths the prolonccd immersion bath V'ichy Douche Sctiicli Douche LIcctriet! 
bull Plombiercs trcitmcni etc Iherc is an OperatvoR llieauc a Dental Surcety an \rn room in 
Ultra \ lolet Apparatus and a Dcpirtmcru for Dhthermy add HiBh rrcquency ircdnicnt ft also tontalns 
Labor itories for bioehcnucil bacicnoloncal and patholORical icscatch 

MOULTON PARK 


Two miles from the Mam Hospital there ire several branch csi iblishmeitls »nd \iltis situated in a 
pa k ind farm of 6*10 acres Milk meat frvm and scRCiahlcs at'* supplied to the Hospital from the farm 
>.arJcns and orehurds of Moulton Park Occupation ihcripy is a fciiurt of this branch ind puiints 
are kuen cverv t leiluy for oeciipjing themselves in farntinfi rardenme ind fruit prowink 

BRYN-Y-NEUADD HALL 

Ihe seaside house of St Andrews Hospital is bcatuifidii situated in i park of 'Ml icrcs Llanfilrfeelian 
imicist the finest scenery in North W ales On the North West side of the Lstaic a mile of vei coast 
forms the boundary Patients may visit this Branch for a short seaside chanpc or for lonaer periods 
Jhe Hospital h iv ns own pnv itc baihinR house on the seashore There is trout fivhint! fn the park 
At ill the branches of the Hospinl there arc cncKci grounds footbiU and hockey grounds lawn 
Jcnms courts Urass and bard courts) crofluct grounds golf courses and bowling greens Lidics md 
kcntlcmcn have their own girdens and facilities arc provided for handicrafts such as cnrpenirv etc 
Tor terms and further particulars apply to the Medical Supcrimcndcnt (Telephone No 2“^% and 2)^7 
Northampton) who can be seen in 1 ondon by appointment 


THE COPPICE, NOTTINGHAM 

HOSPITAL rOR MENTAL DISEASES 
This Institution is exclusnelv for the reception of t limited nnmbei of Prn tie I’lticnts 
of both sexes of the Upper and Middle Classes at model tie 'rales of pajmcnl It is 
beautifully situated in Us own grounds on an eminence a shoil distance from NoUmg- 
ham and fiom its singularly healthv position and comfortable airangcments aftords 
e\er\ facilus for the relief and cine of those mentilly afflicted Occiipalioinl 
Theraps Vohintarv and Temporary Patients received 

Tel 64U7 For tenns etc apph to the Aft'dicnl Viipninfcndr/U 


HAYDOCK LODGE 

NE1VrON-LE-lVILLOWS, LANCASHIRE 

Teliz Street Ashton in M ikcrfieid Phone Ashton in M ikurhcld 7)11 

Tor ihu reception and treatment of PRIVATE PATfLNTS of both sexes of the UPPER AND 
MIDDLE CLVSSES sufTcrmR from mental and nervous diseases either voluntary icmponnly or 
under Ceriihcue Patients arc classified in separate buildings iccording to their mental condition 
Situ ited in pirk and grounds of 400 icres Seif supported by us own faim and gardens m which 
piuents \rc eneour iged to occupy themselves Every facility for indoor and outdoor rccreitioti lor 
terms prospcsius cie ipply MEDICAL SUPERINTENDENT 


NORTHUMBERLAND HOUSE, 

GREEN LANES, FINSBURY PARK, 

A PRIV •\TE HOSPITAL for the treatment of mental andiieivousillneiscs ConvcnicnlU 
situated and easv of access from all parts Six acres of ground highly situated facing 
Tinsburv Park Vohintan and Temporarv Patients received without certification 
Occupational Therapv Psvchotherapv and other modern forms of treatment 
TlIlrIiloc SrVMroItD HILL 26SS TclcBnms SUDSIDIAR'V' LONDON 

Convakseent Home KEAKSVEI COURT DOVER For further particulars appjy to the Medic il iup 


COURT HALL, KENTON, near EXETER, 

for the treatment of eight Ladies, voUmtarj, temporarj, or certified patients 
Large gardens and own dairj 

CLirPDEN TEIGNMOUTH for carlv and convalescent cases A well appointei 
house With spacious balconies and extensive views of the South Devon coasi 
Sub tropical gardens own dairv in 2“! acres Priv'ale road to beach 

Telephones 

Resident Plnsicians BERTHA M MUl ES MD BS Starcross 59 

ANNE S MULES M RCS LRCP Teignmouth 28' 


HEIGHAM HALL, NORWICH 

A PIU\ \TE MLMM HOME Miuatcd m U 
atrcN of well wooded grounds Ter I- ‘‘I'” 
Ocntkmtn suffering from Nervous or Mental 
Illness Voiunnrv Patients Temporry Pancni 
and I wlcms under Certificate arc admiucu for 
treatment fees from 4 gumeis a ivetk iipwaiQ 
at ording to recjuirLmcnts A few vacancies evt 
for ladies and (jcntkmcn at reduced ‘«s 
rcLommcndaiion of the Patients own PhlNca 
Apply to Dr J A Smmi Idcphonc NoovilH 
TcJckrams Small SO Nor wich 

TYKEFORD ABBEY, 

NEWPORT PAGNELT, BVSCUS 
ttivi iioxvi Miivoi's nf-onnui'- 'R”''*" 

VM) (tlNV viisuxT <■''''■= 
nic Hopii. IS 1 Mvnsion of Hisloricd 
snnclitm in I' nens ol sfam 
mil Is siiiiiicd 14 miles from 
snd i: miles Horn nedford on 
10 Nnrih imoion Hold lifi> miles A 
Iloih sixes xri. iccommodvlcd 
raillc Trcitmcni is used exicn I'cl) " , , j 

ewes Rndnni Hew \ ta> inJ 
LibIii DiJIlieriii)' nod Poim Bx'l" 

'',Vppls"Dr DEM DOUOL VS MOHR'S 

Telephone Newport I vs neh _ 

HILL END HOSPITAL AND CUNlC 
ton ant iiiiviNnON xx" 

Ol MIMVI VNP MUVOl’S nl''01t 

(-0 mile from I ondon) 

I idles suirsnoR from vll forms o o 
ILLNESS arc rtceiscd for irojimeni on 
lines IS Voluntary Temporary jin wni 
Pris lie ruienis il Ihe Hill End 
Convakscuni or mild cases cm 
i delightful country mansion warn 
giounds known is 

HIGHFIELD HAf L, 
siiinic iboin n mik n"a> .frooi , . _ [jK 
I CCS 1 WO a o I HRcr cuinlas i > n w l 
Cor fiirihet pvriisulnrs iprly V;'- nrv' 
Sunt v\' J T tviMiirii E II 1 1 

ST ALBANS, HERaS 


CHISWICK HOUSE, 
PINNER, MIDDLESEX 

TelepItonP PliNNtB ^ 

A Piivatc Hospital for the 
md Care of Mental and Nervous IUnc 
n both sexes 

A modern country Vdlrmind' 

daibicArch in beautiful secluded t 

Fees from 10 euincaspcr week, inc'usi'^j 

:ases under Ccrlificatt Lent 

femporarv patients received forlreaim 

Douglas Macau lay M P P jl 

sTRETTON. HOUSE, 

CIvviTch Strettoii S’'r°'’?]j*frocii> 

A PRIVATE HOME for Ihe "'J 
jcnilcmcn snlfcrinc from Iv'enW V,„,jct 5 ‘J 
Uncss incUidinc the aU UPev ‘’1 

vlcohohsm and the Drug -re tcccotJ 

arJy Mental and Nervous eases | 

ulhoiii ccriiticaics os rrcaimc^* ^^'i 

VC provisions of the Mental 
9)0 Bracing lull country supet 

T, rector, P riiilKli Sirciton 

itcndcni Phone 10 P O cmnv" 




\l< iNT n 19'S 


THL BRITISH MEDICAL JOURNAL 


CALDECOTE HALL 

U A K A\ I C K S II I R E 

( Phone Vunrairn 41) 


Him trmifj hrt^rftitr^ on I pmrt ula nofl^ / (im 


Re^iidcntnl frealment of 

FUNCTIONAL NERVOUS DISORDERS 

IncJudmq: AJeohnIism and other Addictions 

(Centf3t'fe Cases arc rot rcccned) 

beautiful r*arsion siitratcd n the b«n cf the ccjn r> (less two n s tr nj 

I nocyi bs L R ) tr*d jrrounded b harmj*'' rl a-ure g^our^i n ah h t. 
anj o ttdfK r occurauona! ih arj arc a»ai he ts d oted to the treatr” nt cj 
runcftrnaJ Ncffwis D crJc s b> P'seho hcrapcuuc -rxJ ar».i r r'chx- 

4 £ CttttFR «/ f), DPtf^ R< rient ml «up nr nrf nt 


CAMBERWELL 

Tefrir anij 
Pi^xnioLi* Lcsoos 


HOUSE, 33, Peckham Road, 

OK TIfF TKIl\T>n:NT OF ME>T/LL DISORDERS 


London, S E 5 

■'Wrf/ re 

Roonet I. hr-s) 


M«:o complclch detached \illas for mild ca^cs v.iih priviie sinic*; if dcMred \ olunlarv palicnls received Twenlv acres of grounds 
Hard and Grass Tcnn s Courts Putting Greens BovvU Croquet Squash Rackets Recreation Hall with Badminton Court and all 
indoor amusements including W irclcss and other Concerts Occupational 1 hcrapv Callisthenics and Dancing Clas es \ ra\ and 
Actino thcnipv Prolonged Immersion Baths Opentinc Theatre Pathological Laboratorv Dental Surgerv and Ophthalmic Dept, 
Chape! Senior Phvsiaan Dr Ht rert Jsvtcs Normss. assisted hv three Medical OHicers also resident «ind visiting Consultants 

An il unrated rf^rccius p\irs fees «.hK.h are sinctly noderatc mar be obtained tics-n ap'«Ji*3t)on lo the Secretary 


The Convalescent Bmnch Is HOA E \TI EA BRIGHTON ard is 200 feet above sea level 


PECKHAM HOUSE, 112, Peckliam Road, London, S E 15 

Tcleg^nms Alleviated London” Telephone Kodnev 2641 2r42. 

The above House is for the care and treatment of persons suffering from mental diseases and nenous disorders Certified 
voluntarv and lemporarv patients are received Separate hoiiso for treatment and accommodation of special cascb adjoin 
the Institution OLCupational ihcrapv phv steal drill and other forms of modem treatment There is a seaside branch kearsnev 
Court near Dover to which patients mav b-e sent for treatment or on holidav \!otor driven are arranged when required 
Tennis courts Enlcriainmenls dances and indoor amusements helo throughout the vear Terms from £3 3s per week 
Illustrated prospectus and further particulars can be obtained from the Medical Superintendent 


LAVERSTOCK HOUSE 

SALISBURY WILTS 

PRIVATE flENTAL HODE FOR LADIES AND GENTLEIIEM 
Completelv up to due Lo\eB house ind grounds (IS acres) Certified and uncertified casei laLen Facilities for going 
to the seaside 

ESTABLISHED OVER SOO YEARS 

AppU to Med Supt for illustrated brochure Tel Sslisblrs 2612 


CHEADLE ROYAL HOSPITAL 

CKE:.ADLE, CHESHIKE 

Tbts REGISTERED HOSPITAL wiUi a SEASIDE BRANCH ai Col«vn B-y s Wales is for the treanrent ard care ct thov: of the LVrer 
and Middle Classes suaennt frm MENTAL and NERVOUS DISEASES 

Th Hose tal is schemed by a Committee apcotntcd b> the TRUSTEES of the Manchester Ro-al Infirrnanr 

In addition to the Mam Buildnc there arc etMrate Milas Etfemise rromds. Hard and erass tcn**ss ccx.’Xs crKket and croquet grcLnds ard a coun 
ter badminicn There arc abo wireless lostallatiom Golf ma> be had witltn easy distance Occup,.ti nal ihcraps 
VOLUNTARY TE.MPOR\R\ AND CERDFIED PADENTS rcLCised 

The Hospital rs nine miles from MarKhe^tcr 0 minutes b) rail from Liverpool and 31 hours from London 

Fcr terras ard funher parueulars apply to the Medical Sucenntendeni may be seen in MXNCHESlER by APPOINTMENT 

Tel<ph<*ne Cailcv —31 <3 fines) 


THE OLD MANOR 
SALISBURY 

Eitcnsivc rrounds Detached \ illaa 

COV\ AXi:SCENT HOME 
nt BOURNEMOUTH 


\ Pri\ate Hospital for the Care and 
Trealinenl of ihose of belli sei-es suffering 
front 'tIE\T4L DISORDERS 

Chapel Carden 3r*d dairy prcdjcc from own farm Terms scry moderate 

Detached NTTas standirs tn 12 cres of omaTcmal grounds witli tennis court, etc wb ch 
\ oTuntary Terporary cr Cerufied PaLcnts nay \ts.i by arraneerfnt, for long or short periods 


Illustrated Brochure on application to the Medical Superintendent The Old Manor SnlisburTT Thone Salishurv 2251 


THE CLIIVIC 

20 Deionsliire Place 
London, IV I 

Tel Welbecl 4444 (20 lines) 


A NURSIiNG HOTIE FOR SURGICAL. lMEDICAL 
AiSD MATERMTY CASES 

Fees lo gn. to x8 fns per x«o State Registered Nurses 
week (Average — 4 gns ) gRcudsiT Medical O Seers 
S Opemiing Tbeaues (for erce-peoaes) 

Patients only received under ifcc supem-icn of ihar opto 
\tedizal P-aconcser 

Dugs and D’e'sin^freefcthcrthanPropnetary Aredes) 

IIlu trated Brochure on appbcauon to Semetaiy 



RUSSELLS 

IIFAIFL IIEVIP^E-VD RD„ Vt 4TFORD 
Tel phone U \TFORD SOl" 

A Convalescent horre for the care ard trea r-ert 
of rn.jd and reco'erab’c nenous conditions m both 
sexes The hcj<e is sitmicd high up tn -0 -cres 
Cf grounds I" mles frem London -x the terruna 
lion cf the Watford by pass 0'»e Mcdecal 0*F e is 
in residence ard two oth-rs arc m d-tly atter-aree. 
Fees Tom ten guineas a week mclusi e 

Apply Resiocvt Medical Orrer* 


ASHVVOOD HOUSE, 

IvEsGSMTNFOKD STAEFOEDSMIKE 

An old-estafclis‘’cd PRIVATE HOME for the ca e 
and treatirerr of I— dies ard Gen, emea rcerulb 
afPictcd Probaticnary cases and nca-cert-C-'d 
p^tieris arc received as well „s these tegu,arly 
cen ^ed 

Tb b^me IS besuufuliT sirtsted m own 
gToun,.s of .to a-*Tcs 

Full Fan.culars ^ 10 recert on ter^ c c maj 
be cbta -cd from the Rcsidem Medical O'Seer 


THE GRANGE, 

near K0THERHA3I 

A HOLSE icened fcr the rece-uen cf a 
IT* cd cumber of L-.. es u"er-«, trem Nctvms 
.. nd vien,al Dnorders- Beth ceTi.-'d and »l ,.n- 
la-y paiienjs reco -d Ap^oxed fo temperary 
Pal •CIS Tb’S o 3 IjE- COL" *y hoisc wi h 

beaut ful r'ou-ds and pi>fc fire ic, s f cm 
SbefF d Tel No ..00 0 Ecc’csf Id Res. Pbys 
Gilsext E. Moled LRCP M P,.C,S Stolen 
Gran-e Lare. I_ N E. Rlv 







28 


THE BRITISH MEDICAL JOURNAL 


Augus- 13, 1938 


The MUNDESLEY SANATORIUM 


The centnl building nnkes 
the Miindes!e\ Simtoiuim 
the best equipped building '■ 
in Enghnd for the cure ot 
Tuberculosis All the bed 
rooms ha\e hot and cold 
running witer electric light 
and tireless headphones The 
public rooms aie spacious 
and comfortable 


Hi \iilint Pin suiain 
S VCRE PEARSON 
MD(Cintib) MRCP(lond) 
E C WANNE EDWARDS 
MB (Cantab) ERCSlEdm) 
GEORGE H DA^ 

M D (Cantab ) 


Tor 'xW jnformTiion apnl> 

The Secrctir> 

THE SANATORIUM MUNDESLEY, 
NORFOLK 

Telipliom MiiiuU'ilc\ 94 nitil 95 
(2 lines) 


The buildings face SSW 
and arc sheltered from the 
se 1 bt a pine clad ridge 
riie sunshine record and dr\ 
air complete a perfect site 
The medical equipment is of 
the latest kind and there is 
a da\ ind night nursing 
staff 


TERRIS ERORI 71 GUINEAS MXEKIA 


LLOWAY SANATORIUM 


VIRGINIA 

WATER 


A Registered Hospital for the Treatment of MENTAL DISORDERS of 
the EDUCATED CLASSES Founded by THOMAS HOLLOWAY in 1885 


This Institution is situated in a beautiful and heaths locilitj within cas\ reach of l^ondon ft is filled 
with e\erv comfort Patients can base Private Bedrooms and Special Niiiscs is well as the use ot 
Genet al Sitting Rooms at modeiatc ritcs of pa\mcni Voluniarv Patients can he admitted 

There is a Bnnch Establishment at CANFORD CLIETS BOURNEMOUTH where Patients 
can be sent for a change and be provided with all the comforts of a well appointed home 


Fr>/ Tunis apph to 

The Resident Medical Superintendent, St Ann’s Heath, Virginia Water, Surro 


THE CORNISH RIVIERA SANATORIUM 

BOSEinLL, PENZ-VNCE 

Tor the treatment of patients suffering from tuberculosis 
The Sanatorium stands in its own grounds of H icres of garden lavvn and woodland and is well sheltered from cold 
The climate is mild in W'lnter cool in summer Aitificial pneumothorav and other modern forms ot treatment arc availiw 
Dav and night nursing st iff Electric light Wireless in ill rooms 

Medical Siipt Francis Chown, M B Lond DPH ConsvUing Phvsician (late Med Supt) Cornwall Couniv Simloriuni 
Terms 5 to 7 guineas vieeRlj ’Phone Penzance IhS 


THE COTSWOLD SANATORIUM 

First opened in 1898 and rebuilt m 192s On the Cotsvvold Hills seven miles from Cheltenham for the treatment of Piilnionan 
and all other forms of Tuberculosis Aspect SSW sheltered from North ind East elevation 800 feet Pure 
Special Treatment b\ Artificial Pneumothorax (Vraj controlled) Tuberculins and Ultra-violet Kavs are " aj 
necessaiv without extra charge X-raj plant Fuliv equipped Denial Department Electric light Radiators hot and coi 
basins and Wireless in all rooms Up to date mam diainage 

Full dai ■•nd nisht NurMn? Slalt Term - en to ki.« ti xerk inriii I'f ov 

\teil Supt GEOPFRCY A HOFFMAN BA MB T C Dub UtO T/in MvRCARETA HARRISON M B" 11 S Lontl /’arftutac/O 
DAVEI MB BCh Camuli Laonmludsl CASSID\ DEW GIBB F R C b Edin Comiilltne Drntal Sum GEORGE A S SUNDERS L 
RCSLond APDli Sccrenn Thu CoiMiold Samtonum Crantnni Gloucotcr Trl 81 and W'itcomiic Grnmt tlorriiis » 


HARROGATE 

Harrogate specialises in the Treatment of — 
Disorders of the Liver — congestion, cirrhosis 
jaundice cholecystitis cholelithiasis and tropical 
liver Also in Diseases of the Skin— eczema psoriasis 
the coccal infections of the skin etc The Chronic 
Rheumatic Diseases— Arthritis Fibrositis, Neuritis 
Gout Hyperpiesis Mucous Colitis Functional Dis 
orders of the Heart Pelvic Disorders of Women 
Convalescence from acute i Iness 
A wide range of Sulphur and Iron 
water- is available for dealing with 


FOR HEALTH 

the large group of disorders amenable to Spa treat 
ment Prescribed diets for Spa patients can be ob 
tamed at hotels and boarding houses without extra 
charge Complimentary and reduced price 
facilities for the Cure, Accommodation and 
Amusements are available for Members of 
the Medical Profession 

Full details of Harrogate for Cure and Holiday will be 
II sentfreeon application to Spa Man- 
ager Information Bureau Harro 
gate 1 (state ifamcdicalenquiry) 


QUICKER BY RAIL 

myntMf return tick ts to Harrogate 
from all stations Any train an/ day 


ATE 


THE MODERN SPA 



\l I <51 I 1 ') <5 


Tiir iminsH Mroicxi journal 


Z9 


^HE CHOICE OF 

.1 suitable icsorr 
(or cons’alcsccncc and 
rccupcnnon u ill be 
made easier by frequent 
reference to this section 
of the Journal 


riea^t vicittioji the 

I BMJ li.h(ii x.iitn’" \ 

to ad ja timers 




If 


r/- ^ 'j ^^^Mieuma 

li ^ 

- of 

' ^ 1 Wales 


I ■ I 


/ 


r £ . 



KINMEL HALL # 

ABERGELE 

S ITUATED between the lovely Welsh foothills 
and the sea Kinmel Hall commands a thousand 
acres of its own parkland and golf course. 

Exquisitely furnished and equipped with every aid to 
comfort It IS an Ideal residence for those needing rest 
recreation or modern Spa treatment, including the 
Continental Pistany Mud and Scotch Douche, 

All Spa treatments for Rheumatic and similar disabihtjes 
are given in a sep-rate wing of the building under the 
supervision of a fully qualified Resident Physiaan 

The cuisine is flrst-cl-ss and careful attention given to 
special diets 

^ Rccrcauon facilifies include o»'/i golf 
course tennis squash bi dnunton 
ndinc fishmc open air sy\fmmmg pool 
Coin tr\ Club ndfotninc (licersed) 


DOCTORS OWN SPA /oi 
RHEUMATISM 


Mud irem rjnny n pjcJ^s reidy or home use S mpleii ji «t. 
rd econom cal ireaiment ruy be entrusted to inr rauent. 
Cost *ds- c **0 treatmenta. Literature on reqoeit, 

PISTANY AGENCY LTD 310 Rejtent Street London W 1 


VOLCANIC- SULPHURIC 

MUD SPRINGS 

in delightful surroundings 

2E ©AYS 

INCLUSIVE CURE 
Special facilities for doctors 
and their wn%es 
Se-ond Class Fare with Sleeper 
r_ li tfj s fre T £"*2 ns 0 rtturn. 

Tcf LA/rhcm 4714 or PISTANY SPA BUREAU 25 CocksourSi eet 5 V/ 1 M t Sail 2394 



ST MARYS HOSPITAL 
MEDICAL SCHOOL, IV 2 


(L^I^E^«n■l OF LO>DON ) 


THE Wl^TFB. SESSION MTIL 
BEGIN ON OCTOBER 1st 1»38 


The \JedicaI S-hool provides Courses n Ire 
Inicmediate anJ Final Sub cctv and 
Studen can nn at on e after '! tn-u-atian 
SITUMION — Between a 1 rsc rorulation pro- 
sid ns Clinical material acd tnc of ihc best 
rcvdentul i- ints t»-i- enab! ns St-d n > Jo li%c 
in d’ve pfcsi-^itN to their «orfc 
Vt%\ BLILDINGS ■— The rew buil-ir* nhich 
cevt €2 0 CUV* arc rovs m u<c 
CLINICAL UNllS IN MEDICINE ^ND 
SLRGtR^ — Cen_in mer-bers cl the Med cal and 
Surjf -a! StaP dexctc ihcir wh'^c lume lo teaching 
and rt>ear h 

NE,\RL^ 1 yiO BEDS a\aib‘' for tea h ng — 
auLiti ral O nt-al r-uettal being pro ^ ed b\ 
,.riLHion t n In rmao and other I n nut n. 

EN*7R \NCL \ND RESEARCH SCHOLAR 
SHIPS t the a le of £I DO are arded ..nnujJJ 
KPIOINMMENIS ^ar^i-vg in \alue up t f“ P 
per aroLm open to S uoen s nfter Qaalification 
Per funhe ranin lars a^d illxTslrated rrt^pectL 
ar-h to ihe N.-hpol Secretary 
C M NMLSON (NIC) Nl D FRSP Dean 


I 

I 


} 

1 


f 


MONTANA HALL, Montana, Switzerland 

OPEN all the \EAR 

THE ONL^ SANaTORILM IN SWITZERLAND UNDER BRITISH OWNERSHIP 
AND CONTROL AND WITH A DAA AND NIGHT STAFF OF BRITISH TRAINED 
N*L RSING SISFERS 

INCLLSIA E TERMS — from " cuireas (sicrlingj ref week 


Med Supt IllLARA ROCHE. M D (M Ih ) MRCP(Lond) Tuberculous D-s DipfWales) 


CITY OF LONDON MATERNITY HOSPITAL 

(Jnec ro aird hx Rcya! Cf’c le ) 
cm FOND EC.1 


The Ht’sptnl p‘*cf 
p'~tnai_l and D-nia 
a Kefroher Course 
rat cn a»ini_llr 


(aclies to POSTGRADUATES for oNening ih- » fV of its Ar en_i i 
Clm -s and to r^a e MEDICAL SIXDENTS (and Piactnicners dcs m 
a tu cf f jr week Midwifery Co rsc (Resdenoal) Nearly 2 C<o 

RALPH B CAN'NINGS Secretin 


QUEEN CHARLOTTE S MATERNITY 
HOSPITAL 


T r R C S (Edin ) I 

EDINBrnGlI POSTAL COIiKSES ' 

Ful cctaiU c iK rJ Oi 1 C'- r> , 
HCO««inFRCS Sa rev n s Hall Ld nturrh 


ALAKALEBONE KOAB MI Jl 


Med cal StinJwtits and Oaald’-^ Fr~ i i n j dr* ted tv. I've P'^cti-.c cf th*s Ht>“F lal Ln or^r 

( nines are aPe ued of cvin ( bv h*tc;J Cemr caticr and Cmeratne M dwi e*Y (about < n'^-h- f of 
the utal adm’^N.cn b* ne rr m purcus a e») 0^e^ -."Of Pwii-m-S ,.rc ..i,’*' tied to the Wards .."rual % 

..nJ in the Arte rut-l deparr-erl there arc o er _0 CVO ,.ticr_an*es ccr ..mum CIn-*al dcmcnstraijors 
are c 'en bi the S aP Caiij 

Fvr rules fees et arr ) H B S’Okes Secictary Surerinienucni 



THE BRITISH MEDICAL JOURNAl 


August 13 1938 


30 


SWSDDLESEX HOSPITAL 

LONDON, W 1 


FERENS INSTJTUTE OF OTO-LARVMGOLOGY 


\p])lic'\tions irc m\itctl for tlie BERiVHARD BARO^ RESEARCH STUDENTSHIP \TCTiit on October Lt I9t8, 
Slid tcmblc Tt the I trens In'stitutc 

1 he "piioiiitmcnt is foi one \c'n in the fiist mst nice, lint i suit ibic CTiuluHtc will be eligible lor re election lor it Inst 
T jcii beginning on October Isl 1939 

Ihc lionorariiim is at the latc of £300 per annum with liolidae lease smonnling to one nionlli in each twehc 
Candidates must be iit'Ics of pure British descent md citi/ens of Grcit Britain or Northern Ireland and must hold a 
r’gistiablc qualification J he selected cindidatc will be expected to eleeote his whole time to icseirch in connection with 
Anatom} Ph}Siolog\ oi Patbologe ot the Nose, Ihioat or Pai under the general diicction ot the two Senior Snrgioiw 

to the Dejiirtment Pull oppoi tnnities arc offered for Climeal iiid Operatue woil No stiici limits arc placed upon the 

nature of the reseaich ni dertakeii and in it the selected candidate ma\ cxl'cct to aiail himself to the lull ot the resource^ 
of the Department both clmieal and pathological Ihesc include a large and fiilK equipped liboiatore, proeidiiig special 
1 icihtics for md with i stafi tamih ir with the technique of tcinpoi il hone prcpiration 

Apphcitions should re ich the School Secictai} Muldlcsex Hospit il W 1 not later than September 3rd, 19JS 


POST-GRADUATE COURSE o 

FRCS Primar\ PHYSIOLOGY (August 15th to Noeember 4th Monda}s Wedncsda}s Fridaas 5 30 pm) MRCP 
CLINICAL AND PATHOLOGICAL (National Temperance Hospital fuesdaas and Thiirsda}s 80 pm September 6lh to 22nd 
MRCP CHEST AND HEART (Ro\al Chest Hospital Mondaas Wednesdays Frida>s 80 pm September 12th to 30th) 
MRCP NEUROLOGY (West End Nerae Hospital, afternoons September 19th to October 1st) RHEUMATISM weekend 
(Ro}al Bath Hospital Harrogate all da\, September I6th, 17th 18th) 

Apply FEELOWSraP OF MEDICINE, 1, Wimpole Street, London, W 1 (Lungham 42CC ) 


EXAMINATION 

POSTAL 

INSTITUTION 

17 RED LION SQ LONDON. WCl 
Foundcd (n 1882 

by E S Weymouth M A (Lend ) 
POSTAL OB ORAL PREPARATION 
FOB AI L MEDICAL EXAMINATIONS 


SOME SUCCESSES 
M O (Lond ) 1901 37 (1 1 Gold 

Medallists during 1913 37) 
M S (Lond ) t901 37 (including 

4 Gold Medallists) 
MB B S (Lond ) FInnI 1918 37 
(Comptcicd Esam ) 
F B C S (Eng ) Primary 

1919 37 Final 

M B C P (Lond ) 1919 37 

DPI! (Various) 1906 37 

(Completed Laam ) 
1918 37 


■C P (Edin ) 

MRCS LKCl 
^ (Co» 

D Various B> 

PrcKirmon (or ih* abovt^ 

1 rcliminan^ and _aU exam n? 


f-/ral 1919 37 
cicd Dcam ) 



to MRCS LRCP or MB 


413 
24 
255 

199 
192 

286 

348 

65 

606 

^^an^ successes 

also for Medical 
;tpns leading up 


'crsitics also tot 
D O M S D T M 
D M U E M M S \ 


M R C P 

D LO DCh D ^ 

seme esaras cl Uommions ^niilrsilli'^ ° ° 

ou\i cr.AssEs 

'rV"cS‘’(Ed'',’ ? a^V7nar'’M''(l"\'-s'' 

Wml. ^Alio'rr'baic Tiimon™ Microscope 

rROSPECTU*? M- \ 

CONTESTS Tb- method ^ 

m ih- Mcdi-al Prorcss.on r^r,^?i ' 

MrJia! Exariirm m, Posnl Courses 7nd Om! 


. - , - Medical 
Hichcr Sur 


Lvjtn n^ti ns Su** (or 

S i\ txrinaions Sussjcsinni 'for 

n -I fPA Lta"! nations RcIrcs^ r Courl^ 
vn-N (Lt Wsf- n lit- s lor «r.r.,s 
Med *al 
^ ‘ c 

J? Ucs. I ijn Sd 
II N.rn 6J1J ) 


Itclrcsh 

rilir theses 

IiCT-caas emus SOS' nit*, [, 

e-" s-n cans-, lo Ih- Pn- irsi 
London W G I (Tel rhoa- 



The Medical Correspondence College 
proMdes ample facilities under highly 
qualified tutors, for oral practical, 
and clinical instiuction in preparation 
for the \arioils higher qualifications 
and for Post Graduate Stud} irrespec 
ti\e ot an\ examination 

Diploma in Anaesthetics 
Diploma in Psychological Medicine 
Diploma in Ophtlialniolog) 

Diploma in Radiology 
Diploma m Laryngology Otology, and 
Rliinology 

Diploma in Child Health 
Diploma in Tropical Medicine 
FRCS Eng , and all higher Surgical 
Examinations 

MRCP Lond , and all higher Medical 
Examinations 

M D Thesis of all UniTcrsitics 


} Oil can qua »/i lor an of the abo\ e bi our Courses 
ol Coinbinetl P ^fal anti practical Courses 

Write at opce staling aour require 
mentj-'io the Secretary, MEDICAL 
L^^OBRESPONDENCE coli ege, 
19, WeIbccK Street, M 1 


W E SPECI\LISE IIV POST- 
GRADUATE COACHING FOR 
ALL EX AMIMTIONS 


DIPLOMA IN 

PSYCHOLOGICAL MEDICINE 

Shon Imcnsi\c O a' anJ Postal Revision 
Courses in rrcparation lor ihc D P M 
Conjotni London Utn\crsrt> cre 

\ppl> SccRCTARS Medical Cor cspon-crcc 
Collcc** 19 Wclbcck Srrcci London N% 1 
Free looklct How ro las rhe D ( M 
arpri^ation 


J 


LOHDOfI SCHOOL OF HYGIENE 
AND TROPICAL MEDICINE 

iNcoRPor \Tisc THE i'istitvte 

POSTS OATERSEAS FOR 
MEDICAL MEN 

A register is kept in the School of 
medical men'-who are 'p ,J,„ 

considered for posts overseas 


and the 


School IS frequently asked to ad'is 
plantation and mining companies "H 
such posts fall \acant 
The salaries offered are ‘'"’"'p!"?. 
conditions ot sersice are goyerned ) 
standaidised forms of contract d 

man} of the posts offer to medical n'cn 
most inteiesting field in which to prae 
their piofession , 

It IS desirable that candidates for p 
oserseas should hold a ‘^'P>°nia 
tropical mediLine and hvgiene i 

course provided b\ the London hen 
for the Conjoint Board s Diploma 1 
SIX months and the tuition 7., 

The course mn\ be taken from O'-, 
to March or fiom Januar} to 
There are generally more yacancies 
the course commencing in Januan 
The Director of the Ross Institnt 
always glad to inters lew medical m 
yvho would like information regir 
the possibilities of a career .. 

they will be good enough to nitkc 
appointment to call on him Lnqm 
may be addressed to 

The Director 

Ross Institute of Tropical Hygiene 
London School of Hygiene A Tropw 
Medicine 


KrniiL Stkfit Goyyni Stiutt 


WCl 


DiriOhLX IN FUBIIC IIFAITH 
The Royal Insbtute of Public 
Health and Hygiene 

Ihc Course of Instruction cjn be 
Tt anj time Spccnl provision i , ifi 

sfticcnts vvh> can Af»c ot > 

... y-tn hi. 

A prospettu nnd furihcr p rtiaiijrs c 
obnmctl from ih'* Sccrc ar> ^ 

Ict-phonc laniham./vi - 
.K loribnJ rijLC Lonjon vv t _ 


\ULST 1' I«'>S 


Till' BRITISH SITDICAI JOURNAL 


31 


LONDON 


HOSPITAL MEDICAL COLLEGE & DENTAL 

Tin W INTI II NI *'‘'II)N will Opi n «ii MoniH^ Oclolicr 3 r(l 


SCHOOL 


Tf'f LOS DOS ilOsriT At «'cN the |at !fHl «f lo'-In M *»thcttth j'sJfcd jnJ nirciv r< ihc bffc^l \clu larj Ho^pit:il m En Ijrd 

I>c <>)t tMl c**! Dc-Nj'''*trt «,ea \ » h a h 'vtrcv. nj pc^v pj* ^ rcr 3r n i\ cTicr i cl» l cJ f r tc-chir 

The i-c of the llw^r al neer^ atrs a Urte r r*hcr if rc^K-ert rri at P cr I »cf> >e-jf c cni> rc' Jent hue rh> siars and hou c ur o~s ^nd 

C£hl> viaricu f> •> rc' ~ -t cl -al a ari are a"'*v i cd ft r* tcvcn I» ui- 1 f cd tut-cr Ihc < •'pi Munil c? phch ihc»c jrr<- f oPer (or 

t*^an-'C cl rival cTpercnve t irial jh 

r>r yttniCAl cot t tet att hed ( thi. aM ti a td h' f r c\ r» i f Phj Fa teno c"> Chcrttcal Pathoo'y N '*ft' d 

Anjli-ni a"- Mci. '•ic <f the L-ncr^ty c( I o'^ t 

"^rt Ct 4L CO(/v<fS H An, and ph' ry f ^ f'c Tr t> I F C S arc. \d»an cd Cc i r^CN in Surref> for the Final F R C S ExaT nation rd 

tn ^feu J- for i''c At D a~v. V! K C r I \ '~i it r are held ti» c * year 

rs~TKiSCr SCHOl <KsHir'> ASD rr/z/s of ih l tal % lae ft* fc ai^ar nJ an'^u Ily Rcccar h Fun-y to «h<* aiue of tllJKO rcrrrn o 

a afVr be i r rn t o •'i arJ cr o tn c* arrd in fed 1 r-'ca h 

T^e ^ftniCAL COLLrC I c n at \ a n •dern Vt reel •*» tf P thi I -> -J a I hr n rr ' ded «ilh aH the current rtedim r>cn-<dicali m h_rge t a 

f" M -re 1 1 *' sr j Ih re ti af an \t*i roe •n Cl *' »r»d l> n»n II I a Cir — a f i es C urt »nv. mo h Cct ns n the S uder s H >>tcl Th- 

Ath’ct CrounJ It «*Tcy at Hale tr.J rs * th n ca s c ar- c f the H ''*' al 

TFe tlO'^ttr At ty t > r* rain, fr 'n C*‘an t Crm afNl I aWet Atrrri At t n fort -^e nho «m S to li c in r^neii i troT 'i y to ihc H 
t -re n n f r sts > J ri irt the A u e-t HoMct 

liri*'CT cetai ma be < bt, red fr *n the Dean Hr A I Ci tcklNMii Ain FRCP Ph) tan to ihe Hmr lal and Fel w. ol Csrpi-s OirMi 
Cc ere Ca-s^rtuc*" •ho i slwayn rased to r~cet stun, rts yucb n ti see ih If •c'* il a-d C 1 ere and lo schen appli »t n for t.r' s n hood be 'n uc 
Icrner A reel Lonj n FI 


THE CLINICAL RESEARCH ASSOCIATION, LTD. 

tt\T!lirAT1 lint "1^ tltllJ Ilf XS id if t Ch^ tnt C o\ Sfouor ) 

A COMPLITL I VBOItSTORI SLR\ ICT- 

The C **yjli ~ Roor^ an<- Laborat me of ihu A c xut n <e>t Mp.»'<d in 1 ere as il h e f r all Afcc-ical Practiui rers dcsinn*’ Laboratory 
a 'cjance m the iniestitatKn and diarnMi rf cn*en under ihctr care All recesvary app ratis ard full tr trueii n< for c Ileciins paihorcn c 
r“atmal or f->f Ihe rersonyl oUerv-ance c' lati rts at rhe Cor uleirc Ro.'o- of the A ocuiion will be f r^Tifded irrntcdiatcly on arr ic..tJon 

rtuniof Rtniir tMi \nl^ i x \ai in ti ion’s o m it’^iNr iiomi iccoaimouition ATiniNrFJ) 

Tclerh ne ilMnr Fit hA-9t (4 1 nest M C*nt>hit Se-rciary Tclexrans Tlpmcle Rand London 



Chartered Society of Massage and Medical Gymnastics 


CHNRTERCD M\S®ELSES nnd \! \SSEURS receise Ho pint Tmininp They are quali^ed lo admini ter IASs \CE1. 
RE^^OI\L E:-\ERCISE.S ELCCTRIOXL And LIGHT TREz\TME\TS 

The Soci«l> ysns printed « Ro> tl Cl arter m l**20 m reco nilton of the f ich standard of i*ork mamtamed C S Jil M G 
Member! do not advertise individually and pledge therstelve* to treat patients only under medical direetton rJ1 
wembgTs of the Society nre eligible for enrolment on iSe National Regnter of Medical Auxiliary Services 
Name ««<< nAA r r «/ m tnle I p o * »nff In «nr <f I f a ifu Count i o of arf mn fcr obtained / on* 

THE SECRETAR'^ C.S-MJ.1 C TAMSTOCK HOUSE (NORTH) TAVJSTOOw SQUARE, LONTJON W C 1 

PAone fu Inn 


LONDON HOSPITAL 
MEDICAL_COLLEGE 

PRLMARY 'fellowship 
EXAMINATION 

\ SPECIAL COLRSL OF INSTRLCllON fo 
the aN.ye Ltamnati n bcvin on Afpn„ay 

Serter— ber I ih 

The fer ftx th- Coonc H *u reay 
Furthc' pannilars r'jy be obtain’d Ir-«ni — 
DR A E CLARk KENNEDY MD FRCP 
Dean Turrer Street London E 1 


LONDON HOSPITAL 
MEDICAL COLLEGE 


University College Hospital 
Medical School, 

UniACrMtA Slrcct \\ C 1 

WINTER SESSION commences 
Tuc daA October tlh I9'S 

Scholarships and Prizes exceeding 
£I 000 awarded annitalh and numerous 
Nacancics for Hou\c Appoinlmcnls aNo 
Senior Posts for Registrars clc 

Dental School Department 

National Dental Hop lal Great Pi^nLnd 
Street W I ) 

Recently recrranjcd and equipped cn the 
hi hest Lan<l,rd of r’odem TcquircT pM 

Full r-articulara can be obtained on crrli at on 
to the Dean 


PreliininarA ExniniiiTlioi s 

Ihc COLLEGE OF PRECEPTORS Kt Pre 
1 mirury ETaminaii -*1 for Vfedi'al »pj D- nul 
Student n Ltndyn and Prenn »al C r res 
m xiarch Jure Sep ember and D'carber For 
Re"i-Iatior’' ..rpl> to the S-ntrciary Cu! c^c of 
Precertprs B oerr Square London \\ C 1 


co\cinNG 

ByMD MRCP FPCS tn SjfEcr> 
ard Patholoc- fo Cen on Xf B c 
Fclloyy^ip CL “s o triniJually Addre<s 
No “918 B X| A Heus TaytstecL Squ-rc 
X\ C I o Phone (tnomirss) kEN 0 


OHN DLNMLLE RESEARCH FELLOWSHIP 
IN EXPERIXtENTAL PATHOLOGY 


FRCS 

A C urve c Im ruction f r the FINAL 
FELLOWSHIP EXAXfINATION wiM bczin on 
Thi.p.da) September l^t 19 X Fcei (ctclinjye of 
Opcranvc Surgery) 25 guircas Operative Sjrgery 
10 guineas 

Further panjculars may be ob-uuned from — 
DR A E CLARk kENNED^ XI D FRCP 
Dean London Hosp lal Xledical CoIIesc Tomer 
Street Lordon E I 


THE M1LR01 LECTLRES ON ST\TE 
MEDICINE AND PUBLIC HEALTH 

The Council of ih- Royal Collexe of Ph Kians 
are prepared to rcccjyc ..pp ications for the oTi e ol 
XIILRO^ LECTURER for 19^0 

ApplicatioiK should be addres ed to the Regi trar 
Royal Ccllesc of Phy-si lans E*all Xfall Cast on or 
before September I“th I9xx ard hould contain a 
tatcraent of the diynon of the subject selected by 
th can nlate 

The course e ns’' s of two lectures 
The Lectures am to be gnen on a Tuesday and 
Thursday in Fcbnarr or xiarcb I'LO 

A cc’'y of Dr Xfilroy s SuggcN ions on Ihe 
sub ect cl hts bequmt and informal on as to the 
emo um nt may obtained front ih Regi trar 
Xugi,^ 193S 


THE ROy AL CVNCER HOSPITAL 

(FREE) 

t/er rpo trd vndcr Roni* Chartr ) 
rilllXXI ltO\D LONDON tV ,3 

The Course of Stud m PHYSICS and MEniCAL 
ftAOIOLOGY qualifying for (he Dip -na in 
Padio’ogy o! ihc Lniycrsiy ot London and the 
Royal Colleges of Phy icians ..nd Surgeon will b” 
held as u ual at the -bote Ho^p tat and will 
cortmcncc eg xlonday October rd 

Apr canons hould be made -s coo as pos h e 
to the Secretary at the H>.pial from •horn all 
parti'mlars can be obt-ined 

clement COBBOLD Sccretao 


"sTAMnERINC SPEECH DEFECTS 
BEHNKEilETIIOD E t.b Ci e non 

rt idcnt treated at 39 Earl Conrt bq 
S Vi a *v»'d in re idence In the Siitnra r ho i 
day tMib Beh-’^ke ’’C en eon tneChi’tern 
** Pre»en:iceiil tecc^ in eJu-ato.- and treat'” n 
of nramer n* andethe ih-€'4i( feel — Ti-e» 
Th r c hi pb lol lesl p me pl« — La r** 
The method i cieciificaUj c rce and perltr 1 
eHeN- re — Gu Uo pi -1 Ga 2 ette.“ 

Slamraenitf Cleft Palzte Speech Lispia* 
3/9 i XU'S BciPsKi:, 9 Xarl Ccan Sq S.W 5 


Applications ire in iicd fo the JOHN 
DL'NMLLE RESEARCH FELLOWSHIP IN 
XXPEPIXIENTAL PATHOLOGY at a <v..!ar> of 
£ 00 per annum The Fe! oivship ts tcn-ble in 
Queens Uruyciiity Be fast for a period of three 
years o for jch furth'n^ penod as the Board of 
Elcmcn m y deierm n*' 

The suc'iss ul candr^ate will be cipeexed to 
lake up duty on Oneber Isi 19 s cr su h other 
dale -.s may be determined 

App •atiors mo t be in the hand ol the 
Scc'ctary o the Urncmiy not later than Saturday 
Seplcirber rd Further particulars m.-y be 

ob-3 n-d from the undeiN g”cd 

Oucen s Limvers ly RICHARD H HUNTER 
Belfast Secretary 


AL 


COLLEGE OF SURGEONS 
EDINBURGH 


OF 


Apr cajir a.c inyued for t c pent ot CON 
SERX ATOR cf the XfUSELX! amJ DIRECTOR cf 
PO^GP ADU ATE STUDIES ter t c for F e years 
•Tth cf s-bi ity for rcappoinimert -t imnal ~Lry 
£1 t-^O pe annjm 

Ap-I^atic- Jong • ib die n_'”-s o t»o pcr‘cns 
to iv^om referemre may be m..dc must be IxJecd 
no L cr than Ocio^'er 1st 19 X Part-culars of 
the dji»es of t*'” post nay b* obtam^d f cm the 
SecTC*..ry Royal Col c'c of SuTceons Nico on 
Stree Edm^u’gh 8 to •bem ^pp ications '•ou d 
be addres ed 







32 


THE BRITISH MEDICAL JOURNAL 


August 13 193S 


^OUNTY COUNCIL or MIDDLESCN 
iiAitrncLo AND clarc hall sanatoria 


OCCUPATIONAL THERAPY 


Npp'icaiions arc inviicd for ihc appointmem of 
tupmonal rhcnpy In tructors (Mc( ai ihc above 
s mjiona 

A knovslcdcc o( the teaching of all or any of 
the undermentioned subjects is desirable 
Prmnnp 
Colblinc 
Lich Woodwork 
Leatherwork 
D tskciwork 
Decor \tv\e Work 

Sdu\ in iLCordanec with the Burnham Scale 
for the I ondon area anplicaWt to an appoin ment 
of this niuirc Superannuation deducted under the 
Teichers Super innualion Act 

Apphcaiions Maiing tee qualifications and ex 
pericnte loteihef wiih copies of not more than 
three recent icsiimonials must be rccci'td b\ the 
under menUuned not later than August 2lUh I9t^ 
Kcliiun hin to anv tremher or officer of the 
Council must be discle''s d in the application 

Suecesslm Candida cs will be required to pass a 
medit i! evamination 

^pp!l iiion forms arc not prowded envelopes 
must be endorsed Oeeiip monal Ihcrapv 
Instruvfors Canvass ng dircetlj or indtrectH will 
be a di Qualifi aiion 

C \V BADCUirE 7 
Clerk of the M d ^Icscx Counti Council 
GuilJh M W csim nster S \V I 
JuU 2''ih 


QOVERNMENT OF INDIA 

Npphcaiiins »rc invited from women candi 
d tics for the innointmcnt of PROrtSSOR OP 
MAICRMTY AND CHILD W FLPARn at the 
ALL INDIA INSTIICIE OF H\GIENC AND 
Pl'BLlC HEALTH C \LCUTTA 
Cindrdiics must possess a registrable medical 
quahficttion nJ trust have experience of the 
executive and administritivc aspects of Maicrni > 
and Child Welfare Preference wiU be M'en to 
candidates posscssinB also experience tn dircctinc 
or conductma rcscanh and in Iccluims to students 
AErtcmcni for five years in the first instance 
Paj scale Rv I 0^0 rising by bicnni tl incremcn s 
of Rs 50 to Rs 1 ^^0 a calendar month plus 
Overseas Pay of Rs 1^0 (Rudcc»1s 6d approxi 
mately) Provident fund First class passage to 
India ind return na saec on sati factory termination 
of service (Over cas Pas and return passaRc 
admissible only to appointee of non-Asiatic 
domicile) 

Applications will be accepted from rrembers of 
the Womens Medical Service (India) who possess 
the rcgiiisiic qualifications In respect of such 
candid ites difTerent terms and conditions will apply 
details of which will be furnished on request 
Further particulars vnd forms of application mav 
be obtained on application by postcard from the 
High CoMMtsstostR tor Inchs General Depart 
mem India House Aldwvch London \V C 2 
Last date for receipt of completed applications 
September lOih I9tS 


I^ENf EDUCATION COMMITTEE 

SCHOOL MEDICAL SERVICE 

AtPOlNTMENT OF WHOLE TIME ASSISTANT 
SCHOOL MEDICAL OFFICER (Ophthalmic) 


The Committee invite applications lor the post 
of Assistant School MeaJieal Officer (Ophthalmic) 
Diploma in OphlhalmoIORy vvill be considered an 
adsaniage 

Salary £700 per annum plus travellins cxpens‘*s 
The appointment is sub cct to the provisions of 
the Lo'-al Government and Other Officers Super 
annuation Act 102'’ and ts terminable bv three 
month nmice on eiib r side The successful can 
diditc will be required to pass a m-dital cxamina 
tuuv as to physjeal fitn-ss 

Application stating jrc full qualifications and 
cxr>cricn e >cc( npimcd b> copies of three icstj 
monn! hould be forwarded to the understpned 
by Stpieaibcr 2nJ 

No olTiei 1 foTa of apnlKaiion will be issued 
and canvassin" vsiU disqualify 

CONSTANT ponder MD 

Ss^hool Afed cal Ofii er 
SC'S ons lUu e Alaidstonc 
Aueust ’nJ in a 


A PPllCATIONS \Rr INAITED in WRITING 
\n the first las an c lor th- EUNICE OAKES 
KTSl ARCH ILLLOWSHir at the HOSPITAL 
fOU SICK CHILDREN Great O mond S reel 
food a \A C I tcnibl'* frora Jaru_fv 1st 19 9 
CanJiJjic' nu t b r^'sJt ally qual fie*d and fulls 
cuai'^'^'d teshn t* and hs exP'-mm c lo con 

de t rrs-3 h wo k wpsa the ptes n irm ard cute 
vf Oi L.r ns D CTscs Thev mus be under ^ 
vgjrs ac an the sj’j > is to be not less il an 
i > r r a*''' 

Xri '-jt tth h rnuM tree full pariiwu ars of 
»h )-i jj P ''->Ncd lire of research 

f''' Tt: trten trs -ird eopi'a of 

s»- oU K auJrcs rd to th- 

liy ** * PUrULIIoro S-crcu.rr 


T he king edw'ard vh welsh 

NATIONAL MLMORIAL ASSOCIATION 


Applications are invited from duly rccistcrcd 
medical pracliitontrs for the po t of HALF 
TIME ASSISTANT TUBFRCULOSIS OFFICERS 
(three in number) to be attached to the Cardiff 
Newport nnd Ponivpndd areas respectively and 
commenemg duiv on October 1st next The 
appointments arc limited to one tear at a rcmuncra 
lion for the year of £2*^0 During their tenure 
successful candidates will be expected to lake 
during the other half of their time the Course for 
the Diploma m Tuberculosis D»sca cs (AA'alcs) at 
the Tuberculosis Department W'cUh National 
School of Medicine tnd afterwards sit the ex 
ammatvon Putveutars as to (ccs (or this course 
can be obiamtd from the Secretary W elsli National 
School of Medicine Cardiff 

Applicants must have held a house appointment 
in mcdicmc or surgerv at a general hospital for at 
least SIX rronths and must also have held either 
a post as resident for a period of twelve months 
in an institution for the treatment of tuberculosis 
(medical or surgical) or a period of whole lime 
work accepted by the S''natc as equivalent thereto 
Applications si ilmg ?gc qualifications expen 
cnee etc together with copies of three recent 
testimonials sh« uld reach the undersigned not later 
than Wednesday August 24th 1938 
D A POW ELL 

Pfin jpal Medical Officer 

Memorial Offices 
A\ csigatc Street CatdlR 
August 1st 19 jS 


f^ONMOUTHSHIRE COUNTA COUNCIL 
ASSISTANT MEDICAL OFFICFR 


The Council invite apphcuions from duly 
qualified and registered Medical Practitioners male 
or female not cxcccdinc ^ vears of igc holding 
a Dipioma tn Pufil/c Htahh and S(uc ^fcdlClnc 
for the ippomtmcnt of Assistant Medical Offitcr 
lo unde take mainly the Medical Inspection and 
Treatment of School Children ind Maternity and 
Child W'clfarc work 

The salarv will be £^00 per annum rising by 
annual increments of £25 to £7 0 with third chss 
rail fares and subsisten c allowance according to 
the Council s. scale 

The successful candidate will be rtqii red to act 
under the direction and supcrvi ion of the County 
Medical Officer to devote whole time to the 
service of the County Council anJ to rcstdu m 
such place as the Council may dtttrmmc 
The po>t will he subject to the provisions of 
the Local Government and Other O/Iivcrs Super 
annuation Act 1922 

A schedule of the duties to be performed 
together with conditions oC appointment and a 
form of application can be obtained from the 
undersigned to whom applications accomp intcd 
bv copies of not more than three recent tcsii ^ 
rronials are to be sent by September Isi 1938 
The County Hall D KOCAN JONES 
Newport Mon County Medical Officer 

August ^tli 19 S 


JJNIVERSITA OF LONDON 

The Senate again invite applications for ih 
UNIVERSITA CHAIR OF RADIOLOGA icnaWc 
at the Royal Cancer Hospital The holder of th 
Chair will be Head ot the Dcpanmcni ol 
'Radiology at the Hospital Salary £2i(X* a yvar 

Applications (twelve copies) must be r-artned 
not later than first pest on September -;0ih 
by the Academic Registrar Univcrsiiy of Lond-m 
Senate Hou c London W C 1 from wh m 
amended partinilars should be obtained 


J^UCKINGH \MSHIRE COUNTA COUNCIL 

It) DEPUTA COUNTY MEDICAL OFFICER Of 
HEALTH AND SCHOOL MEDICW 
OFFlCf R 

(2) ASSISI ANT COUNTA MEDIC \L OFFICER 
or HEALTH 

Applications arc invited from registered ncdi'al 
praciuioncfs not over 40 vears of age holdmz a 
registrable qualiRctfion in Public Health S-mtaTr 
Scicn c or S ate MeJicn for the followint 

apromtments 

(1) Deputy County Mcdieal Officer of HcaUh ni 
School Medical Officer for th-* Adninsirme 
County of B ckingham at a conmcncin'^ salary 
of £72^ per annum nsm'* sub cct to satisfactory 
service by annual mcrcmcais of £2*’ to £v(M) 
annum 

(2) Ass slant County Medical Officer of HcaUn 
and Assistant School Medical Officer at a con 
men me snbrv of £‘'00 per annum ri in" ube i 
to satisfactory service bv ann lal mercat nt- ei 
£2s to a maximum of £700 per annum The dir* 
will pertain mamly to Schoo’ Medical !nv t a 
and Maicrn iv and Child AA'elfa c work bat t c 
wiU he opponimviics for the mvcstigati r el 
sanitary cond tions ccncrallv 

Tlic successful applicants will be required to r-^y 
contnbulions under the Local Govcmrrcni na 
Other Officers Superannuation Act 19'’“’ and o 
pass a mcdisal examination as to rbysisai fiino^ 

Particulars and condition of the appt ntren < 
'•re set out on^thc form of anplicition which can 
be obtained from the undsr igned 

Application on the prescribed form accont 
panicd by con c of not more than thr« 
tcstimon al< which wdl not bt - ,J ? 

be addressed to the Clerk of ibv i w 

Council and delivered at the Couniv luii Avto 
burs not lattf than Ham on 5atu wj ^ 
fember 3rd 19 8 marked ' 

Medica) Olficcr or Assistant ^ 

Counts Hall GUi R 

Aylesbury C erk of the Bucks Coun y Counui 

August 1938 

^OUNTY COROUCH OY SUNDEPUM> 
CHERRY KNOWLC 

(Sunderland County Borough Menial Ho ri 3 
Ryhopc near Sunderland 

APPOINTMENT OF DEPUTY MEDICaE 

rM irvi-iH • v»-rr-VTrNr7VtT 


T he Warwickshire and Coventry 

JOINT COMMirTEE FOR TUBERCULOSIS 


KING EDWARD VII MEMORIAL 
SANATORIUM 
Hertford Hill near W arwick 


Applications arc invited for the post of JUNIOR 
ASSISTANT MEDICAL OFFICER (rtian or 
voman) at the Memorial Sanatorium near 
W arwick of 22*^ beds 

The salary wall be at the rate of £2‘'0 per annum 
with board lodging and laundry in addition and 
the successful candidate vmH be appointed for six 
months 

There ate three other Medical Officers at the 
Sanatorium 

Applications w ih copies of tcstimon als should 
be forwarded direct lO the Medical Superintendent 
ai the Sanatorium to teach h m bv not later than 
Thursday August IStb J93S 

Shire Hall L EDGAR STEPHENS 

AN arwick Clerk of the Joint Committee 

July 29th I93S 


‘OUNTA BOROUGH OF PRESTON 


SHAROE GREEN HOSPITAL 
(250 Beds ) 


assistant resident MEDICAL 
OFFICER (Female) 


Apphcations arc invited from fully qualified and 
rcl,l^leTed practitioners for the above appoinimcnt 
Salary t ihc rate of £300 per annum wuh lull 
ba\rd and rodence The appointr'cnt is a 
icnperary enc and will be fo a period of s x 

naat^'i 

Previous exper cn c n midveifcry is csxcniial the 
dll cs cons ling mam v o' c'^stcirtcal work (3^ 
mate n ly beds arc providcJ) wiih the addition of 
ih cJ n cal ratholo'*jc3l work o' the Hospital 
A*>n -ationv rxiing age qua’ifionor and ex 
per "r c fogc her with conjcs of three rceent tcsii 
m-vnat should tea h the Medical Surcrintcndeni 
not Ixter than hm r''>>i-on Saturday Aucu>i 2fHh 


AppI cations are invited for the post of D 
Mcdicnl Suprnntcndeni of Cherry 
Appheams must base held House ftiO 

n n Gcnenl Hospital The salary 
icr annum advancing per 

crvicc by annual increments of £ ' **3 it’ 
mnum plus emoluments valued for 
upcranniniion at £l^D per annum K ‘ri P 

if a diploma in psychological of 

>CTson appointed will receive an additional sum 
per annum ^ 

The appointment will be subject to * 0 ® ^ ,Q.yj 
)f the Asylum Officers Superannuation Ac 
Form of application may be obtained • ‘ 
md applications addressed to me ^ ^ 

>n cover Deputy Medical Supcrintcndcn ^ 

^.nowle together with copies of three 
cstimonials must be delivered at my 
lall Sunderland nm hicr ^ <■ 

rusnst 23rd nerr Cinrawns 9'"" “„rniKi 
ndrrccilr unii! ifinr ihc lirsi ‘Nhon o n 
Intes by the Commitrce will be a ^hauan 
To«n Hall G S ''<;;^LTIRE 

Sunderland Town Clerk and Glc 

July 3Dih 1938 Nisiiins Con-miiiec 


iQUNTT COUNCIL OF ROSS A'O 
' CROMARTY 

\ppliC3tions arc invited for 
5IDCNT MCDIC kL omCER 
wis Sanatorium and Infectious D >i 

a period of six months n 

isun Salars at the rale of £- p 

h board loJcinc and hundtj '']• < 

at Medical OfTcct at the Sanamrum 
ievtious Diseases llpsp tal and H 

valth diiltcs as ream cd b> Mcoi ai 
■,1th ot his rcsid-n A s slant , , , 

Sppltcations ftvina parti uhrs ot aui , 
i presiDiis cxpcricn c and sratine ' n " - i 
t up dill) u'-companied ly six 
J of lesiinionial in b- Itsdx-d vsith the 
ned on or before Aumis 7«,s 

rouni) Clerk s omce T S » p ,t 

Dingwall 




\Lv,ost I' 19'IS 


THC BRITISH MEDICAL JOURNAL 


33 



Apponitmenls joi Medical Officeis 
m the ROYAL AIR FORCE 


Mctlu il nun nrr iiiMUd lo f«»r blioit ^irxKc Cninrni-«.ion- in tlit Uo\ il \ir Force 

Cnuliiliti'. Ijc n^iltrccl unih r llic Midici! \iN itul I)l not nmn thin 31 )cnr« 

of on I iMrs 

i Jk p< nod of r- 1 \< ir^— < \f< /nlilifc to > At ir< \ pritini\ of i,-fOO or 11 000 

IV piN i!)l< It tin ttrininilion of 3 oi 5 a< irv rt vpct t!\ < N Perm incnl coninn vioiiv irc 
iitU<! in i nunilx r of t i ev IImvo offer a p< iivjon ihlt cnrcci with tin. opponunilN of 
tAtn Iti\< on full p i\ for vp(tn1iv<.d vtiid\ \pplit intv who hold—or nn IikcU lo holil 

— pov( idu lit ipjxnntnu ntv in «i\d Itn^pn lU nj i\ on joining the Ho\ il Air Force be 

Mt.*oiuhd until tin ttiininition of their ip{M)mtnt( ntv (for t period not c\c<.cdin_ one 
\e ir) \n uitedite of coinniivHjoii up to twtKc inonthv js •dloutd for nppoinlmcnt> licid 
nl ipproAtd hovpit'iN 

ruller information can be obtained from The Director 
of Medical Sertftos, Air Mini<itr^, Kingsira\, London 


ROYAL NAVAL MEDICAL SERVICE. 

Vacancies CMSt for Medical Officers in the Royal Navy, and applications are invited for entry 
in September, 1938 

Candidates below the age of 28 years are preferred, and they must be registered under the 
Medical Acts No e.\amination m professional subjects will be held, but candidates will be 
required to attend for mtert'iew by a Selection Board 

Selected candidates will be entered for Service for a period of three years, which if desired is 
usually extended to fise years at the discretion of the Admiralty 

At the end of three years’ service, officers may retire with a gratuity of £400, but those who 
serv'e for fite years will receue £1,000 

At the end of fi\e years’ Short Service, permanent commissions will be given to selected officers 
who wish to make the Naval Medical Service their permanent career Officers transferred to the 
permanent list viill receive a gratuity of £1,000 (less Income Tax) 

Full opportunities exist for transfer to the permanent list, and periods of unemployed or half 
pay are v ery rare The assistance of private mcome is not necessary for the purpose of supplementing 
official pay and allowances 

Opportunities are av ailable for officers on the permanent list for post-graduate study, to specialise 
to take higher examinations and to obtam further qualifications 

Naval Medical Officers are included in the Scheme for Marriage Allowance under the same 
conditions as for other Naval Officers 

Copies of the regulations for entry and conditions of service, mcludmg rates of pay, allov.ances 
and retired pay may be obtained from the Medical Director General of the Navy, Admiralty, S W 1, 
and from the Deans of all Medical Schools 

Applications for entry from mtending candidates mfist be received not later than 
31st August, 1938 



34 


THE BRITISH MEDICAL JOURNAL 


August J3 1938 


c 


1 Tt 


o r 


BIRMINGHAM 


MENTAL HOSPITALS DEPARTMENT 


R 


ADNOUSHmt county council 

APPOINTMENT OF COUNTY MEDICAL 
OrFlCER or HEALTH 


ANCASIURE 


COUNTY 


COUNCil 


WinSTON COUNTY HOSPITAL 
Ncir Prcscoi 


RULERY H\LL AND HOLL^ MOOR DIVIStON 


The CommuiLC o\ Visitors inMtc Applicttions 
from Uuly qintificd medical men for the position 
of JUNIOR MALE ASSISTANT MEDICAL 
Orr ICER The successful candidate wdl be tc 
quircd to reside m the Hospital 
The commcncinr; sahrv \mII be £"^^0 per annum 
ph/s ihc usinJ rcssdentji} emolnmcnis of board 
lodcinft laundry and attendance An mcretsi. of 
C'tO Witt be pramed on complaion of tv.cRc 
months satisfactory service and ihcrcaficr in 
creases of CZ*' per annum up to a maximum salary 
of iA^'O per annum An additional £*^0 per annum 
will be paid to i holder of the D P M qinlifica 
tion or to a person obtaininp the D P M after 
appointment All Res received in connexion with 
panel worlv will be rtciturcd to be pud into the 
BorouRh I unds but for maKinc insurance reports 
reports on compensation cases md Coroner s 
inquests the fees cm be retained 

A person who has held for at least six months 
a medical or surucul residential post in a Rencral 
luispital will be rcRardcd as havmR an •‘dduionil 
qinUhcition Previous menial hospml cxpcncncc 
IS not esstnnal but expenenee in the administration 
of matsihctits is desired 

7hc candidate appointed will be required to 
p vss a medic il examination and wilt be placed 
on the permanent staff after one year s satisfactory 
service when he will be required to coninbuic 
under the Asylums OfTiecrs Superannuation Act 
1909 He will be required to serve in such in 
stmitian bclonein^j to the Mental Hospii ils Com 
mutce as they miy from time to time direct The 
appointment is subject to one month s notice on 
either side 

Applications siatinj} hill pariiculars of quahhea-. 
lions experience and appointments held accom 
pinicd by copies of three recent testimonials mu<:t 
be addressed to the undcrsiRncd o as to be 
received not liter than September 1st 193^ 

Town Clerk sOfTiec f H C WILISHIRE 
Conned HouiC Clerk to the Committee 

liirminRham 1 of Visitors 


^JIY OF nillMJNGHAM 
SCLLY OAK HObPlTAL (520 Bedsl 


JUNIOR MEDICAL omCERS (MALE) 


Applications are invited front fully equipped 
Medical Practtiioncrs (or the whole time innoint 
twem of Junior Mcdieal Ofneer (male! at the ScUy 
Oak Hospit il Birmingham The appointment will 
be for a period of six months in the first instance 
but may be extended nt the end of that time for a 
tuTiher period of not cvcccdina six months 
Stlary at the rate of £200 per annum and full 
tesidcntt vl emoluments 

further particufars may 6c obtained from the 
Medical Supcnntcndcoi at Sc-lly Oak Hospital to 
whom applittpons stating aRc experience and 
quahrications with copies of recent testimonials 
should be forwarded not later than Saturday 
AiiRint 20th 1938 

rue WILTSHIRE 

T)?e Council House Town Clerk 

Birmingham Juiy 1938 


gURRCY COUNTY COUNCIL 
rUBUC HEALTH DEPARTMENT 


SURREY COUNTY SANATORIUM 
Milford (300 Beds) 

JUNIOR ASSISTANT RESIDENT MEDICAL 
orncER 


Applications arc Invited from registered NtcdJca! 
Practhioncrs (either sex) for the appointment of 
Junior Assistant Mt-dical OfTu-cr at County 
Sanatonum Milford near Godalming Resident 
cxpcncni.c in pcncnt hcwpital cs>cntnl Appoint 
mcni IS for sjx months renew iblt for further 
Pvfiod of SIX months 

Salary £-'^0 per annum together with full 
rciij«.niiaf emolument \ppomtmcni is subject to 
the Siaflmc Rcpulations of the Couniv Council 
Appli ations stating age quahTi itions and 
experience and eneJo me copi's of rot more than 
thrci. rc'cnt tcstimoniats. should be sent to the 
Mce! vat StirerinitnJt it Surrev County Sanatorium 
kfilford Surrtv to rttch him not later than 
S\turday \uc i t Nath 19 ^ 

CvuntyHaU DUDLC^ \l KLAND 

Kin,iKsft n upon 1 hames Citrk of the Council 
\u‘'usi -nd I ) "s 


ON DON COUNT'* COUNCIL 

'•(•'ll at Ptactitimcr reamred with appropriate 
Quj’itf n ft r ar^omirrcn: as ASSISJXNI 
1 MllOLOC ISI at Ccriral Hi tolvei at Eabora 
t ' V \r h\ a Ht>s''ttaf Vrchwas Road N jo 
^T\ if»i> b> £.<; |„ fviajV I apcricn c in nc,rbid 
n y ard p tn rtem work o nttil 

f rn cf -ijsp 1 1 n an f further parti ulars 

jnr\.d adJr-' -J f iltip cnscl rs. r*“Ccssar>y 
' 't J a O vf o lUaUh (StviT Di uion 2aa 
Hj \V -sf-n n f r -SCI rcturnal c 


< 

>1 


Cj- 


t -j 


4l * 


Apphcajions arc invited for ibe nbovc nppoinl 
mem from medical men of not more than Tifiy 
years of ape who arc duly qualified for the appotnr 
ment purstnni to the statutory provisions contained 
in the Local Government Act i93X and the Rcftu 
lations made by the Minister of Ucalth thereunder 
and by virtue of the Public Health Act 1936 
The dutrev tviH frtehide tlf sraiuiDry didJcs as 
County Medical Officer and School Medical OfTcer 
work required under the Mental Deficiency and 
Maternity and Child WUfatc and Midwlvcs Acts 
together with duties in connexion with the super 
vision of the work of the County School Dentists 
and Health Visitors Rcncral suncrvivion and con 
trol of the Maternity and C:hiid Welfare Centres 
and various Clinics and such other duties os may 
be prescribed 

Salary £800 per annum increasing after two 
years «;cr\icc by four annual merements of £25 
to £900 

The appomiment will b** subject to the inprnval 
of the Government Departments concerned to the 
provisions of the local Government and Other 
Officers Superannuation Act 1^22 and to a satis 
factory medical examination and will be terminable 
by three months notice on either side 
A form of '’pphtation may be obtained from the 
underMftned by whom applications wusl be re 
ccived not fatcr thin August 19ih 1939 

- t \ ^ indirceilv will be con 

G W MOSELEY 

Clerk of the Council 


f^OUNTY BOROUGH OE DARLINGTON 
ASSISTANT MEDICAL OmCER Of HEALTH 


Applications from quifificd Medical rr»-Ctiiloncrs 
arc mviicd for the combin-'d appoinimcni of 
Assistant Medical Officer of Health for 1 uher 
culosis Public Assistance under the terms of ilic 
Public A Mvtance Order i9W and other Pubht 
Health duties (not including domicihaty vtsumt, (or 
the Public Assistance Committee) 

Appiieants must not cxeectJ 40 years of age '>nd 
should have had at teisi three years post 
ktadviate experience in general medicine tind 
surt.cry and in Public Health work The person 
appointed will be requited to give fulltime service 
under the Ainlioniy to act generally under the 
direction of thc'-Mcdical Officer of Health to pass 
a medical examination to contribute to the 
Supcrannuition Tiind and to reside m a house 
provided by the Authority for which i rental of 
£40 per annum exclusive of rates vvilJ be charged 
The total salary is £450 p^r annum rising to 
£700 per innum by annual increments of £25 plus 
a car alJowance of £30 per mourn and a)) fees or 
emoluments received mvtst be paid over to the 
Local Authority I he appolmmcm will be 

terminable on three months notice 
Application forms may be obtained from the 
Medical Officer of Health Health Centre Green 
bank Darlington and duly completed* ind 

endorsed Assistant Medical Olficcr of Health 
they should be sent to him together with conics 
of three recent testimonials not later than 
August 31st 1938 

I H HOPKINS 

August 3rd 1918 Town Clerk 


^ITY or BRADFORD 

ASSISTANT SCHOOL MEDICAL OmCER 


Applications arc invited for the post pl 
Assistant Stliool Medical Officer at a salary of 
£750 per nnnum rising to £93? lOa by biennia) 
increments of ixp the first increment to t ike cfTect 
on April Isi 1941 

The salary is subject to n deduction of 5 per 
cent per annum under the terms of the Local 
Government and Oihcr Officers Super mniniion 
Act 1922 and the successful candidate will be 
required to pass a medical examination 
Application forms may be obtained from the 
Mcdival Officer of Health Town IlaJ) Brad/ord 
and hould be returned to the tindcrsii.ncd pot 
faicr thin Awgvisi 27th 1918 Envelopes should 
I ear the words \ distant School Mcdica) Ofliccr 
in the top left hand corner 

N L rLCMfNG Town Clerk 
Town Hill Bradford 


01T^ OF BRADFORD 

MUNICIPAL GENERvXE HOSPITAL 
S( Luke » 

HOUSE PHYSICIANS and HOUSE SURCEONS 
required Salary m each cixe £1^0 pur annum 
rlu> board and lodging These appointments arc 
lor MX rromhs renewable for a furher period of 
SIX nomhs 

Npph avion lormx may be oltaincd from the 
Mcdi'al Offi er of Health Town Half Bradford 
anj hould be rctu nM 10 the undcnicncd not I iter 
th^.n \URUM 2''th I9r8 

N L FLEMING Town Clerk 

Town Hall Bradford 


APPOINTMENT OF RESIDENT SURGICAL 
on ICER 


Applications arc invited for the appointmciu of 
Rc'ildcnt Surgical OlTiccr (unmarried) at the 
WliKton County Hospital near Prcscot (500 bcdvl 
Applicants must be Fellows of the Royal Collese 
of Surgeons or hold Degrees or Diplomas of 
similar vt indmg and must be capable of dealing 
with surgicnl emergencies 
lltL salary is at the rate ol £400 per nnmint 
together with the usual residential cmohintcnh 
I he appointment is for a pcnoci of one yetr m 
the first instance but may be Ttnewed lor a further 
year only 

Forms of appllcaiion may be obtained from the 
Counly Medical Olficcr of Health Hospital and 
Medic il Department Counly Oflices Preston tn 
whom apphcaiions must he returned nut later than 
August 31sl 1938 

County Ofiiccs GEORGE ETHERTON 
Pfcsfott Clerk of the County Coimdl 

July 2kih 1938 


A N C A S H I a E COUNTY COUSCIL 

WHlSrON COUNTY HOSPITAL 
Near Prcscot 


APPOINTMENT OF RESIDENT MEDICAL 

orricLR 


Applications arc invited for the appointnicni iCl 
Resident Medic il Olbctr (unmjrriLd) at the Whwton 
County Hospital near Prcscot (500 beds) 
Applicants must hate Jicld previous hiwpinl 
nppcunimcn 5 in which they have gained cxrcnefisc 
tn clinical medicine and pathology and they shcaW 
hold t>ne of the liighcr medical qualifications 
ihc salary is ul the rate of £400 per nnnuni 
tocciher will! the usutl residential cmoUimcnts 
The appomiment is for a period of one ytar in the 
first insuncc but nn\ be renewed for a lutihcr 
year only 

[ orms of application may be obtained fro^ me 
County Medic \1 Ofliccr of Health Hospital anJ 
Medic d Department Counly OITiccs I’rc^iort m 
whom all ipphcifions must be rcftfrncd nw 
than August 31^1 )9t8 , 

Coimu omci!. GLOROE rTHLRTON 
Preston Clerk o( the Ccunij Coiincn 

July 28il) 1938 

J^ANCASrdRC COUNTY COUNCIL- 

WIUSTON COUNTY HOSPITAL 
Hear Prcscot 


VISITING RADIOLOGIST 

Applications arc invited for the 
R Vismng Uvdiologlsi (Part time) nl 
(iouwy Hospital next Prcscot ftcmuncraiun 
the rate of 1 guineas per session 
AppHcalion forms and terms of appomi^cj* ^ . 
be obtained from the County hfcdk-xl 
HospUvl and Medical Department for 

Preston to whom all appficiilons mvwl bc 
warded not later than August 31st 
(bounty Offices M2 Council 


Preston 
July 2C>th 1038 


Clerk of the County C 


C OUNTY COUNCIL OP TUT WTSl RlOINO 

or YORLsuiitr 

SCALCBOR PARK MENTAl HOSPITAL 

The ViMiinR Conimiltcc of (he 
Mcnnl Mostiilil invite wJ-mCAl 

ipno'ntmcnt ol JUNIOR licneiiA 

01 nCFR lit the Sc-ilchor I iH. Mcniil Hh'PJIJ 
for private miicnis nt a wlary pel 

rising by annual Incrcmcms of £-5 A,. jirKniial 
annum with board and rcMdctwc « me i „ 
with in additional £^0 for tlu. ex 

in Psvchological McdKinc General hosp 
pcncncc will be an addition d may 

Further particulars nnd form of !1), 

be had from the undersigned by an 

cations together with copies ^f not mj’ . 
three ftccni testimonials must be rcce 
later than August 29th 1918 
1 ClIARLCi 

CIctL to the V I'ltlHR Cnmmitic 
County Ilnll V\ nkcficld 

August injR — 

JyJCrROIOIlTAN ROUOUGII Of tjriTroHB 

Apnlications are invitcJ tor " nn 
■V nL^TAL <rURGION 

•i sessional hisis nt the Ctntnl ChiW " ' ,,,t 

mtl luhcrciilosrs Dlspcnsirv Art 

ntc o( £00 per mnum in respect o' 
vveet-ty session held (it r wnt Ihf" ” ''"f,',, if 
Application forms m'lng J 

nppoinimcni oWain htc from the ' , p., 

must he teturneef not fatcr Ihm fift' ^ 
•niiirsoiy September ^ G ftETO 

Deptford Town Haff Town 

New Cross i> E 14 
July 2Stt\ 1918 








\i t. VI 1 > 19 'S 


THL BRITISH MEDIC \L JOURN \L 


go KOI H 0| lOVIONlOS 

\rrOIN7Xf!NI OJ \SNJS| \NJ M 

OlIKlkOl HI MTll VM) WSJSl VM 
V H('OL MI Die. \l O! I K. I K 

-M ate ' TiJ It cJ 

M'V 4 I'^J t '-“T' h J " t l> '^3 in I 
Hc4 *- Sa s - c r S He Mo- r f r 

t'*'* fs 5 n t J \ Mcv. "I O'* er I H *1 

a^J \ -N A- V** V Mcx. 3l (>*' or 

Car»- wtc' r- -‘i he tr T t» o 

rcr' n nrrx - £n 1 « N: rev, 1 frj t % c rf> ot 
\ fv -al Ir -w- n I S*.^ x 1 C'^'J cn Hj »« 

1 “sl W i a^J o—tr tcT l> PtJl Nnar r^ris. 
4ft»- '-.hc*“fc -»« ru^ Ix" a’ x- 

a \ -• a" r O 'fei iJ O'* cr r Hci! h anJ 

\ O'* “cr 

7>c per n --*x - ex. •‘i be rr., rex. t i.c\ c 
i^c (i t*' J lex -rx. I r* t hv 

a } n»xxl to c“ Ce *1 peltate p'a'ikc arJ • 1 b 
ICV.U foJ t ro -c w th n t 0 n^*uih r v.;tJ n 
i~ori *■! Knxf-x 

T>c va^Tv x» I be -t t^ie ra c cl 0 r<r am r'l 
rr»t“2 t t iM per «"n-'n b> ~'>ual nTc—ifpi 1 

It I p "x -xl t*ut t** p>.*'i Oij J be a d“\ njtcd 

-e c‘'-0' i**** L xal C verr— r a-j O 

O 'rn n A t I'J-. and the pet n 

a-tx " -d » 1 fc- rccc Tcii t ex n I ‘“tr'c ti t*'c 

bu-XTa- I c-xl a'rJ tvj pax l>’c Ccu- t % 

r’xrxJ vjl e*ca~i oit n 

C -'Ks c* ap- -at n f m atxl icrr'i x 
'♦'V 1 "• -t max be c** a •'cu n jtKT to 

r'c tXe cn_ -x 0 

V’''' x t •- a "T-ar “Jbyc*'c\ofn!nr 

than ih ce fx i— 1 t, re ent <ljtc r-i> x be 
eel cted o i^e r,_t .atcT tVan I o ! ncK 
xn Saicruay \ueii i -7th irjjx 

Ca^xa nc either t tec t> tnJ rcvtljr »lI be 
a drso ' "at* X 

B OrJer 

rRFOK \\ CLAXTOS 

T ixn Hal tc-' rt n To».n OetL. 

Au^jar Lh I9ra 


QOLVn ROROLGH OF DtUSIlLRl 
assistant mcdicvl omccR or hf-alth 

AND 

> ASSISTANT SCHOOL MEDICAL OrnCCR 

Ar^I cat’ are tiMicd Irtn q ahreeJ -rJ 
retx ered n-e xal rra'^sLO''ers (ren cr i * — nl 
for the ix^t cf A v!»tapi Arccp'al O'*" c x f Health 
and Aexi uri ScJjcxI Mediaal O'^ cr 

Apr cans hcxi d haic bad at lea t three tears 
eipenexee si’*‘‘e qual cati i aod pHscx' ibc 
DPH E.tpcnen'e tn r»c rL and refr tuns tx 
d-xjrab e. The cut «x are in csmcM n rviih S hcvl 
Medical work Chifu \AetLtfe and TcberculMi 
and there ajc a so cp'xnu't jpx fer err^nerKe tn 
fcreral PcMj Health »cfL 
The *01317 »< £-<W per annj'h n in b) anneal 
tnere’-ienii cf C2< to fOil per arnim The 
appo n mcnl •ill be subject to ih“ proii ion< f 
the Lccal GoseTn*xcnt aed O her Oncers Sur'er 
annuarien Act 19 and the t -cxxfcl c^ndtditc 
•ill be required to pa s a medival CT3n*in3tion 
Panicclars cf the duties and tern's and ccrsji 
iiom cf the ap^intro-nt lot-ther with appU'aiiio 
fxrm ruv be obu red from Dr J F Gxtto'SAt 
Medical on er of Healib Munxipal Buiwinsrs. 
Halifax Road I>e»sbuD to •hrm appi caitcm 
accenpan ed b> cop’cs of rot rrorc than three 
recent tc'iimoniali should be dcloercd not later 
than Monda> Au'xixt 2-iid 

CansassiQC in anj form »ill be a d&qualihcaiion 
To»tt Hall HOLLAND BOOTH 

Dossbery Tossn ClerV 

July -6th J9tS 


QOUVTT BOROUGH OF BARNSLEA 

ASSISTANT MEDICAL OFFICER OF HEALTH 
(Clmtcal Duties) 


Applications arc insiled from fuM> qual fed 
rcemcred medical practitioners for the aKsc post 
s*hKh skiU be aeant from Oaober I r I9ts at a 
salary of £ 00 per annum. risiOA b> annual 
increments of £25 ro £“00 per smum 
The duties of the post will con isi ma nl) of 
rho^ as Redden: Mediml OTicer for the fso^non 
Hcnpital of 110 beds and as Assi tant m the 
AencTcal Diseases Clin.'' Additional!) the uc 
cessfu! canddate rra> be called upon to perform 
other duties in the Pu^li- Health and Svhool 
Atedical ScrxTCes as ria> be determined b the 
Alcdical OA^cer of Health The officer appo nied 
witr desotc whcle-tirac duties to the pest and will 
not be allowed to undertake any pnsatc practice 
The pcsxes on o! a Desrec or D ploma n robliu 
Health will be an esseniia! qualification 
The appointmctl will be to a ucsignated post 
under the Local Gosenment and Other OfTcers 
Superannuation Act 19 - and the successful 

candidate wall bv required to pass a r"*dical 
•exaninali n The appointment will be detcmuoablc 
bj fhfee rr^ffts non e on cither side. 

Application forms can be obtained from the 
undcrstxned and should be return'd acxortpanied 
b) copies of not r"orc than two recent tcsturon-al 
endorsed Assistant Alcdi aJ OAj cr of Health 
not later than Aupust Z*** 193S 
Town Hall A ERIC GILFILLAN 

Barnsley Town Clerk 

Aurust trd 19 ^ 


C > ri 


or riAFRPOOL 


MMDIM AANfSf ANT MfDfCAL OJIJCIR 
lA/AKlKlIA SANAIORILM ttooBus) 
Mac ard I ~te I u "" " r> and burci al 
1 u*xr xil IS 


Ar^ ii o are irx t-xl f r ih Kuc apP nt 
r>f II f r a per xJ f o-- >cir at a j’ir> of £ f* 
p^r an m k cibcr % ih u t al rcv.d-riijl 
al r c 

t *• 1 trx r** t p m a rc— tcfxl r* u al ai*J 

t rs al «, «al at n and pr etc" t will be xxen 
I an V. tes wi h p c I i h wp I c rxr CP e 
Th rx^t I I ab e f '*■ a cao-i-tTc wucKn for 
iXf M r> 

Th Ajrit I m IS w tx n es rci h f centf 
f Ct L n ri rs srJ Ire Gen ai H "p tal 
Canva le ui | be uctm-cd a c at-»l f -at n 
Ap" 111 n t be rrauc n f rm oMainab c 

fnxn t** Atfj ii <> er f If alth H jU 
D n Afur "a! Ar-'csc Dal btfcet Listryxil 

t be c*x. ed I rs _ "t A i a"t Med *a! 
OT er »nj feti tred to tbc i rdcf coed so as 
t be rece cJ r t later than \A cd -sJas 
Aurnt -Ith 

Mu T'al Bj —s A\ H BAINES 

Da e Street Llscrrxx J Ttwn Cl“Tk 

Auf St 10 js 


^OLNTA BOROLCH Of If A L J T A A 

THL HAtfl V\ GENERAL HOSPITAL 
(..0< Beds ) 

jt'NioR RLsioi-NT medical OIUCER 
fMa c> 

Ap" atixn arc ms ted from dul) qualilicd 
rce terex. A!cd al Pra titjorers Kr the abuse 
appi "trnent ^ 

Salary £—0 rxT annum i see her with beard 
ro V.CP 0 rd laundry l>c appo nljncnt »$ f r a 
tern n t crcceu n -< year ard is pci ren w M 
1 1 rms tf apr -ation and c n-itiufis tl appsini 
rnert -an be ebtan-d Item ih- Medical OT cr 
cf Health Ps cl Street Ila ifax 
O.'-p'cied apnl "a uts to ether with c n ■x cf 
n't f"o e tban three fx-%nt test ntonia s erdtrsed 
Juinr Pexid nt Meoicsl OTicer tau t lx I r 
warUxl o as to be rcvCi cd by the un-er i n-d pot 
btCT than Ato--a> Ajcum “9ih 19 A 
Cansass"" other d rcctly sf Indi ectly will be 
j ursqaalihx'JEon 

The Coun ii hay oct wcop ed a su'setanojaiioft 
vheroe 

Ibe To-n Hall PERCA SAUNDERS 
Halifax Town Clerk 

\u ust 6th i9jA 


^dUNTT BOKOtCH or U EST H ARTLEPOOL 

PUBLIC ASSISTANCE. COMMITTEE 

assistant (RESIDENT) MEDICAL OFFICER 

Apchcatixr> x.e wsitcU from fully qualified 
ladies u'*der 4A years of ate for ibe appomincnt 
cf Asst urn Med cal OTj cr at HOW BECK 
INFIRAtARA West Hartlepool contamin; abG 
beds Salary fj<o per annum nsinc by annual 
increments of t, to ^4*0 pvf annum to-'cihcr with 
(urni hed rooms wasbuu and rauoos \alucd at 
£100 per artsum for superannuation purpo-cs 
The lady ap-Niioicd will be required to desotc 
her whoc time to the xcnioe of the Corporatiun 
urdertakc to gne lectures m Surgical and Afcdical 
Nurxns to Probationer Norso and am out the 
insfrumioos of the Supcnotertdcnt Afedicaf OCR er 
Applications st-unp quaJifiaiioRs ace and pre^ 
sKu expc'ien'c should be accompanied by copies 
of three recent toiunonia! and ddisered to tbc 
imJ r imcd on or before Sarurday Aurust _ th 
jury 

AA E. TUN’N'ELL 
Publi Asyisiarce (jfFcer 
lit* As istan c Offices 
Han Road W cst Hartlepool 


^OLNTT BOROLGH OF DERB) 
DERBA cm HOSPITAL 
assistant resident MEDICAL OFFICERS 

Appli-ations arc mstied for the posts of Assi tan 
Resident Med.'s! OTi'ers (male) at the abose 
Htwmtal of CO bed Tb Hospital proiides 
treatment lor acute medial and sur-ncal cases 
ob'tctn's and chtdrens dtseaxes etc 

Candidates must be reaistered itr med xn and 
surgery Tbc ar'-ottimuotis arc for period of six 
month two months nou c of icrminauon of 
duucs may be e* eti on etthcr s*d On- su-ccssful 
applicant wi.i be required to cemmenT duties cn 
or about Svptcmbcr Sth and rbe other to commcp c 
dcf'Tfie tXrrobc 

Salary at the rate of £2(10 per armum with board 
and rc'idcn-e 

Arnlicaiiops. stating a*je expcnen e and 
accompanied by three recent lestmotuals bouJd be 
sent to the u"d-* r s tg "ed as soon as ross’'fc!c 

Public Health Depannsent GORDON LILICO 
1 Derwent Street Med al Officer of Hca th 
Derby 


JJNION or SOUTH AFRICA 
\ \C \Nr> FOR 

( \) SLMOK IROIESS10N\l OFFICER 
<PMA blOLOC A i— ONE POST ‘Salary 
Svale '*v . < ) ) 

(B) SENIOR PMJl LSslON \L OFFICER 
iBUKHtMlSlPA)— ONE POST (S-Lry 
S-ilc fiiv I ) ) 

Ar“ a„ n X n ted fr n s-ta^-e c-ndida cs 
1 ar- 1 I lo lb to%c m nticncd pc«ia m 

Ih Dr rir'c-i of Atr u tut and F restry m the 
L r " ‘ Souih Afn - 

The r v-i r cs 1 1 be uct imm d 

- r- ne t qtn / wjii ry ant- tpen r 

SF£C/-iL fiL Al IFIC ATfO 5 

If th P t t \ n P otes^ HJ Ot'' er 

tr»i)x ory) 

Ap ant nth n rx" " i>-n f a d xncr 
de rcc wi h Ih x- h i ai nr n r" 1 > and 

r*u t ha c E n jv-r. j iic" i-'n fi ih b r h 

n ihcif ad anced uu -s C r d ai n mil tx 
ett piled ts ctrxncr m rhy al ic^carvh 

esr*cci-l n t** dir-ct n fru fci-ur h all ou h 

ih latter Q al 'ati •) wit pit reu-'v-ril) be rt 

carded -s cs rt— I 

- Fcr P u of y n Pr 1e nal OS^-ctr 

iB c^I er’ / >> 

Arri*3pis mu t be n po es n of a dcctcr 
oe-rce with t^'orou h iran m t cchen.- ry and 
fp t have fncn 'Nctal ati n i n to thn trap h 
n the r ad ar cd ud cs Ey'-erie- c m b »>■ 
ebem -al rmcaruh w rk cy'^^■'3 l> m ih d rc-t-on 
cf fruit rc<car h will bx a rc cr'-cruatjcn 
alihouch h qual -ati^.n will rot rn-c^cinly be 
retard-d -s cixertui 

Caruiua -s bou d furr h full panicuLrs rc 
cardine qaali eati "s and cTperen e O r /u- 
cerlifcaies and tcjhmoTucfj should not be luh- 
m rreJ nt the /irsf mstcr-ce 

Befc e appo -t—ent ro the fired establfshmeni jn 
a rer-nan*"! apaety the <ccccs« ul ardidaies will 
be rcQuircd to sene oa p obaiicn fo a perixd of 
poi Im than iweRc norah thes m.*st be Bntph 
ubiccts a^d ha\c res ded m the Lnixn of S uiH 
Afna or n Lh- Afapd-ted Temtorv of Sxuth Wmt 
Africa f-r pot fe<s p'ap three yar ard they must 
furr h «ot fano^ certifaics cf birth and heal h 
Succcv ful c3Pd uaics who do rot satr fy the 
nai onal ty and or res dcptisl qual *catiopj will be 
appointed on contra t until if their <n ces are 
xati Taao-y they -cquirc cl bi ty for pem-ncut 
ap'X' ntmcni PrcPci-p-y in ore of the cffiaal 
lan-uates— En ush ard Afnk an for Nedcriards) — 
is -n cx emul Tcquucme*'i 

Cop ex cf pjbl atiops «pd or s-tertifi recons 
of wh h the -prliaant b the author nu t be 
atu hed t all applicati rs where po-ible. 

Ary dc'^'c'S obtaip-d by candid-tcs mi«t fcu 
ihoxv of uniycf es of reeo'm ed t-pdjtg Any 
qualif-arions additional or of a s artlsrd equal ro 
they- wS h are requt cd will a’ o be taken info 
ac“cun 

Appl cauon nu t be m-de on th- prcxcn*'cd furm 
fZ ^ ) whi-fi ts obtainable fro-i the Secretary 
Offi c of the Huh Conmi or— f-*r the Un on 
of Sooth Africa South Afna House Trafalpar 
Square London to whom all eofap’eted forms 
ma i be addressed 

Apphauors must ra h the Huh Commi sioner s 
offi'c rot bter than S-ptember 1-th 193S 


J^IA ERPOOL COUNTi BOROLGH 

LOCAI EDLCATION ALTHORITi 

ASSISTANT SCHOOL MEDICAL OFnCER 
(WOMAN) 

Appl Canon arc invited fcr an Assistant School 
Med af Offi er (woman) in th- D-partment of the 
Medial OTi er to the Leal Edcation Autho^y 
at 3 xalary of £500 per ansara n ing by annual 
ncTCmert of ^_5 to £"00 per annum 

(Where the su-cessful candidate hold a similar 
apr»OJntment under arother Loal Eduation 
Au horry and receives a xalary in txccss of the 
advertised mrimain a cofrmcncine salary of not 
Ims than the salary wh cb the andidate is re- 
ccivmc under her cictinr appoiatmcnt (not 
cx'ccdifiR the ma.xtmum under the Liverpool Scale) 
may be paid ) 

Candidate* must be rcjnstered medical practi- 
fxoners ard /rust ha c bad at least three years 
expcnence 

Tbc Off-ccr appointed wilJ be tcQinrea to reside 
within the City ard devote whe1--tci:e semcc to 
The Loal Eduat on Authomy under the d.rccoon 
of the Med al Officer to the Local Eduauon 
Auih my and wnll not be allowed to imdenakc 
an 0*7*31 pract cc. 

The appx mr'cpi will be subject to the Loal 
Government arol Other Offi-ers SupcrannuatKin 
Acu 19 - ard th Sundung Orders of the City 
Coor*il 

FoTn of apnl a ion whch m_y be obta ned by 
ftrwar'^mg a umped -durcv ed fxiLap ervelope 
roj d ^ return-d to'-etber meb cop es of three 
rcc-nt lestimopjals to tb- urd-rsi-r-d rot later 
than SerTer-Ner d )9 ^ a-d ecdor^ed Assistant 
School Afedical Offi er 

Th- canvass n- of m-irwers of th- Eduation 
Comm nee or tbc City Courcl is strctly prehitued 
ard will be con. id Ted a daqualiSauon 
Muni'''val Bu-IdiagN AA H BAINTS 

LiTtrpcol 2. Town ClTk ard Clerk to 
Ao-uxt I Ih 19 9 the Loal Eduation 

Auihcniy 



36 


THE BRITISH MEDICAL JOURNAL 


August 13 1938' 


<JURUEY COUNTY COUNCIL 
lUBIIC HE^L1H DEIAUTMENT 


El SOM COUNTY HOSPITAL 
(2‘'0 AcuiL Beds 126 Chronic Beds) 


FIRST ASSISTANT MEDICAL OFFICER 
(Actine Deputy Mcc/ictI Superintendent) 


Applications arc invited from rcBistcrcd Medic'll 
Practitioners for the 'ippointmcni of First Assistant 
Medical Officer at the Epsom County Hospit'il 
Dorkint Road Epsom The Hospital with twcll 
Pirk Annexe provides accommodation for 376 
patients at present but a programme of extension 
and improvement is contcmpl itcd which will in 
crease the accommodation to 500 beds 

Tlie Medical Officer appointed must have had 
considenblc previous experience in sursic-il nppoint 
menis and should preferably possess a Higher 
Surgical Oualihcation 

The tenure of the 'ippointmcni is limited to a 
period of five years but the appointment is subicci 
to the provisions of the Local Government and 
Other Ofiiccrs SiiperTnnintion Act 1922 TTic 
cish salary is at the rate of £350 per annum rising 
by annual increments of £25 to a maximum of £4^0 
per annum together with full residential emolu 
ments valued at £I2:> per annum T!ie First Assis 
lani Medical Officer will receive an addition il salary 
a! the rate of £50 per mnum while aeting as 
Deputy Medical Siipcrinicndcni 

Applications stating age qualifications and ex 
pcncncc and enclosing copies of not more than 
tlircc recent icstimomils should be addressed to 
the County Medical Officer County Hall Kingston 
on Thames so as to be received not later than 
August 29th 1938 

DUDLEY AUKLAND 

County Hall Clerk of the Council 

Kingston upon Thames 
August 9ili J938 


SURREY COUNTT COUNCIL 

mental hospitals COMMITTEE 

APPOINTMENT OF JUNIOR ASSIS I ANT 
MEDICAL OFFICERS (Male) 


Applications arc invited for the appointment of 
two male Junior Assist int Medical Officers (un 
married) in the Surrey County Council Mental 
Hospitals service 

Commencing salary which will b"c subject to 
statutory deductions under the provisions of the 
Asylums Officers Super innuation Act 1909 will 
be £350 rising by annuil increments of £25 to a 
maximum of £450 per annum together with apart 
ments board laundry and viicndance valued for 
*>upcrannuaiion purposes it £150 per annum TTic 
Persons appointed will also be paid m addition to 
their s ihfics the sum of £50 per annum if they 
hold the Djplom i in PsjchofogitaJ Medicine 
The ippoiniments are subject to termination by 
one cilcndar months nonce on either side and the 
Persons appointed will be required to undergo 
i medical examination 

Applic Uions St viing age accompanied by copies 
of three recent testimonials and enclosed in an 
envelope endorsed Mental Hospitals Junior 
Medical Officer must reach me not later than 
Wedne day \ugust 24ih I93S 

DUDLLT AUKLAND 

Clerk of the Council 
Mental Hospitals Department 
Count? Hall Kingston upon Thames 
\iigusl 9ih I91S 


pE 


r r R n o R o tj G H and 

MCMORIXL J/OSIJIaL 
(154 Btds) 


DISTRICT 


All OINTMENT OF SENIOR RESIDENT 
HOUSE SURGEON 
(TlKee RCMdsms On Staff) 


Appheatjons are invited from fully qualiticd male 
rraeiitianers for the above post which become^ 
vacant on September hi next 

Xpp’icanis muM hi'c held a Hospital appoint 
mem previously for at le i t six months and have 
lad cxperien e in fraeiurt work 

Saluy at ih- rate of ll"a per annum for the first 
u rr mills and t^OO per annum afterwards 
\ppltcaiion sialtne age qualifications and ex 
penen c vNjih copen. of recent tcsiimonnls to be 
^ent to the unUerxicncd from whom further par 
i uHrs may be obtained 

IRWK \ C T\TLOR 

Si.cretary Superintendent 


r>cysroN c E N E R A L nospir\L 

(“0 Red ) 


Rrsioi 


l^-T 

r 


inn '■ 


Nr MEDIC \L OrriCER required to 
duty as s n as pew ibk Salary £1^0 
vsub ts ard rotJ rs.e and laundrv 
''fna ♦'1 ts f -if rn<,n hs arj i 


nr 


tj 

^■xrc I fVu 

t « j 


lo a...* q al atons nj 

t her V.I h ccpi^ of 
» J bn -j j-, 


r IPDDN r vsio r tary 


R 


HONDDA URBAN DISTRICT COUNCIL 
ASSISI \NT medical OI FICER 


Applications arc invited from rmlc registered 
medical priciinoners not exceeding 45 years of 
age for appointment as A$stsianl Medical Officer 
under the direction and vupcrviston of the 
Council s Medic d Officer of Htaftfi and School 
Medical Officer at a salary of £^00 rising 
by annual increments of £25 to £700 a year the 
first annual increment being payable on y\pril 1st 
following the completion of six calendar months 
service under the Council travelling expenses 
necessarily incurred in the performance of the duties 
will also be allowed Candidates must have had 
not less than three years professional experience 
subsequent to registration and must be experienced 
in the disc sts of children the possession of a 
Diploma m Public Health is ilso considered 
desirable 

The appointment which is designated under the 
Local Government and Other Officers Superannua 
tion Act 1922 will be subject to the passing of a 
medical examination and will be terminable by two 
calendar rnonths notice on either side The Officer 
appointed will be required to reside within the 
Rhondda Urban District and will not be allowed 
to engage m private practice 

Applications arc to be made on forms obtainable 
from the Medical Officer of Health Tydfil House 
Pentre Rhondda by whom they must be received 
endorsed Assistant Medical Officer and accom 
panicd by copies of three recent tCNiimonials not 
later than Monday August 29ih 1938 
The Council Offices D J JONES 

Pentre Rhondda Clerk of the Council 

August 8th 1938 


OKCESTERSHIRE COUNTY COUNCIL 


The Worcestershire County Council \ir Raul Pre, 
cautions Committee invite applications from suitable 
persons over 35 years of age for the posts of 
ASSISTANT AIR RAID PREC\UT10NS 
OFFICERS 

The candidates appointed will be required to 
devote their whole time to the duties of the office 
and to work under the direction of the County 
Air Raid Precaimons Officer 

Medical Building or other technical qualifications 
and Knowledge of Local Government will be an 
advantage and only those who have a ihotoug i 
knowledge of the Air Raid Precautions Handbooks 
and Memorandum and of Air Raid Precautions 
work in general will be considered 
The posts arc temporary and the salary will be 
at the rate of £300 per annum Staff ind offices 
arc provided and travelling expenses in accordance 
with the County Seale will be allowed 
Applications In candidates own handwriting on 
the prescribed form which will be forw vrded upon 
request to the County Air Raid Precautions Officer 
Shirehall Worcester and supported by three recent 
tcsiimonnls and endorsed Assistant Air Raid Pre 
cautions Olficcr must be received by me not later 
than first post on Monday August 29th 1938 
Canvassing either direct or indirect will be a 
disqualification 

Selected ctndidaics will be interviewed about 
September 2lvi 

Shirehall C H BIRD 

W oreestcr Clerk of the County Council 

IL 211) 


IRISTOL r\E HOSPITAL 
» (^2 Bedv ) (12 Private Patients) 

19^7 1017 Inpilicnlv 17794 Out patients 


Apnhcations arc invited for the post of JUNIOR 
HOUSL SURGEON Silary £100 per annum 
Senior post atai/abfc after six months \acant 
October Isi I9t8 
Suitable experience for D O M S 
Appfications stating age and qualificalions etc 
with three recent tcsiimonnls lo reach the under 
signed by August 27lh next 

D M BABER 

Scc»’ci iry and House Governor 


gOUTHCND ON SEA GENfUAL HOSPITAL 

(235 Beds ) EiLlit Residents 
Hon^ Specialist Staff of Twenty Members 


Applications arc invited for the posts of 

(1) RESIDENT ANAESTHETIST (male) salary 
£125 pa with hoard residence and laundry 

(2) HOUSE SURGEON (male) incIudinR work 
in the Ear Nose and Throat Department 
salary £100 pa with boird etc 

The Hospital Is rccogm/cd by the Royal College 
of Surgeons in respect of this post 

The appointments arc for six months 

Applications with copies of two recent tesli 
monnls sliould be sent to the undersigned 
immcdi ilcly 

P H CONSTABLE Secretary 


I^ANCHESTCR 

Growen 


EAR HOSPITAL 
Growenor Square All Saints 


The Board invite applications for the following 
posts 

RESIDENT HOUSE SURGEON Salary at the 
rale of £J20 per annum 
NON RESIDENT HOUSE SURGEON Salary 
at the rate of £150 per annum with partial board 
Appointments six months 31 beds Candi 
dales must be duly qualified and registered 
Applications with copies of four recent icstl 
moniaN to be forwarded to Mr Rfoinaid S 
Milford (Hon Secretary Manchester Ear 
Hospital) c/o Mr W J Ellam 17 Drazennose 
Street Manchester 2 


R 


OYAL SOUTH HANTS L SOUTHAMPTON 
HOSPITAL (296 Beds) 


Applications arc invited for the apnoinlmcnt of 
SENIOR HOUSE SURGEON for the period com 
mcncing September 17th and ending Sepfember 
30ih 1939 at a salary of £200 per annum wiih 
board residence and laundry Candidates must be 
male and unmarried and preference will be given 
to those holding the FR CS diplorm This iv 
the senior post of seven residents and previous 
experience is a House Surgeon is essential 
Applications accompanied by not more thin 
three icsiimomaK should be sent to the under 
Signed not later than Thursday August IMh 
6 W BARNES 

House Governor nnd SccreMry 


R 


OYAL SOUIH HANTS A. SOUTHAMPTON 
HOSPIIAL (296 Beds) 


Applications arc invucd for the appoinimcnt of 
HOUSE SURGEON who will also have charge 
of the Ear No c and Throat Department for 
SIX months commcn''me October tst 1938 at a 
salary of 1I50 per annum with board residence 
and laundry Candidates must be male and 
unmarried 

Applications accompanied by not more than 
three testimonials should be sent to the under 
signed not latLr than Thursday August Ihtli 
S W BARNES 

House Governor and Secretary 


R ochdale iNFiRMART and dispensart 
( 110 Beds) 


The Board of Management invite applications 
for the apDoimmenl of SENIOR HOUSL 

SURGEON The salary attached to the appoint 
mem IS at the rate of £2S0 per annum including 
board residence and laundry 
Apphcationv staling age nitlomlity 
tORCtht.r with copies of three recent testimonnh 
to be sent to the Secretary endorsed Hou c 
Surgeon Conditions of the appointment may be 
had on application to the Secretary 

Infirmary OfficL \V WTNNE Secretary 

Rochd lie Lancs 


OTAL WEST SUSSEX HOSPIT \L 
Chichester 


The Board of Mtnapcmcnl will shorilv pro 
cecd to the appomtmcni of an HONOR \RY 
\> AESTHETIST Candidates must be duly 
qualified medical practitioners 

Applications together with three copies of 
te iimonnls showing evidence oF special training 
and cfficicncv in the admin stration of anaesthetics 
should be sent on or before S«.ptcmbcr 5ih 193S 
to th'* unJcfMpncd 

J COXON INCE Scerttarv 


'T'HE CHILDRENS HOSPITAL SHCrTIELO 
'*• (157 Beds ) 

Applications arc invited for the post of HOUSE 
PH\ SiCfXN vncint September Ist 1938 
The appoinimeni is for six months Salary UW' 
per annum with boird residence and laundry 
Candidates (male and unmarried) who must 

possess registered quafincationv should forward 
applicatiom staling age nationality etc tocciuer 

with copies of three recent testimonials to fnc 
undersigned 

T H O GARTLAND 

Supcrinicndeni and Secretary 


gRISTOL RO^ \L INFIRMARY 

ArplKation arc invited for iht pONt of HOUSE 
PHTSICISN for the six months corrmcn ing Sep 
ic'’ L-r K 1*1 s Salary at the rate of f^'i) per 
annum CanJ dates who muii be duly quaTiTcd 
tu send in tbcir a''nh alion. on forms to be obtiincJ 
fr ’vt tht unJers /.red togtth-r with copies of not 
rpi e ih„n three toti-^'ornals 

ELLIS C SMITH TCI^ 

Secretary and House Governor 


T aunton vnd soMrrisrT iiospitai 
T aunton 

Two HOUSE SURCroNS required S^plcmhcf 
2Ud anJ 30ih Six months appointments A ihu ^ 
Ihvsician also in residen c Salaries at the rate <' 
£12^ pa with board residence >nd Imndry ana 
the rt.icniion of ccrtiin fees . 

Xpniicaiionx with copies of not more than in cc 
recen testimonial to I J J Staciv Secretary 









\t.risr * 


THE DRITISH MI DICAL JOURNAL 


R 


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VI IHMVIMI ST 01 R! MOIST MIUICVI 
OI IK I R 


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ScTT a’> a*vJ II •'c C''icfr f 


H IRTIORD col S T T HO’^rilAl 
(jrO Btv ) Thee Re^-x-* 

Vprf^'aii **< -fc 1*1' cj I r i**c tNMt of IfOLiT 
rMVMCIVS Jr-Jtc) 

Sa-n d p^r " •“! u th Nxartl re^ cr c 

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IP"*i Tb r- *i**~ rt I 
( t T n: - n !*■ fn. ir a^ e 

Ap" ua I tP - h r » th p c% cf ih cc rcvc"T 

ic% — “>3 N j b- f >saTucd n the c'is.er 
“'xl r t L.tcT than \l*u t ^ h 1 < ^ 

PCRCT C RROOKS S -Tciafi 


"pJII RVDCLIIII ISIIRVIVR^ 0\r0RI> 

Vpp IP re in cd f f the f ” ire p t 

h xj I b "“c » art n O t ^'cf 1 I U*' 

I IS! KtMUlSI SLKClCAL OIJICIK '‘h 
t*'l I \U cVr ntatic See Si rrci n 

V r\ il 0 r^f ap" "i e-\tr% cif 10 jp~f \i 
PI iclv f ircjtn r tf ro-c t till tSji mi 
He ih C “• »*' 1 r^ 

T nKi I HOI M r nsici vss 

<»M ORMI IRIC iiol SI rinMOvS 
OSl HOLM MRCIttS to I f S jr^ 
T'* i l> -irt^ "i iprc 1 "xc t x r J 

T olI'^tTc r>L<M 

1M»! Hol SI SI I CIOSS 
V I Kr*K. ''t M - a! ti" T yti ha e ert n 
ax N t t t c t r m 

T'-cfx HjcS -s«1 Pc fr‘'v " b 

f C ^ tv 

^ ^ ^ fx* f p, (K » s jr *N at 
ih r il > pet ar'nn**Pid<t 

C '■uutt'x r* b nt a^J a c\i 
Spr ar xhfre-' ft*'fc tr»ti 
f" r it t S rt n the t - r red n f bef 
\! ir l '‘h 

\ r C SVSCTl VF V 

Vt*" r rater 


'J'HI RADClinT ISlIRVfVPV O\ir)R0 

A'— ^tr arc !• it-d f r tb f pxi 

on t*'c H * ms Vied a 1 s tt 

HOSOFVRY niYsIClVS t tbc O'pm'^c- 
« f^i -at M-t 1 

Tbc tC'T' ul cap- date U have the ri bt t 
earn 'n p 1 a c pra txc n hx tc~ rt—rr iJ"t r 
c -M t •''* t be acfccd » p •* between b n elf ard 
lb C IT*'"! tee of V! nafcr-c^i of ih- Irf rr*arv 
1 be V "ccx f il "an- ^-at «i ‘ be rcu red to rev tc 
n Otf fd 

Tb ft> cep rv of apn alt'll mth lcMfp'r*'*jt 
V* ih the rj~r» of ihtcr referetn inir«t be f marded 
tn the t ndcrMcn d frm »h->fn fortber part utarx 
can b- o^ta a*d ret Later than Ttidav 
Vr c^Srr ihh I*** 

AGE. SASCTL \R\ Vtf- n trat r 


T flC CHRISTIE HOSriTVL ASD HOLT 
RVDH M ISSTITLTE 
\V it*'ntton Map bn cr 


TLSSY LISD HOSPITVL FOP CIHLDRES 
J Scr*i h 


\p" "at n •* ip% cJ f P'^t of RCil 

nCST MPDICVL ornCER S r> tl O m th 
b>t.rJ rc'— e** e pJ bt-i.r C' tates fm Ic 
cr female) isho nu sn rr -fed qua f *a 
t r\ *' r i f r«ard arp'cau- tat* c o 
r^nen e ct- t '*■ her •aihc-n fto — 't 
to t*'C u--*! u- J p t L c' t*‘3n the f t pixt on 
Wednev. y Vu- h 1«’« 

TR \ F ISCH 

Aj-~*sx I cb 19 Stf-Tcury 


M VSCHESTER SORTHERS HOSPITAL 
rrcn'fal H^p tal HV Bed > 

Cb-nru*n H I Read MarubcMcr 

\~r •cattc** arc nu ed K the pot of 
RESIDFST SLPGICAL OmCER co— cncin 
tala y £l 0 per ar"u'n m h btafd a"d rtxjderv.'c 
Tbc -rptimr- nt » f r t c!tc month fr “m m d- 
AUTU t 19^N 

Apr idt om tajin~ a *■ quat fi ntjtnv and 
roiuna! r> with to- n cf not In thtn three recent 
tmi'no'*jjJi to be j-nj to the SecTe*ar> Mr 
JiMrs C DtMCLS IS Bai n Vrade 
Manchnter M>on Itot i*- c 


Y^ARSE^FORD GESEI VL HOSPITAt 


■-ten Sn (IM Bedj ) 


HOLSC PHYSICIAN reqv- red bv Sep ember 
’Oih Srr r-'-'r b a-n. j r-c-l S-t P) 10 per 
anram wiJi beard and I j" r> 

Ap*' icaiio~< from qj Jj cd reentered i^cd *31 
rratitJO-en shot d be sent t ecther with thee 
recent teMi'-'onu.h to the ur^'ers zr-d by Au^as 
-9ih T9'S 

EDWARD L WIPCV AS 
Heir>e Goserrer -nu Se*mar> 

Au ust 6th 19 '• 


gRVDFORD ROYAL INFIRMARY 
POST OF HOSORAPV SERGEOS 

Tbc B’^rd of Management at the men hl> 
rrectun- on Friday September nd will proceed 
to he electi n cl an Honorary Surzeon m p ace 
of Vfr r W Goycer 

The Sen*c H n rary As start Sarzevn is a 
anu date for the post 

HY TRLSSOS 

Aimtfth 19 ^ House Gosernor and SecTct-rv 


gOY \L 


\ ICrORI \ HOSPITAL 
(66 Beds Two Res denis) 


DON ER 


Wanted for Vu ust 2 th R M O duly QuaV 
fied and fczjstcrcd SaLry 0 per annem with 
board rcsiden-'c -od laundry 

Ap''Lc3Uon st-Un'* ..pc with particulars cf ex 
per *nce accemnar cd bv copies of three reccm 
tcstimcr*at hould be sent to the Secretary a 
seen as PCX ib c 


\p"J at are /nued f r the isxt of RESI 
DFST MEDIC Al OI IICFR to th ab \c 

H n- tat and Ir ifute f r c t\ with th Rtu iw 
th mpy D p rtn'-'i f> c m-xen u <K.t her IV 
Vp-x rtfpcrt 1 f f iz r~ pth in the hr t ir tiivt 
b-t I rer- a** c 

Salary at the rate f tI*Y p^.r ..nm m pu Tc\ 
c "“c tpnn c su et Nmtu < 

Tbc ax-xi tr’e*“r oT r an z cJ nt p'xriun v 
i*-ui« r enpen nc tn Pauian jrd \ ray 
Tb rapy 

Can'* -a m mu t hi c h d presi VI d ! ■xJ 
h ir< af ezrer t*' e 

A— dtj fx all** aee qaalifcat ons and 
pfc r jy czpcr Pvc t be received b the L ucr 
s r<v. n -ifcT than Sep cm^'cr 9th 

PFRCY S GLASS 

Sjpcnntcpdcn 


T he prince of \ vlcss hospital 

Grec-^'ark Read ri>’n,^jth 
(Fc'T-erly South D vo- and E- t CcrnaalJ 
Hosp al ) (64 B-d ) 

Vppi ainnv are invjteu f r i** pot cf RESI 
DENT ASAESTHEllSr ard HOLSE 5LRGEOS 
to the Special D n_rtmcm 

S-Iary £l 0 per r-um ith bx^ard res -.cn e 
ard laurdT 

Vppoin r~cri c* tcaab'c for z r*cnths and j 
ab cct to renewal Duucy to comn n c September 
10 h 

Tb Hospi— I tv c" t-lly re zntred f the 
-r i-al pmetxc rcuaired before admx nn to the 
Final FclJowxi’n Eiamixat on of ihu Royal Co’Iez- 
cf Surceop of En land 

Vpp anil r*u t be re- tered under the Vied al 
Vets Apx “attc'»i tain* a e ard qualifcatcrs 
with conccs o three retent test nronel to reach 
the umJcr -n-d mi 1 ter than \uzu 6ih 19 
APTHLR R CASH 

Auzu t 6Jj 19 s S'crctary 


T 


HE PRINCE OF W VLESTS HOSPITAL 
Grccpi'anl. Road Pljtr u h 
(Fermer > Sou h Devon and Eavt Ccrnwall 
Hovptal) LG4 Beds) 


There are s C3i»-ic> fo two HOLSC SLRGEONS 
St ih- aVi e Hovp I Ap'^nariins are mnted for 
the SwTie S-lar> £1-9 per 3rr.m w ih board 
rxiw n c ard t-urdry 

ArpOxnir-epii -re t-r-bc for sjl r-onihs ard are 
ub nTt to PTcy al D t ei to cerr—ery c Sepier" 
N. 6th -Pd I6ih 

The Hcxpial is o'*! ally reccznized fT th 
jru •al P” ^ x-dm-^'cn t th 

Final Fellow hiD Ez rjt n of th Roy-1 C c c 
cf Sur-ec’x of En zrd 

Apr yanty r*n i be re— tered erd-r th- Med cal 
Vet Arpli-aiiom st-«pz aze -nd qu-l Feat ons 
wrh cepe- of tbr-e rc-cni tcMmcnal it rca h 
the L— dcr i-red by Vu-u<x 6th 19 9 

ARTHUR CASH 

Aurast Wh 19 9 Secretary 


^vsruE^rrp royal isnPMvRY 

MEDICVL CHIEF VSSISFVST 
fS n rc>t en ) 

TWO % VCaNCIES 

Tbc n rd cf M na n -i nv tc app - ns f 
th ab - J-- r*~c-i Ap— --is r-u> bt 

re creJ m - -al pra i rers Hi •'cr q _! 
t - tev 

n c a J -y a-r t d w be at j b d t 

r- d aJ u~ t ard wi 1 be reqj ed to attc- tn 
c en half t-x -s per wet f wb t I 
f r wilt bcmrrn ev rx Dteswli” <-c 
w k n the l“■-^aI t a-J o p- -n. tr--rtr” ~ 

and pint xii on - t*a b Ir a 1 b f_ 

t -y f r rxcaf h w 

S lary £ >1 p a-r m Th ~ m w 
be f t r- year n t c f t i- a «.c b-t ma be 
r r cd f I o fin*’ r p r >- r c- 1 

-xt to t*' r \ s c e By L 
r ti c ct 

Ca d \ n *’ L d f -ward t ftetn - x t r r 

a uat ^ t n par ulax 1 evrer 

c t ecthcr « h f re e-t lev — n 

r LicTIhnVari n Fhuxuav Aum t 1 h t 
the u-ucryjaned fr m »h —i f m r i rr* i - 
r* bt *' a -tfu 

By Orucr 

F J C VBLE 

Ge— al S - ar— St etary 


P RESTOS AND COLSTY OF LVSCVSTER 
ROY AL ISFIRVl\RY 

RESIDENT SLPGICVL OFFICER 

The Board of Vfarjc-r’-pt i-% a-*' - - 

from urmamed c-c em-n for i‘*c pc^t of Res d - 
S r fcal er ih- du les c »h h a o i'^ 1 ~e 
care of lb- Seri Surz on s beds 

Cassuu. tes should poss-xs a Fe twsh p ct cr 
of t**- Royal Co ezm of Sur— oss cr a po 
rradu. le de rec m Su-?mT 
T^c IrfrmaT "d la two Hc^es of Re every 
eonta n 4 rt be*- Total Rev ucrt St P 9 
Sabry a th rate of t,i>) per a-n — wi h bear- 
res n-e ard w* bin O * sears ar'Kim ——t 
Ap- ►C3iit“ st-ii - 7 qua iFaj m -nd 

p i Vi pcvT be d to th r w th c pv tmt 
n r al to bsr forvar-nl on cr befc c ih f h 
in t-ht to th under i red ■who w II st —ly a* 
dented nf m - 1 n reatjve to t**- pozt 
R yat Ir^rrar lOHN GIBSON 

Prevtpn Saper n -dmi artt, 

Vu irt 1st 19 V 


N obles isle of vtvs hospital and 

DISPENSARY 

D- J I cf Ma- fM- B d ) 

Th C —n It* cl Ma ^ -rent in i -rr 
ti p for t - px ct mal RESIDENT HOLSF 
SLRCtON CanJ da « r- *<t b-* - »e b.a c 

d u*' qua!*' ate- a-- be re efhl upv. r t 
VI n. * 0 ! A t Th dut *< - du ti *• t W ard 
-"d D -CP -fy W ptV com- b - ) y i 

per nnu*n to Ou -alerts in their zn b '-m 
S-l-D twith b'’3 d ard I u- m n au-iti -) tl 
per -rn -nsh-httA-t u — nnJt *'ui 

£ V pc* arnj*n threu h j whxh e 

for peci-l very ev 

Ap- cat o- Slain act -mJ czp-n nx.e r nh 
co-i- o re-er tes i— o-t-l rruv reach the 
und-rv ned before Auetr-t -th Tbe appo n ment 
m V be held fur i else months a-v. wTl be from 
Otober Isi 

W cvtmi reland Read E K K.ELLY 

Douzb IstofVfan Hopital S TCt rv 

Aumnt 6th 19 3 


N orth Staffordshire roy al 
infirmary STOKE-ON TRENT 
\ Gercral Hop lal of 90 Bx Reevomr d 
fo th D L O ard F R C S Ez-m -it r 

HOLSE SLRGEON FOP VLTLAL AND 
OPHTHALMIC DEPT 


Ehe Cc— miit*c in iic apr tcatiors fo ibe ben 
^t 

Salary at the rate o' £1 0 per ar m with 
ird res derwe and Z-uadry 

The ap>. nonert will be made for m r-mi h< 
i-w_b c 

Apnl at r taxmz -zc _nd ezpener c with 
' es of two re-eni tcsumoniat to be x.c to 
: urdcrsi-ijed r=r— d ately 
By Ord r 

W STEVTNSON 

Secrct_ry arsi Hcu.e Go ere r 
Vuzust 9ih 19 i> 


N^" 


SLSSEX HOSPITAL FOR 
AND CHILDREN 
Bn htv,n (Ir orpumted) 


App cations are inM cd from n,ijab qaal d 
Med ml W ■'men for the pcs of HONORARY 
OPHTHALMIC SLRGEON D-t m to cemr- r e 
in Sep emSn’ nezt 

Ap- lations with cepes of tcstimo-— H o b 
en to tbe unde'' '’-d on or before Aum. -Vh. 
Bo- d Roc-P PERCY F SPOONER 
Wirdlcsham Read Secrctirv 

Bnghton Augu x *ib 19 S 



I 


lUL URinsil MLDIC M JCURNAI 


Aiu,i/sr n 19 8 


ricrsiLu 


« o ^ A I 
(500 ncd< > 


INI lUMAia 


nrSlDLNT UNDlOLOGlSr 

AppOt'iuon'i arc invited for (lie alcove position 
wcani c vrlv in Scpii.mbcr 

The «;ucccs\fu) tindidaic wiU Ic expected to ^ct 
'j'v Hou'sC Ph> renn to live Undioloetsts md tv'M t 
m the clncnoMic ind thcnpcuut side', of ihc \ t'i> 
DcfTrimcni 

1 he ippoinimcnt is lor sis months in tltc OrM 
instmvt ind the vThr> is ti the nic of i 00 per 
annum lORcihcr wuh hoard Tcsidcncc and hunJf) 
Cindidatc lioldinc ilic Diploma of Uadmlo i pre 
(erred Put not oscntnl 

App’iciiions RivinR full paniciilars as ro ape 
qinhtievuons cap-ricncc and accompanied P> not 
more ih »n three testimonials should Pc sent not 
later than Autrust l^th to the Ho isc Govermr and 
Secretary 

I % Q ?i lOaR 

JJLIL RO^AL 1NIIKM\R^ 

Applu. uions itc invited from UcRiMcred VfeduaJ 
Prvvtuiontrs fv^r the p<ts( of flOl ST IinsiClNN 
(male) 10 the Sutton Uranch Hospital \aeam 
Stpicmbsr 2nd 

Salan at the rite of llfO per annum pfvis res! 
dcncc board and laundry 

Thr appolnimcni will Pc for Mt months lul will 
, It an\ time be determinable ly one montb s noti e 
on either side 

The Bran-U Hospital is not a recovery annese 
but a General Hospital of lOd beds forty five of 
which arc reserved for medical eases 'Hie post 
now advertised is approved bv the LPi'ersity of 
London for ihc MD Branch 1 tsammition 

Applications civ me particulars of ace evpen 
cnee and nationajitv ipceihcr with copes of recent 
testm onials should be addressed to the undcrsiROcd 
K i C\RLl-SS 

Ausiisi 5ih 1919 House Covernor 


J nUSL% GTsCRVL HOSriTAl AND I OOR 
LAW 1^MRM^R^ 

Applications arc invited (or the foUowinc pos s 
(vac^int October Isl 19ts) 

lo) HOLISF SLRGION (male) 

(MC\SUALn OrnCCK md HOLSL 

PHYSICIAN (male) 

Tltc appointments arc for sis months sub cei to 
re ippomtmcnt 
Salaries £17S per annum 
BovrU residence and laundry arc provided 
y\pphcaiions statinc urc natlonahiy md qualifl 
cations with recent icstimoniaN to be addressed 
to the undcrsiRncd on or before Saturday Septem 
ber 9rd 

General Hospital H 1 PLYMtN 

Jervev C I Secretary Accounlint 


K ing georgc s sanatorium tor 

SAILORS 
Liphook Hants 

(Seamens Hospital Society) for the Treatment of 
Pulmonary and Non Pulmonary rubcrculosis 

ASSISTANT MEDICAL OFflCFR (smpk male 
or female) required as from September Isi for sjv: 
months Salirv at the rate of £.00 per annum in 
the first instance Applications wuh copies of not 
less than three icbiimonials to be sent in imme 
diaiclv to the undersigned 

F A LYON Secretary 
Seamen s Hospital Society 
Greenwich S F 10 
Greenwich Aurusi 3rd 193S 


INFIRMARY 


H uddersfield royal 

(321 Beds ) 


Applications arc mvned from gentlemen posscssinc 
Ihc Fellowship of one of the Royal Colleges of 
Surgeons foi 'he post of RESIDENT SURGICAL 
OFFICER to commence duty on September 1st 
19 j 8 The salary vsilf be at the rate of £223 £2^0 
per annum with board residence and laundry and 
the appointment will be for a period of twelve 
months in the first instance 

Applications together with copies of three recent 
testimonials to be addressed to the undersigned 
immediately 

H J JOHNSON 

Gen Supt and Secretary 


D uchess of york hospital for 

BABIES MANCHESTER 19 

Anphcations arc invited for the post of AUR\L 
UEGIST4VAR Details of the appointment can be 
obtained from the Secretary to whom applicvtions 
together with lestimoniaL should be sent bv August 
24ih 19^8 LOUISE BAILEY 

Secretary 


T>iUCHESS OF YORK HOSPITAL FOR 
-L*' BABIES MANCHESTER 19 

Applicaupns arc mvued for the post of CLINI 
Cal \SSISTANT to work in the Out Patient 
iJv.panmeni Details of the appointment can be 
obtained from the Secretary to whom applications 
stioula be i>cm by August 24ih 1938 

LOUISE BAILEY 

Secretary 


R oy M \ 1 f I o n I s im irmauy 

Ntwiastlc »ux n lync BevU ) 

Applu- 'tiunv »ic Invited f the ft I <f SISIOP 
\(CH)IS1 ROOM HOI Sf MRfifOV vOi i 
will at'' iv.t av D pufv Ucvdi.fi Mcitf d OT cr 
YppliLiut' niiivt li t uly fcridifcJ in Vfr I* in'* 
and m Surgery iml hive Ind vn m olbv re ‘ * ni 
lu' plnl crr>"ritn c 

Iht ip^i intment wiM ic f r « c* s-ar (ft m 
Scpitirlir 'th J9ts arl K jcr* wal (if iv. v 
(iitthcr pen dv <t in year Ihe ten urct vtl m Iv 
at the late vf 1!*0 pci mnimt 

UciwUHtj vnv covtrnnc the ippunin'cnt ray be 
ol tamed from the un Irt'ivn d 

\pnh 4tu>n \ atinc ace cxpcfirn c an 1 qi ah 
liwailonv nnd atevtupantj ty n t mvtc than thre 
icMmu nialv vhi utd be vent ml ht'*r tlnn 
Aueu'i :oib I'it'' 

s ni ssfNs 

YijRuvt <ih I'i *' lli'iivc Go'cim f and Scitcta v 

R oy \i \ I c 1 o u I \ isf irm \ry 
S cwv,avtlc upr n lyne H iS > 

MfOICYt UtGISIRYRS (Open \rrmnim n> 

\pp*i*ationv arc Invucd fit ihc pm v of 
MfOK \l RU.IklUMtS (t«i> v'vin lo) one |o 
take up duty on Scptcnl r <ih nJ ihc vc'-i r 1 
to tike up tlitlv i»n Novemb r 1 rh | 0 i'» 
Candulatcv muvt be tcvl'ictcxl »n Vicvli n- anJ 
In Surgery The valatv iv at the rue if i *9 p^r 
'*nnum Invn rtvlJcni) 

I uTlhcr pattKularv rcpardinw vluticv times if 
aitcudan c cK m iv be t brained from thv I hue 
Gi vetnor and Scvictarv to v^ht m ap'^’i aiion' 
with copies of n t mote than Ihfcc tcvtim >n ih 
vhould vent not later ihvn \uvu i 2*rd lb s 
S I)l SSI \s 

AiJguvi <tb )‘>t^ Hot! c C overn >r an ! Scvtclary 

T \SfS(Ol(H \ir‘I<iRfA itlllLM 
ISI IRMAUY 

HOI sr StIHOION (male) required Sc-ucmlart 
iM I9tk Ypph an V must b- ditdly qualifcd 
and red tcred SaUty £1^0 per annum with bi ard 
rcvIJrnic xmd laundry 

Arrhvatwnv vtiiine acc and other cv'cmnl 
partfiidir md acvompamcd tv copies of recent 
tcvtlmonliU and photo T»rh to tc avldrcv'ed lo 
the undcfvikned tchre Yiicmt isih l‘>ts. from 
whom all pvfiicuho. may K o! tamed 

n»c lUavplt il has two icMdcnt Hoii'c Surgci ns 
and contvlnv SO Icdv md cotv an \ riy D part 
mc^» and an Out patient Department wh rC 
actidcnt canv arc revcucd 

1 NonhumbtflanJ Have CHAS ROW Ft! 
Sorili Shields Secretary 


S OUTHPORT <rNrR\L ISMRMARY 

(Hi> Beds Tlitte House Surge aas) 

Special Departments for Fye 1 at Nose and 
Throat \ Ravs Mawacc Skm I atholocy etc 

Wanted to take up duilcN on Scrtvmlvr Ni 
next n JUNIOR IIOUSF SUI GFOS Sahry 
fHO per annum with rcsidcrwc board anJ 
laundry Arpllcims to be fully qualified rcgis 
tcred and unmarried 

AppUvatlonv stating age experience wuh coplcv 
of tevumonnh to he vent In by Aueuvi 22nd 1939 
to the Supcnntcndcnl and Secretary Infirmary 
Office Pilkingion Road Southport 


S TROUD GENERAL HOSPUAL 
Stroud Glos 

RFSIDENF MEDICAL omCER required 
Candidates must be fully quahlicd and tcgivtcrcd 
Six months appomtmem dmicv to commence ns 
soon as powiblc Salary £200 per annum with 
board and 1 uindry 

Apphe itions stating age nationality etc to 
gether wuh copies of three recent testimonials to 
be sent to the undersigned from whom further 
particulars may be obiamcd 

C FORD SBENCCR Sccrcinry 


T he jessop hospital for women 

Shcmcld (HI Beds) 

Flic Board of Management invln. apphcaiions for 
the post of RESIDFNT ANAESTHETIST (female) 
for a period of six monthx commencing 
August 16th Salary £100 per annum together with 
board residence vnd laundry The candidate 
appointed will bv. expected to carry out other 
House Surgeon duties 

Applications staling age together with copies 
of icstimomils should be addressed lo the under 
signed immcdiaitly 

DAVID OSWALD 

SupcrtnlcnJt.nt and Secretary 


T he tlARTLEPOOLS HOSPITAL 
(95 Beds ) 

Apphvaiions arc lnvited““lot the position of 
HOUSE SURGEON at a salary of £H0 pa plus 
board residence and laundry 

Appomtmcni tor six months subject to renewal 
and duties to commence immcdiatciy 

Applications to be made to the undermentioned 
NORMAN O DLANS 

Secretary 


N OMH ST at I op OSHIP t P0Y\L 

IM IPM YRY 

Si Vc < n frcni (JTO f dv I 

HOI Sf iinsKiw (sreoND) 

Th fen aw ICC {rviic a''*'’ .tl r\ fo t*i P' 
r f H tv rivv ' !ia ( f { p 1) win wul b i\- c‘ ft 
of tie Ted \Hf A cil to th- IHr rary 
I , vkui nr’ h V ill niic- 1 ib n th tyt 
pi 1 11 IlcrjfiT' rt whi h iv very rat m >c 
Silirtatth fit o'fl^^-ipranara wth bviri 
re kn V An<l b rJn 

fh- latr- tt wlM tc mv - f^'r vt r* *•' 
yV 

Spil iln^v vtAtiP2 at ard tx-c Ivr e S 
f« »» '*\ id t o rr cn Icm m a li la be sc^t ij 
Ih- unkrvf ; cd t'Vn d i fy 
IB n Jcr 

w STiriirNSos 

Secret ry an! Hvn Oover 
All i tt 4lh pAs 

B fPMIsnHSM \SD MinLSSD EYE 
HOSriTYU (114 B-v) 

Ypp'i ail av arc Invited (tm d iW c.a!''cd 
MeJ j 1 Fra ii n-’-’x fir th r*''* e-i PfJSinEVT 
SI R(,I( \L Of I ICII at Ih- vc Rev- jil 
S Jary C iM per an" m an! flO h -^ry at n-v-> — 
Ih- Prvi ert Sjj*’ errv v a c( a Rc'lkr 
Suffc a1 Oj’ vcf anJ Ibfre Her. c arj la 

il - ever nf r-ac o* !'•- lapcr ben r "■i 
if> H p-ni »ra tf krv 'cat S.>tc j 1 tr ar 

canti 'h 11 I VI lie vhethcr i**cv wul be wi - n 
a cep apn in " cni ax Ho c b i s-on at a m’jT 
nl £PD inv n- ai the cpd of 'ix r-r hv vita 
fi r'» > 'crvi c £H0> per arc.'a 

Np'' va o-vv viih trvtl-A nialv arJ cv Jc- c c 
rcevifitim mu't be re cived nt Ut-r th a st 
t!ay \j “iMl I h 

Chur h Street J W rrsRCF 

B rnip bam T Hci'c Go\cr*''r 

|y| vNriii su It no\ \i. isFiitMVRt 

llic ni irJ of Mjni-c-cni rl iFe Maivb-sw 
I oval JnfirmvTv fnvl v irpl'catu’*' f ^ *** 
UlMOIsr MI OIL M tilllCrR o' iFc Ptioic 
I alien V Hi me it IPO bedv .» j i 

Spp > aniv ntivl K rc».t tcrcvl aed bo J a 
anJ SifiviJl qualjfiwaili a anJ ru't have naa 
rrevimv tevid-n experience m a sen fat n>‘PJa' 
Die app'ninent iv fir twelve ri.a hv rc^-avarv 
for a futiher petuM Siahry ref a-num wut 
bv'ird rcMJcncc an I laundry a!o'a'"f , 
full intortration la c'''tamaM'* Ben ire 
xigneJ IP whom appli ants mii't < ri P'ehf 
p| !he> app'icatiPn anJ tcvtirv''nutv oh or bvii 
9 am on Ihut dxv Sugvwt Hth 1® '' 

By Order ^ 

t J CABIC 

General Sunefimcndent and S<xtcbjL 


C HESTERIIMD \SD NORTH DERBYSHlRt 
HOY \L HOSPITAL^ ^ ^ 

(2.0 S«tgu.al and Medial Beds) 

House SURCrON m OphMInic mJ E>' 
Nose and TTiroal Dvrattments , 
Apphcaiionx arc Invited from fulb 
men fc'r the abovt povi The ^prointrrcni i 
MX momhx Salary at the rate of £H0 t^r annu 
Applications stating aec together with cop^ 
three tccvni testimonials, should be vent » 
undersigned as soon as possible _ 

M H BOONE 

July 29th 1935 Superintendent and Sccfetary^ 

C UMDERI AND INFIRMSRY C\KI-ISlh. 
(202 Beds ) 

Apph'^tionx arc invited for the IN'S! of 
RCStDiM SURCICSL OI IlCLR , , 

Candidates must K unmarried and hold a n >• 
quahhcation in surgery The '‘Pb^intment 
far a period of one year with po sible exte 
Salarv £.50 per annum with board rt idcn^ <■* 
Application forms and parikuUrs of dutu 
may be ol tamed from the undersigned anu 
be returned by first post on Friday Aupn ‘ 

J S lUFlICR ^ 

August 3rd 1939 Secretary Superintended 


T OUGHBOUOUGH AND DISTRICT GENtJ Yl 

HOSPn \L 

Appli''aitons arc invited from duly 
candid lies (male and unmarried) for a ri 
SUROrON Salarv £1^0 per annum 

fbc appointment is for six month and » ^ 

apirimenis board and laundry - 

Surgeon must be an cxPLn(.nCt.d anacstncti r 
AU appUcauons stating age etc wu” 
of itsiimomiK to Iw. sent to me at once 
I RANK H TOONE 

9 Leicester Road Secret ui 

1 oughbornugh — 

\L UNITED HOSPITAL B\TII 

HOUSE SURGEON required (General Sutsen 
nnd Enr Nnvc and Thrent) , , j 

Silary £150 per annum with board re J 
anJ laundry »-f,mnmal 

Apphvations with copies of three 

to be addressed lo the undersigned > 

J LAW'PENCE-MEARS 
July Sth I93S Secretary Siipcrmtcndcni 










Aicu*;! n 


THC RRITISII MEDICAL JOURNAL 


APPOINTMENTS — ^Important Notice 


Muln. il pr utitioiur- TR rii|in.-ii.(l nut to ippK loi im \p|y)intnit.iit rt.icrr(.<l to in tin. following 
tnlik without Invini, tn-t LO!nnniim.ilt(l with ihi. Storitiri to the rriti--h Mi-dicnl \ locntion B M V 
lloii'-t, 1 n\ Rtook iMpi iiL W C 1 fin till, on t ot Scotti-h Tppnintnicntc with tin. t^cottlsh ''oerttarx 
7, Dniin'ln.iuh (niikn- 1 chiilnir^h) 

(a) Bnlisli Ishnds 


CONTRVCT PRVCTICi: | 

! 1 

CONIR ACT PRACTK 1 -(r/*nr/ ) ! 

PUBLIC HEILTH 

I Mllklisswr MIDICM \ID '-IXTII rx 1 

1 ( Mr- j/ O'^rrr > 1 

1 1 

Miokiiokonv MinicM xio virinx 1 

i4 fit Mr 1 O ) 1 ! 

/-r.i ^ /xj- 0/\v pi u/~li 1 

1 m AFN AVON \tl Die M SOCH n 

j \t h rf 'fr u! O r» > 

Nl All! \N|> niSTHK ) H a t Mr 1 al O t Hr Iih ) 

Of ut t 1 At c j n 1 

1 ciLi xni r(x:ii rLwioiir xs 1 

fH (men t/r uf t h fr^ ) 

(V^MORI A MI FA CL AMO ((AN DISPF NS \R^ APPOINTMENTS 

I (11 if II a 1 r t; * Mcf »/ ,4 / y ,rif ) 

(|{ n ( rrn i )fr <*^1 *‘rh n ) 

1 ILWANAIIA CLAHACH AAIF 

riNACRAK ClAMOkCAN 
(II Irr- n s Mr cal e 1 

1 

1 LIMFRICKCIFA 

I r.r , r /y e ^ ^ ^ 

( Mrd 1 1 O t Mr t {At Atsoc i <'o 1 

(b) Oicrscas 

A[L(llC^l ii' i(.titioiKr-. nre rcinn.-.ti.il mil to appK tor an\ ippiintmciit n.tcrr<.fl to in the lollowing 

1 iIiIl without liiMiii, tii^t <.on]niunicnli.<l with tliL Honorirx Scrrctin of the Dm-ion or Brinch 
n iiiKcl 111 tin. ^i-conil rohiinn or with tin. Nurctir} to tin. Priti-h Mrfhcnl V'-'Ocntion B M -X Hoii't. 
Tui'tnck Sqnrc \\ C 1 


NE« SOLTH 
^\ \LES 

t All Ft frdir 
S K ei) Arre '•f 
mef'is ) 


QUEENSLAND 

(H here A va r 
F lenJh ScKiet tt 
Imt lute ) 


\u<,ubt 10, 193S 


H n Sec of Dtvi 1 

or Brnch 

Ivwn < r 0 trt 1 

I! n Sci. of Dim ion 
or BrafKh 

To n or D trict 

H n Sec jf D i t n 
or Brinuh 

The Afedi af Secretary 
New Svuth ASalcv 
Bran h 13< 'fac 

0 lar e Street Sydney 
N.S \A 

The Hon Sec 0 *cen 

L nd Dnr h Unti h 
Afedtcnl Av octation 
DMA Hc'irtc 
\V f c k h a m 1 ctra e 

Hr bane B 1* 

V t C T O R 1 A 

(All Inttifute r 

Me t ( i! tit pen 
Ufrtrf ) 

Ihe llooyrary Secretary 

A leK'rian Branch 
Dritivh Afcdical A o- 
ciatton Af e d 1 c a 1 

Society Hall Albert 
St Ea t AfclNtirn 

A icterh 

WESTERN 

Al STRATI A 

iCnnf ccf and 
Lodte / artuci ) 

The Hon Sec \% evtcrn 
Australian Branch 

Bnti h Medical As o- 
ciatnn Shell Houe 

0< Si George s Ter 
race Penh \A e<»cnt 
Australia 

8 Bx Order ot tin. Council 

G C WDERSOY Sc^nlary 


R OCHDALC tNFIRMARY \ND 
DISPENS\R\ 

(IJO Beds Thrc- Rcsidenis ) 

The Board of Sfanajremcni msircs ar^f cafjom 
for ihe a~"onincm of HOLSC PHYSICIAN 
(mate) The Mlar> attached to the arrotntment 
« at the rate of £i<0 rcr annum with board rest 
den e lautvdo The duties include work in the 
Out Pari nt Aural Ophthatmi etc derartrrents 
as xs-ell as in th trards The Hospital cosen 
a lar^c nditstml area and affords excellent 
orponuf\it> for exrenen'-e 

Applications statinc ate naticnalns et with 
three recent lestinontals to be sent to the Seere 
tars Rochdale InTirmars 
Irfirmary OHcc 

Rochoalc Sccrctars 


R O^AL LANCASTER I^^R^!ARY 
Lancaster 

(140 B*ds ) Four Residents 

Applicati ns are Insited for the post of SENIOR 
HOUSE SURGEON Salar> C«00 per annum wtih 
Kiard residence and laundrs The appointment is 
for SIX months in the fir i pi ce arJ mai be 
renewed for a funher six months 

AppUcatioas statins ace qualificat ons expvri 
cnee and naiionalit> to cthe with copies of three 
recent icstimonuK to be sent to the undemened 
FRANK \ MILSES 

Superintendent Secrctarj 


R 0^\L LANCASTER INFIRMARY 
Lan-asier 

(NO Bees ) Four Residents 

Applicattons arc innted for the post of SECOND 
HOUbC SURGEON Salar> £1"5 per annum 
i tth board res den c and laundr> The appoint 
mmt is fir six mcnihs 

Appljcautn< tarins ace Quatifcaiions expen 
cncc and nati-vnalit^ loccthcr wuh copes of three 
rceenl testimonial to be sent to the ondcrsisn'd 
FRANK A MILNCS 

Superintendent Sccrct3r> 


J^EUUNG SANMORIUM HOLT NORFOLK 

The Corrmtitec of Nfanaccncnt of the Kelling 
S«.ratorium fFobcr-ulos s> desire applicati ns from 
Medical Practitioners with soitaHc auiltfication 
for ihc post of MEDICAL SUPER|NTENT)ENT 
at Kcllinc Sanatorium Holt Norfolk (169 beds 
men) Preferer c will be eiscn to npplimnis 
between the ares of ihiny-fi%c and lifts who ha\c 
administrative expenence knowled c of modern 
mmhoj of Sanatorium treatment and \ ray work 
The pmitioo is o'^en as from OaoNn" Isi I9.>S 
salary { 00 per annum with exce lent house in 
Sanatorium rr tinds A Supcramjaiion S heme r 
in force 

Apnlicatjonv slatin'* qualifications tor ther 
with three recent testimonials should be sent to 
the Sc rctary Kellin** Sanatorium Holt Norfolk 
bj Sep ember ’rd I93S 


R otherham hospital 

(130 Beds ) 

CASUALTY HOUSE SURGEON 

Applications are rvitcd from qualified men lor 
Ihc post of Casualty House Surseon Duties to 
comracn c as soon as possible w II ip ludc work 
in the Ear Nose and Throat Departmert. Ex 
ceilent experience to be pained in the trcatrrcni 
of fractiircv Salary £I 0 per annum with full 
board residence and laundry 

Applications with copes of recent icstimoniab 
should be eni to the Secretary G Roberts 
8 Mooreate Street Rotherham ^orks 

M erthyr geveral hospital 

(IIS Beds) 

RESIDENT HOUSE SURGEON required for a 
penod of rx months 

Salary at the rate of £l<0 per annum with 
board and launuiy Apr ications staiin«. age 
nationality quahOcations ard accompanied by three 
(copies only) recent tcstirocnialj should be 
addrexved to the Secretary of the McrthyT General 
Htr'pi jil 


for the Prevention -nd Treatment of 
Nfental and Nenous Disx,rders 
St Allans Hens 

HOUSE PHYSICIAN male o female required 
ape under to years Appontr^ent for sue mon hs 
at the rate of £16^ pa with board -nd quarter 
ren-wablc for a funher six months at the rate of 
£ i O pa 

The Host lal has over I OOO bed ard i the 
County Vfcntal Hospual for Henfordsh re 
Laboratory p yeholomcal and CThild Guidance 
Clin c O~cupational Therapy etc 

Arrii'ation forms frtra the Mcdi al Director to 
be relumed with cop cs of reucni tesitmon ui 
Dunes to commen e in September 19 S 


R oaal eae hospital 

Pevency Road Easfbcurre. 

NON RESIDENT HOUSE SURGEON reqo red 
to commence duty in Aumirt The anpointirent 
V ill be for ix month m the first instance 
Salary £11X1 p'T annum and alIowar~^ m lieu ef 
board rcsidcn'c £1 pet annum 

Applications stating age qualifications and 
onhthalmc experience to ether wiih rccem fcstr- 
rnonials should reach the urdersigred as sixn 
as pov ible 

Befire engagement cand dates have to be in cr 
VIC cd b Ihc Hon Surgeon from whom funher 
paninjlarx could b* ob aned n person. 

H BAGRAAE Hen Secretary 

jyjANCHESTER ROAAL EA E HOSPETAL. 

JUNIOR HOUSE SURGEON r-qo ed Salary 
£l-.0 per ^mum with res wcrcc bo-rd etc 
A''p’icai]ons (wiJi copies of testimoru s) 
cPwOfs-d House Surgeon to be addressed to 
the undem mooed 

H R NORTH 
Gen 2 &d Sccret-cy 

(^ippomiincnta con inued on p 




















rnn huitimi mpdicai journai 


AtK.i'sr 13, 1918 


CHARGES for ADVERTISEMENTS 

CIRCULMION OI THIS ISSUI — ll.OOl COI'H> 

CLASSIFIED The Minimunt charge i'? 9s, which co\crs up to 30 
words Extra words arc eh irgcd 1/6 for 5 or less * 
Example 33 words would be charged as for 3S 
Name and address should be included when 
counting words for cost 

If Do\ Number is used, it should be reckoned as 5 
words in the total 

Replies should be addressed separateK to etch 
Box No care of this oflice 

Adxcrtisemcnts, accompanied bv remittance, sliould reach 
this ofTice not later than noon — iuindax, to i suiu 
INSERTION IN CURRINT ISSUE PleaSC write ClIARLX 

DISPLAYED Whole page £24 and pro rata to one eighth page 
Special positions dates and rates on application 


Even. cfTorl is made to ensure the accurace ol 
adserlisemenls ippearini’ in the Journal No 
recommend ilion is implied bj iccepiancc and the 
llritish Medical Assoention re screes the riiht to 
refuse or interrupt the insertion ol in\ idsertisement 


ADVERTISEMENT MANAGER, BRITISH MI DICAE JOURN VL, 
DMA HOUSE, TAVISTOCK SQUARl , W C I 
EUSton 2111 


NOT CLASSIFIED 


CIGARS (ENDCUT) ALL HAVANA 

TOBACCO GOOD SMOK.ES 'll t low price 
Quility gunnniccd Box o( ^0 for 25/ poM free — 
Sole M^nuf'»c^urcrs J J TRcrMAN A. Co Ltd 
90 PiccTdiliy London NV 1 (GRO 1^29 ) 


“BIZIM” CIGARETTES 

THESE luxurious dcliciousU satisf>inB xmokes ^0 x 
or 100 s at 6/3 per JOO 5S/6 per 1 000 poxt 
free — Sole ManufTCturcrs J J Freeman ^ Co 
Ltd 90 Piccadillj London W 1 (GRO 1^29) 


“ SOLACE CIRCLES ” TOBACCO 

THE fincxi combination ocr discoxcred of Choice 
Natural Tobaccos Every pipeful an jndcscribnblc 
pleasure 12/6 per -J lb tin post free — Sole 
Manufacturers J J Freeman L Co Ltd 
90 Piccadilly London W 1 LGRO 1^29) 


N ational adoption society 4 baker 

STREET W 1 Telephone WGbeck 7211 
offers assistance in the legal adoption of 
illegitimate and orphin babies into suitable 
family life Chairmm The Lady Gwenetii 
Cavendish 


T ypewriting —specialists in typing 

Medical and scientific papers lectures 
iheses and books Shorthand typists ilwn>s 
available Proof reading indexing — Margaret 
Watson Ltd 16 Palace Chambers Bridge 
Street S W 1 WHltchall 3838 


T ypewriting duplicating transla 

TIONS — Experts in Medical work TESTI 
MONIALS THESES cic accuraiclv copied m 
stvit lhai commands attcmion — W oburn Bureau 
D ravton House Gordon Street London \V C 1 
(close B M A House) EUSton 1775 


YOU COME TO LONDON STAY AT 

3311 , residential club 

pLNTLCMFN Hampden Street N W 1 
clo,c Kins s Cross and Custon 300 bedrooms 
clean ne"' A®iiP" .'"‘"J"'’ P'"'’* tuend and boot 
Mcil rarilT '‘mins room 

lor students n rcadins rm studj 

stuacnls J||i,s pro, Soe EUSton 22-M/5 


ASSISTANCirs 


W XMED IMMCDIxniX INDOOR XND 
Outdoor ASSISTANTS for lown and 
Countr> Praciitcx with and without view to I artner 
ship Good salines olUrcd State full pariinilars 
— llRtriXH MCDicsL Buri Ml Cuvvs Street Min 
Chester 2 


W ANTED IMMIDIXTLLT M\KKIID 
ASSISTANT DritiMi for South Walo 
coUicr> pcac icc Salary £4^0 and £50 car allow 
ance or car ptovidcd free unfurnoheU houvt — 
Address No M)^2 BMA Hod'c TaMstock 
Square W C 1 


W ANTED END OF AUGUST \OUNG 

male Indoor ASSISTANT English or 
Scotch preferred for mixed practice in North 
London Time for reading Car providi^ 
Salary £300 —Address No 7825 BMA House 
Tavistock Square NV C 1 


W ANTED OCJTOBER 1st MALE ASSISTANT 
Outdoor for large panel and private practice 
in ShcfUcld £300 pa plus board res dentt Allow 
ance if own car — Addros No 8040 B M A 
House Tavuiock Square NV C 1 


W/ANTED ASSISTANT CAPABLE OF 
TV taking charge of easily worked Practice (espe- 
cially if Principal decides to open Branch) Partner 
ship with view offered later to suitable man 
Furnished flat board attendance Excellent pros 
peels Scope Fullest essential particulars to — 
Address No 8037 BMA House Tavistock 
Square NV C I 


W ANTED MALE ASSISTANT BRITISH 
Isles for South Vorkshirc town Indoor car 
dispenser hospital excellent experience Salary 
£300 £350 p a —Address No 7S01 BMA House 
Tavistock Square NV C I 


W ANTED ASSISTANT OUTDOOR SINGLE 
for panel and private practice in country near 
Birmingham Dispenser kept Salary £450 pa If 
own car £50 extra allowance Usual bond — 
Address No 7914 BMA House Tivistock 
Square NV C 1 


W ANTED OUTDOOR ASSISTANT IN 

good-class suburban practice (Maneficster) 
Salary £400 pa Car allowance £50 State cssen 
ti il particulars Partnership prospects — \ddrcss 
No 7924 BMA House Tavistock Sqii ire N\ C 1 


W NNllI) MMl OUTDDOP UNMNRMID 
NSSISI I n^tf Cardiff a . 2 

to exp ticn r r'unimi *33 iUO iwh f •'‘■-j 

ti’ a v atten J r c anJ car pfciv e J I) i 
liven c c cnihl No i'’** c” r r J*' pd P 

s ale nail m ir ml a c a" 1 fufn vh tea ^ 

nn 1 r? I ra*-!! wi h ral \d 

" ‘ t ll Nt N III la- TaviMOwi S arc NN C J 



af'l aU fi jn J w ih c»r a’* 
">tl B Nl A \U la liS a ^ 


tw a-vc — Nv-rexa N 

.k V t a c NN C I 


W NSTID INDfiOU AkSlSTANf LNGLISM 
ar Sob ^-''J Iirj t'3 P fcrr*d f'T 
pfj c I n ni ic (ri rt I f "d '' w ih V 13 
pjri- f -a if dcM r! S d iry £ ' -1! f u~d w '* 

f*l var al* »a"» c - Ne *r~aa Si "9 0 B Nt N 
III c fjvia Kk a c NN C I 


W NMID NSMSlNSr (SINGLE M ME' 
r a Cardiff 5* r*c opet P cf "f-i 

(.MtJ r Silary £4<0 pt am m 4 i 

to t f^ri r - — Nd Ifcas No "'1 B Nl N H "S 
Tavi tis.k S 1 arc NN ( 1 


W NSnU MNU NSSlSrVNT OUTDOOR 
I m early l> her NJncd iv^n pr ^ c 
DuVin Sihrv ) r annum anal £'0 ■' f 
me — NdJeaa So * B N! \ \U T-aiCxN 
S mate NN 1 


W Nsrro AssisENSisHii uurno'N't bn 

ytaur- d vli r— aj aU *d ci h c-a r " P 
Ttwn r vti c MjJ) ’'ws ( s-a ih r cf red h P i 
csxvTt a Cl " 1 IcraN evp t cr c of OP k 

O'vn c If — ' Nd Irc" N "‘MO B Nl \ H -s 
I M u k S 1 are \N C I 


A xsIMXXr KIOURFD I OR BRIIISH 

( I mu t H il Ccrn*.n p N» JP"*” 
Palionvlity ho dire LegTcc of c be ^ 

Brill h qualifi nt vm e are •• ^ „ 

£(tw> p pji,, bonus pa stKe pa'* ^ ^ 
cv>nirvei ml view to partn rshm sjrr'al cxpcfi 

tn c c'vcnlul Suljcvi to Govern- cnt p'trd-- 

Write Irttiva Jiasta Ltd Mu’enLare 
StrnJ NNC: 


ALXIXTAVT OUIDOOR W \NTrp 

fndu trill distrut Essex Mar icd and ct^ 
cn cd G P Neung cncrgcl e Lngl shman cr 
required Salary £4t0 £50 car allmvan'c 
lurni hed houNC larly view if desired 
Ni> "s3| DM \ House T iviMOCk Square N' u ‘ 


ASSISTNNI I FQLIRCD M NLE SCOTTI^ 
or Cngli h unnnnied young totre 
cnee Rcnerxl rnci e prefertxxl Own 
b meh Kent border it*0 ref nnnum all »ci 
£50 car nllowmce md garigc — Ndore^s No 
BMA Hou c Tavibloek Sq larc NN C I 


ASSISTANT I XRTNLPSIllP FOLLOWING 
wanted Mixed practice NNcsl 
English or Scot married Govd pro pcvi 
woo pill, 1 . ir ilIo» m-c Semi pirti ubm 
dated photo to— Addrev'- No 7^8 B M N He 
T^vlslol.k Square N\ C 1 


A ssistant (nnoman) 'wanted ns soo 

ns possible by NN oman Doctor 
London Fumt hed flat •'nd ‘^crvive Car 
allowance) provided Commencing 
Address No 7915 BMA Hou c Tavutoci 
Square NN C I , 


M T>(L0ND) FRCSE REQUIR^ 
Ij assist ANTSHIP— one year or m 't^ 

good mixed pnciiCL town or countrv 
year with unfurni hed hou t at t 

Address No 790f B M A House Tavntex*. 
Square NV C I 


M t> ENPERIENCED HOSPITAL 

> general practice rcquirv:* ”'w^np|{ 
NNORK London or Leeds to lit m 
course communcing late September ^ -o s 
surgeries week end duly — Nddre^s no 
BMA House Tavistock Square NN C 1 _ 


P ART-riME ASSISTANT W' XNTED ’^0^5' 

London area Sun public health c'** j; 

— Addre s No S03N BMN HouiC TaM>row 
Square NN C 1 

PXRTTIME WORK W XNTED IN LONDON 
i- by English posignduaic ^ix 
hospitU and general praeiicc f'f 

thciivs Long or short Pen^ vVl" Hoiw? 
interview — Nddress No 7927 BMN 
Tavistock Square NV C 1 


















t I sT I ^ 19'V 


N orth \\ vu r — w sviin vkmstnsi 

••v V ( { V H f C il -^c t •» 

xx \\c h rv-Vtnc even al I>r v car — IiH 

XI a u CMi*»t 4'i Hjr*i n Vj ect 

M X C OcvlfT 

X^^OMaS t>OCIOK RIOIMKIS \VMV1 \S1 
" Mnr ' C» t rvUTNIRMUI *r 
s\CClssn>S N cxrvnf-x-c\ orcvjall r~Kl 
« ._rvl r* n t\r.JC\ ’'tnal rirrty — \Owrrv 
S> '■a V i; M ^ Ilxfic Tax Xk '^Wfc 
\\ r I 


r 0CT7^T<; 


WASTTiT LOCUM WITH fNrfRirscr 
»* (tf !)C l-ar inJ Threat H'^rtal LonJ n 
OcTr> N fthem Irc^nJ \'a!Ai xrvi tn Mil 
Sr-f^hcf Hx-'-aj c (xf per nccl jnJ 
r'J a’c rr* “C h> arta*^ec~cri A tx*''-'xl ii n 
prv xx-cd arJ a l'"irxJ — Kc~ j tex Vcrct rx Txc 
Lar a•^a Ihr xat Hop- Jl Lo-'u rvJcrn ^ nhf n 
IrcUnd 


W VVTrO LiX*LMS in MiniCM \OM\N 
fri-^ betin r Sc^ criNrt h exper cncc 

jn p I iJc -ftJ P-neJ pra it On car - \tS tc\i 
Vx r M \ Hie T^x xk s..iiare W C 1 


W^KVTTD LOCI M \SMST\NTMIir OR 
»* r\RTTIk!r WORK cxpcficn oJ in p^ ate 
a-d r-"c! Tree \i t •'t ir>ih (. i anx^hpre 
I h nc Ad - rvre n t — ex S VO ' 11 M A 

Hcjxc Tuxn rxv S^,uarc W C 1 


W ASTLD TOUVG M AU LOCtVI J OR 
Alan- h^JCT trxj i iiul pmux cruJ rf A jntxt 
Of rar!> Sep c^xber Car er^i— » — Ki.t3rr* S 

“9 i B M V H sc Tax ic<i Scoarc W C I 


E xrnRiLsciD rRAcrniovrp thirty 

tes ex SLASIDL LOCLM la t haU Scprcm- 
tc' CK'en >ct I'Tx I c exxn car m return for 
fixe fj-eax per xveeV p beard elf xxifc arid 
9 bab O her eferv cc^ d-TcO — Ndwrpvs Nt -jif 
C M X Hpxrvc Ta i texk Square W C 1 

E XrFRIESCrD <lXrORD MAN (CNGLISH) 
uxcrrtcxl f r LOClWf APrOlNT 

MENTi— A lvIcx So -^7- U-Vj a Heme 
TaxnTi^l S»,u re W C I 


L AD\ doctor REOtlRES LOCUM WORK 
fro-n Ausuxi th i Sepicmbcr <th Espen 
en ed r-n-nil rr-^icc arxJ Jexm* l>^ixe> car 
E 1 .J 11 pumea per xxcek IfrJcx>r — Vcufcvx Sx 
>0 0 r M A Houxe Ta j xk Square W C I 

R etired ceneral pRAcmiosip 
dexrev LIGHT LfJCU M or ASSIST WCT 
WORK Reaxonah e icrp*x Htfh-cia rcfcrenccx 
and cir>-Ticnce Alter Auruxi . nd— Lix-tM r 
W altham Rtxad Car halton 


S/OLNG INDIAN DOCTOR MD ENPERI 
i enced p-n 1 pr'Cicc e\ HI H-S »artx 
LOCUM c ASSIST ANTSHIP Can drt e Ice 
tculc —Ncfdrcx? No "9 X BM A Hu« e Taxi 
reck Square W C I 


^ILDICA^L POSTS DISPrN<^RS 


W^'*'TED MEDICAL OTFICER FULLT 
» » qual f r ^haline xeniurc tatlirc Scr^ 
icnber Octi her — W me No 91 Kcim no Co 
Affxcriisjn Aeen 5 Edinbureh 

A ladt dispenser bookkeeper si p 

CV p led r*~medi3icly on request qua! icd 
rxJ «* rh praciioJ erp^ricncc m pnnfc pr ci ce 
and di p^nsar> Wiork slxo truncd in Bacter o'pKical 
Lahonieries of the LONDON COLLEGE OF 
PHARMACY FOR WOMEN Pr.-^rai on f r 
Eaam tut nx — Wrte wifp or ph oe (Baxx- 
•vatcT 0X9) ScerctaD 7 Wc^tKurre Park 
Read W 2 


A COURSE OF TRAINING IN DISPENSING 
Ev and Pharmc^ i oxen at GORDON H \LL 
SCHOOL OF PHARAfACT and SccTC!ar> Ds 
penxers can be supplied to Doctors Sexxions 
January Apnl and Serienbcr — \rr1> PnncipaK 
School of Pharmacy Drajton Home Gordon 
Street W C ! Phone Emton 9’0 

r\ISPENSER WANTED FOR PRACTICE I'n 
L-' coxrrtn tP»n in Wc-t of Cnsland Applx 
» tb photo— Addrex No ^0 0 BM \ Hou>e 
Taxetock Square W C 1 

rSISPENSING CAREER FOR A OUNG LADIES 
FULL TRAINING for Apothecanex Hall 
Ccnificate Enro rrentx cxcr> three month • — 
Ap*x X Tbc Pnn ipal Central S h >» I of Pharmao 
-P Aforcton Sweet L nd n S W I Telcphcrc 
Nietena 1641 


Tin BRITISH MEDICAL JOURNAL 


D ociou nismrs pLBAiAsrsT post 

Afrn In iiiut n piamcxl quirters Fx 

H M'x S trees n Ca nliy OfTl cf \txi ixnt Stmertn 
lc*v!ent lour Tu*KTcuIr«ix expeften e tnn 

pract e t*<jy IxNfaf n F rvn AnxcxthettsT 
— rs No ■*)If n A| A Hotixe Tavi t «k 
V. ate W C I 

D oertms RFot iRiNf o A I I r I r D 

D rNr>crv Nnrxc D ren ctx Sccfctafx 
D r^nvCT » ChxuPc i e D ren ers arc in ted 

t i»fi c » re x'f ph ne Te*rplc B r <Axe fur 

Di rtv II X Bi »i t 1 Imuxav Home F’l 
N jflC'b'irx Ax-nu I < nd n AA C 

D OClOk S W mow t40c BOT ) RFOinPIi? 

roSIIK'N 01 TRUST Thofo Sx 
tpfrrxiK ted ctnom at mar-afcr kn wled c bo 1 
kerf "r Sea u p eferred — I H tufli il rs tr* — 
Ad*, rx N )0«| B A! \ Ho c Ta 1 ck 
Nti.xrc W r I 


L ancs town —partnership yielding 

£1000 ercKS Middc and p.crkin..-cb s 
Parcl GCO Pnxatc hou-e xvith para c for sale 
Pretrium £! ixo invludin" drugs book dc^'ts — 
Addrex No *90< B M A Hou c Ta x tovk 
Squa c W C I 

M pk OR AIRCP AA anted to JOIN 
L/ three cih rx in Scuth Co_3i cr'ctit.e 
SHARE equals one-<e enth of about £" r^n"* 

to equalit) CosxJ b me f r purcha e HopitaJ 

facilities axai ab’c — Addrex No St B Af A 
House Taxistock Square W C I 

P ARTNFKSHIP AfIDL AND DISTPICT SITE 
•cured on r'p Jly d-xcl 'x ate f n 

co-nin man O J-onat bed praci 4 N) p 
1 OiO med *al xer i c Ore th rd '•..re >1 d e 
£1 I'd p.f year Firj'* c *30 be arr»r -d A jn 
cne'r't Er bnun rrc erred — A d o' ''o “xt- 
B At A Hue la I t Nk S<, r re W C I 


JU IaUA *< A fN'xt H-ll X, n Kn XX 

lei c f h fi*'ar 1 ex p » it n" arxJ Ns kk cp n.. 
— Ad rex N BAfA H e Ta •N.k 

N re AA C I 

L ada oialhifd as niociiiAiisr 

eCt nu.av ur t\ f r B xixl ard t rca Arafysis) 

I xpericrx-cd ftoil fcfeTcn<.cx Ir*fcfcvtcd in fc 
Nca th res, 1 tex lOSI n bxi''itat o pfi tc xi rk 
xvl h Patho *xt — AdJrox No 71*^ DMA 
H tixc Ta tcxk Square AA C I 

T in ROAAL ARMA Ml OlCAU CORPS 
ASStiCIAtlON fix Tctlo.tx'x Sq re 
SU I rTelcphoftc Aicirfia urr> c* 

qiatifed Doremcn nxcklceretx Laboratory 
A niants San tary A -Man Male Nur es 
Afe lal and Special Ttrairrent Orderl Den a I 
Clerk Otuerlcx P net Caretaker etc xi ih ut 
chafre ro fTOirci .»/ t emroyer 


^iiiiiiiiiiiiimimmiiiiiiiiiiiiiiiiiii^ 

S The Names and Addresses of ^ 
ZZ Advcrliscrs using = 

I BOX NUJylBERS | 

S arc held b\ us in stnci con S 
S fidence and mas nolbedisclosed “ 

S Applicaiions should be S 

~ 'eparalclj enclosed and clcarlj ~ 

S addressed ^ 

S Ai'drcss So S 

S B \t A House S 

Toiisiock Square II C 1 ^ 

A I ermmun cations arc fo^arued ZZ 

M to adxcrusers under plain coxcr ^ 

^iiiiiiiiiiiiiiiiiiiiiiimiinimiiiiiiii? 


U RGFNT — ONF TfflRD SHARE fN INDtV 
trial p act! e n ar L dm lis j xc rs p r 
hxxc La t xe-fs rece -ts er M/» tc r 

Umixt to rc''t En hr-an r S^ct E per n - 
G P Aceq lie rca n di •' al — Ado “x so 

>;!■) B A| V House Ta x. i^k S.,jar AA C I 


rn vcTTicES 


\T/ANTED IMMEDIATELA UNtyppOirO 
> T -runtry PPACTICE, from £1 ' p i 

%*ith Paref Good sardeo apd bou m en u — 
Address So “fO B Af A Hem Ta ^to*.k 
Square AA C I 


W ANTED IMAfCDrATCLV PR ACTICE IN 
Ltwd m preferxM)' in xxe«crn half ItNrrrc 
about £^ COO » th a fairly la jre pane! C^h 
axaUatk.— Addres No ■'9t BAfA Hcyxc 
Taxi lock Square AA C 1 


W ANTED NOAEAfBER OR DECE IBER 

sm-tl counm PRACTICE ta D'*^ct Dexen 
er Cc'TX'aall £■<'■0 to £6c0 Heuxe lo ren p c 
ferred — Ad-fesy No “SD B Al \ HoLt5 ra>>- 
stcNk Square AA C I 


W ANTED IN LONDON OR PROMNCES 
practices Xkt h I- ones E'OO to t. roo 

pa Alanv pur haverx xx i ip-* and qui k irans- 
cti ns for immcdQte CLxh— P mcdcv cqj H*olex 
Ltp 67 M Chardos Street Strand AA C- 


A ni mber of sai all practices at low 

peniins Etce leri e^'-oriun ics for c c 
iioners xx'shme to rci a pra t»ot » h xcopt — Apr!) 
Pr COCK A o Hadley Ltd 6 6S ChanJi S ect 
S rand AA C • 


E stablished practice London area 

f> dt 'X>'al Rcccipvs atC" t *^1 TO pa m 
cIuJ nc apt f I*3'0 r-n ard npo ntiTmt eo 
Rccei*' s fr m private and panel n ma 1 

insrreaxc A irac'ixc bouse on ir r *.d inth 
paraee and L. re parden — Ad ro No _ 
B A! A Horn Taxi cck Squ_ c AA C 1 


r\RTM.KSHirs ' 


»» tan hr PARTNERSHIP n courtry rr 
courtry loxxn nea xea by Af D<Abe"d ) T R C-S 
(Ed) aped -5 Surp -al "t*~c — Address No 901 
DMA House 1a\isiOi.A. Squ-rc W C I 


W/ ANTED — ''ARTNFK TO PEPL CE ONE 
r r retirin'’ Ixfe of 'Ai ht T»tvfifihs hare 
com"ncncinp Ape t» Mao keen on rred nre 
preferred — Adurexj vo “911 BMA Houm. 
T..X 1 tcvk Square AA C 1 


A PPLICATIONS ARE INAITED FOR A 
PARTNER in scry otd-exiabl'xhcd suburban 
praciice mate n t oxer 33 Protcsiant hon pro- 
hatanary is’am hip xaluabc -rpoint— ent* held 
un que sccuniv anJ ptoxpeew Share xivonh *■! —0 
increase lo £—500 to 5u l be man two years pur 
chaxe — Address No “^14 B Al i\ House Tan 
Slick Square A\ C I 

D EAON cm — PARTNER WANTED 
\boi t £1.500 at _ years D ireh se capital 
cs ent a! Adequate rca en fer disposal Phys jan 
..jred bout preferred Panel about IjCO — 

Addrex No BMA Huusc Ta istcs-k 

bq are AA C I 

D ea onshire.— applications INA itep 

for a HALF SHARE m an xncteas ng 
rradi c of £2 000 in a fasounic fcsdcnital xc2s,dc 
resort Panel -00 Surpical cipcncncc an adxan- 
la c State Fidf pan cufars — Address No S033 
BMA Hcttse Taxi icck Square AA C I 


F ashionable sc coast resort 

Prexent o vner s b nds ID year" pa 

n t - years p*.rch..<e S x betr(N~‘-vj hr*, c ^rd 
pardtn breehod nust b bv u h — 

Ad revs No 6A 0 BMA Hou e 1..X ovk 
Square AA C I 


F or sale — col'ntra toaa-n a idlands 

PRACTICE Grt-cx in oTC L-DO lu-al for 
partnership Pane! aln'ost 3 fCO Medem ho-jxc 
and partfen vnth tcnni court Edt •ationaf f hues 
ur ftuilli ..mre Ccua^e hoxrral AAide cc-- 
for su fc r y Premium ear pur ha^e Hoxixe 

£2.500 On y ap- icant xii h som cap al please 

\ddfcss No “'“-O BMA House Taxrvtock 

Sqjarc AA C I 

G LASGOAA south side — PRACTICE 
private and pairel for *ale axera"* rrosx 
camrjrx approv r- tcly £I DCO coed reasons for 
disrxosal tea ortable prem um a-cepted adequate 
IP reduction — For further parti-uars, bply 
CKXV.FOSD Hekkon -o Ca tEJiON Sol aiots 25 
AA csi Georyq Street Gla poa C— 

L arge aiidland toaa’n (SLBLRB)— aaell 
esU-Msbed PR \CT1CE. Receipts ..vera-e 
rcarl) *“^00 pj pood p-r^el Attraetnc hoox^ on 
rental Prer' ~i about -I.5CO — Pr cocx avo 
H DLXY Lt? 6 “ 6 Chandos Street S*. pu 
AA C.2 

M edical pp actice of the late dr 

Charles Dous^ax. Ayr ts for sale Part^-ular^ 
from and apn i atJOn< tn J T Dolglis Sc Niter 
H *h S reet Penh _ 





















42 


M tDLVND sunuun — SOUND nu) 

crcssiVL prtviic iml ptnci lUSCTIICr ik if 
plLisinl Lountrjstdc CMIOO per innum puict 
1S‘'0 Dcnehccl eorncr tiopse Tnd hniKli surcer> 
for Prcmunn i\vo purchisc — Address 

No 791- B Sf \ Uouve fTMstock Squuc WC I 


N CAR HOLBOKN W C — Will ISIAU 
hslKd PRSCTlCr lUeeipK iNeftee tlPOO 
n I pmel 1 IP4 Splendid Mirccr> 'icci'innuul uion 
onlv Lon«. uurodutuon 1 rcmlum n — 
\ppl\ I I vtcK K 1 TD (7/<s C lnndi'\ 

Sirtei Sir md \S C 2 


N L \U M WC \SIL' ON IS Nr — Ol O 1 SI Ml 
lishcd p^ncl nnd tlub I’UACIICl C^^h 
rtceipis hsi icir £ 00 mere is»nc \iirKti\e 

house hrpe fiirden Tn 1 piricc £I ^00 pritiuc 
Premium 2 icnrs purth ise lor dispo'jl hciwceu 
J uunr\ nnJ \pril 19 9 — \ddrc s No '9 9 

H M \ House 1 iM loek Siju »re \S C 1 


O IHIHSLMIC IN IMIOKIANT HISIISIS 
(111 and indusuni eii\ in South produeinE 
Tloui 1(00 p 1 Ct n idc \b)e scope for cxpinoon 
ot PKNCIICr Sun I RCS or I) O M S 

IKu il pri\ lie ei n uli iiu n fees ind appointments 
1 remuim tl 22^ Nddres No "Q|9 B 
floiise r iMsttek Squire W C 1 


P R verier (NORTH I ONOON) I SI MU ISIH O 
o\cr thirls scir rceenils nken pmcl 100 
Splendid scope for enercctie iblc min ruhnK 
lie ilth Premium 1(00 or ncir — Vddee s No 
7012 UM \ Hone li\isnek Squire W C 1 


Y orkshirp old rsT mu ISHFO COUNTRV 

PRACTICL It (HO per innum p met £1^0 
Sm ill ippoinimcnis 1)i iinei scope I xccltcni free 
hold house cirden Ririec Lducitiond ficilmcs 
Pnetiee ind Hi u e IWOO Vddress No 79U 
n M V House 1 i\isii>ek Squire W C 1 


19 MltrS CHARING CROSS RAIIOIS 
i ^ incrcisint nrci I met I ^^0 Pruitc 
£l 200 Dentist on premises House freehold 
to ler or sell — Vddress No 7S**2 B M A House 
I iMstock Squire NV C I 


HOUSES, CONSULTING ROOMS 

HARLEY STREET 

Well Tppointcd House, suitable for 
Medic'll Profession with 9 bedrooms 2 
bithrooms 3 reception rooms "ind lisa'll 
offices 

TO BC ILT OIS LHASn 
NO PREMIUM 

Addiess No 7903, B M A House 
T'lvistock Sqifare WC I 


C OUNTRY COTTAGi; (6 .ROOMS) rUFT 
September Furnished necessities quiei rural 
surroundings biih telephone issured water 

limps smill garden Range London 50 miles 
n istbournc 12 Monthl> rent £G for long lei — 
Morton BrooKlinds Honm E Sussex 


D evonshire street two doors prom 

Hirlcy Street in cxccllcm CONSULTING 
SUITE of three good rooms in one of the finest 
profcssionil houses Rent only £250 pi or 
single rooms miv be hid it £100 pi with plilc 
on the door and ili services Vacinl Sept 29ih 
IVis —Address No 7610 B M A House 
Puistock Squire WCl 


F or DISPOSAL B\ DOCTOR IN CENTRE 
of lirge ind npidly cxpinding South Coast 
resort altnctivc dcnchcd two floor RESIDENCE 
with giragc House divided into modern s.t>lc 
flitlcts from which in income of £200 £250 per 
annum may be derived No entering or service 
undertaken Price for 14 years lease (lindlord 
responsible for exterior rtpiirs) goodwill ind 
V iluible contents £7^0 — Address No 7921 B M A 
House Tavistocl Squire W C 1 


H arley street and district— a num 

ber of excellent CONSULTING ROOMS ire 
iviilab’w for full ind part time use it modente 
rents Pirticulirs on apphciiion — E icood and 
C o 10 Henrictii Place Civendish Square 
W I Lang 2601 


H VRLEY STREET (FIVE MINUTES)— A 
birgiin riRST FLOOR PLAT rent re 
duced five years Icisc lift c h w part cent 
h^ii lounge 20 hy 14 pirquei floor dining room 
{v ^ bedrooms kit bath —Before noon 


iiir nitnisH medic ai jouknm 


1 1 r oiifl tf If 

(ONSIjIIINO llOOM^ 

ruol rssioNAi iioiisi s tV i r ats 

in II trio Street ml the mcdievl 
ifc i kcnet tllv intludirip MufUr 


LCY CLARK & PARTNERS 

MKIIONIIRS suitvnous L \ M UPRS 
1 1 \\ imp »tc Street Cavcnilnh S nnre I 

Icliphonc I mehim 7 

lUpresented n ( vnnrv N| c -sm! Vfiinic Cirlo 


HARLEY STREET 

AND MEDICAL DISTRICT 


Pot itl types of ftsiltihic accoinmrxfitlon 


BERTRAM & CO . 

59 Connati hi Street \4 7 


StirvcYPt' md I sm 
Veentt 

PartdInKlon 1C4'’ 3 


pARMlMI USl 0| ROOM ON IRIMISIS 
• of < cncnl I raetitu n t In I on ton required 
hv (teulot ( i iX! rent otfered Vpptv Be \ 
llvssvroro esp ( (K>t»st\N I to '9 ludiitc 
Hill 1 1 nd n f ( 4 


Q I'Ms \nn( sTRin— oNiy f4t» i \ 

scetifc^ txecpii nvltv line CONSt/llISf 
ROOM for use wlicn requi id vsith nicndm e and 
ill services Uc idcntlil leetmimixl itlon aviilible 
Vddress Nil ( Kx || M \ lime I m tiKk 
S pi irc VV C 1 


S M TDI \N «£M» r I I VNN I\ RVUSVND 
lixts SMMl HOIS! ^ t'^'mv *' t vih 
I IS (■' flu ) I Iceirieiiv e irdenv cinvir' or 
I studio flit I'v per vecik 1 roe tnv I ilh l\v 
— Vddfc N,» -u 3 BMV Htuve Tavit.sek 
Squire W C 1 


I BINIINCK SI III II (CORNIH U M BPCk 
1* Street) —I mest New ( ONSl I IlNP Sltlll S 
in Vtcdle it \fe » I ie!» 2 nnims and livitorv 
Vlso 4 roomed II \IS- Sole Actnis l•sl^T 
DuRUfttut vst» Co 4 Duke Street W 1 
Uelhctk V 

N I VR MVRBII AUCIl— WHOl! OR 1 VRI 
01 HOUSI to let ! xeellcnt Mtintion — 
AreOts iRMsT DtfiRllKi ANt> Co 4 Duke 
Street W I WcUcek s 9X 


Miscni T ANEOUS SMFS etc 


I M PORTANT 

to MEiMiU ns or the 
iMnniCAi iMtornssiON 

CLOTHLS or DISTINCIfOV for GEM 1 1 MEN 
of DISCKIVfINATING fVSlC Spcvnllj Cut 
luted ind Moulded to cich individuil ngurc 
m ide from nnest Quality Miierlits and in the 
Best bovsibtc Style cost no more ilnn miss 
production tcidy mide clothes 
The inviUnblc Incticil Experience and Adviec 
of our 14 Expert West End Cullers ind Pitlers 
IS ilvv lyx at your disposal 

ML HMI/OM ProaitrUins nrc II VM) 
IN MPRT Fss|M|\I 01 EVH 
SllCtil Or^fit 

JVCIvrr V. MSI (In Mick or t.rr> ) £1 t 

Lined lie t 4|tiiiliis \m Sptin \ri ^ilk oi Mpnn 
soiin l\N<\ VVOUSIIO IHOIJMU^ > 

TIic Uleni Snil foe Pr«fes It nnl or Bn Inp iweir 
LOOM h SHIPS to mrii iiir from £f» f 

OM UCOVIS £- ** 

DINM U M IPS £» 9 

Dili SS Sill from £l()i lOs 

1 LUs lOUU SHIPS from ££ f 

Till IDI \L Suit for Ooinlrv mil Sporting V3 rir 

(OID MID VI niDlNt imiicnis from i 

R1UIN( IIVBIIS £a lU 

R1D1N( BOOlb £ I Is 

COblHMIb V I ONE CO V PS LC C 

UNSOLICITED APPRECIATION 
I ttroMe/i athise oil tnallcal men m/io to 

lia\ e saiisfaciton to patronise Harr^ Hall Ltd ns 
all the clothes I ba\e hod from them f/frr//ie 35 
sears ha\e been perfect in Fit Cut and Finish 
(Sti,ncd) SJA MA MB ERCBS 
PATTERNS POST TREE 
Perfect Ht Guirintccd from Simple Self measure 
mcni rorm or Pattern Girmcnts 
Si Itors to 1 ondon can order and Rl ftumc day 
Speclil Fittcrns v otild tlirn be rut and Perfr t 
Filling. Clothes riuppllrd nfter v Ithoni trvlng on 

HARRY HALL, LTD. 

Governing Director Harry Hall 
Tlir Coat Breeches Floblt nnd Cotiunic 
■ bperlnlldtR 

101 OMORDST VV 1 1 19 ClII VPSIDL ECd 

Telephones 

GERnrd 4905 4906 ind 4907 NATional 8696/7 
Makers ot Fmcsl Omliiy Bespoke Civil Sporting 
ind Hunting Clothes for Ladies ind Genilcrntn 
(Behest V^ard 12 Tohl Mcdils 
L»l over IB ye trn 


INCOME TAX 

VOHit 1 nrden I OHB l.n Inr 
Tai *‘|rr|ntUla to the Medlral ProfMdnn 


HAni>\ A IIAKI)> • 

l*» (liVNflltV I \M lONDON Vt C.2 
Pelejlunei Ilf II fn (d “ ) 

H rite Ity free enpr of Ad\ ce o \ Ircciee Jar 


F or sMi-foMinu thpvprp polip 

Vfl N r Sint it I frr Cottiec Hovruit or 
Nufvlp Hnric -Nedfew No “91” DMA Ih'ux 
Tim toi,k Sqinrc W Cl 


P MHOIOilfM MIARVIUS POR SMF 
vcv« nJ htn ! nearly eomr etc outfit £ 0 
In ul ai( r tcnirdu c bdm c Cf1 rimcicr ci — 
ViMriXv N) 7Ht BMV Hojvc Taviqc<k 
S tuifc VV C 1 


R M)H M — <0 Mil I inRAMMP RADll'M 

I t f Mf NT in SIX u, I V tides with ccriificaics 
Ihv 1 i1 Ic hm il Rci hstirsiili Bvflin for vile at 
very fr is mb c pfi c ~ Vd Ire s No “’<07 BMV 
If m e I avistcvV S j nrv VV C I 


C()\ I US I on IHNDINO 

\ 1 I nn I II f 11. IIIIITI'-II MM)IC\L 
JIIIKNM r r I IT mil i rr.li it J.ar .anil 
I, 1 I I r[ r » I ,1 I y I ar..l pn I :! 10 I .afl 
Ur I r ftl!, n| I rt I rl.l. rrmltlanr. liiniM ^ 

oiir. ii I 1 — Tin ••I I HIT tin nuiri II 

III nil n Jill ns ii u n i iio< ' 

riii'-niif, <01 <i<f i(i^iiti\ V I I 


n M»1 It 


C-MS 


1) 


coi'vtii ur Minoirsrx 


1 1 m IC vsviM sNcr i)iiu!iMr'>T 

lINDIIts I OK oniSSISOS WRHCU 
MIIIVNCLS SUKC.irvL 

nt n\sir oKurs n r or prc 

IM(\llON% IKOIHIITMO Dl tos SER \ 

siiKois oMDi r\s oMcrs nc 

I MHOlOt IGM lilOllMTL'! IR'l Uv,i3, 
AM) It SDR M KIOMSITIS (SIS SIOMID' 

IlK Cmmo Ciun il iit MulJlcu-s Iniiin IdJc^ 

for the supply of the iNwe tiMxh or ,,5 

the pcriixl stiied from October ht Ntx ti 
ever il HovpitiK In tuutionv Sanatoria Cnii 
Homes Ofli cs ett , _ . „ „,il 

I ormx of tender (upin whnh otah tenJerv 
1 L con idercd) inJ condiiu ns 1 1 coninct 
ol tuned on ippiic It on to the Director 

Vssi tin.c 7 V Centrd nui!Jini.s (fourth ti Kf 

Miiihcw I vrkcr SlrcLl VVcMmmMcr S W i acco 

Piniid Iv 1 M imptd iddrc cd foolscap envelope 
Staled tenders marked Tender fur - _ ^ 
nuivi be dchvcri.d it or b fore Ham ^ Tm 
Sipitmbir Ht I9t addrtxstd to L 

iht Middkstx Countv Council Guildhall 
mlnsitr S VV 1 the 

Ihc Council d acv not load la 

lowc i or inv tender and reserves the re 
lecepi snv tender or pin only .j, 

Psiimiled quimitie required arc pu 

form of tender and tenderer mav under to 
ill or nnv one or more of the Psiahlishmcn 
t^erned ir-rr 

r.niiiinii c w RAr>cL'rr^„„„i 

W csiminxicr Cletk of the County Coi 
Aueuxt 19tV 


\PrOINTMFNTS — Conld 

\KDirr ROYAL INnlt'I'K'' 
(Associated wuh the VV'ebh National 
School of Medicine) 


of 


Vpphe ilions are invited for the pod 
RESIDENT MEDICAL OrPICER j 

Duties will include case record kcePinR j 
leaching nnd Mtdieal work under the uirct 
the Honorary Stall , .. a 

Candidates must be Doctors of of 

University of the United Kingdom or Memhc 
one of the Uov al CollcKes of Physitians 
United Kingdom nnd must have previous y 
a Resident Hospital post 
The salary will be at the rate of 
with board residence nnd laundry ^c iPP . 
meni is for one year nnd the holder will he c g 
to apply for reappointment and may retain 
for three consecutive years -w- 

Further particulars may be obtained fro . 
Medical Superintendent to whom ^ 

(indorsed R M O ) with not more ihr" mt 
testimonials (copies) must be cni b) 
Wednesday August 3 1st 1938 
Bv Order of the Council 

R ARMS! RONG , . 

Medical -Supcnnlcndeni 
















\Lt iM p ms 


un BUniSH Ml DICAL JOURN\L 


'^t>KK nlSIlN\^K^ 

31 3tr t M f f ih i> ! I 

Klvtn SI MlOU M OlMClk c) i 

cto? '•n^ 

lb ti *ri r-cv 3 l ar ct r » t t r cc 3I 

t3njL.atr> r'u't K c t i. a -xi tcft'TrtcO 
rvl ~ tt T ! "v wfve I'l t < -o— rai 1 

« ov* ul 

Sj \ X f O' rvf ar- -n Hi *1 N -r\! 1 v « nc ar 1 
c*' -ocr H h ar all h »s,-c t h rv. ~>t orcr* t 
rvi f r k Tv. 5 

Ar* *031 •*' H h tc-i •" '"a in Kc '<"1 » 

JOHN c n U HV 

•* b reel \ r t VvtctaT 

“pHL CLW 0\\ LM JSIIRM^R\ 

T> D rort m tc ap'' aii"^ fn'*T^ rrr ifttd 
^tcvs_! Pr3“* I net ft I'-c I -^1 c Rf^inisr 
){l)LhL }>L KC Ct^S SiL^*^ tl 0 pcf am ■*n 
» *j 3’*_Ttr*-r a-'.a t -rii. 

A""~»w'ai 'j f tnt «h Jik? 

be Kv4,rvl '»uh lb u'><-cr r^cv. b> \i,ru I «''ih 
|«.Jv 

T C CNLDWrtL, 

l-T \\ CM Gcscc '' fCTi ScTci n 

C JL -'H C. 

^tr -'1 o-b I*- 


R T U 1 S G 


HOSPITAL 


S’'” “ arc n'l cvJ iNr r "i ol IIOI si 

rH^ilC.I\N a- ari 01 (kTC*^ •bh Ibc ar'> n 
r'c'- ■' fee IT r"T' »• Si^r> at tb r^t f fPO 

per ■" ^3 H tb Kurd ItcJi -t and lax.»vlo 

Ca'v- - tcT Imalc) bud f rn rd ap" KJtw 
a a *c nan n^I r> c -at 'm arvl carcrv 
c*vc « ed by tc^t r'nn 3 «0 the un^ef 


\ur t ih I® ^ 


\ \ OSklOS 

ScTctarj Supemterdert 


OKTHISG HOSriTSU 

-> M n 1 eu f f th ro«i cf fU'LSE 
SLROEOS 3-a p-*w. Tb- ar'v ntr'cnt 1 (cf 

S.T r“ n h S-lan -t the ra e cf £Po per nprum 
H h Nva d 1 'u. J”r arnl taurwo 

Cj-nui-jin true) *• -’d f'rw.ard arr "a' 
tat "s •‘•t p n 1. itT ’ lain a*sJ e>'*et>- 
<r - 'iTrn--r -u bv i« -r-'j’ to the ue- cr 
r-v 

S % OSKTOS 

^ cjm '' 1®* te 30 Su'«cTin iTdcrt 

C ESTRAL LOSDOS OPHTHALMIC 
HOSPITAL 

_ JjdJ S re« S! Par-^ W C 1 

Arr cat! re trt t» ft -1 re*-<tcfcd ned t 
t pcrr for ib< pcko t f SiSfClK ard it NfOR 
HOI SE SLRGEOS 3 catii on Serier'bcr fbh 
Th lun IT H Su icen t 3 catv-^te f 'T the 
Ser r rc<t Salar> £! 0 a-d £lOO per annum 
reMW’t'clt ^Mtt l^rd ard rc'^JcrKc 

Apr > 3 t "‘th coper of ihrcc ie«tifoorul 
bouM re- h the vinder'isncd on cr before Ausirkt 
1st 

GEOPCE M ATJS 

Secicury 

E ast haai memorial hospital 

SbrcHvbuo Road E 7 <104 Beds) 

Ar*' railom are ntiied for the pen of HOLSE 
PHASICIAN (r-jl ) The arroiptncrt b for si» 
months comr-crtwins Sertcrr'fcw 1 st 

Salarr at the rate cf £10 per anaun mib 
beard rcs-uen-e and laundT 

Arp*>cauor» statiax -re nai orulity arcnerce 
arc fuM ranfu^fs topeth-r nith copies of three 
tc^t "*cn^ s bouU reavh the uncers-^ned b> 

\UC\ 3 t Hdi 

regisald perry 

^ SCCTC arr 

R oaal free hospital 

Gra> s Inn Road London \\ C 1 

Apr mticns are mstted from dul) qual fied and 
resr^ered 'fedtaf M omen for ihe f Tfcwirr pext 
RESIDENT CASLALTS OFUCER Duties to 
corT'cnee Octi-ber 1 1 for « months 

Salio £1 0 per -nn itn 

Candidates mu t ha\c bcld p esfciis Resxlent 
ho'C 4 I a-rv nt*ncnts 

Arrifcat n ( nn mas be had from ibc und-r 
-r>cd and sbcjid be culy filled in and returned 
cn c- before Ati-u t ^Ist 

RICHARD T BARTLEA 

Secret ry 


T he infants hospital 

A ir cm bquare \A csimtrtstcr 

Ap'* “tl r re intued f ■>' the post f HOLSE 
PHAS4CIAN tenher «ics) SaUrs at the rate of 
£!»' per "n-um Htthbo^rd rCMdence and l-undry 
Tb^ arTo.riT-'ent k f r i\ men hs from Ovicbcr 
bt 

A Jot ns s nh e’ries of tojimi n iJ to be 
fcTH ded to the unccrMjred not later tban 
Ac**u '1st 

ALFRED J SMALL 

Secretary 


Q l I I N M ARA s IIOSPITM I OR Till I AST 

Straif I I nJ n I !< 

RISIDINT MiniCAl OIIICLR 

Ap-f at n at in ited ft m fu f» qn d 

and let creU rred al r^cn t r t> ft r the N e 

r'*'t 11 c H -‘p tal et n n 19 bcc jn 1 1 m 

O f r M ffn t» paten 

lb a-»v''nir" nt H 1 be f \ r-ontb dst n- 
fi m <kt Kt 1 t 1«1 t Alir h *1 i I9i» niib 
a rs at the 1 c 1 it O per arn m In acd t n 
t b v»i i\ the Rovcri Atcdtal OH cr re civc' 
certa n im pj 1 b> t e Nati ral Hralih 
In iirarv c 

C-rv.Katc' h 1 mu t bs. n e and nho should 

prcM **•'!> ht c hc.d h Hp tj| ap-t ntmen ho ifd 

rn 1 ap- at c rp'ur ed b> ic'tmtral to 

the un et cn*d n I ter thin IburvJ > 
Auru 1 ih I91A 

RM II ATL JACKSON Maitr 

ScvTciary 


Q i I IS aiaka s ih>s! ital I or Tiir i ast 

IND 

Sttatf nd LooJ n 11^ 

on<>TrTRic IIOI sr surgeon 

Appi ati< rrs arc insiffd fr -rt f itU quatif ed it'! 
ren rered rr-d »l men (only) ft r the ah< \e p*^! 
Ibc Htwri I t riaiot '*19 bed m uJmc 0 for 
Afaterr t> pat cm 

The ar*fv nt— ent Hill dale ff*m Oci< her I I 
I9tt and HiH be f f ibfcc moo hs as Jin or at 
£Ud per ann m ar*d three m rths a Sen or at 
£no per annum 1 tn )niht in all icrminatine t n 
Afar h 'Itt I9J9 

CandKlatm mir^t be n«tc arsJ stho hould 

r*fr* HT'l) b^xc held hmp lal appo nirrent hould 
x<r>d ap- mtion acctmpnn -d bx le^t mor al to 
the under icn-xJ p-t later thart ThurvJa) 
Aucust ^th 19 e 

R APMACL J ACKSON A!x,or 

Secretary 


XHE PRINCr or AA ALES'S GENERAL 
A HOSPITAL Lonccn N 15 

The fcloHinc Rcsc-pt P^nts mil be vacant on 
Sep ember f*fh nexr 

I (at O-e ILNIOR HOLSE PHASIC! AN 
* tb) Txxt JUNIOR HOLSE SURGEONS 
‘ Salary al the rate cf £®0 per annum N-ord 
tes dence and laundry Appomttrents held for 
n''nth but ht dcfi arc eli“i^ e fer a further term 
as Se-KT ^ 

CardidafcA <male »T»d unourned) mtrst be fully 
I qjalt-d and ret« tered and aprl*eattons ton the 
prexenbed form) icfcthcr mth copies cl three 
recent test/rPonuK should be sent to ih- under 
sicned co or bef rr aucum 'It 19 S 
, ) C IIURDETT 

i July -I t 1919 Director arxd House Goxerncr 


T he PRINCE or w ales's general 

UOSriTAU LONDON N 15 

ApplicaiKns are tnxitcd for the appo ntTTcm of 
HONORARA CLIMC-AL ASSISTANT with 
rectal Psych jtru. cxpcrictyrc 
AppL'cations bcuM be sent to the uodcrsipned 
on or before Aupost ' 1 st 193 S 

J C nURDETT 
D^cctor and Hotne Coxerncr 

July 'O'h 1939 


D readnought hospital 

Greenvxi h S E -10 
tSomcn s Hospital Sccietj ) 

Halftime Noo-Re?Klent Afale RECEIMNC 
ROOM OrnCER required from Scpiem!^ 1 st 
for IT months. Morninc or afternoon sessions 
sxith alternate Saturdayrs 9 a ra to L noon 
Prextous erpenen'T in residentul posj rss-ntial 
The post IS suitab c for those stLdymz for hieber 
cxarninations Salary at the rate of £ 1'0 per 
annum mth r*eals. 

Apr *aiion statins ape mtionaliiT and espen- 
encr accompjnied by copies of tertiraomals to be 
sent at once to the uodersipned 

r A LA ON Secretary 

July ' 0 *h I 9 'E 


M iller general hospital 

Grccnsu h Road S E-IO 

Appl call ns are Inxiicd for the followims pesu 
HOL'SE PHASICIAS (male unawreed) Salary 
-IPO per annam 

HOUSE SURGEON (male, unmarried) Salary 
tlOO per -n-uTt 

CASU ALTA OFFICER (male) part Dire after 
noon e<^on Salarx £1 n per anrutn non-rcsidcnt. 
Ful cr part nilars on ap^ * 03 x 100 . 

The ap-omtments arc for w months from 
October 1 t I® ** There arc sa Resident OfS-ers 
Appl cation (■'rms can be obtained from the 
Sccrcusrx and inu<t b- rctunted not Her tban 
Au UN- -O-h 19 S 
August fd 19 9 


W rST HAM HOSPiTAl TOR NTRAtHS 
AND MENTAL DIS )RDERS 
Goocnayex Ilf rJ E ut 

Apr ( Jlior are i-x ted f r a rr c Jl NIOR 
ANSISl AST MEDICAL OTflCCR ai ihe ■%*'tc 
Umpml Card uaicx mu t be unmarr d 

The c mmen r xauiry i ji the raic f £'<0 
ref nrum r b annual n reme of t 

to a maiinii nt f 0 per annum i her u h 
c*” I rrcni - tin of t ard I un r> nd 
attendance xalucd f r ip ranrujlion r rpoex t 
11'® per annum Tbc perM n apr ed t' 
be pa d in adJiti n i h «aJ r me urn 
£ d ptf annum m **1 n n the Dr "“a f 
P h *al Aledi inu 

Th appo ntm ni is ub c t t m - h 

pfoNiion nJ to the p - o th A slum 
0"i erx Sure annual in Act 1V09 C1 s 1 d 
to a V3 1 fan ry med al ex mmai n 

A IroHlcdf- of bactefio o al werL * I! be n 
adxnntjcc 

App i-ati n statin acc ard expencr m 

p.tr cd by co ics of ihfcc text r*on als m t re h 
the Afed -al Super mend ni nor la cr ib n 
Augu t Mst 1® 9 


T he kOAAL EAE HOSPITAL 

St Gcorcc < Circu S*. jtb'»'»rk S E I 

SLNIOR HOLSE SI RCEON od TWO 
ASSIST ANT HOLSE SI KGtONS required at tbc 
abo c Hmpi al The appo mment t n the fir t 
m tarve for a perod of lt rnuotb h b rd 
and residence *s from O..iober 1 t 

Sa-res Sen r H jc Surgetn at the r le f 
£1^0 per annum A tant Hcu'xc Surpeurx 1 £H<> 
per annum Cand dates rri-t be reg e cd 
practm ncr\ 

Appl -aticfi with cx PIC* of three rci-cnt tmti 
mon al hould be ent to the Secretary not later 
than Thurxday Sep emb- J$t 

r E. D ALTON Secretary 

SALAATION ARMA THE AfOTHERS* 
A HOSPITAL 

Loxxer C3:ar on Road Clapico E.5 

Applicatt 03 -le inxi ed f cm Alcd ml U rren 
for the r>o«t of JUNIOR RESIDENT AIEDICAU 
OrncCR meant October It 19 9 Salary £9n 
per annum vxuh board rK*dence and Lundry 
The appoinfment a for te months 
Applimti rx xxith tesum n -! ntix be ent to 
Ihe Secretary en or before Afor^lax Aumt -9 h 
19t« FRED HAAfMOND Secretary 


THE CENTURY 
INSURANCE COMPANY LTD 

7 LEADENHALL STREET 
LONDON E.C.3 

18 CHARLOTTE SQUARE. 
EDINBURGH 

Assists Doctors 

TO PURCHASE 
A PRACTICE 
OR 

PARTNERSHIP 

NO GUARANTORS REQUIRED 
REPAYMENTS ARRANGED 
BY EQUAL QUARTERL'i 
instalments HIGH DO 
NOT VAR-i UnTH FLUCTUA 


nONS IN THE BANK RATE. 

PLEASE WRITE FOR 
PARTICULARS, STATING 
AGE !\E\T BIRTHDAY^ 


MENTION B M J 




44 


THU HRIIISI! MIDICAI JOURNAI 


Auc.usi pi 193'! 


THBB^ A^nBiliVrY. I.tlol. 

DuuTc\ iioust "ir. in souiiuiMinoN si \\ ( 2 

TWrp/ioHfs— lunplc Htt 1034 1054 I MiWhhcJ In b> J A ! r*Mt»r 


WISI COUNlin — I MUNI RSUH* Oldclil 
lishccl loun Tnd CounirN Ir slut suit to 
Cl niptltni Mirccon One third vh iri i>tTirtd 
with Mc\N to Inlf Ucttipls <■4 0( 0 ! irtt 

puul Prtmuim >tirs pmtlnst 
Dr\<JN — \SSISI AN I SI IIP with to Mttis 

Sion Unopposed Counirs fritti t \ it\s pirt 
ntiship in SIX months Prtf n muiud min 
Rtctipts £1 00 I unher det nl on rtipu i 
lONDON W . —Mixed Cl re tdtninl liuihiN 
Double fronted house I iri.c ^llrdtn nr ice 
Receipts nenrij £- 000 IMntl 1 ‘^t'O I rtmium 
for Rpoduill md house 14 <00 or nt ir olftr 
1 ONDUN S r — orkinR tliss G I lion c to itni 
Receipts npprox £2 00 I’lncl 3 00 m f tes 
1 6 up 1 \pp 1 rcmiiim ) vcirs pitrcln t 
or ncir offer 

LONDON \\ — Ets\ disnnet NN csl Pnd Middle 
class C P House to rent on leist Rcetipts 
approx £2 400 Panel I ^tH 1 Stxtril app 
Pee up Premium £4 000 or near olTer 

MA^X OTIIKUS 1 oil s\ir 


ElsTAULisiiro 1877 

LEE & MARTIN, LTD. 

The Birmlnffh'im IMcdlcil Ajjoncji 
71, TEMPI E now. BIRMINGHAM 

Telegrams f^iephnne 

Locum IhrminRhim 5063 Midland lUnm 

TRANSFER O^T PR/XClICFS AM) 
PARTNFRSnirS ARRANGED 
MWIMUM TLC £50 If cxclust\cl> 
cntnislcd to ux 

ACCOUNTS tWrSTlC ^Tl n IND t\CO\it 
T>t\ rrivp'^s tnriAhhn 
RCLINOLC AND CrriCICNI LOCUMS SUP 
ILILD AT SHORT NOTICE also ASSISTANTS 

II WTfD TO ri rcuASi 
\ BIRMINGHNM (or ssnhin ^0 mile thereof)— 
Good Mixed PRACnCI ssith ii I incl of I ml 
over and receipts of from 11 *(M» U UOO 
URGCNTL') RPOUIRED CSPHAI W Ml 
ABLE 

2 REQUIRED —Good Lnehsh Scottish and In h 
LOCUMS Immediiit post> to olTer \lso 
ASSISTANTS pood posts to offer vsiih ind 
without view 10 Partnership 

FOI DtslO%\t 

1 GLOUCESTERSHIRE — Well established 
middle tnd workinp class PRACTICP Re 
ccipts av £1 250 pa Panel 1 200 scope to 
increase and pood house with all services 

2 STATFS — Rapidls mere tamp Mixed Private and 
Panel PRACTICE Rceeipts last >car £1 OsO 
and Panel 1 230 over tvccllent House all 
sen ices 

3 MIDLANDS — Old established industrial ind 
middle class PRACTICE Rceeipts averace 
£1 068 pa Panel 562 scope to increase and 
pood house 

4 SOUTH WALES — W'cll established middle and 
workinp class PRACTICE Receipts last 'ear 
£2 200 Panel 2 100 Good house 

5 LONDON — Old established mixed Private and 
Panel PRACTICE Receipts av £1 7<0 pa 
Panel 966 Ample scope to increase and good 
house 

6 WEST COUNTIES— Old established workinp 
class PRACTICE Receipts £1 7<0 Panel 2 •'26 
Good dclacticd corner house wlueh mav be 
rented 

FINANCIAL ASSISTANCE aHorded to approved 
applicants for the purchase of Practices or Partner 
ships on very rcisonable terms Full particulars on 
application 

RELIABLE AND EFFICIENT LOCUMS 
Sui PLIED AT SHORTEST NOTICE 


CSTAIILIMIED 186S 

PEACOCK & HADLEY, Ltd, 

MEDICAL TRANSFER AGENCI, 
67-68, Chmdos St BedfordSt Stnnd,WC2 

Telcf:rarns Herbaria Lcsquarc London 
Telephone Temple Bar 5^64 
This old established Agency negotiates the Sale 
of PRACTICES and PARTNERSHIPS on reason 
able erms which can be obtained on application 
LOCUM TENENS and ASSISTANTS supplied free 
of charge to principals 


CAVENDISH NURSES 

•A- aiALE AND FEMALE 1 

Head Office I 

UEVUMONT STRCIT LONDON V 1 I 
Crunches M INCHESTER 176 Oxford Road I 
GL/tSCOU 28 U indsor Teirace H 
DUBLIN 23 Upper Dacnot St fl 
Tetephonei London 1277 \\ clbcck (2 hius) I 

Manchester 3152 Ardwick i 

Dublin 6^006 Glas 477 
lelesranis Tactear London Surgical 
^_^^^^^_^^^^T_£Cic^f^^Manchcstcr Tact ca r 


N I ft) \S1 ~ kliTial C» t RiLiiptv ij pfi X 
£ t>0U I incl ncartv “* on ( hit a ii'-ulv 
1 \pp Itimium 1-. fWMi <r ncir nITcf i 
in hide II >nk Del tv Stirkvf) I iitnlturi. Druv. 
etc 

)ORI SIHRI —Mixed (.1 Uodcnlnl I ujlttv 
ncit lirpi lown ^ftdiiim M/cd In uve I ific 
Ritdcn iince Ilceclpiv U stKi I mtl I'Vwr 
huo I CLN 3 f lip I rcmiinn i ‘■(t** 
lONDON W. -IMUMRSHH Sid iirl m Ci P 
tope loii'c to tent Re ciptv ncarR ff 
I incl ippfivx 4^00 One Iifth vh ire - it irs 
ptitthi I vtttl) \it V to < nc tlurd vhirc 
MIDDllMX (W ) — f* I crnwin'’ re Ifcnttal 
lot iUi> I ucllcnt hou e with Urt pin ant 

tarJen Re tipiv approx £3 I in ! I 

lees up Item vtirv piiri.have I rtt 
ht Id ho ot and lurniturc f * 
lONDON S I — Mildlt-vlixx (» I Rctcipiv 

approx £ I incl I PO I rcmi m ■*)c«rv 

putthivc or near t'flcr 

DFIAIIS ON IM QLl si 


HIE WESTERN 
MEDICAL AGENCY 

TON DON iiiiil RRISTOT 

Dr K. H IlisNin and Dr W ) IvT»vin>*i wh » 
give person d aitcntum to tvtrv th nt 
I iniiniiid A^duettee for Pnttlu ten an! n'l C/ntri 
• / Medutil intiifttme itrr in\e I 
I on MS \N|> \SSISIANIS sun ! H D 
WllHOLI CII\RCI lO IRlNtllMS 
For txthiMve NveovV maxinun commi vi 'n o £<0 
whi li irtUidcs tvtrythint ni» <1 extep* ht u't pri ptriv 


1 MIDLSND cm -Sicidilv m r istn I R \C 

IICI fn fax niritc pdi M^ngt pa 

(receipts C. ‘*2< lot >c»r) I «ntl ' lt)n Well 
ctihlilud I ftmiiim i< Hou e In ex 

cclkni rep dr I tUM» 

2 MIDLAND cm — Womin V I R vniC I Ih 
Irtciitt has been worked cniircl) indtp^ndtuilv 
to the ibovt but tht> tincisil> Ic imiUamattd 
itid worked as i I irtnctvhip tf rcipured 
\vtrjtt £*'60 pa (feecipts £10x3 hM \cir) 
Panel 9(H) Old established CoivJ scope 
Premium £1 MM) Hou c rent 

3 DURHVM— IR\CriCI dome ibout L. OOP 
pa Panel 2 n< Old e labhshed 2 vcirs 
purehise or ncir offer to in hide drue furni 
ture etc House £700 

4 SOMFRSCI CO\SI — PARTNERSHH In 
countrv tovxn Min keen on mcdUinc and 
accustomed to good class patients preferred 
Panel 1 400 Over 13 000 pa Third share at 
2 veirs purchase House sale or rent 

< MIDL\ND CITT — I MUNCRSHIl in good 
part in rapidlj intreasing I ratliec Panel - <00 
£2-12 last >ear 11 df share it £3 000 or near 
offer Choice of luni c 

( LONDON we— PRNCTICC doing II 000 

p i Pmcl I 104 I remium £_ 0tH> LiKk up 
surgeries to rent 

7 BRISTOL — Womins PR \CT ICt wiili cxccp 
tional scope Vendor wi hes lo retire inJ is 
consiaml> refusing work His not encouraged 
panel Cm be quiekly mere iscd Reeeipi 
over C 00 p a Offers eonsidered 

s S COAST — PR \CT ICL in popular town 
Panel 1 600 Avtfge 12 <S0 pa 2 vtirs 
purchase House rent 

9 Genuine increasing PRACl ICt ten miles south 
of London Premium £4_0 Low expenses 


22, Cl ABE STREET, BRISTOL 1 
TeUs* Medgen Bristol TeJ Bristol 22689 
15, BEDFORD ST , STRAND, W C 2 
Tel Temple Bar 2532 


Telephone W eibcck 27-8 
Iclcgrams Assistixmo London 

NURSES 

MALE OR FEMALE 


TRAINED NURSES TOR 
MENTAL MEDICAL SURGICAL 
AND FEVER CASES 

Stirses teside on the pfemises ana arc 
nv«f/u6(c tor itrqtni calls Dm and Nii,l t 


THE NURSES’ ASSOCIATION 

tin conjunwUon with the MALE NURSES 

association ) 

29 York St , Baker St , London, W 1 
Mn, MILLICENT HICKS Siipt 
W' J HICKS Secrciar} 


Douglas I 
Glasgow R 
Dublin B 


PERCIVAL TURNER 
no 

MEDICAL AGENCY 

■ M l sFM I l*snn) ro 

27 MAIDIN I \Nr STR VM) \\ C’ 
(Corner of B dford sjfcci) 

Trlrjrruii i I { < ml m lontlnn 
I III n»» Irtit|tr Ilir *1011 (T linf ) 

Nfict I rii c h Mjrx \\ 1 ton on Tbarex 1 '5 
Nwiv in V an 1 I i cur v f fovuJ J wi h lut f c ta 
Inn ipilv I nCti ex |pvcvtt'’a!ct! DloK kc pi 
Dc*'t Co k tip- etc 

'iwniiM iNdisiM coM3ii*>sinv rnr 

‘•CHI \( I Nt ) OS V.VII oi ntxrrin dm 
*•11X10 ivtiisiM Of noi -I ritorriTi 
t'O nil IMUI- ON IHOl 1>J 

I on HIPPOS \i- 

DI\()N -liNDI’POSFD ASSl WllH 


Half '‘•arc of 
hi'u«c ren fr-c 


viLV I I inn rvhtn nnd vu n 
1 1 " 1 I riinl m 1 1 f'H* V erv n c 
dufine Xxvv — I 

MCI! US SLRRl 1 SUBURB - 

\b uji 1400 pa \Mt T ex cpiionjl xeope Demt n 
ff I r I ITcr Nmill h US'* rent or ve 1 — 

IRINCH RIMfRA— OVER £1 9^0 

pa (J d c\iiblih'*d I ecx 21 Cu'oJ ece-i ' 
1 rtim jnt t <im Nl D ex cnual — 3 

DIRBISIIIRI — COUMRl PR'C 

I IC I about £"”’0 pa c iNl claw vclcet r^r I i 
crcivip and v i pc lIio e of h U'C Pr — va b 
VC ir> p ir hi e -4 

NORlin RN TOWN— ABOUT £'’P0'1 

P* Ncr> I'M cMd land CliiN ad Ar « 
MINI pa Viitv </ to 6/ Pren £3 ip * 

I > k dcM ct H use pnl> £ I'd — ^ 

RIM, CONSa — \\OM\NS PR \C 

Tier Average £4fH) p a Pine over A) 
fee’N < to lO/f Pfemuim f( lloi'c 4 bed 
c Kent ts< p a — ( 

MIDDIISrV — JI\ir SHARP or 

II (MX) pa with V i pe PincI "fO NPP s over 
£!IK) pa I rcmuim ixiH) Nice hi u c to rent 

lONDON W s — VBOUT £^>0 PA 

I incl Viite 3/f to </ premio-n 2 )wr> 

pur h Hi u«e 4 bed ct to rent —8 

I ON DON N \V — ONP PIFTH SHARP 

n( I.,CT f« (WX) n I met rm 

Plcn :/(, n l(> f trem : \car, pjrch smiii 

nnivonelic to let —9 rwiro 

SCOT I AND (N ) — COUNTRl ON PR 

£1 tHH) p I me! pinel of £300 pa 
L5 <x Innmim I) years purehaw or ofTvt 
house rent or ell — 10 ^ n i 

MIDDl I sn\ —SUBURB £1 O'O 

Pincl (00 inercaxing I MS CJOO it 

>e irs piireh Comfx houxe (4 besl ) xell or ic 

SURREY SUBURB —HALF SHAKt 

of £3 (HK) p a OldMbd Increasing modern nou 
garden and g irage to let Pfenuum £3 IX ^ 

HYDH PARK NCAR — 

THLRAP) IRACTICL nboui £1 600 pa ' 
c>t good cl ixx \niplc aceommiHlation o 

I rcniiuni fl <00 — 13 ^,>^r»rAC 

l ANCSTONVN — OI D EST 'NCREA^^ 

INC £1100 p» Select panel of ‘ j-, ,^0 

house ample acconimodalion Prcmuin 
inel drugs and xurgcrv furniture — ‘■*,,,nsrair 

RENT SUBURB— GOOD MIDI's, , 

CLASS nhoul 1700 p i incrnsiiw (,r 

MMis 7/6 ,IP siirstr, <1 Tudor 

mIc might let Premium U Jears purena 

SOUT H COAST -OLD EST NEARH^ 

£1 400 pa increasing Fair panel 3tti'W 
and better class Detached house S ritn— 16 
g irage for sale or might let itfii FS 

COUNTY TOWN WITHIN 00 

OF LONDON —PARTNERSHIP anJ 

sun in EN I Practice about ^ \ Piir 
appointments £8s0 pa 2 yeirs - ^17 

eh iser should have F R CS Choiee of n j,. \ 

BIRMINGHAM NEAR - NEARP^ 

1800 p a pood scope panel ncarlv SOU p 

ingarei House garden V!,d 18 

or let ai 27s 6d p w Premium i‘^7,-nA/Tr 

HANTS - OLDCST 

£1000 pi Pmcl I 000 Appts al out £Pi» f ‘ 
fmiilj house nice garden ind garage 
Premium 11 >cirs purchase — 19 v-inTirlll 

YORKSHIRE DAI CS — BEAUW 

countrv old csiab tIOOO pa oatieno 

grounds rent onlv 160 p i Suit pa 

Smaller house ivailab'e 1 md "Ofti 
Premium £I <00 — 20 , UP. 

NEAR VICTORIA S W 1 -LO^^’ 

about £800 pa intrcising panel 3X0 at £4 

Ample professional accommodition on re 
pa Premium H ycirs porch kc -"-J . « ixi 

MIDLANDS -OLD EST NE^'^aVo«< 

POUT ANT town tcopL Vendor ru irins ^ t 

£650 m PlnelTjO Trent 2 yearb pnreM« 
reeep 6 bed itoodeitden for sale or nue 
NO CHARGE TO fURCHASER' 
financial assistance lN 

ASSISTANTS — VACANCIES „ 

Town nnd Countr, Indobr ind Outdoo 
applitalion 




BRITISH MTDICAI JOHRNM 


BRITISH MiEEDnCAIL 

(The Scholastic, Clerical and Medical Association Ltd ) 

IFOUNDED 1880 ) 

NORTHEBBW BlEAMCIII 


33. CROSS ST.. MAKCIIIESTEK. 2. 


Ttlcphc-ies 


(Manchester - Blackfrlars 3925 
t Manchester - Rusholme 2 S 49 Cofli) 


Tel prams 

“Locum, Manchester* 


Branch Offices al Leeds and Belfast 


Recommended with every 
confidence to the pro 
fcssion by the BRITISH 
MEDICAL ASSOCIATION 
as a thoroughly trust* 
worthy medium for the 
transaction of all Medical 
Agency business 


TRANSFER OF PRACTICES AND 
PARTNERSHIPS INTRODUCTION 
OF RELIABLE ASSISTANTS AND 
LOCUM TENENS at Short Notice 
VALUATION and INVESTIGATION 
OF PRACTICES, Etc 


FOR DISPOSAL 

I Fb* 1 aJ *» /fft r»i *ar»l I 


Practices and Partnerships 
wanted Large list of 
bona fide purchasers with 
ample capital available 
Enquiries invited from 
prospective vendors All 
information treated in 
strict confidence 


L.\NCS TOU*N — Sv micJ pjpcl anj IV. ate PRACTICI cU e to 

c u*i3r\ In r e'en: hand^ a'' 'cars Ca h rree pt' >ear £I I jnel I 4fn 
Nkx hcjse 2 rrctruon 5 bcdf'Hmt gara-e and lar~c gurjen 

— c^cno Nt n ^3 

UVCOLVSIMRr.. — oM-<^tab nh d PR \CnCC in p’-aun country 
tc«TV C^h rece p 1 %car £2,4'*| Pane' ahou: I to ta** llo<"ta1. 

Good hojv * heuroor-n, srna ga d n. Pren: o.'n— Pra*t»*-— 

r f ousk sal- —No 1 13_ 

OlEiniRi-— O J-«3t3^'tsbeJ nu-d Parel rj Pn'4 e PR VCTICC in p easao 
Ciyptrv t »n A'era— cash recci-ts Par-I t <9. Auraniv 

htnsv 3 recer n 5 bed*oo-Tn, ra ape arj f rv pard a with tennis cajrt 
I TC** Pre-n Ltn— 1 1 stars purchase —N 

MANCHEyrER — O sJ-es ab shed nidJl and w lin-<tt PRACTICf m 
iu»'orb C-sh rece "tj las sear 12.527 Panel Co-wJ sco— O v»J 

se^Hcei- h*d h"* ise 2 re*epttnn i bedrtx'ns pane- a-d small pard-n 
Prc*"JirTV— I * c«rs purthav. — No I IN; 

YORKSHIRE O' R.) “O d-e'taW sh J mit-d Pjn-I and Private PR tCHCE 
n b- ter w(?fV.tr''-c!as5 and ru al drrnct Cash receipts las; j tr £I |V6 Pan ! 

I N, Scc-e. C>x! hoase 2 fe'ep ion, 3 bedrooms, rnaij i res m 3 Pro* 
femora! roo"is (sc-a-a - cntrarsrel pard-n with tenn« coan Rer £4Sr^ 
Carape rc-ted Premtun — I! e-rs purchase — 

No 1122. r" 

hUNOIESTFR— Nerv oM-estabUsh-d Par^l 
arsd Pnsa e PR \CTICL, i. Bering s. pe f< r preai 
jni,re-ae Cash feceip*s -pproxirtateh £I 3^ pa 

P-rcl 1464 Gotx. hotase 2 reception 6 bed- A COf o*t-m iLi*rc 

To^ ms, 2 Pr^ressional rooms (separate cr ranee) AooloTAni I 5 

parope and small parden Premiun—Practice— 

£3.2*0 (to include book deb%53 —No Ffir Tmnifdi 

MIDLANDS— Incrc- mg nidd- and working iiuiiicui 

class PRACTICE in larp- town. Cash receipts 

last 'ear £i 0*0 Panel oser 1,200 Scope 

Excel ert T~oc m house 2 reception 4 bedrooms Apnl\ with iuU mir 

parage .-d large parden For sa*- Freehold wtinjttupar 

Premiuin — Practice — £2.000 — No 1123 
EANCS T03\'N — Nen o'd-CMabItshed mixed 

Panel and Pnsatc PRACTICE Cash rcceip s (as sear £1,372 Panel I 925 
S»jnpc Good house 2 reception, •* bedrc*orTis 3 Proressjotul rooms (se'^arate 
entrance) Premium — Pr3-t»*c — II sears purchase — No 1131 
MANCHESTER — NNell-es ablished pux-d Pan-I and Private PRACTICE in 
pcasar suburban d stm adpeen to new Hoasinp Es at- Cosh receipts 
a-p oxima e'y £I 100 Parse! abou t 000 Excel ent moJmn hoase 2 recep- 
tio- 4 bedreonn. orage and nice parden- For sal ornuybereaed Premium 
— 11 sears purchase — No 111' 

SHROPSHIRE — O d-extablrshed tnoppoxed Countrx PR NCTICE Cash 
I^t 'ear Panel 4^3 Modem hou>e 2 reception 5 b-droorn^ 

< Pfcressional rooms, parace and large paid n Elcctfrc lii,ht Rent £i0pa 
Prem um — best ofer — No I0>6 

^^^^'^''‘CHESTER — N'e t-es abl shed m dJ e and better workm-'-wIas 
PRACTICE m p asam suburban distrsct in pT<.-ni hards 15 years. Vxera- 
a h receipts ov-r £3 OCO p a Par-l 1 S33 Good s,.ope Good corner h as- 
- recc" ion, ^ tedroorr.s, 3 Profess onal rooms garage and pard n also Br3n,.h 
Surge'' premtses. Bo h nu' be r-r ed on lease Prem um — 1 1 years parches— 
—No II a 

LEEDS — O d-es afclished middle and workin -c*ass PR \CTICE 
CwSh recem 5 asera e £1.2tX>ra P-ae! 900 Lxeell nt d ta hed hous- 
2 leceptio^ - b-u-ooms. Profess onal rooms (<;ep-ra c cnrancc) garae- and 
f^i-en Prj-e £1 000 Mortga-e can be arranged. Premium — Pract .e— 
di >e_rs purchase err ar offer — No 11^ 

NEA R M WCHES I hR — Aers old-estabi $ i J midd’e and workm-'Clas 
PRACTICE in prope-ous to n Aer' s-iiab’e for i o fne-o in pann-rshm 
or max be run b' o— rran and an Ass s ant Ca>h rec-ipis las ear E '4‘*D 
P-^eldCOO Ni-'emod m house 2recerion 4 bedrxms, se-jr’te Professio ~il 
rcH.n garag- anu l_rge card n For sale at 'aluaiion Premium — bx. offer — 
No 1 1 " 

«r-r, , rtdde-cass PRACTIC" 

lb 'ears Cash rece ptso 
sc _ r-'-p I in 5 b^roi m 
* garage ard ni-c garden Premiu"’ — 11 ears pur-hasc 

NORTH AAALES COAST— Good-class PRACTICE m sele- res d n al 
res rt Cash re-m -ts la t ' ar £*^0^ No Panel c appoin rc-nis. NiceueiaheJ 
heu e ' th S''e''dd axommodaiion garace ..rd garden Premium — Praai'e 
—2 years pur hase — No 


— WANTED — 
ASSISTANTS and LOCUMS 

For Imnicdiole Eiij. ipenicnts 
Apph with fttU partuulars f<? <7^0l c m/r'rrjs 


NORTH AAF-ST I^SCS — O d-estaWished m xed Pan 1 and Private PRAC 
nCC in farg- t n Cash rem pts last year £I 102 Panel oxer 1 033 Co J 
house p’eaonti situated 2 re-eption ' bedro ms, garage and small card a 
Premium— Pra tice — IJ xcarx purthasc — No 1 10' 

NEAR MANCHESTER —PARTNERSHIP in o»d-cs abitsh d mix J Ji t 
Pramre t Ain- to dea h of s-nior pann r Ax-ra - cash r-asi'' s £2.445 o i 
(i>.rcasin ) fanel2, hj S op f rinmeas Gond house to rent, 2 re*eptJon 
4 < bedrooms, 3 Prt e x xnal rooms, gam m and smJJ gird n Premium- 
one half share— 1* ears pur has,-— No 1114 

DERBASHIRE— 01d<si3*'liih*J PRACTICE canaSi of great in- rea^ Cash 
rece pts las ear £ ■•0 (ifvreajin*) Pan I '52. ExceP'nt hijse 2 recepjon 
4 bedrooms. 3 Pro esstonal rooms (ser.ra.e en ranrei ga ac and gtxid garu.i- 
Prem am— Pra-*ice and bouse £1 533 —No. 9b7 

MIDLANDS— PARTNERSHIP m cM< tah ish*J Pra-'i-* in larg- Citj 
Ca h rC'Ctpis las year £2.-4. Pan*) % 107 S-o*^ Ni*e house 2 reception 
stud k un — hall 4 b*dfv-.Ti<, sma'I gardm and gam-^ Pri*e £1-303 of 
whi h suHtan u! sum c uld rema n on mortgag* Premium— h-lf share— 
LL.40-.No 11*6 

NEAR MANCHESTER — Aerx o!d.«t-blrsheJ midJ e and be t r sxo k rg 
cJ-ss practice Cash rc'eipix oxer £2, '03 pj 
I Panel I .*'0 Excel -nt d-tached hoa^e 2 
reception 6 bedrooms, carage and gard,n with 

EJ) icnnrscourt Pn-m £1 000 Premium— IJ ears 

purchase— No 110a 

J f MIDLAN ' prc 

nd LOCUMS limmao Prac 

tice Ca an-1 

iiij. icenicnts 1 ^ In-ommc partner may choose own 

res dcnce Possibility of Hospital appointm*'',. 

Premium — 7 2-»th share — ■* scars purch-se. — • 

Funher s.hare n three yearv. — No 1069 
irc f /7 /jhfix/’ nilftrrKx NORTH ELAST COAST ^—Old-es abluhed mixed 
irs toanosc aiurcss p^^^^ PRACTICE Cash recetr,s 

— - — I las: x-car £2,160 Panel 2,220 Appomtment. 

riraps'erab’c) oxer £400 pa. Goc^ house 2 
reception 3 bedrooms, > Protcssio-il roomv mrage and sma 1 card a. 
Pnee r“00 Premium — If years purchase— No 1094 

NORTH STAFFS — A e'y o d-esjxblish d b-'te working and midd'-vass 
PRACTICE Ca h re^ipts las year £-,431 Pan*l 1 225 Sco-'- as distnc: 
dexeloping. Excel! nt house 2 recep ion 4 bedrooms, maid s room, sepa ate 
sur—rx premises, garac- and gard n For sal- Freeho’d. Pr mium — Praaiw 
— li 'ears purch_sc or near offer — No 1120 

'lANCHESTEE — Sound old-es aMtsh-d PRACTICE in industna dis net 
Cash recei" s last xcar £2,203 Par-l 2—30 SwO'xe House 4 bedrooms, 
2P ifcs'ional ro xms. Rent£5Qpa. Premium — b-s offer — No 10x4 
NORTH MIDLANDS — Old-es-ablbh d mix d Pan I and Pri ae P? AC* 
nCE in Country dirnn near larr* town A era- cash r“"eip s £1 0^7 px 
Panel 9'*0 and transferab’e apnoirim n s £200 p a Excelieru deta h*J house. 
2 reecpiion 6 b-drooms. Pro ms onal rooms, gara-'e and larc ga d n. Pnee 
£1 2*0 — Prcmi-m — IJ cars purch-sc — No !l!" 

CHESHIRE TOWN near Alanche^ter —DEATH A ACANCA — O d;<^a^ 
Iishcd mixed Panel and Prix-te PRACTICE Cash rece pts last «r£‘6-,6 
Parel —la' S>.or« Exc* Vnt deta hed house (in own g ounds) - fe'C'^tio- 
rooms s ud 4 bedr'».ms o'’ * h ■*r\ msnuiytcr 

ard garden For sale at xalu- —No Hub 

NORTH EANCS —A ORK' ^ 

Countrx PRACTICF n pr , u 

Paref-nJ appointments approximate y Opa. AAd-buiIl bouv. tn amv- 
•..-c immodai on cenir-I heating, c eciri- Iikh* garag- and a of . ames. 

Rer IT'pa Premum— £l_Q0 Ae-dor re'inrc — No 1119 
MONMOLTHSHIRE— O d-esiabltsh-d Con ran PRACTICE Ca ^ n s 
la l year £2 114 of whi h oxer £2,000 i from contra- wor*w Ex el -n h j 
conta nir*' 3 recemion 4 bedrooms. 2 maids roomv gara'e for 2 ca's, and 
gard n Rent £a_ p a. on long lease Good pro -'e-ts of icm-.-se in in 
Premum — bes oTe — No ll-r4 

YORKSHIRE IW R ) — O d-es ablish-d m dd - ard bett-r wo km cass 
PR ACTICE m lar-^ town Ca^h receipts la_ ear £I "o— Pan. m t 
n..xu'a~cd) ' 0 Good bou^ 2 rN-p i n -♦ bedroor^ a P o‘’-*ssi -_J r mi, 
g^ra c Fors_le o ma be re.-'ied Pren lum — 11 earn ''U'ch-i.— Nx il-»I 
NORTHWEST CO AST — Mmltaal Womans PRACTICE oT m ..mat 
scope Ca h rcc-ip^ ^6"* Good h'^U' o rer a. £4' pa Pr mum — 
be*! xfT-r — No 114 


All eo'nmunications to be addressed to the Branch 11; 


:er BRITISH MEDICAL BUREAU 33 CROSS STREET ;iANCHESTER, 2. 







4(5 


FiK nuifisn \ii OK 'I ro(JKN\i 


\( I ST \' IT 



(I t I *.1 11 1 


Tele Adilri ss 

Triform, Weslctnl — I omlon 


IVMSiOdv noi ‘'i SOI, MI 
J \\ !S|0( Iv SOI MU W ( 1 


f"' li pli'iiip IiistnnI 


The Assocnlion Ins lone, heen fi\our\hl\ tiiown to tin. iiimltf' ol tin \kilu li frolcnmn i ihprot, M 
Inislwoiths ind siieccssUil Irenes loi tlic ti in'. o.tion ol c\ti\ ikwiii'lion of Mt.thi.il S,.h(ilis'i ,n,i \ccoiriar 
business ond the BRlllSll iMl DlC \l \SSO(_1\1ION i is L\tis sontulciuc in rcsornn tn liiu its ninbrs 
to consult The M linger in ill ti ins u.lions tLi|uirini the '(.nuts o' i Medu it \icni 

Mtmlu r of the British UTiitii il \ssiii t ition in i\ t it < aihiint ii.i of ii rrtltii i il si itr of i Inrges npiiliciUi 

to lliLiu 

U1 1)1 (T ION IN Ills 

In cisLs whciL the lull HI m ol. A, • nl tin loiiiiil ion In 
icsiiLCt of in\ lit of (ooltlll liool ,1, ti' fiiniltitii tlrui 
tilling:. Hid oUiLi t tfi ( t (i\chidln> tb o' nils fri'hotdor I, i 
hold jiiojuils Ol of 1)1 Klin, ittii.li t i out idi (rii t I rtt ilnl 
Is limit, d to I m-wiiniiiii f, , of 1 ift\ 1 o iiid 

llll ri ItMs ON \1'1 I 1( \1 ION 


Pniilicts 'lul I'lirtii, rships for Olspositl 

I VACANCY — Rcsidcnti il town in lUrk 
shin. Cish iLctipis ) ir tiultil Dittnihir 'Isi I'lT? il 'H 
i intI rtUiincil 16 0 Moum. (6 tXtilrooms) to utM 

m PIIACIICL iboilt 

n,s;,Wn'’r‘ 'I'd ''oAin^sliss disiritl I’uul I 7SS 

IJoiiDic fronted house (I btdrooiiis) to nnl I'rtiimini IS(H)() 

^1 ^ ^**DLANDS — Well est ibhshcd PR \C I k P 

l)n?,ti F ’ PukITSS IXtuliul tornti 

house \Mii\ ind jsirclcn to itnl Piiinaint IH^t) 

4 KENT— Medic il Worn in s PRACTICE of 1600 
P '1 m oulbing siibiiib Pinel 191 IXl ulud lioiiss iMih 
£,tn£,L TntI g\i(Jcn to rent Picnmim IbOO 

renn WALES— Old established PRACTICE o\er 

,oZFl“roFU'F'' I'Ollse t4 lull 

tooms) for stIc Premium li >i.'\rs purclnsc 

PRACTICE 

nr ipm pL?,?F ^loiise (6 bed ind drcssme rooms) lor si t 
or lent Premium one and \ lull \cars puichue 

Ti^i? COAST— E-isily woikcd middle cl iss PRAC- 

Lonis clc9®m®hesXF ? "> sumnier rcsorl llousi. (6 |ud 
lou ^ ^ u \'\ruc i,ardui uul | itill foi 

Premium ■" ^^<’pV 

LAr9irr COUNTIES -Old established cot.nin 

i , °°°‘' sscellcm position wiih ■ u in 

and garden to rent Picmiiim £800 "iiiigiiin 

W 12 — Old cstiblislicd PRACTICE 

Sl“” ‘ "r-'S *1“ "SoZ, i™:.' 

with gange foi sale or to lent Picmiiim £f,so 

II SUR^Y -PARTNERSHIP (afte. a prehmm „ v 

Assist mtship) in growing lesidential distiut about 10 mile's 

Pmel ^0S0 °"a 9’^" about £2 

yeTs pmehase for d.sposil „ Fiio 

12 S E COAST -PARTNERSHIP (with succession) 

in non dispensing Pi ictice about £2 000 pa Vciy small nmtl 
Attiactne house for siK or icnt Premiiim 7/IOths shaic two 

.’n'T^oTSS yZ?'"' ' »’"« f” rKZ 

PARTNERSHIP in Practice of about 

£1000 pa in residential distiia Pmel 630 Modem lioiisi. 

(4 bedrooms), girage garden To lenl Prefeicnee would 
be gnen to an F R C S One half 'hate £3 000 “ 

•T-fri? established coiinliy PRAC- 

1 300 Weu'lFSS^^'’ f* ’’ "'•P’'" easy distance ol coast Pmcl 

frs 

MD or MRCP or r- R r e F!, ‘'at 

connections ^ ' RCS and picftiably hi\c Cu> 


1 lilt I'nrtli tit trs m nt ftie 

\U S W Ml S COLM\ 1 0\\ N -P \RTNER 
Si I II iM I M irwc t f> T r » ul f>»Lr H* ' Vi ' ^ 
t> £1 I ,!i t isiri O u lull 'In c Ol tW''’'!'’ I 
PitliKi mi I lu>M I R C S 1 III IlO'rtil irJ ci" ' 
opl oiumii' loi Mil I I '^op. uul ippj n.n "i e"' 
Piiiiminir' \' n i ii'hip m 

l~ I SSI \ (liorders ot Eppine I orest) — PVRTNER 
sun 111 s'L iiliK tiisu I 111 Pr utuc our £ f-* 

tiottiii! n. dv. unl ill lut I’inil I Tiv) Ih'U e^ j , 
Om fouilh 'tnii. il two u its piusl i e Cot' r 
Ssopt toi 111 ic'lh ,U' 

IS Sr CO\SI -PMnMIRSIilP m 

iiiu Pf ivtit*. dmut t p \ l^vncl I ^ ^ f, . 

liHirili 'll in il two siirs piirslnu PiclmnaJO '' 

'hip ScoMiiin pnlitnil -oiC 

19 1 ONDON N 12— Middle el iss incrcasinj PRV / 

1 ICl in i rowme di'lrict Receipts pi I 'i u W d *’■‘5, , ' 

Modem lihmii sieme liou e tor sile or rent 1 reniiu ' , l 

20 S WALl S — Conirtel mil snail pro ate P 

PRVCIICI our£I9iy)pi 111 indiistrn! di in I 'hr ‘ , 

2 10 1 I louse with sun ere pienii'es 10 relit Pro ro 
ippoimnieiil Premium £1 sou 

21 S COAST HE \ET11 RESORT -OPHTH 50 ';; 
PRACIICI Kiceipls I 91 S £1 6tH) Iloii'e to n."' 
Iimiled seope Premium one \eirs piirelii'e _,,ooA 

22 LONDON SW— ELECTRO jHEKd 

PIUIKAI PRACniC! Reeeipls ’‘',,,9 .IfeV 

suUim, loom uul ireilment room to rent t teniu 

plus ippii mis \ lined iboiil £710 «-rir-c fiW 

21 LONDON N— LOCK-UP PR \CT*Cfc tn 

PI urn be medie il eeomin Puiel '27 ‘'*-nt ' ^ 

21/ weekle Good scope Premium U 's'"' JI'iniiDR — 

24 DEATH VACANCY— ESSEX 

Receipts iienue £9S9 p i Pmel 71' Well'd' 

foi sile Seope . /anmkb" 

25 N WALES —Popular seaside resort Oow 

eliielle non di'pensinu PRACIICI n.e fw s'' 

No pmel Lseclleiith siUilted detielud re'iui 

Good seope Piemium two \e irs piireln e „r,ArTlCE 

26 LONDON E— Cash and pmel P^lFdroo"’' 

ilerigmg £2 SOO pi Pmel 4 100 |,ilf w" 

Rent £|S6 pa Seope I’lemuiiii li'O 'h" 

piiiehise to inelude dings etc in Pr'CllC' 

27 W MIDLANDS-PARTNERSHIP 'n ” q c- 

neiigiiig £6 000 p I m miihet town ' J'F' ,„nu r-idN 
Sislh sliiic at lii'l at t\ o eeirs piiielii “ ^una' J"'' 
should be iged 2S/'0 and able to do srhir’' ^,int hip 
mmoi FN md 1 woik Ilospiti! rnodinlH 

2eS N MIDLANDS— PRACTICE m P'; P,rl 

disliiet lieu prouressiec town Receipt', ,FF.L|iiin 


eiisiiiei neii prouressiec town iseccii-. ■, ■ u, tw 
about too Hou'C tor sile Good scope I 5 \fJA 
29 S OF ENGLAND-Wclleslibii'l'^^, pnif 
TORIUM lor the open air treatment fEnnn 10 ""''“^ 
It latc of iboiil £1 000 pa Premium ti ' 
fuimuiic etc . -snint! f , 

TO LONDON, SE— PRACTICE 

pi m populous subilib Puiel 80 () Delaclicd £1 7 0 
house Price of Icischokl £1 2 s 0 Swpe . ■ pRA^ 
TI FRENCH RIVIERA —Old eslab sn^^^j 
TICE MD csscnlnl Vendor U pnscnl i" 


Al LM 1 


IHr RRITJ5H MtDICAL JOURNAL 



iTI.c 


“irUOI VSTK 


CllltICM t 

({ t.>t tu t >) 


ASSOCIATION LTD ) 


Trie Address 

Triform ^^esl^rnl— Ixmdon 


1 VA IS^TOUv 
TU I^^IOUv 


IIOLSL 

bQL \ur 


bOLTlI 
W C .1 


Telephone 


lloll 


I f'lcthis nnd I nrtiirrsbips for Dispos il (continued) 


.2 S\\ ENGI \ND— Countr\ PR \CTICC OMr 

tl'.OD m Kiu iful pjri Panel aboui I IM i xccpiionilU 
niuc m d-n 1 ousc land r- jn own prourds for vile Huntin;* 
and vhoo mg Svop<. I rt niuni iwo scars pur^.linAC 

3^ SC COAST— PARTNERSHIP m Pncttcc 

ascn^mc t- KK) in growint, resort Pare! |^<0 Good 
houv. (•. bcdrooTis) to rent O-c tifih sh n. ni lirst a! two 
\c^ purclu'C 

■^4 Consulling Ear Nosl and Thro u PR \CTICE 
in jndustna! c?i\ Ke-cipt tscrik^ £I pa (in iddii on 
ap’XJtntmcnts worth about £*^^0 pa) Centralis nuated 
houM. to rent Purwliascr should hold FRCS and hose 
spcvi list cspcriuncc I remiuni two scars purchase 
35 KENT — PRACTICE in dc\cIoping district 
J. mi cs from London Receipt p 'j seir oscr ^<00 Pmtl 
about ** 0 ^ liou c (j l>cdroornsl to rent Ample scope 
Prem um £7^0 to include drugs etc 

■^6 BIRMINGHAM —Medical Woman s PR \CTICE 
a'tnzjng il Z69 pa Panel ncarls 9(0 Good hou c with 
parage and gsirdcn Price £^00 leasehold SwOpt Premium 
one ard tlirec-quirter Ncars purtha ^ 

37 WEST END near Lords Cricket Ground — 
PRACTICC a'ene.ing about £1 9()0 pji in ideal r-vidcnu*.l 
part Panel about UtX) w th p o^pe^.ts of good increase 
\\ellbu l del-ched doub'c ^rented hoUiC with garage and 
n»“C izcd garden Good introdust on Premium £t ^25 

3S MIDDLESEX— PARTNERSHIP in stcadilx 

inurca ne town Prac i*r about £2 (Xk 1 pa Panel I £00 
Hou c to rent Premium one half iharc (wo jears purebase 
Appheant should be English or S otnsh 

39 SURREY— Medical Womans PRACTICE o\er 

£ 00 m outiving suburban di iriti Panel HO Hou c 
for sale or rent Kop^ Premium £ 00 
dO S AFRIC a — Medical Woman holding D O M S 
required in Ophthalmiv PraU cc Exp^n-rced in operative 
ssork and not o\i.r -.0 preferred SHAKE about £l (X)0 offered 
after ASSISTANTSHIP 

41 S COAST —PARTNERSHIP m Practice o\er 
£ 000 pj3 m sea d" report Panel about 2 (K-0 Semi dciotbcd 
house b-drooTis) for sale or rent Premum on half share 
£ 000 Excel ent ho p la! and scope for surgtr. 

42 N E ENGLAND —PARTNERSHIP in non panel 

PractiwC doing about £6 000 in ort of the chef towns 
Hou c available Ore sixth shire at two vears purchase 
Partner should be surgicrllv inclined 

43 S COAST HEALTH RESORT— PARTNER 

SHIP m Pr-’cii e about £I ^00 p^ Panel over 1 100 House to 
rent Premium two share £1 2*0 to include druc< etc 

44 N OF ENGLAND INL AND SPA —PARTNER 
SHIP m Practice about £I 900 pj Panel 1 2 CjO Excellent 
housc for sale Premium one half hare £1 8(X) 


45 S COAST — PARTNERSHIP in non dispensin-, 
Pficli e o'tf f^JO pj in ht illh re ort Pantl bout 
Share vvorih ah^ul -.9tf0 iwo vear> pureh^ t 

-,6 WEST END or LONDON —Good class non 
di pensing PRACTICE about ^1 1^0 No panel Lvir-,c 
hou c to rent Premium Ic- c and praet/ec £ noo 
47 BUCKS — PRACTICE in growing town Reueipis 

I M star £^94 I inci about 7‘K) Hou c tor ^le Well 
xquippsd ho pital f renium tl ‘‘00 

4b LONDON \V6— Non dispensing PRACTICE 

II 00«) pj Pleivini suburb No panel House b dreonvi 
{.^r3ge and pjrcfcn lYtmium hou c ard praetiec £2JLO 

49 LONDON S\V— Medical Womans PRACTICE 
about £960 pa in oiilvinu suburb No panel SuiL.be 
iccommodation ivailabe f rcmium £9^0 

50 PARTNERSHIP in mcrtasing Ear No«e and 
Tliroat Pf iciKt m provincial town Partner must hold FRCS 

51 MIDDLESEX— FOURTH PARTNER required 

ift Practice over 17 600 pj in residential d sind on the 
Thames Panel 1 6(X) House bedroom ) to rent Scope 
Premium 6 0 hs sh'‘rc £ 10^ 

22 LONDON N W —partnership m Practice 
averaging about £^200 pa Panel about 6 000 Maisonette 
(2 bedroom*- cic > lo rent One hfih hare al first at two 
vear purchase 

N E COAST — Midd’e and better working class 
PR/vCTlCE over £I I'O pa in weapon town No parel 
Private rev denec for sale Prenmm £7^0 to include furnish 
inc.s lie of eon uliine. room:> or near offer 

24 LONDON W' 9— practice doing between 

19X1 £9^0 pa n rc>idcninl di trict Parel alToui 60 but 
p^eniv of xcopc Rent of nui onetic (•» bedrooms) £2(X) pa 
Premium £! or offer 

^2 LONDON \ W' 4— Middle class PRACTICE 
nbom tPOO pji in developing part Panel OO Hou e (3 
bedrooms) for salt or rent Sco'N Premum £12 0 

56 HOME COLNTA —FOURTH PARTNTER 
required m Practice m growing town Panel 000 Incoming 
PwHner mu>t b c'^crgctic ag”d about 0 (mam-d preferred) 
with a Icininc towards medicine Initial share about £121^0 
pi Premium £ 000 PrJinm'’p. Asbi l'»ntship 

57 CORNISH COAST— PARTNERSHIP in non 

divpcnsinn Practice ncarlv £^003 in favourite report P^nel 
1^00 Hou c oblimiblc Oie third share ai two veirs 
purchi c Good amestheii^i required Short Assi tanl<hip 

58 SW OF ENGLAND— Non dispensing PRAC 

TICE ivcnijjing £16 6 p.a n favounte watering p’-ce 
Small panel Scmi-dciichcd hou*c for sale or rent Good 
hosp ral Premium £2 ^09 

COLONIES — Number of Colonial PRACTICES 

Incomes range from about £7 0 p a upw-ards 


Purchasers cm raise additioca] capitil for the purchase of approved practices or shares 
Particulars vnll be forwarded on application 

All communications to be addressed to Tlie Alanager 


SCOTTISH BRANCH 21, Alva Street, Edinburgh, 2 

FOK DISPOSAL. 

D E OF SCOTLAND— Countr\ town Receipts 
last vear £685 (appointments £112 panel *6S) Except 
hou^ With garage and carden Phlc £14 0 Premiu m £ i hW 
E N OF SCOTLAND — Countn PRACTICE 
Lone Mnbliilied Receipts approximatcK £1 000 Panel 27*^ 
F WALES— PARTNERSHIP in country tomn 
Receipts £1.200 Panel oscr 1 000 Suitable house En.e 
£S00 One half share at one sears purchase 
G EDINBURGH — PRACTICE doing £450 House 
must be bought Premium pracjce and hou.e £I 620 


A S or SCOTLAND —Countn PRACTICE in 
Io\eI) distnct Rcceip s approsimatei> £1 000 Panel 760 
Exceptionalb consenient house Pnee £2 000 Premium for 
pnelice ore and a half sears purchase 
B SCOTLAND —Old-established Cit> PRAC 
TICE Receipts approximatcb £2,‘t00 Panel 2,s00 Hou e 
price £900 Premium mo sears purchase or near offer 
C YORKSHIRE— Countn PRACTICE Receipts 

£1200 P.nel sQO Excellent house s\ ith garage Pnee £! 200 
freehold Premium one and Ihree quarter sears purchase 

For further details apple The Manager 21 Alea Street Edinburgh 
Terms on which the business of the Branch is transacted will be submitted on application to the Branch 
2Ianager to whom all communications should be addressed 

KEI TABLE LOCCMS and ASSISTANTS are TTRGENTLV KEQTJCRED lie A LL OFFICES of the BITKEAL^ 


48 


THE BRITISH MTDICAL JOURNAI 


Auciusi n, I93S 


INDEX TO ADVERTISEMENTS 


PUBLISHERS 

British Mcdicil /\ssoniiioii 
Churchill J iS. A Lid 
Lewis H K ^ Co Ltd 
Livincstonc L ^ S 
Nelson Hassmi, 

Suitidcrs NN Co Ltd 


Supp I 


ASSUR \NCE & INSUR VNCC 

Cenlurs Insurance Co 

Medic'll Defence Union Ltd 

Snpp 1 


BANKS & riNANCC 


British Medic'll Finince Ltd 
Ceniur\ InsuruKe Co 


A\ 


CHEMISTS 

Bcntcr s Food Ltd 
Boots Pure Drut Co Ltd 
Burrouths Wellcome S. Co 
ChnsiN Thos 4L Co Ltd 
Coates 5. Cooper Ltd 
Denver Chemical Co 
Dinneford & Co Ltd 
Eh Lilly & Co Ltd 
CenTtosin Ltd 
Glaxo Laboratories Ltd 
Hewlett C J A. Son Ltd 
Iron Jelloid Co Ltd 
Kaylene Ltd 
Martindalc W 
Oppenheimcr Son & Co 
Parke Davis & Co 
Peat I roducts Ltd 
Phil Sino Ltd 
Prentif Ltd~ 


14 

19 

Supp M 
U) 

15 

14 
!7 

15 

20 

11 
4S 

16 

12 
16 
20 
10 
4 


Ltd 


rooDs, ni \i u\Gi s 

Mien Lllinbiirw ltd (ovcriv 
C rooke s L ihor itonc lid Supp i' 
Mom Ltd 11 

I lush mil J K LCo Ltd * 

Itii run S. Rovlc I td H 

I iciai ol 1 Id 11 

1 ibhj McNeill L 1 il h\ 1 id 1 
I ollci Co 1 td 22 

Sumners Tv phoo fc i ltd Supp ii 
\ dentine s Me It Juiee Co C over ii 
\\ indcr \ 1 td 12 


MOJOUS A ACCI SSOUIl S 

Ilcnlvs 21 

Lodke I Itikv I td 22 

N\ML PLMIS Uc 

Cl oke s Ltd 22 

Hill I II S. Co 2 

Herd S J k \ 22 

O borne I L Co ltd 24 

NS bwe Ut otM e C o 24 


puiNUNO, nPLwuiirus, 

etc 

Tavlor s Tvpcwnters 24 


SURGICAL APPARVTUS 

Curtis H L ^Son L^d H 

Lverett S R J C Co 1 id 4 

Llcnun^ A &. Co 24 

Hidnril 2 

Salt N. Son Ltd Supp in 

Spencer Corsets Ltd 7 


TAILORING & CLOTHING, 
etc 

Regent Dress Co * 22 


lonuco A cif.Miri IDS ' si»\s. iiiAirii nrsouTS, 

le inniios 

Ilirro itc < 

} mm I Mill 


I I ivtf s Ni» 1 

\N ill V C apvt I 1 


\ACCIMS, SIRV etc 

Bfitivh Drtn I h live I I 1 
I V uit S ns Icicher L 44clh 
I td 


\ RAVS .Sill ClRO 
Ml nicu 

C»o\iliiruts ltd 

1 >rt ible \ Raw I id 

\ I t V \ Riv C k rp u itioit I Id 


HOMIS eC 

! KCs 


INSIIIUIIONS 
24 24 2( 27 


IIOUSI 

1 Ike 


AG! MS 


llOSrilALS dl CIINICS 

1 oiidoo Chiiie 
Ruthin C istle 


SANAl ORIA 

Cornish Rivicri Siniiorinni 2s 
CoisMold Sunlormm 2S 

Hollow IV Sanatorium 2S 

Monnm Hall 29 

Mundei,lcy Sinatorium 2S 


I ivtanv Sp i 
Sni JIcv V H>dr i 


MiniCM SCHOOIS 
IL10RS, vS. irCTljRFRS 
I 1 s 31 

NLRSING, etc 

l K * 


4t 

47 

44 

44 

44 

44 

44 


IRANSITR VGIMS 

B vrd M-di al \\cn v LlJ 
Brm h Mch il Bureau 4< • 

Lee C Martin I td 
Me !i al \i ca"! I td 
!ci i^k k Uadtev ltd 
Turner Krcival LlJ 
West rn Medi al \kcn v 

coMRvcT nnaici 

1*1 e 

nospn M vvciNCiLS f(‘ 

Cl ASSII ILD 

AON'ERTISI MENTS- 
(W intwl ^nl^ 

^ J 1 41 

I IkCv 


GENER \L 

llrili'.h OvM,i.ii Co CM 
Clnncrul SiKiiC' M ' 

rur|'i>«r'- ^ '''' 


Modevn Iron Therapy 


Iron Jclloids ’ nre nn elegnnt and rclnblc 
menns of administering the protocnrbonnte 
of iron The preparation has none of the 
disadvantages of Pil Bland The iron content 
lemains fresh and unoxidizcd indcrmitclv and 


injttrv to teeth is avoided 

The JcUoids are highfv clTective in the treat
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